Achey Breaky ACL: Conservative Management Take 2

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Image Courtesy of Stylish Canine

This post is a part of the Caring for Critters Health Issues Round Robin hosted by Heart Like a Dog. All month long, pet bloggers will be sharing their personal experiences, health problems their pets have faced and how we dealt with them. While we consulted veterinarians and specialists in determining our own course of treatment, we are not vets and nothing shared should be considered medical advice. Capische?

It happened almost a year to the day after Felix first tore his ACL.

We were sitting outside the gelato parlour at the lake house and Felix was sitting, just so, in front of a warm brick wall and I couldn’t resist snapping a shot. He looked so happy and cheerful, sitting there. I was thrilled.

As the day wore on, I kept flipping back to the photo and staring at it. I couldn’t put my finger on why, but I was drawn back to it, again and again. It felt like one of those puzzles, where you’re supposed to spot what’s wrong with the picture, but you never can figure it out. I was showing it to a friend who laughed, commenting on how funny Felix was sitting and it hit me like a tons of bricks.

Felix had a tear in his other ACL.

I’m no vet and I couldn’t do a drawer test if my life depended on it, but I knew, staring down at that picture that I was right.

On the left, Felix last year, following an ACL tear. See how his leg is kicked out to one side? That’s super common with ACL tears. On the right, Felix this year, note the kick to the opposite side. UGH.

A trip to the vet confirmed it…kind of. Felix was definitely a little limpy on that leg, but only very intermittently. He was fine for days and day, but then he would have a bad day where that knee looked stiff and sore. He wasn’t failing the drawer test, but the results weren’t glowing either. You couldn’t tell there was anything wrong when he walked, but when he ran, every 4th or 5th step was followed by a tell-tale hop.

All signs pointed to the same thing: a light tear in his ACL, probably not due to an injury (like his other ACL which was injured while playing), but this time due to strain, as that leg was over-compensating while the other healed.

And just like that, we were back on conservative management.

I read an article recently that referred to conservative management as “doing nothing” and condemned it as unfair and cruel to the dog. I won’t link to the article here, because I don’t want to give it any juice, but if that’s the case, then this is the most frustrating, time consuming,  expensive “nothing” I have ever done.

Conservative Management is not doing nothing.

Conservative Management means trying to help your dog’s body heal using non-surgical intervention.

Conservative management is not a good fit for all dogs, but it’s the right fit for Felix. He’s is not a great candidate for surgery due to his squat little legs, but he is considered a good candidate for conservative management, in that he is under 20 lbs, no longer in his “bouncy puppy years” and most importantly, we’ve already successfully treated the other knee, which had a more serious tear, using these methods.

1. Restricted Activity & Carefully Supervised Exercise – The cornerstone of any good conservative management plan is restricting your pet’s movement. Reduce activity. Limit straining behaviours. Eliminate jumping. For many, this is no easy task, particularly if you have a small, fluffy dog who fancies himself part kangaroo. Still, the treatment will only work as well as your implementation of it, so we’ve worked hard to keep Fe relaxing. We started with slow, short walks – no more than 5 minutes, many times a day, then we slowly increased that time, adding a few more minutes and a bit more challenging terrain every week. Managing this while still providing Koly with enough exercise has been tough, creating a need for a dog stroller. (They see me rollin’, they hatin’.)

2. Introducing Stairs & Ramps – Last year, we built a DIY Dog Ramp to help Felix safely climb in bed out of my high antique bed. Even once his leg was better, I never took it down, mostly because I suspected it was a million times quieter for my downstairs neighbour and probably a lot nicer for her not to hear 20 lbs worth of dog hurtling themselves out of bed in anticipation of breakfast.

This year, we’ve taken it one step further. While I am more than happy to life Fe on and off the couch (and possibly steal a snuggle or two while I’m at it), Felix beleive he is part kangaroo and he delights in springing just before I reach him. Something needed to change. We have a set of Solvit Wood PUPSteps (<-affiliate link) for our couch and we’re teaching Felix to use them. The goal is to completely eliminate the need for jumping, thus lessening the strain on his cruciate ligaments. Teaching a dog with anxiety issues to use stairs and ramps is no small task, but Felix has taken to them quite well. (We’ll be sharing our training process with you next week.)

He’s naturally very suspicious of these stairs and the fact that I’ve left snacks on them, but in just a short time, he’s realized that they are responsible for great things happening. These are magic stairs.

3. Weight Management – Luckily, Felix is a fit & trim little guy. Though it’s sometimes hard to tell through all his fluff, he has a clearly defined waist and a well muscled rump. He’s well exercised and strong, which is lucky because ACL injuries are even worse if you happen to have an overweight or large breed dog. Choosing a non-surgical treatment means that I have made a commitment to Felix to manage his weight and keep him physically fit for the rest of life. This isn’t always fun, as it’s hard to say no to one more cookies, especially when we can’t just walk a bit longer to burn off any extra cookies.

4. Physical Therapy –  One of the problems with ACL tears is that ligaments won’t regrow themselves. Unlike other areas of the body that can regenerate and heal, the best outcome you can hope for with a ligament is that strong, but flexible scar tissue will form on the ligament giving it some structural stability. Flexible is the key here. Stiff, unyeilding scar tissue won’t do you any good, as it’s more susceptible to damage during strain & use. Physical therapy, first done by a canine physical therapist, then done by myself having been taught what to do, helps ensure that Felix maintains a good range of motion and that his muscles don’t atrophy while he is resting. We’re also working on exercises to strengthen the muscles around the ligament. The better the muscles are, the less strain there will be on the ligament. If we keep building up the muscles, I’m hoping that Fe will become the canine equivalent of the Rock and we can get him some sort of catch phrase and a spangley wrasslin’ suit.

5. Cold Laser Therapy –  After each injury, Felix underwent a 6 week, 6 squillion dollar course of cold laser therapy. (OK, it probably wasn’t quite THAT much, but man, it felt like it.) Laser therapy can help to reduce inflammation, manage pain and promote healing. There are rumours that it may be being studied as a viable alternative to surgery, but for now, some consider it to be little more than voo doo. (More than one person has expressed shock that I was willing to try it for my dog, but I feel strongly that it played a key part in Fe’s healing.)

6. Canine Massage – Aside from it feeling lovely, a good massage can actually do a lot to help your body heal. Techniques like effleurage, skin rolling, and petrissage can help to improve lymphatic fluid flow, lessen swelling and fluid build up. I learned these techniques working with our horses many years ago, but was surprised how easy they were to use with my much, much smaller Fe. After a few sessions with a canine massage therapist, I felt confident enough to continue the therapy at home. Felix LOVES his massage sessions and will often come request one when he’s feeling sore (or neglected or needy or spoiled).

Rub me, Mama. Alllllll over.

7. Managing inflammation & pain, naturally – Felix did not do overly well on pain medications and I’m not a fan of using them, if I can help it. That being said, I do not want my sweet boy to be in pain or even uncomfortable. We use a natural pain killer (which I actually use myself as well, so I’m confident in it’s results) and we use supplements to help us minimize any inflammation.

8. Nutrition and Supplements to support great joints – There are lots of great supplements out there and it was so hard to settle on just one. In the end, we choose Glycoflex by Vetriscience. He also gets supplements for inflammation. We frequently give trachea chews as treats, which are high in natural glucosamine and condroitin and I make novel protein bone broth frequently. We avoid foods that are known to be inflammatory (grains and refined carbohydrates, large or frequent amounts of dairy, and cooked proteins (which can be high in ACE)) and frequently add anti-inflammatory foods to his diet.

9. Aqua Therapy – If Fe was a different dog, he would have undergone swim therapy or aqua therapy with an underwater treadmill. Fe, being Fe, is pretty much terrified of the water, lost his mind the first time we tried to take him in the water and we were afraid he would hurt his knee worse desperately trying to claw his way out of the water. It’s all for the best. The canine swim centre was 45 minutes away and cost us more than human swim classes.

As far as Fe is concerned, this is swimming. You’ll note the water is no where near his knee and he looks like he wants to murder me. Image courtesy of Fat Cat Creative.

Conservative Management isn’t the right choice for every dog, but it’s been the right choice for my dog.

We’re almost 8 weeks past when I first noticed Fe’s leg so casually kicked out to the side and I’m please with his progress. We still have months of work ahead of us, but I’m confident that he will heal. Somewhere down the road, there’s a chance he may develop arthritis in his knees, but there’s a chance of that no matter what. All I can do is manage the problem in front of me, help my sweet boy feel his best today and cross that bridge when we come to it. That’s a different problem for a different day. For today, I just need to steal another snuggle, take Fe for his walk and then massage all his cares away.

Want to learn more about how some of my canine buddies have managed this same injury? Check out:

Fidose of Reality          Heart Like a Dog          My Brown Newfies

And head over to Rescued Insanity tomorrow where Kristine will be taking about my favourite Shiva!

Have you ever faced an ACL injury with your dog? How did you treat it?