Part 1: Healing our 11 year old German Shepherd Dog's torn ACL / CCL without surgery (weeks 1-4)

Dog torn ACL -- A non surgical treatment approach

Dog torn ACL / CCL - Is recovery without surgery possible?


Wednesday November 14th 2018 at approximately 10:30 AM our 11 year old German Shepherd Zero was racing towards a ball running away from her on slick grass. Muscular and well trained she flew at it. Past it. Stopped short and came up lame.

She limped back with her hind right leg in the air. Picked up and put in the car she was taken home.

This is video from one year before the tear. It's a pretty good representative shot of what she was doing when she tore the knee.



[Reminder - we are not veterinarians -- You should not do what we did without experts with you. This is simply a biography of Zero's torn ligament odyssey.]

She had done this before over the years. As we mentioned - she was a supremely conditioned exercised to exhaustion daily GSD. Weighted vest on days she didn't run. And every time it was the same. 650mg of aspirin with her next meal. Another 12 hours later with the next. And by the third meal 12 hours apart already showing signs of recovery. One last 325mg aspirin with a meal and a few days later she was back running.

Not this time.



Friday November 16th we went to the vet at 4pm. Exam showed it was her right knee. There was an audible pop upon manipulation but we didn't know if that was a secondary issue. X-Ray showed the smallest bit of fluid. The vet said torn anterior cruciate ligament (ACL) i.e., cranial cruciate ligament (CCL) or (CrCL) because dogs have 4 legs. She advised waiting a week to watch before setting up a surgical consultation with the orthopaedic surgeon. She added that he liked to do tibial plateau leveling osteotomy (TPLO) or Tibial Plateau Angle (TPA) and not Tightrope or vertical suture surgery on large, strong dogs 'so that they had complete recovery' and could go rough and tumble post surgery.

Asked what the recovery was like she said: '15 days and the leg will be down.' '30 days and we're close to recovered.' '45 days for full recovery.' We were given Rimadyl 50MG BID for 10 days and told to restrict her movement. If she looked any better in a week we could extend the script for the carprofen longer. Zero was not putting ANY weight on the leg 48 hours post injury and we feared hearing 'you need surgery today' so the wait one week and the anti-inflammatory sounded nice and conservative. $200 bucks and we were back in the car and headed home.

Saturday November 17th we posted video of her on Facebook now 36 hours post injury and leg still high in the air. It was when we really started research. ACL in dogs. CCL injury management in dogs. Supplements for ACL tear in canines. Treatment for CCL sprain in canines. ACL, CCL, TPLO, TPA, Tightrope, vertical suture surgery in dogs. ACL, CCL, TPLO, TPA, Tightrope, vertical suture surgery in large dogs. Dog ACL tear non surgical treatment. Dog ACL tear no surgery. What had friends done in similar circumstances?

And that's when we knew - this sucked. All the surgical options were sketchy. There were no good studies with any of them. And TPLO or TPA was extremely invasive. It involved CUTTING THE DOG'S BONES to create a different geometry in the leg. An unnatural geometry with metal and screws to boot. An unnatural geometry in one side that obviously would create an imbalanced dog. (And that's when we found TigerPoz.com and Tiger's owners experience with ACL tears in dogs. It is a must read for all dog owners facing a ligament surgery in their own dogs. Go there now and come back after you've read everything there. Then go read what surgeons at the School of Veterinary Medicine at the University of Pennsylvania think about TPLO surgery. Finally, read what Dr. Ron Hines thinks of ligament repair in dogs. It combines all of the above and is a must read too.)

This look like a good ligament repair idea?



Zero had already been on cannabidiol (CBD) oil from Endoca for sleep (she'd workout in the morning, rest most of the rest of the day...and be up at 3AM, done!). 60 pound dog we would have maxed out at 15mg but just two milligrams at bedtime worked. We immediately began giving her 2mg in the morning and 5mg at night. The additional amount helped a now not exercising doggie sleep through the night. The anti-inflammatory effect was the reason for adding the morning dose. We also kept the bottle in the bedroom (where she'd now be locked in with us for sleep at night) along with some water. (Typically cut off from water at night now not drinking much during the days as she rested we wanted her to have it - especially under the drying heat of a winter furnace.) A few times when she awakened either from boredom or from what might have been pain - we gave her 2mg more during the night.

Conversations with an MD and friends and family who had avoided surgery lead us to collagen, vitamin C, and quercetin. Purely Inspired Collagen Protein Powder was delivered by Amazon Saturday night (same day!). Didn't notice the stevia until it got here but...she loved it. Based again on her 60 pounds we aimed to get 10 grams of collagen protein in her. Started with a tablespoon that night. One tablespoon 2X on Sunday. During the upcoming week we actually went to 20 grams (approximately 2 tablespoons twice per day). Collagen needs vitamin C to work to heal ligaments and to cushion joints and there's a quercetin benefit we'll get to later so we had Vet’s Best Seasonal Allergy Relief delivered as well since it had both in it. (We're also fans of Vet's Best neem oil toothpaste.) One pill that night. 2 the next day. Up to 2 in the a.m., 1 at lunch, and 1 at dinner by mid week watching both new supplements for stomach issues - there were none.

We kept her on the Rimadyl for 3.5 days until Monday 11/19. Now 5 days post injury she'd tap her foot down from time to time and we didn't want her to do more just because a drug was artificially making it feel better. We were out of the acute phase and felt it had done all that it was going to do. We kept the remainder in case of a slip up.

All along after day 3 if Zero laid on her left side (right side up...) -- we'd run to get an ice pack on her knee. Often she'd get a good 20 minutes with it. Then we'd switch up with a heat pack (a buddy) for contrast therapy. i.e., hot / cold - that we'd learned from herbalists Dr. Christopher and Dr. Richard Schulze.

There wasn't much change the next few days. A week had gone by and she was still just toe tapping. Thursday, Thanksgiving, we created a penned off area in the living room and told family the Dog Whisperer Cesar Millan refrain, “No touch, no talk, no eye contact.” I stayed with her as folks entered -- careful not to push her down but also keeping her from looking to stand up near the fence. After they stayed for a while she calmed down and we could have family pet her while she stood actually lifting her from sitting cross legged because she was trained to sit! (She also had to be stopped from sitting when treats were given. What a good dog.) This was the first day that her stretches (done by her, not us...) included the right leg a bit. She also would walk extremely gingerly for steps at a time. Finally - it was something. Thanks given on day 8.

Days 9-11 the stretching she does now included the right foot at all times. Also the stretch would occur most of the time without a jut like shake in the leg. Here's video of her limping around day eleven.



Week 2 -- Today, 2 weeks after the injury, we see some improvement. If she was at zero percent (pun intended) day 1, 5-6% after day 9 -- this morning she's at 10%. 10% is still very bad. Especially when you recall what this dog was doing 2 weeks ago but it is a strong signal of hope. Little more walking from bed to get ready to go downstairs. Little more walking around after eating. And a little bit better 'look' to the pee and poop squats. The leg went up after walking a minute or so after all that. But she's putting it down more today.

That said - if she were to run after something right now...have to keep vigilant. Do not want to lose what we currently have.

Day 13 and we were able to grab good video of her hot cold contrast therapy.



Day 16 and we got to thinking -- if we're trying to get her to form enough scar tissue to hold the knee why wouldn't the less invasive Tightrope (TR) surgery be of a benefit? Kevlar in there would be like a stronger scar at the very least, right? So we emailed James L. Cook, DVM, PhD, OTSC -- William & Kathryn Allen Distinguished Chair in Orthopaedic Surgery Director, Thompson Laboratory for Regenerative Orthopaedics & Mizzou -- BioJoint® Center -- Chief, Orthopaedic Research Division University of Missouri -- Missouri Orthopaedic Institute (4028A) summing up what we were doing and asking him for a list of local TR surgeons. Dr. Cook replied with a list and a note, "Happy to try to help however I can. Did you have an Xrays taken? I would like to see if so. TR can really be done anytime that you feel surgery is necessary. The keys are good joint exploration, clean up, meniscal treatment, good TR, good imbrication and great postop care."

See, there are good guys out there. We are in the process of getting the Xray for Dr. Cook to look at. We replied thanks and, "I thank you very much for the quick reply. So you're ok with an athletic dog of 60 pounds and TR? Also, when we finally are complete with this journey I'm going to publish our diary." His answer? "Yes if you address all components listed then TR good."

Got that? All those local yocals who tell you no TR if over 40 pounds...pfffst. Also, you know how the local vets tell you give the dog with the torn CCL one week confinement to see if it gets better? Recall how tiggerpoz said you gotta go at least 6 weeks and more likely 8 weeks? How about the vet who tells you TPLO is a fast recovery? 2 weeks and they're walking. 30 days and they're close to fully healed. 6 weeks and they are all healed up and going strong. Dr. Cook's protocol for post Tightrope surgery? Ready?

EIGHT WEEKS RESTRICTIVE CONTAINMENT of your dog! Remember that if you are trying to cure your dog's torn CCL without surgery and, PLEASE, remember this if you have chosen to do the extremely invasive TPLO or TPA surgery no matter how quickly your vet has told you it's ok to run or go for those long runs. (Published with Dr.'s approval)

POST SURGICAL CARE FOR TIGHTROPE PATIENTS 
We want XXXX to have the best possible outcome after his/her TightRope surgery and your role in the postoperative care is CRITICAL to success! Please follow these instructions exactly and call us if right away if you are having problems in doing so. 
1. Please do not let XXXX lick or chew at his/her incision sites at all. An Elizabethan Collar MUST be worn at all times until the incisions have healed well and we are able to take the sutures out. Please check the incisions each morning and evening for any swelling or drainage. If at any time any incision looks like it could be infected or you have other concerns about it, please call us. Please schedule an appointment for XXXX with us for 10-14 days after surgery so we can examine the incisions and remove skin sutures or staples. 
2. XXXX should be strictly confined for the first 8 weeks following surgery. Three activities are allowed:  A) he/she can be in the house under your direct supervision on a carpeted or other non-slip surface without the possibility for jumping on or off furniture, playing with toys or other dogs, or accessing stairs. B) When you are not home or are unable to DIRECTLY SUPERVISE XXXX, he/she should be in a kennel or crate. C) You may take your pet outside on a short leash to go to the bathroom and a very short (2-3 minute) controlled walk. No other activities such as running, jumping, flexi-lead activity, stairs or playing of any type are allowed. Prolonged walks are not allowed. These restrictions are necessary to allow the knee to heal well and provide the long term, pain free function we are working to achieve. No unrestricted/off leash or unobserved activities are allowed until proper healing is confirmed at your 8-week recheck. Please schedule an appointment for XXXX with us for 8 weeks after surgery so we can examine his/her knee and assess healing. Based on this 8-week assessment, we will then set up the rehabilitation phase of recovery with you in order to progressively bring XXXX back to full function. 
3. During the 8-week confinement period, it is recommended that XXXX be given a reduced portion of his/her normal food amount to prevent weight gain. We will discuss the details of this with you at the time of discharge. 
4. It is very important that you complete the prescribed medication regimen when you go home. The medications help with inflammation and pain relief after surgery and decrease the risk for infection. If you feel that XXX suddenly becomes painful, has an abrupt change in limb use, or is experiencing side effects from the medications, please contact us as soon as possible. 
5. Please schedule your recheck appointments as soon as possible, ideally as you are checking out today.

Make a note of that again. EIGHT WEEKS. Our vet told us 30 days and we were on the road to a complete 6 week recover with TPLO!

More on our vet. We got Zero's Xray and sent it to Dr. Cook. This really bucks a guy up when the reply from THE guy in the field is, "Thanks, unfortunately these are very poor quality films - poor positioning, only one view, don’t include the ankle - so they are not diagnostic." A ninety dollar waste. I replied as much adding, "- is the x-ray any good as to any level of OA might be in there?" Doc answered, "Not really. Can say there is not severe OA based on it but not much else." Ok, so at least we had that. But the x-ray, pretty much, was a complete moneymaking waste.

canine acl xray dog ccl xray

Day 17 and she's showing more inclination to walk further distances and we have to stop that. We took her out front for the first time since day 2's vet visit and did a two minute walk up and down our block and then back in. Heartguard day we lessen up on the vitamin C for the day. Tonight the glucosamine sulfate, chondroitin, and quercetin arrived. Gave her 800mg of Glucosomine. Will give her 800mg of glucosomine twice tomorrow and watch for any stomach upset. Plan to stay at 1600mg per day for 30 days. Will add the chondroitin later and the pure quercetin when she finishes the Vet’s Best Seasonal Allergy Relief which has Q in it already. She's still on that and the collagen (plus the CBD oil now nightly only).

Day 18, new video below. Apparent when compared to day ll - less to no holding of leg up. No roll over of toes while walking. Took a sniff and pee (S&P) 5 minute walk out front. She let us know when to turn back up the driveway and head in and it was exactly at the time we were going to do the same anyway.



Part 2



Biggest ray of hope today was when we didn't stop her quickly enough and she sat down. Leg was pulled in. Looked more like a GSD is supposed to (ie, the right leg was not jetted all the way out akimbo while sitting.)

Day 19 and she's ancy for the first time. Probably as she now has a bit of support in the knee. We did two 5 minute S&P walks out front. She wants to play and we have to be the ones to say absolutely not and head in. Hot colds continue and we've added the chondroitin sulfate to the mix.

Day 20 and she's a bit slower today. Temps dropped to the low 20s. Still, every day sans snow is a blessing. No front walk.

3 weeks. The slowness is gone. Did a 5 minute S&P. She's not a big fan of the chondroitin on her food. Going to get a video of her taking her CBD oil one night though.

Day 25 -- We walked across the street at a place where the curb is flat. Walked for 10 minutes and later for 5 minutes. Gimpy's energy is back and we have to be careful as she grabs a bone and comes and pushes against us.

Day 26 walking video.



Also began noting day 26-27 a return to using the right hind leg to scratch things. i.e., scratching her head, behind her ear, or around her mouth.

Let's sum up one month in. Almost going to finish up the collagen. On the Vitamin C, Glucosomine & Chondroitin (SULFATE for both), and on the quercetin. Gimpy can walk. No longer hopping, she's got the walk with the limp. We can walk 10 minutes. We aim for the grass. On the past few days that we've pushed through and done say 15 min at once (still S&P pace) she will come home tired like the old sprinting to exhaustion days. So that's one thing owners have to watch - don't push it. She's also wanting to play. Pushing at us with her toy, etc. Watching that and doing it is difficult. We have to push down on her front shoulders, not back like you would typically. The same when she turns it into tug of war. Can't let her do that because a pull slip and that leg is in real jeopardy again.

If you didn't know her and you saw her walking you would probably just chalk it up to a slowed down older dog. Not one rehabbing a devastating injury. And that is hope right there folks. Especially considering we were told, 'Give it a week.' and that, on day 10, she still wasn't putting the paw down...

Another thing you'll notice a month in? Those missing walks and trips to the park? Those sidewalks and parks collected, at least some, of her shedding hair. Now it is all in the house with us.

Month 2 of our dog's ACL non surgical treatment is up! (Hint...on the 35 day anniversary of the ACL/CCL rip we're going to start seeing some real promising changes so stay tuned.)

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Extra Sources

*Comparison of long-term outcomes associated with three surgical techniques for treatment of CCL disease in dogs

*Glucosamine and chondroitin use in canines for osteoarthritis: A review

How Dr. Callum Hay, BVMS, DACVS from Veterinary Surgical Specialists in Tampa selects what CCL treatment he'll suggest to patients




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