Over the weekend my very active and rather large 1 yr old lab mix Jack was limping at his worst. I noticed the limping began 3-4 weeks ago on what I thought was one of his legs ( however turned out being both legs). After careful  online research I was hopeful that Jacks limping was the result of an injury that he would eventually walk off within a few weeks of rest. Just in case, I looked for thorns, splinters, broken toe nails, and felt around for soreness in his leg following YOUTUBE tutorials I watched online posted by vets. Not exactly being in the best financial state, the last thing I wanted to do was pay a Vet dramatic amounts of money to fix something wrong with Jack I could have done myself. Considering being a dog owner San Diego which is nationally known as “Dog City USA” I figured that he was limping from one of the many days he spent at dog beach, the dog park, or even daycare.

However, a month went by and the limping did not get any better. In fact, I noticed it was getting worse as he had trouble getting up, sitting down, walking up and down stairs, jumping in and out the car, basically doing everything mobile.

With careful observation ( what I thought I noticed ) was that he began to favor weight on one leg over the other.  He would lift what appeared to be his right hind leg when walking, putting all his pressure on the left hind leg. However a couple of days ago I noticed that he began to lift his left hind leg, putting pressure on the now right hind. Now both legs where being lifted putting pressure on his front two paws. At this point I knew I had to get him into the vet to find out what as going on with my Jack that only a professional could diagnose. Myself, family and friends were scared to admit that my one yr old pup was suffering from early on set arthritis or even worse Hip dysplasia.

Day one consisted of a visit to our always loving and caring vet Dr. Tracey Mendlen at Aviara Animal Health Center in La Costa, Ca. After carefully feeling around on Jacks legs she decided that the only way she could fully diagnose the problem was with X-rays ( something I wanted to aviod due to the cost ). To make things worse, Dr. Mendlen also emphasized that the X-rays would have to be done while Jack was sedated as he was refraining from letting Dr. Mendlen move his knees in a certain position that most dogs would not ( the problem with animal fractures/injuries is dogs tend to cover up their pain both emotionally and obviously verbally. Rarely will they whimper let alone “tell you with words the pain hurts ) Making X-Rays mandatory in situations like Jacks. After getting shots of all parts of BOTH his legs, the Dr. confirmed that Jack did NOT have hip displaysia. ( Phewww ) However, was concerned in his knees. With the consideration of the xrays and the restraint movement of Jack in the knee area, Mendlen was more than positive the knees were the issue. The problem was she could not give or perform the type of attention that Jack would need if this was the case. She suggested Jack would likely need knee surgery so she referred us to a Knee Specialist for a second opinion, $459.42 dollars later. Dr. Mendlen sent Jacks X-rays over to the specialist.

After one day of keeping Jack from the parks and beaches as I did not want to tease him, we finally made it in to see Knee Specialist Dr. Seth Ganz at North County Veterinary Specialty Hospital in Escondido. After careful observation  Dr. Ganz was certain with evidence of the x-rays, the way Jack walked, along with Jack’s response to pressure in certain areas, he knew Jack had torn ligaments and diagnosed Jack with Cranial Cruciate Ligament rupture (CCL)- generally referred to as ACL injury in humans. It’s known to be common in very active dogs, preferably big dogs, however more and more cases of small dog diagnoses are rising. Unfortunately this CCL injury prone disease made sense especially living in San Diego where Jack had been a very active pup at the beach, parks, and dog daycare etc.

Dr. Ganz diagnosed that Jack had complete tears on both his knees ligaments.  This was not as common. The next step was to figure out what the medical optionals their where for Jack? The Dr. suggested that we go ahead and do both knees at once – as the healing time was shorter, it was less traumatic, and at the incredibly high price this surgery was going to cost, doing both at the same time would be cost effectively cheaper.

The Cranail Cruciate Ligament of both needs would be fixed with a surgery known as the Bilateral TPLO. This is a surgery performed on dogs to stabilize the stifle joint after ruptures of the cranial cruciate ligament . Normally, the CrCL prevents backward–forward movement of the joint. When it tears, the joint becomes unstable and the dog suffers lack of mobility (lameness) acutely and is subject to chronic progressive arthritis in the stifle if untreated.

In a TPLO procedure, the tibial plateau, the portion of the tibia adjoining the stifle, is cut and rotated so that its slope changes to approximately 5 degrees from the horizontal plane. This prevents the femur from sliding down the slope of the plateau when the dog puts weight on its knee. Thus surgery generally results in faster recovery times compared to other procedures to stabilize the knee. Most dogs (over 90%) are expected to regain a very active and athletic lifestyle with no post-operative complications and without the need for any long-term pain relieving medication

The x-ray photo below shows the pre and post-op positioning of the bottom of her femur knee ligament. One photo without the metal implant, the next with the implant to fix the cruciate ligament.

Many of you might ask what are the pro’s and con’s to doing one knee at a time versus both. After talking with knee specialist Dr. Ganz here what he came up with:

With one knee the Pro’s are: less chance of infection from anesthesia, and less pain. The Cons:  takes 3-5 months to recover before you can do the second knee so rehab will take twice as long as doing both, and recovery could be harder as the dog will be putting different concretion on opposing legs at opposing times.

Two knees the Pro’s: while recovery might be more painful than one knee, is sync which mean recovery will more easily follow accordingly for same progress in both knees since the pup will be challenging the knees at the same time. It is also cheaper to do both knees at the same time.

One knee: roughly around $2-3000
Both Knees: roughly around $5000

Yes I know, these numbers are staggering making this the worst nightmare for dog and owner. Many of us don’t have that kind of money to shell out on such a surgery for a dog. However please be hopeful, as there are many programs out there such as Trupanion that are out there and can and will help cover costs and approve payment plans for you. Other ideas to help pay for the surgery are starting fundraisers, and asking family and friends for help.

With care full thought between my family and I, we narrowed down these options:

Option 1) to not do the surgery and let Jack live a miserable painful life
Option 2) do the surgery and pick up double shifts at the boutique over the next year to pay off dramatic $5415
Option 3) put Jack to sleep due to the prolonging inevitable

It was clear, option 3 was not an option. I much rather do option 3 before option 1, however 1 was not an option either. Leaving option 2 as the only option and the final decision. So we went forward with doing both knees at the same time.

After 3 hours under anesthesia, Jack did great in his surgery. The hospital kept him for the next 3 nights for close observation. Then he came home. From here we have yet to see how Jack recovers. Being such a strong athletic dog, I have not doubt that Jack will do fantastic in his therapy and rehab the next 4-6 months.

With that said I put together a FAQ forum for this topic. Questions I raised as this situation surfaced Jack and I.

Q: How long ago did you notice the limping?
A: 3-4 weeks ago. I was hoping he would fight it off but it was just getting worse. I noticed it in one hind leg over the other ( where he favored lifting one leg more than the other ) however then I noticed it in the opposing leg.

Q: How did he tear BOTH knees? That is very rare, how did that happen?
A: Blowing both knees is very rare but it happens. Often times when both knees are blown this is the result of the dog getting hit by a car. Like I emphasized, it happens in very active big dogs. Our Vet liked to describe these torn ligaments not so much as injuries but as a disease. Jack knee ligaments were not strong enough to with stand the pressure he naturally puts on them as a big active dog. The ligaments were deteriorating due to the pressure of his weight.

Q: If the knee ligaments are strong enough can’t you find alternatives instead of costly surgery? Why not make him stronger with medications and vitamins?
A: The problem is not natural it is mechanical. Medicine will not rebuild and incision enough hardware necessary for the knees to feel comfortable with the everyday pressure the dogs puts on the knee(s) when just standing up.

Q: Can/ Could have this disease be/ been prevented?
A: No. It happens with dogs whom are very active. It is sometime a genetic disease however much evidence is pointing to the consideration of active and big dogs who are born with low counts of ligament knee coverage in their knees. Being a cool Mom or Dad who takes their dog to play actively everyday is not a result of this situation it happens to all dogs with low cartilage count who just happen to turn their legs the bad corner. No one is at fault for this. Not  the dog for playing too hard, or the owner for letting the dog play too hard. This what they most recently are calling a large breed dog “disease” is the result of many factors depending on the dog.

Q: What is the success rate for the surgery?
A: Wether just doing one knee, both knees at the same time, or one after the other the success rate seems to be 95%. Especially since this is very common in young big active dogs, the success rate is always in their favor as they are strong enough to trick and rehab their muscles back to health.

Q: How much is this surgery going to cost?
A: In total Jack’s Surgery came too $6,346.00. The x-rays for both legs to check for hip dysplacia and knees was $459.92. The surgery including anesthesia, hospital visit, surgery time, IV’s etc $5053.

Like I discussed earlier in this post, cost is always a determining issue for some families, which is why I always encourage the importance of applying for insurance if you have a big very active dog in case this were to happen to yours. There are programs out there which a minimum fee of as low as $15 a month to cover your dogs insurance to help pay for something like this if you ( God for sake ) had to encouter the same sitaution. Other programs help offer grants that will approve payment plans threw specific hospitals in your area.

Q: How long does recovery take?
A: generally 4-6 months. After surgery it is VERY important the dog NOT lick the wounds from the surgery ( incisions and stitches ). For the next weeks the dog should not be encouraged to walk more than roughly 20 yards max a day unless it’s for bathroom breaks. The next 2-3 months with critical advise from your doctor, you can slowly start therapy with the dog such as slow walks in the park. It is encouraged to not tease your dog to want to play with other dogs so refrain from dog associated social scenes such as dog beaches and parks. This seems to be the hardest part on the dogs not being able to run, jump, and play. Keep the pup from activity in the short run and in the long run it will be well worth it. Your dog will be playing in no time.

I hope all this information helps. Until this happened to Jack and I, I had yet heard about this serious disease prone to big active dogs. Please understand how serious a Cranial Cruciate Ligament rupture is, and how important it is to get it fixed. For more advice that I might have missed in this post feel free to email me and ask at: taniamilberg@gmail.com

I am more than happy to help. Best of luck and always take care of your pup.

– Tania & Jack