Coopers Bilateral TPLO Surgery and Recovery

So, one of the reasons I decided to start a dog blog in the first place is because recently, my canine little brother underwent a bilateral TPLO surgery.  Let me start by saying that Cooper is a BIG boy. He looks like a very, very large golden retriever - and for the last few years showed some lameness in both of his rear legs. I was EXTREMELY thankful for others who had also blogged about their experience with TPLO surgery when we had first got Cooper home. It made the entire thing feel SO MUCH less difficult. We found plenty of information on single leg TPLO recoveries, but only a couple of stories out there in which dogs had undergone both knees - and we were left with quite a laundry list of questions. I wanted to share our unique experience in hopes that we can help others through the bilateral surgery, because having an idea of what to expect offered us so much comfort and relief. A TPLO is an extremely stressful and emotional experience for both the humans and the pooches, and any information I could find helped us all cope a little better. Hopefully, there is something in here that will be helpful to anyone else about to have their furbaby undergo a TPLO, or for those who already have and are desperately researching for any way they can help their own furry friend through it all!

Here's where it all began

When Cooper first started having problems a few years ago, our vet thought that it was due to his hefty weight and the fact that hip dysplasia is common in many large breeds. Although, this seemed a plausible explanation for his pain and limping after playing or running for any length of time, we recently discovered that this was not the case.. It turns out that the problem was in his knees!

This past holiday season, we had a bit of a cold snap here in Calgary. After a few days of being cooped up in the house, we thought we might bundle up and take the boys for a short walk at a nearby off-leash park. Later that evening, we noticed that Cooper was having a really hard time walking and could no longer support his weight on one back legs. Not even a little bit and yelped when anyone tried to move or touch his leg. Normally, after just a short walk he is totally okay - but this time his limp was as bad as if he had possibly broken something.

We decided that he needed to see a vet right away. We took Cooper to the Crowfoot Veterinary clinic in NW, Calgary. They had treated him in the past for pain and the associated limping he had been having after his more rowdy and playful walks, under the impression that his hips were to blame. After examining his injury, they told us that he had very likely torn his Cranial Cruciate Ligament, and recommended we book him in for a TPLO surgery.  They referred us to Western Canada Veterinary Specialist and Emergency Center, where Cooper was to have Dr. Audrey Remedios perform the surgery. He was booked in for the 7th of January.

A few days had passed, and Cooper was learning how to cope with balancing on three legs. He is a heavy guy, so this was quite the task as my parents home is split into three levels and has laminate stairs. Our first task was making sure the stairs were easy for him to navigate on three legs. We did keep him downstairs for the majority of each day, but his bed was upstairs in my parents bedroom, so we needed to think up a way to help him on the stairs as best we could. He REALLY doesn't enjoy being lifted. I took one of my yoga mats and cut it into stair width strips and placed one on each stair for some extra cushioning and to offer better traction (I must have been really stressed out and worried, because the idea literally came to me in a dream the night before). This worked wonderfully, as he was no longer afraid to attempt the stairs at bedtime and he no longer slid on his good back leg. Even Tigo and Iggy were more confident on them!

Christmas finally came and went, and everything was going good as far as keeping Cooper still and quiet. On the 27th we were running low in the grocery department and so we ventured out (sans dogs) to load up for the coming New Years festivities. We arrived home to have all of the boys excited to see us and waiting at the front door. Cooper usually comes outside to greet my Dad, his most favorite person in the whole wide world, on the path up to their door - but this time on his way out, he let out a shriek that scared the bejeebies out of all of us. That was when we knew we had a much bigger problem on our hands. Knee number two had officially torn, and we weren't sure that Cooper would be able to wait another week and a half without the use of either of his rear limbs! We called the vet right away, and luckily they were able to move his surgery up to December 30th. We only had three days to wait (three very long days!) before Cooper could finally be on his way to getting better.

Surgery Time

The last few days had been really hard on everyone. Cooper had only relieved himself once or twice, as walking was very painful and he didn't want to get up from his bed (we had yet to discover the towel sling). We got up bright and early, and took Cooper over to see Dr. Remedios. They gave us a rundown of what will happen; how long they would keep him, what they would be doing, and what we could expect over the next few days. They told us that it wasn't likely he would be coming home the next day, like the smaller breeds sometimes do, because larger dogs often take a bit longer to become mobile again. They didn't want to send him home without knowing that he could move around and relieve himself and all that good stuff.

We said our goodbyes, and anxiously awaited the phone call saying we could pick up our beloved Beast.

They called us both days to let us know how he was doing - great, and that he would definitely need the extra day at the clinic. We were happy to have him stay because we knew he was in great hands, and the techs at the clinic knew much better than we did how to care for him in his condition! Then came the scary part - Cooper was ready to come home, and we were all very afraid that we wouldn't know how to help him. This was an emotional time. From the human perspective, we were happy to have him back! On the other hand, HE was obviously chapped that we had left him there. I can imagine if he could talk, he would have chewed us out about leaving him alone at the hands of some pretty crazy people, but we as humans knew that he was in the best possible care with Dr. Remedios and her staff.  :)

This is the x-ray of Cooper's left knee, both before and after surgery. Notice they had to use two plates because he is so darn heavy! The angle of the tibia is much less diagonal in the photo on the right, which means a job well done for Cooper's doctor!

Recovery Begins

They took us into an exam room and showed us how to perform all of his physical therapy exercises and how to help him walk with a towel sling. In my opinion, the bruising was VERY alarming to see, but it is normal with this kind of surgery. They answered any questions we had - although, I really regret not being able to look past the excitement of bringing him home and not really knowing what would have been good to ask when we were there. A lot had to do with not being able to foresee a few of the events of the next few days. Hindsight is 20/20, and if I were to do it over again, these are some of the things I would have had the vet show me/explain:

• Cooper, being male, obviously has his manly bits right there on his belly. Some dogs have a penis that is far enough between their legs that peeing with a belly sling is no big deal... Cooper, on the other hand, made quite the mess because his is positioned further up on his belly - directly under the belly sling. Our first time helping him pee was quite a challenge! We didn't know how to hold him or the sling so that he could properly relieve himself. Ultimately, he ended up peeing RIGHT into his sling, which eventually ended up all over both him and us while trying to get it out from under him. I would have liked to ask beforehand what to expect when taking him out to do his business and the best way to hold it while he was doing said business. We ended up buying towels and having a whole arsenal of extra towel slings, because in the beginning he was too sore to stand on his own, and it was tough to move them far enough forward. He peed into a good number of them. 

• Another good thing you will probably want to know is exactly HOW to remove/put on the belly sling! When the vet tech brought him out to us, he was obviously already wearing it. We did ask how to do it, but she really only explained that you could shimmy it up and down his tummy to put it on or take it off. This was a much more daunting task once we got him home and he had been laying with it under him for a few hours. Even more daunting when it was soaked in pee! We were worried that when it was tucked under him, we would be causing pain to the incision sites inside both knees when trying to pull it out from under him, as it almost always rubbed against them. This got easier as he became more mobile. We found that as he got more confident in sitting up with just his front half, it was easier to slide in and out. We never did find an easy way to do it while he was laying down, which is the position he was in for the better part of the first week. 

• What signs can I look for so that I will know if my dog is in too much pain? I ended up making a 3am call to the clinic on Coopers first night home to ask whether or not he could have a dose of his pain medication sooner than the directions stated on his prescription bottle. They were happy to run through his behaviour and symptoms with me to determine if he was in pain or if he simply was just not tired. He was on a different medication than most dogs will be when recovering from this kind of surgery, as he had been taking Vanectyl-P (which is a combination of prednisone and antihistamines) for his allergies. From what I gather, most dogs are prescribed Metacam after surgery, but being that it cannot be taken during a course of steroids, Cooper was prescribed Percocet. 

This is a shot of Cooper the afternoon that we got to bring him home. He was more than a little uncomfortable, and we soon discovered that he needed a bigger bed!

We did notice that on a lot of other blogs we read, some dogs had been up and walking almost immediately. This was not the case for Cooper. He was very slow getting up and around, and was not interested in trying for most of the first week. He tried his best to hold his pee, literally for 24 hours at a time, because he hated having to get up. Despite our taking him out and cheering him on, he was stubborn and would only pee when he absolutely couldn't hold it anymore. We were a little bit worried, and somewhat discouraged, but Cooper knew better than all of us when he was ready. We did have to remember to consider how the Vanectyl-P was affecting him though, which is important if your dog was on this particular steroid prior to surgery. It inhibits the immune system, which maybe explains why he was a little slower on the recovery front than most other dogs. Lucky for us, Dr. Remedios had a plan. She said that normally they would have liked to wean him off it a few weeks ahead of the surgery to avoid any possible complications with the healing, but because Cooper tore the second knee so soon after the first, we didn't have time to wait for the steroids to make their way out of his system completely. Instead, she prescribed him a two week cycle of antibiotics to take after his surgery to prevent him from coming into any infections. 

I will say that wearing a plastic cone (or e-collar, whatever you prefer to call it) was pretty overwhelming for Cooper. He HATED it and would get all spastic and clumsy while he had it on. Not to mention, it looked very uncomfortable to lay with. I discovered on another TPLO blog that there are MUCH more comfortable alternatives to the dreaded plastic cone if you are handy with a sewing machine! We measured around his neck, and I threw together what I like to call the donut pillow. Basically, its a big round pillow with a hole in the center that fits right over Cooper's head. This little contraption effectively stopped him from licking at his incisions, and he immediately fell in love with it because it enabled him to be more comfortable. We used the remaining fabric and stuffing to sew a second pillow that was long and thin. About the same length as Cooper. This worked well to elevate his legs to help reduce the swelling, as well as create a gap between his legs while laying on his side so we could ice both knees. I think he really appreciated them because in the early days, he could only lay in two positions - flat on his left side, or flat on his right. There was no in between for a few days until the pillow. With the new pillows, he was able to lay in a given position for quite a bit longer than before. There was much less painful changing of sides once we learned how to use the pillows to an advantage. He is currently 6 weeks into recovery, completely mobile, and STILL sleeps with his favorite donut pillow. 

Cooper's second donut pillow was made with a much bigger hole - we discovered one night that he liked to force one paw through the neckhole with his head, tearing it a little bit in the process. Now he has two. On a side note, I ended up making Iggy his very own donut a few days later. His has rubber duckies all over it, although he seems to prefer Cooper's drooly, stinky yellow one. Every time Cooper wasn't wearing it was a perfect opportunity for Iggy to steal it and use it as a cozy little chewing hideout! Notice my dad in the background, this is where he slept with Cooper for over a week and a half. He was relieved when he was finally able to sleep in a real bed, however the futon mattress really came in handy. It was big enough for both my dad and Cooper to sleep comfortably in the Kitchen for so many nights!

After the first week was over, Cooper was finally able to hold his own weight a little bit while he peed. This was so exciting for him, especially when he figured out the almost-squat. He really had a tough time peeing in a total stand-up position, and although he was never much for lifting his leg, he did usually get into a good deep squat before picking one foot up ever so slightly. This was a big step for him.

After the really slow first week, we saw him getting noticeably better and better every day. By about day 8 or 9, the bruising was changing from a deep puffy red to a pink that was a little bit closer to his normal color/texture, and the swelling of his legs was very minimal. His feet were back to a normal size (they had been quite swollen) thanks to being able to get up and move around a bit more. He was getting more and more comfortable with his physical therapy exercises, and was getting more and more confident each and every day. He was happy to get up and try and stand or waddle over to a nicer, cooler spot on the futon mattress.

After about day 12, Cooper was behaving a lot more like the old Beast. We decided that he (and my dad) didn't have to spend his nights sleeping in the kitchen anymore. We set up a carpet runner path from his bed in the kitchen to his regular bed in my parents room, and after his final pee of the day, he was able to go right off to bed and get a good nights sleep with a little more normalcy. He didn't quite understand the fence we fashioned around his bed at night to prevent him from trying to get up undetected, not that he ever tried, but he was happy for the change of scenery. Even if it was just for bedtime. We noticed around week 3 that he was able to stand comfortably on his own for a much longer period of time as well. In the days prior, he was walking really well, but would do a move that looked very much like a preschoolers pee-pee dance when standing to do anything for longer than a few seconds - namely, while eating and drinking. This was really quite comical, as he insisted on standing to eat, but it was nice when we noticed for the first time that the pee-pee dance was no longer happening!

It is now week 6, and Cooper is getting really stir crazy. And a nice juicy bone out on the back deck isn't doing very much to keep him stimulated these days. He definitely thinks that he's all better, because the pain is gone, but he is just now figuring out that he is much weaker than he was before. He is still largely contained within the kitchen and bedroom, as there are way too many stairs in his house for him to be afforded anymore space than that. He is happy to get up and walk around the kitchen whenever he wants, and he is also back to doing the full deep squat again. On top of his newfound freedom in the kitchen, he is allowed a very short leashed walk each day - he collects the mail a few houses down the street with my dad in the afternoons. This has helped him with his cabin fever immensely. He can't quite figure out why he is still stuck upstairs most of the time, but he has become MUCH more willing to be carried down them if it means that he can go walking. Even if its only for a few minutes! 

Week 5: Cooper looking not so happy to be sharing his cozy futon bed with the pesky youngins, Iggy and Sophie. Kira the Shiba knew better and decided to play with her toys on the carpet instead.  =)

We are so happy that we decided to do both knees at the same time - mostly because 8 weeks is a VERY long time to keep a dog in confinement, and they get really sick of staying put (and increasingly difficult to keep there) once they aren't in pain any longer. And also because an 8 week recovery is a long time to completely modify your entire life! You literally eat, sleep, work and even grocery shop based on who is available to watch over the King of the Household dog. And as scary and overwhelming as it may seem in the beginning, it was definitely manageable and one recovery is more than enough for him to have to go through. Obviously, writing this at week 6 has left me with a few details that are not so fresh in my mind. Initially, I wasn't sure if I was going to write a post, due to my lack of photos along the way, but I was so thankful for the blogs that I read in the early days that I thought I owed it to everyone out there to share what I could remember. If you are reading my post, and happen to have any questions about your own experience or if there's something you'd like to know about Cooper, definitely leave them in the comments! I will do my best to respond to any and all of them because I know how big of a difference it can make throughout the process!