# The Procedure of Choice for CCL Ruptures



## EdA (May 13, 2003)

This veterinarian's choice for his own dog with a CCL rupture is

the tried and true TPLO to be performed tomorrow morning by Dr. Robert Radasch of the Dallas Veterinary Surgical Center

www.DFWVetSurgeons.com

Good Luck Chef Boy and sorry for the interruption of your field trial career....


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## jeff t. (Jul 24, 2003)

Sorry Ed, hope he has a rapid and complete recovery.


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## Shayne Mehringer (Jan 3, 2003)

EdA said:


> This veterinarian's choice for his own dog with a CCL rupture is
> 
> the tried and true TPLO to be performed tomorrow morning by Dr. Robert Radasch of the Dallas Veterinary Surgical Center
> 
> ...


Damn... good luck Chef.

SM


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## Lady Duck Hunter (Jan 9, 2003)

Those of us who've nursed a dog through this are with you in spirit. Best of luck for a great outcome. Wishing Chef a great result!


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## Andy Carlson (Jan 3, 2003)

Here's to hoping for a speedy recovery for Chef. 

Andy


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## JKL (Oct 19, 2007)

Here is to you and Chef, wishing you good luck and a sucessful recovery. 
I am almost 4 weeks into it now.


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## Old School Labs (May 17, 2006)

Good luck to you Ed and to our little Cheffy boy.


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## lablover (Dec 17, 2003)

Dooey says, "best of luck" in the operation and rehab. His was done 18 months ago by in Raleigh, NC. Since Dr Sherman released him to training, he's been "running like a deer".
Chef will too!


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## Gun_Dog2002 (Apr 22, 2003)

Good luck to you and you pup Dr. Ed. My heart goes out to anyone and any dog having to go through this....

/Paul


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## Sharon Potter (Feb 29, 2004)

Wishing Chef a speedy recovery and great results.


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## EdA (May 13, 2003)

Sharon Potter said:


> Wishing Chef a speedy recovery and great results.


Thanks everyone, I am more than a little bummed out, the Chef Boy was making good progress and with some good fortune MIGHT HAVE BEEN.... ready to be competitive in the Amateur this year. Now we have at least a 6 month setback.....

I deal with this regularly with clients and always have a positive outlook for them, unfortunately I know too much to be excessively optimistic when it involves my own kid.....

Dr. Ed Loves His Dogs Too Regards


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## DSemple (Feb 16, 2008)

Good luck to Chef & you Dr. Ed. You successfully put my Kate back together for me from the same injury some 25 years ago.

....Don Semple


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## Howard N (Jan 3, 2003)

Ed, Good luck to Chef. My girl Missy went through this over 2 years ago. She was back in training in 2 months and did her first trial 3.5 months later. I hope Chef does as well.

She's still doing good.


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## Buzz (Apr 27, 2005)

Very sorry to hear it. Hope everything goes well.

If he's anything like Raven, he's got so much go, it scares you a little. I don't know if we ever want to run her without jewelry.

Is that him in your avatar?


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## Sharon Potter (Feb 29, 2004)

Ed, a good friend of mine is a veterinarian, and he does a ton of TPLO surgeries...probably 150 a year (that's his area of specialty). I'll have to ask him if he's ever had to do one on his own dogs...he runs setters in horseback shooting dog trials and has a couple of National wins under his belt, so safe to say he knows sporting dogs.
He's offered to let me sit in and observe a TPLO surgery....and so far, we haven't been able to coordinate our schedules, but I think it would be fascinating to watch the procedure.
It's gotta be harder when it's your own dog...but hopefully that recovery and rehab time will fly and Chef will be back to work before you know it.


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## Miriam Wade (Apr 24, 2003)

Ed-

Hope all goes well with Chef's surgery today and that his recovery is smooth. I hope this is just a bump in the road and you get to post a Comeback Kid story from the Amateur.

M


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## Paula Richard (Jun 18, 2004)

Best wishes to Chef for a complete recovery.

Paula


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## Lisa Van Loo (Jan 7, 2003)

It's not the surgery, it's the rehab. As soon as he wakes up from anaesthesia, get him to a rehab facility, and let them do their magic. Makes all the difference in the world!

Good luck to you both.

Lisa


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## MikeBoley (Dec 26, 2003)

Good Luck Chef and Ed.....
Speedy recovery regards
Mike


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## Vicki Worthington (Jul 9, 2004)

Ed,

Sorry to hear about Chef. FWIW, Petey is in rehab right now for his 2nd ACL repair. The rehab is EVERYTHING! I'm sure you have a good facility in the DFW area, but I can highly recommend the one I use in Michigan. 

Have you investigated TTA surgery in place of TPLO? What are your thoughts? PM if you would.

Keeping my fingers crossed....

Vicki


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## EdA (May 13, 2003)

Vicki Worthington said:


> I'm sure you have a good facility in the DFW area,i


Even better than that I have a wife who was the first, and perhaps still the only, Veterinarian to receive a Master's Degree in human physical therapy (she also has a PhD in Neurophysiology) and she has a rehab lab at Auburn University.

http://www.vetmed.auburn.edu/index.pl/steiss

http://www.findretrievers.com/marketplace/viewlisting.php?view=8

I have a lenghty history with DVSC and Dr. Radasch and I talk regularly. He does both procedures and he has bird dogs, he said if it was his dog he would still do the TPLO.

When I get caught up at work I will post further about our conversation and the pluses and minuses of each procedure.


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## labdoc (Apr 18, 2003)

Good luck, Ed. Now the real question is meniscal release or not. Anyone got a coin?


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## EdA (May 13, 2003)

labdoc said:


> Good luck, Ed. Now the real question is meniscal release or not. Anyone got a coin?


I did not ask him this morning, I know they have been back and forth on that one, I'll post that when I hear from him postop


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## frontier (Nov 3, 2003)

Dr. Ed...hope all goes as planned on the procedure and rehab. 

I read with interest the article on page 52 of the January RFTN "Canine Degenerative Cruciate Rupture, A Consequence of Rheumatic Disease?" 

Until reading the article, I had always believed that it was accidental injury, but it states that most CCL ruptures in dogs are degenerative, and are not associated with accidental injury.

Certainly an informative read given the number of RTF family who have had to go thru this surgery and rehab with their dogs.

Is the incidence of CCL repairs as high in the other retriever breeds that participate in hunting, trials, and tests, Chessies and Goldens?


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## tshuntin (Mar 22, 2003)

Good luck Chef and Ed.


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## msdaisey (May 13, 2004)

Wishing you and Chef the best.


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## EdA (May 13, 2003)

My first personal experience with Tibial Plateau Leveling Osteotomy was in 1993 or 1994 when our dog FC-AFC Super Bounce Andre reinjured his stifle during rehab from extra-capsular CCL surgery performed by me. Not wishing to do further extra-capsular surgery Bounce and I flew to Eugene Oregon where Dr. Barclay Slocum (inventor of the TPLO) did surgery on Bounce.

Subsequent to that I talked to Drs. Barstad and Radasch at DVSC and encouraged them to start doing the procedure (something they were considering at that time). I have no idea how many TPLOs they have done but it must be in the thousands by now.

TPLO
Advantages
1. lengthy history and followups of several generations of dogs
2. the success level is high with failure rates less that 1% or 2%
3. predictable outcomes
4. if implant problems occur the implant is much easier to remove than the TTA implant
5. the long term results MAY be better than the TTA (speculative at this time)
6. many surgeons nationwide experienced in the procedure
Disadvantages
1. Catastrophic failures leave few backup options
2. potential for infection (true with both procedures)
3. slower recovery time than TTA 

TTA
Advantages
1. faster post surgical weight bearing
2. quicker return to normal activity (generally)
3. catastrophic failures have backup options
Disadvantages
1. implant removal (if necessary) is very difficult
2. the long term results are not as well known because of the relative newness of the procedure
3. at least one veterinary school did them but quit

At some future date the TTA may become the procedure of choice but now (for me) the TPLO is still the most desirable method


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## Steve (Jan 4, 2003)

I & my dog Chef wish your Chef as speedy recovery.

What is the CCL? I've heard of ACL, MCL and PCL.


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## 1st retriever (Sep 2, 2008)

I wish you and your dog a quick turn around time and that all is well!


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## 2tall (Oct 11, 2006)

frontier said:


> Dr. Ed...hope all goes as planned on the procedure and rehab.
> 
> I read with interest the article on page 52 of the January RFTN "Canine Degenerative Cruciate Rupture, A Consequence of Rheumatic Disease?"
> 
> ...


I just went back and read the article. Frankly, most of it is way over my head. But one question it did raise, is if it is degenerative in nature, can you see a particular lameness developing? Those of you that have posted here, did your dogs gradually grow lame or did it show up after a particularly hard work out or accident? What shows up in real life?

Dr. Ed, I know with your resources and dedication to Chef, he will be fine!


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## Vicky Trainor (May 19, 2003)

Any news on Chef? 

Good thoughts and prayers for a successful surgery and rehab!


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## Paul Rainbolt (Sep 8, 2003)

Best of luck with Chefs surgery and hopefully his quick return to the field.


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## EdA (May 13, 2003)

Steve said:


> I What is the CCL? .


cranial cruciate ligament, the quadriped equivalent of the anterior cruciate ligament (ACL)


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## EdA (May 13, 2003)

2tall said:


> I just went back and read the article. Frankly, most of it is way over my head. But one question it did raise, is if it is degenerative in nature, can you see a particular lameness developing? Those of you that have posted here, did your dogs gradually grow lame or did it show up after a particularly hard work out or accident? What shows up in real life?
> 
> Dr. Ed, I know with your resources and dedication to Chef, he will be fine!


CCL injuries and tears come in different forms and are seen primarily in two groups of dogs, sedentary and often obese dogs and athletic dogs

There is some scientific support for a degenerative condition involving the ligaments, the CCL is actually 2 separate ligament bands composed of longitudinal fibers much like a rope.

Some tears are traumatic and acute, in most athletic dogs they tend to begin as strains or partial tears, usually of one band. Joint inflammation ensues and further weakens the remaining tissue which eventually fails.

Chef had a very subtle gait abnormality in his RR in December 2007. He was reluctant to fully flex his stifle and tended to sit crooked. While he was never overtly lame I suspected a CCL strain at that time. After 30 days of very restricted activity and Deramaxx he returned to full training in February 2008. There was no evidence of a problem until 10 days ago when he had similar symptoms of 2007 plus he would occassionally hold his foot off of the ground when at rest. At this point I was fairly certain of a CCL injury (probably a partial tear) as the joint was still stable. Back on Deramaxx for 1 week and I resumed training him. Sunday after a retrieve he was noticeably lame, I checked his stifle and it was unstable.

This is a fairly typical history for most dogs that I see who have CCL injuries.


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## DarrinGreene (Feb 8, 2007)

Sorry to hear it Doc, hope all goes well for Chef!


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## EdA (May 13, 2003)

Vicky Trainor said:


> Any news on Chef? !


I just got off of the phone with Dr. Radasch, "the surgery went very well, there were minimal inflammatory changes in the joint, and the medial meniscus was intact". 




labdoc said:


> Good luck, Ed. Now the real question is meniscal release or not. Anyone got a coin?


no meniscal release, he did them for awhile but no longer, some feel the release causes an overload to the medial joint compartment thereby leading to osteoarthritis at an earlier time than would be expected otherwise.


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## paul young (Jan 5, 2003)

i'm hoping for the best possible outcome for Chef...-Paul


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## MooseGooser (May 11, 2003)

Man Dr Ed!! What a bummer!
But,,, He's in great hands!!

Hope all goes well,,

Gooser


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## Georgia.Belle (Dec 5, 2006)

Nothing hurts me more that seeing my dog injured. Thank you for the info and I hope for a quick recovery.


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## 2tall (Oct 11, 2006)

I am so glad you got an encouraging report on the surgery. I wish you the best for a smooth recovery and rehab.

Thank you so much for your reply regarding the onset of the condition. I have some concerns for one of my dogs, and even though the vet examining him could find no "click" or instability, I think after reading this, I will just have to monitor him very carefully.


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## Aaron Homburg (Sep 23, 2005)

Here's hoping for a speedy and full Recovery!

Aaron


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## Vicki Worthington (Jul 9, 2004)

Ed,

You really are a lucky guy to have your own personal rehab expert!!!!

How is Chef doing?

It's way tooooooo cold up here--you can tell I'm bored!

Guthrie must be as well, since he's been away so long & just now returned!

Can I take a Texas vacation & come out & train with you guys????

Vicki


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## EdA (May 13, 2003)

Vicki Worthington said:


> Ed,
> 
> You really are a lucky guy to have your own personal rehab expert!!!!
> 
> ...


Chef is doing well except for the nagging Elizabethan collar he is supposed to wear, he is currently asleep in my office sans Elizabethan collar. 

He is weight bearing much better than I expected and even stands on the operated leg while he lifts the normal one to pee.

Both Jan (Dr. Steiss my wife) and Dr. Radasch are very conservative about doing any heavy duty rehab until the osteotomy has helaed. I know there are some rehab facilities that start using the underwater treadmill before the skin has healed but we feel there is too much risk and ultimately not enough reward for being so aggressive so early in the healing process.

He will be on Tramadol and Deramaxx for 7 to 10 days, after 3 days we will begin some passive range of motion exercises followed by icing. In 2 or 3 weeks I will begin leash walking and when the osteotomy has healed (end of March) he will go to Auburn and begin his rehab with Jan.

After a month there I will bring him home and start walking him using the roading harness to pull weights. When his thigh muscles have redevloped to about 90% we'll begin some light work in the field. Hopefully he will have relearned enough of his training to be ready for competition by the Fall.

Chef and I thank everyone for their concern.....

To anyone with questions I am always available by e-mail for phone, this is my 5th dog to have cruciate surgery.



Vicki Worthington said:


> Can I take a Texas vacation & come out & train with you guys????


come on down, highs around 70 this weekend, with only 9 year old Reggie to train I will be spending lots of time in the field as designated semi-permanent bird boy


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## Julie R. (Jan 13, 2003)

Dr. Ed, so sorry to hear about the injury but sounds like young Chef has the best surgery & rehab team available, and I'll keep my fingers crossed this will be but a tiny delay in a great career. Keep us posted on how he does and thanks for the information, it's always good to hear the treatment modality selected by an experienced vet/competitor for his own dog.


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## EdA (May 13, 2003)

Julie R. said:


> sounds like young Chef has the best surgery & rehab team available,.


it is truly remarkable what incredible medical care we have available for our pets, much better than the majority of the world's human population who have little or no access to advanced surgical procedures, CT scan, MRI and ultrasound for diagnoses, and chemotherapy and radiation therapy for cancer


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## cakaiser (Jul 12, 2007)

So sorry, and he's just a young guy, too. Hopefully this will all be behind you this fall. and Chef can do what he was born to do, work!

It's obvious Dr. Ed loves his dogs, too.


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## Howard N (Jan 3, 2003)

EdA said:


> it is truly remarkable what incredible medical care we have available for our pets, much better than the majority of the world's human population who have little or no access to advanced surgical procedures, CT scan, MRI and ultrasound for diagnoses, and chemotherapy and radiation therapy for cancer


Dr. Ed, you are so right!!!

We are blessed in where and when we live.


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## CBRHunter (May 15, 2007)

Here's to a speedy and full recovery! Dozer is a year out of back to back tplo's and doing very well, even better than before and we couldn't be more relieved. Extra treats for the Chef boy!


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## EdA (May 13, 2003)

Perhaps I should post a daily log for those who have yet to have this problem.

Earlier I posted that I had 5 dogs with CCL tears and surgery, actually it is 6, the most recent an under 50 lb bitch with bilateral tears at 9 and 11 years old both repaired by me with extracapsular repair, at 14 she is doing very well.

As a result of newer and improved surgical techniques and post operative pain management Chef is more weight bearing on his injured leg than he was before surgery, indeed he is more than 80% weight bearing and I am certain if unrestrained he would break into a full run, it is truly remarkable that he would feel this good after having a major bone cut into two pieces......

more later...


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## JusticeDog (Jul 3, 2003)

Glad to hear the baby is doing well...... (they are all babies to me)


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## Gun_Dog2002 (Apr 22, 2003)

Dr. Ed sir, I said it before and I really mean it. My heart goes out to any owner and dog that has to do go through this. My baby girl Gracie blew out both back legs, the first one at a trial on her last bird on the way to her second open win. Her heart tells her to keep running and her body says I can't run any longer. Her life now consists of pointing whatever quail I can plant for her and any pheasant I can find during the season. The rest of her life is diggin holes all over god and creation and sitting on my lap watching 2 1/2 men. I wish you and your dog the best. 

Gracie










/Paul


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## Rudd (Jan 9, 2008)

I have yet to experience this as my dog goes in for TPLO surgery on Monday. Even better, she just suffered from FCE three months ago. This will be fun.

I say this, as I would really appreciate a journal telling of your experience and what you are going through. It definitely would help those in the same boat, now or at some point in the future.


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## Janet Kimbrough (Aug 14, 2003)

Dr Ed'

It sounds like Chief is doing outstanding. I am sure he will be back to normal before the fall.

Your comment on Chief already walking on that leg is truly amazing. I have one that had both knees done in the past year. With the first one it took him about 2 1/2 to truly put weight on that leg consistantly. With the second 8 months later, he was walking on it when I picked him up. I could not believe it. In fact, as the vet tech was handing me the lead, he jumped up on me. That shocked both of us.

Good luck with Chief's rehab. I know it will go well.

Janet


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## Boondux (Feb 10, 2006)

Best wishes for Chef.


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## Vicki Worthington (Jul 9, 2004)

Dr. Ed,

You are following much the same path that we have with Petey. No water work until stitches/staples removed and incision healed. I did passive range of motion exercises followed by leash walking followed by icing during that period. Ankle flexes; knee flexes; hip flexes - 10 reps each; then 5-10 min. leash walking on level ground; followed by 20 minutes of icing on the incision/knee. 

Once the stitches were out & the incision healed, Petey began underwater work and dry treadmill work. He progressed to inclines on the treadmills and then to resistance bands to further work the muscles surrounding the injured knee. 

People need to understand that simply swimming the dog will not progress them as rapidly as regulated depths of water on underwater treadmills. The deeper the water, the less resistance on the appropriate muscles surrounding the knee; the shallower the water, the more resistance on the lower leg.

He will be using balance balls to strengthen his ability to move laterally on his injured leg(s) as well as wobble boards.

His first surgery resulted in a very conservative approach to rehab. He had 6 weeks of flexes and leash walking before being released to physical rehab using treadmills and other tools. This second one was performed by a different surgeon who only wanted him to have the incision healed before beginning light treadmill workouts instead of the 6-week leash walking routine. He did extremely well on both surgeries. The reports I'm getting are great. We will take x-rays soon to determine bone healing as well. Dr. Comrie (rehab vet) falls into the middle of agressive vs. conservative treatments. She did his other leg & you simply cannot tell he had a problem!


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## HiRollerlabs (Jun 11, 2004)

Dr Ed,

A daily blog on Chef's rehab and recovery would be very interesting and educational.

Best of luck to Chef. Hope he is ready to run again soon.

Do you feel there is any benefit to using a glucosamine/chrondroitin supplement on dogs to help prevent arthritis and joint issues? If so, what amt daily is necessary? Ann


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## EdA (May 13, 2003)

HiRollerlabs said:


> Dr Ed,
> A daily blog on Chef's rehab and recovery would be very interesting and educational.


this leash thing is going to be a real PITA, if I allowed it he would take off at a full run now, he is already weight bearing as much or more than he was was presurgery, it is as if nothing was done to his leg...

he likes to spin in place for 2 or 3 revolutions before he poops and he doesn't like the presence of the leash...;-)



HiRollerlabs said:


> Do you feel there is any benefit to using a glucosamine/chrondroitin supplement on dogs to help prevent arthritis and joint issues? If so, what amt daily is necessary? Ann


I give Cosequin to my older dogs (including me), I use the Double Strength caps (2/day) each cap 500 mg glucosamine and 400 mg chondroitin

there is much variation in the quality of these supplements, I tried one of the brands sold at Sam's which had 3 times the glucosamine of Cosequin, after 2 or 3 weeks I realized that my knees and shoulders missed Cosequin


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## EdA (May 13, 2003)

HiRollerlabs said:


> Dr Ed,
> 
> A daily blog on Chef's rehab and recovery would be very interesting and educational.


On a new thread of it's own or ongoing here???


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## 2tall (Oct 11, 2006)

I am looking at the bottle of triple strength, store brand, glucosamine & chondroitin that I take. It says it has 1,500 mg of the gluc, and1,250 mg of a "proprietary blend" that includes something called boswelia serrata, (wood resin) and boron. Is this stuff fit for a dog? I am starting wonder if it is fit for me!

I think maybe a sticky thread at the top like the eic results, etc. would be a great way to keep up with this subject. Thanks for doing this.


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## Rudd (Jan 9, 2008)

EdA said:


> On a new thread of it's own or ongoing here???


New thread.


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## jeff t. (Jul 24, 2003)

EdA said:


> he likes to spin in place for 2 or 3 revolutions before he poops and he doesn't like the presence of the leash...;-)


Ed,

I've run into this as well and found that a flexi-leash with the button depressed worked well. When I needed control to keep her from breaking out of a walk I depressed the button. When she needed to poop, I could give her more room by releasing the button and holding the leash a bit higher, then could quickly regain control.

It does get old, and I can understand why some don't strictly adhere to the "on-leash" regimen as well as is needed for the best outcome.

Hang in there!


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## Vicki Worthington (Jul 9, 2004)

Petey hated airing on lead! He would be so stubborn about it, but finally give in. It was much easier when he was allowed a longer lead.

Like Chef, he too was on Tramadol and Deramax, plus Simplicef for 10 days.

A play-by-play would be nice.

Cautions about the spin-a-rama when airing. I think some muscles have to be sutured back to the bone (at least with the one leg that Petey had TTA done on--not sure about TPLO). The spinning can jerk those sutures loose and set back the rehab by as much as a month.


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