No Surgery, Owner Choice – 5 Posts

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Hi Deborah!

I’ve enjoyed following the stories you post on FB about the dogs you heal, and who’d’ve thunk I might one day need your services?

My dog, K, has been gimpy for about a month or so (back right leg)… took her to our vet a couple of weeks ago. By poking and prodding, they figured it’s her knee. Gave us some anti-inflammatories and said to keep her from running, going up stairs, etc. It showed improvement during the first week, but then we let her back on the stairs and it’s back to the same.

My former vet friend, P, looked at it a couple of days ago… She strongly suspected an ACL tear.

I poked around a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought I’d ping you and ask you a few questions:

– What would our next step be? (we haven’t had x-rays or the “drawer-test” that Pam described to me)

– If we wanted to do any rehab through you, how would that work and what would the fees be?

K seems very happy and it doesn’t really slow her down too much (unfortunately! She wants to continue being the family dog that she is, around us all the time). Yesterday, we decided to confine her (like crate rest), but the problem is, the gimpiness seems worse after she’s been lying down for a while, then it seems to warm up and work itself out once she walks around a bit. So by keeping her confined, she’s lying on it a lot more and not moving as much, so it actually seems worse. (making me wonder if the confinement is the right thing to do…)

Thanks!!
T

My Answer Today:
Hey Gurl…
Goody…I happen to be home and able to give you a better answer via the pc keyboard!
The best option, imho, is to have me come out and do a consult regarding how you should proceed. It usually takes an hour for something like this. I prefer to see animals for the first visit in the home environment so I may discuss potential pitfalls and see home items we may use for drills, among other reasons. I am also able to do phone consults at $1/minute, but I prefer to see the pet in person…

The second best option is for you to go onto my rehab site and look under notes for the homework for post cruciate ligament rupture rehab.
I also have a video posted on YouTube and my WordPress site regarding a massage technique that is beneficial. The Pittie featured in the video is 3 years out from a cruciate ligament tear and never had surgery. He is doing great because the owner did the homework as I recommended. The YouTube link is on my WordPress and is under RehabDeb if you search it.

I do not think I would ever have surgery on one of my own dogs for this issue again. My little Grace had two TPLO’s, the major surgery where the bone is cut and replaced at a different angle, and both didn’t work out. One wouldn’t have worked out because she had a congenital joint disorder on that knee and the surgery wasn’t ever going to be solid, and on the other knee she ended up getting a raging infection at the time of surgery that eventually ate up the whole joint. The Grace had a poor immune system, and she was open too long on the table, due to unforeseen circumstances, among other things.

She was bone on bone in both knees for the last 3 years of her life, yet she was definitely full of life! She ended up tearing all three ligaments in the second knee, so far as I/we can tell, and it was muscle support of the joint that enabled her to function as well as she did. None of the available braces were of a good enough design for her, and I’m not a fan of what is currently available for most dogs, especially not without working on my walking and exercise drill protocol first.
I deal with many dogs whose owners don’t want surgery for a variety of reasons, and the feedback I receive is that they have done great without surgery.
Of course, I also do rehab with many pets that have had surgery also, from both boarded surgeons and regular vets, using all types of modifications.
I’d be glad to discuss the differences.

We don’t do surgery on every human athlete, much less every human, yet most of the dogs are immediately referred to surgery as if there isn’t another answer the vet knows to suggest. This is because the vets are trained to react in that manner, and they usually don’t have any foundation in muscle-building and joint support protocol. Most of the reasons I’ve heard given in favor of surgery aren’t necessarily scientifically correct, according to available research and anecdotal evidence. I’m trying to make my functional rehab protocol using principles of exercise physiology more readily available.

My background in sport science definitely gives me a huge edge in developing protocol for recovery, and it is just taking slow time, getting the word out and getting people to think more wholly about the situation, and to see/know therapies that exist in other areas of physical science and apply them here. The angle of a dog’s knee, or any quad-ped knee, is definitely different than that of a human/bi-ped, however many principles of physiology and of the relationship between soft and hard body tissue apply and are useful to improve function and quality of life.

Blessings!!

(10-17-13 and now you may purchase the guide book for rehab of this condition at http://wp.me/p1wSDA-cU )

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

(From RehabDeb: This report is from human medical research, however animal studies are currently being conducted at Colorado State University. When I began animal rehab in 2005, I developed some protocol for people to use to benefit their animals if they did not want surgery for their pet, even though I was working at the time in a surgery specialty hospital. When I began independent practice in 2007, I took years of accumulated research, experience, and knowledge and created some simple functional exercise and drill protocol that has benefited hundreds of my canine patients whose people opted to not pursue surgery. That protocol and some other papers citing surgery text recommendations may be found elsewhere on this site-see the index to the right. In every case where my protocol has been followed (and there are no extenuating circumstances), the pets have stabilized the joint with muscle and scar tissue, and they have functioned very well. This work is all done in the home environment with no dependence on specialized equipment…no need when we are drawing from centuries of known exercise physiology and dynamic principles of body function. Blessings-)

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 findings have been published in the British Medical Journal and 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 experiencing symptoms of instability.

“In this study, there was no increased risk of osteoarthritis or meniscal surgery if the ACL injury was treated with physiotherapy alone compared with if it was 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 were operated on straight away, those who were operated on 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 5 000 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 are operated on. In Sweden, just over half are operated on, 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, however, if we are to look more closely at the development of osteoarthritis in particular,” says Richard Frobell.

The research group, whose study is called KANON, Knee ACL NON-operative versus operative treatment, is now moving on to the next stage. This year, the third part of the study will begin, following up the patients ten years after anterior cruciate ligament injury.

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

Journal References:

  1. 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 trialBMJ, 2013; 346 (jan24 1): f232 DOI:10.1136/bmj.f232
  2. 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

 

Questions About Hip Surgery

About Clark

From the client:

You are so awesome!!! We took him to the vet yesterday and he gave me Rimadyl and Tramadol to help with pain and inflammation. I haven’t had him in for x-rays yet, would that be helpful for you? The vet said he didn’t see any signs of being hit by a car recently that would tell him that there was something broken. I was going to have him fixed this weekend, but I can wait if you think it would be best to see you first. You are worth every penny + some and I will be prepared to pay you for the time you spend with him. ;0) He is a shepherd mix about 14 months old. Just a baby with a sweet, sweet heart and a crappy start. Let me know if you want x-rays and if I should wait on having his boys removed and I can be available anytime Wednesday on next week.

Me:

I’ve been thinking about it, and I think it would be a good idea to get the manly-man surgery out of the way first.
When he gets pain meds for that, you may be able to see a difference in his demeanor or comfort, regarding his hips/legs, so take note of that.
Yes, and it may be hard to tell ;))
I can tell a lot without xrays, and often they get in the way in part of our brains regarding a better clinical evaluation. On the other hand, since he will be sedated, it will be a great time for x-rays, so go ahead if your vet is on board (which I’m pretty sure he will be!)
If he gets surgerized this weekend, I could see him next Thurs or Fri or when ever your schedule allows after that…
What do you think?
:)) Blessings-

Me:

After our first evaluation, my bullet point recommendations were to

1) restrict and crate when not at home for the next 2 weeks.

2) Begin exercise protocol noted on my FHO homework sheet, beginning with week 2, 2-4×10 min walks daily, very slowly (wedding march).

3) Use medications as per label, giving the Tramadol 30 minutes to 2 hrs. prior to walking if possible. Regarding your dosing question and the variability noted on the label, give the larger dose in the morning if you will be walking him in the morning, otherwise just give the smaller dose. Give the larger dose when you get home in the afternoon/evening, in prep for 1-2 pm walks. Give 2 hrs. rest period in-between walks (as per homework sheet).

4) Feed grain-free kibble (no barley or oats or rice, either, right now), Omega 3 in fish oil capsules as discussed, and joint formula that contains at least two of the following: glucosamine, chondroitin, msm.

Client:

(after having some problems with Clark, a rescue, and other dogs adjusting)

Hi!

We still have our friend. We made some adjustments and he seems to have settled a little bit. He has the sunroom to himself at night and during the day…we call it his puppy apartment. ;0) Everyone seems happy.
We took him off the Rymadal (SP?) because he was getting sick. And I’ve scaled back on the pain meds and give them when he is looking a little stiff. We are trying REALLY hard to stick to the directions, but I’m afraid it’s a modified version. He is still during the day and at night and we have shortened his time outside with the girls and I’ve been good at at least one walk a day…sometimes I get lucky and can get two. We will get it fine tuned…it’s just going to take a little time.
The vet is REALLY, REALLY pushing the surgery…I’m not doing Clark long term harm by not opting for surgery…right? You would think it by talking to him.

Anywho, thanks for checking in and the great direction. You idea to crate him at night helped everyone out!! ;0)

I will keep you posted on progress…just might be a little longer than 4 weeks.

Have a wonderful week!

Me:

Ok, so, I’m going to tie in our texts here and I think we should have a recheck to keep you guys on task…so that you see the improvements, and Clark improves, and others may see and reevaluate their insistance on surgery.

In Clark’s case, I don’t hear that anyone is concerned about gross malformation of the pelvis or a femur that is deformed beyond function, so there is no clinical reason to not employ muscle-building & joint strengthening techniques to appreciate improvement. The reports you have given me, verbal from the vet and the view of the x-rays, don’t indicate “horrible hips” and don’t indicate hips beyond the level at which others have improved without surgery. Clark is young. Perhaps your intervention staves off the need for surgery for the remainder of his life or perhaps it serves him well until he is older and then you may re-evaluate.

Usually in a case like this pain control plus the right type of exercise slowly improves the body and therefore the situation.
Some dogs improve, some don’t. The ones that don’t usually have owners who don’t do much of the protocol. So, if they keep doing the same thing as before, they get the same result, yes?

I don’t think you are in that catagory.

You guys represent a lot of families I see in my practice, in that you have two working adults, small child(ren), other dogs, etc…and several variations of this norm exist, of course. This norm is perfect for my home-based protocol because it only causes home-based disruption, in that you only have to sacrifice a little time, and my recommendations are based on 30+ years of my understanding of program design for improved function. This combo brings the biggest benefit, greater results, when all factors are weighed. And there is always the option to pay me to come do the exercise and drill work.
I know you get that

And of course my perspective is a little more broad, because I have seen a lot of what happens to animals in a wide variety of circumstances.

The most predominant point I make to clients is that the protocol does not get easier if the animal has surgery; in fact, it becomes an absolute necessity in order for the healing to occur and for the desired outcome from surgery. Without surgery, using my protocol, there is more room for letting something slip with less immediate ramifications, the main two of which post-surgically would be great damage to the surgery and money down the drain, since re-dos aren’t free (in most cases).

More than that is the additional stress and pain for the animal.

I am writing more here than need be to address you guys directly because I plan to share some of this discourse on my blog and giving more info helps a wider range of readers.

You said you stopped the Rimadyl because it was causing gastro distress…GOOD! And I presume from something you said in your texts that you let the vet know. You were not using the Tramadol as consistently, and I recommended you return to dosing as per the label for adequate pain control and especially since it’s all the pharmaceutical pain control you are using. Don’t forget the fish oil, grain-free food, and the glucosamine/chondroitin/msm…and I think you’re doing all that.

And you wondered if you were doing some sort of long-term harm by not having the hip surgery since the vet and staff seem so insistent on Clark having surgery. I covered this answer in part above. Additionally I will say that the exercise physiology and functional rehabilitation protocol I bring to veterinary rehab are not necessarily new to vet med, since race horses have been using protocol similar to that derived from human sport science for decades. These are, however, new concepts in small animal medicine, it seems. I came into vet rehab after 25 years experience in human sport science and nutrition protocol covering the gamut. These principles were novel where I began rehab practice, and I find the programs I have been designing for humans, based on much research performed by people living long before I came around, also are the most beneficial programs and protocol for animals for pre-hab, re-hab, and instead-of-surgery in many cases. No, you can’t just copy a program from Muscle and Fitness magazine…but you can pay attention and learn what actions produce what results. That will take time. The paying attention and learning…

There are some cases that really may need hip surgery, and when the clients have contacted me for pre or non-surgical intervention, at the very least we may say we are doing pre-hab. In the case of luxating hips, even though keeping the dog in a tight sling for weeks will/should work, as per science and experience, it seems almost impossible for most people to maintain the restrictions necessary for the sling to do its work. Disruption too soon=ligament laxity, again, and the ball of the femur keeps popping out. At any rate, it stands to reason that a body realising better function prior to surgery will improve easier post-surgically. That is also proved in research. Dynamic exercise improves every body system, from strengthening bones to improving the health of soft tissue.

I know for a fact, from years of study, evaluation, and observation, that cross-training rehab specialists in sport physiology and program design for dynamic function would elevate overall rehabilitation outcomes across the board. This has actually been an extreme discussion in Europe for the past yea-many years, that of the need for physiotherapists to have a deep(er) foundation in sports physiology and program design. I haven’t seen it hit here as forcefully yet (and we’re talking human medicine, which is paving the way in this arena). Europe is quite a bit more progressive regarding body wellness treatment and sport program design and a variety of similar topics.

Simply put, these exercises will not change noted gross malformations of the femur in an animal with hip problems, however, to note, any gravity-based exercise, weight-bearing exercise, will improve bone density, so changes along those lines will accrue. These exercises, performed as per a program designed for Clark, should improve tendon, ligament, and muscle strength, muscle size, and neuro-muscular signaling, simply put.

Other beneficial things will happen as well, as always do with exercise of the right type for a particular entity. The changes I noted should improve his overall function. To my knowledge, the surgical protocol is to not operate on hips based solely on x-rays and is to operate based on severity of clinical signs. That is what the surgeons say, and that is what the literature says. Vet surgeons in other parts of the U.S. will not operate on dog hips without having the clients do 4-6 weeks of pre-hab first, with the intent of gaining owner compliance and improving the dog’s health, most especially in cases of obesity.

So, the catch here is to have enough of the right variety(ies) of pain control on board while the dog is performing the best exercises for his/her situation and thereby learning to use the affected limb more freely again. With that increased use come the improvements I mentioned. With the improvements comes the need for less medicine, since increased muscle mass and supportive tissue strength will better support the joint.

That’s all I have time for right now, and I think this will help you guys.

Blessings-

Torn CCL/ACL on 10 yr. Old Lab, Been Torn a Year…

Hi Deborah – I’m so glad I found your blog/website after researching for hours. I am at a total loss of what to do for my beloved yellow lab, Sam. Sam is 10 years old, weighs 98 pounds (vet said he had a large girth) and that his weight was fine. A year ago this vet said he had a pulled or torn ligament in his left leg. She said he could have surgery even though he was old, or prescribe adequan (very expensive) or keep him inactive. There was no guarantee of either treatment. I kept Sam inactive for quite a few months, with limited leash walks. I thought he was getting better but he’s not. There have been a few times; he took off running across our yard, which I know was bad. But I’m more careful now about opening the door and him on the leash. I took Sam for a 2nd opinion yesterday (1 year later), this vet said he had a torn cruciate ligament and needed surgery. He gave no medication for pain or recommendation of using anti-inflammatories. Neither vet recommended Xrays or other tests. They just did the manually testing of his leg. He is slow to get up, limps for a minute but then walks on that leg, but does not put full pressure on it. He doesn’t limp when he’s walking. It’s mostly after he’s been lying down, he struggles to get up, limps for a minute or two, then he seems fine. I limit his walking to about 5 minutes 4 times a day. He never seems like he’s in pain. He’s always wagging his tail even when he’s lying down. The only thing I’ve really noticed is at night while we are watching TV, he normally sleeps; now he seems to stay awake and look around, which maybe that means he’s in pain, I just don’t know. I really don’t want to do surgery on Sam, not at his age. I’ve read quite a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought you might allow me to ask you a few questions: Deborah, I live in Foley Alabama, is there anybody like you my area that you know of? Anybody you can recommend? Can you give me any kind of advice of what I should be doing for Sam? Should I let the Vet give Sam Adequan? I will do it if you think it will help. When is surgery really necessary and should it be done on a 10 year old lab? I don’t know who else to turn to, please help. Thanks Lisa from Alabama

Here is the first answer I sent you via Facebook-

Hi-
Here is my FB rehab page, and you may already be a fan, since we have at least one friend in common, but there is no easy way for me to search and sort who follows this page
I will get to answer your post on my website as soon as I can. Otherwise, I do know the answers to all of your questions are on one or both of my sites…it just takes a lot of reading ! So while you wait for me to be able to answer, check out the homework and other related posts if you haven’t already.
Sam does need pain meds of some sort and he does not need to rush into surgery based on what you have told me. X rays won’t show torn ligaments, however they will show clouding in the joint which just tells us what we already know, that there is joint disruption and damage.
See the post I just made on the wordpress blog regarding Clark, the hip dog.
Blessings-

And here are more answers now that I have some time:

I will always do a paid phone consult, so if you are interested, let me know and we will set that up.

I do not know of anyone else that practices the way I do, with standard therapy interventions and certification within veterinary medicine (CCRP) yet using the tried and true, long-standing principles of athletic training and strength training protocol. There are a few people in the U.S. that I know of who also carry the strength and conditioning certification that I do, the CSCS®.

The protocol for dealing with this situation did not exist that I could find when I first came into companion animal practice, in 2004-05. I began writing simple programs based on my background and experience. These have been refined and honed and proved to be beneficial.

Additionally I was blessed with a Great Dane companion for 10.5 years who was bone-on-bone in both knees, had all three ligaments torn in the right knee and two torn in the left. She had a genetic bone disorder called OCD (for short), and had two TPLO’s that didn’t work out, or, the end result was not what we would have aimed to accomplish. I am not anti-surgery and not because of her situation. It is through her situation that I learned even more about improving function non-surgically or in the face of very complicated circumstances.

At the least, I have substantiated with some vets in this area and around about (who have inquired and followed my simple homework) the beneficial effect of slow, weight-bearing, pain-controlled return to function after surgery. I built my Grace’s thigh muscles to better support her joints, and I had plenty of opportunity to see the benefits of increased muscle mass in her case. I have also appreciated the benefits in other cases.

I hope that you have found many of the other answers you were seeking elsewhere in this blog.  I suggest pretending like it all just happened and start at the beginning of my homework suggestions (under “homework”) and I strongly suggest, as I said previously, that you obtain an anti-inflammatory if Sam’s system will support it (your vet will do blood work to substantiate this), and if not an nsaid, then use Tramadol or Gabapentin. There are lots of options for pain control (see my Q&A post regarding limping after surgery), and if you just pretend like it happened recently and really start again at the beginning, building up from there, I really think you will realise great benefit for Sam.

Adequan seems to work really well on relatively few dogs (animals). I tried it a lot in my Grace, and I was working with a surgeon friend, so we tried it three different ways (IM, IA, SQ)on three different trials, to no effect for her. Some of my clients say it has helped their dogs substantially. A surgeon on the East Coast told me in 2005 that he didn’t think it would work for my Grace and that they had stopped using it in horses due to little effect. It’s expensive, yes, and it’s great if it works on your dog.

In the meantime use fish oil and a glucosamine/chondroitin/msm combo for joint health. Your vet may carry these products. I have info posted elsewhere regarding these supplements. If Sam takes off running and injures the joint, then make him rest for the remainder of the day and he has to go back to slow leash walks until he is no longer lame. You may also use ice, right on his knee, 20 min, when he has a limping/lameness episode. Hopefully you will be able to have a veterinary relationship where more pain medicines are utilised for greater overall benefit. Check out www.ivapm.org for more pain management info. I’m with you in that he is probably uncomfortable at night. Pain meds will help this, and the other options I gave you will help it some.

If he were my dog, I would definitely follow my homework and the supplement advice, the pain med advice, and I’d recheck with me when the first four weeks of homework are completed. I would not have surgery on him right now based on what you have told me, however I also have seen older dogs do well in surgery…so it’s not the surgery that is offputting; it’s just that I think he can thrive, based on what you have told me, without surgery. You have opportunity to find out if you get strict with the restrictions and homework again. He will have difficulty every time he spazzes out until he builds more thigh muscle. Then the joint should suffer less impact. At the least, if you follow this simple homework, it could serve as pre-hab, and if you decide on surgery, he will be in better shape and presumably recover better after surgery.

That is all I have time for right now.

Our next consult should be a paid phone consult if you’d like to go further. Thanks for presenting Sam to us-

Blessings-

Deborah

Anecdotal Progress

Exercise is thought to have beneficial effects on Parkinson’s disease. Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride.

“”The finding was serendipitous,” Dr. Alberts recalled. “I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.” As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson’s disease patients.”

The above is a quote from an article regarding research looking at the benefits of exercise for Parkinson’s patients, found on Science Daily dot com, and as I read it this morning, I thought it to be a perfect example of the practice protocol I have developed that has proved beneficial for several orthopedic conditions in lieu or surgery…whatever reasons one might have for not having surgery performed on their pet.

I am one person working alone, however I have over 30 years background and experience in principles of human sport science, exercise physiology, program design, and the like. There are others with similar backgrounds working in veterinary rehabilitation. I began using simple principles based on years of experience, and I’ve seen much success, as evidenced by improved quality of life, improved function, and veterinary professional confirmation.

I don’t have money to drive clinical research, and while I have ideas of those whom I could approach to get involved with this research, I am busy in my practice and haven’t wanted to take the time aside to pursue grants or corporations. At some point I intend to write more about the beneficial outcomes and to further discuss cases, however in the meantime, take the first paragraph as affirmation that science is observation of a particular outcome or experience as well as the steps to prove what we imagine/postulate/thought we observed.

It has been proved anecdotally time and again that when the conservative and slowly progressive non-surgical interventions I have outlined in the homework discussions on this site and/or in my books are followed within the parameters I outline, improvement of the condition ensues, barring extenuating circumstances. I do not see the discussion as being whether surgery or no surgery is better; I present the protocol I use as beneficial guidelines instead of not giving a program of recovery to those who choose to wait or altogether forego surgery for some conditions.

In other words, for injuries and conditions that are not “life or death”, the fact is there are very many people who will not choose surgery for their pet (or for themselves, for that matter). The instead-of-surgery protocol I develop and use fills a need to help the pet recover.

Keep moving forward; there is no time constraint on the “one step at a time” methodology…you can always begin, again, now.

Blessings-Image

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Possible Torn ACL (Cranial Cruciate Ligament)-How Should We Proceed?

Hi Deborah!

I’ve enjoyed following the stories you post on FB about the dogs you heal, and who’d’ve thunk I might one day need your services?

My dog, K, has been gimpy for about a month or so (back right leg)… took her to our vet a couple of weeks ago. By poking and prodding, they figured it’s her knee. Gave us some anti-inflammatories and said to keep her from running, going up stairs, etc. It showed improvement during the first week, but then we let her back on the stairs and it’s back to the same.

My former vet friend, P, looked at it a couple of days ago… She strongly suspected an ACL tear.

I poked around a bit on your site, and it looks like there may be a nonsurgical route for ACL injuries…. I thought I’d ping you and ask you a few questions:

– What would our next step be? (we haven’t had x-rays or the “drawer-test” that Pam described to me)

– If we wanted to do any rehab through you, how would that work and what would the fees be?

K seems very happy and it doesn’t really slow her down too much (unfortunately! She wants to continue being the family dog that she is, around us all the time). Yesterday, we decided to confine her (like crate rest), but the problem is, the gimpiness seems worse after she’s been lying down for a while, then it seems to warm up and work itself out once she walks around a bit. So by keeping her confined, she’s lying on it a lot more and not moving as much, so it actually seems worse. (making me wonder if the confinement is the right thing to do…)

Thanks!!
T

My Answer Today:
Hey Gurl…
Goody…I happen to be home and able to give you a better answer via the pc keyboard!
The best option, imho, is to have me come out and do a consult regarding how you should proceed. It usually takes an hour for something like this. I prefer to see animals for the first visit in the home environment so I may discuss potential pitfalls and see home items we may use for drills, among other reasons. I am also able to do phone consults at $1/minute, but I prefer to see the pet in person…

The second best option is for you to go onto my rehab site and look under notes for the homework for post cruciate ligament rupture rehab.
I also have a video posted on YouTube and my WordPress site regarding a massage technique that is beneficial. The Pittie featured in the video is 3 years out from a cruciate ligament tear and never had surgery. He is doing great because the owner did the homework as I recommended. The YouTube link is on my WordPress and is under RehabDeb if you search it.

I do not think I would ever have surgery on one of my own dogs for this issue again. My little Grace had two TPLO’s, the major surgery where the bone is cut and replaced at a different angle, and both didn’t work out. One wouldn’t have worked out because she had a congenital joint disorder on that knee and the surgery wasn’t ever going to be solid, and on the other knee she ended up getting a raging infection at the time of surgery that eventually ate up the whole joint. The Grace had a poor immune system, and she was open too long on the table, due to unforeseen circumstances, among other things.

She was bone on bone in both knees for the last 3 years of her life, yet she was definitely full of life! She ended up tearing all three ligaments in the second knee, so far as I/we can tell, and it was muscle support of the joint that enabled her to function as well as she did. None of the available braces were of a good enough design for her, and I’m not a fan of what is currently available for most dogs, especially not without working on my walking and exercise drill protocol first.
I deal with many dogs whose owners don’t want surgery for a variety of reasons, and the feedback I receive is that they have done great without surgery.
Of course, I also do rehab with many pets that have had surgery also, from both boarded surgeons and regular vets, using all types of modifications.
I’d be glad to discuss the differences.

We don’t do surgery on every human athlete, much less every human, yet most of the dogs are immediately referred to surgery as if there isn’t another answer the vet knows to suggest. This is because the vets are trained to react in that manner, and they usually don’t have any foundation in muscle-building and joint support protocol. Most of the reasons I’ve heard given in favor of surgery aren’t necessarily scientifically correct, according to available research and anecdotal evidence. I’m trying to make my functional rehab protocol using principles of exercise physiology more readily available.

My background in sport science definitely gives me a huge edge in developing protocol for recovery, and it is just taking slow time, getting the word out and getting people to think more wholly about the situation, and to see/know therapies that exist in other areas of physical science and apply them here. The angle of a dog’s knee, or any quad-ped knee, is definitely different than that of a human/bi-ped, however many principles of physiology and of the relationship between soft and hard body tissue apply and are useful to improve function and quality of life.

Blessings!!

(10-17-13 and now you may purchase the guide book for rehab of this condition at http://wp.me/p1wSDA-cU )

Sully’s Story: Great Dane with Lick Granuloma, Spinal Infection (probable), Paralysis, Ulcer, Pneumonia

I first met Sully March 4, 2011, and you have seen him if you have followed some of my posts about him on Facebook and Twitter. I was first called to see him by a mobile vet and the owner stated as her main concern for Sully at the time, “loss of use of hind legs”. The owner, a woman living alone and not able to easily cope with this just-under-200 pounds-dog who couldn’t move on his own, contacted me on Feb. 28, 2011, and our schedules did not match up until the fourth of March…and by that time he had ceased to be mobile and had been stuck, lying on one side, for several days.

The short story for those of you with attention span issues is that Sully couldn’t walk, had a lick granuloma that was about 2 yrs. old, had likely incurred spinal infection from the infected granuloma site, had several urine burn ulcers, developed pneumonia, was treated for pneumonia, which, in turn, developed into long-term treatment for possible spinal infection, was treated for pain, was pushed daily to move in increasing amounts, and is now walking down the street with no assistance.

A case outcome like this is relatively rare, primarily because the owner has stuck with treatment (it works if you work on it and give it time…), and usually a case like this would have been euthanized because he is huge, the owner did not have additional help in the home, he is aggressive, and the owner was not going to have him hospitalized for any reason-not for pneumonia, not for machine-based diagnostics, not for urinary incontinence, not…period.

Sully definitely had some dark moments, yet everything that has happened with Sully has been “do-able”, maybe not optimal by  some of today’s standards, yet definitely “do-able”. I have pushed Sully, the vets, the owner, and any other caretaker every inch of the way to drive us all to give Sully the best treatment we all could…it has definitely been a collaborative effort, and I knew from my background and experience that experiences like ours with Sully were/are very novel to the majority.

Silly Sully

Thank you for your attention thus far, and blessings…please take any of the following info and use it to heal in your corner of the world.

Two block-and-tackles, a belly sling, a saddle girth, some caribiners, and a hind end sling…gets the day going!

April 7, 2012

Today is Sully’s 10th birthday! I have been working with him for one year and one month. A year ago, he couldn’t stand on his own and was sporting a urinary catheter. Last week he tried to run down the street with me! We love us some Sully!

Fat and Fat Reduction – 5 Articles

Quality of Life of Obese Dogs Improves When They Lose Weight

This is actually recent research that was done in the UK, where they estimate 1/3 of the dog population is obese. Study conducted by Waltham/Royal Canin. I wouldn’t think we needed research to prompt us on this, however human nature proves we do! For those of you who need research to tell you that your dog will have a longer, happier life (same goes for humans…) if they drop the extra fat, here it is! Wheeeeeee!

The results showed that the quality of life improved in the dogs that had successfully lost weight, in particular vitality scores increased and the score for emotional disturbance and pain decreased. Moreover, the more body fat that the dog lost, the greater the improvement in vitality.

‎…and, interestingly, the study notes this: “The research also found that dogs that failed to complete their weight loss programme had worse quality of life at the outset than those successfully losing weight, most notably worse vitality and greater emotional disturbance.” …sort of as if the dogs failed the program and not that the owners were part and parcel. lol…the dogs didn’t fail to complete the program. And their finding here denotes the close connection and issues to be explored within the human/animal psychology bond; it works both ways-to the positive and to negative effect. The failed dogs notably had ‘worse quality of life at the outset” than the ones who ended up succeeding, and most compromised were their vitality and emotional status. We definitely pass our moods, demeanor, and worry onto our animals. Breathe peacefully with your pets 🙂

The “HOW TO” is up to me to help you accomplish, usually in conjunction with your vet. 🙂 I have over 30 years experience in program design and nutrition, so I am well qualified to help with lifestyle changes and subtle or great control measures. People are usually able to follow my plans because I work with them to determine how they operate best, whether with large changes or baby steps or in-between. Blessings-

Feb. 21, 2012 — Researchers at the University of Liverpool have found that overweight dogs that lose weight have an improved quality of life compared to those that don’t.

A study of 50 overweight dogs, comprising a mix of breeds and genders was undertaken by scientists at the University in collaboration with the University of Glasgow, Royal Canin and the WALTHAM Centre for Pet Nutrition.

Owners completed a questionnaire to determine the health-related quality of life of their dog prior to weight loss. A follow-up questionnaire was completed by the owners of 30 dogs that successfully completed the weight loss programme, enabling changes in quality of life to be assessed. A range of life quality factors were scored, including vitality, emotional disturbance and pain. The quality of life of dogs which succeeded with their weight loss programme was also compared with those dogs that failed to lose weight successfully.

The results showed that the quality of life improved in the dogs that had successfully lost weight, in particular vitality scores increased and the score for emotional disturbance and pain decreased. Moreover, the more body fat that the dog lost, the greater the improvement in vitality.

The research also found that dogs that failed to complete their weight loss programme had worse quality of life at the outset than those successfully losing weight, most notably worse vitality and greater emotional disturbance.

Dr Alex German, Director of the Royal Canin Weight Management Clinic at the University, said: “Obesity is a risk for many dogs, affecting not only their health but also their quality of life. This research indicates that weight loss can play an important role in keeping your dog both healthy and happy.”

Dr Penelope Morris, from the WALTHAM Centre for Pet Nutrition, added: “Strategies for combating obesity and keeping dogs fit and healthy include portion control, increased exercise and diets specifically formulated for overweight pets.”

Established in 2004, the Royal Canin Weight Management Clinic at the University’s Small Animal Hospital UK’s is the world’s first animal weight management referral clinic and was set up to help tackle and prevent weight problems in animals such as dogs and cats.

Veterinary surgeons from any general practice in the UK can refer overweight animals to the clinic. The patients receive a thorough medical examination, and are then given a specific dietary plan and exercise regime to follow over several weeks.

Taken from ScienceDaily

Fat is Pro-Inflammatory! Weight Loss Helps Relieve Pain From Arthritis (among other things!)

Copied from a recent post on the IVAPM*:

“…I would be looking for some of the non-pharmacologic strategies. You have already mentioned an important one, getting the weight off. Adipose tissue is the body’s largest endocrine organ, and it secretes, especially when in excess, a slew of nasty cytokines that essentially bathes the body – including the synovia and joints – in a soup of pro-inflammatory mediators. We have increasingly strong evidence in dogs that nothing more than weight loss will improve comfort and mobility in this species, including excellent one this year where the authors conclude “results indicate that body weight reduction causes a significant decrease in lameness from a weight loss of 6.10% onwards. Kinetic gait analysis supported the results from a body weight reduction of 8.85% onwards. These results confirm that weight loss should be presented as an important treatment modality to owners of obese dogs with OA and that noticeable improvement may be seen after modest weight loss in the region of 6.10 – 8.85% body weight”.”

Weight loss. There is no substitute. • Lago R, Gomez R, et al A new player in cartilage homeostasis: adiponectin induces nitric oxide synthase type II and pro-inflammatory cytokines in chondrocytes. Osteoarthritis Cartilage. 2008 Sep;16(9):1101-9. • Impellizeri JA, Tetrick MA, Muir P. Effect of weight reduction on clinical signs of lameness in dogs with hip osteoarthritis. JAVMA 2000 Apr 1;216(7):1089-91 • Burkholder, 2001 • Mlacnik E, Bockstahler BA, Muller M, et al. Effects of caloric restriction and a moderate or intense physiotherapy program for treatment of lameness in overweight dogs with osteoarthritis. J Am Vet Med Assoc. 2006 Dec 1;229(11):1756-60. • Marshall WG, Hazewinkel, HA, Mullen D, et al. Vet Res Commun. The effect of weight loss on lameness in obese dogs with osteoarthritis. 2010 Mar;34(3):241-53

*International Veterinary Association of Pain Management

Exercise training in obese older adults prevents increase in bone turnover and attenuates decrease in hip bone mineral density induced by weight loss despite decline in bone-active hormones.

J Bone Miner Res.  2011; 26(12):2851-9 (ISSN: 1523-4681)

Shah K; Armamento-Villareal R; Parimi N; Chode S; Sinacore DR; Hilton TN; Napoli N; Qualls C; Villareal DT
Division of Geriatrics and Nutritional Science, Washington University School of Medicine, St. Louis, MO, USA.

Weight loss therapy to improve health in obese older adults is controversial because it causes further bone loss. Therefore, it is recommended that weight loss therapy should include an intervention such as exercise training (ET) to minimize bone loss. The purpose of this study was to determine the independent and combined effects of weight loss and ET on bone metabolism in relation to bone mineral density (BMD) in obese older adults. One-hundred-seven older (age >65 years) obese (body mass index [BMI] ≥ 30  kg/m(2) ) adults were randomly assigned to a control group, diet group, exercise group, and diet-exercise group for 1 year. Body weight decreased in the diet (-9.6%) and diet-exercise (-9.4%) groups, not in the exercise (-1%) and control (-0.2%) groups (between-group p  <  0.001). However, despite comparable weight loss, bone loss at the total hip was relatively less in the diet-exercise group (-1.1%) than in the diet group (-2.6%), whereas BMD increased in the exercise group (1.5%) (between-group p  <  0.001). Serum C-terminal telopeptide (CTX) and osteocalcin concentrations increased in the diet group (31% and 24%, respectively), whereas they decreased in the exercise group (-13% and -15%, respectively) (between-group p  <  0.001). In contrast, similar to the control group, serum CTX and osteocalcin concentrations did not change in the diet-exercise group. Serum procollagen propeptide concentrations decreased in the exercise group (-15%) compared with the diet group (9%) (p  =  0.04). Serum leptin and estradiol concentrations decreased in the diet (-25% and -15%, respectively) and diet-exercise (-38% and -13%, respectively) groups, not in the exercise and control groups (between-group p  =  0.001). Multivariate analyses revealed that changes in lean body mass (β  =  0.33), serum osteocalcin (β  = -0.24), and one-repetition maximum (1-RM) strength (β  =  0.23) were independent predictors of changes in hip BMD (all p  <  0.05). In conclusion, the addition of ET to weight loss therapy among obese older adults prevents weight loss-induced increase in bone turnover and attenuates weight loss-induced reduction in hip BMD despite weight loss-induced decrease in bone-active hormones.

Overweight vs. Lifespan

Dr. Gabe Mirkin’s Fitness and Health e-Zine
January 13, 2013

Being Overweight Does Not Prolong Lives

A recent meta-analysis of  a hundred large studies showed that being a little bit overweight offers slight protection (a six percent decrease) from premature death (Journal of the American Medical Association, January 2, 2013).  This study has been widely reported in the media, with headlines such as “Our Imaginary Weight Problem”. Instead of being told that overweight is beneficial, people should continue to hear that excess weight shortens lives, particularly if their fat is stored in the belly.
WHY THE REPORT IS FLAWED:  People with wasting diseases usually lose weight long before they die.  All chronic diseases that shorten lives have a tendency to make people lose weight. Heart diseases, cancers, late stages of diabetes, kidney failure, arthritis, and even aging itself, usually cause weight loss before death (J Cachexia Sarcopenia Muscle, 2012;3(1):1-4).  Weight loss that precedes death can last as long as 10 to 20 years, so it is impossible to correct epidemiological studies for this effect. As people with wasting diseases approach death, their rate of weight loss increases dramatically. Sicker people, and those closer to death, lose weight faster than people with wasting diseases whose immunities are successfully holding their diseases at bay. It is true that people who have diseases that will eventually kill
them may live longer as long as they do not lose weight.
EVEN A LITTLE BIT OF FAT IN YOUR BELLY CAN KILL YOU.  Not all fat is harmful.  Fat stored on your hips and upper legs protects you from disease.  It does not turn on your immunity or cause inflammation; and it helps to prevent diabetes and heart attacks. However, fat located inside your belly and around your
organs:
* turns on your immunity to cause inflammation that leads to cancers, heart attacks, strokes, diabetes, inflammatory types of arthritis and so forth; and
* blocks insulin receptors to raise blood sugar levels, leading to diabetes that can damage every cell in your body.
This large study should not make you believe that being overweight is beneficial.  You should maintain a healthful weight and try to lose any excess fat that you have in your belly. Belly fat is harmful and shortens lives.

from Dr. Mirkin dot com

Fast Walking and Jogging Halve Development of Heart Disease and Stroke Risk Factors, Research Indicates

The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome — a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels — say the authors.
This has been proved in different studies in different ways for different reasons, mostly related to sport science and training, for many years. Don’t think you don’t have enough time to exercise 🙂

Keep in mind, though, that it’s very slow walks that bring about the benefits at the beginning of rehab, as per my homework instructions!

ScienceDaily (Oct. 8, 2012) — Daily activities, such as fast walking and jogging, can curb the development of risk factors for heart disease and stroke by as much as 50 per cent, whereas an hour’s daily walk makes little difference, indicates research published in the online journal BMJ Open.

The findings indicate that it is the intensity, rather than the duration, of exercise that counts in combating the impact of metabolic syndrome — a combination of factors, including midriff bulge, high blood pressure, insulin resistance, higher than normal levels of blood glucose and abnormal blood fat levels — say the authors.

Genes, diet, and lack of exercise are thought to be implicated in the development of the syndrome, which is conducive to inflammation and blood thickening.

The authors base their findings on more than 10,000 Danish adults, between the ages of 21 and 98, who were initially assessed in 1991-94 and then monitored for up to 10 years. All the participants were quizzed on the amount of physical activity they did, which was categorised according to intensity and duration.

At the initial assessment, around one in five (20.7%) women and just over one in four (27.3%) men had metabolic syndrome. Prevalence was closely linked to physical activity level.

Among the women, almost one in three of those who had a sedentary lifestyle had the syndrome whereas only one in 10 of those who were very physically active had it. Among men, the equivalent proportions were just under 37% and just under 14%

Of the remaining 6,088 participants without metabolic syndrome, just under two thirds (3,992) completed the fourth and final survey and assessment, by which point one in seven (15.4%; 585) had developed it.

Again, the prevalence was higher among those leading a sedentary lifestyle, with almost one in five (19.4%) affected compared with around one in nine (11.8%) of those who were very physically active.

It was not only the amount of exercise, but also the intensity which helped curb the likelihood of developing the syndrome.

After taking account of factors likely to influence the results, fast walking speed halved the risk, while jogging cut the risk by 40 per cent. But going for an hour’s walk every day made no difference.

“Our results confirm the role of physical activity in reducing [metabolic syndrome] risk and suggest that intensity rather than volume of physical activity is important,” conclude the authors.

Question: Walk Slow or Walk Fast?

Q: “Dr. *Surgeon* did X-rays and said she is totally healed. He said sometimes the implant can be irritating for her and he can remove that since the bone has healed…could be the reason for some of her discomfort. He also said slow walking is more painful for her and she should go at a faster pace. What do you think???”

A: Yes, walking slower is more painful because they are having to use the affected limb more completely, and they need to do that for true, more full, healing. They always cheat when they go fast; they don’t use the affected muscles & limbs like they should for better development and recovery. A little pain medicine goes a long way toward encouraging healing and making the whole system work more properly. I do not agree she should walk faster; it defies sports medicine principles and the principles of functional rehabilitation. A slow return to positive function will most likely insure against additional injury.