Walk Slow or Walk Fast?

Q&A –

Should your pet be walking slowly or walking faster after injury or surgery? Science says slow and steady –

Question –

“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???”

Answer –

Yes, walking slower is more painful because she is having to use the injured limb more.

She has to use the injured limb more for good recovery.

It is also painful when the pet is not receiving enough pain medication to go along with a proper home rehabilitation plan.

She needs to use her leg for full healing.

If your pet is going fast, they are usually skipping over using the injured body part, whether you think you see them doing that or not. If they don’t use the painful body part, they won’t grow bone & muscle as well or much at all, and they won’t heal as well. They cheat on leg use when they go fast after injury or surgery and if they are in pain, which they most often are in my experience.

Pets don’t use the affected muscles & limbs like they should for better development and recovery when they are in pain. Proper dosing of pain medicine goes a long way toward encouraging healing and making the system work better.

I do not agree that she should walk faster; it defies sports medicine principles and the principles of functional recovery and rehabilitation to have her walk faster now. A slow return to positive function will most likely insure against added injury.

Here is a booklet to help after surgery or with most basic recovery for the first four weeks. Real rehab should be progressive and will last at least 12 weeks on average. Persistent problem cases may take up to a year or more to heal more fully. This is the same as in human medicine. 

 

Published August 13, 2011. Updated May 3, 2018

My Dog is Just Old…Old Pet Tricks

My Dog is Just Old…

Quite frequently I hear this comment from clients and even from people active in the practice of animal health and science.  I provide a mobile rehabilitation and conditioning service to encourage better recovery after surgery or otherwise improve quality of life through functional rehabilitation. Roughly 80% of my client base is elderly dogs, usually with orthopedic and/or neuro issues.  Following are some short comments on beneficial treatments for aging pets:….Any fitness/rehabilitation/conditioning/bodywork program should be collaborated with your pets regular veterinarian, i.e., they should be in the loop. This may be accomplished by having your veterinarian refer you to me or by my contacting the vet after you have contacted me should you desire to work hands-on with me as a rehabilitation and conditioning specialist.  Dachshunds flying off couches is not the same as plyometrics training, and many owners may not know the risks or benefits to either activity!  So make sure to include your primary care veterinarian in your plans to have additional therapies practiced on your pets….. In addition to #1, pain control, and #2, functional (possibly assisted) exercise protocol: Massage is a common therapy that almost anyone can use beneficially to encourage circulation and subsequently possibly encourage healing.  Many owners may take a stab at performing massage, but instruction from me is always best to start.  Different massage techniques accomplish different results, and hands-on massage is not even recommended in some cases! Otherwise, I have found great benefit in using the little AAA battery-operated massagers produced by the Homedics company.  My favorite ones cost $5.99, have four balled feet, and the spread of the feet is usually just right to straddle the spine of different animals.  These little massagers have a great vibration frequency and anecdotal evidence proves that their use is extremely beneficial. I ran across them in a store about 5 yrs. ago, and based on reading years of research regarding vibrations and circulation, etc…I decided to give it a try. At the least, this massager will increase circulation and the animal will hopefully enjoy it. Cat owners are using it too! I recommend beginning by slowly using the massager from neck to tail without it turned on, travelling the spine one direction, again, slowly.  After a couple of passes, turn on the massager and do the same movement as when it was off.  I like to divide the body into 5 minute sections, beginning with the department giving the most discomfort, i.e. mid-spine to tail base, then neck to mid-spine, right thigh, right shoulder, left thigh, left shoulder.  If your pet has hip problems, start with the thighs then do the spine then the shoulders, etc…The idea is that doing this form of massage on the whole dog could take 30 min. in one sitting, but if you only have time for 10 minutes’ worth, then do the most important parts first.  It is all complimentary and helpful; an animal with hip problems is taking more stress on his front end, and one with elbow problems is straining the neck, spine, and other parts of the body in compensation, so hopefully you get the idea.  Passive range of motion (PROM) should usually be performed and instructed to owners by an experienced practitioner.  Some owners I have counseled have come away from surgery discharge having been told to perform massage or PROM, yet the owner actually does not know what this means or how to perform it so that the animal is not injured.  A referral to a rehab practitioner to judge protocol and beneficial movements would be great for owners in these cases.  Joint mobilization should only be performed by an experienced practitioner.  PROM is not usually necessary if the pet is moving on their own, and other physical activities will be a better use of owners time.  If your dog is moving and flexing & extending his knee after surgery, very likely his joints are staying mobile and you need not bug him by making him endure your “bicycling” his knee.  Other drills and exercises will bring about improved use and recovery of the knee, and you subsequently have less opportunity to hurt him (or you) if you are not trying to manipulate him. Animals do not have the same hesitancy to use their offended joints as humans do, and the PROM is largely unnecessary unless the animal has nerve damage and cannot move the limbs, THEN PROM is indicated. Controlled, specific swimming in warm water can be beneficial for the improvement of muscle tone, fitness and strength, especially if an animal is too sore in their joints to walk well for just basic fitness.  Swimming for conditioning or therapy should be done in a controlled manner with the use of a dog life jacket and in short, steady bouts while better fitness is achieved.  Just because a 15-year-old dog “likes to swim” does not mean he/she should go at it for 15 minutes straight the first or even the fifth time.  I carry a full set of life jackets in my mobile practice should an owner possess facilities for swimming at home.  In some environments, a regular harness may be used instead of a life jacket. Small dogs with short legs, like Dachshunds, may be swum in many home tubs.  ….I find that outside the home environment, elderly animals (and many of other ages as well) are usually not happy to be in a swim tank in a foreign environment.  I worked with a water tank/treadmill during the first years of my practice and determined that I would not miss it one bit in mobile practice.  Elderly animals are often slightly confused and seem to want to do things in the comfort of their accustomed environment.  In addition to incalculable fear levels when trying to use a facility-based water tank for therapy, this fear often induces nervous diarrhea in the water and the fear is potential cause for new injury.  Travel to and from a facility can produce unnecessary stresses on both owner and animal.  Therefore, I have come up with a variety of exercises and slings to assist elderly animals while they learn to return to better function on land….. Epsom salt baths have been very beneficial for my elderly patients whose owners have tried them.  Your pet may have health conditions making these baths prohibitive, so check with me or your veterinarian.  Make sure to rinse off all the residue after the bath, otherwise when your pet licks off the residue, diarrhea will likely ensue…(magnesium). Many machine modalities may be used in the practice of rehabilitation.  I consider low-level laser therapy to be the most complementary and productive machine modality I utilize in my practice.  Laser therapy has immense benefits which I will not attempt to cover here.  A wonderful website to peruse is Thorlaser.com, and much information regarding laser therapy may be found there. Ultrasound therapy on arthritic or sore joints and muscles has been proven to be beneficial.  I also utilize this therapy in my practice and have had very positive owner feedback with regard to improved function in their animals.  Much research information, including evidence-based research, is available on the web regarding these modalities…..People often ask me about using heating pads on their dogs; the use of heat depends on the nature of the injury or disease process.  A combination of ice/heat/ice is often more therapeutic or the use of moist heat or brown rice in a sock heated in the microwave are usually preferential heat application options, but moist is good for some things while dry heat is for others.  When in doubt, use ice.  Instructions for the use of ice and heat may be found on my websites. Chiropractic interventions are the choice of some and in my opinion should be combined with other therapies, especially massage, and should be administered by vets who have studied chiropractic
or by chiropractors who have studied animal chiropractic—especially with regard to spinal issues—and are working in conjunction with the vet. Acupuncture intervention has been proved to be beneficial as well and especially for pain control.  There are several vets in the Austin area who practice acupuncture. Diet:  There are commonly-recommended neutraceuticals for elderly and injured dogs as well as for young dogs that have genetic or early-onset of disease process in their joints.  Younger sporting dogs should benefit from these as well.  Animals, like people, are not always being fed an optimal diet, so the receipt of quality nutrition from feeding varies, and the supplementation of neutraceuticals is often warranted.  It is my preference, based on 30+ years’ experience, well-performed and founded research, and successful nutritional healing protocol, to encourage my patients toward a grain-free diet.  The research is out there, and I will not attempt to summarize is here.  Among commonly-used and readily-available supplements in this catagory are Glucosamine Hydrochloride with Chondroitin Sulfate (synergistic benefit), MSM (additional synergistic benefit), SAMe (joint, liver, tissue, brain, pain), and Omega 3 fatty acids, preferably in the form of fish oil.  Oil-based supplements included in animal food are chemically altered during the production process to the point of diminishing their efficacy and/or they soon become rancid when the bag is opened.  Omega 3 fatty acid chains are very fragile and research shows use of the capsule form is best. Additional options are digestive enzymes, probiotics, vitamin C, B vitamins & L-Glutamine, to name a few. Bed: Bedding DOES make a difference. If your old dog/cat is still trying to jump onto your bed, I recommend you either stop them and provide an eggcrate bed nearby or get them started using stairs or a ramp up to the bed (and into the car, too…). Infrared bedding is nice (expensive), and solid research proves benefits. I have a Great Dane, and she has the chaise end of a couch, a Papasan Chair cushion, and two egg crate foam beds (in different rooms). Elevate Food and Water: this reduces strain on elbows and neck. I put my Great Dane’s kibble in a Rubbermaid container that stands about 18″ high. Many varieties of elevated stands are available from stores and many homemade ideas about on the net. Definitely makes a beneficial difference. There are definitely more ideas to be shared, and you are welcome to make note of some in the comments section. Pain control and exercise are key to keep your pet moving and healthy. I have a 10.5 year old Great Dane, Grace, as of this writing (Aug. 4, 2011), and she has had many severe orthopedic and some neurological issues, as well as several systemic internal issues. She appears as though she is 3 years old to most people. She does okay…:)

 

 

 

 

 

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