Polly 3 Weeks Post-TPLO (2nd Leg) in France
What a BIG three weeks it’s been! We’ve completed 3 serious medical procedures (2 paw-related and 1 human), I’ve driven over 1800 km solo, I’ve visited another country, and our little family has gone through an emotional roller-coaster. I haven’t wanted to blog during it all partly because of stress, and partly because I wanted these weeks to be over and done with before I wrote about them.
But here we are, finally! The three weeks of hell are done and I am happy to say they went well. PHEW!
There’s lots to share, but we’ll start at the beginning…..
Our big month of craziness was launched when Polly tore the ACL on her right rear leg back in mid-May. As soon as it happened we knew exactly what it was. We went down this road with her left leg back in 2016 and it basically re-routed our entire year of RV travel that year. It was a looong path to recovery and I wrote in detail about it on the blog in these four posts:
- Summer Plans Change Again (This Time It’s The Dog)
- Polly 3-Week Post-TPLO Surgery Update
- Polly 7-Week Post TPLO Surgery Update
- Polly 3 Month Post TPLO Update
This time around the right ACL was badly damaged, but not completely torn, so we gave her several weeks to see if it would start to recover on its own. Sadly it didn’t, and by the end of week 3 she was still not using it, preferring instead to hop around on 3 legs. At this point our options were clear and the vet agreed. Surgery was going to be needed and it was going to be needed ASAP.
Finding A Surgeon
Of course our first barrier was finding a good surgeon on this side of the pond.
Our previous experience with Dr Acker in Sun Valley, ID was SO good that we were dubious we could find something that matched over here. After all, Dr Acker is a wizard and we are supremely difficult customers. We wanted someone who specialized in leg operations and who does A LOT of them (good surgery is so much a function of feel & practice). Plus we wanted a surgery that was minimally invasive with a small scar (= faster healing), minimal swelling or bruising, and internal stitches that wouldn’t require her to wear one of those horrible collars afterwards. We were asking a lot!
After weeks of research we narrowed it down to 2 options:
1/ Drive to the UK – The first option we thought of was to drive to the UK. So while I was visiting my sister in Bristol I spent every night researching & reviewing orthopedic vets, and there was one which consistently popped up on every search. Fitzpatrick Referrals is a top-notch facility in Eashing, UK (southern UK) that has everything you’d ever want for doggie orthopedics. World-class surgeons, a first-class rehab facility and a whole-dog holistic approach to healing. It required a referral from our French vet, a 2-week wait while our case was analyzed & scheduled, driving ~13 hours (each way!), and a cost of £3,800-£4,200 to complete. Yikes! Still, the idea of having everything done in English at a top-notch facility was tempting. Was this the right place?
2/ Get It Done Locally – Our other option was to do it locally. Our house is located only ~1 hour from Toulouse which has one of the top vet schools in France, so the probability of finding a top-notch surgeon here should be pretty high. But HOW do actually you find them? In France vets are not legally allowed to advertise their business (it’s literally against the law), and Google reviews are kinda hit and miss (folks just don’t seem to do them as much as in the USA), so almost everything here is done by word-of-mouth referral. We’d already established ourselves with a local vet who said she knew the right guy to do it, a very innovative surgeon by the name of Dr. Guenego who practices at a small, but specialized clinic, Clinique Veterinaire du Vernet just ~30 mins down the road. It sounded OK, but how would we know for sure?
We decided to get a referral done to both places and then talk to them in person in order to make our final decision.
I called up the UK place first. It clearly hit all our “buttons” and I was super impressed when I talked to them, but it would take over 2 weeks before they could see us, not to mention the price and the complicated logistics of getting there and back with doggie. I really, really liked them, but it wasn’t going to be easy.
The place in France was a bit more of a mystery. It had exceptionally good Google reviews (a rarity in France), but I couldn’t actually find any comments that were specific to the ACL surgery. Plus there wasn’t much info about the procedure beyond what (very) little was on their web site.
It wasn’t until I talked to Dr. Guenego himself that the pic came info focus. He’s a specialized orthopedic surgeon who’s been doing surgeries for over 25 years. He prides himself on the very latest operating techniques, specializes in minimally invasive surgery, and constantly tops up his knowledge by writing papers and presenting at conferences (always a good sign).
I spent over an hour talking to him, asking WAY more questions than he’d likely ever been asked before (tell me about the exact angles and how they compare to regular TPLO, talk to me about stitches and the metal alloy that’s used in the plates, describe the post-op complications, tell me how this impacts the arthritis she has in her hips etc.), but he was patient and SUPER detailed, and in the end he totally won me over.
This vet knew his stuff and my gut told me he was the one for the job. Plus he could operate right away and it would only cost us EUR 1600. Clearly it was meant to be!
The TPLO Procedure
So what was it exactly that we were getting done??
Those of you who remember our last TPLO procedure will recall that this is a very serious orthopedic surgery. During TPLO the bone is basically sawed in half and rotated in order to change the angle of the tibial plateau. This basically takes the torn ACL “out of commission” allowing the dog to use the leg normally without it. In theory it’s quite an elegantly simple operation, and in the right hands it’s quickly and accurately done, but it IS also a very serious op.
For our surgery in France, things were going to be a little different too.
Dr Guenego doesn’t actually do a “classic” TPLO surgery, but a type of modified TTA/TPLO that uses a wedge and a much smaller double plate. It’s something he’s developed (and presented on) over the years through his own expertise and it’s very interesting stuff. The bone is still broken and the result is exactly the same as a regular TPLO (a leveling of the tibial plateau, with pretty much exactly the same angles), but the procedure is less invasive overall. The advantage of this is typically less post-op complications and faster initial use of the leg.
However the absolute recovery time is similar.
It’s A The Loooong Recovery Process (Get Ready!)
The general rule of thumb for doggie TPLO/TTA recovery is that it takes ~8 weeks before the bone fuses with up to 6 months for FULL recovery. Each dog is a little different and the exact recovery time is highly variable. Some dogs use the operated leg right away and are back to normal after 3 months, whereas others take weeks to use it and/or have to be re-trained to have confidence in the leg & walk normally again (Polly’s last recovery was like that).
Either way, during recovery it’s super important to follow a strict regime.
During the first 8 weeks the dog must be firmly restricted to short leash-walks (starting at 5 mins, and increasing slowly over time), and there can be absolutely NO jumping, NO running, NO stairs, NO play/roughhousing & absolutely no off-leash activity. It can be hard to keep an active dog quiet enough during this time, but it’s CRITICAL for proper healing that you do.
With Polly we find that mental games (nose touching, identifying objects, playing “find the treat” etc.) really tire her out. Plus car rides and lying quietly at a park or restaurant tires her out too. So we focus on these things rather than physical exercise during the first 8 weeks.
Home Rehab really helps too. Although doggie can’t walk much during the first 8 weeks there is LOTS you can do at home to get the healing process on the right track. This includes range-of-motion exercises & icing (during the first 2 weeks), followed by massage & the introduction of specific, limited exercises (after week 3 only). For Polly’s last TPLO we downloaded this FREE rehab booklet from Top Dog Health and used it together with their very helpful online videos. It only requires an e-mail to sign-up and is tremendously helpful. We are using the exact same booklet this time around.
Supplements & Laser are also a good addition. We’ve got Polly on a good Omega 3 oil and and an awesome joint supplement that we discovered during her last TPLO called Duralactin Triple Strength Chews (Amazon link). Plus we use a medical-grade red light therapy pen called Tendlite (Amazon link) which we’ve had for years and always seems to help her immensely. Down the line we hope to find a water therapy (hydrotherapy) place just like we did in the USA. In my opinion, everything helps in the recovery process.
Polly’s Operation Day
The night before the op I don’t think I slept a wink.
I took Polly in bright and early to the vet (a lovely, clean, quiet facility), watched her get taken away to the back room and promptly broke down crying. The poor vet techs were a bit taken aback I think, but they managed to console and promised to give me detailed updates during the day. It was a looong drive home.
Polly went in for her op around 10AM, she was out by 11AM and a few hours later she was awake and I’d been given the relieving info that everything had gone as planned. She had to stay overnight (no way around it here in France, unfortunately) so I had ONE more sleepless night, but I did get a call from the vet himself that night (a nice bonus, and more opportunity for me to fire off another ream of questions), and the next morning dad and I picked up a very whiny and exhausted Polly from the clinic. Our girl was definitely traumatized, but she was safe and she was home!
My very first impressions were good too. Polly’s leg scar was small & neat, and covered simply with a large plaster (kept on for 2 weeks until the external stitches were to be removed). Best of all, the discharge instructions said that NO cone of shame was needed unless she picked at the wound (she has never touched it). Yesssssss!! For meds she was given antibiotics and a strong anti-inflammatory with pain killer. Simple stuff.
Week 1 Post-OP
If your dog is going thro’ TPLO, the first thing you should know is that post op is very individual and every dog recovers a little differently. There might be bruising & swelling (or there might not), the wound may ooze a bit (or it might not), and the dog may start using the leg right away, or it could take them weeks before they put any real weight on it. All of these are perfectly normal and as long as the swelling isn’t excessive and the wound is healing normally (no bleeding, or weird discharge) then your dog is considered on track.
With that said, here’s how this first week in France went for us:
First Day & Night -> Toe-Touching
The first day back she did a little toe-touching (= paw touches the ground), but didn’t use the operated leg and simply hopped around on 3 legs whenever she wanted to go anywhere. This was basically how she’d been getting around before the op, so she was happy and didn’t have any trouble with it.
She did however drink a TON of water (a common post-anesthesia, post-Morphine reaction) which meant I needed to carry her outside to pee 4 times that night. Time to re-build those arm muscles & endure another restless night for moi.
Second Day & Night – First Use Of Leg!
The second day she started tentatively using her operated leg!!! This totally freaked me out since it took almost 3 weeks for her to use her leg when she had her previous TPLO operation on the left side. However it’s not completely abnormal and does happen in the best of cases (so clearly, this was a good case!). The first use of the leg was VERY wobbly and looked rather dangerous (“is it going to hold???”), but thankfully I remembered this dangerous wobble from her last op, so I took it all in stride. It looks REALLY crazy when your dog first uses their operated leg!
The second evening we finally got POO too, a total of 3 days since she last went! Fellow dog owners know how important this little point is and what a stress it can be when their dogs don’t go. Thankfully I knew to expect it since it took 3 days for her to poo after her previous TPLO. Anesthesia can be a little constipating and it just takes a while for doggie to fully recover. Expect up to 3-4 days for this first elimination and don’t stress out if it doesn’t happen right away.
The second night we also had less water drinking which meant only 2 carry-out pee outings, and a teeny bit more sleep for all concerned 🙂
Third Day & Evening – Walking & (Very) Slight Bruising
By the third day back she started using the leg for slow walking! This really did astonish me. As I mentioned above, with her previous TPLO it took almost 3 weeks for her to progress from toe-touching to full leg usage. This time it happened almost right away and it really blew me away. The leg still looked very wobbly when she used it, but she was using it consistently and it was working as it should.
Following the Top Dog rehab brochure, we started icing the leg after every walk, and doing range of motion and easy muscle massage several times per day. She loved it.
This was also the day I noticed some SLIGHT red bruising around the leg plate, so slight in fact that without an eagle eye most would not even have seen it. On the other hand, she had zero swelling (none at all), and just a slight “warm” feel around the operated area, all of which is a testament to the excellent skill of the surgeon. Plus she was not in any pain or discomfort & was not trying to lick or sniff the leg (she’s such a good girl!).
The next 3 days or so the leg continued to heal. The slight bruising from day 3 went away almost right away and she continued to use the leg while walking. By the end of the week the dangerous-looking “walking wobble” had gone away, and the leg started to look pretty normal during use.
However when she was still (lying, sitting or standing at rest) the leg angle still looked kind of odd, but that was also something I had expected. During all of week 1 she was standing heavily on her “good” leg while stationary (her spine curved to one side and the operated knee pointed outward and away from her body, “knee out”) and sitting or lying with her leg stretched out in front of her (almost completely straight, rather than bent). Both of these are perfectly normal and can go on for many weeks while the leg gains strength & flexibility.
Weeks 2-3 Post OP
The following two weeks of post-op have gone very well.
She’s been walking normally on the leg everyday and we’ve been sloooooowly increasing her walks from 5 mins to 15 mins each time she goes out. All our walks are very sloooow leash-controlled walks with lots of rest in-between. Inside the house there is only normal walking with NO running, NO jumping and NO stairs. Her stitches came out on day 14 and apart from some skin irritation (from the adhesive of the plaster) the wound looks perfect.
She’s still leaning to one side when she stands (a little less everyday) and sitting with the leg stretched out when she sits (although she’s starting to bend it more). Plus she doesn’t really use the operated leg yet when she goes from sit to stand. All of this is perfectly normal for this stage of healing and something we’ll work on slowly over time.
For home rehab we started home red light therapy on top of the range of motion and muscle massage that we were doing in week 1. We haven’t started exercises yet, but that will come.
Well things are obviously progressing much better than we expected, but we are going to remain restrained & super vigilant.
One of the biggest mistakes you can make post TPLO is to think your dog is OK and then let them loose. We will NOT be doing this! The other big mistake is to read too much into your dogs’ current progress only to get despondent when you have a set-back. TPLO recovery is a process and you’ll have good days and bad days. We saw this during her last recovery, so we’re fully expecting the same this time around.
For now our plan is to keep Polly on leash with very sloooow increase in daily walks, very slooow introduction of exercise (e.g. sit-to-stand) and lots and lots of rest. At around 6-8 weeks she’ll go back to the local clinic for follow-up X-rays to make sure the healing process is on track, and if all is good we’ll continue the rehab plan. Hopefully we can also find a hydro-therapy center, but that’ll come down the line. Paws crossed everything keeps going in the right direction! Either way we’ll keep you informed…
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