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How can I tell if my dog is in pain?

Dogs do not typically demonstrate pain in the same way that people do. Yelping and whining are very unusual behaviours for dogs affected by orthopaedic pain.

The commonest sign of pain in dogs with orthopaedic problems is lameness. Most cases of lameness in dogs are caused by discomfort when trying to take weight on the affected limb. However, there are some causes of lameness (for example cruciate ligament rupture) that can be related primarily to abnormal mechanics rather than pain.

When dogs return home to their owners after staying in a veterinary hospital, it is quite common for them to be very clingy and to whine a lot. In the majority of cases this whining and attention-seeking are behavioural responses to the recent stress of being separated from owners and having surgery. Because whining and yelping are not common signals of pain in dogs, when dogs show these behaviours, it is a good idea to look for other indicators of pain. If dogs are able to walk comfortably, then it is unlikely that they are suffering from significant discomfort. Pain severe enough to cause whining or yelping should also stop dogs using their operated limb.


How lame should I expect my dog to be after an operation?


The amount of lameness depends on the procedure performed. Here are some general guidelines.

The smaller the dog, the more easily they can move on three limbs. It is quite common for small dogs to take 1-2 weeks to start loading their operated limbs after surgery.

After TPLO (Tibial Plateau Levelling Osteotomies) and TTA (Tibial tuberosity advancement) surgery, most dogs will return home with a visible limp and some dogs will not start loading their limbs until 3-5 days after surgery. Some dogs walk very well straight after surgery, but some lameness is expected for several weeks after surgery. Peak function is not expected until 2-3 months after surgery.
After patella luxation surgery, lameness depends on the procedures being performed. On average, dogs have a similar recovery to dogs treated by TPLO.

Arthroscopy is keyhole surgery. Most dogs have arthroscopy of the elbow to diagnose and treat elbow dysplasia. Most dogs will take weight on their operated limb soon after surgery but the speed and completeness of improvement depend mostly on the amount of cartilage pathology in the affected elbow. In most dogs, peak function is not expected until 3-4 months after arthroscopic surgery.

Total hip replacement has a reputation for fast recovery. Typically dogs will walk quite well on their operated limb within 1-2 days after surgery. If there is obvious lameness, especially worsening lameness over time, you should call and let us know.

Speed of recovery after a fracture repair depends on the complexity of the fracture. For 2-piece fractures that don’t involve a joint, most dogs will use their operated limb with mild lameness within 1-2 days of surgery. For complex fractures and fractures involving joints, recovery can be significantly slower and it can take several weeks for lameness to resolve.


What should the surgical wound look like after surgery?


In some cases the surgical wound is covered with a plaster known as a ‘primapore’ or a bandage. When a wound is not covered there are three types of wound closure. The first is suture closure, the second is stapled closure and the third is intradermal closure, where the wound has been closed with buried absorbable sutures.

The wound should be sealed without any gaps more than 5mm showing along its length.

In most cases there is a small amount of bloody discharge for the first 3-4 days after surgery.

Moderate wound swelling is typical. In some cases, obvious fluid swelling occurs. This is called a seroma and is an accumulation of fluid under the wound. Provided the wound is sealed, this is considered a cosmetic problem and should be left to resolve by itself. We avoid draining these with needles as this can introduce infection. As a general rule, swelling is considered benign if a dog is able to walk well on the operated limb. Seromas can take several weeks to resolve completely.

Significant swelling accompanied by marked redness and worsening function can indicate a problem and you should let us know if this happens.

What should I do if the sticky plaster (primapore) starts to peel off or is stained with blood?

The job of the primapore is to catch bloody discharge for the first few days after surgery. When it starts to peel off, it can be removed. In some cases the primapore will stick to the skin well and last until the time of the wound check/suture removal 10-14 days after surgery. If this happens, your local vet can take it off for you when they check the wound.


Should my dog wear an Elizabethan collar?

In many cases your surgeon will recommend that your dog wears a collar after an operation. Contrary to popular opinion, a dog’s saliva is not useful for wound healing. There are many nasty bacteria in a dog’s mouth that can trigger severe infections. It is very common for dogs that lick their wounds to suffer infections that can significantly delay recovery and can sometimes mean a second operation to treat the infection.


When should the collar be removed?

The collar is used until the wound has healed completely and the skin sutures have been removed. Your local vet will sometimes recommend using the collar for an extra 2-3 days after suture removal.

The collar should only be removed in the first 10-14 days when you are directly supervising and can ensure with 100% confidence that your dog cannot lick the wound. Dogs are normally able to sleep well and eat their food with the collar in place.


Which design of collar is most suitable?


There are several designs of Elizabethan collar. For most wounds, the traditional plastic collar is the only way to ensure a dog cannot reach their wounds. In some cases, flexible Elizabethan collars work equally well and for small wounds at or above the elbow joint on the fore limb, inflatable collars can work well.


My dog has sickness or diarrhoea after an orthopaedic surgery. What should I do?


Sickness and diarrhoea are relatively common problems. There can be many contributing factors including anaesthesia, stress and the medications being given during recovery. The best plan is to stop giving the medication and to call us or your local vets to ask for advice. If we need to withdraw a medication due to sickness or diarrhoea there is typically another medication that we can substitute.

For more information or to request images please contact mike.farrell@vetspecialists.co.uk

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