2016-03-10

Managing Multiple Orthopedic Issues

All of my dogs are here to teach me something important.

Buzz taught me about the importance of relationships.

Bailey taught me about the importance of understanding how mental and behavioral issues impact every aspect of life. And how to maintain quality of life for a dog like her.

Diego taught me about the importance of identifying and treating medical issues. Which led to an impressive decrease in behavioral issues.


And Gabby is teaching me about managing multiple orthopedic issues.

When Gabby entered my care in 2013 she was severely obese and didn't move around well. In 2014 she was officially diagnosed with arthritis in her hips and elbows, as the result of dysplasia. And thus began the journey to ensuring Gabby is as happy, healthy, mobile, and pain free as possible. For as long as possible.

Everything listed below is recommended or prescribed by one of the rehabilitation and sports medicine veterinarians she sees on a regular basis.

I'm not even sure what came first. I know that in the first year we put Gabby on a diet (Wellness CORE Reduced Fat), Dasuquin, fish oil (high doses can have an anti-inflammatory effect) and Adequan. She received massages and veterinary spinal manipulation therapy (chiropractic) on a regular basis. We also started targeted strengthening of the muscle groups that support the affected joints. The stronger the muscles are, the more the joint is protected.

She made such dramatic improvements that sometimes it was hard for me to believe that she still had a problem. But, with each improvement, she gained more desire to be active. And with more activity came more pain. In an effort to avoid using pain medications long term, we tried a number of modalities from 2014-2015.

Gabby's most painful areas when palpated are consistently her right hip and her right elbow. However, she also has pain in her left hip.

Laser Therapy
Our first choice of pain management was laser therapy. A course of six treatments over about three weeks resulted in a non-painful right elbow and left hip. Her right hip was still painful but much less so. As we did treatments less frequently, her right elbow remained comfortable while her hips became more so. We have continued to laser her right elbow on a regular basis, she currently exhibits no pain when palpated!

Hyaluronic Acid Joint Injection
When laser therapy didn't give us the prolonged positive effect we desired, Gabby's rehabilitation veterinarian recommended we inject her hip joints with hyaluronic acid. This procedure is typically done under sedation (light or full). Since Gabby is such a cooperative and calm dog to begin with, we chose to use a local anesthetic instead. Gabby tolerated her injections pretty well, but was obviously uncomfortable for about 48 hours after that. I saw no change in her comfort or mobility for almost exactly 7 days. And then she was SO MUCH more comfortable. It is typically recommended that joint injections are repeated if a positive result is seen but not complete pain relief. Her left hip remained comfortable after the first injection so we repeated her right hip. This injection went a lot less smoothly. While I saw a positive effect, Gabby was quite uncomfortable with the procedure itself as well as for a bit longer after the injection.

Gabby was started on Metacam (Meloxicam) and Gabapentin (Neurontin) for a different issue. This was intended to be temporary but we saw a significant positive effect in her comfort and mobility so these two medications were continued. However, her Metacam dosage was about half that recommended for her weight. This was her lowest effective dose (where I saw no change in comfort from her maximum dose), to help protect her internal organs for as long as possible. Even with these medications on board, she was still painful over her right hip when palpated.

As her joint injections started to wear off, we got a new piece of equipment at work.

Shockwave Therapy
Gabby got to be a guinea pig for a demonstration of piezioelectric shockwave therapy. I was warned ahead of time that she may be more sore for 24-48 hours after the treatment, but that it should help improve her comfort soon after that. We did Gabby's left and right hips in the same session. I took home a very sore, very gimpy dog that night. When Gabby hurts, she tends to lie around and pulls herself up with her front end. She did this for nearly two days, and I doubted what I'd done to her. By the third day she was back to her baseline. By the fourth day she was stretching her rear legs. By the fifth day she was trying to run around outside. And by the seventh day, I was witnessing a joyfulness I didn't know Gabby had. I'm not one to claim something works after the first try. But I couldn't believe what I was seeing.

We did three treatments about a week apart. Each time the pain post treatment lasted less and less. Those three treatments kept Gabby's hips comfortable for 3 months. Between 3 & 4 months I saw a decline in her comfort but it was gradual. I don't think I would have noticed had I not been checking for comfort on a regular basis.
2015
Yesterday Gabby had her first of three treatments in the second set of shockwave therapies on her right hip (we are splitting her hips into two separate sessions this time). She was painful for about 12 hours this time, and even then, it was so much less obvious than after her first treatment.

We've added and subtracted medications and modalities to manage Gabby's arthritis over the last three years. The following is a list of what we have determined to help her lead the most comfortable and active life she can.

Dasuquin, Adequan, Metacam, Gabapentin, fish oil, a lean body condition, veterinary spinal manipulation therapy, targeted strengthening, massage, laser therapy, shockwave therapy, and appropriate exercise.

Gabby has helped me to have a working understanding of the modalities we use at work. She has helped us to better understand how to treat multiple orthopedic issues successfully. I really love when people who know her see her xrays, and don't believe me it's the same dog. With this approach, we have also minimized arthritic change in her joints since 2013. On repeat xrays late last year (2015), there were only minimal changes to her hips and elbows.

On a typical day, she doesn't act like a 10 year old dog with hip and elbow dysplasia.

Gabby with friends about a month ago.

2016-01-18

Titles

When I was in 4-H and I had to keep records of my dog activities, I remember finding a quote. I was intrigued but it's one of those things that I can only now truly appreciate. Now that my first dog is gone. I trained and showed Buzz because I enjoyed it. Because we enjoyed it.

"A title proves that your dog inspired you to that special relationship enjoyed by so few; that in a world of disposable creatures, this dog with a title was greatly loved, and loved greatly in return." -Sandra Mowery from Why Title a Dog?

There are some titles I value more than others, simply because I know how much work went into being successful. I never mentioned Buzz's titles in my tribute to him. That's not what our relationship was about. But training and showing to get those titles, that is what our relationship was about.

The titles I am most proud of:

UCD (United Kennel Club-Companion Dog) earned on 1/19/2008. Obedience used to be "boring" for Buzz. This was when he would leave me the most frequently. This video is of his third consecutive qualifying UCD run, for his title. I was THE MOST PROUD. I still am.



Novice Versatility Award (NADAC award for completing the requirements for all class titles-NAC, NJC, NCC, TN-N, TG-N, and WV-N). Buzz earned this when he earned his WV-N on 3/15/2009. He was never good at weaving, but it's something we worked on. A lot. My goal was never a NATCH for him. My only goal was to get his Novice Versatility. And we did. Thank you Annelise.

ARCH, RLV, and RLVX (APDT, now WCRL Rally Champion, Rally Veteran, and Rally Veteran Champion). We started doing this type of rally because the signs are more exciting, the courses are longer, there is space to heel between signs, and I could feed him in the ring. The most important though is the availability of the veterans class. Long after Buzz could do Level 1, 2, or 3, he could still compete with me. He absolutely LOVED doing WCRL. I loved that I could still get out in a ring with my boy and watch him shine. He earned his last title, RLVX, on 7/27/13. I still cry every time I watch this video.



I've learned to live my life without you. I'm trying to never forget the lessons you taught me. Titles are about teamwork and relationship, never take either for granted.

My Buzz Lightyear.
ARCH UCD URO1
Sir Buzz Domino
RL2 RLVX NAC NCC S-NJC O-TN-N TG-N WV-N RN ThD CGC
Novice Versatility, RL1/2/V Award of Excellence
May 5, 1998 - May 20, 2014

2015-01-26

Gabby's First (and second) Title(s)

I was so caught up in school and work that I never acknowledged Gabby's first title. Which is actually a huge milestone. And she doesn't just have one title now, she has two!


The road to getting Gabby trial-ready has been a long one, and it certainly isn't over. The above photo is what I want, and these days what I get most of the time! More of the above, and less of the below.


The good news is that the more we work on it, the better she gets! Her first trial, she had a 50% qualifying rate going 2/4 over the two days. Despite that, I was thrilled with how she worked. I'd had her for less than a year, and had been training her for less than 6 months. I entered the trial because we only have 2 per year. I entered the trial hoping I could see where our holes were, and make trial environments a happy place for her! Both of her qualifying runs were in the Veterans class.
First trial!
This is a video from her second trial. So much improvement in her ability to work. Much longer duration heeling. And her heel position remained clear. There is no halfway, she is either heeling with all components there, or she isn't. Which is exactly what I want.
Obviously, the end result is heeling with more duration. But I was SO happy with her. In her second trial, she qualified in 4/4 runs! 100% qualifying rate! She qualified in two Veteran runs and two Level 1 runs! Qualifying in veterans earned her FIRST TITLE! Aroha's ESRA Gift of Gab RLV!

We got really lucky and our club decided to host a one day WCRL trial in December last year. I entered her in Veterans and Level 1 again. And in this trial, she worked as the dog I train. I was so incredibly happy with her. I walked into the ring with my fabulous girl and she blew me away.

Qualifying in Level 1 earned her RL1 title! And qualifying in Veterans earned #2/5 for her RLVX.

Aroha's ESRA Gift of Gab RL1 RLV


2014-10-19

Sporadic Blogging (but I have pictures)

School is over, I graduated (in August...)! Now I just have to take my VTNE in December. The dogs haven't been getting out as much because of a lot of reasons (my injuries, their injuries, time, daylight, I can think of more excuses if I need to) and I also haven't used my camera all summer.

Yesterday we remedied that.

I haven't used my camera in ages, and neither Gabby nor Diego are used to being photographed so most of my initial pictures look like this. They looked nice but as soon as I crouched down to focus, they started moving toward me. Oops.

And then I forgot I had a zoom. But Gabby gave me some great faces anyways.

I always seem to end up with a lot of photos like this. And I'm always worried she's going to stick her nose on my lens! This worry is justified, because she has!

And then I took a bunch of Diego rolling because I find it so adorable.






He really is a handsome dog. He just doesn't often stop long enough for me to admire him!

Oh the derp. I can't stand it.

Rolling was the theme of the day I guess.



Again with the handsome!

Group photo time! Diego looks nice, Gabby looks nice... and Bailey looks stoned.

Diego looks moderately sad. Gabby looks great. Bailey looks less stoned.








2014-09-30

Gotcha Gabby

Gabby's "official" gotcha day is October 6th. She entered my care on June 4th. And her date of birth is November 30th. 

On September 30, 2013 I emailed Ellie, one of our regional coordinators, "a hypothetical situation." 


If I were hypothetically interested in keeping Gaby, would I be allowed to?
YES, AND I WOULD LOVE NOTHING MORE.
Hypothetically.
 Anyone who knows me a little bit, knows that I adore this dog to pieces. She does virtually nothing wrong and she is as good as gold. Gabby came into my life when I needed her most. She learned so many important lessons from Buzz, she helped satisfy my desire to train when Buzz no longer could, she provided company for Buzz when I worked long hours, and she sat with me while I cried and cried and cried when he was gone. She has been invaluable in helping my heart to heal from the immense loss of my heart dog. Gabby and I have bravely forged our own path where we are learning how to work together. She makes me so happy. She is so joyful. 

And she wouldn't be mine without the compassion and generosity of English Springer Rescue America. Being Gabby's foster means that I know how much money was spent on her care. And I know that her adoption fee was less than half of her veterinary care cost. Thank you for helping me find my Gabby.

Happy gotcha day Gabbers.


Aroha's ESRA Gift of Gab RLV





2014-09-17

Bailey's Behavior Modification Medications

Some of you know that Bailey has been struggling physically and mentally lately. Really struggling. She couldn't seem to settle unless she was sleeping and she was often restless even then. Unfortunately her "just not right"-ness has actually been going on for about a year with quite vague symptoms that seemed to change week to week.

She takes a variety of prescription medications as well as supplements. I've learned it can be quite difficult to manage so many medications successfully, there are so many potential interactions! One of the things her vet(s) and I have discussed recently was the possibility of incorrect medication doses. In medicine there are "relative overdoses" and "frank overdoses." The simple way to explain it is that a "frank overdose" means the patient received too much. A "relative overdose" means that even if the correct, calculated dose was administered, it was too much for that patient.

I'll start by saying I am so very lucky to have the resources I do. As we reviewed Bailey's symptoms, time-frame of onset, various diagnostics, and medications for the hundredth time I heard "what if one of her medication doses is now wrong for her." And we all paused. So we started looking up side effects of ALL the medications she takes. Fluoxetine is metabolized by the liver. Earlier this year, Bailey's liver values were elevated. She was started on a supplement from Standard Process and at her next recheck, her liver values had normalized. She, however, did not normalize. Hyperserotonin syndrome is not common as far as I can tell, and the onset is usually very quick with serious consequences if it isn't addressed. However, many of Bailey's symptoms were the same. She was more anxious, she was nauseous, she was ataxic (all four limbs didn't seem to get the correct signals from her brain), and she was restless (just to name a few). We had tried to rule in or out so many other causes without success. Nothing else added up the way this did.

Bailey was weaned off her Fluoxetine completely (and very carefully) over the course of 6 weeks. The lower her dose got, the more she improved. Both physically and mentally. She is no longer ataxic, she has more coordination than I've seen in a year. Her appetite is much better. And she is able to relax.

I've hesitated to share this publicly, because I am an advocate for behavior medication in dogs. Her life changed, for the better, because of it many years ago. As dogs age, their bodies change. It was a lesson for me to keep looking for an answer, because there was one for Bailey.



2014-06-18

Geriatric Care: Exercise/Pain Management

A very delayed part two in my Geriatric Care series.

Exercise is important for cardiac health, muscle strength, and mental health. Many older dogs struggle to maintain the amount of muscle that was easily built in younger years. At work we tend to see older dogs losing muscle as a result of pain because exercising becomes increasingly difficult.

Step one has to be pain management. Talk to your veterinarian (or a rehabilitation veterinarian if you are lucky enough to have one nearby) about diagnosing and managing pain. A general place to start is finding a high quality joint supplement. Dasuquin is recommended by many veterinary professionals as the go-to joint supplement. In addition to that, the International Veterinary Academy of Pain Management is an organization devoted wholly to the management of pain. There is a "search for member" tab at the top to assist in finding a local veterinarian experienced in pain management. In Minnesota alone, there are 51 members!

An alternative complimentary approach is using Low-Level Laser Therapy (therapeutic laser) as an anti-inflammatory and pain reliever. Buzz benefited greatly from regular laser therapy. His overall comfort level improved, his mobility was better, and he certainly didn't mind spending quality time alone with me. Not all lasers are created equally, so it is definitely a treatment that should be prescribed and overseen by a professional.


Once pain is under control there are so many options for strengthening. At work we utilize underwater treadmill therapy in conjunction with specific exercises tailored to each dog. We have exercises that target specific muscle groups to engage them, or relax them, based on the needs of the dog. 


An example of Buzz's exercises at home included a chest elevation stretch, weight shifting, and front limb range of motion. The exercises were prescribed twice daily, and I was pretty good about getting them done at least once daily. Doing his exercises took about 10 minutes start to finish. His exercises changed frequently based on how he seemed to feel while I was doing them, and after. A few exercises he really enjoyed, I made a point of doing regularly (chest elevation stretch and spinal traction). Before I started working at TC Rehab, Buzz saw Dr. Julia every month or two for re-evaluation. 

Structured exercise is very important in keeping a geriatric dog happy and healthy. While enjoying smells in the backyard and interacting with other dogs is still considered exercise (and can be great mental stimulation), an exercise regimen can help to keep your dog more comfortable and active as they age. It is very important to remember that we want to give them enough exercise erring on the side of too little rather than over tax their bodies and make exercise painful.