No Surgery, No Problem: Treating Our Dog’s ACL Tear
Birdie graduated this month (from physical therapy, not Yale).
Turns out, we are doing pretty ok without that surgery she was supposed to get. Conservative Management has officially saved the day by taking care of Birdie’s injury and respecting our budget. Let’s discuss:
First of all, I’m double-dog-daring myself to believe that she really is doing as well as she seems to be doing. The pessimist in me isn’t entirely convinced. Frankly, I’m afraid that as I write about how well she’s doing, Birdie’s leg is going to spontaneously combust. I have a fire extinguisher next to my desk, just in case.
Anyway, when Birdie tore her ACL this summer (a complete tear, not just a partial), surgery was the recommended course of action. For better or worse, we couldn’t afford it, so we had to explore other options. We landed on a conservative management plan. Here’s what we did: First we restricted her activity. No jumping on and off the couch, no running around in the yard. The goal was to restrict movement and allow stabilizing scar tissue to form. Birdie didn’t mind this lack of activity as her DNA test revealed that Birdie is indeed half Beagle and half a baked potato.
That being said, Birdie isn’t overweight. If she was, we would have had to put her on a diet. Extra weight is hard on injured legs. We did add a new heavy duty joint supplement, plus lots of stinky fish oil to her diet. After a couple of weeks on NSAIDs (which were too hard on her liver and kidneys to continue using them), she’s been off any and all medications. We also added non-slip area rugs around the house, so that Birdie wouldn’t slide on our hard wood floors and tweak her leg or back.
Most importantly, we started hanging out with our physical therapist, Gayle Hickok, a lot. We started with five visits in a row that first week post-surgical consult. At each visit, Birdie got some time with the cold laser, manual treatments and exercises, and then hydrotherapy in Gayle’s heated saltwater pool.
Birdie was not interested in swimming – never, not once, not at all. She chose to practice nonviolent resistance by standing still on the pool’s ramp without budging or blinking. Birdie is the Rosa Parks of canine hydrotherapy.
She is also surprisingly strong for a small senior citizen and “Ton o’ Bricks” Birdie had to be lifted into the water, all dead weight, by her life jacket. Once she was in the water, Gayle would gently guide her through exercises. Birdie occasionally faked massive reverse sneezing attacks in order to escape the pool (we know she was faking because the reverse sneezing stop the second her paws hit the concrete. Also, she was laughing at us).
On the other hand, Birdie thought the laser and manual treatments were exquisite, since that part of the rehab required that she be hand fed chicken while lying down on a soft bed. That’s my girl. I was also happy that these treatments were addressing her whole body, not just her bum leg.
Over the past three months we reduced our visits to twice a week, then once a week, then just every other week. From the start, Gayle felt that we had made the right choice – conservative management – rather than surgery, and Birdie’s improvements have backed that up.
About a month into Birdie’s physical therapy visits, we also began using a product at home called the Loop which produces a Pulsed Electromagnetic Field around her injured bits.The Loop is supposed to reduce inflammation and pain and increases blood circulation. I can’t say for sure if it’s helped, but it does compliment the other therapies we’re doing and Birdie continues to be pain-med-free.
Last week, Gayle said that Birdie was good to go for a month or more until our next visit. This worried me (my DNA test reveals I’m part Eeyore). But Gayle swore to me that Birdie’s leg is in great condition. She has full extension, is weight bearing and can walk and run around, plus she has no obvious signs of pain when her leg is being manipulated. She’s come a long way since our first visit when she was only using her leg about 50% of the time.
Birdie won’t be competing in a decathlon any time
soon ever, but our hope was to reduce Birdie’s pain and help her get mobile again. It looks like we did it. She still has days where she’s a little gimpy, which could be the injury or it might be coming from her atrophied leg muscles. We’re working on rebuilding her muscle and strength in that leg. But most of the time, she’s doing fine.
It’s hard to say which piece of the puzzle had the biggest impact on her recovery. Our physical therapist isn’t sure either. She keeps reminding me that all of the therapies and supplements are playing a part in her recovery and are working together to support her overall health and well being.
That’s the funny thing about taking this approach – it’s clearly working, but there are days when I still doubt myself and the choices I’ve made for Birdie. The surgical option, plus the recovery and physical therapy that would have followed it, seems so much more tangible and measurable. With the conservative management approach, it’s a bit more subtle and there are fewer vets involved. Things have been going so well, we haven’t been back to see a vet since our original surgical consult.
I’m not sure why it’s so hard for me to believe Birdie is really ok. Sometimes I get a little panicky with an internal dialogue that goes something like this: “What if she’s not really better? What if we were wrong and she really does need the surgery? What if her leg is only pretending to be a real leg, but it’s really made up of marshmallows and candy canes, which is why she’s always licking herself? Will we have to buy her a whole new leg then? What if? What if? What if?”
That’s why I have to keep reminding myself that when Birdie runs across the yard it’s the real deal. She’s not faking it so that I won’t worry about her. Dogs are a pretty honest bunch, which I really appreciate. They don’t put on a show for our benefit (They will do it for their own benefit. See: Birdie sneezing in pool).
Dogs don’t tell fibs or fake it to save us from feeling badly or worrying about them. If you give them a toy that they don’t like, dogs won’t play it. Or eat food they think it’s awful. Or sleep on a bed they think is uncomfortable. Dogs don’t tell white lies to spare our feelings.
So I’m starting to believe that Birdie really is as good as she looks. Her life is back to normal. Opting out of that surgery we couldn’t afford in the first place wasn’t such a bad choice after all. In fact, it might have been the right choice, even if we could have afforded the surgery.
It makes me wonder how many dogs would benefit from a conservative management approach as a first option, not a “that’s all we can afford” option. Based on your earlier comments, many people never hear a peep from their vet that conservative management/physical therapy might be an option. That’s a shame. Some dogs do need the surgery, of course, but depending on the individual dog and/or the financial situation of the owner, there are other routes to explore. Vets should at least mention it.
I don’t want to jinx anything – Birdie’s leg hasn’t burst into flames yet – so I’ll just end things by knocking on wood and sharing some resources for non-surgical options if you’re in a similar boat and want to learn more about what’s out there.
In Maine: Pawsitive Results K-9 Rehabilitation
Whole Dog Journal: Alternatives to Canine Surgery
Whole Dog Journal: Laser Therapy for Rehab
Yahoo Group: Canine Conservative Management
If you know of others, please share in the comments!