[Music] so your dog doesn't seem as active doesn't want to run and play and is limping we're on the road for this episode of the Paul report to talk about one of the most common Orthopedic injuries in dogs Dr Hadley Gleason a surgeon from the University of Illinois Veterinary teaching hospital will discuss diagnosing and treating CCL injuries that's coming up [Music] it's almost impossible to imagine life without internet today it keeps us connected to work school and loved ones no matter where they are fidum fiber internet now serves over a million locations providing reliable consistent service that keeps these connections strong from vibrant cities to quiet rural areas fiber Broadband is a key driver of economic growth fidum is dedicated to supporting communities and enhancing lives through this essential technology learn more at fidum fiber.com at Tender Touch grooming we groom dogs of all sizes and breeds tenderly our team Pampers your furry friend with care because every pet deserves a Tender Touch appointments are available via text at 217 317 9489 the Paul report on weiu is supported by Rural King America's Farm and Home Store livestock feed farm equipment pet supplies and more you can find your store and more information regarding ring at ring.com Dave's decorating Center is a proud supporter of the Power report on weiu Dave's decorating Center features the mohawk smart strand silk forever clean carpet Dave's decorating Center authorized Mohawk color Center in Charleston thanks for joining us for this on the road segment we're at the University of Illinois at the veterinary teaching hospital today we're talking about probably something that our guest has seen a lot of and gets a lot of patience into her office to to talk about and that's CCL injuries and joining me on this episode of the Paw report is Dr Hadley gleon a surgeon here at the University of Illinois thank you for joining us First Time guest on than much for having me I really appreciate and you brought along this is Ruda um he's one of our traine dogs he's just along for the ride he said I want to be on TV today bring my bed in I'm going to chill for comfortable minutes well you're a new guest to the Paul report and we always put our new guest on the spot introduce yourself tell us a little about you and your journey to the U ofi yeah um I am originally from the East Coast I went to veterinary school at University of Pennsyvania um and I originally wanted to be an equin orthopedic surgeon um so did mostly equin horse training all the way through veterinary school and then I switched to small animal um ended up doing my residency small animal surgical residency here at the U ofi and then I've stayed on after finishing in 2020 excellent and you love every every minute of it every day it's a different different Adventure I'm sure well as I mentioned it's the number one reason probably patients come to see you absolutely um for consultations and we're talking about CCL injuries can you talk about what that is and is it is it accurate to say a lot of clients come to you for that oh completely accurate I'd say that's probably the most common reason that we see dogs coming to the orthopedic service um and the CCL it stands for the cranial cruciate ligament injury so it's the exact same thing analogous to your ACL um so the we say cranial cruise ship because they're quadrip heads they're walking on all fours so then wording is a little bit different um but the same kind of thing that you would see um for a person now what um what causes the injuries the CCL injuries is it more physical activity is it more you know a degenerative type of um problem that dogs develop yeah exactly so um unlike people the ACL CCL tears in dogs are a degenerative injury so if you look at these after the ligament tears if you looked at it under a microscope it would look abnormal it would look diseased versus in a person you know you're playing soccer you're skiing and you're perfectly normal ACL tears due to unnecessary stresses so unfortunately in dogs these ligaments start to generate and then even with normal you know running they're walking outside they're jumping onto the porch um those kinds of things can lead the ligament to tear I'm going to put you on the spot because you brought in a little model behind yeah it's right here oh right here uh and maybe that could give our viewers just a little better description of what you just told us as far as the what it is and where it's at definitely so the ACL I don't have one on this model but it goes from the femur which is the thigh bone down to the tibia and it prevents um hyperextension it prevents internal rotation of the tibia and also prevents shearing forward so this model demonstrates that when whenever these dogs step down after they've torn their ACL they step down and their Shin bones slides forward they don't have a solid leg to stand on when they step down so that's uncomfortable um it pulls on the joint capsule it pulls on the other soft tissues it can crush the meniscus so if any of you all had an ACL tear um you might have had some meniscal injury um can crush the meniscus and it also just feels uncomfortable they don't feel like they can step down on that leg and be confident that it's going to be there for them um so that's generally what's happening if the dog doesn't have an ACL tear they'll step down and it'll feel very solid and they won't have any of that sliding forward that leads me into my next question is some signs um but some may be pretty obvious others not so much um um talk about what if I'm a pet owner and I noticed just something a little off what am I looking for yeah generally what you're going to notice with this injury is lameness so often times if they tear it fully um acutely or all at once um they're probably going to be non-weight bearing they'll be holding the leg up they won't want to put it down they'll be perfectly happy to run around on three legs dogs are really tough and and you know they're always in good spirits they want to play so even if they have this injury they may they'll likely be eating fine drinking fine using the bathroom Okay wanting to go outside and play they just won't put the leg down and so we'll often we have owners come in and say oh he's not in pain or anything you know he's not vocalized ing um but the fact they're not using the leg at all indicates to me that the leg has some pain associated with it and they're just so happy go lucky they want to please you they want to enjoy their day they're just going on saying I don't need this leg I'm just going to run around without it my dog CU I actually had a a labador retriever that had this and did a lot of toe touching is that a thing yes so when they're they're kind of testing the waters of saying hey can I put this leg down and then if it hurts they'll say no I'm not not quite ready and over time once the inflammation goes down you know you get 2 three four six weeks out from this injury they'll start to use the leg a little bit more uh commonly so usually they'll start off very very painful not using it at all and then they'll gradually kind of get to this toe touching or even using it very regularly just with a lameness do you do you notice any swelling is that part of it as well so I can notice the swelling there's usually some swelling inside the joint that I can feel um and depending on you know how tuned in the owner is they may notice it as well so diagnosis so I noticed that my pet is toe touching picking up the back leg and not walking on it I call the doctor's office I bring them in let's kind of go through step by step on your end of things the process to diagnose yeah yeah so the first step that we're going to do to a diagnosis we always want to First assess the whole patient make sure there's nothing else going on um that could be leading to this uh lameness make sure the heart and lungs sound okay uh make sure everything else looks good once we've ruled that out this is just an orthopedic problem we'll start with a gate exam or we'll walk your dog up and down the hallway or maybe watch them walk in the exam room with you um to confirm how lame they are how well are they using the leg or not using the limb um then we'll do an examination where we palpate the limb kind of feel for any uh loss of muscle mass so muscle atrophy from them not using it for a period of time will palpate for joint swelling as well any excess fluid in the joint as evidence of inflammation um and then we'll do two specific tests generally called cranial drawer and tibial thrust and what those are doing is T testing for that instability in the joint so when I'm doing those uh so for cranial drawer I'm grabbing these two bones the femur bone and the tibia bone and I'm trying to get this abnormal motion on the dog um the other manipulation I can't really do on this model U but we're trying to see what happens when this dog's foot hits the ground we're kind of testing pressurizing the foot and then if we see this shin bone slide forward we can essentially confirm on exam that this is very very likely to be an ACL injury we'll also look for other injuries especially if it's a traumatic event you know if your dog was hit by a car or something else we'll want to test for the collateral ligaments uh being intact as well as the codal cruciate ligament there's other ligaments in the joint that we want to make sure okay um it's pretty uncommon for them to tear those um you know just doing regular things though so once you make the diagnosis you're sure that it's a CCL injury um you're looking at either physical therapy or surgery um walk us through both of those scenarios and what those entail but how do you determine which one is better than the other yeah and I guess every patient is probably different absolutely absolutely that's the Crux of the issue so the patient selection is really really important and and frankly kind of client selection as well so making sure that you know you and the client are on the same page about what our what our expectations are for each outcome and then what's going to be required of each outcome so um I do mostly surgery I think for most patients surgery is going to be the best choice um unfortunately physical rehabilitation in dogs um especially a larger dog the bigger the dog gets we're just not able to create the level of stability that you can in a person the reason being with physical therapy the reason being is that when you look at a person's knee the top of their tibia the top of their knee is flat and so every time they step down unless they're doing some kind of dodging motion or or something like that their knee is not moving around independently the way that a dog's is a dog's top of their knee is at an angle so every time they step down they're getting instability and that kind of motion and and and insecurity in their leg so it's very hard you know especially as the dogs get bigger to combat that with physical therapy um some people like to ask about putting a brace on unfortunately because dogs come in such different sizes um it's very hard to get a brace to fit appropriately um and then dogs as I said before they're really happy go lucky they want to run they want to jump they want to play they're not very good at telling you this brace is kind of bugging me it's it's itching in the back or it's rubbing in the back and they'll end up with sores and discomfort and irritation of their skin because they just can't tell us or won't tell us that the that the brace is bothering them so it's very hard um to do physical therapy on a dog that is is as they get larger small dogs sometimes they can do quite well we'll get them in the water treadmill we'll try and build up a lot of muscle around this area and sometimes the smaller dogs can build up enough scar tissue in that uh around the knee that it will stabilize enough they don't have as much discomfort um bigger dogs much more challenging and unless there's a contraindication for surgery generally that's going to be my recommendation um for big dogs so surgery what does that look like I mean as far as um the whole process the time um and I'm sure there's a lot on the back end yeah that pet owners need to be aware of yeah um so for surgeries there's a couple different big categories that we have um the one thing that we don't do is reconstruction of the ligament so a lot of people are familiar with that because that's what they have for their procedure they'll take a little bit of their patellar ligament or some of their hand string and basically reconstruct a a prosthetic ligament for them in the knee and we just haven't we've tried that with dogs um and we just haven't had the success um that we have in people likely because of the shape of the tibia of the dog um the procedures that we typically will do are uh procedures where we'll cut the bone and we'll change the shape of the of the dog's tibia to more closely match a human's knee and provide more stability um that procedure is called the tplo and that's going to be my number one recommendation for dog that are larger some small dogs um and we'll do this sometimes but a lot of general practitioners will also do this procedure another option is called the lateral Feller suture or lfs where the surgeon will essentially take a suture um basically a big fishing wire um and go from the femur to the tibia to kind of create an analogous or something that acts it's like the cruciate ligament but on the outside of the joint so those are the kind of the through two surgical options that we have and those as you mentioned were really based on size of the dog and injury for you to kind of evaluate okay this is the best option do they have different outcomes I mean long term yeah yeah generally um the tplo the bone cutting procedure is going to have the best outcome compared to every procedure that we've compared it to generally those dogs do better on average in the long run they when we put them on uh when we test this procedure we're looking for lameness visually but we'll also walk them on a pressure walkway that'll say how much they're actually using that leg and across the board uh um those dogs do better than the dogs that have the Stitch that goes across the knee that being said for a lot of people you know if you have a little Chihuahua or a dog that spends a lot of time in your arms they're not trying to be an athlete they can have a perfectly passable um outcome for you um with the suture and just depends on again technique and communicating to the client um what's needed afterwards our biggest worry with using the suture in a dog uh is is having it stretch or tear before that scar tissue forms around the knee so dogs that are more at risk of that stretching and tearing are big your dogs dogs that are really active dogs that have some specific U Anatomy differences in their knee um and so hopefully your surgeon's going to go over that with you and make the decision with you about what s what procedure to perform postoperative what does what can a pet owner expect so the dog gets through the surgery um they're doing well and they go home yeah so I'm sure there's probably a very strict regime that pet owners need to try to follow to make sure that their pet heals properly yeah and so this and this is the hardest part you know I always say my my part is very easy doing surgery on a dog under anesthesia you know something I've done you know hundreds of times at least at this point the hard part comes when the dog has to go home and I always empathize with clients trying to restrict your you know 2-year-old Labrador um for a period of one to two months and have them no running jumping playing rough housing that's that's very easy for me to write on the release paperwork very challenging for you all to do at home but it is very important to do to for success of the surgery and so often we as the veterinarian can help you with um having an open line of communication you know what is working is the dog feeling very crazy putting them in a crate can we modify this to like a big xen or a baby inclosure can we modify this to they in a small bedroom that you have um and then can we provide some sedation or anti-anxiety medications to help make it a little bit easier um on the owner at home um I always say with surgery there's kind of it's a kind of a three three prong stool you need the dog to be healthy enough to tolerate the surgery which is something that you know we should discuss together and your vet should be with know disclosing to you there's the surgery that we do you know making sure that we're using the right equipment we're choosing the right procedure and then there's everything that you all do at home and if any part of that kind of falls apart then even if you're perfect in the other aspects of of the situation you're going to have a bad outcome so it's if a client you know comes to me and says you know I can't restrict my pet that's not something that it's going to be possible for me then I shouldn't be recommending surgery because we're not going to have success do you have repeat customers sometimes definitely so one thing that people may have you know may read as they go through is that um you know in dogs about if you tear one one knee uh because as we discussed it's a degenerative process that's kind of happening across globally in the dog um the other knee is likely to tear by about 50% so about half a dogs will tear some good news is a recent paper came out is if your dog is older and they tear their ACL their CCL um there's only a 20% chance they're going to tear the other side so the older the dog is when they tear the tear the cruet um the less likely it is that they're going to tear the other side you kind of hit on it but what are some of the complications that you know once surgery's over the dog goes home pet owner doing everything that they can but then they do experience some setbacks yeah I would say uh one of the the more common things we can see is surgical sight infection so one of the really important parts of going home postoperatively which is also always another real kind of pain point for clients is putting the cone on and having them wear the cone so they can't lior chew at their incision um it feels mean I kind of same thing with restricting the pet I kind of liken it to having a toddler you know your toddler doesn't want to go to bed they don't want to eat their vegetables they don't want to you know put their coat on when it's 0o degrees outside but you know as a parent that that's what's important for them in their health and so it's kind of like you're having a dog postoperative it's kind of like having a toddler it's like no no no you need to take your medications you need to wear this cone and it feels mean they might throw a tantrum and be yelling at you um but it's our job to be you know do what's best for them um so keeping the cone on so they don't liquor chew at the incision um and introduce bacteria that can lead to a surgical sight infection um we can see kind of continued instability so even with uh you know if we put the suture around and then they're a little too active and it stretches um or they lose muscle mass and some of that additional support structure goes away um they might have continued looseness of the knee that might lead to some discomfort we can see meniscal tears after surgery as well umid build up usually that's uh um kind of secondary to something else so if they do a lot of fluid build up to me that says do they have an infection or do they have a meniscal tear something else going on the fluid is is kind of a secondary uh problem that's telling us something else is happening um and then failure to heal so sometimes when we're cutting this bone we can have dogs that if they're you know a little bit older um or they have on some medications that might delay their healing um seeing slow healing of that of that cut in the bone is another thing that we can we can appreciate how do I know what the right decision is for me yeah and my pet I I know that probably every single pet owner relies heavily on the surgeon um for reassurance and for guidance but do you do you get that a lot from a patient or from you know the the human parent yeah people like to ask you know what would you do and I that would be my first question what would you do and it's always a hard question to answer because I'm in a very different position than you all you know I come to I come to the vet every single day and so if my dog needed to come back to be seen um or and you know I've seen kind of the breath of of what can happen and and so I think I have a very different perspective um than a lot of you know your standard owner might uh I think I would say be honest with with your veterinarian um about what you what possible for you at home what your dog is like what your dog likes to do um what your financial capabilities are um and a good veterinarian should be honest with you and have that discussion about you know I think this is a good idea um or sometimes I've definitely had clients come and present to me they have their initial consult we talk about the restrictions posttop um and they kind of express some uh you know some hesitation and I say well let's try these at home try and do these restrictions right now without having surgery see how it goes if it goes well then come back and we can do the procedure if you feel like you're really struggling then maybe doing surgery is not is not something that you all can really uh handle right now do clients fear the financial end of yeah what this could mean because it it's not something that's inexpensive to do c certainly not and I think that's um you know something that as time goes on and we get more and more we have more capabilities we're able to do more for your dog now than we were even 5 years ago and so we're obligated to offer that to you you're not obligated to to move forward with that um and so we all empathize I know we have a lot of trainees um and certainly even myself some of the estimates that I give to people I'd be thinking twice about as well and so that's not wrong to discuss with your your veterinarian or whoever you're speaking with that you know the hardship are there other options that we could do what do those other options look like and then but the when it comes down to it only you know your finances and what your family um can manage um and so if you need time to do that the blessing of Orthopedics a lot of time and for AC alars is that um it's not an emergency you can go home and you can think about this you can talk about with your family talk about it with uh you know your mom uh your kids your husband whatnot and take some time to make sure that you're making the right decision that's what we want as veterinarians we want to make have you go in with eyes open and feel that we're in a partnership we trust each other and and we can move forward for what's best for your dog are most of your clients larger breed dogs the labs the Rottweilers the Shepherds uh I know you mentioned taas and I'm sure you do that on smaller dogs but are the bulk of your clients bigger dogs absolutely for ACL tears um it's going to be those breeds that you listed out um we do see this injury with small dogs and often times it's tied in with having their patella or their kneecap luxate as well um so that's something we see in smaller dogs we can see it isolated in smaller dogs as well in our last few minutes um I guess my question will be twofold is what's the best advice and you gave some advice you know talk it over with your family what is the best advice maybe some other advice you can give to families and maybe any success stories that over the hundreds of surgeries that you've done that you've one maybe stands out or maybe a couple stand out in your mind is you know oh I was really worried about this dog getting to run and play again now he's at the park with his buddies um I would say as far as advice goes I would say be honest with your veterinarian be open and honest if you're if you're struggling at home with a certain uh part of the recovery um reach out to your veterinarian and say hey we're struggling with this what can we do to to kind of mitigate that often times we can change some of the medication protocol um or discuss with you you know what other things we can do to try to make that a little bit easier at home it's never going to be pain-free it's always going to be a little bit of a challenge to go home with a postoperative dog but sometimes there are things we can do to to communicate and if you think something is wrong please reach out we'd rather catch something sooner and be able to jump in and intervene for you um then have you show up for your your we check at 2 months and have something have been wrong for a long period of time um as far as success stories the ones I always love to see are those that come in you know perhaps they had surgery somewhere else or they've been putting off surgery um and they're having struggling to get around um we had one little dog who had had surgery I think at another facility on both knees and was really struggling um she had I think torn had an infection and had torn her meniscus in one knee and so we did uh another procedure to revise that knee and then I'm blessed here to have our our rehab Service as well and we really work as a team all of us and so they helped her um with the water treadmill um doing some physical rehabilitation exercises the owners were very diligent bringing her back here they had her boarding here for some period of time for Rehab every day twice a day sessions um and she ended up um having a really successful happy life and was able to run back around um with her family so it's always really nice to to be able to to provide that for our pets is is that with Dr nap the water therapy yeah Kim Dr Dr nap is a former Paul report guest so she invited us into her her area and showed us the pool and uh quite impressive uh nonetheless well Dr Hadley gleon thank you so much for joining us very informative um I learned a lot myself uh coming from a pet owner that had this uh situation happen in my life settle down oh Ruda he he did so good today thanks for joining us on the Paw report we didn't mean to thank you and we thank you our viewers of the Paw report for joining us here at the University of Illinois the veterinary teaching hospital until then we'll see you next time if you're a veterinarian trainer groomer specialist rescue organization or shelter that would like to partner with the Paw report by providing expert guests for the show please contact us by emailing weiu weiu.net or call 217-581-5956 if you have a topic you'd like to see on the show or questions for our experts contact us with those too Dave's decorating Center is a proud supporter of the Power report on weiu Dave's decorating Center features the Mohawk smart strand silk forever clean carpet Dave's decorating Center authorized Mohawk color Center in Charleston the Paul report on weiu is supported by Rural King America's Farm and Home Store livestock feed farm equipment pet supplies and more you can find your store and more information regarding R king at ring.com a Tender Touch grooming we groom dogs of all sizes and breeds tenderly our team Pampers your furry friend with care because every pet deserves a Tender Touch appointments are available via text at 217 31794 9 it's almost impossible to imagine life without internet today it keeps us connected to work school and loved ones no matter where they are fidum fiber internet now serves over a million locations providing reliable consistent service that keeps these connections strong from vibrant cities to quiet rural areas fiber Broadband is a key driver of economic growth fidum is dedicated to supporting communities and enhancing lives through this essential technology learn more at fidum fiber.com [Music]