Frequently Asked Questions from DVMs

Veterinarian referral is appreciated but not required for a patient to begin therapy at CROC.

We do require the patient’s medical records prior to the initial Consultation appointment. When a client schedules a Consultation with us, they are asked to provide the name of every Veterinary facility that has seen their pet within the last 12 months. We then request medical records and all imaging from those facilities, as well as the best email or fax number so we can share our findings once we have evaluated the patient.

There’s a common misconception that Rehab only exists to treat the presenting complaint, but the truth is that a complete picture of your patient’s overall condition is imperative for effective therapy.

For example, if we have a patient that needs to rebuild muscle, but isn’t progressing as expected: Are they receiving adequate nutrition to support muscle growth? Do they have significant periodontal disease that is affecting their ability to intake the nutrition required to build muscle? Should we be looking for cancer or another systemic condition that is reducing the body’s ability to respond to therapy? If they have comorbidities, are we able to continue therapy safely given appropriate adjustments to their treatment plan or does this patient need more in-depth evaluation before continuing therapy?

If you would like to expedite the process for your patient, feel free to send your SOAP notes along with any imaging to CROCrecords@gmail.com. When referring your patient to CROC, you are welcome to share any thoughts, questions, or concerns you would like to have addressed. In addition, please let us know if we should expect this client to contact us or if you would like us to reach out to them. Since Veterinarian referrals are not required, you can also just give your client our information and we can get started as soon as they contact us.

We are pleased to share that our practice exclusively offers Canine Physical Rehabilitation.

We do not prescribe medications nor do we have any diagnostic or imaging equipment. We do not perform surgeries of any kind. We don't even perform minor services such as nail trims and the like.

Why?

Physical Rehabilitation is most effective when our patients trust that they are safe with us; that we will handle them with care and not cause any further pain. Often, they have recently been to their primary Veterinarian and any number of specialists before coming to us and they can have their guard up pretty high. We have to teach them to relax so we can heal their hurt and once they realize that Rehab feels good, we can do more and more with them each visit. Radiographs, while integral information for your patient's recovery, can be scary and painful for some patients and if we performed services like this, we would damage our relationship with your patient. By only offering Rehab services, we can preserve the relationship we have with your patient and avoid the "white coat syndrome" that is commonly experienced in Veterinary Hospitals.

Patients in need of these services are referred back to their primary Veterinarian or to a Board Certified Veterinary Specialist as appropriate. This means that you can comfortably refer your patients to us knowing that they will come back to you for anything outside of Physical Rehabilitation services.

Ideally, your patient will have had diagnostics/imaging completed & already be started on any medications necessary to keep them comfortable before they come to see us.

We strongly recommend that labwork & imaging be performed before you refer your patient to us so that we will have a complete record of your patient’s condition, thus enabling us to customize their Rehab Treatment Plan for maximum benefit. Since we do not perform any imaging, we will refer your client back to you for these services. Since we do not prescribe any medications, we ask that your patient be started on pain medication (if appropriate) before coming to see us so that they are more comfortable and cooperative for therapy.

Pain medication does not interfere with our ability to assess your patient. Please remind your clients to give all medications as prescribed on the day of their consultation, as many will assume that they should withhold pain medications.

Please do not tell your client to request specific modalities.

CROC’s team is composed of Veterinary Professionals that have specialized in Physical Rehabilitation Therapy, so we ask that you please trust in our many years of education and experience to choose the safest and most effective treatments for your patient. While very popular, Hydrotherapy isn’t always the best modality and we have had clients get upset when we tell them that their pet should not participate in this exercise. In addition, optimal recovery is achieved with a combination of modalities such as Electrostimulation Therapy, Thermotherapy, Stretching, Massage, Therapeutic Ultrasound and exercises to improve Balance, Stamina, and Proprioception. Skipping these aspects of therapy can delay or even be detrimental to your patient’s recovery.

You can trust that we create customized Treatment Plans for our patients using clinically proven modalities which are performed by Licensed Veterinary Professionals. We offer flat fee pricing to ensure that an owner’s budget doesn’t take away from a patient’s optimal Treatment Plan. CROC does not allow clients to pick from a menu of modalities.

We do not offer Chiropractic, Aquapractic, Ozone Therapy, or any other modality that is lacking peer-reviewed evidence of its safety and efficacy.

Our team of Veterinary Physical Rehabilitation specialists will prescribe treatments aiming to address your patient’s insufficiencies as efficiently as possible, but with safety as our primary concern. 

CROC only offers treatment modalities that have been clinically-proven to be safe and effective. You will not see modalities like Chiropractic or Ozone Therapy, among others, offered at CROC until substantial, peer-reviewed evidence is published stating that treatments such as these are medically helpful and safe when utilized appropriately. We are always keeping an eye out for any potentially helpful modalities to add to our available treatments but we are extremely careful about bringing in new therapies.

We’re also extremely careful about what therapies are prescribed for each patient. For example, swimming would be contraindicated for an IVDD patient but beneficial for the Swimmer Syndrome puppy. Therapeutic Laser is wonderful for relieving pain and inflammation, but can also encourage neoplastic growth or cause premature closure of growth plates.

Your patient’s Rehab Treatment Plan will be prescribed by our team of highly experienced Veterinarians and Certified Canine Rehabilitation Practitioners who have completed additional training to become specialized in Veterinary Physical Rehabilitation, so you can trust that your patient will be handled and treated appropriately by medical professionals that understand their anatomy and physiology.

Yes! Every time your patient is examined by one of our Veterinarians, you will receive a summary letter with our findings and recommendations.

Keep in mind that it’s not uncommon for 12-16 therapy sessions to pass between Progress Exams. We do not send summaries for each therapy session. We ask that you also share any updates on our mutual patient so that we can adjust their Rehab Treatment Plan if needed.

Yes, however not all patients are good candidates for a cart and a Physical Rehabilitation Consultation is often a more effective use of your client's time and resources. 

The senior patient struggling with osteoarthritis and muscle atrophy may not have the strength to safely or adequately use a cart and should instead be referred for Physical Rehabilitation Therapy. The paraparetic patient has a better chance at achieving functional mobility by initiating therapy as soon as safely possible after the incident, but if the patient remains non-ambulatory 4-6 months out from the incident, a cart may be a good option providing that the dog is otherwise physically sound. If the injury to the spinal cord only occurred a few weeks ago, contrary to popular belief, the use of a cart is more likely hinder your patient’s chances of returning to functional ambulation and should be avoided until it is clear that the patient will remain non-ambulatory.

End stage Degenerative Myelopathy patients often enjoy cart use, but Physical Rehabilitation Therapy has been clinically proven to be the most effective treatment to slow down progression of the disease. This, combined with the fact that most cart-using patients require some level of physical conditioning to be able to comfortably use their cart, is why we recommend that your patient begin with a Rehab Consult rather than jumping straight to a cart.

Pre-made carts are easily available for purchase online and often at a lower price point than a custom-built cart, but frequently lack the ergonomics required for safe and comfortable long term cart use and can even cause further pain and injury if they are ill fitting.

Tissues have Timelines & Timing is Everything!

No, really – check out our article here where we discuss the importance of beginning Rehab Therapy at precisely the right time to give your patient the very best chances of maximum recovery.

To summarize our article, some conditions, such as severe FCE’s or Swimmer Syndrome neonates, should begin Rehab as soon as possible for optimal results. Others will need to wait until adequate bone healing takes place or inflammation has sufficiently resolved before we can safely proceed. Our team has many years of experience treating a wide range of conditions and will be able to weigh in on the appropriate time to begin therapy once we have more information on your patient’s case. When in doubt, it’s better for your client to call us too soon and book a little farther out than to call and find out that therapy should have begun two months ago.

Contrary to popular belief, swimming is not the best modality for most of the conditions we treat.

Conditions such as IVDD, CCL tears, post-op FHO’s & TPLO’s, FCE, MPL, among many others, attain better results using an Underwater Treadmill. In fact, swimming can make some of these conditions worse! In an Underwater Treadmill, the patient’s use of all limbs is slow and deliberate and involve the muscular loading/unloading cycles created by weight bearing ambulation that is required to improve musculature. By contrast, swimming involves spastic paddling of the thoracic limbs, minimal pelvic limb involvement, as well as increased twisting movements and strain of the patient’s neck and back.

Not only is an Underwater Treadmill a safer and more effective tool for Hydrotherapy; it’s also significantly more sanitary for our patients. Because of the time, effort, and cost involved in draining and scrubbing, then refilling with fresh water, pools are only “cleaned” using chemicals and filters. Our Underwater Treadmills are drained and disinfected multiple times a day in addition to our filtration system and frequent replacement of the water in our reservoir tanks. Given that so many Rehab patients suffer from some form of incontinence, the ability to thoroughly sanitize our equipment is of utmost importance.

Lastly, we also have more control to fine tune the patient’s Hydrotherapy session by using an Underwater Treadmill. We can control the temperature and depth of the water, the speed of the treadmill belt, and the incline of the treadmill. This in turn gives us a wider range of exercises we can have a patient participate in and we can make Hydrotherapy safer for patients with respiratory compromise, such as those suffering from LarPar. In the event that swimming is the hydrotherapy of choice for a patient’s condition, we can just fill the Underwater Treadmill until the water is deep enough for that patient to swim.

CROC is not equipped for overnight care and we do not offer house calls.

We encourage you to check out the American Association of Rehabilitation Veterinarians for a list of other Rehab specialists near you that might offer these services.