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Conservative Management

Tucker with his brother, Guapo at ChristmasTucker has gone through Conservative Management twice – once for each leg. To read each story click the titles below, or just scroll through the whole page to read both stories.

First Conservative Management Attempt – For Tucker’s first CCL tear we attempted CM for about 6 months and eventually opted for a Traditional Repair surgery.

Second Conservative Management Attempt – When Tucker tore the cruciate ligament in his opposite leg we again opted to proceed with Conservative Management. After much patience, rest and sticking to a strict regime, we were able to avoid surgical repair.

First Conservative Management Attempt

When Tucker was diagnosed with a cranial cruciate ligament injury via a physical examination exhibiting a positive drawer sign and x-ray showing a small degree of arthritis, we were not comfortable jumping right into a surgical repair. My husband and I felt Tucker was doing quite well, as at the time of his initial injury he was using his leg and putting weight on it a majority of the time. He never showed any of the typical dog signs of being in pain like whining, panting, licking his knee, which can be partially attributed to the high pain tolerance of American Bulldogs, but we felt that as long as he was not showing us he was uncomfortable, we would try conservative management and see where it lead.

And so our journey with CM began, against the advice of our veterinarian. We were reluctantly prescribed Rimadyl to control Tucker’s inflammation and any pain he may be having, started giving him daily glucosamine supplements, and started him on a strict regimen of rest with controlled leash walks for potty breaks. This was quite a change for our active little boy, and he was not always the most compliant patient, always wanting to sneak out in the backyard with out other dogs for a quick game of tag. We did manage to do a good job of keeping him confined, despite the other doggy distractions, fashioning his own little “nest” for resting where he could be separated from his playmates.

We did conservative management for a few months, noticing somewhat of an improvement during the first few weeks, which was followed by a sharp decline in function of the knee. At this point, his knee becoming much worse – the toe-touching was now constant and he would often hold the leg up when taken out on a lead to relieve himself – and I started to become more and more uncomfortable with the prospect of Tucker needing to remain on this medication for a prolonged period of time. I also began to notice that Tucker was in pain. He could no longer sit with his legs tucked under him, needing to hang the injured leg out to the front or off to the side. Also during the last few weeks of our attempt at healing the leg with conservative techniques he began to bite at the injury site, and we could notice a distinct change in the appearance, temperature and conformity of the joint.

Tucker’s ATrac Dynamic Knee Brace for CCL InjuryAs a last resort we tried using a brace for his knee. Our vet had never heard of much success using this technique, but we decided that anything was worth a shot if it meant we would not have to put our dog through a risky and unnecessary surgical procedure (at this point the vet was trying to tell us TPLO was the only option for a dog of Tucker’s size). I will expand upon this in another post – My Experience Using a Dog Knee Brace – but to sum it up, the brace was a complete waste of time, money, resources and effort. Not only was the thing almost impossible to put on, it was not exactly tailor made for a dog of Tucker’s build and the different ropes, ties, levers and velcro would often irritate and/or pinch different parts of his body.

As Christmastime was approaching we decided that we needed to make a decision whether or not to proceed with surgery, especially since time is a factor in the successful repair of CCL tears and ruptures. I spent hours on the web researching each of the procedures available, and despite our veterinary surgeon’s recommendation to do a TPLO, we decided to go ahead with a traditional repair. While we were not successful with CM alone, Tucker is now 3 months post-op extra capsular imbrication surgery and has made significant progress in recovery. I would not consider his leg to be at 100%, but he is no longer in pain, which is really my only concern.

If I had access a time machine and would I change my decision to proceed with conservative management? Absolutely not. I wanted to give Tucker every chance possible to heal his knee on his own, viewing surgical intervention as a last resort if the CrCL injury persisted despite our best efforts at a natural approach to healing. CM definitely works, not for all dogs and certainly not in all cases, but I truly think each dog should have the chance to see how they fare. Tucker is living, breathing, running and galloping proof that there is no need for dog owners facing a cranial cruciate ligament injury to need to rush into surgery.

Second Conservative Management Attempt

After almost two years, Tucker began showing signs of a CCL tear in his opposite leg.

In late 2009, Tucker once again became intermittently lame in his rear leg, but this time it was the non-surgical leg. He had been limping on and off on his surgical leg for about a year following the traditional (which is an extracapsular repair using the leader line technique) repair, but had seemed to finally be getting around ok until this new lameness began. At first it started that he would only limp in the morning, but it gradually progressed to toe touching every other day. We decided to take him to the veterinarian to have the drawer sign test performed and get a definitive diagnosis.

Tucker presented drawer sign positive at our veterinary visit, although the he did say that he did not think it was a full tear “yet” due to the fact that Tucker was constantly toe touching. Despite not believing it was a full tear, the veterinarian recommended a TPLO or TTA be done within the next month. I spent the next few minutes explaining my history with Tucker’s other knee and the wealth of knowledge I had gained as a result of starting the Dog Knee Injury site, and he wished me luck, informing me that generally only dogs under 30 pounds have success without surgery.

After leaving our appointment we began a strict Conservative Management regimen. Remembering all of the trials, tribulations and difficulties we encountered during Tucker’s Traditional Repair surgery, I REALLY wanted to make sure we could make CM work this time and avoid the trauma of surgery.

Luckily, we do website development and have the flexibility to work from home. One of us would be able to stay with Tucker at all times to make sure he was staying calm, quiet and resting throughout Conservative Management.

This second time around I did things a bit differently. I still kept him confined to controlled, leash walking when he needed to use the bathroom, but I also made it a point to walk a half a block or so each time we went out. My logic here was that it was important to keep the joint somewhat strong and mobile while his body was working build up scar tissue and muscle around the torn ligament. I was careful to make sure that he did not get overly excited, jump and/or run, because I was sure that any strenuous activity or quick motion would tear the ligament for sure and set us back.

Conservative Management for Knee InjuriesAlong with the short leash walks, he was confined to a small, carpeted space in the home at all times. This was slightly different from the first attempt in that this ensured he would not be able to get up quickly and run to the door if he heard something, or be able to slide on the non-carpeted areas of the house. I felt absolutely terrible forcing him to stay in such a confined area, but I knew I was doing what was best for him.

Weight management – the often overlooked piece of the puzzle. I found out this second time around the importance for any dog with CCL issues of proper weight management. During the time leading up to his second CCL injury, Tucker had been getting one too many handouts while visiting our relatives in Pennsylvania, and had subsequently gained a significant amount of weight. As part of his Conservative Management plan I decided to cut back on his food intake, and switched him to a higher quality, protein rich food. Over the first month of CM he lost about 5 pounds, and got down a total of 12-15 pounds during the entire CM period. We have worked hard since then to keep the weight off, and it seems to be an important part of maintaining his joint health.

The inflammatory process can be very damaging to the body in both humans and dogs. Managing inflammation is an integral part of any successful round of Conservative Management. This time I really wanted to go as natural a route as possible, but seeing how much pain Tucker was in at the beginning of the CM period, I decided we should at least start him on a round of Rimadyl to make him more comfortable. The only downside to the Rimadyl is that it tends to make him feel so much better that he forgets he is hurting! To keep this in check I adjusted the dosage to ensure he was not in any pain, but made sure he was aware of it enough to take it easy on himself. Concerned about the effects of long term use of NSAIDs on the liver, I wanted to transition to a more natural approach to inflammation control as soon as possible.

TPLO AlternativesAfter about the first month of the Rimadyl, I found information on using Yucca Root to help ease inflammation, and thought I would give it a try. I transitioned from one to the other over the period of about two weeks, knowing in my head that I would keep him on the Rimadyl if I noticed a decline in the way he was feeling. After completing the transition to Yucca he seemed to be doing just fine, and we’ve been keeping up with the Yucca Root extract ever since. His dosage is 9-10 drops of yucca extract in his food with a bit of water to dilute it.

In addition to the Yucca, we began giving 1000 mg of Omega-3 Fish Oils twice per day during Conservative Management. The idea behind the Omega 3 fatty acids is that it helps to lubricate the joints and reduce inflammation. We’ve had nothing but positive results from using this supplement, and it is another one we continue to use. We also had always been doing the Glucosamine/Chondrointin supplements, and continue to use these as well.

After about 8 weeks of CM, significant improvement in Tucker’s knee health was seen, and he was no longer limping or toe touching as he once had been. This was a long 8 weeks of strict CM, but in the long run it was worth avoiding the cost, risk and recovery process associated with any of the surgical procedures.

We are aware that CM is not medically defined as a “fix” for an injured cranial cruciate ligament (CCL), but with the use of supplements and an alternative, holistic anti inflammatory medication like Yucca, we have seen great results. Over time his leg will build up the scar tissue necessary to stabilize the joint, and hopefully do so without any major arthritic consequences.

Overview of My CM Protocol:

  • Weight Management – We cut down on treats and snacks while transitioning to a higher quality food which we fed less.
  • Inflammation – We started with Rimadyl and Omega 3 Fish Oil (1000 mg capsules, twice per day). After 1 month of the Rimadyl I transitioned to Yucca Intensive, and give 9-10 drops diluted in food.
  • Joint Support – Glucosamine and Chondrointin supplements are good to support joint health in any dog.
  • Rest – Make sure your dog stays in a confined area without distraction. Carpets are preferable, avoid steps, jumping, running or rough play during this time. Toys such as frozen kongs filled with peanut butter or bully sticks are a good way to help them alleviate boredom.
  • Controlled Exercise – Take a few, short, leash walks per day under controlled conditions to ensure your dog maintains muscle, and to also encourage the growth of scar tissue around the injured ligament.
  • Pay Attention to Your Dog – Your best friend will tell you how they’re doing. Go at their pace, and avoid doing too much, too soon!