Rehab for Pet Surgery – 3 Steps

Spaniel dog with plastic Elizabethan collar on her
Jicky the Spaniel in the E-Collar after FHO

A quick bit of info for you after your pet has had surgery.

I do work on lots of cats and a variety of other animals. If you want to know more about cat specifics now (because I haven’t finished developing the cat pages), please search for cat in the search box 🙂

For more specific info on a particular surgery or diagnosis, please refer to the menu (and drop-downs) at the top of the page. If you do not see what you are looking for, please use the search box on each page.

If the injury is a torn knee ligament in your dog, and you have been told surgery is necessary but you have not yet taken your dog to surgery, then please click here to read more info about that condition. After that, please go to the instructions on this page!


“My pet just had surgery…
…and now that I’ve gotten them home, I realize I’m not really sure what to do!!”

First and foremost:  pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or you have received instruction about an injury.  Please pay special attention to the part about no running, jumping, or playing. If you follow my booklet instructions, you and your pet will be doing work proper for recovery and should not be causing any harm.

If your veterinarian did not say so, please note there should not be any flying over couches, no galloping on stairs, no jumping into or out of cars and trucks,  no jumping onto couches or your bed, no jumping off of couches or beds, no twisting very fast in tight circles, no sliding on ice or slippery floors, and no freedom in and out of doggie doors.  No owner jumping out from behind things to scare the dog into running crazy funny around the house like you sometimes like to do.

No running really means no running…

…to the door when the doorbell rings, no running away from Halloween costumes, no running from one end of the house to the kitchen every time the fridge or a plastic bag is opened, no running to you when you yell to ask the dog if it wants to go outside, no kitty running from anything right after surgery, and no running inside after the ball, which is very similar to no running outside after the ball. No, no swimming until at least 8 weeks after surgery and then only if no lameness is present at a slow walk.

DO work on the protocol below and the info contained in the instruction booklet.

1) Here are guidelines to follow for the first four weeks after surgery:

Right now I only have one book published with information about helping your pet through four progressive weeks of functional therapy and recovery after any surgery. Guidelines for Home Rehabilitation of Your Dog: After Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

This book is specifically addressing surgery after a torn knee ligament, yet until I am able to publish the books I am working on that deal with hip issues, other knee issues, elbows, spinal issues and more, this book will be very helpful to you for the first four weeks of recovery if your dog has had one of these other surgeries.

This book has the information, restrictions and advice I would give after almost any orthopedic surgery, so if you follow the restrictions and the practical applications in the booklet, your pet should do well and recover progressively if there are no additional issues.  These restrictions will match a lot of what your vet surgeon gave you to follow after surgery.

Additionally, these instructions incorporate information for functional recovery, my specialty, so there is a LOT more structured and guided info in the book. The links to the book I made for this page will take you to Amazon U.S. and if you would like the links to Amazon in other countries, read below the picture of the book.

I also have info elsewhere on this site about cats and surgery. Cats aren’t small dogs. Unless your cat will walk on a leash, which some do very well, I recommend looking at this page for now.

So, the following book will help you calmly and methodically approach the recovery of your pet’s surgery, and the book will guide you about establishing a functional base of activity. After the base is built, then there are more strengthening programs and other drills to be done to return your pet to a rambunctious lifestyle.

A good recovery plan helps guard against future or further injury, especially in the opposite limb! I am very happy to report that people and dogs that follow both this and the non-surgical program for 12 weeks do not end up with the other knee ligament tearing. It’s all a matter of balancing the work, my experience with exercise physiology recovery principles, and people being connected to their pets!

Amazon for USA, CA, DE, ES, FR, IT, & UKMy booklet with instructions to follow after dog knee or any orthopedic surgery
Amazon in other countries 

Books are also available on Barnes and Noble and you should be able to order them from any bookseller, especially if you use the ISBN.

Instructions for first four weeks for dogs after FHO (hip surgery where the ball of the femur is cut off):

Instructions for first four weeks after surgery for luxating patellas (flopping kneecaps):

and there are a few more homework pages to be found by following the links in the menu at the top of the page or by using the search feature.

2) In addition to thoroughly reading any of that info (some of which now includes exercises available in book form), please watch > this video < twice, and begin to do this massage daily for a month:

Please watch the video to see my recommendations on method of use for massager unit AND so you will hopefully have success introducing the massager.

There are written instructions under the video on the linked page.
Here is what the massager looks like, and if you click on the picture, you may buy it on Amazon if you choose:

Homedics brand hand-held massage unit with four feet

3) If your pet is still limping 5-7 days or more after surgery, please read this > pain post < all the way through!

There is more on the topic of pain within the books-

Check out other resources under the “Rehab Resources & Tools” link in the menu under the website title at the top or by clicking here



(Original Post March 17, 2015. Updated March 3, 2018)

Fighting Foot Drop in Humans Translates to Pets, Too!

Fighting Foot Drop in Pets

This Post:

  1. Helps you understand why the foot doesn’t go flat on the floor
  2. Gives you suggestions to fix that condition
  3. Helps you see how human rehabilitation can be helpful for pets

RehabDeb Comment:

Employing these techniques for foot drop in pets is what I do and is highly successful. You may also build neuromuscular strength in pets by doing proprioceptive training.

Boots and Splints –

I use foot-bed hard splints and  dorsi-flex assist soft boots on a case-by-case basis for foot drop in pets. Both of these helpful tools serve a different purpose; they are not necessarily interchangeable in use!

People sometimes order a soft boot with toe flexion help when they actually need a hard splint and vice-versa. Please confer with an experienced rehabilitation specialist who has used both of these products. They should have experience with a large variety of cases so that you don’t waste resources or damage your pet.

I also urge you to listen to your common sense in the matter of braces or splints. Sometimes staff at brace or splint companies have suggested to mutual clients equipment that is too generic.

The course of action with assistance tools should be based on a broad problem-solving thought process. Each client will do best with a solution unique to them. I have had discussions with physical therapists at brace and orthotic companies to point out functional and physics errors in their designs for some few cases. I love that orthotics for pets are available! Getting the wrong fit leads to unnecessary expenses, possible pet injuries, and not as much help with recovery. Plus you have to spend lots of time on the phone working out the problem. Meh.

Making Braces at Home –

See the end of this post for a brace I made for Anatolian Shepherd Parker with hind limb dysfunction and partial paralysis. I purchased the materials at local stores for less than half the cost of commercial boots. This method was less expensive, however the client had also paid for a commercial boot I measured and ordered.

We needed the boot right away and the boot we ordered was going to take almost two weeks to arrive. I wanted to give the caretakers proper tools for the situation and use those tools to avoid paw dragging and new sores on the top of the paw. The commercial boot works better, in general, than my temporary boot. If I spend more time on my creation boot, then it works as well as the commercial boot. Regardless, we had mine to help in the meantime while we waited for the other one.

I create many helpful tools for pet rehab on a case-by-case basis. I know what results I am hoping to achieve and have a lot of MacGyver-type experience. If you try this at home, I recommend you get a veterinarian or a human physical therapist to help you with design. These professionals should have the most experience with neurological problems and help your pet get the best results.

The standard education for most veterinarians and veterinary rehabilitation specialists does not train them in advanced neurological problem drills. I am not slighting them; I am guiding you so that you may have more options for helpful tools. That is why I suggest a human physical therapist, hopefully one with lots of neuro experience. Your veterinarian will usually tell you if they have a lot of advanced experience with diagnosing and recovering neurological cases. Many veterinarians do not have this experience because of the advent of great veterinary specialty education. Board-certified veterinary neurologists are a thing.

From “Advance Journal for Human Physical Therapy”

The Foot Drop Fight
Early treatment and compliance with a home exercise program are essential.
By Rebecca Mayer Knutsen

Originally Posted on: December 20, 2012

Foot drop, a general term for difficulty lifting the front part of the foot, can be a temporary or permanent condition. The condition signals an underlying neurological, muscular or anatomical problem.

A patient with foot drop due to weakness or paralysis may exhibit behavior such as scuffing her toes along the ground. Or she may develop a high-stepping gait so her foot does not catch on the floor as she walks.

Beyond the obvious frustrations and limitations that accompany this condition, these patients are at greater risk for falls. According to physical therapists, early treatment and patient commitment to a prescribed home exercise program is often the best approach for patients with this gait abnormality.

Gaining Control –

The source of foot drop is most commonly a central neurological impairment such as stroke, multiple sclerosis or traumatic brain injury or a peripheral injury such as nerve damage stemming from knee replacement surgery.

“Controlling foot drop through strengthening, orthotics or a functional electrical stimulation foot drop system may address the instability of the ankle, limit the possibility of catching the toe during gait and increase safety and stability to decrease the potential of falls,” said Gregory A. Thomas, PT, physical therapy supervisor, Rehabilitation Center at Eastern Idaho Regional Medical Center in Idaho Falls, ID.

Therapists must conduct a thorough PT evaluation that includes a complete patient history and an assessment of range of motion, strength, sensation, spasticity, reflexes and mobility. Treatment varies depending upon the cause and presentation of the foot drop. Treatment options range from therapeutic exercises including ROM, stretching and/or strengthening to electrical stimulation and gait training.

“The first thing I do with a patient is determine if the dysfunction is central or peripheral,” explained Douglas O. Brown, PT, CSCS, manager of Raub Rehabilitation, Sailfish Point Rehabilitation and Riverside Physical Therapy, all part of Martin Health System in Stuart, FL. “Is it a brain injury such as stroke or MS?” Brown asked. “Or is it a pinched nerve in back or leg or damage from a hip surgery?

After Diagnosis –

Once the origin of the foot drop has been determined, Brown must determine if the patient is flaccid with no movement whatsoever. If so, then the outcome /prognosis will not be as good as someone who exhibits some movement,” he shared. (Flaccid limbs or muscles in pets are the ones that need range of motion drills, NOT limbs that the pet moves moderately well on it’s own – Deb).

According to Thomas, PT exercises for this patient population include range of motion exercises for knees and ankles and strengthening leg muscles with resistance exercises. And, stretching exercises are particularly important to prevent the development of stiffness in the heel.

“There are no exercises that are off limits to these patients as long as the ankle is stable during the exercise,” Thomas explained. “The exercises can be closed chained or open depending on the level of stability.”

Focus Work –

We have to focus on restoring normal movement patterns but also on stability,” Brown said. “Can the patient stand on one leg without swaying back and forth? It’s important that we remember the static part because these patients function on different surfaces in real life.” (I focus on these principles with my patients that have neurological problems-Deb).

Brown prepares patients for challenges met in the community and at home by having patients walk on foam mats in the clinic and then on various surfaces outside.

“If my patient’s goal is to be able to walk the beach in her bare feet, then we need to work on uneven surfaces,” Brown said.

The therapists need to understand a patient’s case 100 percent and treat each one as an individual. These patients need to be assessed on their own merits, according to Brown. “If I have a patient with a traumatic ankle injury from being run over by a car, then I may stay away from certain load bearing exercises,” he shared.

Enter the AFO –

If a patient does not have functional use of his muscles, then an ankle foot orthosis (AFO) can be used to keep the ankle at 90 degrees and prevent the foot from dropping toward the ground, thereby creating a more even and normal gait.

The type of AFO used depends on each patient’s specific needs. Some of the types most commonly used include solid ankle, articulated ankle and posterior leaf spring and are most typically made of polypropylene. Articulated ankles allow for some ankle motion, dorsiflexion assist and partial push-off during gait and solid ankle AFOs are rigid and more appropriate if the ankle and/or knee are unstable. Patients typically need to wear a larger shoe size to accommodate these types of AFOs.

Goals –

“As a physical therapist, I need to realistically fulfill the goal of a patient, which in the case of foot drop, is most typically to stop using an AFO,” Brown explained. “But there are other issues to consider aside from the annoyance of the device. I may need to worry about comorbidities such as diabetes and how the AFO may be causing skin breakdown.”

Brown aims to improve his patients’ optimum function and quality of life while decreasing the fall risk. “Once a patient tells me his goals, I need to determine if they are realistic,” he told ADVANCE.

The goal of physical therapy with these patients is to use the least restrictive device, according to Thomas. “If there is active movement at the ankle and we can strengthen it back to normal, then a temporary brace can be used for support and to increase safety,” he stated. “If the foot drop is more long standing, a custom fitted AFO may be needed.”

In the last 10 years or so, AFOs have improved in quality and function, according to Brown. In fact, he says, some AFOs are made of carbon fiber and elicit a dynamic action instead of keeping the foot rigid while going through the swing phase of gait.

FES, Another Option –

Another option is a foot drop system that applies electrical stimulation in a precise sequence, which then activates the muscles and nerves to lift the foot and bend or extend the knee. This type of device assists with a more natural gait, reeducates muscles, reduces muscle loss, maintains or improves range of motion and increases local blood circulation.

The foot drop device allows a flexible ankle during gait to obtain a more normal walking pattern. A good alternative to bracing, the device’s gait sensor adapts to changes in walking speed and terrain, allowing the patient to walk easily on stairs, grass and carpet.

Brown recently treated a 37-year-old woman with early stages of MS. He put the FES foot drop system on her and it helped her walk normally for the first time in years, bringing tears to her eyes.

“FES can help patients develop great gait patterns and fire muscles,” Brown observed. “FES shows the potential for improvement and the patient can rent the device themselves to wear all day instead of an AFO. The technology is helpful but the device isn’t for everyone. There is a better response with central foot drop as opposed to peripheral lesions.”

The device works well when the peripheral nerve is intact. Patients with a peripheral nerve injury-from diabetes or trauma-who have no palpable muscle contractions may not see improvements.


“If the damage is peripheral nerve, then a FES foot drop system will not work in correcting foot drop and [you will have to use] a passive AFO system,” Thomas shared.

If disease or injury interrups the patient’s spinal cord in any way, then retraining the muscles is often very difficult.

An AFO remains the appropriate solution for patients with lower-extremity edema, unstable ankle stance or cognitive impairments. Those conditions will all interfere with operation of a foot drop system.

Complying at Home –

For this condition, patients typically go to therapy for about 45 minutes, two times a week, according to Thomas. “If a patient is going to make gains, it’s imperative that there is good compliance with a home exercise program,” he shared. “The patients who have the greatest success are the ones with a solid work ethic outside the clinic.”

Brown’s approach to ensure compliance with a home program begins with the patient’s first evaluation. “I tell them how important the home program is and that participation is crucial,” he shared. “I put them on the spot and go through the exercises the first day and send them home with illustrations. During a quiz at the beginning of the next session I will ask them to demonstrate the exercises I assigned.”

With this approach, Brown knows whether or not they’ve followed through based on their familiarity with the exercises. “I give additional exercises and instruction during each session,” he said. “And that’s how I make sure that they are compliant. It usually works because patients come prepared because they don’t want to fail.”

Therapy When?

When it comes to foot drop-and really any PT-related injury or diagnosis-Brown stresses the importance of seeking care with a physical therapist as soon as possible. “I don’t want to see someone with foot drop after 6 months,” he stated. “Once a patient is medically stable and safe to treat, they need to be sent to PT.”

Brown recalls seeing a patient with foot drop after having a stroke one and a half years earlier.

“There was a lot less I could do for her compared with what I could do right after her stroke”. “It’s crucial to treat these patients as soon as possible with exercise, stretching and weight bearing.”

Rebecca Mayer Knutsen is senior regional editor of ADVANCE and you may reach her at

(Updated February 23, 2018)

More Than Half of All ACL Reconstructions Could Be Avoided, Five-Year Follow-Up Study Shows

Another Human-Based Study, and I’ve Been Proving This in Canine Cases For Over 10 Years-

From RehabDeb: This report is from human medical research, however Colorado State University has since conducted some animal studies. I would love to conduct studies with advanced exercise physiology protocol that I have been using for over 20 years even with my own pets before doing “official” vet med work. I look forward to when I have resources to do those studies.

When I began independent practice in 2007, I used my accumulated research studies, experience, and knowledge begun decades before my work in veterinary medicine in order to create some simple functional exercise and drill protocol. These programs benefited hundreds of my pet patients whose people opted to not pursue surgery. I have used these programs for both cats and dogs.

In every case where people follow my protocol (and where there are no extenuating circumstances), the pets have stabilized the knee or other joint with muscle growth and strength and with proper scar tissue (sometimes we want some scar tissue).

These pets have also functioned very well after rehabilitation. You may do all this work in the home environment with no dependence on specialized equipment in a clinic. There is no need for specialized equipment when we are drawing from centuries of known exercise physiology.

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. This means that clients and veterinarians do the work and get good results. You can too, if you want to do the work 🙂

Jan. 30, 2013 — In the summer of 2010, researchers from Lund University in Sweden reported that 60 per cent of all anterior cruciate ligament (ACL) reconstructions could be avoided in favour of rehabilitation. The results made waves around the world, and were met with concerns that the results would not hold up in the long term. Now the researchers have published a follow-up study that confirms the results from 2010 and also show that the risk of osteoarthritis and meniscal surgery is no higher for those treated with physiotherapy alone.

“We have continued with our study and for the first time are able to present a five-year follow-up on the need for and results of ACL surgery as compared with physiotherapy. The British Medical Journal published the findings and they are basically unchanged from 2010.

This will no doubt surprise many people, as we have not seen any difference in the incidence of osteoarthritis,” says Richard Frobell, one of the researchers behind the study, who is an associate professor at Lund University and a clinician at the orthopaedic department, Helsingborg Hospital.

Richard Frobell explains that the research group’s results from 2010, which were published in the New England Journal of Medicine, caused a stir and questions were raised as to whether it was possible to say that an operation would not be needed in the long term.

Half of the patients who were randomly assigned not to undergo reconstructive surgery have had an operation in the five years since, after they experienced symptoms of instability.

“In this study, there was no increased risk of osteoarthritis or meniscal surgery for ACL injury treated with physiotherapy alone compared to treated with surgery. Neither was there any difference in patients’ experiences of function, activity level, quality of life, pain, symptoms or general health,” says Richard Frobell.

“The new report shows that there was no difference in any outcome between those who had operations straight away, those who had operations later, and those who did not have an operation at all.

“The message to the medical experts who are treating young, active patients with ACL injuries is that it may be better to start by considering rehabilitation rather than operating straight away.

In Sweden, over 5000 people every year suffer an anterior cruciate ligament injury, mainly young people involved in sport. There are different schools of treatment and Sweden stands out with treatment that is in line with the results of the study.

“On an international front, almost all of those with ACL injuries have operations. In Sweden, just over half have surgery, but in southern Sweden we have been working for many years to use advanced rehabilitation training as the first method of treatment. Our research so far has confirmed that we are right in not choosing to operate on these injuries immediately. Longer-term follow-up is important to look more closely at the development of osteoarthritis in particular,” says Richard Frobell.

KANON, Knee ACL NON-operative versus operative treatment is the name of the research group. They are now moving on to the next stage. This year, the third part of the study will begin, following up the patients ten years after acl injury.

Richard Frobell has also entered into a collaboration with researchers at the School of Economics and Management at Lund University. He is evaluating the health economics aspects of different treatment methods for ACL injury.

Journal References

  • R. B. Frobell, H. P. Roos, E. M. Roos, F. W. Roemer, J. Ranstam, L. S. Lohmander. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ, 2013; 346 (jan24 1): f232 DOI:10.1136/bmj.f232
  • Richard B. Frobell, Ewa M. Roos, Harald P. Roos, Jonas Ranstam, L. Stefan Lohmander. A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears.New England Journal of Medicine, 2010; 363 (4): 331 DOI:10.1056/NEJMoa0907797

From ScienceDaily

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests

Just One of Many Studies Published on This Topic-

My programs for conservative (no surgery) treatment are clinically and anecdotally successful. So, this means that clients and veterinarians do the work and get good results.

Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests –

“Surgery may not always be the best first course of action.

A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. To reinforce that, this study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.” Mar. 21, 2013 — A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).

The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.

“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”

According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial.

These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”

Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery. Furthermore, patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. In this situation, thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.

According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”

Story Source:

The above story is reprinted from materials provided by American Physical Therapy Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above.

Journal Reference:
Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; : 130318220107009 DOI:10.1056/NEJMoa1301408

When Should I Begin Rehab on My Pet?

Rehabilitation Begins Immediately!

Begin rehabilitation immediately by taking proper care of your injured pet or your pet that has had surgery . Timing is key to the best recovery. Whenever you or your pet are injured, beginning proper movement as soon as possible is very important to recovery.

Timing of activity and recovery are especially important in the sporting pet world (dogs, horses, etc.), where workout programs and drills are designed for competition training and injury recovery.

Bella the dog playing in water with her person a year after recovering from several issues
Bella the Wonder Dog Being her Athletic Self

Learning how and when to do particular activities with your pet after injury or surgery is all part of rehabilitation. From going outside to potty (for a dog) to climbing the indoor kitty tree to running wildly and free; all in the right timing will make you and your pet’s lives easier.

The care you give when you and your pet are together and how you care for them when you are not with them is all a part of rehabilitation.

white plastic pen for small dogs
Gracie Crate for Bedroom

The information on this website will help you to begin rehabilitation and work on doing the best rehab you are able, because your pet deserves it!




Updated February 17, 2018