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.”
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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.
After you listen, please feel free to add your experiences with my rehabilitation services in the comments, below. You are welcome to compare and contrast rehab experiences if you have information about that, too.
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.
A quick bit of info for you after your pet has had surgery.
I do work on lots of cats and a variety of other animals. If you want to know more about cat specifics now, please search for cat in the search box. I’m still working on developing the cat information pages.
For more specific info on a particular condition, please refer to the menus at the top of the page. If you do not see what you are looking for, please use the search box on any page.
If the injury is a torn knee ligament, then pleaseclick here to read more info about that condition. After that, please go to the instructions on this page!
“My pet just had surgery… …and now that I’ve gotten them home, I realize I’m not really sure what to do!!”
First and foremost: pay attention to the discharge instructions your veterinarian has given you if your pet just had surgery or you have received instruction about an injury. Please pay special attention to the part about no running, jumping, or playing. You and your pet will be doing good work for recovery if you exactly follow my booklet instructions.
If your veterinarian did not say so, please note there should not be any flying over couches, no galloping on stairs, no jumping into or out of cars and trucks, no jumping onto couches or your bed, no jumping off of couches or beds, no twisting very fast in tight circles, no sliding on ice or slippery floors, and no freedom in and out of doggie doors. No owner jumping out from behind things to scare the dog into running crazy funny around the house like you sometimes like to do.
No running really means no running…
…to the door when the doorbell rings, no running away from Halloween costumes, no running from one end of the house to the kitchen every time the fridge or a plastic bag is opened, no running to you when you yell to ask the dog if it wants to go outside, no kitty running from anything right after surgery, and no running inside after the ball, which is very similar to no running outside after the ball. No, no swimming until at least eight weeks after surgery and then only if no lameness is present at a slow walk.
This bookis specifically addressing surgery after a torn knee ligament. Until I am able to publish the books I am working on that deal with soft tissue surgeries, hip issues, other knee issues, elbows, spinal issues and more, this book will be very helpful to you for the first four weeks of recovery if your dog has had one of these other surgeries.
This book has the information, restrictions and advice I would give after almost any surgery. If you follow the restrictions and the practical applications in the booklet, your pet should do well and recover progressively if there are no additional issues. These restrictions will match a lot of what your vet surgeon gave you to follow after surgery.
My recommendations are based on decades of information we have in human sports medicine recovery. These methods matches up very well how your pet thinks and moves and behaves. This program matches up scientifically with how the body recovers.
These instructions incorporate steps for functional recovery, so there is a LOT more structured and guided info in the book. The links to the book I made for this page will take you to Amazon. You may order the book from any bookstore using the ISBN.
I also have info elsewhere on this site about cats and surgery. Cats aren’t small dogs. Unless your cat will walk on a leash, which some do very well, I recommend looking at this page for now.
So, the following book will help you calmly and methodically approach recovery from your pet’s surgery. The book will guide you to establish a functional base of activity. You have to build a good base to help recovery and to of avoid additional injury. This is only the base. I have more strengthening programs and other drills for you to do to return your pet to a rambunctious lifestyle.
A good recovery plan helps guard against future or further injury, especially in the opposite limb! I am very happy to report that people and dogs that follow both this and the non-surgical program for 12 weeks do not end up with the other knee ligament tearing. It’s all a matter of balancing the work. I design programs based on decades of experience with exercise physiology recovery principles. My programs also help encourage people being connected to their pets!
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
“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.” DVM, ACVS (American College of Veterinary Surgeons), South Texas
“Thanks so much, Deborah! The book is impressive. Maybe you should leave a copy at (some shelters) since they put so many cruciate dogs on the euthanasia list…Great work and thank you!” DVM, Austin, TX
“Read your book. Excellent job. Now at ACVS they are all for non surgical acl (rehab)…Good job!” DVM, Austin, TX
“Finished reading “instead of surgery” kindle booklet. Bueno! Great discussion on importance of pain control, in particular. ” DVM, Austin, TX
“Hi Deborah! I read your book the night I got it. I really like it and have already recommended it to a client last week. I hope she bought it. I will write a review for amazon for you, too. I hope you are really successful in this. I know how hard you work!” DVM, Kerrville, TX
“Once again, thanks for engaging the veterinary industry and client owners with your work and experience. I enjoy your enthusiasm and passion for the area.” DVM, ACVS, South Texas