Pain Management for TPLO

March 3, 2010 by james  
Filed under Blog

Pain management is a topic that we take very seriously at TopDog animal health & rehabilitation. Whether your dog has not had surgery yet or is weeks out in the recovery process, it is important to ask the question…Is my dog in pain?

To date there is still a HUGE misunderstanding or inability on the part of both veterinarians and pet owners when it comes to evaluating pain in dogs.  9 times out of 10 when I ask a client if they think their dog is in pain their answer is always NO. They usually say that their dog does not show any signs of pain, such as crying or whimpering.

Yet, if I then put the dog on pain medication, the client notices a huge change in overall disposition of the dog. They “seem” happier or in the case of dogs who have had a tplo they will use the surgery leg more often or with more confidence.

The point I am trying to make is that we need to change our overall perception when it comes to evaluating pain in dogs and at the same time question whether or not we are either not giving them pain medication for a long enough period of time or not choosing the right pain medications.

We have to remember that evolution defined dogs to be predators as well as pack animals. Therefore, we must understand that dogs have been conditioned to “mask” or “hide” pain very well.  In the wild, an injured dog is going to do everything in its power to not show weakness to its pack or other potential predators.  Dogs very rarely will verbally display signs of pain.  Yet if you look closely they do show signs of pain in many other ways such as: sleeping more, slower to rise, hesitation to do what was once a normal activity such as jumping up on a bed or climbing stairs, or even something as simple as they are not putting full weight on a leg. The list can go on and on.

No one knows your dog as well as you do, therefore if you pick up on any slight changes in overall disposition or activity, make sure you ask yourself ….Is my dog in pain?

Most of the pain medications on the market for dogs are very safe and therefore a lot of times I give my patients the benefit of the doubt and treat for pain.  Often if there is any question of pain we will run a course of pain meds for a weeks period of time to see if there is any change in overall disposition or change in use of an injured limb. If there is no change then we will change course and reevaluate.

In addition, it is important to understand that a NSAID or non-steriodal anti-inflammatory is really not a true pain medication. Yes it will relieve discomfort due to inflammation, but it really is not a “pain” medication.  Therefore, you may need to ask your veterinarian about other options such as opioids, like tramadol, or other neurologic  pain meds such as gabapentin.

Lastly, when it comes to pain management for the tplo patient make sure that you veterinarian prescribes these medications for an appropriate period of time.  Many times one week of pain management is not enough, therefore discuss this with you veterinarian.

Making sure your dog is comfortable is an important part of the recovery process so once again ask yourself…Is my dog in pain?

Comments

13 Responses to “Pain Management for TPLO”
  1. Rita Lynch says:

    Hi, my 3 year old lab just had TPLO surgery a week ago. He has been butt scooting the last few days when I take him outside to go to the potty. My vet said his anal glands are not full. They prescribed a steroid spray for the spot he rubbed raw, but he continues to do this, even on the carpet. We have him gated in a confined area with a little bit of room to move around. Any suggestions? He seems like the area is itching him. We are giving him Benadryl for the itching and his allergies. Thank you.

  2. james says:

    Rita I am so sorry that I was not able to get back to you in a timely manner. I just realized finally realized how to get to the comments section on this site. Tell me if you dog is doing ok. You can write me at drj@topdoghealth.com or join us on facebook @ http://www.facebook.com/topdogheath and share you story. Again i am sorry for this. Dr.J

  3. davenycity says:

    great blog thank you

  4. Brian Snavely says:

    My lab 7yrs of age just had a TPLO on left leg and two yrs ago had it done on rt leg. It’s been 5wks now and he still toe taps alot. When will it get better ? Also a soft ball like bubble forms on the patalus or that spot of knee. Is this ok?

  5. james says:

    Thanks a lot Dave. Hope your dog is doing well!

  6. james says:

    If your dog is 5 week post-op TPLO and they are still toe touching then you definitely what to have your veterinary surgeon just check it out..This does not necessarily mean something is wrong, it just would cause me to want to take a closer look at the situation. As for the bubble if it is soft most likely this is what we called a Seroma, which is a pocket of clear serous fluid that forms. This is fairly common. BUT because you dog is not using the leg this should also be looked at and drained to see exactly the type of fluid that is inside. Make sure, if you have not to download the TPLO Home Rehab Guide and also join our facebook community at http://www.facebook.com/topdoghealth

  7. keithsklar says:

    i have a question, i have a tibetan terrier 1 1/2 years old, he is currently po 9 weeks tplo surgery. he has seemed to heal uneventfully. we have followed all po instructions. he has rarely limped.

    for the first 8 week we were instructed he was to be leashed in the house.

    We have slowly increased his walks and r currently up to 2 miles, he never limps during or after his leashed walks.

    at week 9 he has been given freedom in the house with no stairs, however when he gets excited and jumps a little or sprints to the front door, he will start to limp for 10 to 15 minutes. is this normal, should we b concerned. my wife certainly is, and of course every time he does limp, it is my fault.

    any answers

    keith

  8. james says:

    Keith, Thanks for the comment. BTW it is always they guys fault :) . Overall it sounds like you are doing well hear with the recovery. At 9 weeks I would still try to avoid these kind of explosive actions. The reason being that there is still the opportunity for injury. At 9 weeks you just have some decent boney callus that has formed. Callus is of course not as strong as bone itself. With that being said this slight limp every once in a while is normal. As long as he recovers quickly from it, your should be fine. Make sure that you have him on a really good joint supplement, such as our GlycanAid Maintenance Formula as you move forward in his life. http://topdoghealth.com/glycanaid-maintenance-167 Also make sure you check out the video on evaluating and measuring your dogs muscle at http://www.topdoghealth.com/video. This is so important to prevent your dog from injuring the other leg. Good luck

  9. Naomi says:

    Hi, thanks for the article.
    Our dog had been toe touching. At first it started out as a 3 legged hop, and at times I thought he’d recovered but now he is definately toe touching. I took him to the vet after a month and vet thinks knee injury. Have you experienced any success with CM? he estimated the x-ray with sedation at $270, not sure if that price includes the exam or not. I really don’t even want to know how much the surgery is. We don’t have that much money. i love my dog. I’m hoping he could recover after activity restriction. But how to restrict a hyper active dog? seriously, I don’t know how we could feasibly do that. And how long is he on activity restriction after a surgery?
    Thanks.

  10. james says:

    I assume CM you are referring to Cetyl Myristoleate which is one of the ingredients in our joint supplement GlycanAid HA Advanced Formula. Unfortunately rupture of the ACL is a surgical repair but you have options. There are several different surgical repairs all at different price points. The traditional extracapsular repair runs between $1200 and 1800 depending on the veterinarian and your regional location. With surgery, recovery is at least a 12 week time period. We wish you the best of luck.

  11. pam says:

    My 9 yr old standard poodle is going in for TPLO surgery on left leg tomorrow. She had the right leg done 19 months ago and did well with the surgery (the recoup period was probably harder on us!). I am concerned about her ability to handle the surgery due to her age and the fact that she had surgery on the other leg less than 2 yrs ago. Are there options available besides the TPLO surgery if it is full rupture?

    Love the blog.. great feedback
    Thanks

  12. james says:

    Pam, I would not worry so much about the age of your dog. 9 is really not that old. Unfortunately, since it is a full tear, really the only option is surgery. As per your question if there are other options my answer is yes…or course. There are multiple surgical techniques to repair this kind of instability. There is the traditional and older procedure called the Extracapsular Repair in which a suture is placed about the outside of the knee to stabilize it. There is also the TTA or tibial tuberocity advancement which is a new procedure but equally as effective and then of course the TPLO which you are already familiar with. He is my thoughts. Personlly I dont think anyone surgery is the best. What is more important is that you get your dog signed up for some post-surgery rehabilitation, specifically in a facility that has a underwater treadmill do that you can build muscle mass. Second, the proper joint support is key. Though there are hundreds that are on the market there are really only a handful that are high quality products. Lastly I suggest that you join our support community on facebook at http://www.facebook.com/topdoghealth. There are hundreds of people just like you going through this same situation and TopDog Joint Health & Rehabilitation staff are also online to help answer any questions that you may have. Best of luck and if we can be of anymore help please dont hesitate to ask.

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