Aftercare FAQs

A harness is a very useful “handle” for lifting the front end.

The towel belt from a dressing own or a broad leather belt can make useful loose loops to function as slings for under the tummy to help lift the hind quarters. These are better than using towels, as they are easier to hold and less likely to slip out of your hand.

See our "how to correctly transport pets" information sheet here (PDF)

Some dogs with long term oesophageal and swallowing problems – e.g. patients with megaoesophagus, which remains present after vascular ring anomaly surgery – need to be fed from a height long term.

Feeding pups from height can be done as shown:

For adult dogs, you can buy food/water bowls that are elevated on a stand and train the dog to eat in a seated position so that the oesophagus slopes down from the mouth to the stomach. If your pet is resistant to eating seated, you can achieve the same effect in the standing dog by having the bowl even higher and putting a step – an aerobic exercise step works well for big dogs – in front of the bowl so that the dog has to put its front feet up on the step to reach the bowl.

Some surgeries bruise and swell post-operatively. Some cruciate ligament surgeries do this.

The key things to look for are:

• Is your pet still well in themselves and eating well?
• Is there any discharge from the surgical wound?
• If the surgical wound is an orthopaedic one, is the leg capable of weight bearing?
• If in doubt, take a picture and email/text it to us.

The picture below was taken 2 days post-op after a cruciate ligament surgery, done with a bone cutting technique (closing wedge TPLO). This one has bruised and swollen more than most, but there is no discharge and we expect this to settle down over the next few days. So, a simple picture emailed through, and a phone conversation was all that was needed.

Some cases really benefit markedly from hydrotherapy – e.g. femoral head and neck excision.

Many cases can benefit from hydrotherapy – e.g. cruciate surgery.

In some cases, hydrotherapy is specifically NOT recommended e.g. total hip replacement.

The aftercare sheet we will have given you very often specifies whether hydrotherapy is recommended after the surgery your pet has had. It will often have been discussed during the consultation. The wounds must be well healed before hydrotherapy, and this means no hydrotherapy at least until we’ve seen you at 2-3 weeks post-op. We see almost every case back at this time. If in doubt, ask us!

The hydrotherapy industry is unregulated – meaning just about anyone can set themselves up as a hydrotherapist. Skills, experience and facilities vary widely.

Rehabilitation, physiotherapy and hydrotherapy have moved on in recent years and many vets are now getting personally involved with rehabilitation. The use of underwater treadmills is becoming very popular as a more readily available method of using water for rehabilitation than a large expensive swimming pool with all of the plant that that requires. In addition, there are often wider physiotherapy services available alongside hydrotherapy.

Our referral catchment area is very wide and we can't psosibly keep up with the servcies in all georgprahic areas. Similarly, we can't be sure we've heard all the latest news about a pet - has it got ear infections? Or skin disease? Or developed seizures? All of which could have big implications for rehabilitation. 

So we  may advise rehab/physio/hydro, but we leave the actual referral for this to the referring general practice who normally sees the case. See our section About us / Policies for a full explanation of our policy for referring on rehab/physio/hydrotherapy

https://www.wm-referrals.com/images/2021-content/policy-on-redirections-for-hydrotherapy-physiotherapy-and-rehabilitation-170101.pdf

There are two organisations that hydrotherapy centres can voluntarily submit themselves to for assessment, which includes assessing their cleanliness and standards of hygiene. These are the Canine Hydrotherapy Association (CHA), www.canine-hydrotherapy.org and the National Association of Registered Canine Hydrotherapists (NARCH), http://www.narch.org.uk.

There are two good options for getting quality hydrotherapy and physiotherapy local to Burton on Trent with veterinary supervision. While many centres continue to do a good job without veterinary staff on the premises, centres that have veterinary staff involved with the rehabilitation are able to offer a more refined and involved rehabilitation service.

Pool House Veterinary Hospital are located in a rural on the southwest side of Burton on Trent. They are a large well-established general practice with an excellent reputation giving a very good service at sensible prices. Their lead hydrotherapist is a Registered Veterinary Nurse who is involved in the advanced training of other hydrotherapists.
www.mobilitymattershydro.co.uk

Emma Poore is a veterinary surgeon with special interest and expertise in physiotherapy and rehabilitation. Emma runs her own general practice, the Star Veterinary Clinic at Appleby Magna. Her clinic is also in a rural setting on a small industrial park, but it is very modern and she has invested heavily in quality equipment right from the off, including a water treadmill and gait analysis mat. Emma sees a heap of agility and working dogs, and rehabilitation is her passion! She is involved in the training of other rehabilitation practitioners. www.starvetclinic.co.uk.

Stair gates are a good means of preventing access to stairs or to particular rooms. If your pet is normally allowed into the lounge to climb onto chairs etc, or if it has a favourite window sill to climb onto, consider keeping the door to that room firmly closed, and hang something on both sides of the door handle to remind you to shut it! Use a lead, this can even be considered for cats, and cats often do better with a lead and harness rather than a lead and collar. For neck injuries you need to use a harness rather than a collar anyway. Assist your pet into and out of cars. Use ramps, or else use a helping hand under the pelvis on the way up, and a helping hand on the breastbone on the way down.

Consider using a cage. Ones that are about 36″ long (approx. 90-100cm) work well for cats and small dogs. We sell these for £60, but we suggest you buy in advance on-line, or else beg/borrow one from friends/neighbours to save yourself some money. Try putting a request to borrow one on your Facebook network – you’ll be amazed how many of your friends have one folded away idle in their garage.

Really big ones can be conveniently and economically bought from large stores or on-line. Keep your pet’s playmates calm and under control. Avoid winding them up to exercise with toys. Make sure children know the rules!! If you aren’t sure they’ll comply, consider using cable ties as a cheap way of securing the cage door from inquisitive fingers! But in our experience, children often love the responsibility of feeling that they are in charge of supervising the pet’s restricted activity!

As a rule, no. Gentle blotting of any discharge with a dry, clean, non-linting cloth like a clean tea towel or kitchen roll is a good idea. Avoid cotton wool. Avoid rubbing. If you wet the wound you may make it look cleaner to the naked eye, but you are actually turning bacteria on the skin and any discharge into a soup that is then washed back into the wound. If there is discharge, seek advice. Consider sending us a digital photo to This email address is being protected from spambots. You need JavaScript enabled to view it.. Two particular wounds that can often look a little crusty in the early stages are ear wounds, and perineal urethrostomy wounds in male cats that have had surgery for an inability to pass urine. These wounds should be left alone other than blotting. They will look much better after suture removal!

Licking at the wound can result from clipper rash, which is skin irritation caused to the skin during wound preparation. Licking might also reflect suture irritation; sutures may become a little tight if the wound swells at all. Discharge, sometimes indicating infection, can encourage licking as normal cleaning behaviour. But licking can be destructive, and it is best avoided. Seek prompt advice if licking persists. We may use dressings or collars to prevent licking causing damage to the wound.

Discharge, especially smelly discharge, from a wound is cause for concern. Infection often causes increased interest in the wound with licking noted. Your pet may be off-colour and declining food.

Infections are not likely at all. We are scrupulous in our standards of disinfection and hygiene, and in preparing wounds for surgery. We strive for zero-infection rate, but the sad reality of surgery is that this elusive goal is never quite reached. Infection risk in otherwise routine surgery is often quoted at around 2%.

Willow had a tracheostomy procedure to allow her to breathe through a stoma (hole) in her neck, by-passing the larynx. (Some saggy flaps of skin were also resected from either side of the neck to stop them flopping over when she slept and inadvertently blocking the stoma). Hair round the stoma can accumulate exudate and smell a little. The moist skin under the wet hair can get sore. It is an easy matter to keep hair clipped from around the hole. This is best done with two people, one to gently hold the head up, and the other to use a quiet pair of clippers (e.g. male grooming kits from Boots or Argos) and a vacuum cleaner on a very low setting to draw the clippings away from the stoma.

This technique also works well on simple skin wounds – e.g. on the legs and body.

Then just blot the stoma or wound dry with kitchen towel (not cotton wool which will “lint”). Once it is dry, a sparing smear of Vaseline/petroleum jelly will help protect the clipped dry skin from further moisture.

Let’s be honest, your pet isn’t likely to want the collar on! But consider the consequences of the collar coming off. It is usually best to put it on and leave it on. They can often be cleaned in situ with a damp cloth without the need for removal. Let them get used to the collar, have their moment of annoyance, and then come to terms with wearing the collar. If you keep taking the collar on and off, the pet gets frustrated because it thinks the collar is a punishment and they don’t understand what they’ve done wrong. If you take the collar off, they are back to square one, having to get used to it all over again. Most animals can eat and drink just fine with these collars on, even though at first it might look impossible. An alternative to an Elizabethan collar is an inflatable one which may be adequate to protect wounds from licking in some cases.

Inflatable collars are one alternative to the classic “Elizabethan” collar or “lampshade” collar, to prevent licking. They don’t stop licking as effectively in our experience, but they are usually better tolerated by the patients. They need to be kept well inflated! An inflatable collar can be used behind a shorter/smaller Elizabethan one than might otherwise be used. The inflatable collar can keep the smaller Elizabethan collar well forwards, whereas otherwise the shorter one might ride backwards on the neck, rendering it ineffective.

T-Shirts or home-made vets made out of fleeces and tights have been used by many of our clients, to avoid Elizabethan collars. You can buy these from suppliers like Equafleece.

Don’t let the dressing get wet. Walk your pet on pavements, on paths or on well mown, dry grass, not muddy fields! For limb dressings, use a thick polythene bag over the end of the limb during toilet breaks. We often give out drip bags (bags that have previously had saline in them). If these are cut in half and the inside is dried out, they make for strong “wellies”. Parcel tape is handy for keeping the bag up for the few minutes that they need to be on. But don’t leave bags on for more than a few minutes at a time, as they keep moisture in as well as out. That means that if they are left on for long periods, the foot will become sodden anyway.

Some animals urinate on dressings by mistake; to guard against this, you can place a bag over the foot as above, and then wrap the dressing that is still exposed above the bag with cling film. This can then be removed a few minutes later after the toilet break.

If the dressing slips, get it seen to. A slipped dressing is an irritation to your pet, is no longer protecting or immobilising what it should be protecting and may even be increasing the leverage on injured bones/joints. The great majority of our dressings are put on so that you can just see or feel the claws at the end of the leg. If you could see them, but now can’t, the dressing has probably slipped.

Make sure the dressing is changed at the appropriate interval. If you can’t remember when, please ring and ask!! Usually dressings are removed and/or changed every 3-7 days. Sometimes we’ll leave them on a bit longer, but it would be very unusual for the interval to be more than 10 days.

Most dressing changes can be done conscious while you wait. For some more feisty pets, sedation may be needed so it would be wise not to feed your pet for a few hours before a dressing change, just to be on the safe side.
For some surgeries, a dressing incorporating a splint, or a cast is used, often for several weeks.

Animals will often try to pull the padding layer out of a dressing if they are given half a chance, so please be pro-active in using an Elizabethan collar to prevent interference with the dressing.

Dressing sores will unfortunately occur from time to time. These are more common if the dressing is allowed to get wet; if the dressing incorporates a splint or cast; if the dress is maintained for several weeks; if the dressing slips; or if the dressing is interfered with. These sores usually resolve uneventfully once the dressing is removed.

Many surgeries will simply have a thin Primapore dressing over the site. This is a thin white dressing. If the wound is exudating, it will be obvious through the dressing which will be wet. If this occurs, let us know promptly. Many wounds will leak the odd spot of blood or tissue fluid immediately post-operatively, but in this case the evidence of exudate will be minimal, dry, and the Primipore will look the same every time you look at. Be wary of trying to replace the Primpaore yourself unless advised to do so. We glue ours on, and it is unlikely that you’ll be able to get a replacement to stay on long at all.

We advise that you just leave the Primapore alone and let it fall off in its own good time. This often occurs in 2-3 days, which is fine. The record is currently held by a post-op spine patient who kept his original Primapore on for 4 weeks before even we got impatient and took it off!

Socks held up with loose laces

Sports socks (they are harder wearing!) can be adapted to cover the claws. Laces can be threaded through them. Be careful not to over tighten these as this could interfere with blood supply and also adversely affect tendons (e.g. the Achilles tendon).

“Hobbling” the bag legs together with Elastoplast can be used if all else fails to prevent the legs from being lifted forwards by the pet independently. Be careful not to use tape applied too tightly; we would advise that this is only ever done under vet/nurse supervision, at least for the first time you do it so you are shown what is required.

Pins and wires, and screws and plates, can sometimes be the cause or irritation months or years after surgery. If this happens there will often be swelling and/or licking at the site. Removal of the metalwork usually leads to rapid resolution of the problem.

Antibiotics:

• Claviseptin and Baytril are two antibiotics that we commonly use. Side effects of these are few and far between.
• Non-steroidal anti-inflammatories:
• Metacam and carprofen are our usual choices. Only one NSAID is used at a time. They can sometimes cause gastrointestinal upsets – vomiting or diarrhoea. If these signs are seen, stop the medication and seek prompt advice. We may avoid these or use reduced doses in the event of liver or kidney problems.

Analgesics:

• Tramadol. This is an opiate painkiller. Side effects are occasionally seen and can include drowsiness and vomiting, and dysphoria ("tripping").

Our fixed price scheme includes an initial supply of drugs from us that typically lasts 5 days. 

We typically supply antibiotics (usually clavaseptin), non-steroidal anti-inflammatories (NSAIDs, usually carprofen or meloxicam), and often extra analgesia (usually tramadol for dogs and buprenorphine for cats).

We typically supply enough medication for 5 days, a common time for an early post-op check-up.

We don’t make any charges for follow up checks, but we do make charges for any follow up drugs. As policy, we ask that further medications are sourced from the referring veterinary practice. As a surgical practice our drug stock is far more restricted in range and quantity than is the case for a typical general practice. So, we can’t supply some medications, and even if we could, they are almost certain to be substantially cheaper when sourced from your own practice. 

So for some drugs that we don;t stock we will need to arrange for you to get these from your usual vet, and these will be chargeable to you.

Eating and drinking should be occurring pretty much as soon as you get your pet home. Your pet will normally have been observed to eat and drink in the hospital before discharge, although some animals, especially cats, simply refuse to eat in a strange environment. Urination should have occurred in the first 12-24 hours after discharge. If it hasn’t, we need to know promptly! The bowels often grind to something of a halt with a general anaesthetic and with the opiate drugs that we give for pain relief around the time of surgery. Add to this the starvation before anaesthetic / surgery and reduced appetite post-operatively (or enforced with-holding of food in some cases), and it can take a few days for defaecation to normalise.

Passive extension exercises are required in the two months following this surgery. We recommend 3 sessions of 5 minutes each per day, for two months. Giving your pet pain killers over this time will make life a lot easier for them and for you.

Femoral head and neck excision (FHNE) involve removing the ball of the hip ball-and socket joint, usually with an oscillating saw. As healing progresses, a fibrous tissue articulation develops to replace the joint. Diligent physiotherapy and/or hydrotherapy is needed in the following two months to keep this pseudoarthrosis (“false joint”) articulation flexible to achieve a decent range of long-term extension. One major benefit of FHNE over almost every other orthopaedic procedure is that there is no need to restrict activity in the post-op period. Activity, including stair climbing etc, is very much encouraged. See our post-op aftercare sheet for FHNE for more detail.

This surgery is vastly cheaper, less technically demanding and less complication-prone than total hip replacement. Indeed, when THRs do get serious complications, they often get revised to FHNEs. The function that is achieved with FHNE is usually more than adequate in cats and small dogs. FHNE is generally less adequately functional the larger the patient gets. That having been said, good outcomes can still be achieved in larger dogs.

Common indications for FHNE include:

• Luxation of the hip joint(s) secondary to hip dysplasia where hip replacement is not an option.
• Chronic degenerative joint disease failing to respond to medical management where other surgical options have been ruled out.
• Fractures involving the joint where fracture fixation is not possible /desirable or is ruled out by economic considerations.
• Legg Perthe’s disease, typically seen in young terriers. One or both femoral heads lose their blood supply and disintegrate. Legg Perthe’s disease is painful.

These images show how to do the extension exercises:

Slings can be bought, or they can be improvised from a leather belt, a scarf or an old bath towel. Helping your pet to balance, while letting them take much of their weight, can be very useful. Keep your own back straight when you are lifting them!

Regular short periods of lifting, every 2-3 hours, are better than less frequent periods of lifting. If intervals are longer muscles stiffen up and cramp.

Partly inflated Pilates balls can be useful for big dogs. Straddle the dog over the bag and gently rock left and right, forwards and back to encourage them to make decisions about weight bearing and adjusting posture.

Your pet should be regularly alternating how it lies, and on which side. Hydrotherapy is really useful, as is advice from one of our recommended physiotherapist / hydrotherapists. Short, dry grass, rubber matting or rough carpet is an ideal surface for early walking attempts. The texture is good for stimulating sensation, while providing some grip and cushioning.

Take great care that your pet doesn’t traumatise the top surface of their feet on hard surfaces. Steps made out of paving slabs are a nightmare for this as they have very sharp and unforgiving edges. To screen off these edges, get some foam pipe lagging material from a DIY shop, slit it long ways and stick it with duct tape over the edge of the step.

Tickling the toes with an electric toothbrush is a good way of stimulating sensation.

For large dogs, a frame supporting a sling can be very useful to take the dog’s weight while the individual legs are worked on.

Swimming under the control of an experienced hydrotherapist or physiotherapist helps maintain muscle mass and joint range of movement after orthopaedic surgery, and using the support of water can greatly assist mobilising limbs after spinal surgery before recovery has progressed far enough to allow unaided walking. Wounds must be healed before immersion, so we would rarely advise swimming earlier than 3-4 weeks post-operatively. We would only recommend hydrotherapy pool that are affiliated to the Canine Hydrotherapy Association (CHA) or the National Association of Registered Canine Hydrotherapists (NARCH).

Some hydrotherapy services have veterinary and physiotherapy advice available on site. eg Pool House Veterinary Hospital in Burton on Trent and STAR Rehabilitation Clinic at Appleby Magna near Swadlincote.

Some orthopaedic procedures involve the use of an external fixator see photo which involves pins protruding from the skin connected to a scaffolding that links them. Some minor discharge from the pins is normal. Blot any discharge gently with non-linting material once or twice a day and don’t bathe the wounds. It is very important that the frame doesn’t get hooked on to carpets, tassels on furniture, curtains, the bars of cages, under radiators etc. If your pet escapes from the house, there is a pretty good chance the frame will get hooked on a fence so keep them in!! Consider the use of a cage. Consider screening off the bars of the cage with cardboard or hardboard inside the cage. The sharp ends of the pins often concern owners because they fear that the sharp pin ends will prang the other leg. Animals very quickly learn to avoid doing anything that hurts! However, the sharp pin ends pose quite a risk to your hard-earned furniture. Please take precautions before bits of wood get gouged out of favourite chair legs etc!

The clamps, (the bits with nuts and bolts which connect the pins coming out of the leg to the connecting bars), should be well clear of the skin. if you can’t see “daylight” between the clamp and the skin, get advice. You can bring the patient for a recheck, or you might consider taking a photo and emailing or texting it to us, and then giving us a call.

Simplest is to “express” the bladder. Gentle pressure is applied across the abdominal wall to compress the bladder so that urine is expressed down the usual channels. This requires a compliant patient that will tolerate the manipulation. We do this a lot for hospitalised patients. Some owners and some patients might be suitable for this technique being taught for the owner to do at home on a short- or long-term basis. Please don't try this yourself unless you have been shown how to do it porperly. 

Bladder expression is done 3-4 times per day. Sometimes drugs can be used to reduce the outflow resistance, to make it easier to express the urine.

In male dogs (that have willies!) it is easy to pass a catheter and we regularly teach owners how to do this, so that they can empty their pet’s bladder at home. This most commonly done for convalescing spinal surgery patients where the ability to urinate has not yet returned, and where cost issues mean that prolonged hospitalisation is not desirable. There is some risk of introducing infection into the bladder at the time of catheterisation, which could cause ascending urinary tract infection (UTI) with cystitis, and even pyelonephritis (kidney infection). So hygiene is imperative for catheterisation and we often have these animals on prophylactic (precautionary) antibiotics and bladder wall protectants (Cystaid, Cystease etc).

We can place indwelling catheters (most commonly in females), but this has increased risk of UTI and there is the need for an Elizabethan collar to prevent the patient from interfering with the catheter.

Owners often ask what the future holds after an osteotomy (“bone cutting”) procedure for cranial cruciate ligament rupture. These dogs either have at the time of surgery, or else will go on to get in the future, some degenerative joint disease (DJD). This is to be expected because a joint with a ruptured ligament and/or torn cartilage is no longer “pristine”. It is also important to remember that many dogs develop problems with the cruciate ligaments in BOTH of their stifles (knees).

But after osteotomy surgery for cruciate ligament rupture(s), most dogs return to a quality and level of activity that is, for all practical purposes, normal. They can run round the park, enjoy games with the kids and go on long family walks. Often owners report no significant lameness at all in the months/years following surgery, or else report a dog that just gets a bit of stiffness for a few moments on first rising from rest but is not apparently stiff or lame after that. Later in life, treatment for the DJD that follows cruciate ligament injuries might be required – see our information sheet on this topic under “fact sheets”.

Consider, the footballer Michael Owen had the best cruciate ligament surgery that money could buy … but it almost certainly won’t save him from arthritis in that joint when he is older!

We recently heard a very pleasing report from the owner of Otto, a large breed dog (Doberman), sent to us a by a delighted owner one year after surgery. This dog returned to full-on athletic function. In March 2015 Otto was 2 years old and 40 kg in weight when he had a TTA osteotomy procedure. He also had a cartilage tear which was tidied up at the same time. In March 2016 we received an email update:

“I wish to thank you for the remarkable recovery my working Doberman Otto has made in the 12 months since his cruciate repair. He has gone from being totally lame to competing in the dog sport Schutzhund and claiming his first title of IPO 1. Not only that, but he had the highest overall score of all dogs competing and the highest Tracking score of all the dogs entered! I cant thank you enough as he is so fit and agile. From the state he started from, never thought this would be possible. Once again thanks for the care you gave him and top class surgery that put him on the road to recovery from a serious injury. I have attached a couple of pics from the day he arrived home and from last Sunday to show him before and after. I cant say how much I appreciate what you and the team did for Otto. Many thanks from Mark & Otto”

[From Wikipaedia: Schutzhund (German for “protection dog”) is a dog sport that was developed in Germany in the early 1900s as a breed suitability test for the German Shepherd Dog. The test would determine if the dog displayed the appropriate traits and characteristics of a proper working German Shepherd Dog. Today, it is used as a sport where many breeds other than German Shepherd Dogs can compete, but it is a demanding test for any dog that few can pass].

We were similarly delighted to get this email . It is always nice to hear long term follow up on how cases are doing.

“Good Morning All, One year ago today our 3 year old Cocker Spaniel Cav was admitted to your fantastic hospital for a cruciate ligament operation. I must admit I was extremely nervous and Cav was to! From start to finish all the team at west midlands referrals were fantastic and the operation has been a huge success. I would just like to say one year on he is back to his old self with long walks and always looking for the next adventure. You looked after my best friend like he was your own and I am extremely great full for all your help and hard work so please accept and enjoy a small token of some flowers which will be with you today and please enjoy them in your reception. We’ve sent a picture of Cav, back to his best! Thank you again kind regards. The Scott family, Derbyshire”

A client had a dog with two splinted front legs after surgery after it fell from a cliff. The dog was struggling to walk on the splints on slippy floors and was a bit like “Bambi on ice”.

So, a bit of old rubber matting, double sided industrial tape or strong glue, and a bit of ingenuity led to the attachment of these “grips” on the slippy ends of the splints.