Dakota's Knee Adventure

At Maybury, Winter 2007

The journal of Dakota's torn CCL and his subsequent surgery and recovery.

Dakota is our yellow lab. He would easily be described as athletic. He is lean and very active going on hikes several times a week and swimming whenever he gets the chance. Considering how hard he goes, it's never been unusual for him to occasionally come home and favor a leg after a particularly hard hike. As a matter of fact, we've been suspicious that some minor knee damage occurred back when he was two or three but on the odd occasion that signs of this pop up, they usually go away with just a day of rest. In February-March of 2008 though, Rasa noticed that he was favoring one back leg every time he hiked. Even after a day or two of rest, he would walk better but wouldn't put any weight on it. Finally, she decided to have the leg looked at and what follows is a journal of the adventure that ensued.

04/11/08 - Diagnosis

Rasa called me at work just before lunch in tears. Our vet, Joe Osbourne, examined Dakota's leg and determined that he had torn his cranial cruciate ligament (CCL, canine version of the human ACL) in his knee. If there was any good news to be had from this, it was that the condition could be fixed with surgery. The bad news though was that the rehab would be difficult and would require a lot of committment on our part.

Dr. Osbourne went over two possible surgical procedures to fix Dakota's knee. One was the extracapsular procedure which involved removing the ligament as well as the meniscus and stabilizing the joint with a suture. The other is the Tibial Plateau Leveling Osteotomy or TPLO. This procedure is more invasive and involves cutting the tibia and re-aligning it with plates to create a more stable joint without the ligament. Dr. Osbourne is a canine orthopedic guy and also somebody we've know for twelve years and trust. If we opted for the extracapsular procedure, he would do it himself. If we decided on the TPLO, he would have to refer us to someone else. Clearly we have some decisions to make.

04/13/08 - Dakota on the Treadmill

On the Treadmill

Rasa has been researching like mad. She seems to really be leaning toward the TPLO procedure and has created a list with about a million questions for Dr. Osbourne. It's clear we need another appointment with him just so we can discuss our options some more.

Regardless of what we decide though, we started talking about what we're going to have to do to get ready for the rehab. We will need to create a space for him to live in for a few weeks that is free of anything he could jump on or off off. He won't be allowed anywhere near steps. He'll need to be crated while we sleep or when we're not at home. Once he is able to start putting some weight back on the leg, he'll need to start doing slow walks on the treadmill.

Huh? What? Treadmill?

Realizing the spectacle that could be Dakota on a treadmill, Rasa immediately suggested that we might want to spend the days leading up to the surgery getting him used to the idea. So we put him on the dreaded machine twice for ten minutes at a very slow speed. He didn't do too bad really. We used some treats to keep his attention but he never fully relaxed. Later on, we tried it again and had our neighbor Ann help as she will likely be helping out with his recovery quite a bit when the time comes. Again he did ok but still needs some work getting comfortable. Ann noticed that he seemed to do better when Rasa was not in the room. This isn't a huge surprise really as he's always been the world's biggest "momma's boy" and tends to fixate on her every move.

04/15/08 - A Decision

I came home from work yesterday and found a note from Ann that she'd had a treadmill session with Dakota and he did great. After coming home from work, Rasa had a second session with him and he did well for her too. So it would seem he is getting used to the idea which is good.

We went for another vet visit. This time Dakota stayed home while Rasa and I went just to talk and ask questions. Rasa made her case as to why she was leaning toward the TPLO and he didn't disagree with any of it. We talked for quite some time about the details of both procedures, the pros and cons, the rehab and anything else we could think of. Finally Dr. Osbourne suggested that we consult a specialist with experience performing both procedures just to get another opinion. We got a name and left. Rasa and I continued to discuss all the way home and finally Rasa decided that she would feel the most comfortable with Dr. Osbourne doing the extracapsular repair. Plus, the TPLO procedure is still an option if, for some reason, the extracapsular procedure is not successful. So we called back and told him to keep our surgery date of next Tuesday.

04/21/08 - The Night Before

The Fentanyl Patch

We had an appointment at 6:30 tonight for a pain patch and for x-rays. Dr Christlieb shot two x-rays and everything looked good (aside from the obvious). His hips look healthy and, even better news, the meniscus looks pretty good (as good as you can tell from an x-ray, we'll see tomorrow). To back track just for a minute ... Rasa had some concerns about the fact that generally, the meniscus is removed entirely when this procedure is done. After some discussion with Dr Osbourne, he agreed that he would try to leave behind any healthy meniscus that he finds. So if it's even mostly still good, we'll consider that a bonus.

After the x-rays, they shaved a big old patch of hair off the back of Dakota's neck and stuck a fentanyl patch on. This is a pain patch that should kick in by tomorrow morning and will likely stay on for several days. So he's taken on a bit of a retarded look already but that's only the start. He'll have quite the hair style by the time he comes home on Wednesday.

So until tomorrow morning ... we wait.

04/22/08 - Surgery

Getting out of bed in the morning without feeding Dakota ... much less getting out of the house ... is more of a chore than you might think. But alas, he was to have no food after 8:00PM last night. We did our best to ignore his starved puppy look and went about our normal routine. At around 9:00AM, he was dropped off at the vet.

I talked to Rasa at about 4:20PM and she'd just gotten off the phone with Dr. Osbourne. The surgery went really well. Once he got inside, he found that the meniscus was completely intact so he was able to save all of it. The ligament itself was two thirds torn and it was removed. He found some arthritis that had started and that was cleaned out. He then did the extracapsular procedure and that was that.

Tomorrow should give us a better picture of how he'll do with his rehab. He will be ready to come home by the time we get off work. Then the work starts on our end. Tonight we'll be getting the house ready for Dakota's rehab.

04/24/08 - First Day Home

Naked Knee

Rasa talked to the techs at the vet on Wednesday morning and they said that Dakota was doing well. He apparently hadn't lost the ability to flash the "I'm starving" eyes at the techs and ended up being fed breakfast three times (and happily devoured all of it I might add).

We went over to pick him up at around 5:00PM. I have to say I was surprised at the energy he seemed to have. I was anticipating a much more pathetic looking pup but he bounced out of there on three legs like there was no tomorrow. We got him home to the newly rennovated family room (removed all furniture bet left the futon) and hung out in there all night. He did ok. Later in the evening he grew pretty uncomfortable and started to whimper a lot likely due to pain. We were hoping on holding off on any rimadyl (pain meds) until today as he was still wearing the patch he'd gotten Monday night. We ended up giving him one rimadyl right before bed though and that seemed to settle him down for the night.

Today he's been in better shape all the way around. Still staying down and still keeping the weight off but he doesn't appear to be in as much discomfort as he was in last night. He's been outside a few times as well and seemed to insist on standing for his breakfast. During lunch I noticed that he took a couple of steps putting just a tiny bit of weight on the knee in question which is a positive sign. Rasa pointed out that that was the second time today that he'd done that. So for now, everything seems to be right on schedule.

04/25/08 - Third Day Home

Lap of Luxury

As we closed out day two, we setup a dog bed out on our back porch. We got the fire pit going and let Dakota come out with us. He headed straight for the bed and that's pretty much where he called home for the rest of the night.

Dakota's third day home marked the exit of the pain patch. All day he seemed to put more weight on the leg. It seemed like there was more swelling today and some very noticeable bruising. After work we took him to the vet so they could remove the fentanyl patch. We kind of wondered why we couldn't just do it but seeing as how it is a controlled substance, they need to dispose of it properly. We really wanted to have him looked at again anyway so we really didn't mind.

Dr Osbourne was pretty pleased with Dakota's progress. He had him walk around and liked the amount of weight Dakota was willing to put on the knee. He also said that any of the swelling and bruising we're seeing was normal and thought the amount of swelling was actually more on the minimal side. He also said we could start doing some stretching and that we could start taking him on some very short walks in the middle of next week.

He is definitely getting more active which is likely to become a problem. He's tried jumping up on people already and at one point today, he grabbed the TV remote and Rasa had to chase him around the dining room table to get it back. This could get ugly.

04/28/08 - His Old Self (kind of)

Enjoying the Bed

So far so good. His progress as far as putting weight on the leg has slowed down somewhat. He'll put weight on it and walk on all fours if he's moving slow (like sniffing around the yard) but still spends most of the time hopping around on three legs. Still, we're starting to move into the difficult phase. That being the phase where he dedides he feels good enough to do some of the things he did prior to surgery even though he shouldn't. We had some friends over on Saturday and when we turned our back for a second, he hopped up onto the couch in our back sunroom. We put him back on the floor and he kept trying to sneak back in there to hop on the coucn again so we eventually had to close him out.

All in all though, he's enjoying the makeshift bedroom we've created in our family room. He's lounging on the bed pretty much all day and doesn't seem to mind. We've moved from cold packs to hot packs and have started doing therapy on the knee (moving it around) and some massaging of the leg. He should be ready to start some really short walks today or tomorrow.

05/01/08 - Setback?

We're both somewhat concerned right now. Ever since last weekend, Dakota hasn't really improved at all. Actually, he's probably putting less weight on his knee today than he was a week ago. We've been doing everything we're supposed to ... hot packs, stretches, massage ... but we're simply at a standstill. He's going in to get the staples taken out tomorrow and Dr Osbourne is aware of where we're at so he'll give him a thorough checking over. We're really hoping he didn't do any damage trying to jump up last weekend. We'll know more by this time tomorrow.

05/05/08 - No Change

The staples came out on Friday and the incision area looks fantastic. We were a bit surprised when Dr Osbourne remarked about how swollen the knee looked. To us it looked great. But I suppose we've never seen his knee with no hair on it so we really didn't have anything to compare it to. Dr Osbourne checked the knee over and found it to be very stable and figured the swelling was likely painful for Dakota and was the reason he wouldn't put weight on it. So in addition to the rimadyl, he prescribed an additional pain med to give him and gave us instructions to NOT walk him for a week.

Now it's Monday night and we really haven't seen a change. He still won't put any weight on it and he still seems bothered by the stretches. We're taking Aspen in for her heartworm check tomorrow night so we'll talk to the doctor more then.

05/15/08 - Turned the Corner

This week is looking much brighter than last week. We did talk to Dr. Osbourne last week and he also examined Dakota again on Friday. He said he was still not going to worry yet because the leg felt stable. He thought that maybe the area around the knee felt a little hot and put him on some antibiotics. Last weekend, we started the short walks again. For about five minutes, we would take him around the court at a very slow pace and if we slowed him down enough, he would use the leg. We started doing this twice a day and as the days wore on, our pace picked up just a little and he's using the leg much more with no prodding from us. Today he and I covered quite a bit of ground in 10 minutes and he used the leg practically the entire way. We also took him out for a swim last weekend and he seemed to enjoy that.

Obviously we're still a long way from home but, as of now, we are seeing steady progress. We are starting the process now of getting him off the meds he's on. We're still doing the hot packs and stretches but we've taken those from three times a day to two times a day. Of course, the walks continue.

05/25/08 - More Goodness

Therapy in Lake Michigan

Dakota continues to improve every day. Ever since he turned that corner, it's been a steady improvement. The pace of his walks is picking up. He's using the knee all the time without much prodding. It's just great! Of course, he's not out of the woods by any stretch and this is the point where we have to be even more careful as the better he feels, the more he tries to do. It's really easy to say "oh ... he can do stairs" or "go ahead and let him jump off the couch" but that's what gets you into trouble and is likely to land your dog back in surgery. So ... we're being diligent.

That's not to say we haven't had our moments though. For the Memorial Day weekend, we opted to take Dakota north with us. For the most part, he can't get into a lot of trouble in the cottage. We've blocked the stairs going to the second floor and the only furniture he has access to is pretty low to the ground. We've had a couple of incidents though. On the first day, a service guy was here and while he and I were upstairs doing some work, I turned and noticed Dakota standing next to me. Ooops. Then about a day later, I opened the back of the car and when I bent down to pick him up and lift him into the vehicle, he jumped and took care of it himself. Ooops again!

The nice part about being up here though is that the proximity to the lake means we can take him out swimming two or three times a day. He's been loving that but we're a little concerned about the way he bounds into the water.

He has another vet appointment this coming Tuesday at which point we can get the vet view of his progress thus far.

06/09/08 - Steady Progress

After his last visit north. Rasa took Dakota back to see Dr. Osbourne again. In spite of a couple moments where we thought he pushed way too much, the knee is still coming along very nicely. We finally got him off all meds including the antibiotics and the Rimadyl. We noticed a definite change after the Rimadyl. He back-tracked just a little limping after his walks but nothing that really slowed him down and nothing we couldn't ease with a buffered aspirin. Dr. Osbourne seemed pleased that he had the opportunity to swim so much and encouraged us to keep that up.

So in the last couple of weeks, he's gradually quickened his walking pace and is up to two 30 minutes walks a day. We've been letting him walk stairs for about a week or so now and will take him up and down some hills on his walks this week. We also get to start running him a bit this week but only in straight lines.

Right now, we're back up north again and I plan on taking him out for a swim later this afternoon. He's looking like a happy camper.