Posts Tagged ‘canine rehab’

Arthritis Management

Monday, January 26th, 2015

ArthritisManagement-01Managing Osteoarthritis 

Osteoarthritis is common amongst both dogs and people—it’s one of the things about which we can commiserate with our furry companions. Put simply, “osteoarthritis” means “bony joint inflammation.” That’s an oversimplified representation of a complex degenerative process, but that’s the basic idea. Just like in people, arthritis is the result of bony changes within joints; once the cartilaginous “brake pads” have worn down, bone grinds on bone, resulting in microtrauma, inflammation, and pain. This, then, often leads to decreased use of limbs, muscle wasting, and immobility.

Perhaps because we can relate to the woes of arthritis, it is a common thing for vets to address at any given appointment. Unfortunately, there is no cure for it, nor one “silver bullet” treatment. Many factors play into this condition, and as such it requires a multifactorial treatment plan. If improperly managed, arthritis can lead to premature euthanasia due to extreme discomfort. Here are the basics for managing arthritis in your dog to help ensure a long, happy life.

HEALTHY WEIGHT. The most important factor in managing arthritis is weight management. That’s significant enough to say again, so let me repeat it: The most important factor in managing arthritis is weight management. More weight means more stress on arthritic joints. No other factor is as important in keeping your pet comfortable. Even with a slue of other aids, such as medications, supplements, even surgery, your pet will still be in pain if he or she is carrying extra pounds. One study showed that in arthritic dogs, healthy weight management increased the median life span by two years! In other words, dogs of a healthy weight were comfortable enough to delay euthanasia by an average of two years relative to their overweight cohorts.

It can be difficult to help your dog stay slim if he or she is already arthritic and slowing down. Do not give your dog “free choice” food, but feed him or her in measured meals two or three times a day. Use a measuring cup so you know exactly how much you’re feeding rather than guessing. If you’re already doing that, try replacing a quarter to half of a meal with green beans (fresh, frozen, or no-sodium canned), or feeding a favorite vegetable or fruit for treats instead of high-calorie processed ones at the store. If your dog has specific dietary limitations, talk to your vet about some options you might try.

CONSISTENT EXERCISE. In addition to helping shed pounds and keep them off, this is an important piece of osteoarthritis management. A moving joint is a healthy joint. If your dog never gets exercise, joints don’t move, weight builds up, and muscles waste away. If you and your dog are “weekend warriors,” and squeeze ALL your exercise into a couple days a week, that aggravates arthritis and causes more inflammation. The same thing happens with “spring fling” dogs that have been lazy all winter and hit the trails running in the springtime.

Instead, focus on small doses of daily exercise. Work within your dog’s physical abilities; if your dog can only make it around the block, then that is his or her limit. If he or she can play fetch for half an hour, make it a priority to spend that time with your dog. It is essential to helping your dog maintain his or her mobility.

REHAB. If you are having difficulties keeping your dog’s weight down or his activity level up, we can help with rehab. The underwater treadmill is an excellent tool to help reduce stress on painful joints while strengthening muscles to help maintain mobility. Modalities such as laser and ultrasound can relieve chronic pain, reducing the need for medications. Massage, acupuncture, chiropractic work, and joint range of motion are other tools that rehab has to offer. Even simply swimming for 10-15 minutes can loosen up tense muscles and provide excellent cardiovascular exercise. The exact exercises and modalities used in your dog’s treatment will be up to your rehab vet, but together, you can make a significant difference in keeping Fido healthy!

NON-STEROIDAL ANTI-INFLAMMATORIES (NSAID’s). Most clients are familiar with the dog-equivalent of ibuprofen, carprofen or Rimadyl. (Please note: never give a dog any human NSAID’s or acetaminophen, as they can quickly cause liver failure and death. Dog livers are different from human livers and cannot handle drugs made for people.) Anti-inflammatories alleviate pain whenever there is inflammation present in an arthritic joint, but they all come with adverse effects. Unfortunately, many veterinarians build a treatment plan centered around NSAID’s. They should be used sparingly due to side-effects; consider these a bonus of modern medicine to have during times of increased pain (due to cold weather, increased activity, or a slip or fall, for example) rather than a cornerstone of treatment.

SUPPLEMENTS. Arthritis supplements can be very useful, but I caution all my clients to do their own research first before purchasing any. By nature, supplements and other homeopathic remedies are not regulated by the Federal Drug Administration (FDA), so there is no one to ensure that the label matches the contents. For example, one study evaluated label claims for chondroitin sulfate; of 32 products tested, only 5 contained the actual ingredients and concentrations of chondroitin sulfate advertised on the label. There is a lack of scientific studies when it comes to supplements, as well, so it can be a tricky subject to approach. Having said that, innumerable people have seen a difference in their dog with several reputable supplements, and if used in conjunction with weight management and an active lifestyle, they can be very beneficial.

Glucosamine, chondroitin sulfate, and omega-3 fatty acids have been shown to be the most beneficial supplements available. They contain essential factors for maintaining healthy cartilage within joints, slowing the breakdown that occurs with normal wear and tear.

OTHER THERAPIES. Less commonly pursued and treatments include intra-articular injections (injecting a drug directly into the joint) and surgeries. Sticker shock usually accompanies these therapy options, but they can be useful if the other therapies used above are not adequate to keep your dog comfortable. Injections contain purified versions of important cartilage and joint components, such as hyaluronic acid and glycosaminoglycans. Surgeries can realign a joint, replace a joint, or eliminate bony chunks that have broken free and are floating within the joint. These options should be discussed carefully with your veterinarian before undertaking them due to their potential risks, especially in older animals.

For more information on managing your dog’s arthritis, or if you have questions not addressed in this article, please contact us at CRCG or your regular veterinarian. We are happy to help, and we look forward to being part of the team to keep your fluffy friend comfortable and going strong for as long as possible!

Meet Noah

Friday, January 16th, 2015

NoahMeet-01Noah is a 9 year old retriever mix who was brought in to see us because of such severe arthritis in his one of his carpi (wrists) that he was completely non-weight-bearing in that limb (he was holding it up when he walked).  He needed to be on two pain medications and was still uncomfortable in that wrist.  We started with gentle manual therapy to help increase the production and flow of joint fluid which lubricates the joint and improves its health and comfort.  We used laser therapy to decrease pain and inflammation, massage for his significant muscle tightness (which was secondary to his joint pain), and ended with cryotherapy (ice) to further decrease inflammation in the wrist.  We helped his owner with an exercise restriction plan and guided her through a safe and gradual return to more activity as he started feeling better.  One week after his first visit, he was bearing weight on that leg again.  We started exercising him in our underwater treadmill which allowed him to walk with less stress on his joints because the buoyancy of the water helped to support his body weight.  We also started strengthening exercises because a stronger leg means more stable joints.  Each week that followed, his limping lessened until it was completely gone 1 month later.  He’s now back to walking 2 miles a day, is comfortable, and off all pain medications.

Ellie’s Success Story

Wednesday, July 9th, 2014

 

ELLIE

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Ellie, a 13.5 year-old FS English Cocker Spaniel, was a champion hunting dog who lived in a hunt club kennel in Longmont.  She retired after an accident in 2009 and shortly after was adopted by her new dad.  Ellie has rear limb weakness and dragging that her RDVM diagnosed as mild hip dysplasia. When she was diagnosed, Ellie’s dad started swimming every other week.  They were eventually referred to us, where we found compensatory pain in her paraspinal muscles as well as restrictions in her neck range of motion.  The first couple of weeks with us was spent focused on manual treatment and laser therapy to address her pain. Shortly after we started hydrotherapy, clinic exercises, as well as an at home program.  We’ve been seeing Ellie since May, 2014 and we have seen a significant improvement in her muscle pain as well as an increase in her strength and stamina. Dad has also seen significant improvement in her strength and discovered that one of the best reasons to come weekly is for the mental stimulation it provides for her as well. Ellie is a super sweet, albeit opinionated, girl–but that’s one of the reasons why we love her.

Top 5 Conditions that Respond to Rehabilitation Therapy

Monday, May 12th, 2014

Top 5 Conditions That Respond to Rehabilitation Therapy

Suzanne Starr, DVM, CCRP, Paws in Motion Veterinary Rehabilitation Center, Natick, Massachusetts

top5conditions

The goal of physical rehabilitation, in combination with medical and surgical care, is to restore normal or near-normal mobility and musculoskeletal function. Manual therapy includes massage, stretching, passive range-of-motion (ROM) exercise, and joint mobilization. Modalities include heat and cold therapy, therapeutic neuromuscular electrical stimulation, laser therapy, and therapeutic ultrasonography. Targeted exercise can include use of exercise balls or wobble boards, cavaletti rails (ie, horizontal poles positioned at varying heights and distances for dogs to step over), underwater or land treadmills, and pools.

Although dogs with assorted conditions can benefit from physical rehabilitation, the following are the top 5 canine conditions that the author believes best respond to rehabilitation therapy.

Top 5 Conditions That Respond to Rehabilitation Therapy

1. Postoperative cranial cruciate ligament rupture surgery
2. Postoperative femoral head and neck ostectomy
3. Spinal cord diseases
4. Osteoarthritis
5. Obesity


1. Postoperative cranial cruciate ligament rupture surgery
Cranial cruciate ligament disease is one of the most common orthopedic conditions in dogs. Surgery is arguably the best approach to restore stability when the cruciate ligament has been damaged. Regardless of the surgical procedure, rehabilitation initially involves pain management, massage, passive ROM, and icing. As tissues heal, patients often progress to weight-shifting exercises and water treadmill walking (Figure 1). As lameness improves, therapy may include leash walking (ideally involving hills), followed by jogging and trotting.

Figure 1. Because underwater treadmill walking has little impact on the joints, it can benefit dogs affected by orthopedic and neurologic conditions.

2. Postoperative femoral head and neck ostectomy
Femoral head and neck ostectomy is most often performed to treat Legg-Calvé-Perthes disease (ie, avascular femoral head necrosis), coxofemoral luxation, and femoral head and neck fracture. In addition, this surgery can be a salvage procedure for painful hip dysplasia or osteoarthritis. Adequate pain management is important to encourage early use of an affected limb. Early therapy involves massage and gentle, passive ROM. After the skin incision has healed, underwater treadmill activity can promote partial weight bearing and return to normal gait. Once the affected limb is used in a four-legged walk, additional weight-bearing exercises can be introduced. Tools (eg, balance board, exercise ball) can help improve weight bearing while strengthening the core.

3. Spinal cord diseases
Common spinal cord diseases include intervertebral disk disease, fibrocartilaginous embolism, degenerative myelopathy, spinal trauma, and inflammatory CNS disease. Classic signs are proprioceptive deficits and severe paresis or paralysis of the pelvic or all limbs, depending on lesion location. A thorough neurologic examination is essential. When indicated, cerebrospinal fluid tap and MRI or CT should be pursued. Once the diagnosis has been confirmed, therapy, including physical rehabilitation, can be planned. Physical rehabilitation therapy has a role in both these circumstances.

Therapeutic goals for dogs with spinal cord disease include reducing pain, maintaining joint flexibility, preventing or reducing muscle atrophy, and restoring coordination and proprioception. Techniques depend on the severity of signs and spinal cord disease, but massage, passive ROM, targeted exercises using an exercise ball (Figure 2), and water therapy are commonly used. In dogs with severe paresis or paralysis, the benefits of water therapy are extensive. Buoyancy of the patient when surrounded by water strengthens mobility, as dogs often initiate movement in the water before initiating movement on land. When the dog can walk without support, adding exercises such as stepping over obstacles (eg, cavaletti rails) can help improve overall coordination.

Figure 2. Targeted exercises, such as using an exercise ball, can help core conditioning, weight bearing, balance, and ROM.

4. Osteoarthritis
Patients with osteoarthritis can benefit from a multimodal therapeutic approach. A patient’s condition often deteriorates rapidly becomes a vicious cycle: because the arthritis is painful, the animal typically becomes more sedentary, leading to muscle atrophy and weight gain, subsequently worsening the condition. Pain management through analgesic medication and physical therapy can help. Gentle exercise in an underwater treadmill or a pool helps build muscle strength and endurance while minimizing stress on painful joints. When the patient is able, targeted weight-bearing exercise is ideal to strengthen the joints.

5. Obesity
In the United States, an estimated 50% of dogs between 5 and 10 years of age are overweight or obese, making this one of the most common canine medical disorders. Health problems caused or complicated by obesity include joint and/or musculoskeletal problems, exercise and heat intolerance, and pulmonary and cardiovascular disease. Although attention may be given to designing the appropriate diet for weight loss, exercise is often overlooked. When combined with caloric restriction, exercise can induce a negative energy balance critical for weight loss. Scheduled sessions of physical activity can help burn calories,  build muscle mass, and improve client motivation and compliance. Exercise sessions should be customized for each patient.

Closing thoughts
Therapists not only provide a service during rehabilitation sessions, but also participate in designing daily home plans. Clients often benefit greatly from receiving specific guidance following their pet’s injury or surgery. In addition, therapists can recommend slings, harnesses, wheels, and other assistive devices that can help patients and caregivers. It is therefore important for general practitioners and specialists to consider and discuss rehabilitation as part of their patients’ complete care plans when appropriate.

SUZANNE STARR, DVM, CCRP, practices at and owns Paws in Motion Veterinary Rehabilitation Center in Natick, Massachusetts. Her areas of interest include senior and postoperative patient care. Dr. Starr completed an internship at Angell Animal Medical Center and earned her DVM from Tufts University.

 

Canine Arthritis

Monday, May 5th, 2014

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Arthritis. At one point in time, we have heard that word either for ourselves or for our four legged companions. This condition can be seen in any joint from head to tip of the tail. But what exactly does that word mean? In studying many definitions for arthritis, the consensus is that it is inflammation of a joint, loss of joint cartilage, and bony changes that result from the first two situations.

In simple terms, arthritis can occur for many reasons. Some arthritis originates from infections the companion has contracted. Some arthritis occurs because of an autoimmune situation. The most common form of arthritis noted in our 4 legged companions is osteoarthritis. This particular type of arthritis slowly occurs over time, and is related to instability in a joint whether from an injury, congenital situation (like hip dysplasia) or a repetitive motion on a joint.

So as guardians, what do we see with arthritis? A common story is that your companion is having trouble rising after lying down for a period of time, is slower to go up or down the stairs, cannot walk as far as before, and will whine, groan, or vocalize more often. Some guardians report an increase in panting- a sign of pain in companions. There is often a loss of muscle associated with arthritis. This complicates things because as stated before, arthritis occurs because of instability within a joint. Muscles, ligaments, and the joint capsule, along with gravity, are the main stabilizers of a joint. The more muscle loss, the more difficult it is for a companion’s body to keep a joint stable and the more stress on other tissues.

If a companion has arthritis, cannot walk as far as before, is having trouble moving and transitioning in everyday life, and appears to be losing muscles mass, what can be done to break that cycle? It is amazing what you can do with your companion to help make them more comfortable, more stable, and stronger.

First things first- you need to have your companion assessed. This involves a thorough physical examination, gait, joint and muscle evaluation, and possibly other diagnostics (like radiographs or blood work) if indicated. At this time, a pain assessment will be done. If your companion is painful, medications will be recommended to help with the inflammation and pain. It is important to know that if the inflammation and pain is not under control, you may increase their pain response in the long term. Pain is a tricky situation. If the pain becomes chronic, there are changes to nerves that occur not only at the site of the pain, but that can also occur in the brain. This can ultimately cause a companion to perceive more pain than is present or pain when there is no pain stimulation. Aggressive pain control and inflammatory control helps to prevent this from happening. Icing and heat therapy, when applied correctly, have been known to help with inflammation, swelling, joint effusion, and pain. Joint supplementation has been very controversial in human medicine, but increasing the joint fluid within a joint and its ability to provide nutrition to joint cartilage can be a benefit from supplementation. Ask your veterinarian or rehabilitation therapist about what may be right for your companion.

Next, we need to help the joints and the soft tissues move better. This can be done by gentle range of motion of an arthritic joint. This allows for increased movement of joint fluid- fluid that bathes the joint cartilage and provides nutritional support. This also gently stretches the capsule and ligaments around the joint. Massage of the affected muscles can also help to increase muscle activity and awareness as well as decrease tightness and pain. Gentle stretches are also able to help arthritic patients increase flexibility of the affected area. In some cases, short, frequent walks on surfaces that are compressive (dirt, grass) can help to activate the joint and it’s receptors (muscles/ligaments) that help support the joint, and increase brain and nervous activity. All of these things help to improve an arthritic companion.

Lifestyle modification is another way to help an arthritic companion. Ramps instead of stairs are less stressful on arthritic joints. Rugs can be placed in common pathways or areas that your companion resides to prevent slipping or make it easier for an arthritic companion to rise from the floor. A decrease in running, jumping, and rough play can help prevent painful situations where the companion has over exercised and inflamed the arthritic joint(s).

So how can this be fun for the whole family? Getting together to go on a walk can be fun. Massage, passive range of motion and stretching can be a very one-on-one bonding time with that companion and the family. Not to be left out, other non-arthritic companions can get a massage too! There are also trick classes, nose work classes, and some obedience classes that can be done by arthritic patients to help keep their mind engaged. All of these classes are ways the family can be involved together, and the arthritic companion does not get left at home by themselves, and instead continues to be an active and integral part of the family.

Although arthritis may change your life with your companion, there are many things that can help improve and maintain a good, engaging life and relationship for you and your companion.

Yukon’s Success Story

Tuesday, April 29th, 2014

Yukon

Yukon

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Yukon

Yukon, an 11-year-old husky, first came to CRCG in July of 2013 for elbow and shoulder osteoarthritis and hind limb weakness.  During his visits, he enjoys walking in the underwater treadmill, has laser therapy to decrease pain in his spine and hips, and targets strengthening his core and rear limbs through in-clinic exercises. Yukon’s 5-year-old energetic younger brother, Bandit, likes to join in on the treadmill next to him for conditioning and moral support.

Both Yukon and Bandit love their Saturday excursions to CRCG and are pleasantly tired after their appointments. Today, Yukon has strength and energy when running around at home on his family’s property. Yukon, you are an all-star!! And Bandit, you rock too!

Bandit

Bandit

 

 

 

 

Canine Neurological Diagnosis & Rehabilitation

Monday, April 21st, 2014

lab_treadProblems in the nervous system can be as variable as our patients. Signs and symptoms range from a mild weakness or dragging of the toes to seizures and behavioral changes. Proper suggestions for rehabilitation in these cases are based on signs and symptoms, neurological evaluation and diagnostics, and realistic goals set by guardians and therapists.

As previously mentioned, neurological signs and symptoms are widely varied. Proper diagnosis of the problem is based on a thorough examination, localization to the proper area of the spinal cord, and diagnostics to confirm. Examination involves a full physical examination and a neurological examination. Based on the patient’s history and the signs observed at home and in the clinic, a picture is created to help localize the most likely problem area(s).  A list of differential diagnoses is then created. Diagnostics to isolate the problem may include blood work, urinalysis, radiographs, advanced imaging (MRI, CT) and cerebral spinal fluid analysis. These help to create a good picture of the problem at hand.

When a diagnosis is found, an analysis of the most proper treatment for the patient is identified. Rehabilitation is an important part of this treatment. Using rehabilitation to help patients with neurologic symptoms can help resolve weakness, improve balance, and reteach proper gait patterning—helping patients to move as well as possible. Weakness is addressed by exercises focusing on muscle contractions. It may start as exercises to maintain a standing or sitting position and can progress to advanced exercises on a fit disc, peanut, or pods. These exercises for strengthening also address balance, which is important because every patient needs balance to perform normal functions such as posturing to go to the bathroom and navigating the house. Regular walks (to the patient’s tolerance) can encourage proper gait patterning. If a patient cannot walk without assistance, other modalities can help to encourage normal movement. These can include carts, treadmills with assistance, and swimming. Each of these modalities engage the central pattern generators, spinal cord and brain to retrain the body to walk again. Even if there is no muscular or spinal issue to address, rehabilitation can help patients that are having trouble with integration of information. Exercise and repetition can increase the input to the brain, and the proper amount of input to a specific part of the brain can help maintain nervous cell health. Nerve cells need stimulation in order to remain healthy and active.

In rehabilitation, realistic goals are necessary to anticipate a return to function. Some problems with the nervous system will not allow for full return to function or may even be slowly degenerative. The goals and expectations of rehabilitation should reflect this so that the goals are reasonable for the patient to achieve.

Success in cases of nervous system involvement is dependent on a collaborative effort from the patient, guardian, regular veterinarian, neurologists, and a rehabilitation therapist. With communication, information, and realistic prognoses, a pet can maintain or recover function to live with a good quality of life.

Welcome To Our Blog

Saturday, March 1st, 2014

Welcome to our blog!

Here you will find articles posted from our website, inspiring success stories, educational and informative posts, as well as fun community posts with pictures of our (and your!) furry family members.

If you have a great story (or photo) you’d like to share with us, we would love to hear it! Just shoot us an email at clubfetch@dog-swim.com

Looking forward to this blog experience being an interactive one with you.

Helping your dog fetch more out of life.

TEAM HORIZONTAL PHOTO