Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

12 Responses to “Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?”

1. 

   Deb,

   I am so glad to see your marketing and direct connection with clients via the internet, social media and direct communication, as I believe it is something most vets do not do well. I read your most recent response to a client with great interest.

   I preface my comments by saying that my original background before jumping into small animal surgery full time, was primarily working with sports medicine and surgical cases in equine athletes.

   I too believe that not every canine patient with a torn cruciate is a good candidate for surgical stabilization (age, poor immune system, other systemic disease that affect healing, etc), however most are based on the anatomical defects of canine species, peer reviewed literature and the overwhelming comparison of surgical vs. non-surgical candidates. While I do not confess to know if there are established peer reviewed articles showing better overall results (lameness, post cruciate tear arthritis and overall function of the stifle joint) of non-surgical conservative methods for cruciate injuries, there are plenty of peer reviewed literature to support surgical repair. I would be interested to know if there are journal articles of non-repair methods providing superior results – I will try to comb the literature, but if you know of some, please forward them as well.

   I hate to mix anecdotal and proven scientific results into conversations, but at the end of the day – clients, clinicians, and other experts always consider both when it relates to suggestions and their choices. As I have previously mentioned, I am not aware of any scientific literature stating non-surgical repair of cruciate injuries in canine patients is superior to surgical repair – but let’s both take a look and see. I will also look into the human literature. Not every human cruciate injury patient has surgery, but the vast majority do from my understanding. There are many reasons to evaluate the joint and clean up the joint even if not stabilizing the stifle joint, however as you are aware the human anatomy is considerably different than canine. Based on my own personal clinical experience and performing surgieres for clinics that offer in-house surgeries or for clients that can’t or won’t seek referral – I have noted that surgical stabilization (TPLO, Tightrope, extracapsular methods) for cruciate deficient canine patients has dramatically improved those patients vs. the population of patients that couldn’t or wouldn’t elect for surgical stabilization. This is for many reasons, the first of which involves stabilization of the joint. Stabilization decreases the effective laxity within the joint decreasing the cyclical inflammatory events that are occuring, as well providing immediate relief to the soft tissue elements (muscles, tendons and ligaments) that support the stifle joint. In addition, joint exploratory reveals the integrity of the menisci (if torn, definitely requires removal or repair), cartilage and remaining structures. I do believe that with appropriate rehabilitation, that these muscles can compensate for this destabilization that occurs with cruciate injuries, however also believe that the benefit of appropriate surgical stabilization based on the specific patient when combined with appropriate rehabilitation is far superior to either alone. Most experts in the rehab field of veterinary medicine would agree.

   Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiam and passion for the area. Look forward to more engaging discussion.

   Respectfully,
   Justin Harper

   Posted by Justin Harper | January 15, 2012, 12:04 pm
   Reply to this comment
   • 

     Hey, Justin
     Thank you so much for writing and for including your thoughts and comments in this discussion/post!
     The majority of the public that would read this blog, to my knowledge, has not had the excitement and benefit of sitting in on ACVS lectures and arguments at the yearly conference, wherein the knee experts argue ad-infinitum regarding the best approach!
     And I appreciate that you are a surgeon with a variety of experience and who is open to relationship and dialogue
     I don’t have much time to type, and I rarely make time/use time to post longer writings…especially regarding concepts the public really wants/needs to hear, like this one, because it does take a lot of time to present well-formed thoughts. So, I won’t claim to make a lot of well-formed thought process appear in this reply, except to say thanks, which is genuine.
     I definitely have a vast and varied background, and the biggest thing that has changed has been my thinking and approach to so very many things, especially in medicine, regarding medicine.
     The bottom line in my case, and regarding the world of people who personally come to me for assistance, is that I find out more and more how to develop a broad approach to their needs and try to see the issue from many points of view.
     Many clients I see simply cannot afford surgery in this economy, so whether surgery is grossly or minutely an improvement over the current condition of the dog is a mute point. I will refer to dogs in this writing because that is the majority of what I see for torn or ruptured ligaments.
     I inform people that if we know there to be a torn meniscus, I believe scoping (surgery) to be the best option to take out the garbage. Of course, we can usually only know this if surgery hasn’t been performed by hearing the clicking sound in the knee when the dog walks. There are other specific signs, however that is the most prevalent…sounds like long toenails on a cement floor. kinda. For those of you who are wondering…
     I cite Slatter’s volume in one of the papers I have written and posted online, entitled Conservative Treatment of Ligament Ruptures (or something to that effect), and I wrote the following paragraph:
     “Slatter’s Textbook of Small Animal Surgery, 2nd Edition states that small dogs often do well without surgical intervention, and that based on particular studies, “it is prudent to wait for at least 6 to 8 weeks before recommending surgery for small dogs. These dogs are older at diagnosis and are often obese with concurrent medical problems. Small dogs that are lame for 6 weeks after diagnosis and show no improvement often have meniscal tears and are operated on for meniscectomy and joint stabilization.” (pg.1832) Your veterinarian or I may help you evaluate whether or not your dog has a meniscal tear. Additionally, I have successfully used basic and advanced functional rehab protocol to address torn and ruptured ligaments in large dogs. Some positive feedback from veterinarians and owners is cited on my websites.”

     I am in too much of a hurry to go look it up (!), but I believe the weight ideal is around 40#, and you are welcome to correct that. It may be that the whole surgical manual has been revised since the edition I cite, however that doesn’t change the potential for an outcome that is beneficial if someone does not opt for surgery. I have worked with several Danes and Mastiffs whose owners have opted to not have surgery on their knees after ligament rupture/tear.

     When I first came to animal rehab, it was because a surgeon asked me to based largely on how I had dealt with my Dane, Grace, after her surgeries and considering Graces comorbidities/conditions. There were other factors, too, but that was an important one. She would have probably been a better candidate on the OCD knee for extra-cap/suture or tissue stabilisation, however her TPLO plate was in place until her death at 10.5 yrs. last month, and it was a non-union (the bone never grew back together where it was cut).

     She was an extremely unique dog, yet I believe every case is unique. I approach cases that have had surgery with the same respect as those that have not, and I do sincerely believe each case needs to be considered holistically.

     Based on what little I know of you, I would guess you do a lot of Q&A with owners prior to surgery, and at the least to determine which surgical approach you would believe to be the best for the case.

     Perhaps, and most likely, our mild differences have a lot to do with our positions in this world, our journeys and those of the people we meet. You are very well trained in methodologies that are potentially life changing in a positive manner and you likely believe with all your heart that surgery for most dogs/animals with a ligament tear is life improving and just plain wonderful.

     I totally agree with you on one level.

     And when I was presented with Grace’s first tear, I didn’t even think of another option to surgery, in 2002, even after about 20 years of active work in human sport science.
     I don’t regret the TPLO. And I didn’t know there could be another option; never would have crossed my mind, because my surgeon friend said this was what we needed to do, and I did it.
     She had also previously performed stimulation surgery in that same knee because of the OCD.
     For the sake of expediency I am not explaining everything here, and I know that our readers can zip around the internet and look up terms they don’t understand that we write.

     At the time of the opposing knee ligament rupture, I went to the surgical hospital and built their rehab dept., complete with water treadmill, which I campaign against in large part today because I believe it is overused in lieu of real, complimentary, gravity-based healing and dynamic exercise. But that’s another discussion…

     It wasn’t until sometime in 2006, perhaps when I had a case in the hospital that didn’t want surgery, or maybe not until 2007 when I left the hospital and began my independent practice (I just don’t remember), when it really dawned on me that the dogs could definitely enjoy quality of life and most, if not all, of their regular activities even without surgery on the knee with the ruptured ligament. Some years later I was treating a degenerative myelopathy dog for a human M.D., and I commented about knee surgery during a discussion, and she made the comment, “We don’t even recommend surgery for every athlete, much less every human that crosses our path.”

     And so, I agree/believe each case is specific. I am a lifelong runner who doesn’t run much any more. I have been told that one of my knees is bone-on-bone. I was a decent cross-country runner in high school but I trashed my knees on Outward Bound the summer after graduation. I walked on the U.T. cross country team, but I couldn’t finish a practice. This was in 1981. I was referred here and there, surgery was recommended, orthotics, etc, etc, and I realised I didn’t care so much about running any more. I began cycling, and that opened some very wide doors. It also helped my knees.

     I don’t have time to go into the biomechanics here, and we already noted that the structure is different between humans and dogs. Perhaps dogs would be further aided if I could teach them all to ride a bike…:)

     So, perhaps, my schtick is that there is no harm in giving the dog 6-8 weeks of functional rehab, especially if there is a question in the owner’s mind, and then if performance is poor or improved quality of life would seem to be the obvious outcome from surgery, go for it!. What I find in the few cases that go to surgery after some functional rehab is that they recover better and they are in better “shape” than they would have been without pre-hab, as it were.

     I don’t believe we will find much research that definitively states non-surgical options for canines is better than surgery on a torn ligament. Not too long ago I ran across a piece and posted it on my FB site. I don’t go looking for them, usually, and I wish I had time to do more of that (sometimes). Fact is, the research is where the money is and the money is where someone stands to profit. You know this. I have seen this in action over and over. I’m not going to get on another soapbox or begin another discussion here, but we can if anyone contends that “anything beneficial would be proved in research”…that is simply not true.

     I often ask my oncologist why this or that has not been explored, and she is in charge or trials for Texas Oncology (US Oncology group), and she says, “That, my dear, is something you should get a grant for and get it done…”
     Along with all the other bright ideas we have…

     I used to be very black and white. My life experiences, along with an increased understanding of quantum physics and an increased ability to see things in a variety of ways, has lent to my being open to paths that were previously shut to me.

     I am all for cutting to cure, and I am all for cutting to remove painful pathologies, like fragmented bones in the elbow, torn menisci, tumors, etc…I am even a fan of laminectomies (surgery for blown disks), however I have needed to develop ideas and protocol for some few dogs I have seen whose owners have opted to not have surgery. Thanks to my Grace and to a lifetime of personal physical pain of one sort or another, I have become a well-studied student of pain management…in order to help the animals and to hopefully pursue functional rehab with less/no pain.

     A lot of my open-mindedness regarding evaluating surgical needs very likely comes from my own experiences with breast cancer. I have a different blog for that, and I have some basic info regarding my treatment decisions on my personal FB info page. I am very active with two women’s cancer groups, and I end up having a lot of discussions with gals who are trying to figure out their treatment options. This has undoubtedly broadened my thinking. I had been receiving mammograms and ultrasounds, sometimes twice yearly, from the time that I was 30 until my dx at 44. I chose a double mastectomy (OR, if one is a purist, a mastectomy in the cancerous breast and a prophylactic mastectomy in the other) based on what I knew, my fibrocystic breasts with many calcifications, and an holistic approach to my body. My surgeon supported my decision.

     Many of the gals I meet, most of whom are part of a young women’s breast cancer group, the Pink Ribbon Cowgirls, haven’t been given many or even more than one option. They show up at our lunch get-togethers, having had their course of action dictated by a breast surgeon, not having seen an oncologist yet, and already invested in a particular treatment (usually lumpectomy & radiation) without further education or knowledge of options.

     At four years out, I have seen 3 friends and 2 acquaintances die, all from bc, all for similar but different reasons. I have seen many friends deal with relapse/recurrence. I am part of the dynamic core that looks at treatment options and tries to at least make sure that the gals have a variety of options, that they know there are other approaches, and even that they know about other approaches even if many of us agree that the approach they have chosen seems to make the most sense, seems to be the best option.

     I have a good rapport with my oncologist. I email and text both her and my surgeon. I am the liason between them, their support of Team Survivor and the BCRC/Pink Ribbon Cowgirls, on many occasions.

     If anything, I would like to get people to think. I would like them to read actual research papers and not the disseminated info put out by a dog group or the Mayo Clinic or what=have-you.

     I now am in a position to work with others to bridge the gap between specialists and themselves, to build bridges and eradicate the “us/them” thinking. I am only one of many people trying to do this.

     And, for that reason, whether I agree with any specialists point of view or not, I appreciate the opportunity for positive dialog. I am a specialist in my field, and I work to collaborate and integrate. If I get a case post-surgically, I work with what was done. If I get a case instead of surgery, I work with that. Sometimes the vet wants to talk about non-surgical options, and we have a more collaborative dialogue. I really like it when the same vet will send me post-surgical, non-surgical, and pre-surgical cases for animals with the same pathologies…I think that means they are open to working within the limits, desires, or understanding of their clients, too.

     I really have to run and wish I could write more, and so I apologize for not answering some questions and for not developing some ideas more fully-
     Blessings

     Posted by rehabdeb | January 15, 2012, 1:33 pm
     Reply to this comment
     • 

       Great dialogue and discussion. Once again, I am impressed with your passion and glad you are there as an advocate for pet owners and a liason as well. Good luck with the current patient. I look forward to meeting you some day!

       Regards

       Posted by Justin Harper | January 15, 2012, 7:54 pm
     • 

       I’m researching treatment for a ruptured cruciate ligament. We have a 4 & 1/2 year old welsh pemboke corgi who is normally very healthy & joyful. She weighs 33 #.. The only med she takes is tramadol for her pain. She was scheduled for a TLPO February third but after reasearch we found that surgery is very invasive with many complications. We are considering conservative management. Waiting perhaps 8 weeks & if she is no better … then some kind of surgery. Do you have any advise for us. We love Tator tot & want the best for her. thank you.

       Posted by Lynda Shugars | January 19, 2012, 12:09 pm
     • 

       Lynda,

       I think your approach is more than fair and in the meantime while you are waiting, working with folks like Deborah on rehabilitation and therapeutic physical therapy will help no matter what you decide. Good luck.

       Posted by Justin Harper | January 19, 2012, 4:10 pm
     • 

       Hi Lynda-
       My first advice (and you have probably already done this) is to read the full stream of this post, from the original post from an owner in the same position as you, or similar, through to my thoughts and Dr. Harper’s thoughts. There is a lot of advice contained in this whole thread.

       That being said, then your plan to follow conservative treatment protocol (which may be found in other posts on this blog) and then re-evaluate is not a bad plan, considering what you have revealed about the case. My treatment protocol depends on restrictions as well as exercise, just like you would do if your Tator had surgery. Protecting the joint is key.

       I have not been able to spend a lot of time on this blog since I developed it, so I will say that more papers I have yet to pull over to this site may be found on my rehab website and on my Facebook rehab page, under the “notes” section. https://www.facebook.com/AnimalRehabConditioning and http://www.rehabilitationandconditioningforanimals.com. Eventually I hope to maintain this blog as my primary posting vehicle.

       I meant to add the other day, and ran out of time, some brief notes about a case I saw when I first became mobile and independent. It is clear from my postings that I am all for beginning with conservative rehab, along with moderate to substantial pain control, to see how the pet progresses. I was called into that case I mentioned by a vet who had never used my services previously and who wanted to have me speak with the owners regarding conservative treatment, no surgery, for a ruptured ACL/CCL on an un-neutered, 2 year-old, chocolate Lab…the most anxious one I believe I have ever seen to date. The owners were very science-minded, had him crated, had some sedatives on board (Ace, not my fave, and to no avail), and hoped one day to take him hunting. They hadn’t heard of surgical options. I presented some of them to the couple. I also gave them the names of some surgeons in their area and told them if they chose that route, that they needed to ask their vet for a referral. Given that dogs presentation, demeanor, proposed lifestyle, etc…I believed surgery was the best option for him. It wasn’t my place to say exactly that, however they took the info I gave them, spoke with the vet, whom I had told my reservations regarding conservative treatment in this unique case, and he referred them to surgery, which they had done. That is a short-long story, and I need to go to an appointment now, so I won’t have time to write some of my other thoughts. There are enough of my other thoughts on this blog, so I trust you will be helped along your way.

       Thank you!!

       Posted by rehabdeb | January 19, 2012, 4:20 pm
   • 

     So, for those of you who are following this post/story, here is a copy of a feedback email from the client. Please know that I work with many dogs in this same situation, and I receive case notes and positive feedback even on this specific subject very often. I hope to be able to keep you informed as to this dog’s progress and to keep posting feedback.

     Also, if you missed this info, there is a video of me demonstrating massage techniques using a very simple and very effective method on a Pit Bull who used the same exercise protocol as Kxxx over 3 years ago when he tore his CCL (ACL). His vet (staff?) at the time relayed that his person/owner would have to “put him down” if she didn’t get surgery. Many of us know that simply isn’t true, however I hear of this happening every so often in cases, so I’m sure it happens so much more than I know. You will see in the video that he is doing very well, and at the end he trots around a little, with ease.

     Here is K’s owners feedback email…

     “First of all, THANK YOU so much for coming out to take a look at Kxxx!! I really appreciate all of your advice and guidelines.

     So far, so good. The vet did fill the prescription for Tramadol, and we’re giving Kxxx 2 tablets twice a day, plus her antiinflammatory in the morning. Not sure if we should cut back to one tablet of the Tramadol (twice daily)? The instructions said 1-2, the vet suggested starting with 2 then maybe cutting back to one, but not sure how to tell when to do that.

     We’ve been giving her the recommended dose of Omega 3′s. And I found a doggie treat in the pet section of Whole Foods that has glucosamine/chondroitin/msm (comes in 4 flavors! lamb, beef, veal, or chicken!)

     We’ve been walking her for 5 minutes at a time, usually 4 times per day. She’s not limping during the walks. The rest of the time, she’s in a pen.

     I was finally able to find the massage tool — it was the last one at a nearby CVS. She’s had three massages with it… she doesn’t like it too much (yet!). But she’s patient with it.

     Been palpating the joint… haven’t noticed any swelling.

     To help us keep track of all her pills, meds, walks, etc. (esp. since we have several family members helping out, and some of us are getting old and losing our memory – haha!), I have created a logsheet, which I’m sending to you. Feel free to pass it along to your other clients — modify however you’d like, and feel free to put your business name/logo at the top.

     Tomorrow will mark a week since we’ve begun the rehab with her, so we’ll be starting week 2 of the homework.

     THANK YOU!!!
     Txxx”

     My hope is to spread the word, as I noted in previous posts, to promote wellness, pre-hab, post-op rehab, and no-surgery rehab.
     Blessings-
     Deborah

     Posted by rehabdeb | January 26, 2012, 11:55 am
     Reply to this comment
     • 

       …and here is part of my email answer to her…

       Yay!
       Txxx…
       Thank you so much!! for the chart and for sending it along.

       I’m super excited that everything is working out well.
       If/when you begin to cut back on pain meds, I suggest pm dosing, and then see if you can tell that she is continuing to sleep/rest well.

       I think we spoke about this, but make the second dosing, if you are just doing 2x/day, in the late afternoon, so that she may benefit from the pain relief during one or two of the later walks. 6-8 hrs. between dosing is just fine for Tramadol and accomplishes the relief so we get good compliance on the walk.

       Also, when you get to 10 or even 15 min walks in the program, then cut the morning dose and not until you have a couple of days of extended walks under her collar (ha ha, I’m brilliant. get it? under the collar? under her belt?). It’s no “failure” if she has to go back to using more to achieve the same amount of pain control. Remember we are using the meds as a tool to help regain function and build muscle to support the joint…then she will very, very likely get off of them altogether in the future.

       You’ve done wonderfully with the assignments!

       Good job on the massage…I also went to CVS on Lake Austin Blvd and scored 4 the other day…

       Now that you are accustomed to how her knee feels, you don’t have to fixate on that, however I suggest you feel it occasionally, and then if she does something to injure herself again, you will be able to see if the joint is swollen, effused, and that is no dramatic emergency…just a time for lock-down and reduction and starting from the beginning and making her comfortable.

       Thank you for being so communicative and attentive.

       I did send a mail, the same one I sent to you guys, to the vet clinic general mail…

       Blessings

       Posted by rehabdeb | January 26, 2012, 12:04 pm
     • 

       we are going into 4 weeks since Tator hurt her leg. She is taking the tramadol 2 x daily but we thought perhaps we should start weaning her off of it. She is walking better altho at times has an obvious limp. We TRY to reduce her activity. Not easy with her being the bouncy busy corgi. We carry her up stairs but she goes down on her own. No walkas yet. She goes out to potty & around house. I’m getting some glucosomine chondroiten, MSM for her to take. If we cut pain med down to one a day for a week & then stop …would that be alright? Should we give her any baby aspirin ? Thank you so much for your help. You are appreciated.

       Posted by Lynda Shugars | January 27, 2012, 4:12 pm
     • 

       Hi Lynda-
       I have some brief comments on your questions, and I welcome Dr. Harper to chime in if he wants and if he has time…

       1) I recommend carrying Tator downstairs also, for many reasons, and I don’t have a lot of time to expound on my reasons right now.

       2) Along with the idea of carrying Tator down stairs is my strong recommendation that you control the speed at which she does almost everything (including descending stairs) and especially since she continues to limp on 200 mg of Tramadol daily.

       3) While baby aspirin is widely recommended in certain instances and circles for use in canines, I am a bigger fan of using the products specifically developed for animals, meaning, see your vet for an anti-inflammatory. If your pet has had gastric issues, ie vomiting & diarrhea, while using species-specific anti-inflammatories, then aspirin is definitely not an option for you/anyone to use instead.

       4) If your pet is limping, it is in pain (unless there is a specific orthopedic abnormality, like one leg being shorter than the other, and even then there is likely some pain associated). Lameness=limping. Lameness=pain. Limping=pain somewhere in the high 90+% of the time. There are very few exceptions to this concept.

       5) Pain relief means better compliance in using the leg during structured exercises. People tend to approach injury by doing nothing and waiting for healing, using some analgesics and waiting for healing, using analgesics and a structured program to invite and encourage healing. I choose the third. The pain meds are not going to heal Tator nor is it my preference to take an animal off of meds (unless systemically indicated) if they are still lame/limping. We want to encourage joint use for now only under structured exercise, controlled exercise. That way the joint doesn’t incur more damage while it heals. The same goes for if an animal has surgery, so don’t think that recovery from surgery is easier than rehab/pre-hab…it should actually be a little harder, mentally-if nothing else. And while I am responding to you, Lynda, I am also making general comments for the other readers as well, so not all of my comments diectly reflect what you have done with Tator
       In addition to helping the joint recover and getting the animal used to using it well again, the structured exercise at very slow speeds *makes* them use the leg they are favoring. They will favor it when they go faster than a wedding march/funeral dirge because it is wounded. hurt. even with pain meds on board. until you pull them back and work with them to use it consistently and steadily again.
       We have to step in and help in this manner.

       6) All of the positive results that I have experienced from working with dogs with torn CCL (ACL) have been realised when owners have followed, exactly or almost exactly, the instructions I give on my homework protocol sheet for 4 weeks. After that, I recheck with them and based on the individual animal, I give new drills and exercises for the next 4 weeks of healing and muscle-building.

       7) I recommend omega 3′s from fish oil and getting a glucosamine/chondroitin/msm combo preferably from your vet or using a pharmaceutical grade human product. If you lived here, I could recommend some brands/stores. I’m going to avoid that right now and say check with your vet. I have yet to like any of the products sold in pet stores specifically for pets. If you are getting a pet version, get it from your vet. Otherwise, I have 30+ yrs. history with nutritional supplements and trust specific brands. Anyone can check out the ConsumerLab.com site for help with that if they want. To make it very fast and easy, you will not err if you give around 6-8 mg. of EPA (along with the complimentary DHA) in fish oil per pound of weight of the dog daily. I used to give my Great Dane, Grace, a 90# dog (with a lot of muscle atrophy and a plethora of orthopedic issues) around 700 mg of EPA daily. The total amount of oil will vary depending on the product you get. I prefer capsules to liquid in pump or pour. Don’t have time now to go into that. I have posted articles on it in the past, though. I could have given the Grace more but this seemed to be a good amount for her.

       8) So, I would not stop the pain meds so long as Tator is limping. Do the massage as per the video I mentioned previously. Slow her down. Do the structured walks, beginning at week 1 if you have not ever done it all according to my instructions. Slowly. Time the pain meds so that she has them at least 30 min. prior to one of the walks & not more than 4 hrs. In other words, if you are walking her in the morning, give the Tramadol, then do the homework 30 min or so later. There is no need to give the Tramadol in the morning, or to give so much, if you are not going to do the exercises. Use the pain meds as a tool to help with your structured program. Otherwise, they are not helping in a broader sense.
       Gotta go!
       Blessings-

       Posted by rehabdeb | January 28, 2012, 1:47 pm
2. 

   Hi Deborah – I’m so glad I found your blog/website after researching for hours. I am at a total loss of what to do for my beloved yellow lab, Sam. Sam is 10 years old, weighs 98 pounds (vet said he had a large girth) and that his weight was fine. A year ago this vet said he had a pulled or torn ligament in his left leg. She said he could have surgery even though he was old, or prescribe adequan (very expensive) or keep him inactive. There was no guarantee of either treatment. I kept Sam inactive for quite a few months, with limited leash walks. I thought he was getting better but he’s not. There have been a few times; he took off running across our yard, which I know was bad. But I’m more careful now about opening the door and him on the leash.
   I took Sam for a 2nd opinion yesterday (1 year later), this vet said he had a torn cruciate ligament and needed surgery. He gave no medication for pain or recommendation of using anti-inflammatories. Neither Vet recommended Xrays or other tests. They just did the manually testing of his leg.
   He is slow to get up, limps for a minute but then walks on that leg, but does not put full pressure on it. He doesn’t limp when he’s walking. It’s mostly after he’s been lying down, he struggles to get up, limps for a minute or two, then he seems fine. I limit his walking to about 5 minutes 4 times a day. He never seems like he’s in pain. He’s always wagging his tail even when he’s lying down. The only thing I’ve really noticed is at night while we are watching TV, he normally sleeps; now he seems to stay awake and look around, which maybe that means he’s in pain, I just don’t know. I really don’t want to do surgery on Sam, not at his age.
   I’ve read quite a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought you might allow me to ask you a few questions:
   Deborah, I live in Foley Alabama, is there anybody like you my area that you know of? Anybody you can recommend?
   Can you give me any kind of advice of what I should be doing for Sam?
   Should I let the Vet give Sam Adequan? I will do it if you think it will help.
   When is surgery really necessary and should it be done on a 10 year old lab?
   I don’t know who else to turn to, please help.
   Thanks
   Lisa from Alabama

   Posted by Lisa Bakey | February 9, 2012, 9:44 am
   Reply to this comment
3. 

   Lisa-
   I’ve moved our conversation to a new post in the Q&A file, so please go there to continue…thanks!
   Deborah

   Posted by rehabdeb | February 12, 2012, 8:27 pm
   Reply to this comment

Leave a Reply Cancel reply

Enter your comment here...

Fill in your details below or click an icon to log in:

Email (required) (Address never made public)

Name (required)

Website

You are commenting using your WordPress.com account. ( Log Out / Change )

You are commenting using your Twitter account. ( Log Out / Change )

You are commenting using your Facebook account. ( Log Out / Change )

Cancel

Connecting to %s

Notify me of follow-up comments via email.