Recent text convo with the referring veterinarian after I saw a new Doxie X client for ACL/CCL rupture:
Me: I’m sending *her* back to you to get joint formula and talk with you about pain meds for the “hard” work days. Client said you had already mentioned we’d probably do that, and I know you are a new vet to her and that she only recently sought you out for a 3rd opinion on what could be done for the CCR since she didn’t want surgery. Otherwise, *she* just needs a lot more restrictions 😉 her left stifle is slightly effused and she’s been running amok. Her right is actually sensitive also and she did not like my palpating it. Thanks for the referral, and I’ll get a written report to you…wanted you to know about my sending her back to you since she may come in before I get to the computer to make the report. I really appreciate working with you, and your clients really appreciate you, too.
Him: About to see *her* again this afternoon. When I palpated right side last time, it was normal, but the dog was somewhat resistant to everything I did, so I didn’t notice her being more reactive on that stifle. Will check again though, although I guess it really wouldn’t change much at this point.
Me: I’m with you and that’s what I told her when I said, “you know, Dr. X would probably say the same thing and it wouldn’t change anything we are doing” 🙂
Him: I didn’t know how targeted your rehab is, but I assumed it was more for hind limbs in general, not necessarily for left stifle specifically in a case like this. Thanks!
Me: Definitely doesn’t need to be targeted while laying the foundation, which takes about 4 weeks of consistent and progressive work. My work is designed to target while using more of a natural lifestyle intervention program. I told her to get some joint formula from you and she does toe-tap around the house some. Plus, until my visit she’s been a lunatic dog and client said that you had already told her there was a likelihood we’d use Tramadol for hard workout days. You are right…very few findings change what I’m already doing most of the time. I think I will make this into a blog post 🙂
I have had only a handful of cases wherein diagnostics changed the game plan. Some of them that I recall are as follows:
1) I was called out to see a teenaged Lab that had FHO surgery. My recovery plan for post-FHO is currently posted elsewhere on this site and involves progressive, controlled walking protocol. The dog was being allowed to run up and down the street in the neighborhood. The dog was also not on any pain meds. I suspected that the dog also had a torn cruciate ligament in the opposing knee that hadn’t been addressed by the vet (because he didn’t yet know). My progressive walking protocol for the first 4 weeks is the same for both situations, however the clients believed since the dog was “x amount of time” out from hip surgery that the dog could “return to normal activity”, especially since the surgeon had said to do that. The dog wasn’t given enough pain meds to help with successful function of the hind end after either the injury or the surgery. Of course she was running up and down the street with the children because it was fun! I would have begun that dog, with appropriate pain meds and based on function at this point after FHO, at a longer time period of recovery walks than I would have used for her to begin recovery from the torn knee ligament. Thus, the protocol changed to the shorter, introductory version.
2) I’m not counting the handful of cases where I’ve been called out to address function and after an hour of history-taking and function assessment I’ve discovered “hiding” masses…which have resulted in a recheck with the vet and a dire diagnosis/prognosis=euthanasia.
3) On the other hand, I’ve been called out for the same as #2, found masses that were deemed removable and subsequently cancer, and this has rarely changed the plan for functional rehab. The plan reduces if need be for recovery from surgery to remove a mass or reduces to help recovery during chemotherapy. Sometimes there has been amputation, and my goals for recovery and assisting the people and the animals changes to help everyone adjust and the animals to improve function.
More examples to come-out of time for now