FCE – Fibrocartilaginous Embolism – Rehab for Sammy

Hello,
I adopted Sammy from the Humane Society in 2006, we’ve had a great journey together! Two years ago, he had a very rare accident that they called FCE (fibrocartilaginous embolism), he recovered and was able to walk again…thank god!!!!!! Recently, he has shown significant signs of his back legs being very weak, my vet has him on Adequan….he just took his fourth shot, but I’m not seeing any improvement. I’m wondering if water therapy would help him…he still has so much life, but watching him try to get up is very heart breaking. Also, I’m assuming its very expensive, so I’m not even sure I can afford it.
Please let me know your thoughts, I would greatly appreciate your wisdom!
LH

Hi, L!

I apologize for the delay in my response 🙂 If you got onto my website, you likely saw my info about traveling, etc, and my not always being able to answer quickly!

Glad you & Sammy found each other!
I realized after a couple of years into my independent business that many veterinarians had not ever seen what they knew to be a FCE case, yet due to my particular focus in veterinary rehab, I’ve dealt with dozens of them. Just so you know that I do have a lot of experience with FCEs 🙂 I have created functional improvement programs that work on increasing neuro-muscular strength, based on neuroscience, principles of exercise physiology, and individual needs.

Also good news…
I recommend you go to my website and follow all the instructions on this page:

Pet Injury

If you read everything on that page, you will see why that’s the place to start with Sammy now, for FCE or for many other injuries or setbacks. I explain on that page that I intend in the future to make a more specific FCE rehab instruction booklet, but tempis fugit…

If you do follow all the instructions I have on that page, you’ll save over $500 in rehab costs, on average (or more if going to a rehab clinic), and you’ll be using an advanced, dynamic program. Also, if you do follow everything I recommend, you and Sammy should be in the proper condition to move to advanced strength-building and proprioception-improving work. You may contact me again at that point if you’d like to have an evaluation for the next steps!

I also have some supplements and helpful tools listed on my website. Adequan is sometimes helpful for some few pets with arthritis in my experience with 100’s of cases that have tried Adequan for joint pain, however it isn’t something that will automatically help with muscle and nerve strength, which is what it really sounds like Sammy needs. Nothing will help improve function to the best possible in the situation “automatically”, whether you’re wanting to improve neuro-muscular strength, or recover better from surgery or injury in general; we all need to add a functional activity program that suits our particular needs, both humans and other animals, in order to recover beyond “average biological existence”!

Regardless, prior to doing dynamic drills, a foundation always needs to be laid, so my site will help you toward that goal 🙂

Blessings-
Deborah

What Would You Do For MPL’s? (Medial Patella Luxation)

Hi, Deborah-

Dr. D at our clinic is referring a 1.5 yo M 31# mixed breed with bilateral medial patella luxation to you. How should we proceed?

Thank you-

 

Hi!

Glad you contacted me, and I will tell you that I start out MPL’s here on my website, if they will (and, as my website says 53.7 times, I’m editing and revising and changing a lot of content appearance):

Luxating Patellas

and this is one of the many pages I have yet to fix all the links on, add photos to, revise content, etc…
but it’s still relevant, so check it out if you’re interested.

The books on the page noted above are titled about CCR, but I cover how the books are relevant to MPL on this page:

Pet Injury

I have a lot on my website to help pet parents and clinicians and others work with their pets on their own in the home (or at the clinic).
I have a lot of words explaining that ^^ on my site, so I won’t fill up this email with more 🙂

Let me know if you have additional questions!
Thanks!
Deborah

Arthritis in Hip

Hi Deb-
My dog has arthritis in his back hip. He is losing muscle in that leg and has a hard time walking and just getting up. I was wondering if this is something you would work on?
Please let me know-
M.J.

Hi, M-
That is a great question, and I have a great answer!

If your dog’s veterinarian diagnosed your dog with arthritis in his back hip, I have a lot of info that should help you on my website 🙂

Start with this page:
Pet Injury

And also please read this page:
How to Use the Rehab Website

And then follow the instructions on both of those pages!
If you do follow the instructions, you will help your dog go a long way toward recovery, and then you may check back with me when you have finished all that I recommended.

Blessings-
Deborah

Degenerative Myelopathy: Nutrition and Exercise

1/27/16

Q:

I THOUGHT I WOULD ASK YOU IF YOU EVER USED DR CLEMMONS PROTOCOL FOR DEGENERATIVE MYELOPATHY IN DOGS, AND DO YOU PUT ANY FAITH IN IT? DOES IT WORK AT ALL. OR IS IT THE EXERCISE THAT HELPS THE MOST? THANK YOU, MARK. LOST MY LAB COAL TO DM, RECENTLY, AND IT JUST IS KILLING ME , THANKS AGAIN.

A:

Hi Mark-
First, I wish you peace and healing regarding the pain and loss of Coal…I would already guess you are a good dog dad just based on your having cared for a DM dog and seeming like you are pursuing information to help with your thought processes.

I have been familiar with Dr. Clemmons’ protocol for about 10 years (I think…time flies…), and prior to my coming into veterinary rehab, I had already about a 30 year background in progressive and varied approaches to nutrition. I have worked with many humans over the years to improve health status when they have been fighting a debilitating illness, and I have worked with world-class athletes to hone and “perfect” the body machine for competition. We began eliminating preservatives and colorings from our house at my mom’s instigation in the mid-’70’s and ate almost no refined foods at all, making many food items from scratch for our family to eat. I was also a distance runner in high school, and Mom got into nutrient supplementation for endurance sports, too.

All that to say that I tend to have at this point a wide and broad history of work with nutrition ideas, and I’ve been able to see effects of a lot of different protocol on a lot of types of beings. A shorter answer is that nutrition is very important in the healing process. People considered experts on the subject don’t all agree on a recipe for this nutrititive health. I don’t agree in total with most of the “experts” whose protocol I read, and I do read a LOT of research, too.

I am a big fan of eliminating all sorts of additional items in the nutrition protocol, in a less-is-more methodology, and beginning by giving the body only a bare minimum of basic, whole, biologically-appropriate nutrition for a 2-4 week foundation at the least. The body is designed to do a lot of good with the right amount of the right types of fuel. In the U.S. we tend to overdo it. We feed/eat too much. We feed/eat too much of biologically inappropriate foods. And we pile on a bunch of “good” foods and supplements in the hope and with the notion that they will right additional wrongs, as it were.

Successes in nutrition occur, despite inexact protocol, and with incomplete pictures more of the same is pursued. I have seen the best results regarding nutrition for any problem be very minimalized and simplified. Only after a few weeks of clean and lean animal protein and minimal non-grain-based carb sources should supplements be added. This is because many, many fringe issues will clear up as the body is allowed to pursue it’s own healing to whatever extent it is able. Short story.

Without going more into the nutrition aspect, I will say proper nutrition plays a big part in any recovery, but it is equally or even more important to focus on proper exercise to make real gains. Exercise of the right type for whatever condition will make a huge difference regardless of the nutrition protocol, however good nutrition without the right type of challenging exercise for the condition will make less of a difference.

There were no good exercise protocol broadly shared (or anywhere that I found) for neurological issues for small animals in veterinary rehab when I came into this work in 2004. I developed a lot of helpful foundational exercises and drills for strength and proprioception in an ordered method over time to use successfully in my practice. I intend to publish them more definitively this year. In the meantime, all the different types of neuro cases I dealt with, including D.M., have made progress so long as they were able to begin with my foundational 4 week exercise base program. If the pets I encountered could not move on their own, I had a different set of protocol and drills, depending on the condition. As they progressed to auto-ambulating, most would get up to doing my intro program. Right now that is only published under this title: Guidelines for Home Rehabilitation of Your Dog: Instead of Surgery for Torn Knee Ligament: The First Four Weeks, Basic Edition

Because I have broad and extensive experience utilizing principles of exercise physiology and functional recovery exercise, I see the tremendous benefit to adding the right type and amount of the right exercise and drills to any being’s life. I have been working over 10 years to get more exercise-physiology-based protocol into veterinary small animal rehab. I hope to be able to compile data from my cases and publish more of the successful protocol I’ve developed through this year.

I hope this helps some with your thought processes. I would guess it doesn’t help much to know my perspective regarding how important the right amount of the right kind of exercise is, mostly because it’s not a view that is widely promoted in vet medicine…yet! But I think little strides are being made. In the meantime, some of the same barriers and lack of cross-training in human medical science exist, too. For more on some of my favorite and some of the best sport science information, visit the National Strength and Conditioning Association and the American College of Sports Medicine.

Blessings-
Deborah

Should My Dog (or Cat) Still be Limping After ( Knee ) Surgery?

Should my pet still be limping after surgery or injury?

This info about pet limping and pain could apply to almost any orthopedic surgery…
and some of it applies to almost all injuries as well!

Chocolate Lab lying on floor with bandage on leg after surgery
Pet limping after injury or surgery is overwhelmingly due to pain. The pain is caused by one or more of the situations I introduce in this post. Continued pain is so common that this post on my website has been the most visited post for over a decade. This most common answers I give to questions about limping are as follows, based on what I have found true in my practice:

Limping –

If your pet is limping, your pet is very likely in pain. More below ⇓

Bandage –

If your pet has on a bulky bandage, as Jake does in the photo, and your pet is limping, it is likely because of the bandage or cast, that they are bulky…and there may also be pain.

Eating, Drinking, Happy –

Eating, drinking, running, tail-wagging… if your pet is doing some of these things, it doesn’t mean they are not in pain. (Hint: Most pets shouldn’t be running anyway after surgery) More below ⇓

In contrast, if your pet is NOT doing these things (wagging, eating, drinking, seeming  happy), that could indicate pain. More below ⇓

Pain – 

There will be general pain on average for about 2 weeks after surgery, because…surgery. Plus, sometimes the surgery doesn’t go well or complications occur with surgery methods. More below ⇓

There may be other pain, on top of general pain, due to overuse of the body part that had surgery and…

There may be pain due to an obvious or a hidden infection. This one happens A LOT. More below ⇓

Lesson is: your pet can be in a lot of pain and could still be wagging their tail, eating well, and chasing prey!

That’s the short answer section.

Your pet is not limping “just because he/she had surgery”

I put part of that sentence in quotes because many times I’ve heard people (clients, veterinarians, clinic staff, etc…) say the pet is limping because of surgery or injury as if surgery and injury are somewhat abstract and causing the pain. Surgery is painful, and torn ligaments and other soft tissue damage are painful, too. Your pet is usually limping because they are in pain.

I try to bring people around to understanding factors other than a good surgery or injury can cause the limping. Pain is the #1 reason for limping.  Additionally, injury is painful, surgery is painful, infection is painful, bandages are awkward and may cause a feeling of instability, torn connective tissue may lead to a feeling of instability, and all these factors can contribute to limping.

When we work out a cause for the pain/limping/lameness, then we may work  on more correct solutions to the problem.

Your pet is limping because he/she is painful after surgery (or injury) in almost every case.

Your pet should not be limping more than a couple of days after surgery if

1) they have enough of the right pain medications,

2) don’t have an infection,

3) the right procedures were followed in surgery,

4) your pet didn’t destroy the surgery by chewing or with activity.

I have worked with many pets that have limped or been lame more than a full year after surgery. In some cases the lameness has been going on for a few years. Some of these limping cases are because there are problems with the surgery. All of my cases have improved when we have done the right work as best possible for the true problem causing the lameness. This may mean getting x-rays to check the surgery if there was surgery. This may mean getting another opinion if necessary about post-surgical limping. You may need to try out antibiotics if the other factors I’ve mentioned are all eliminated. You may also need to get better pain management drugs plus use them to the best benefit to go with rehabilitation work.

An exception to the “limping due to pain” rule would be as in Jake’s case (above photo), because if your pet’s surgeon is using a bandage on your pet after surgery, the bandage or cast will be a little awkward. The awkwardness will make your pet walk funny. Your pet will probably act a little weird with the bandage in place. They may not want to walk in the bandage, they may be a drama queen, they may take exaggerated movement strides, etc…

Most surgeons have discontinued bandaging after knee surgery.

Don’t worry that your pet does or does not have a bandage after surgery.

Whether they have a bandage or not, most pets will do best with the e-collar around their neck until 2-3 days after stitches or staples are removed if they have had surgery.

The post-surgical or post-injury pet limping is not an abstract limp caused by mystery forces.

The limp and lameness have overwhelmingly turned out to be because of pain, in my experience with hundreds of cases.

With right amounts of pain medications for your pet’s particular situation, body chemistry, and processing ability, the severe lameness almost always stops. Sometimes “right amounts” of pain medications for your pets particular situation” includes antibiotics. The “particular situation” may be a sneaky little persistent infection. Medications for pain usually do not help very much in combating infection pain; usually only antibiotics will stop infection pain.

Next step is often to try a course of broad-spectrum antibiotics. Infections are not always hot, not always swelling tissue and joints, and they do hurt! At the same time, your veterinary team should be checking out the surgery area to see if it is in tact from what they can feel. They will likely want to do another x-ray to see what is going on inside your pet. This is a good idea in most cases; an x-ray shows random surgery failures as well as cloudiness from swelling in the area, among other things.

If the pet limping does not stop after thoughtful application of treatments I have mentioned in this post, then other factors may yet need to be discovered. Again, your pet should not continue limping more than a day or two after surgery if the above factors are met. The same goes for pets that have had re-do surgeries; if they are limping, there are other problems. The main problem in these cases is usually not enough of the right pain medications.

There is probably some “odd” discomfort and/or feeling of instability after surgery or after those injuries that involve tearing or rupturing of supportive connective tissue, and…

Maybe things feel a little “different” or unstable to your pet. Usually you will notice pets being reluctant to walk on slick floors or are using more caution over tricky surfaces when they feel unstable. I have torn connective tissue in my shoulders, hips, and knees, and I find that I guard my body while doing certain movements. Sometimes I subconsciously tend to be suspicious of my joint’s dependability in some situations. I have been active in body science for many decades, and I know my body well.

This body guarding happens in pets, too, and overcoming this disuse is a big part of my work on them and with their humans to achieve better overall function.

I do in-person and phone consults to help people help their pets to solve pain issues. I will write more on topics that are introduced in this post. In the meantime, please search the words “infection” or “pain” in the search box. Please look over the Q&A and some case stories on this site. I have hundreds more stories than I’ve had time to post, and I’d like to post them to help you. I will as time allows 🙂

It is often a LOT of work to get to the bottom of continued limping problems. In my opinion getting to the bottom of limping diagnosis takes so much time because

1) people do not know that their pet should not be limping after a few days in most cases.

2) people have not followed a solid recovery base program like this for injuries or this for surgeries,

3) veterinarians are hesitant to override the medications the surgeon has given.

Sometimes they are not well-versed in multi-modal pain moderation. Most doctors are not taught a lot about pain evaluation and pain control in school. What your vet learns about pain control is mostly from drug reps, journals, through word of mouth from colleagues, from conferences, and personal experience working with hundreds of cases. I have also learned this way over the decades. Personal experience with hundreds of cases is the best long-term teacher if the learner is open to making changes and solving puzzles.

4) In some cases the surgery has failed.

Surgery failure happens most often because the pet is too active, the pet’s body rejects some of the surgery technique, or the surgery technique wasn’t complete. The last event happens frequently in FHO surgeries, in my experience. I have created successful non-surgical programs for recovery from all hip and knee issues without surgery. I have recovered lots of pets that had too much bone remaining on the femur after FHO and the client didn’t want another surgery. In those cases, we followed deep pain control protocol and my foundation-building programs as well as my advanced drill programs.

If you can get your veterinarian to work with you on the steps I mentioned while you are following strict restrictions and a program like mine, then you will be able to solve the limping issues much sooner. I have a local “team” of veterinarians who have come to understand working on pain in a more focused manner. Some are members of IVAPM and have worked on discovering more about animal pain. Some of them also perform acupuncture as therapy for pain, and often the client and I bring one of them onto the evaluation and treatment team. More on this later or elsewhere on this site…check Q&A for now.

me giving laser therapy treatment for pain control and nerve regeneration on Magnolia the Weimaraner after spinal surgery

These are some basic bits of information for your thought. I mostly deal with continued pain cases, surgery complications, non-surgical interventions, and neurological cases. Daily I work with people and pets to help them pursue avenues to in order to get to the bottom of things and reduce or eliminate pain.

Blessings-

Deborah

(Revised January 27, 2018. Originally posted 2007)