- Tiffany Downing, RVT
Caring for the Recumbent Dog
Caring for a dog that cannot walk or otherwise move on their own is a challenging endeavor which only gets more difficult depending on the size of the dog and the level of debilitation. Pending the reason for your dog’s condition, you may be responsible for some or all of your dog’s most basic bodily functions – eating, drinking, urinating/defecating, maintaining Range of Motion, minimizing muscle atrophy, preventing bed sores, and even mental stimulation. In the worst case, you may also be responsible for deciding when it’s no longer fair to put you and your dog through this situation. We’ll discuss all aspects of Recumbent or “Down Dog” care so that you’ll have the knowledge you need to make the right decisions for you both.
Why is Your Dog Down?
There are a multitude of reasons that your dog might not be able to rise or walk. The important thing is that you find out why so that you can appropriately care for your dog. Is your dog expected to get better? How do we help them get better? Is the goal just to keep your pet comfortable while you mull over other decisions? How do we evaluate comfort? Can your dog flip themselves over or hold themselves in any upright position? How do we prevent decubital ulcers (bedsores)? Is your dog able to control their bladder and bowels? How will you keep your dog and your home clean? Knowing the answers to these questions will help define the overall goal when caring for your dog.
Nutrition & Hydration
If your dog is completely unable to eat or drink on their own, they may require hospitalization for intravenous fluids and a feeding tube. Sometimes, when patients are otherwise stable, owners can be taught how to feed their pet using the feeding tube and can continue to do so at home with the goal being that the dog will eventually be able to eat on their own so the feeding tube can be later removed. If your dog is able to swallow or chew, then you may be able to hand or syringe feed them at home. For both situations, it’s important that your veterinarian gives you a clear outline of how much food and water your dog will require each day and how many feeding sessions to split that amount into. Too few calories, and your dog will lose weight and muscle mass, making it even more difficult for them to heal and recover. Too many calories and your dog will gain extra weight that you will have to lift and move and that they will then have to overcome when/if they start moving on their own again.
Monitoring your dog’s hydration is especially important in these situations since your dog may not be able to drink on their own. There are a couple simple observations you can make to assess if your dog is well hydrated. The first is to check their gums. While some dogs have extra pigment that can make this observation more difficult, the hydrated dog will have wet gums of a nice bubblegum pink color. Dry gums are an easy indicator that your dog is experiencing dehydration. If your dog’s gums are dry and pale in color, you should contact your veterinarian right away, as your dog may need more urgent veterinary care. Next is to check Skin Turgor. To do this, gently pinch the skin (gentle enough that this should not hurt) in between your dog’s shoulder blades and pull it away from the body, then quickly release. In a well hydrated dog, the skin should snap right back against the body immediately. If the skin is slow to return to position, your dog is dehydrated. If your dog’s skin is slow to return to position AND their gums are pale/dry, absolutely contact your veterinarian immediately as your dog will need more advanced care right away. Lastly, monitoring the color of their urine can help indicate hydration but is not always a reliable indicator on its own, so it is best to use this only in conjunction with the above methods. Darker, more concentrated urine can indicate dehydration, but it can also indicate other serious conditions.
If your dog is able to eat and drink on their own, your job is to make sure that they are eating nutritionally balanced food in appropriate quantities and that they have easy access to water. The recumbent dog’s body condition can be tricky to maintain. Dogs that aren’t moving on their own quickly begin to experience muscle atrophy, where the muscle wastes away, but they need those muscles to have any chance at being able to move on their own again, so quality nutrition is paramount. Dogs that are extremely lean with prominent skeletal features are also more likely to develop decubital ulcers since there is less tissue to cushion their body. At the same time, being less active makes them prone to putting on extra fat that will make it more difficult for them to regain their mobility. More weight to haul plus weaker, wasting muscles is not an equation for recovery. Lastly, remember that what goes in must come out and if your dog can’t get up on their own, you will be responsible for cleaning up. A balanced, nutritious diet should produce well-formed stool. Figuring out the right diet for the Recumbent Dog can be tough, so be sure to stay in good communication with your veterinarian until you find the right balance.
Decubital Ulcers, Skin Infections, & Urinary Infections
More commonly referred to as Bed Sores or Pressure Sores, Decubital Ulcers are painful wounds and a serious concern for the Recumbent Dog. They are preventable, but once they
form, they can be very difficult to heal. Combine open wounds with a dog that cannot control its bowels or bladder and we’ve got a recipe for a nasty infection. To prevent Decubital Ulcers, your dog must be kept in a clean, soft, and well-padded area, so a good quality dog bed is a must have. Orthopedic Memory Foam beds are ideal. For our Large to Giant breeds, we recommend a Big Barker bed. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight.
The recumbent dog requires frequent repositioning, at least every 4 hours.
If left in one position for too long, the areas of the body where bones are most prominent experience too much pressure and do not get the circulation needed to support the tissues. The tissues then begin to break down, forming open wounds. If allowed to continue, these wounds can become so deep that they expose the bone itself. Commonly affected areas include ankles, hips, elbows, shoulders, and eyebrow area, but these can occur anywhere that experiences too much prolonged pressure.
Especially for dogs that do not have bowel or bladder control, skin care can be particularly challenging. Bedding, diapers, and belly bands require regular and prompt cleaning to avoid skin and urinary infections.
Monitor your dog’s skin for redness, excess moisture, hair loss or odor, especially the areas in regular contact with diapers, harnesses, or any other accessories.
If your dog requires frequent baths, make sure to use a dog shampoo intended for very sensitive skin. Regular shampoos may be too harsh for frequent baths, stripping away the skin’s natural barriers and therefore making it even weaker and more likely to break down or develop infection. Wipes can be helpful for quick, small clean ups, but wipes intended for humans are often the wrong pH for dog skin and can cause irritation from regular use.
Depending on the condition, some dogs who are unable to hold their bladder just dribble urine uncontrollably while others are unable to empty their bladder without human intervention. Your veterinarian should give you a clear indication of your dog’s condition so that you know how to keep your dog clean and comfortable. Dogs left to sit in urine or soiled diapers are at high risk for skin infections and urinary tract infections. Dogs that are unable to empty their bladder will require their owner to assist them several times a day. If their bladder is left full for too long, serious illness and even damage to the kidneys can occur.
If for any reason, your dog cannot urinate, make sure you consult with your veterinarian immediately or seek emergency veterinary care.
On another note: Dogs are emotional creatures and their state of mind can absolutely affect their recovery. Dogs that are left in dirty bedding/diapers or that are experiencing prolonged pain can develop significant stress, anxiety, and even depression. None of these are conducive to healing, so remember that keeping your dog clean and comfortable will also help keep their mental state healthy which will help support their physical recovery and Quality of Life.
Thermotherapy, Massage, Stretching & Range of Motion
You know how after a long drive, you get out of the car and your body aches from sitting for so long? Recumbent dogs feel something very similar but on a larger scale. Their muscles simultaneously tighten and shrink from disuse and their joints become stiff and achy. Since they cannot move their body as they normally would, that task now falls to you. You will need to stretch their body to keep things limber and you will need to move their body through it’s normal Range of Motion in order to maintain that range. Stretching and Range of Motion exercises help maintain flexibility but also promote circulation and stimulate muscle and nervous tissues which can help your dog on the road to recovery.
Do not perform stretches or exercises without direction from a Veterinarian as some of these may be harmful for your dog depending on their condition.
At CROC, we will give you a custom Treatment Plan for you to follow at home that has been tailored to your dog’s needs. By following a customized Home Care Plan, you’ll know that those stretches and exercises are not only safe for your dog, but also handpicked as the most effective and beneficial.
Stiff and atrophied dogs need some loosening up before they can stretch and move. Using a warm pack and therapeutic massage to relieve tension and increase circulation will help make Stretching and Range of Motion exercises more
comfortable and more effective. Trying to jump straight to Stretching and Range of Motion exercises can, at best, be ineffective at treating your dog’s condition, and at worst, cause pain or even injury. Thermotherapy, Massage, Stretching, and Range of Motion is a lot to get done every single day (and often multiple times a day) but the alternative is far worse. When a dog’s leg experiences long periods of disuse, the muscles not only waste away, but also contract and tighten, locking the dog’s leg into one position. This process is called Muscle Contracture and is both painful and difficult to reverse, so the goal is to avoid it entirely by keeping your dog flexible and moving. Once Muscle Contracture takes hold, it will take several months of intensive Physical Rehabilitation to have any chance at reversing it and there is no guarantee that it will be reversible.
Rehabbing the Recumbent Dog
Physical Rehabilitation for the Recumbent Dog will look different for every condition and how it affects each dog. Generally speaking, our goal is to help your dog have the muscular strength and neurological control to be able to get up and walk on their own. Some conditions will recover faster or better than others and some will never recover despite our best efforts. For dogs experiencing Neurological conditions like Fibrocartilaginous Embolisms or Intervertebral Disc Disease, there’s a good chance we can improve function and mobility with dedicated, consistent therapy that begins promptly. For dogs experiencing progressive conditions, like Degenerative Myelopathy or Geriatric Onset Laryngeal Paralysis & Polyneuropathy, we know that we will not be able to restore function but we can slow down the effects of these conditions and keep the patient comfortable and mobile for as long as possible. Once they are Recumbent, it’s time to pay close attention to Quality of Life for everyone involved.
For Recumbent Dogs that are expected to make any kind of recovery, the first stages often appear tedious and insignificant. We start by re-teaching the dog to be able to lay sternally, where its legs are underneath them and their head is up, and after that, sitting up. These might seem like simple things, but strength, stamina, proprioception, and balance all play a part in being able to do these simple things and when we start, your dog has almost no strength, stamina, or balance and they may or may not have proprioception. Once they are able to sit unassisted, we start working on standing. Your dog may have spent a noteworthy amount of time just laying down, not supporting their own weight, so we have to retrain the body to be able to hold itself up again. This is where weight management plays a huge role in the level of difficulty your dog experiences during recovery. Getting to the point of standing may take weeks to months and during that entire time, you will still be responsible for all the movement and maintenance that your dog cannot do on their own and we will be working/supporting all aspects of your dog’s body to encourage healing and recovery. Many of the exercises your dog will participate in both at home and in clinic, are recreating normal movement to help the body “remember” how to function as it once did.
Tools To Make Your Life Easier
An integral tool for Recumbent Dogs is the Help ‘Em Up Harness. This harness was made to help you help your dog stand and walk in a way that is safe and most comfortable for you both. By using this harness, you will more easily be able to help your dog get around the house, get outside to potty, and complete their Rehab Exercises.
It comes in two pieces, one to go around the chest and one to go under and around the pelvis. As your pet’s ability increases, your pet may no longer need the back half. It is comfortable enough that your pet can wear it for extended periods and it is more ergonomic for you and your dog than just lifting them or using a sling/towel. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. You can learn more about it here: https://www.caninerehaboc.com/post/help-em-up.
While relearning how to stand and walk, it is important to protect their paws from scuffing and abrasions. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten!
Home modifications like adding rugs and ramps are quick and easy ways to help your dog get around the house more easily once they are moving or while you are doing Home Care Exercises. Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling and helping with the sensation of feeling the ground. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging once they’re up and moving, although care should still be taken to monitor your pet while using these.
Some clients elect to pursue a Cart (sometimes referred to as a wheelchair) for their dog, but this option is highly dependent on the individual dog’s condition. Carts for animals do not work the same way as a wheelchair for humans and require significant physical strength and stamina from the dog. Not all dogs are good candidates for this and it’s quite the investment so it’s important for pet parents to approach this with realistic expectations. Dogs that are good candidates should be fitted for a custom-built cart. The only company we recommend for this is Eddie’s Wheels. Over the years, we have seen many other carts and found serious flaws in all of them, with some even causing severe pain for the dog using it. For more information about carts, be sure to read our online article at https://www.caninerehaboc.com/post/the-wheel-deal.
Is There Anything Else?
One of the best things you can do for your dog is keep them lean!
We generally recommend a Body Condition Score (BCS) of about 4 out of 9.
The less weight there is for them to haul around, the less strain is imposed on their already weakened body. Many recumbent dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information on the BCS and Weight Management, read our online article https://www.caninerehaboc.com/post/body-condition.
Since there are many reasons a dog may become recumbent, it can be difficult to recommend any medications or supplements across the board. It is important to treat any sources of pain such as injuries or arthritis. CROC does not prescribe medications, but we can help evaluate your pet’s current pain management plan and give you the information you need to discuss it with your regular veterinarian. Supporting arthritic joints with a quality supplement like Dasuquin Advanced with MSM can be helpful for many patients. Since recumbent patients are battling muscle atrophy, a supplement for muscle growth and maintenance like Myos Canine Muscle Formula may be recommended.
CROC strongly discourages the use of marijuana products for canine patients. While emerging research shows some promise for marijuana products in veterinary medicine there is much more to be done and recumbent patients are already weak and have diminished coordination, making them poor candidates for this treatment.
Cannabis products marketed for pets are not currently regulated in California and multiple incidents of harmful, even life threatening, ingredients in these products have been reported.
As another alternative, Veterinary Medical Acupuncture is a clinically proven option for both pain relief and neurological stimulation that can be pursued here at CROC.
Quality of Life
We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for recumbent dogs. Especially if their paralysis becomes more advanced or they lose control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. At any time during your pet’s journey, we completely understand and support humane euthanasia as an option.
When deciding “when it’s time”, it’s always best to go weeks or even months too early than a day too late.
Make sure to be realistic with your resources, your time and energy, and frequently check in with yourself. Are you still enjoying your dog’s company? Are they happy and still enjoying their favorite activities? At any point, are you building resentment for the amount of work your dog now requires? It is important to note that for any end of life evaluation, the fact that an animal continues to eat is NOT a significant enough reason to delay euthanasia if other aspects of their life are filled with suffering. If you would like more information about how to properly evaluate Quality of Life for you and your pet, please feel free to reach out to us for assistance or read our article discussing Quality of Life in more depth at https://www.caninerehaboc.com/post/quality-of-life.
Overall, caring for the Recumbent Dog is a tall order. There's a lot to consider when deciding how to move forward, but having realistic expectations for yourself and your dog can help make the situation a bit easier to manage. The CROC team is here to support you and offer advice at any time during your pet's journey but it's also a good idea to find support with your regular veterinarian and anyone else in your household.