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TPLO Frequently Asked Questions

We've got answers below.

General

Can you work with my veterinarian?
Yes. We encourage you to speak with your veterinarian or contact us directly to find out if your hospital is a practice partner with Midwest Veterinary Specialists, LLC. If you have a veterinarian and they refer out of hospital for specialty surgeries, let them know you may be interested in having the surgery done at their clinic.
Do we work directly with you or with our regular veterinarian?
The great thing about mobile surgery is that we are able to bridge the gap between your regular veterinarian and specialty services. We have the great opportunity to work directly with you AND your veterinarian. Once a diagnosis has been made and surgery is scheduled, we contact you prior to surgery being performed. We are happy to discuss any questions you may have regarding your pets injury, surgery, and post-operative care. Once the surgery is completed, we call you again to let you know the surgical findings and again to address any questions you may have. We provide a surgery report for your veterinary records and a copy of discharge instructions. Your veterinarian will recheck your pet 10-14 days following surgery to evaluate the incision site, remove the sutures, and place the limb through range of motion to determine how your pet is progressing. You will then recheck with your veterinarian again 8 weeks following surgery – this time for x-rays to be taken of the knee to ensure appropriate healing of the bone. If at any point during the recovery process you feel your pet is not progressing the way you would like, we are happy to perform an in-house recheck with you and your pet.
What if I don’t have a veterinarian?
No problem! If you are new to the area or just haven’t established a relationship with a veterinarian in your area, feel free to contact us. We are happy to talk with you regarding locations where we have practicing partners and can arrange a pre-op evaluation and surgery.
We are interested in finding out more and/or scheduling – now what?
Please surf our web page and then give us a call.  We are happy to answer any questions that you may still have.  We can then work with you and your veterinarian directly to set up a time for surgery.
What are your hours?
Due to the nature of our business, our appointment times are dictated by the hours of your veterinarian.  However, we typically perform surgery Monday through Friday, from 9am to 5pm.
Is ACL or CCL surgery a time-sensitive procedure? What happens if I wait?
Yes and no. A CCL injury is not an emergency surgical procedure. However, our biggest concern is your pet’s quality of life. As a general rule, we strongly feel the earlier we can address the injury, the more we can slow the progression of arthritis and the faster we can improve comfort in your pet’s knee. Assuming we can address your pets discomfort with an appropriate medical protocol, then the only drawback of waiting is that arthritis can continue to progress. If you are on the fence about deciding between medical or surgical management, there is typically little harm in not rushing the decision until you and your family can decide what is the best course of action for you and your pet.

Pre-Surgery

Does my dog need x-rays before surgery?
Yes. Radiographs (x-rays) of the knee are required prior to surgery so that the tibial plateau angle can be measured and the bone templated for the optimal saw blade size. This is required to determine how much the small top segment of the tibia must be rotated. This x-ray is typically best performed on a sedated patient and with a calibration marker, so precise patient positioning can be obtained.
Does my dog need blood work prior to surgery?
Yes. Most patients with ACL tears are happy, healthy, middle aged dogs, however, we want to ensure the highest care is being provided to you and your pet, and attention to detail is part of this. A patient’s overall health is important to know prior to undergoing general anesthesia. Blood work allows us and your veterinarian to evaluate certain vital organ functions prior to administering medications that alter the body’s physiology.
Can my dog eat and drink the day of surgery?
Your pet can eat and drink the evening before surgery. The morning of surgery, small amounts of water are allowed but food should be withheld.
What do I need to bring to the hospital?

Bring all medications your pet is currently taking and all previous medical records.

Should my pet’s activity be restricted prior to surgery?
Once an ACL tear is diagnosed, institution of a medical management protocol can be immediately instituted, including limiting activity to controlled leash-walks.
My pet’s surgery is coming up soon and I still have questions. Should I just wait until the day of surgery to have these answered?
NO! We want you to be calm and stress free when dropping your pet off at the hospital. In order to ensure this, please call when you have questions so that we can help you work through the decision making process.

Post-Surgery

Where does my pet stay the night of surgery?
There are several options for post-operative care. For most cases, patients are hospitalized overnight at your veterinarian’s hospital. Medications can be administered to ensure your pet is comfortable overnight so they can rest in a quiet environment. In other cases, you pet may go home the same day as surgery, depending on your veterinarian’s business hours.
What happens if there are complications after surgery?
Approximately 10% of patients that undergo a TPLO surgery have complications of one sort or another.  Most often these complications are minor (swelling, bruising, inflammation).  We expect to be fully invested in your dog’s recovery.  If complications occur post-operatively, we work directly with you and your veterinarian to make sure your pet returns to peak potential as soon as possible.  Sometimes, this may simply involve emailing photographs of an incision, while other times it may require a full evaluation at your veterinarian’s office.  It is important to remember that even if your pet endures a complication, a good to excellent outcome can still be obtained.
My dog hasn’t pooped since surgery – what’s going on?
Patients undergoing surgery are typically fasted the night before surgery, and may not eat normally the evening or day following surgery. In addition, they have undergone anesthesia and receive pain medications, which can slow down motility of the intestinal tract. Fortunately, dogs do not become truly constipated like humans, so try not to worry, as it is not uncommon for patients to go up to 5 days following surgery without a bowel movement.
Why won’t my dog eat since surgery?
It’s not uncommon for dogs to not want to eat the evening after surgery.  Sometimes, this may even extend into the day or two following surgery.  If this is the case, feel free to offer a diet of bland food – boiled chicken (no skin or spices), white rice, low-fat cottage cheese, or plain yogurt.  Warming the food may also help entice them to eat.  Other options may include baby food or canned dog food.
My pet is vomiting after surgery – what should I do?

Remember that your pet has just gone through an anesthetic event and is then placed on multiple medications including a non-steroidal anti-inflammatory drug such as carprofen. If your pet is only a day or two out from surgery, the vomiting or regurgitation may still be associated with the anesthesia and should subside. If vomiting persists, the non-steroidal anti-inflammatory drug should be discontinued, as continuing to give it may cause other gastrointestinal problems. Additional pain medications may need to be prescribed in its place. Please contact your veterinarian if your pet is vomiting after surgery.

What do I do if my dog is in pain?

Prior to administering any medications, please consult with your veterinarian. Anti-inflammatories such as carprofen or metacam are options in patients with healthy kidney and liver function with no current gastrointestinal upset. Other medication options may include gabapentin, amantadine, or fentanyl. Other options can include gentle limb massage and icing the incision site with a bag of frozen peas, which conforms nicely to the leg, and provides good local pain relief.

Does my dog really need to wear this ridiculous "cone of shame"?

Licking or chewing at the incision site can lead to premature removal of the sutures and/or incisional site infection, both of which can require a second procedure to repair. Your pet must not be able to lick or chew at the incision until it is completely healed and the sutures have been removed. If you are by your pet’s side, or feeding him/her, you may remove the e-collar temporarily. However, it takes only a few short moments for a pet to cause significant trauma to the surgery site, so please monitor your pet closely. If you leave your pet’s side, an E-collar (i.e. “cone of shame”) or a similar product should be utilized.

Rehab

How much activity should my pet have after surgery?

Your pet’s activity needs to be severely restricted until there is radiographic evidence of bone healing, which typically takes around 8 weeks. He/she must remain in a small area (6×6 feet) with good footing or in a kennel when he is not directly supervised. Your pet should not have free roam of your home. Running, jumping of any kind, playing, stair climbing, and uncontrolled off-leash activity are strictly prohibited to reduce the risk of delayed healing or implant failure. Please be extra careful when walking on slippery surfaces such as tile, linoleum, or wood floors during this period of recovery. Please follow the instructions for activity outlined below:

Week 1-2: Leash walks for urination and defecation purposes only – no longer than 5 minutes each up to four times a day. All leash walks should be slow enough to encourage your pet to place his/her operated foot with each step. Please use a sling under the belly or a Help-em-Up Harness for support when walking on slick surfaces or if stairs must be used to go outside.

Weeks 3 and beyond: In addition to leash walks to urinate and defecate, 2-3 additional leash walks are allowed. Please start these leash walks with 5 minutes of “active walking” and gradually increase the length of the leash walk by 5 minutes each week up until the 8 week recheck. All other restrictions apply. If at any point your pet begins to demonstrate signs of lameness, soreness, or becomes uncomfortable following walks, please decrease the duration or frequency of the walks. A sling or harness is advised when walking on slippery surfaces.

Excessive activity may result in implant failure, delayed bone healing and other healing complications. If your pet suddenly stops using the leg, or seems painful, please contact your veterinarian for recommendations.

What sort of other rehabilitation should be performed after surgery?

Physical rehabilitation therapy can improve the speed and extent of recovery from surgery. There are exercises that you can perform at home and those that you can have done with a veterinary rehab specialists. We recommend the following exercises post-operatively:

Passive Range of Motion: Gentle flexion and extension of the operated limb can be done 2-3 times daily to ensure very good range of motion of the stifle joint. Support just above the stifle (knee) and at his hock and gently flex the leg up to the body and then extend the limb first straight down in a standing position and then back behind him/her to extend the hip. Hold each position 3-5 seconds and repeat the exercise 10-15 repetitions. This may take a second person to relax your pet in the front end, but this should not be painful.

Massage: Gentle massage of the thigh and lower leg muscles will help your pet to relax and it can encourage him to use his leg better and to allow better range of motion exercises. It can also help reduce some swelling in the limb. It can be performed for 5 minutes before the range of motion exercises.

Weight Shifting: Please encourage your pet to stand on the operated leg at all times, or at least to keep his/her toes on the ground. Gentle weight shifting can be done by carefully pushing the hips side to side, while they are standing. Reward your pet when he/she is standing on the limb. It can be performed for 5 minutes before or after the range of motion exercises.

Should we ice or heat pack following surgery?

Both ice and heat are appropriate following TPLO surgery, but at different time points, based on the healing from surgery.

Ice packing: For the first 5 days following surgery, you may ice the incision for 10 minutes 2-3 times per day. A frozen bag of vegetables or an ice pack works well. Do not place an ice pack directly on the skin without a thin cloth or paper towel over it.

Warm packing: After 5 days of icing, a warm washcloth *in a plastic bag* may be used on any residual swelling or bruising to aid in the reduction of swelling, bruising, and to increase circulation. Please make sure the warm pack is of a temperature comfortable on your own skin before applying it to your pet’s skin. If he/she does not tolerate the icing or warm packing well, please discontinue.

If at any time during the recovery your pet stops using the operated leg, or fails to begin using the leg within 2 weeks, please contact Dr. Bergh or your veterinarian.

OUR CLIENTS

"We just wanted to take a minute to thank all of you for all your hard work with Winnie. Dr. Bergh went above and beyond to help fix Winnie up when she tore everything imaginable in her right hind leg! She says thank you as she can run and play like nothing ever happened! We are truly grateful."

-Shana

"We hands down fell into the right hands with you and I am certain she wouldn’t be where she is today if we hadn’t. So, thank you so much. Truly grateful. We are coming up on a year since her accident/injury and her 5th Birthday It’s so great to see her take off and run like she loves to do!"

“The outcome of the TPLO surgery performed by Dr. Bergh on our German Shepard was almost magical. Our dog now runs, jumps, and plays like a puppy again!”
- Adam

“We are so grateful that our young dog was in Dr. Bergh's care. Her knowledge related to diagnosing our dog's leg and joint issues and the subsequent TPLO surgeries was impressive and comforting. Dr. Bergh  loves her patients and is great at communicating every step of the way.  She also provided several options for addressing our dog’s needs and made it really easy for us to explore pros and cons. Couldn't be more pleased with this vet surgeon superstar!”
- Marla

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