January 31, 2023

Originally Whiskey was supposed to have her consult and surgery on Monday, January 30th. However, we decided to use a different hospital for Whiskey’s surgery. On January 31st Whiskey had a consult with Dr. Kate Morris, the Surgery Department Head at Mount Laurel Animal Hospital. A great friend of ours, Amanda, is the Nursing Supervisor for Specialty Surgery at Mount Laurel Animal Hospital, so we know Whiskey will be in good hands, and the clinic is much closer to home.

Exam

Dr. Morris examined Whiskey and confirmed that there is a suspected cranial cruciate ligament injury (bilateral, right worse than left). It was decided that Tibial Plateau Leveling Osteotomy (TPLO) surgery will be performed on Whiskey’s right knee first. Four to eight weeks later, Whiskey will need a second surgery on her left knee in addition medical management.

Tibial Plateau Leveling Osteotomy (TPLO) Surgery

In surgery, the first step will be to look in the knee joint in order to confirm that the cruciate ligament is torn, and to assess the meniscus. If the meniscus is damaged, the damaged portion will be removed in order to provide pain relief.

Dr. Morris explained that during the TPLO procedure, a cut is made in the top of tibia, allowing her to rotate the top of the tibia to remove the slope. By altering the biomechanics of the joint, Dr. Morris will be able to negate the need for the cruciate ligament and provide a stable surface for the femur to rest on. The two parts of the tibia will be held in the new position with a plate and screws. Though the plate and screws are no longer needed once the bone has healed, most patients keep their implants for the rest of their lives unless infection or irritation occur.

Following surgery, most patients begin toe-touching within the first few days. By the two week recheck, most patients are consistently placing their leg though lameness will still be noted. This should steadily improve over the following weeks. Strict rest is required until the bone has healed, at approximately 8-12 weeks following surgery.

Potential complications associated with this procedure include infection, need for implant removal, future meniscal injury, patellar luxation, incisional complications, pivot shift, persistent lameness, and fracture.

Pending Whiskey’s progress with her right knee, surgery will be performed on her left knee as soon as 4 weeks after surgery on her right knee.

Medical Management

• Weight management
  • Keeping Whiskey lean will decrease the load going through her injured knee, and will
    also decrease systemic inflammation.
• Activity modification
  • Limiting Whiskey to controlled exercise such as walks and swimming as opposed to
    high impact activities like jumping and running may help maintain her comfort.
• Physical rehabilitation
  • Whiskey may benefit from enrolling in a formal rehabilitation program where her
    muscle mass and range of motion can be maintained while she is also mentally stimulated.
• Joint supplements
  • Glucosamine and chondroitin supplements are thought to support cartilage health. A
    recommended veterinary brand is Dasuquin.
• Omega 3
  • These fatty acids work as anti-inflammatory medications and can be particularly effective in
    treating joint pain. Recommended veterinary brands include Welactin, Nordic Naturals and Canine
    Omega Benefits.
• Non-steroidal anti-inflammatory medications
  • These medications are used to decrease inflammation and
    keep Whiskey comfortable. Examples of NSAIDs include Rimadyl/Carprofen and
    Metacam/Meloxicam.
• Pain control
  • As Whiskey’s arthritis progresses, other medications such asGabapentin, Amantadine or an
    opioid may become necessary to keep her comfortable, especially after periods of activity.

Procedure

Whiskey is scheduled for tomorrow morning, February 1st, for the first of her two surgeries. Dr. Morris said that the decision to have Whiskey spend the night at the hospital following surgery will be determined once Whiskey is awake and assessed.