Deborah Carroll's Blog, page 11
June 10, 2014
NSIDE Texas MD Magazine Highlights Animal Rehabilitation
June 5, 2014
June 4, 2014
April 28, 2014
Ice (Cryo) Therapy – 4 Posts
April 27, 2014
Ice (Cryo) Therapy – 4 Posts
Why Ice Delays Recovery
March 16, 2014 by Gabe Mirkin, MD When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping. In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261). Healing Requires Inflammation When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1. The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010). Ice Keeps Healing Cells from Entering Injured Tissue Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage. Anything That Reduces Inflammation Also Delays Healing Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by: * cortisone-type drugs, * almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)), * immune suppressants that are often used to treat arthritis, cancer or psoriasis, * applying cold packs or ice, and * anything else that blocks the immune response to injury. Ice Also Reduces Strength, Speed, Endurance and Coordination Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play. My Recommendations If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself. If the injury is severe, follow your doctor’s advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain. Dr. Mirkin, M.D.
ICE (CRYO) THERAPY
Here is how you do it for some of the best benefits. Prior to writing a pretty basic protocol for widespread use almost 10 yrs ago, I examined research papers regarding efficacy of types of ice, including papers that dealt with muscle biopsies as evidence. That being said, for almost 4 years I have not been using ice very often, if at all, on my own athletic injuries, on animal patients, or on others athletic injuries. This is due to great evidence in broader science regarding the benefits of the inflammatory process in most situations and the detriments of stopping that process. Ice stops that part of the healing process. I currently only recommend ice for a pet that has ongoing joint issues and is having a lot of trouble with pain resolution. I recommend icing directly on the site, using the “pupsicle” method, for 5-10 mins, depending on the size of the animal, prior to walks or drills in order to facilitate better compliance. Meaning that perhaps the ice will dull the pain some and the pet will use the leg and build muscle, increase joint use and healing, and overall improve. Otherwise, see other information I have posted regarding research about ice and the problems with using ice. (4-27-14) Ice therapy is used to decrease pain and inflammation and to increase healing. Ice may be effectively applied 2-4 times per day, with 4 being optimal within the first week after injury/surgery. Ice may be used in several forms, some of which are as follows: *Frozen vegetables make a tidy ice pack, although not as cold as other options. These should be left on the treatment area for approximately 20-30 minutes without a towel and on bare skin. Frozen veggies are not cold enough, nor do they retain cold well long enough, so that is why extended application times are recommended. *Slush ice in two zip lock-type baggies. This turns out to be very cold and is made with one part water to two parts rubbing alcohol. If the mixture is too watery, add more water to make it icier. If the mixture is too hard, add more alcohol to make it slushier. This ice pack should only be left in place for ten minutes at a time without a towel or twenty minutes on a medium-to-large dog with full fur. Fur is no more a barrier to icing than a towel on a human would be, especially if “colder” icing options are used (pupsicle, slush packs, etc…) and ice is applied for adequate time, i.e., 20 min. Smaller animals with less dense hair coats will still only need a 10 min. ice application, so try to use good judgment. Dish soap in double sliding zip-locked baggies and frozen works like the slush pack mentioned above. *Pupsicle ice is a cup, either paper or Styrofoam, that has been filled ¾ with water and then frozen. This ice is especially effective and may also accomplish some surface tissue massage at the same time as the cryotherapy. The ice melts into puddles, so grab a towel. You should rub this ice over the affected area for approximately ten minutes at a time using circular or stroking motions, as in massage. Ice, not heat, should be used for at least the first 72 hours post-surgery or injury, and there is generally no need for heat at all. This phase is often referred to as phase one inflammation-breakdown or phase one post-trauma. Pupsicle and slush ice may be left on 10 min, taken off 10 min, and then reapplied 10 min. during phase one inflammation. I am often asked if ice may be used any time, and the answer is yes. If back muscle spasm episodes occur, if there seems to be pain or inflammation, or even if a new incident of disc rupture occurs, ice may be used even while on the way to the vet. In these instances, always use ice and not heat. Ice increases blood flow by cooling and slowing blood while constricting the blood vessels, after which the body reacts by sending more blood to the cold area to warm it and thus increase the flow of body fluids through the area. This is actually beneficial in reducing swelling. Heat increases blood flow by opening up blood vessels. The opening of the blood vessels by heat early in post-injury phases could cause unwanted swelling and inflammation, so even though heat may seem to feel good, it is not what should be done to help healing at this time.
Rehabilitation and Conditioning for Animals
Deborah Carroll, CCRP, CSCS
copyright 2007
Intense Exercise, Muscle Soreness, Recovery, and Anti-inflammatories
Rehab Deb’s Comments: One of the most important bits of this report is something I’ve been reading more and more research regarding, and that is that nsaids (non-steroidal anti-inflammatories) stifle the healing process. I have also read several reports regarding the same and ice. Nsaids in animal medicine include Previcox, Deramaxx, Rimadyl, Metacam, etc…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? NO…it means think about the application, and possibly combine smaller doses of several analgesics, depending on the issue, rather than higher and continuous doses of nsaids.
This is only one suggestion.
Ultimately this should be discussed with the medical practitioner who prescribed the meds in the first place. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other analgesics to alleviate pain for the short run while building muscle to support damaged joints. Many practitioners are aware of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, which came out of human sport science, vets seem to be interested in the information when it is presented to them.
Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine May 6, 2012 How to Recover from Muscle Soreness Caused by Intense Exercise Muscle soreness should be part of every exercise program. If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising. You must damage your muscles to make them grow and become stronger. When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning. Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed. DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear. Your body treats these tears in the same way that it treats all injuries, by a process called inflammation. Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain. The most beneficial intense exercise program is: * severe enough to cause muscle pain on the next day, and * usually allows you to recover almost completely within 48 hours. ACTIVE, NOT PASSIVE, RECOVERY: When athletes feel soreness in their muscles, they rarely take days off. Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days. Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours. TIMING MEALS TO RECOVER FASTER: You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin. Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate. This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours. The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids. The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle. Waiting to eat for more than an hour after finishing an intense workout delays recovery. WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt. You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables. If you prefer animal tissue, you can get your protein from fish, poultry,or meat. Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods. BODY MASSAGE: Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers. NSAIDS DELAY DOMS RECOVERY: Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing. HOT BATHS: Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006) (RehabDeb’s comment: On the other hand, Epsom Salts Soak/Bath works well for humans and the dogs and cats I’ve encouraged toward that therapy. Of course, this is more than “just” a hot bath…) COLD OR ICE BATHS: A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths. They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.
Where Do I Put The Ice?
I have read the homework and this is a dumb question but I do not know where to put the ice on an ACL tear. I would like to have an evalution to see what and if I can do to make my guy better. He has started limping more and I want to start using the ice. He does not seem to be in any pain at all and I do not have him on any meds except a chinese herb which is not helping. I will be setting up my work schedule tomorrow for the upcoming weeks. Is it possible for you to evalute my boy? 
Not a dumb question at all…for now, you may just place a pack directly on his knee, on the side while he is lying down. Leave on the pack for 20 minutes, no towels or other barriers, especially if he has fur…that is enough of a barrier. Yes, we may set up an appt. I have some openings next week, and I will write you mail this weekend to set up a time and day. Thanks- Oh, and if he is limping, he is likely in pain. It is common for people to think the animal is not in pain for a variety of reasons, however the best demonstration that he is in a little pain, at the least, is limping. I suggest you speak to the vet about getting an anti-inflammatory, if you are open to that idea, and if not, we will talk about some other options when I see him. I also highly recommend fish oil capsules…they are anti-inflammatory, for one, and good for many things. I forget how big he is, or I’d give you an amount recommendation.
Filed under: HOMEWORK SUGGESTIONS FOR FUNCTIONAL REHAB (make sure you follow the link for older posts at bottom of page) 
February 28, 2014
Abby, Old Old English Sheepdog with Undiagnosed Neurological Issues and Hyper-extending Tarsal (Ankle) Joints
Here is the short write-up of my recommendations/reminders for Abby’s functional rehab and the process I believe will improve her neuro-muscular capabilities and strength.
Some of this will be stuff I’ve mentioned several times over the course of working with Abby, however it bears review, and most of the time, when I reevaluate a program, often we need to go back closer to a beginning point and press forward methodically in order to achieve expected gains.
I can’t emphasise enough how beneficial the vibrational massage is, even if you do it every other day instead of every day for now. For a refresher, please watch the 10 minute video here:
http://rehabilitationandconditioningforanimals.wordpress.com/category/videos/
And do it as best possible without cutting corners. Pertinent questions are also covered in the video, as well as methodology and benefits. Make sure you change out the batteries as soon as they seem dull, because the best benefit from this massage is realised from the vibration, which stimulates circulation, lessens tension, and potentially improves nerve conduction. I recommend, for now, doing the massage at the end of the day, at bedtime or thereabouts.
For the next week, please walk Abby twice daily, super slowly and consistently, without stopping, for 15 minutes. There are very many reasons why I use this method, and they all contribute to the gains we are trying to achieve. Super slow walking encourages use of all limbs to the best of their ability. Abby has already been able to walk multiple times daily, super slowly, for five and ten minute sessions, having built up slowly. Using the same exercise protocol for a week allows more time for the body to adjust to the work load, and it should go well, because these are introductory workouts, to build a base.
For the following week, please walk her 2×20 minutes in the same manner, if the 15 minute walks are completed well. She should be able to complete these walks without dragging a hind limb and without sagging or falling down. Otherwise, she needs to return to 10 minute walks and do them multiple times daily to ensure success. I am not after complete fatigue and maxing ability at this point; I am after building successful progress, which I believe her body will adapt and accomplish.
I really would like her to wear two supportive hard braces during these walks, and I realise you have only one. She hyper-extends her tarsal joints, and in order to use her hind legs properly and to subsequently use the muscles better/properly, the supportive brace that prevents hyper-extension while she is doing her slow drills would be additionally beneficial. (Orthovet Splint) Use the one you have on her R hind, since that leg has the most deficits and is the weakest. She hyper-extends because of nerve weakness and defecits.
After the week of 2×20 min slow, relatively flat walks, please add in cavalettis, obstacles, to improve her proprioception. This may be accomplished in many ways and several locations around your environment. I have photos on my rehab FB site that depict a trained sporting dog doing cavalettis using an extension ladder. I have a video on this site of a cat with neuro problems using a lineup of remote controls across a bar top. I have a pic on my FB site of another older dog using obstacles in the back yard. When time allows, I will attach some of those pictures to this post.
Abby needs to do the cavalettis every other day and during one of the walk workout times. You should warm her up walking for 5 minutes then do obstacle repeats for 10-15 minutes. I suggest you use about 5 items in a row, spaced about half an Abby-length apart, and between 4-6 inches high for now. If we could get the old cat to do the work, I’m pretty sure we can get Abby to do it! If she is too stubborn for you, I will be glad to take a rehab session and work with you and her on this drill.
After a week of this drill, keep doing it as prescribed, and add in hill repeats every third day as one of her twice-daily workouts. I suggest walking out the front door, around to the back yard, and then up and down the hill on the far side of the house for 10-15 minutes, very slowly. I was able to get her to do this work this past summer when I came for rehab checks.
During the hill phase, it may be more beneficial for Abby to receive laser therapy on the hill work days. This should have the effect of stimulating nerves and cellular process and often improves work ability in the older and neuro-challenged animals. In her condition, I see reason to have twice-weekly laser sessions for at least a month.
I think it would be great if you were able to just start where I suggest, as if we were beginning from scratch, and let’s see the progress that comes from scripted protocol and collaborative effort. She won’t improve from this point if she keeps doing the same walks and leads the same life she has been leading…the body stagnates, and the same happens for humans as well. Our brains aim toward conservation while our bodies are able to do more. I believe, based on my experience that is also based on years of research, that we will see strength and muscle gains if you start here again. I suggest we review in one month after these exercises have been completed. I will then revise the protocol and change the challenges.
Thanks!
Blessings-
Deborah
Filed under: Q&A (Make Sure You Click Link to Older Posts Too)
February 27, 2014
Clark, 14 Month Old Shepherd Mix With “Bad” Hips, Questions About Surgery
From the client:
You are so awesome!!! We took him to the vet yesterday and he gave me Rimadyl and Tramadol to help with pain and inflammation. I haven’t had him in for x-rays yet, would that be helpful for you? The vet said he didn’t see any signs of being hit by a car recently that would tell him that there was something broken. I was going to have him fixed this weekend, but I can wait if you think it would be best to see you first. You are worth every penny + some and I will be prepared to pay you for the time you spend with him. ;0) He is a shepherd mix about 14 months old. Just a baby with a sweet, sweet heart and a crappy start. Let me know if you want x-rays and if I should wait on having his boys removed and I can be available anytime Wednesday on next week.
Me:
I’ve been thinking about it, and I think it would be a good idea to get the manly-man surgery out of the way first.
When he gets pain meds for that, you may be able to see a difference in his demeanor or comfort, regarding his hips/legs, so take note of that.
Yes, and it may be hard to tell ;))
I can tell a lot without xrays, and often they get in the way in part of our brains regarding a better clinical evaluation. On the other hand, since he will be sedated, it will be a great time for x-rays, so go ahead if your vet is on board (which I’m pretty sure he will be!)
If he gets surgerized this weekend, I could see him next Thurs or Fri or when ever your schedule allows after that…
What do you think?
:)) Blessings-
Me, After Eval:
After our first evaluation, my bullet point recommendations were to
1) restrict and crate when caretakers not at home during the next 2 weeks.
2) Begin exercise protocol noted on my FHO homework, beginning with week 2, 2-4 x 10 min walks daily, very slowly (wedding march or “wagons ho” pace).
3) Use medications as per label, giving the Tramadol 30 minutes to 2 hrs. prior to walking if possible. Regarding your dosing question and the variability noted on the label, give the larger dose in the morning if you will be walking him in the morning, otherwise just give the smaller dose. Give the larger dose when you get home in the afternoon/evening, in prep for 1-2 evening walks. Give 2 hrs. rest period in-between walks (as per homework sheet).
4) Feed grain-free kibble (no barley or oats or rice, either, right now), Omega 3 in fish oil capsules as discussed, and joint formula that contains at least two of the following: glucosamine, chondroitin, msm. These are all proved anti-inflammatory measures.
Client:
(after having some problems with Clark, a rescue, and other dogs adjusting)
Hi!
We still have our friend. We made some adjustments and he seems to have settled a little bit. He has the sunroom to himself at night and during the day…we call it his puppy apartment. ;0) Everyone seems happy.
We took him off the Rymadal (SP?) because he was getting sick. And I’ve scaled back on the pain meds and give them when he is looking a little stiff. We are trying REALLY hard to stick to the directions, but I’m afraid it’s a modified version. He is still during the day and at night and we have shortened his time outside with the girls and I’ve been good at at least one walk a day…sometimes I get lucky and can get two. We will get it fine tuned…it’s just going to take a little time.
The vet is REALLY, REALLY pushing the surgery…I’m not doing Clark long term harm by not opting for surgery…right? You would think it by talking to him.
Anywho, thanks for checking in and the great direction. You idea to crate him at night helped everyone out!! ;0)
I will keep you posted on progress…just might be a little longer than 4 weeks.
Have a wonderful week!
Me:
Ok, so, I’m going to tie in our texts here and I think we should have a recheck to keep you guys on task…so that you see the improvements, and Clark improves, and others may see and reevaluate their insistance on surgery.
In Clark’s case, I don’t hear that anyone is concerned about gross malformation of the pelvis or a femur that is deformed beyond function, so there is no clinical reason to not employ muscle-building & joint strengthening techniques to appreciate improvement. The reports you have given me, verbal from the vet and the view of the x-rays, don’t indicate “horrible hips” and don’t indicate hips beyond the level at which others have improved without surgery. Clark is young. Perhaps your intervention staves off the need for surgery for the remainder of his life or perhaps it serves him well until he is older and then you may re-evaluate.
Usually in a case like this pain control plus the right type of exercise slowly improves the body and therefore the situation. Some dogs improve, some don’t. The ones that don’t usually have owners who don’t do much of the protocol. So, if they keep doing the same thing as before, they get the same result, yes? 
I don’t think you are in that catagory.
You guys represent a lot of families I see in my practice, in that you have two working adults, small child(ren), other dogs, etc…and several variations of this norm exist, of course. This family model is perfect for my home-based protocol because it only causes home-based disruption, in that you only have to sacrifice a little time, and my recommendations are based on 30+ years of my understanding of program design for improved function. You don’t have to load up Clark to go into a clinic in order to gain the best functional rehab for him in this case. This combo brings the biggest benefit, greater results, when all factors are weighed. And there is always the option to pay me to come do the exercise and drill work.
I know you know that .
And of course my perspective is a little more broad than that of some practitioners, because I have seen a lot of what happens to a lot of animals in a wide variety of circumstances.
The most predominant point I make to clients is that the protocol does not get easier if the animal has surgery; in fact, it becomes an absolute necessity in order for the healing to occur and for the desired outcome from surgery. Without surgery, using my protocol, there is more room for letting something slip with less immediate ramifications, the main two of which post-surgically would be great damage to the surgery and money down the drain, since re-dos aren’t free (in most cases).
More than that is the additional stress and pain for the animal after surgery.
I am writing more here than need be to address you guys directly because I plan to share some of this discourse on my blog and giving more info helps a wider range of readers.
You said you stopped the Rimadyl because it was causing gastro distress…GOOD! And I presume from something you said in your texts that you let the vet know. You were not using the Tramadol as consistently, and I recommended you return to dosing as per the label for adequate pain control and especially since it’s all the pharmaceutical pain control you are using. Don’t forget the fish oil, grain-free food, and the glucosamine/chondroitin/msm…and I think you’re doing all that.
And you wondered if you were doing some sort of long-term harm by not having the hip surgery since the vet and staff seem so insistent on Clark having surgery. I covered this answer in part above. Additionally I will say that the exercise physiology and functional rehabilitation protocol I bring to veterinary rehab are not necessarily new to vet med, since race horses have been using protocol similar to that derived from human sport science for decades. These are, however, new concepts in small animal medicine, it seems, based on what I find is known and not known about standard principles of exercise physiology and return-to-function program design. I came into vet rehab at the end of 2004, after 25 years experience in human sport science and nutrition protocol. These principles I utilize and design programs around were novel where I began rehab practice, and I find the programs I have been designing for humans, based on much research performed by people living long before I came around, also are the most beneficial programs and protocol for other animals for pre-hab, re-hab, and instead-of-surgery in many cases.
There are some cases that really may need hip surgery, and when the clients have contacted me for pre or non-surgical intervention, at the very least we may say we are doing pre-hab. In the case of luxating hips, even though keeping the dog in a tight sling for weeks will/should work, as per science and experience, it seems almost impossible for most people to maintain the restrictions necessary for the sling to do its work. Disruption too soon=ligament laxity, again, and the ball of the femur keeps popping out. At any rate, it stands to reason that a body realising better function prior to surgery will improve easier post-surgically. That is also proved in research. Dynamic exercise improves every body system, from strengthening bones to improving the health of soft tissue and more.
I know for a fact, from years of study, evaluation, and observation, that cross-training rehab specialists in sport physiology and program design for dynamic function would elevate overall rehabilitation outcomes across the board. This has actually been an extreme discussion in Europe for the past yea-many years, that of the need for physiotherapists to have a deep(er) foundation in sports physiology and program design. I haven’t seen it hit here as forcefully yet (and we’re talking human medicine, which is paving the way in this arena). Europe is quite a bit more progressive regarding body wellness treatment and sport program design and a variety of similar topics, or so it seems.
Simply put, these exercises will not change noted gross malformations of the femur in an animal with hip problems, however, to note, any gravity-based exercise, weight-bearing exercise, will improve bone density, so changes along those lines will accrue. The same exercises will also improve muscle hypertrophy, which will, in turn, displace the femur away from the acetabulum and therefore reduce the pain element so often accompanying “bad” hips. These exercises, performed as per a program designed for Clark, should improve tendon, ligament, and muscle strength, muscle size, and neuro-muscular signaling, simply put.
Other beneficial things will happen as well, as always do with exercise of the right type for a particular body and situation. The changes I noted should improve his overall function. To my knowledge, the surgical protocol is to not operate on hips based solely on x-rays and is to operate based on severity of clinical signs. That is what the surgeons say whom I’ve heard, and that is what the literature says. Vet surgeons in other parts of the U.S. (other than where we are) often will not operate on dog hips without having the clients do 4-6 weeks of pre-hab first, with the intent of gaining owner compliance and improving the dog’s health, most especially in cases of obesity.
So, the catch here is to have enough of the right variety(ies) of pain control on board while the dog is performing the best exercises for his/her situation and thereby learning to use the affected limb more freely again. With that increased use come the improvements I mentioned. With the improvements comes the need for less medicine, since increased muscle mass and supportive tissue strength will better support the joint.
That’s all I have time for right now, and I think this will help you guys.
Blessings-
Filed under: Q&A (Make Sure You Click Link to Older Posts Too) Tagged: does my dog need hip surgery, dog bad hips, dog hip surgery, exercises to help dog hips, lab hip dysplasia
Bella, 5 yo Lab With Hip Dysplasia, No Surgery
Hi Deborah,
We were referred to you by Dr. Mxxx. He believes you can help us with Bella, our 5 year old blonde lab who was diagnosed with Hip Dysplasia 2 years ago. Since then, she has consistently been on Rimadyl. We visited Dr. X (a vet surgeon) and discussed surgery options. At that time we opted for the routine and consistent Rimadyl therapy and to consider other options (hip replacement) for the future.
We were very intrigued and encouraged to receive your information from Dr. Mxxx as we would very much like to pursue alternative forms of therapy and conditioning to improve Bella’s current and future quality of life.
We would be most pleased if you could contact us at your earliest convenience to schedule a consultation to discuss our options.
Kindest Regards,
Art and Caryl
parents of Bella (Lab), Dakota (German Short-Haired Pointer), Raja (cat) and newest addition, Tucker (horse)
Hi, All!
Even though I left you guys with a written note card of things I wanted you to follow for Bella at the time of our in-person visit, here is also the aforementioned bullet point email summing up our discussion during our visit pertaining to Bella last Tuesday.
I am also sending a copy to Dr. Mxxx so he may be in our loop.
Thank you for inviting me to help with Bella’s quality of life, and I hope you find the protocol easy to manage. Text, call, or mail if you have any questions after having worked on the protocol the past couple of days.
1) Consider switching Bella to Wellness Core or another grain-free food. One reason for this change is to cut down on inflammation-causing agents in Bella’s lifestyle. All the dogs (and humans) I have dealt with have thrived when fed grain-free and a substantial diet using other nutrients. You indicated that Dr. Mxxx would be open to this suggestion.
2) Begin giving Bella ~500 mg EPA (and complementary DHA) in fish oil, using capsules, daily. I am not a fan of bottled oil due to potential for rancidity and potential for breaking up the fatty acid chains with shaking, which people tend to do with bottles of liquid. Long-term research evaluation has led me to understand that there are too many complications (rancidity, fragile fatty acid chain, heating of oil changes composition, etc…) when fish oil/omega 3′s are added to processed food sources. As well, I find fault with the research promoted by predominant dog food manufacturers, in that the therapeutic dosing for a dog Bella’s size may be found in 1-4 capsules of easily-obtainable fish oil, as opposed to the much higher number reported in the food company’s statements, either from a vet or from a “human” brand source. There are other major questions and loopholes regarding the research promoted by the dog food companies, and if the animal is to have the best opportunity to “fight” arthritis and thrive in other ways, then the choice of going grain free eradicates some of the popular food brands containing fish oil at the outset. The addition of fish oil and the elimination of grains has been proved in research over the years to be of much assistance to a variety of mammalian corporeal systems, if for no other reasons than that grains are pro-inflammatory and most mammals don’t digest them well, as well as most of us just don’t need all those starches…
3) Add a glucosamine/chondroitin/msm supplement to Bella’s daily routine…check with Dr. Mxxx to see if they carry one of the vet formulations. I recommend obtaining this from your vet or from a “human” brand source vs the products at the animal supply chain stores. You may check ConsumerLab.com or Labdoor.com if you are wary of some of the human brands or look for some of the brands I recommended that are available locally. I do not recommend a “dog” version other than the ones you may find available from your vet.
4) Continue Rimadyl and any other pain meds as scripted. Don’t forget to schedule bloodwork rechecks with the clinic while on the nsaid (Rimadyl).
5) Using my FHO homework, start Bella at week 2, 2-4 x 10 min walks daily, very, very slowly. Please read all the guidelines cited on the homework. 
6) Go to my dog massage video under “Videos” on this website. Please watch it and follow the instructions, massaging Bella daily for 2 weeks.
7) We will recheck in 2 weeks to evaluate her homework performance and upgrade her homework and drills (hopefully).
Thank you, again!
Blessings!
Deborah
Filed under: Q&A (Make Sure You Click Link to Older Posts Too) Tagged: dog hip dysplasia, hip dysplasia no surgery, lab with dysplasia
Border Collie-Golden Lameness After FHO in Mexico
Hi Deborah,
I came across your website after doing some research and I was hoping you could help me. I have a Border Collie-Golden mix, he is medium sized. He had FHO surgery on New Years and the discharge instructions from the vet were no heavy running but just to let him be himself, no rehab instructions or anything. I’m in Mexico and there are no rehab specialists in town, so internet research is all I have.
My dog was toe tapping the first week or so, but he has a really fast walking gait so he started cheating and keeping the leg up. Now, two months later, he is basically not using the leg at all. He sets it down when marking/peeing but you can tell all of the weight is on the front legs because half the time the rear just lifts completely while peeing. I also need to mention that he lives in a large backyard and he has always been a highly energetic dog.
I started this last week to do the rehab exercises since the vet seemed concerned my dog was not using the leg. I have followed them as best as I can but my dog seems not to trust his operated leg. I have tried to do the slow leash walks but he wont set his leg down. He is also reluctant to use it when I do the weight shifting exercises. I don´t know if this is just him getting used to being on 3 legs or if there were pain or discomfort.
All advice I have found is for immediately Post-op but how do you deal with a dog that is just starting Rehab 2 months after surgery?
Thanks for your time
Robert
Hi Robert-
It turns out that so many of the FHO rehab cases I see come about weeks and usually months after surgery. That surgery is one of the least-attended-to surgeries for post-op care and there seems to just be a lot of vague idea among vets regarding recovery after FHO.
The short answer for now is that 100% of the time the disuse I see soon after this surgery is due to pain. This pain can come from the femur scraping against the acetabulum or scraping against raw tissue, can come from tearing of newly-healed tissue, and can come from tearing of scar tissue, among other sources of pain.
I recommend you read my post about pain after CCL surgery and that you work on getting at least two analgesics into your dog just as if it were right after surgery.
There is likely a lot of the wrong type of scar tissue built up along with muscle atrophy and therefore not much muscle displacing the modified femur from the pelvic area.
Here in Austin, I’d talk with the vet about scripting an anti-inflammatory for 2-4 weeks in order to start walking drills successfully along with moderate-to-high doses of Tramadol for the same reason.
After the first 4 weeks of success, we’d at least continue the Tramadol for exercise success for another 4-6 weeks, reviewing response along the way.
See what headway you can make with that, and if you get the meds on board, barring another unforeseen issue, I can almost guarantee he will use the leg and then you may start at the beginning and achieve success.
If you cannot gain access to pain meds, for whatever reason, then you may resort to trying the vibrational massage (which I recommend anyway) as I have cited under ‘Videos” elsewhere on this site and use ice before and after the walks. Both of those interventions can go a long way to help with soft tissue pain. If acupuncture is available, you could gain some brief pain relief from that as well. There are a lot of “helps” for pain relief besides pharmaceuticals, and some of them are over the counter “natural” anti-inflammatories and supplements. Your pet may or may not be able to tolerate those, so please check with your vet or a veterinarian who is knowledgeable about those interventions. You really want to use oral analgesics as a tool and not just load your dog up on stuff
Blessings-
Deborah
Filed under: Q&A (Make Sure You Click Link to Older Posts Too) Tagged: dog lame months after fho, fho in mexico, fho lameness
FHO for Westie Going Well Now…
I went last week out to a veterinary clinic at a vet’s request to see a Westie that had hip surgery and whose leg was just dangling after about 2 weeks. The young dog has been diagnosed with Legg-Calve’ Perthes disease, and he has had an FHO surgery on one hip.
This is the text I got from the owner Saturday, three days later:
Hi, Deborah-
We are seeing good improvement in JJ. He’s standing on his leg at each meal and he has started to use it during our slow walks. He appears to be much happier-caught him smiling today! We haven’t completed all the walks you prescribed yet. Only 2 five min walks today. He’s keeping still most of the day. If not in his crate, he sleeps on the floor in my office or in our family room. We look forward to seeing you next week.
That’s great news, and we had an hour and a half appointment, in person, to ensure that the caretaker really understood what was going on and my instructions.
It also really, really helps that we have full support from the veterinarian, a young man who does a lot of surgery and with whom I have only worked infrequently. He became familiar with the type of exercise physiology-based rehab I promote and practice through injury during his own life adventures, and he seems to understand and embrace the concepts I talk about with him. He successfully uses a lot of these guidelines without my intervention, and I’m really glad to have been brought in on this case. I think together we’ll make a huge difference!
I’m soon to publish the guidelines for post-FHO surgery, but in the meantime, you will do well to begin by using the same guidelines I have already published for post-knee surgery. Here is a link to the Amazon page with the booklet, currently available in paperback or on Kindle:
http://www.amazon.com/dp/B00EY3D03S
Blessings-
Deborah
Filed under: Q&A (Make Sure You Click Link to Older Posts Too) Tagged: FHO, fho westie, legg calve perthes, not using leg after fho, westie not using leg after hip surgery
