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?

Pain, pain, and also pain –

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. The 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.

Many clients say they don’t think their limping pet is in pain and/or their vet said their pet isn’t in pain. Trust me, limping is usually because of pain.

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)

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

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. In those cases, the pain will last a lot longer.

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.

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 too much incorrect 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. Without bandage is proved to be best in general.

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)

 

What to Expect From Rehab-

Realistic Expectations From Rehab –

When I discuss what to expect from rehab, the importance of maintaining workouts and scheduled appointments is key to the equation. I urge pet caretakers to continue the work and not put too much time between our rechecks or phone updates.

If you do the work as prescribed, then you should expect improvements.

Formerly paralyzed Sully the Great Dane walking around the block.

People frequently contact me.

People that contact me all have the same intent of finding solutions for their pet’s (and often their own) discomfort after injury, surgery, or prolonged diagnostic challenges. How they respond to my information and to their pet regarding my information all differs. I have made it a point to observe and adapt my work to differences in their interpretations of medical information and my plans. Hopefully my adaptations address a greater number of worldwide people and some broader issues.

Other life happens during the intent to do planned life and plans for rehab work. Some common interruptions to rehab work are holidays, school breaks, and trauma in the human family.

As I was encouraging one client to not postpone our two-week recheck during a school break, I noted the information in the following paragraphs. She rescued her dog, it’s young, it’s her first adult dog, and he had one FHO to repair the pelvic area prior to her rescuing him and after an unknown accident . The other hip seems fine. This was her first rehab rodeo.

About your text and the schedule…

We can meet when you want, however I recommend sticking with two week rechecks for now. 

Part of the benefit of meeting in two weeks is to help encourage your staying on track.

Part of the benefit of meeting is that in two weeks, potentially he’s had three or four workouts of at least two of the three drills I gave you to work. If that’s the case, I will need to change the drills in two weeks to advance him to the next point.

It actually ends up being somewhat of a waste of time if you do the same base-building drills for four weeks. Sometimes people stick on week one when they should advance. Sometimes people advance all the way to week four but they should not have gone forward past week one as per my written parameters.

BUT, if you cannot meet when I propose, by all means, continue the same plan. Don’t stop 🙂

Also, often people get tired of doing the same drills if we don’t meet to discuss results and upgrade the work. In this case they often begin to cut jout certain work or allow too much time to pass in-between drills. 

Don’t find other drills online to do because they are not part of the foundation and recovery we are building.

Follow-through…

So, if you are doing a drill every other day, and you really only get to work on two out of the three drills I prescribed, then you will definitely need an upgrade for your pet in no more than two weeks.

Adaptation to exercise drills occurs in specific amounts of time. Doing the same workout over and over without changes is a waste of time and energy if you want improvement.

If you abandon ship altogether, when recovery is not complete, then the injury will likely resurface or other injuries will occur.

Sometimes people don’t follow through at first, yet they often pick the program back up and begin again and the pet improves again.

The reality is that regardless of what happens to any body, mine or yours or your pet’s, there isn’t a “going back” to a set point; there is a “new normal”.

You have already seen great progress with him, and that’s from your doing the work. When you do the work for surgery recovery, you also strengthen the opposite side without overusing the “good” leg.

In humans or any other animals, disuse leads to dysfunction. It doesn’t matter how many thousands of dollars a person may have spent on clinical rehab; if people don’t go back to doing their exercises when problems arise then dysfunction continues.

Often the problems returning are obvious because lameness and limping return. This is disuse. Sometimes people notice muscle atrophy or weakness before limping begins. This is because of disuse.

You should expect…

My programs work to build muscle to support the body, support the joints, and improve function. They also work to improve proprioception and increase neuro-muscular abilities.

Pets will use the better-functioning body parts and will ignore damaged ones to get to where and what they want.

So long as they are comfortable with drugs (or adjunctive therapies or both), they will use the injured limb more, and I count on that for them to build muscle and to better support the joints. When they are comfortable on their own, they will usually use *all* their parts as normally as possible. Without interventions, animals will not usually use a painful, damaged, or disabled body part very well, and their dysfunction will continue.

After we work more and he progresses, I will give you guidance to return to certain drills. You will also use other drills once or twice a week over the next year just to maintain better function. 

Check out this post on Goals of Therapeutic Exercise for more ideas.

Thanks!
Deborah

Updated February 12, 2018. Originally posted December 8, 2014

Elderly Sheepdog With Neurological Problems – Homework Review

Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.

To Abby’s Caretakers:

Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I re-evaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains. As always, I am available to do this work and especially if you need assistance because it is hard on your own body or even just to make sure it gets done so that Abby may recover well! 🙂

I can’t emphasize enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:

http://wp.me/p1wSDA-kp

And do it as best possible without cutting corners. You will get the best outcome if you follow the video instructions, and I’d really like it done daily to better encourage healing on several levels. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realized from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.

For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. I chose 15 minutes because you said she has already accomplished doing 10 min walks for a week, 3-4 times per day. Before that, she laid a foundation with 3-4 five minute walks daily for a week. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.

For the week following the twice daily 15 min walks, please walk her 2×20 minutes in the same manner, and only if the 15 minute walks are completed well for a week. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. That’s because we spent time building the base. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not wanting complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt to and accomplish.

I really would like her to wear two supportive hard braces during these walks, and I realize you have only one. She hyper-extends both her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and deficits in this case, and that has been a problem since I began giving you instruction for her over a year ago.

After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my Facebook rehab page that depict several home-based cavaletti designs. Please be sure to read the descriptions below the pictures, because not every type of cavaletti is for every pet 🙂

Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.

After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.

During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month-I’ve had good outcomes from doing this with similar cases.

I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading for the past many months…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.

Thanks!

Blessings-

Deborah January, 2013

Degenerative Myelopathy and Neurological Conditions

Question from the International Veterinary Academy of Pain Management, 2012:

“Does anyone have any recommendations regarding treatments for a 14 year old Husky with Degenerative Myelopathy? So far, the only thought I have is a cart. Also, my understanding is these animals are not in significant pain – is this true? Thanks for any info.”

From: A Veterinarian in the U.S.A.

RehabDeb Response:

Hi!
I apologize for taking so long to reply. I have a 30-yr. background in human sport science and nutrition, worked two years in a veterinary specialty hospital designing and building the rehab dept., and since 2007 have had a mobile practice wherein I serve a huge number of “mystery-ortho-neuro” cases, many of which are presumed to be D.M. (Degenerative Myelopathy) (or, as of 11/2014, may have been tested using protocol at Missouri).

The functional rehabilitation protocol I have developed over time, and which has been successful at improving function to varying, yet notable, degrees is derived predominately from my experience in sport science program design coupled with principles of neuroscience. A body at rest stays at rest and only changes with dynamic interference…
(original RehabDeb quote :))

I DO agree that while D.M. may not produce pain in and of itself, it is highly likely that an animal with any neuro condition has self-induced pain by nature of the fact that they are compensating, stressing tissues, and possibly pinching nerves, akin to when our sciatica or sub-scapular, etc…get impinged and cause us pain.

Pain management discussion aside, for my own patients I introduce a system of simple, vibration-based, massage with a less-than-ten-dollars Homedics unit (see the video elsewhere in this blog), Low-Level Laser Therapy (MUCH research exists regarding nerve conduction, regeneration, re-invigoration), and a plan of return to whatever level of function is possible via primarily-human-induced and animal-activated movement exercises, retraining brain-to-limb neural pathways and encouraging focus on movement and function. I prefer to use dry land and gravity, and I work with clients on methods to help them get this work done. Strength and endurance/conditioning drills I concoct depending on each animals status are implemented.

I begin with laser twice a week for a month and review exercise protocol that the owner is charged with doing if they are capable and which I do if the owner prefers. I use a front harness designed for riding in the car that has fleece and the best stitching I have found and only costs $30 shipped from Petsmart (no longer available-2014). This is the Travelin’ Dog harness. I turn it around, and it is “perfect” for hind end support (legs through arm holes, tail through neck hole) while relieving owner back stress, if used properly. It is much better designed for the body than the blue neoprene sling, less pressure on the abdomen than a belly sling, and less problematic than a Bottoms-Up sling. No one pays me to promote these items; I have just found that they are simply the best and cheap, and in my years of experience I deem that they work better than a lot of what is out there. I have pics around this blog of neuro dogs wearing these harnesses.

There are many more things that may be done, however getting the owner started on helping the animal around the home in a manner that hurts neither owner nor animal, and in a manner that is most productive time-wise, is one of the major components of my mobile practice. I tend to not involve owners in activities that, again, would potentially cause more harm than good or waste more time than be productive.

I also utilize a brand of boots with excellent traction, usually sometime along the way but not usually right away. Depending on function-ability I will introduce the boots when I believe they will not encumber the pet and will be more help than hindrance. The right boots always seem to encourage hind limb use when there already is function and they give stability in the home on tile and wood floors. I also often have pet owners stop using boots if they have begun using them before the pet is functionally ready.

On several elderly canine patients I have also used Epsom salts baths to great benefit.  Owners HAVE to ensure they rinse off all the salt residue after the bath, otherwise if the dog licks it, which they usually will, diarrhea will likely ensue.

These are some of the basics, and I will be glad to discuss the topic further if you’d contact me.

Blessings-

Deborah Carroll