About Exercise Physiology-Based Veterinary Rehabilitation, Rehabdeb, Rehabilitation and Conditioning for Animals, and Move2Live
As you may have seen on social media outlets, our Moving2Live interview about Rehabilitation and Conditioning for Animals is now live on the Moving2Livewebsite.
The interview discusses my background and exercise physiology-based veterinary rehabilitation. You may also find the podcast on Apple Podcasts, Google Play, Stitcher, Spotify and other platforms by searching “Moving2Live.”
Move2Live has posted on Instagram, Facebook, Twitter and LinkedIn, so you may find the podcast there. I’m posting on all of my social media outlets as well, so you may find the podcast link there.
Please subscribe to the show on Apple Podcasts or your favorite platform, and please write a review!! This will help the interview get found by others.
You probably already know how the internet works regarding “getting the word out”. Please spread the word if you have benefited from this rehab. It’s a great idea to share the interview with co-workers, friends, and family! You never know who needs the help or who knows someone else who needs rehabilitation and conditioning for animals.
If you follow this exercise prescription well and would like advanced exercises, then contact me for a consult. There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your pet.
I have frequently seen cases where veterinary surgeons performed these two surgeries at the same time, on both knees, so a quadruple whammy. On the one hand, reasoning for doing so includes such thoughts as, “You only have to put your pet (usually a dog) through anesthesia and surgery one time”, and “You *only* have to go through recovery once”, and “We might as well do both surgeries once we open the knee”.
For now, I will tell you basic functional details of this case without the additional info I’d report in a formally published case study for a journal. I’ll put all the additional info into my booklet when I write it.
Feel free to ask questions.
This particular client found me after her dog’s surgery, having been referred to me by a groomer. The client, like most, was at a loss as to how to handle what was a very fragile situation with her best buddy.
Within the first 2 days of working with this little cutie I noticed tissue swelling, redness, and heat in one knee. The other leg was limping along in a fairly average recovery yet also not seemingly infected.
I typed reports, including extensive details about the signs and symptoms of a possible infection in one knee post-surgically, and I faxed them (years ago when we used fax more) to the hospital for the surgeon after my first visit with the dog.
The surgeon didn’t respond to me regarding my observations so I guided the client in solid restriction protocol, including how to help her dog potty, while she waited for her recheck appointment. I also thoroughly explained to the client the discussion she should have with the surgeon or her regular veterinarian to get the knee re-evaluated for possible infection asap and/or rule out other post-surgical complications.
Infection or Activity Level?
At the time of the appointment, instead of recognizing infection, the surgeon offhandedly blamed the owner and rehab for doing too much, saying that was why the knee was red and swollen. I assure you, Dear Reader, that neither the client nor the 1st week of rehab recovery was the problem…not at all! I emphasize this so that if you feel strongly about your or your pet’s health, you don’t feel intimidated when you pursue answers for healing. Politely speak up for yourself and for others. Try to build a bridge while not settling for any answer that belittles you or your thinking, if possible.
Recovery Protocol –
The client had gone above and beyond regarding securing the best recovery she could for her little dog. She frequently worked from home, a multi-level home, and she purchased baby playpens as good recovery pens for her fuzzy kid and put them on each level and in at least one room on each level. The dog was confined to the pens or to a crate.
The client originally hired me to come daily and strictly perform my very basic first week recovery plan just so “it would be done right”. I assured her that the plan was so simple for the first four weeks that she would not mess it up and that she could do it herself, but she really wanted me there daily.
The client was incredibly attentive to *doing everything right* and wanted me to do all the work except for potty breaks and other relevant work I couldn’t perform because I didn’t live with the dog. That turned out to be beneficial for the dog, since I caught signs of infection early.
Outcomes and Results –
The surgeon did not return my communications regarding the signs I noted that pointed to a problem that was likely infection in one knee. He also made the client to feel inadequate when she most very likely had nothing to do with the onset of the infection (based on preventative measures & type of infection), and she did return to have the surgeon address the issue, as anyone should.
You, Human Reader, should have your concerns addressed without your being made to feel inferior by the surgeon. Just so you know that’s a potential great outcome from the encounter, should you have one.
Soon thereafter, the pin the surgeon had placed in one knee as part of the patellar luxation surgery began to remove itself from the knee due to the infection and swelling. The pin notably moved out of where it was placed during surgery to a place that was easy for anyone to feel it poking out.
The client and her regular veterinarian were both timid with regard to “going over the head of the surgeon” and didn’t want to “step on toes” by addressing the now fairly obvious infection. This does happen fairly frequently in some communities.
Activity and Pain –
The Yorkie was in so much pain that he wasn’t trying to bounce around or get out of his confinement(s). I’ve never seen a dog that received this quad-whammy surgery bounce and try to play soon after surgery. They are usually very subdued by the pain of the surgeries. Also, bouncing and playing on a post-op leg usually produces a different type of swelling than infection swelling.
It is my opinion that we need better pain controlfor our pets . We do for humans, too, and you may already know that. Help for pain, especially nerve pain, has been a fave topic of mine for decades.
Is it an Infection?
I have also found that it is often hard to determine whether or not infection is present. We (client & care team) discover sort of anecdotally most of the post-surgical infections I see in cases. These infection areas are not hot and do not cause tissue swelling. These infections are causing pain in the joint. This pain doesn’t go away with combos of the right amounts of the right pain medications.
Dealing With the Infection –
When I suspect infection in a post-op orthopedic case, I recommend the client and vet discuss trying an antibiotic. I base this recommendation on something I learned in about 2006 from a surgeon. I always tell them that it was the surgeon’s idea, not mine. If the limping stops around three days after beginning abx, it is likely that we’ve found infection causing the pain.
I can’t legally diagnose infection, however I may share information about infection and potential treatments to inform the client. I also easily have many conversations with veterinarians to share what other vets might have done in a particular situation. That is collaborative work.
Of course antibiotics are considered only after ruling out the other usual pain scenarios (not enough pain medications, destroyed surgery, etc…) and/or medical reasons the pet cannot take antibiotics. Often this abx (antibiotics) dosing is the cure for continued limping if all else seems okay. I have shared the info from this surgeon with many veterinarians in my area. It has helped a lot of pets.
Usually I also tell the pet’s regular veterinarian about the many situations I’ve encountered where antibiotic treatment has produced the pain relief we hope for. In these cases it has eliminated an infection that wasn’t even suspected. I cannot legally diagnose any medical issues, but I don’t hesitate to relay my findings and experience to veterinarians. By doing that, sometimes we all get to learn and collaborate.
This infection was not the fault of rehab nor of the client and possibly not the fault of the surgeon. Infections like this are actually a common occurrence. I cannot say whether or not this infection could have been avoided. In my experience it seems very difficult to avoid infection under certain circumstances. Let’s just recognize it and deal with it medically on our ends, because we are working after the fact.
If there is swelling in your pet’s knee (or other body area) or if it is hot and red after surgery or injury, please go to your veterinarian or veterinary specialist and have it evaluated sooner than later.
…and the Pin?
This Yorkie’s infection advanced quickly. The surgeon removed the pin from the infected knee after the dog finished a course of antibiotics. In the meantime, the infection did its damage. This Yorkie never gained as full a use of the infected leg as he did in the other leg.
“That’s What I Thought!”
If you feel like your pet has a problem that the surgeon or veterinarian is ignoring, then please go ahead and get a second opinion from another licensed veterinarian. I post information about cases like this because I receive many, many emails from all sorts of people about their pet’s cases, which are similar to what I frequently encounter in my practice. I want to give strength to your voice if you are trying to get to the bottom of a problem with your pet and aren’t sure to trust your gut.
What Else Helps With Infection and Infection Pain?
Ice will not do much to help infection swelling and pain, in my experience and according to research. Usually other time-consuming therapies don’t get rid of the infection, and therefore the pain, either, and waiting for them to help with pain allows the infection to cause additional joint and tissue damage. Bacteria are causing the pain in the case of infection pain and have to be killed for the pain resolution.
Anti-inflammatories and narcotics don’t usually help against infection pain and they don’t kill the infection bugs, either. I never recommend heat compresses or dry heat in general right after surgery or injury. I base that idea on decades of published research that practitioners still argue about. Sometimes heat and/or ice are the best idea, but only in specific cases and not across the board. Sometimes moist heat is great for certain infection cases AFTER infection diagnosis.
Ultimately, there is no “blame” here, especially since that isn’t productive in this case; what there is, however, is discovery and learning through experience. Ultimately the pets health (or yours) needs you to be the best advocate you can be. Trust yourself if things don’t seem right, and push to find a practitioner who listens and collaborates.
There is a contact form at the bottom of this page <<Click on link . Use this form if you would like to schedule a paid phone or in-person consult with me for rehabilitation for your pet.
Physical Therapy as Effective as Surgery for Torn Meniscus and Arthritis of the Knee, (Human) Study Suggests –
“Surgery may not always be the best first course of action.
A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. To reinforce that, this study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.” Mar. 21, 2013 — A New England Journal of Medicine (NEJM) study showing that physical therapy is just as effective as surgery in patients with meniscal tears and arthritis of the knee should encourage many health care providers to reconsider their practices in the management of this common injury, according to the American Physical Therapy Association (APTA).
The study, published March 19, showed no significant differences in functional improvement after 6 months between patients who underwent surgery with postoperative physical therapy and those who received standardized physical therapy alone.
“This study demonstrates what physical therapists have long known,” explained APTA President Paul A. Rockar Jr, PT, DPT, MS. “Surgery may not always be the best first course of action. A physical therapist, in many cases, can help patients avoid the often unnecessary risks and expenses of surgery. This study should help change practice in the management of symptomatic meniscal tears in patients with knee osteoarthritis.”
According to lead physical therapist for the trial and American Physical Therapy Association (APTA) member Clare Safran-Norton, PT, PhD, OCS, “our findings suggest that a course of physical therapy in this patient population may be a good first choice since there were no group differences at 6 months and 12 months in this trial.
These findings should help surgeons, physicians, physical therapists, and patients in decision-making regarding their treatment options.”
Researchers at 7 major universities and orthopedic surgery centers around the country studied 351 patients aged 45 years or older who had a meniscal tear and mild-to-moderate osteoarthritis of the knee. Patients were randomly assigned to groups who received either surgery and postoperative physical therapy or standardized physical therapy. Within 6-12 months, patients who had physical therapy alone showed similar improvement in functional status and pain as those who had undergone arthroscopic partial meniscectomy surgery. Furthermore, patients who were given standardized physical therapy — individualized treatment and a progressive home exercise program — had the option of “crossing over” to surgery if substantial improvements were not achieved. In this situation, thirty percent of patients crossed over to surgery during the first 6 months. At 12 months these patients reported similar outcomes as those who initially had surgery. Seventy percent of patients remained with standardized physical therapy.
According to an accompanying editorial in NEJM,”millions of people are being exposed to potential risks associated with a treatment [surgery] that may or may not offer specific benefit, and the costs are substantial.” Physical therapist and APTA member Mary Ann Wilmarth, PT, DPT, MS, OCS, MTC, Cert MDT, chief of physical therapy at Harvard University, said, “Physical therapists are experts in improving mobility and restoring motion. The individualized treatment approach is very important in the early phases of rehabilitation in order to achieve desired functional outcomes and avoid setbacks or complications.”
The above story is reprinted from materials provided by American Physical Therapy Association. Note: Materials may be edited for content and length. For further information, please contact the source cited above.
Journal Reference: Jeffrey N. Katz, Robert H. Brophy, Christine E. Chaisson, Leigh de Chaves, Brian J. Cole, Diane L. Dahm, Laurel A. Donnell-Fink, Ali Guermazi, Amanda K. Haas, Morgan H. Jones, Bruce A. Levy, Lisa A. Mandl, Scott D. Martin, Robert G. Marx, Anthony Miniaci, Matthew J. Matava, Joseph Palmisano, Emily K. Reinke, Brian E. Richardson, Benjamin N. Rome, Clare E. Safran-Norton, Debra J. Skoniecki, Daniel H. Solomon, Matthew V. Smith, Kurt P. Spindler, Michael J. Stuart, John Wright, Rick W. Wright, Elena Losina. Surgery versus Physical Therapy for a Meniscal Tear and Osteoarthritis. New England Journal of Medicine, 2013; : 130318220107009 DOI:10.1056/NEJMoa1301408
(click on the THIS LINK, and you should be directed to Amazon in your country, unless you live in these countries – Australia, Brasil,India, Mexico, Nederland = you should click on the name of your country to be taken to the book).
(available on Kindle and in paperback, and you may order the paperback through any bookseller)
A Few Amazon reviews I took time to copy/paste here for you (additional testimonials are above, in the “Feedback“ section):
“I’ve known Deborah Carroll for several years and she has worked with us rehabbing our 90lb Hound/Lab mix. I have always found her to be chock full of great scientific information in rehabbing your pet and the booklet simplifies all that into simple to understand protocol and reasons to follow the protocol to help your dog. Short read but well worth it. I love it!” D.B., Amazon Review
“The book easily outlines a plan to rehabilitate your dog from a knee injury. I now feel like there is hope for his long term recovery. Thanks Deb!” Amazon Review
“Using the methods described in this book, we were able to completely rehabilitate our Labrador retriever from a torn ACL without having surgery. Very thankful that this book was so easily accessible!” H.P., Amazon Review
“I chose not to have my 9 year old Lab put through the stress of surgery on his torn CCL – knowing that he is already showing signs of the other leg being injured. After much research, I found Deborah’s website and read a lot of the blog posts where I learned of her book. I have been using the therapy in the book now for about a month and it is working well in conjunction with some holistic remedies and massage, Since the process of healing is really the same for both non-surgery and surgery dogs, this book will help either way! Easy to follow, but you do have to stick with it to see results.” Amazon Review
“I have worked in a variety of animal care fields – as a veterinary technician, pet sitter, and behavior consultant – since 1997, and have several mutual clients with the author. As such, I have seen first-hand what she can do for both her clients and patients. Her knowledge, skill, and bedside manner are impeccable, to the point that she has become the only person that I refer people to for small animal rehabilitation in the Austin area. I am so glad that she has written this book, so that people who live outside the Austin area can benefit from her expertise. I highly recommend it!” Emily S., Amazon Review, From Beaks to Barks
“This was an easy to read and understand guidebook. There were lots of practical tips offered. Her program is something I can follow on a day to day basis. The author has obviously had lots of experience with dog rehabilitation and wants the best for our dogs.” Lori L., Amazon Review
“I love Deborah Carroll and her approaches to rehab/conditioning- we see her next week.” Courtney K, Austin, TX Courtney’s Agility Page