Author: Stride Canine Physical Rehabilitation & Fitness Center

Kristin Wolter, CVT, CCRA, CCFT                             

October 25, 2017

I started off intending for this blog post to be about post operative complications. Quickly, I realized that while complications are important to the topic they are not really what I wanted to address. What I really wanted to address was the why and when patients should begin a physical rehabilitation program post-operatively.

We get many calls from veterinarians and prospective clients in regards to when a patient should start a physical rehabilitation program.  In all honesty, for most orthopedic and neurologic surgery, we would love to start a program within the first week of surgery. However, most often, we begin a program after sutures are removed and occasionally even several weeks post op. With all cases, the key to a successful physical rehabilitation program is to start it when the patient is doing well, not after it has been determined that they aren’t making desired progress.

Why does it matter?

Getting an early start with physical rehabilitation allows us to help address residual inflammation and pain, which helps increase function, reduce scar tissue and promote healing. In addition, starting early empowers the client by having them actively participate in their dog’s recovery from the very beginning. Thoughtful progression of therapeutic modalities early in recovery, followed by appropriate exercise when the patient is ready can help mitigate the risk of short and long term post-op complications.

Because there are no cookie cutter dogs, we do not use cookie cutter protocols nor expect every patient to recover in exactly the same way. We regularly assess gait, function, strength, surgery site and compensatory pain and inflammation. Close monitoring allows us to tailor a rehabilitation protocol for the patient that is in front of us, not the patient we saw last week. Progression is malleable and adapting to the patient’s needs is imperative in helping them achieve the best return to function possible. If a patient is not meeting our goals we can then refer them back to the surgeon for more in depth evaluation.

Occasionally we are referred patients who simply aren’t making any progress post operatively, or, who started to make progress and then things went sideways or backwards. (Hint – these are the patients we wish we could have seen from the beginning of their recovery.) The hope is that physical rehabilitation will turn things around.

I am going to be blunt…generally speaking, if a patient is not making some steady (even slow) progress without physical rehabilitation, adding a physical rehabilitation program will probably have marginal impact. It is virtually impossible to increase function and strength when a patient’s pain or continued dysfunction is not addressed. If a limb is comfortable to use, has relatively normal range of motion, good alignment, is structurally stable, has normal neurologic function and no secondary injury, infection or tumor has been diagnosed, then, regardless of how long the patient had been hopping, skipping or limping before surgery, they should begin to make steady progress after the initial post-op inflammatory response has resolved. Teacup and micro-dogs can sometimes be an exception to this rule, but perhaps not as often as one might think.

Additionally, It is very important to couple pain management with dedicated strengthening, balance and coordination exercise. Doing one without the other is a bit like trying to ride a bike without both pedals. It can be done, but it’s not as efficient. There is still a misconception that discouraging over use by means of reduced pain control is an effective method in reducing complications. While the patient may certainly not overuse the limb due to pain, the long term complications from the increase in compensatory movement is often overlooked with this particular methodology.

Physical rehabilitation should be used to enhance and improve the outcome of surgery both in the short and long term. When we miss the opportunity to begin a physical rehabilitation program early in a patient’s recovery, we also lose the opportunity to quickly address setbacks that sometimes occur. Complications will unfortunately always be a possibility for patients recovering from surgery. Our hope is that with patient specific monitoring, appropriate pain management and therapeutic work, hopefully some of those complications can be avoided all together.

Cheers!

Kristin

Kristin Wolter, CVT, CCRA, CCFT

Since it’s animal pain awareness month I thought it would be a great opportunity to discuss pain prevention. So often we wait for a painful event to occur and then treat it rather than taking the time and consideration to find ways to keep it from happening at all.

There are many medical conditions that contribute to pain – both acute and chronic. Some are preventable and others, less so.  Congenital orthopedic and medical disorders, autoimmune disorders, disc disease, some types of cancer and infection can all result in pain and may be challenging to prevent. However, many injuries and illnesses in dogs, that result in pain and inflammation, are well within our ability to avoid all together.

The best way to reduce the risk of painful conditions is to develop good monitoring and management skills of your dog. Importantly, management of body weight, of physical activity and of environmental access are three key ways to keep your dog safe, happy and comfortable through out their lifespan.

Weight Management

Weight management, without a doubt, is the number one way to help prevent musculoskeletal pain related to injury and chronic arthritis. Starting at puppyhood and throughout a dog’s entire life, carrying extra weight can have a significant impact on orthopedic health.

A scale is not needed to assess your dog’s body condition at home. You should be able to feel your dog’s (or puppy’s) ribs almost as easily as you can feel the bones over the back of your hand. 

Large breed and bully breed dogs are often grossly overweight because many people do not realize that what they think is ideal body weight is actually obese. Small dogs have their own set of rules as they are often over fed and perhaps get less exercise than other, larger breeds. If you aren’t sure about your dog’s weight ask your veterinarian, or better yet, a veterinary technician to make a body condition assessment.

Activity and Exercise Management

Central Oregon is a highly active community. Biking, running, hiking, paddle boarding are all common activities that dogs also enjoy.

Managing exercise and activity is a huge factor in pain prevention. I know a lot of you reading this right now are probably of the mind that “A tired dog is a happy dog.” Really, the saying should be “A tired dog is a happy human.” Yes, appropriate exercise is important for every dog’s health, but too much of it can have detrimental affects when it comes to causing chronic pain. Repetitive, erratic games of chase (to a toy, a “SQUIRREL!!!,” or at the dog park)  are key predictors of orthopedic injury which can lead to chronic inflammation, pain and osteoarthritis.

Daily, moderate exercise such as leash walking, swimming, short distance (1-3 miles) jogging coupled with longer hikes once or twice a week is ideal for most healthy dogs.  Weekend warrior type activity is ill-advised for our canine counterparts. 

Certainly, playing fetch is a great way to increase cardiovascular fitness, but it is important to end your session well BEFORE your dog offers to stop. When muscles are fatigued (or are not properly warmed up), strains and sprains are much more likely to happen. Another way to help reduce the risk of “fetch” related injury, is to allow the toy/ball/frisbee to come to a complete stop then send your dog to get it and bring it back.

Alternatively, not getting enough activity can decrease strength, limit flexibility and reduce overall function and longevity. The saying “Don’t use it, you lose it,” applies to our canine friends as well as it does to us. Maintaining core strength and flexibility through appropriate exercise is vital to quality of life. More and more canine sporting competitors are realizing the benefits of dog fitness, and this should not be overlooked for the canine, couch surfing athlete.

Puppies have their own special set of rules when it comes to exercise. In a nutshell, puppies should be allowed to be puppies on their own terms with very little encouragement from people or other dogs. They should not ever play or run to the point of exhaustion. They should be restricted from long walks and hikes and should not ever  “go for a jog” until they are at least a year old. Growth plates are extremely prone to injury.  Severe growth deformities, elbow and hip dysplasia can result from repetitive or high impact play and trauma.  Puppies can appear to be very athletic, but their physical maturity does not truly align with their athletic ability until they are 2 years old.

Environmental Access Management

Keeping your dog safe (sometimes from themselves), is very important in decreasing the risk of painful events such as GI upset, trauma or injury. It is easy to slip into the thought process that dogs automatically know how to safely navigate a human’s world. They do not understand that eating a fishhook or stuffed animal is not going to end well. Or that getting into the garbage only results in a new cleansing diet followed by an expensive carpet cleaning appointment. Most dogs have the cognitive ability of a 2 or 3 year old. They truly are not aware that stepping in front of a moving vehicle could result in loss of life or limb, or that jumping from a second story deck going after a squirrel will only result in the squirrel getting away while they take a trip to the vet.

Additionally, keeping them safe means teaching them how to rest in a crate or kennel (or reliably on a bed) so that when you are distracted, you know exactly where they are and what they are doing. It means being sure that the garbage is out of reach, that the leash is attached and that your dog has a good recall and will come back to you regardless of what is going on.

Moderation is the key to helping your dog maintain good health and lead a physically comfortable life. Be your dog’s guardian when it comes to pain prevention.  Keep them at an ideal body weight, keep them active but not exhausted and keep them safe from themselves.  They will thank you for it with many years of smiles and wags.

Janice McConnell, DVM, CCRT, cVMA

Treating Chronic Osteoarthritis Pain in Our Pets Osteoarthritis (OA) is a common cause of chronic pain in our pets. It is estimated that 20-25% of adult dogs develop osteoarthritis, and that number may increase to 80% of geriatric canine patients over 8 years of age. In studies of cats, the prevalence of radiographic changes of OA ranged from 22-33% when all ages were included; and prevalence went up to 90% in cats over the age of 12 years. Recognition of chronic pain in our pets can be challenging, as the symptoms are often subtle. Please talk to your veterinarian for guidance on how to recognize pain in dogs and cats.

When we identify that a pet is painful due to osteoarthritis, we assess the nature and severity of that pain to develop a short and long-term treatment plan that will best support joint health and the pet’s function.

We are fortunate to have a variety of therapeutic approaches to choose from and we will be most successful if we take a multi-modal approach to pain relief. The following list is intended to provide information on some available treatment options, including medications, nutraceuticals, and physical rehabilitation methods that can be utilized as part of a multi-modal pain management plan for your pet. While this list is not comprehensive, it does focus on the more commonly prescribed therapies and those with evidential support.

Pharmaceutical Medications

1) Non-steroidal Anti-inflammatory drugs (NSAIDs): NSAIDs, such as carprofen and meloxicam, are still the mainstay for osteoarthritis care and can be used safely longterm in many OA patients.

2) Galliprant is a new medication that targets a specific prostaglandin receptor involved in mediating inflammation, rather that inhibiting production of prostaglandins, as the NSAIDs do. This medication holds promise for control of OA pain and may be tolerated by some patients that cannot take NSAIDs.

3) Gabapentin plays a role in managing neuropathic pain and has become increasingly prescribed for chronic OA pain. While we have appreciated some benefit of this medication, we still lack studies to support it’s benefit for our OA patients.

4) Amantadine is a medication that helps to prevent or control ‘wind-up pain’. Wind-up pain results when the central nervous system becomes sensitized to repeated pain signals. The result is a more intense and frequent firing of pain signals, and thus the perception of pain become stronger and more persistent. If your pet’s chronic pain is moderate to severe and does not respond well to NSAIDs alone, a course of amantadine may be warranted. Nutraceuticals There are many nutraceutical options on the market, many of which can provide benefit in OA care. But given the lack of regulatory standards on supplements, we will best serve our pets by being mindful toward potential harmful substances in over-the-counter products, and by seeking out good quality control and evidence to support efficacy.

Nutraceutical Supplementation

1) Omega-3 fatty acids are beneficial for OA by reducing inflammatory mediators. Eicosapentanoic acid (EPA) and Docosahexanoic acid (DHA) are the key omega-3 fatty acids for dogs and found in fish oil. It is important, however, to understand that not all fish oils are equal nor safe. Things to consider when researching a company include whether the source of fish is certified sustainable, and whether every batch of product is tested for toxins and contaminants. Dosing in dogs for joint care starts from 50-100 mg/kg per day of combined EPA/DHA.

2) Polysulfated Glycosaminoglycans (PSGAGs). Adequan ® is an FDA-approved injectable disease modifying osteoarthritis drug that provides cartilage protection by inhibiting enzymes that break down cartilage. There is good evidence to support that the product reaches the joints and helps clinically to reduce pain.

3) Glucosamine/Chondroitin support cartilage health and protection from damaging enzymes but a review of the studies demonstrates mixed results. The data do indicate better absorption and clinical results with low molecular weight chondroitin, as is found in Cosequin® and Dasuquin®.

4) Avocado/Soybean Unsaponifiables (ASU) appear to work synergistically with glucosamine and low-molecular weight chondroitin to support cartilage health and may inhibit some mediators of pain.

5) Others: There are a few other products that deserve mention and may hold promise for joint care but still lack robust clinical data. Curcumin (a substance in the spice turmeric) may help reduce inflammatory mediators. Green-lipped mussel contains components that appear to have anti-inflammatory and joint protective effects. Microlactin is a milk-derived protein with anti-inflammatory effects. Elk Velvet Antler contains glucosamine, chondroitin, and other factors that appear to have an antiinflammatory effect and may promote an increase in muscle mass. Cannabidiol (CBD) products are currently widely available for dogs and cats and have seen mixed results, perhaps due to a lack of data on dosage and production variability. There is currently a clinical study at Colorado State University on use of CBD in osteoarthritis patients and we look forward to the results!

Weight Control

Arguably the most important thing you can do for your dog with osteoarthritis is to keep him/her lean. Weight loss in even mildly overweight animals can significantly reduce pain from osteoarthritis. And the additional health benefits of weight management include longer life span and slower onset of symptoms of other chronic diseases. Please work with your veterinary team to develop a weight control program and monitor the weight loss in your dog. We recommend targeting no more than a 1% weight loss per week.

Non-pharmaceutical Modalities

Physical rehabilitation offers several non-pharmaceutical options to provide adjunct pain control and anti-inflammatory effects:

1) LASER stands for Light Amplification by Stimulated Emission of Radiation. Therapeutic lasers are used for photobiomodulation – they emit light waves at specified wavelengths to stimulate cellular change. Clinical effects include a reduction in pain and inflammation, and enhanced tissue repair.

2) Acupuncture is a means of neuro-modulation by placing needles in specified locations to elicit a physiologic response and enhance endogenous pain mechanisms.

3) Therapeutic Massage can relieve pain and stress, improve blood flow and lymphatic drainage, relieve local muscle tension, and reduce myofascial dysfunction.

4) Pulsed Electromagnetic Field Therapy (PEMF) uses electromagnetic fields to induce cellular changes, and shows benefit for wound healing, bone healing, pain management and reduction of inflammation.

5) TENS delivers an electrical currently across an area of injury and can help reduce swelling as well as provide pain control.

6) Therapeutic Ultrasound sends sound waves into tissues to reduce pain & inflammation, and heat tissues to relax them and allow stretch.

7) Joint mobilizations done by a trained rehabilitation therapist can reduce pain in a diseased joint and improve range of motion of a joint.

Therapeutic Exercise

Positive effects of regular therapeutic exercise in OA patients include maintaining mobility of affected joints through daily activity, strengthening the muscles around affected joints, improving balance, and weight control. An appropriate and safe therapeutic exercise program for your dog is best developed by a therapist trained in canine rehabilitation.

Central Oregon Summer Heat Is Here.  It can come with a variety of potentially life threatening consequences for our dogs, some of which seem obvious, but others are more insidious. Certainly, most people understand that cars and pavement are primary culprits of summertime heat related illness, injury or death. But there are many other heat/summer related illness which can include:

• Exercise induced heat exhaustion – occurs when dogs exceed their ability to cool themselves.
• Hot hiking trails/lava rock – Even if you start in the morning, the ground can quickly. heat up during the summer season. Pack boots for your dog.
• Toxicity
  • Water – common for dogs that love to chase water from a hose.
  • Plant/Mushroom – check your yard regularly.
  • Blue Green Algae – becoming more and more common in our surrounding lakes and reservoirs.
• Snake and insect/spider bites or stings
• Drowning – swimming, especially in rivers or even irrigation canals, can be treacherous. A life jacket can save your dog’s life.
• GI obstruction – Bones, corn on the cob, grass – yes if eaten in large quantities can cause a bowel obstruction.
• Cheat grass awns (foxtail) – evil things can work their way into feet, ears, eyes, upper respiratory tract, lungs and urinary tract.
• Parasite infestation – warm weather means more parasites such as heartworm and giardia.
• Communicable infectious disease – More outdoor events = more dogs = more chance of parvovirus, kennel cough or other transmissible disease. Avoid letting your dog meet/greet strange dogs and avoid communal watering holes.
• Trauma – dogs are spending more time outside = more play, more off leash activity = more chance of orthopedic injury, dog fights or  being hit by a vehicle.

Have questions about any of these?  Contact your veterinarian for a more detailed description of symptoms and treatments. Most can be prevented with good monitoring and care.

Happy Summer!

‘Exercise restrictions are the best part of every physical rehabilitation protocol”,  said no dog ever. If you’ve been through it, you understand the challenges of “no running, no jumping, no playing, leashed potty walks only” to seem insurmountable. I know, because I’ve been there myself with my own dog. And I see the involuntary eyes glazed, deer in the headlights look my clients give me as if I’m speaking a foreign language when, for the umpteenth I remind them not to allow off leash activity.

In the most basic of analogies, this situation is probably comparable to taking a 2 or 3 year old child out to a fancy restaurant for every meal of every day for 3-4 months and then taking them back home and locking them in their room. Luckily, there are ways to get through the restrictions without feeling like everyone is in solitary confinement or on the brink of needing professional psychological evaluations and treatment.

Here are a few suggestions.

1. Hope for the best, plan for the worst.  Be prepared. Always assume, that at some point in your dog’s life, there will be a requirement of activity restriction – be it after an elective surgical procedure or the ever popular cruciate surgery. Some common issues/solutions that occur with these restrictions include:
   • Teach your dog to potty on-leash. I, for one, am always amazed at how many dogs do not understand that they can, in fact, assume the posture to defecate or urinate while on leash.
   • Teach your dog to enjoy being in a kennel, crate or pen.
   • Teach your dog to walk quietly on leash, without pulling or lunging.
   • Teach your dog how to safely use a dog ramp for loading and unloading out of a vehicle.
   • Teach your dog how to lay down on one side or the other while you “inspect” various body parts.
   • Don’t get sucked into a daily routine that is filled with only with high energy, exuberant activity. Contrary to popular belief, dogs don’t actually NEED to go to the dog park EVERY day, nor do they NEED to play chuck it. Having a good off switch can be a life saver for many different reasons.
2. Give your dog food-toys. When your dog is restricted to crate rest, getting a food toy, such as a Kong, filled with mashed up food then frozen is a great way to keep them busy while also letting them work for their meals. (Be sure to check with your vet or rehab professional first!)
3. Do your exercises! Home exercises should give your dog as much of a mental work-out as a physical work-out.
4. Learn something new with your dog. Learning a new training technique, such as clicker training, can be fun while building a connection with your dog.  Many training of the games can be very low impact or even stationary and even more can be implemented as strengthening exercises.
5. Change your perspective. Look at restrictions as a way to finally get that training into your dog that you’ve been putting off. Make it a game. How many steps can your take without you or your dog pulling on the leash? What fun party tricks can your dog show off at the end of recovery? How can you help your dog recover better? Having surgery or an injury is definitely not fun, but it doesn’t have to include solitary confinement.

Most importantly, enjoy the time that you have with your dog. Do what you can to help your dog recover while remembering that these creatures are their own beings and we can’t control every single action or reaction. Engaging with them in a positive way will strengthen your connection so use the time wisely – you might be surprised at what you learn about yourself and your dog.

Cheers!

Kristin