Whiskey definitely had a tougher time with her left knee compared to the surgery and recovery of her right knee. Prior to the appointment I had been in touch with her surgical team to let them know that she was still favoring her left knee at times and that the lymph node in her rear left leg was enlarged. Whiskey also still needed to be on Gabapentin twice a day to minimize the limping on her left side. On May 4th, Dr. Morris examined Whiskey and felt that overall she looked great. Whiskey was using both of her back legs without hesitation during the appointment, but still had some swelling along her left incision. The lymph node behind her left knee was still enlarged, but Dr. Morris said she is hopeful this will resolve on its own as the swelling continues to improve. Whiskey also had X-rays done which did not display any sign of infection, and showed that her bone has completely and appropriately healed.
Home Care Instructions:
Unlimited leash walking- allow off leash for about 5 minutes after each walk
Figure 8 Circles, to the left and the right, trotting/ running speed
Trotting or running in a straight line- no sharp cuts or turns
Whiskey can return to her normal activity level at the end of 2-3 weeks of gradual increases.
May 8, 2023
Despite how well Whiskey’s final check-up went, swelling at the incision suddenly seemed to have increased, a sore had formed, and Whiskey was limping a bit more.
Left knee (left) in comparison to the right knee (right):
View of both knees:
I shared my observations with Whiskey’s surgical team, who was very responsive and extremely supportive. After reviewing the photos and videos that I had shared, Dr. Morris decided to put Whiskey on a round of antibiotics. If the swelling, sore, and limping does not improve upon the completion of the antibiotics in two weeks, Whiskey will have to return to Dr. Morris for a re-examination.
Whiskey began taking Cefpodoxime Proxetil on May 8th. We are hopeful that by at the end of her antibiotic regimen, the overall condition of Whiskey’s left knee will have improved. The conclusion of Whiskey’s antibiotic schedule happens tofall on the Feast Day of Saint Rita! (Saint Rita of Cascia (Born Margherita Lotti) is the patron Saint of impossible causes and bodily ills). I will be praying to Saint Rita for relief and healing for Whiskey.
Dr. Morris said that Whiskey looked great today and that her incision has nearly fully healed. Whiskey is using her leg without hesitation and Dr. Morris is very pleased with her progress.
Goals next 6 weeks
Maintain stifle stability, improve muscle mass and range of motion
Home Care Instructions
Whiskey’s incision has healed so she no longer needs to wear her E-collar. However, Whiskey has been trying to lick this incision (last surgery she did not attempt this) so we may need to replace the E-collar if we note that Whiskey is licking excessively at the incision site since scar tissue is weaker than normal skin and may be more prone to trauma.
Whiskey will need to continue to be restricted to leashed walking only; no running, no jumping for the next 10 weeks.
No off leash activity outside.
Continue leash walking program with gradual increase in duration:
Week 2-3 after surgery: 5 minute intervals 3 times per day
Week 3-4 after surgery: 10 minute intervals 3 times per day
Week 4-6 after surgery: 15 minute intervals 3 times per day
Week 5-8 after surgery: 20 minute intervals 3 times per day
Begin post-op rehab exercises
If increased fatigue, soreness or discomfort is noticed with increased walks, we are to revert to previous level of activity and begin again from there.
Whiskey cannot exceed 20-30 minute intervals until x-rays confirm appropriate bone healing.
Gabapentin will be continued for at least 1 more week as activity is increased, and then discontinued or used as needed.
Trazodone will be continued on an as needed basis to enforce exercise restriction.
Whiskey’s next recheck appointment is scheduled for May 4, 2023. At that time, x-rays will be obtained in order to ensure adequate bone healing prior to allowing her return to normal activity.
Fixing Pains, Taking Names, Making Gains
I’m relieved that we are back in the swing of Whiskey’s PT program. Whiskey had been getting antsy and was definitely ready to get moving again! The next 6 weeks we will be knee-deep in PT working hard and hoping our efforts will result in a positive report during her next evaluation on May 4th!
Well…more like plates and screws…Today Whiskey had TPLO surgery on her left knee. I’m not sure why, but I was even more nervous this time around!
The surgery was performed at Mount Laurel Animal Hospital by Dr. Morris. Whiskey’s drop off time was 7am so we arrived a few minutes early so that she could visit her farm friends before being admitted for her procedure.
7:00 am: Check-In
Here we go!
Whiskey was a good girl (for the most part!) while in the waiting area after we checked in.
Once I got back home, I did a deep cleaning of the Fish Fortress so that her recovery area was super clean and ready for her arrival home.
8:55 am: Surgery
Whiskey was induced under general anesthesia and X-rays were obtained. She was taken to surgery, where she was confirmed to have a partial tear in her cranial cruciate ligament. Her meniscus was normal. A tibial plateau leveling osteotomy (PLO) was then performed without complication. Whiskey received an injection of a long-lasting numbing medication along her incision during closure to aid in post-operative comfort.
12:00 pm: Recovery
Whiskey recovered smoothly from anesthesia.
3:00 pm: Will Work For Food
…Specifically chicken! Whiskey schmoozed chicken from her Aunt Amanda after surgery.
3:20 pm: Potty Time
Whiskey post-surgery soaking up some sun on this beautiful sunny day.
3:30 pm: Post-Surgery Selfie
Hanging out with her Aunt Amanda after a post-surgery snack and walk. Our friend, Amanda, is the Nursing Supervisor at Mount Laurel Animal Hospital.
4:30 pm: Pick-Up
After the first surgery on her right knee, Whiskey walked out of the hospital on her own. This time, she was reluctant to walk at all or to put any weight on her left knee. She had to be carried out to the car. This is understandable and expected because Whiskey’s right knee is still in the process of healing. Whiskey will be a bit more unsteady this time around, so we will have to be extra cautious and take things especially slow.
Home Care Instructions
Whiskey’s incision will need to be monitored daily for excess draining, redness, swelling or discharge. Bruising is expected at the incision site and it should progress thru the healing phase as it changes colors. Any bruising that spreads in surface area will need to be documented with photographs and reported to the hospital staff.
A cold pack will be applied to the incision area 2-3 times daily for 5 minutes for the first 3 days following surgery.
The incision will not be covered and will be kept clean and dry
Whiskey is not allowed to swim or be bathed for the first 2 weeks following surgery to allow the incision to heal.
Seroma formation is common with knee surgery. A seroma can present as swelling around the ankle, the joint below the incision. This is where edema from the surgical site will settle over the first 10 days post-op. It will feel like a fluidy sac. Applying a warm compress to the area for 5 minutes 2 to 3 times a day and gently massaging the area will help.
Whiskey will be wearing an E-Collar at all times when not directly supervised.
Many patients are able to reach around inflatable donut collars or soft cones. As a result, it is recommend to use a hard plastic cone unless Whiskey is being directly supervised because if Whiskey is able to access her incision, she may be at increased risk of complications such as infection or dehiscence.
For the next 14 days, Whiskey will be confined to her Fortress and activity is restricted to short (less than 5 minutes) leash walks in the yard only to go out to the bathroom…then it’s back to her Fortress.
Whiskey must always be on a leash when outside.
Whiskey is not allowed to run, jump, stair climb or play with other dogs.
A sling will be used to support Whiskey while walking.
This medication is a non-steroidal anti-inflammatory medication used for pain control.
This medication is used to target neuropathic pain.
This medication is used as needed to keep Whiskey calm.
This medication is a opioid derived medication used for pain control.
Whiskey is expected to increasingly put weight on the operated leg over the next 2 weeks so that she is at least touching the toe to the ground by the time she goes to her two-week check-up appointment. By 6 weeks post-op, Whiskey is expected to be comfortably weight bearing on her left leg. Full recovery can take up to 3 to 6 months once Whiskey is allowed to resume her usual activities.
One week ago today, (2/1/23) Whiskey had her first TPLO surgery on her right knee. I am happy to report that she is still doing very well! Her incision and surgery sites both had normal progression and she is tolerating wearing her cone as well as her confinement.
In this post I included a photo of the incision as well as a rear-view photo from each day over the last week, as well as some videos of Whiskey progressing with using a few stairs and walking (with a lift sling in place in case she stumbles). A lift sling is especially important for Whiskey since she has a tear in her left knee as well.
Day 1: Thursday 2/2/23
She slept well her first night and only woke up once at about 4am to go out to potty. Swelling and bruising had started around the incision.
Day 2: Friday 2/3/23
Evening: Bruising was at its worst tonight.
Day 3: Saturday 2/4/23
Today the Nocita was due to wear off. Nocita is given for postoperative pain relief. It is a long-acting local anesthetic that provides up to 72 hours pain relief and helps prevent increasing pain during thetransition period from the epidural given before surgery to the oral pain relievers we administer at home. We saw absolutely no change in Whiskey – she was in good spirits and did not display any signs of pain. The bruising looks much better already this morning.
Day 4: Sunday 2/5/23
One of her mini walks around the yard today:
Today I took the bed frame and headboard away so that the mattress was on the floor. The mattress is 14 inches high so I put a child safety guardrail on the far side of the bed as well as the foot of the bed so that Whiskey can’t fall off. Runners were placed at the exit side to help with traction when Whiskey is able to get on/off the bed independently.
Whiskey is learning to navigate the stairs. She is allowed to try up to 5 stairs as long as she has her lift sling to assist her.
February 2, 2023 …The First 24 Hours: We Made It! (Phew!)
I have to admit, even with having a great friend on the surgery team to prepare me and guide me through the surgery procedure, I was still SO nervous about… well… EVERYTHING! However, the first 24 hours have gone much better than I expected! Whiskey slept well the first night until about 4am this morning when she needed to go out to potty. She has been calm, tolerating confinement, eating well, willingly taking her medications, having normal bowl movements and urinating regularly.
Pimp My Crib Fish Fortress
Once Whiskey was in her recovery pen, I noticed that she was having trouble repositioning herself on the bed I had placed inside the area. It seemed that the bed was a bit too small for her to safely maneuver herself. I also observed her shivering. After I had taken her out to potty again at 7:30am and gave her breakfast, I knew changes had to be made.
Whiskey enjoyed “breakfast in bed” before the “renovations” began.
Immediately following breakfast, The Pimp My Crib Fortress Crew did an on-the-spot makeover (it’s me… Hi.. I’m the crew, it’s me…) I changed out the dog bed for a bigger one, and added a heavy blanket “wall” to block cold drafts from our ancient cabin’s exterior wall. I also added a “bed comforter” … a Pointer themed blanket that is on the human bed Whiskey normally sleeps on and also included one of the bed pillows because she loves to sleep with her head on the pillow. I felt these items would have a familiar smell and comfort her.
Lastly, I performed some surgeries of my own and “de-squeaked” a few larger stuffy survivors from Christmas to help block out cold drafts as well as to provide padding against the wire walls of the pen. (Squeakers removed so that the stuffies didn’t squeak while Whiskey leaned on them or played with them … in an attempt to avoid a whole-house riot when the others hear the squeak and realize THEY don’t have a toy!
Whiskey in Good Spirits
Whiskey has been alert, wagging her tail and even felt well enough to nom on some of the stuffies!
Whiskey seemed to approve of her upgrades and was much more settled after the “renovations.”
Invest in Rest
Lights out! Sleep gives the body time to repair itself so we kept Whiskey’s area as quiet as we could.
Some of the pack visited Whiskey throughout the day. All of the dogs except for Jägermeister have been respectful of visiting hours. Jagermeister has decided he’s just going to bark at Whiskey so he has been banned from visiting for the time being … I think he is a bit put-off that he doesn’t have nice digs like Whiskey! Haha!
A quick check-in with our friend Amanda…We sent her a photo of Whiskey’s incision and she told us that it looks normal for 24 hours post surgery.
🎶All The Pretty Girls Walk like This, This, This, This, This🎶
Whiskey is supposed to take a 5 minute or less leash walk around the yard a few times a day to keep her right leg moving. A lift-sling is used just as a precaution for support – but only if needed so that Whiskey can naturally rehab her leg and learn to walk on it. The video below is Whiskey on her most recent walk before I wrote this post. There is no support being given to her -and she is doing wonderfully!
Medications…Get it Write
In order to keep track and make sure I don’t miss any medication doses, rehab walks in the yard, or cold pack sessions, I made a very simple chart to keep myself organized. I’m sure it would look much prettier if it were completed on the computer, but I tend to make less mistakes when creating these by hand.
Keep Your Cool (Packs)
The hospital sent us home with a cold pack which I have been using, but our friend, Amanda, gave us this great tip as well. Take a wash cloth or dish towel, run it under water, then ring it out. Place the cloth in a zip lock bag and put it in the refrigerator. The temperature won’t be too cold for the dog, and it remains flexible instead of a hard/stiff frozen pack so that you can wrap it around the leg. Whiskey has been so good and has let me apply the cold pack throughout the day with no issues.
I am so relieved and thrilled with the first 24 hours and I will remain hopeful that Whiskey will continue to have a smooth recovery. Brian and I thank everyone for their continued support, positive thoughts, and prayers!
Today Whiskey had her TPLO Surgery at Mount Laurel Animal Hospital. She was in the best hands with our our good friend, Amanda, who is the Nursing Supervisor for Specialty Surgery.
Porter’s Poo Palace that we use for camping has been sanitized (twice) and brought indoors to be transformed into The Fish Fortress for Wish the Fish’s recovery from TPLO surgery. A secluded, confined area for Whiskey is imperative for her safety and proper recovery from her surgery. This area included a low, flat bed, a feeder, non-skid whelping mat that covered the entire floor, and lighting courtesy of a rechargeable camp light. Luckily we had all of this on-hand!
Checking out her recovery digs:
Lounging with Mom after we administered the pre-surgery medications to help her relax:
We arrived a bit early to Mount Laurel Animal Hospital…but Whiskey didn’t mind because she was watching all of the farm animals from the car, then took a short potty break before entering the hospital.
Amanda checked Whiskey in and fully explained the procedure and what to expect.
Radiographs were taken and confirmed that Whiskey has a complete tear in her cranial cruciate ligament. Effusion is present in the left knee where the suspected partial tear is located.
Dr. Morris called me once the radiographs were taken to let me know Whiskey is doing well and was about to get her epidural in preparation for surgery.
Whiskey was sedated and anesthesia was administered.
Once the incision was made, Dr. Morris could see that luckily Whiskey’s joint is normal and her meniscus is intact. Whiskey’s X-rays are displayed on the screen so that there are live views of her measurements as Dr. Morris reconfigures the angle and makes a curved cut in the top of Whiskey’s tibia bone
Whiskey’s heart rate, oxygen level, blood pressure, CO2 levels, breathing rate and body temperature were all monitored throughout the surgery.
The TPLO was performed without complication. Whiskey received an injection of a long-lasting numbing medication along her incision during closure to aid in post-operative comfort.
Whiskey’s incision was closed and post surgery X-rays were taken before moving her to the recovery room.
Although we are optimistic that Whiskey will not have any complications, we need to be aware that it is a possibility. The risk of these potential (and hopefully unlikely) complications far outweighs the benefits of repairing Whiskey’s knees so that she can return to her normal Pointer shenanigans and be provided with the opportunity for the best achievable quality of life. Potential complications associated with this procedure include infection, dehiscence, need for implant removal, implant failure, implant migration, persistent lameness, patellar luxation, progression or arthritis, pivot shift, fracture, future meniscal injury, and need for additional intervention.
Whiskey recovered smoothly from anesthesia. The breathing tube was taken out and a warming blanket was placed over Whiskey while she recovers with her IV fluids. Dr. Morris called to review the surgery. After a few hours of recovery, Dr. Morris called us again and let us know that she was comfortable at this point to release Whiskey to come home since she was doing so well.
Whiskey hung out with the best nurse any patient could ever ask for…our friend, Amanda! Whiskey took a trip to the kitchen and ate a snack, which she was able to keep down!
Amanda met with me and reviewed all of the post-surgery instructions. Success of the surgery depends heavily upon the adherence to the post-operative instructions for the next 8-12 weeks. Too much activity too soon, or failure to closely follow the given instructions could disrupt and potentially fail the repair, which would require a re-operation. Whiskey is expected to increasingly put weight on the operated leg over the next 2 weeks so that she is at least touching the toe to the ground by the time of suture removal. By 6 weeks post-op, Whiskey is expected to be comfortably weight bearing on the leg. Full recovery can take up to three months.
Monitor the incision daily for excess draining, redness, swelling or discharge: Bruising can be expected at the incision site and it should progress thru the healing phase as if changes colors. Any bruising that spreads in surface area should be documented with photographs if able and the hospital should be contacted.
Cold pack the incision area 2-3 times daily for 5 minutes for the first 3 days following surgery.
Incision does not need to be covered. It should simply be kept clean and dry.
No swimming or be bath for the first 2 weeks following surgery to allow the incision to heal.
Seroma formation is common with knee surgery. A seroma can present as swelling around the ankle, the joint below the incision. This is where edema from the surgical site will settle over the first 10 days post-op. It will feel like a fluidy sac. A warm compress can be applied to the area for 5 minutes 2 to 3 times a day and gently massage the area. If the site is painful or red, the hospital should be contacted.
An E-Collar is imperative at all times when not directly supervised. If the incision is accessed, there will be increased risk of complications such as infection or dehiscence.
Many patients are able to reach around inflatable donut collars or soft cones. As a result, use of a hard plastic cone is recommended
Restrict activity to short (< 5 minutes) leash walks only to go out to the bathroom for the next 14 days. Whiskey must always be on a leash when outside.
No running, jumping, stair climbing or playing with other dogs. If you need to use stairs and your pet is too large to carry up and down – make sure Whiskey is on a leash and walk up and down the stairs very slowly.
Whiskey should be crated or kenneled in a small room without furniture when not directly supervised. Using a crate is a security for Whiskey to heal appropriately. If Whiskey is hyperexcitable when you are home, use the crate to create safe periods of rest.
Use yoga mats, bath rugs or carpet runners to cover slick floors in the kitchen or hallways to prevent slipping. Major areas of concern are around doors where Whiskey will be coming in and out as well as around food and water dishes. If needed, use a towel or sling to support your dog during walking around these areas of your home.
This medication is a non-steroidal anti-inflammatory medication used for pain control. Adverse effects include anorexia, vomiting, diarrhea, and dark tarry stool. Please stop this medication and call if you note these. Do not administer this medication with other NSAIDs (Aspirin, Meloxicam, Previcox, Deramaxx, etc.) or steroids (Prednisone, Temaril-P. or injectable/topical steroids).
This medication is used to target neuropathic pain. Adverse effects include sedation, anorexia, constipation and occasional anxiety/tremors/neurologic sions.
This medication is used as needed to keep Whiskey calm. Adverse effects include excessive sedation, anorexia, constipation, and occasional anxiety/tremors/neurologic signs
This medication is a opioid derived medication used for pain control. Adverse effects include sedation, anorexia constipation
Bag of Goodies
a pill cutter to help us with the dose amounts
food that is easy on the belly in case her stomach is upset
folder with post-surgery instructions
Shortly after the post-surgery discussion, Whiskey walked out of the hospital with Amanda!
Besides setting up a safe confined recovery pen, we also had these two items to assist us to lift and/or support Whiskey if needed:
Once we were home, Whiskey quickly settled in to her Fish Fortress.
Whiskey’s same-day release was possible because of the outstanding skill and medical expertise of the Mount Laurel Surgical Team. We are so grateful for the compassionate attention and professional care displayed from each and every person involved in Whiskey’s surgery.
A recheck examination will be scheduled at the 2-3 week post-surgery mark. At this visit, Whiskey’s incisional healing will be assessed.
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.
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.
Keeping Whiskey lean will decrease the load going through her injured knee, and will also decrease systemic inflammation.
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.
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.
Glucosamine and chondroitin supplements are thought to support cartilage health. A recommended veterinary brand is Dasuquin.
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.
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.
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.
Below is a journaled account of how we discovered Whiskey’s bilateral CCL tear. As with just about everything else our pack members acquire, it is never presented in textbook fashion, and always a puzzle to figure out!
Whiskey took a walk with Jägermeister. Nothing out of the ordinary was noted during the walk, and she was completely fine afterwards. About an hour later her hind end collapsed and she could not stand back up. This lasted only a few seconds and then she was walking normally…well…normally for Whiskey… Those of you who have been following along for a while now or who have met her in person know that she has a “wonky” gait due to a broken shoulder and broken growth plate – both acquired before she was rescued by Pointer Rescue Organization as our foster dog, “Wish.” We thought maybe she just tripped or lost her balance but to be sure, we put her on crate rest into the next day. She seemed fine and resumed normal activity…playing, walking, running, jumping up/down on the couch, etc. She continued to show absolutely no symptoms for the next week.
Whiskey and I took a walk with a friend and her dog. Whiskey was absolutely fine throughout the entire walk. It was a nice day so after the walk was over, I sat down to eat lunch with my friend and Whiskey remained her usual busy self for approximately 40 minutes, walking around and keeping an eye on the geese in the nearby lake – and then all of the sudden once again – her hind end collapsed. She got right back up and seemed fine – absolutely no limping. We had a 25 minute ride home. When we arrived to our house, Whiskey could not support her hind end at all, and was not recovering. Luckily, our primary vet, Dr. Campbell, got us right in for an appointment. When we arrived, Whiskey still could not support her hind end. An exam was performed and an X-ray of her spine was taken. No significant findings were observed. Dr. Campbell gave Whiskey a steroid shot and sent her home with Prednisone. Dr. Campbell suggested that we see a neurologist.
Lateral TL spine (T4-Sacrum): Spondylosis at LS. No other significant findings.
Whiskey was able to walk and was not limping.
Jan 19: Neurological Exam
Whiskey was still displaying no symptoms at this time. Porter and Whiskey’s neurologist, Dr. Eagleson at BluePearl Pet Hospital, performed a neurological exam on Whiskey.
General – BAR, appropriate, ambulatory
ENT – No significant findings
H/L – No murmur ausculted, lungs clear, strong synchronous pulses
ABD – Soft non-painful, no masses palpated
lUG – WNL
PLN – WNL
INTEG – Clean hair coat
MS – BCS ~ 6/9, thickened right shoulder joint
Mentation – Alert and appropriate
Gait – Normal
Reflexes – Normal withdrawal in all limbs; normal patella bilaterally; normal perineal reflex
Postural Reactions – Normal
Cutaneous trunci – Normal
Cranial nerves – Normal
Sensory – No pain on CTL palpation or neck ROM
(NEUROANATOMIC LOCALIZATION – Normal exam
Release Notes from Dr. Eagleson:
Whiskey’s neurologic exam was normal. In the video, it appears that she is having trouble/difficulty supporting weight in her back legs. This is causing her to shift her weight forward onto her thoracic limbs and she walks with her back arched. She would be taking on this posture either due to weakness or discomfort when bearing weight. I did not find any source of pain on her exam and her stifles and hips palpated normally. We performed bloodwork which was normal (including her muscle enzymes). A lack of blood flow to the back legs could cause weakness; however, she has no evidence of this (she has great femoral pulses). To further rule out a spinal cord problem an MRI is recommended. This is scheduled for next Tuesday (1/24/23). In the meantime, we are going to wean her off of the prednisone. If she has another episode, I would like you to try to evaluate her reflexes if possible.
Whiskey began limping again, but this time only what appeared to be on her right side.
January 24: MRI appointment
Whiskey was still limping predominately on her right side. Prior to our appointment, I had sent all videos I had taken to Dr. Eagleson. I took Whiskey to her MRI appointment and when Dr. Eagleson examined her upon her arrival, he suggested that we hold off on the MRI when he saw that she was now presenting in a different fashion. He suspected that Whiskey torn her right CCL. Dr. Eagleson had the Surgical Team look at Whiskey and noted that if Whiskey were to continue to have episodes of hindlimb weakness after correcting her knee(s), we will pursue the originally planned MRI.
Dr. Deahl, a surgeon at Blue Pearl viewed all the videos and examined Whiskey. Dr. Deahl determined that Whiskey has a bilateral CCL tear after palpating her knees….a complete tear on the right, and a partial on the left. It was suggested to surgically repair the right side and then reevaluate the left side once the right is healed. It is suspected that the left will have to be repaired as well. An appointment to sit down and speak with Dr. Deahl has been set for January 30th. It is also quite possible that Dr. Deahl will perform surgery on Whiskey’s right CCL that same day.
Release Notes from Dr. Eagleson:
On exam today Whiskey had a consistent right pelvic limb lameness. On physical exam it was found that he had a torn right cruciate ligament. An orthopedic consult was performed which confirmed the right cruciate ligament tear as well as evidence of a partial tear/chronic remodeling in the left knee. I showed the videos to the surgery service who agreed that the way Whiskey was holding the right leg up is peculiar for a CCL tear. It’s also a bit strange that she wouldn’t bear weight in both limbs as episodes and then recovered. However, since there is evidence of the left knee not being completely normal, then it’s possible that she was just sore in both knees on those days (since it happened after longer walks). Although it’s possible two issues could be going on, I feel it’s more likely the cruciate tears presenting in a slightly atypical fashion. We discussed either performing MRI first to rule out a possible neurologic issue versus correcting the knee first. I feel that a 5 year old Pointer will need to have the knee fixed in order to remain highly active. The only reason not to correct the knee would be if there was something seriously bad going on in the nervous system (e.g. tumor), which I do not feel there is a high likelihood of. If Whiskey were to continue have episodes of hindlimb weakness after correcting the knee, we would always pursue MRI at a later date. At this time you have decided to follow up with the surgery service.
CCL Tears and How a TPLO Surgery Works:
More Great Resources That Were Shared With Me to Help Explain CCL Injuries and TPLO Surgery: