Today’s Question: Torn Meniscus? Tearing CCL?

Hi Deborah! (My son) and I are in Canada with our dear friend J. J. has two border collies…one about a year and a half and one about 8 months. I have a question I’m hoping you can help me with. Any advice would be most welcome:

The baby (Morfydd) began limping several days ago. I would classify it as a mild limp. We took her to the vet and the vet diagnosed her with a pull cruciate ligament. (She attempted a drawer sign and felt a little click on that side accompanied by Morfydd indicating discomfort). She said that it was not a tear but a pull. She prescribed a modified version of your house arrest: No running or playing, only walking slowly on short leash, no walking up or down stairs, swimming okay if carried in to deep water. She also prescribed a NSAID- not Rimadel but something similar. She suggested doing ROM three times a day, daily comfrey as well as Reiki. (They are WAY more progressive here!) Here’s the problem and I would love your feedback if you would be so kind:

It is truly impossible to keep her down like that. Her “big brother” is a full energy dog and they play all the time. We would need to keep her crated all day which simply isn’t practical or possible. Yesterday I kept them separated much of the day, but then she was so cooped up that when she would play, she would go nuts and play harder than ever. Her limp doesn’t seem that bad at all- nothing like what (my dog) was like. Gosh- I hope I’m explaining this adequately.

Our question to you: Is there a way to deal with this with some care but without this level of restriction? Can a pulled ligament heal without this level of rest? Without exercise, she seems destined to injure it further due to play that is more… unbridaled, if you know I mean. One piece of info I should add is that she is on the thin side and her muscles are a little underdeveloped so we are trying to get her fattened up a bit. She is getting glucosamine added along with fish oil already. She is on a mostly raw diet. She refuses vegetables so we have been trying to sneak those in with limited success. Okay, I’ll stop now. Tell us any and all that you are willing/ able to. Thank you SO much in advance, dear Deborah!!!!
xoxoxoxo,
S.
p.s. I hope this makes sense!!!

MY ANSWER FOR TODAY:

Now, several options…
First, regarding diagnosis (dx): a click often means meniscal damage. A torn meniscus is different from a torn/tearing/ruptured cruciate ligament (CCL dogs/ACL humans). This may not be what is going on, however I am more familiar with a click=meniscus than a click=ccl-only damage when performing drawer motion. Drawer motion is designed to reveal what it suggests; the tibia slides forward like a drawer opening, and if it does, to whatever extent it does, damage to the CCL is indicated. Meniscal damage may only be rectified by surgery (sx), to my knowledge, and it is problematic and painful to endure, to my understanding, without sx. It is like having a sharp rock in ones shoe, on the one hand. The corrective sx for torn meniscus, on a positive note, is usually arthroscopic and, therefore, less invasive than a full opening of the knee.
I agree with the vet’s prescription regarding structured leash walks for exercise, and you may better structure it by following my plan (available on this blog) for conservative and/or for post-sx CCL tear homework.
EXCEPTION to her recommendations is that swimming is NOT A GOOD IDEA; swimming with a damaged knee usually causes more and different damage, particularly potentially patellar tendonitis, and that is if they use the hind legs to swim at all. Dogs do not tend to swim using their hind legs in plane, which would be optimal, imho; instead they give thrusts laterally, or more laterally, and this potentially brings the additional damage.
I also see no point that is largely beneficial to performing ROM, and although that is what the vets are instructed by the powers that be in the dominant paradigm to instruct owners to do, it makes no practical sense in a case like this. Morfydd is able to move her own leg and will do so fully so long as she is not in pain. Period. People run the risk of damaging the dog or, at least, wasting time and activity on ROM when more beneficial activities may be pursued.
Reiki=good, comfrey=ok…I would add fish oil and Arnica Montana 30, along with the type of massages I also recommend in my video on this blog. I re-read your note and see that you have fish oil on board, so see that you are in a good dose range…fish oil, probably ~300-400 mg EPA (and concurrent DHA), daily, in capsule form, which you may puncture and squirt onto food. I usually place the punctured capsule in the food dish as well. Your Cozzie likes to squish them whole. Either way. :)Potentially good that she is on other joint protective (glucosamine, etc…) also, depending on the brand and dose. I appreciate that M. is fed raw, however it may be, since she is not eating her veggies, that introducing a grain-free canned (for the crack-appeal, immediate gratification) and eventually grain-free kibble would be a good idea for her juvie self. I have utilised many brands and find consistent beneficial results with Wellness Core. Unfortunately they don’t pay me to promote their product. 🙂 Grain-free seems to be the best option regardless and based on much science, especially results of studies that indicate that grains are implicated in joint dz (disease) and autoimmune dz.
Consider this: there is no option for recovery outside of recovery…so, if y’all don’t keep her quiet so we may see what the more true nature of the damage is and/or dx toward next tx (treatment) options, then she will continue to damage her joint and it will get worse. If she had sx, then she would have no option but to be quiet for recovery.
So, regardless of how you perceive the dynamic, restriction is entirely possible. I see all sorts of animals and homes and owners with varying psychology, and most people resist restriction on behalf of their animals and their projections as to what they think the animal will be “happiest” doing.
Just sayin’.
She should be restricted and NOT ALLOWED TO PARTICIPATE IN POTENTIALLY DAMAGING PLAY, yet entertained by structured walks, wherein you project to her that this is an important job, and then entertained by mind games, i.e., guess which hand the kibble is in, guess which cup the kibble is under, etc…
I do understand that some breeds need more stimulation.Try her on restricted leash walk, 5-10 min, going over a short cavaletti course. This will give her a project, naturally induce greater ROM, and help her “feel” satisfied for having completed a task. Short as in height, perhaps 4-6″. Go over cavs 10-20x.

You won’t kill her either way…you will just induce more pain and potentially she will have to live with pain J. doesn’t recognise for the remainder of her life, will live on higher doses of pain meds (which may be unavoidable in some cases, like my Grace), and/or will need sx. So, being more conservative in the short run may bring gains for the long run. Most people do not think their pet is in pain, and most people do not know the additional signs I see when I evaluate the pet.
This advice coming from the queen of noting that shortcuts usually don’t work.
Luvsu.
Let me know if you have additional questions.
Think practically, intuitively and spiritually with less projected emotion and you will likely do well by her.
That will be a thousand dollars. You are welcome.
xox

3/17/13 note: this dog is doing fantastic and most of the homework suggestions were followed.

Degenerative Myelopathy and Neuro Conditions

Degenerative Myelopathy and Neuro Conditions

Question from the vet pain assn. board:

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.

My 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.

The protocol I have developed over time, and which has been successful at improving function to varying, but notable, degrees is derived predominately from my long-time experience in sport science program design. A body at rest stays at rest and only changes with dynamic interference…

Pain management discussion aside (and 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), I introduce a system of simple, vibration-based, massage with a $4.99 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-animal-induced movement exercises, retraining brain-to-limb neural pathways and encouraging focus on movement and function. 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. 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 of neuro dogs wearing these harnesses around this blog.

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 utilise Ruff Wear boots, usually sometime along the way, for dogs, depending on function-ability, to encourage hind limb use and stability in the home on tile and wood floors. I have contacted the company twice to positively discuss their product and have never heard back from them, nonetheless, they have a product that provides great traction and encourages increased mobility.

OH! And on several elderly canine patients I have 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.

I am in a hurry to get to a dog event today and have been intending to respond to this mail and to the mail regarding laser therapy for quite some time. Only have time for this right now, and while it is definitely not all-inclusive, I trust it is a help.

Blessings to All, and I much enjoy and forward many of the informative posts to vet and pharmacist friends. I have been through surgeries and injuries and I am also a patient advocate and navigator for humans, especially for cancer, so I have paid much attention to pain management for many years. Thank you, thank you for your progressive and beneficial attitudes and approaches!
Deborah Carroll

(from a note posted to the IVAPM, veterinary pain management forum)

Probiotics and Antibiotics Given Together?

Question/statement via email from a client this morning –

My client wrote the following to me about probiotics with antibiotics :

“I always give P*** yogurt with his dinner and forgot about the interactivity with Cipro.  So 2 of his first 3 doses (Tuesday and Wednesday nights) may have had diminished effectiveness.  I will discontinue the yogurt until he is done with the Cipro.”

Her overall understanding was that the antibiotics and the probiotics cancel each other out or interfere with one another’s work.

Answer I gave –

Actually, no problem with giving the yogurt and the antibiotics together.

The probiotics and the antibiotics are both primarily processed in different parts of the g.i. tract from one another.

I always recommend taking probiotics when taking antibiotics or other medications. I also recommend increasing probiotics to a multi-strain instead of the limited amount found in most commercial yogurt. Give probiotics to support the system while on antibiotics.

You may, however, potentially support giving probiotics with antibiotics better by separating giving them by an half hour. Most people give the probiotics several hours away from giving the antibiotics.

For recommendations of probiotics and more information about giving them to your pet, click here!

Thanks!

Rehabdeb

bottle of pet probiotic powder for sale on Amazon

Volumes of research exist on this topic, and I randomly chose this link to include for further reading.

 

Originally Posted April, 2011, Updated April, 2018