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The tips & recommendations within this article may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian and/or schedule a Fitness Consultation with the Physical Rehabilitation Specialists here at Canine Rehabilitation of Orange County to discuss what is right for your dog. Check out our other Canine Sports Medicine articles! It doesn't matter if your dog just dabbles in dock diving on the weekends or if they are a full-time TSA Officer. Dogs live to please us, sometimes to their own detriment, so it's up to us humans to keep them safe and physically sound. We're digging into injuries commonly experienced by Canine Athletes in hopes that they can be avoided or identified so your dog can continue to perform and thrive in their work. Cranial Cruciate Ligament Rupture Often compared to the human Anterior Cruciate Ligament (ACL), rupture of the Cranial Cruciate Ligament (CCL) is the most common injury in pet and sporting dogs. While dogs do not have an ACL, the CCL is also a stabilizing ligament between the femur and tibia. In young dogs, rupture typically occurs with fast & forceful movements but in older dogs, rupture occurs over time with chronic wearing away & fraying of the ligament. Cranial Cruciate Ligament (CCL) rupture is the most common injury in both pet & sporting dogs. Careful conditioning helps reduce, but not eliminate, the risk of injury by keeping the muscles, tendons, & ligaments flexible, supple, & balanced. Cross Training to avoid injury involves slow, controlled exercises & a focus on enhancing stabilizing structures like the Patellar Tendon. Check out our Cranial Cruciate Ligament (CCL) article to learn more about this condition, how to minimize risk, and treatment options. Iliopsoas Injury The Iliopsoas (pronounced ill-ee-oh-soh-az) is a grouping of muscles in the groin that flexes and rotates the dog’s hip in addition to stabilizing the lower spine. It is comprised of two separate muscles; the Iliacus and Psoas major which originate in different spots on the spine and pelvis but fuse into a common tendon on the femur. Highly active or sporting dogs are frequently affected by this type of injury since the activities they participate in are high intensity like jumping, sprinting, or rough play. Injury to this muscle group usually happens when it is overstretched during activity & if left untreated can become a chronic source of lameness & pain. There are some conditions that can make your dog more likely to experience an Iliopsoas injury like Hip Dysplasia, Intervertebral Disc Disease, or Cranial Cruciate Ligament Rupture but a dog’s overall fitness level & lack of preparation for high intensity activity can also be primary causes. Thermotherapy, massage, & stretching are particularly effective to reduce risk of this injury. Check out our Iliopsoas Injury article to learn more about this condition, how to minimize risk, and treatment options. Repetitive Motion Injury The dog equivalent to human Tennis Elbow or Swimmers’ Shoulder, the repetitive movements, even low-impact ones, gradually wear down & inflame the soft tissues & joints. This condition is common in Search & Rescue dogs but can occur in any working or competing canine. Even dogs at home that pace along the backyard fence are at risk! This type of injury is preventable & the likelihood of occurrence can be reduced by taking breaks, cross training, training for good ergonomics, & practicing “opposite” movements. Soft Tissue Shoulder Injury The most common shoulder injuries in working dogs are Medial Shoulder Instability & Biceps Tendinopathy. Both can occur as Repetitive Motion Injuries. Medial Shoulder Instability This injury is the result of the degeneration or breakdown of stabilizing structures within the shoulder. This injury is chronic & progressive in nature; as the shoulder joint becomes increasingly unstable, arthritis will develop and luxation (dislocation) of the shoulder joint can occur. Mild shoulder lameness is usually the first sign, followed by pain on extension of the shoulder joint. MSI is common in water sports, like swimming & dock diving, as well as frequent jumping down or even poor landings in fly sports. Biceps Tendinopathy Biceps Tendinopathy involves the Biceps brachii muscle, which is responsible for extending & stabilizing the shoulder, as well as flexing the elbow. When the tendon that attaches the biceps brachii muscle tears or becomes strained, dogs become lame, painful, & have reduced range of motion in the shoulder. Strains or low grade tears require significant amounts of rest since this is an exceptionally slow healing & frequently recurring injury. Severe tears/ruptures require surgery & sadly, retirement from most sporting activities. A good warm up routine, cross training, & regular breaks can help prevent these injuries. No-pull harnesses are also known to exacerbate shoulder injury because of where they apply pressure to the shoulder, thus their use should be avoided. Check out our Gear & Resources page for examples of harnesses we like. Carpal Strain High impact and repetitive activities create weakness and excess laxity of the carpus (your dog’s wrist). It happens most often with jumping down activities like jumping out of vehicles or off of furniture, but it can also happen when a dog pushes off a surface with too much force or with frequent ball play. The force of falling and the impact on the ground are initially absorbed by your dog’s front legs with the biggest impact on the carpus. Flyball athletes often experience this injury just from the force of slamming into the ball box at the end of the course. This is a cumulative injury, adding up over time, and permanent damage can result. Compensation for carpal pain & referred pain are common, as is osteoarthritis formation. Regularly practicing balance work and using cross-training to strengthen the ligaments and tendons of the forepaw may help reduce injury to the carpus. In situations where jumping down is not strictly necessary, such as when a ramp or stairs can be used, it’s best to utilize those tools to minimize impact forces whenever possible. If your Canine Athlete must jump down from things, do what you can to make the landing surface “impact friendly”. Metacarpophalangeal-Interphalangeal Joint Disease The CROC Team refers to this as “Polar Bear Paw” because bony changes within the carpus, metacarpals, and phalanges cause the front paws to resemble that of a polar bear. This is a repetitive motion injury often associated with frequent games of fetch, acrobatic movements with hard landings on the front paws, & dogs that live exclusively on hard surfaces like tile & concrete. Most of the cases we see are dogs that repetitively run along a fence or property line. Their intense speed followed by abrupt, sideways stopping results in chronic abuse to the tiny joints within the paw, causing osteoarthritis formation and thickening of those joints. These permanent changes often cause pain, reduced range of motion and loss of flexibility within the paw and toes. To prevent this injury, try to prevent repetitive, high impact activities & focus on building strength in the forearms & paws to support the joint. This might mean mixing in other games besides fetch or in the case of fence running, training to modify your dog’s behavior. Adding softer surfaces with better traction can also be helpful. For example, you can add grass outside and rugs or yoga mats inside. Dental Injuries Canine Athletes can experience premature wear, chips, fractures, & even lose teeth. Frisbee dogs often experience chips & fractures when catching hard frisbees. In such an intense and fast-paced sport, Canine Athletes are often so focused on making the jump and catching the frisbee, that no attention is given as to how that frisbee is caught. Even in minor cases of damage to the enamel, that still opens up the tooth to more significant dental disease. Dogs performing bite work, like Police K9's, often fracture or lose teeth during their work. We’ve all heard of Police K9's getting titanium implants and seeing those impressive silver chompers! Fractured teeth are extremely painful and invite infection to quickly take hold. They often cannot be salvaged, thus requiring extraction. Having a healthy tooth knocked out of their mouth is exactly as painful as you’d imagine. Tennis Ball Mouth Tennis balls are known to be extremely abrasive, wearing through enamel & down into the pulp of the tooth. As the tooth is worn away, it can be extremely sensitive and painful to eat, drink, or even pant. Tennis balls are so abrasive, that many veterinarians can look at a dog’s mouth and extrapolate that the patient is a “ball dog” from the pattern of wear on the teeth. Regardless of your Canine Athlete’s profession, make sure to have their teeth examined by a Veterinarian on a regular basis & use softer, less abrasive balls, frisbees, & other toys whenever possible. Generally speaking, if you cannot make a dent in it with your thumb nail, that object is a risk for chips and fractures. In addition, the Veterinary Oral Health Council is a great resource for safe and effective dental care. Cuts, Abrasions, & Avulsions Canine Athletes are often so focused on their work that they are completely unaware of these small injuries until all the excitement dies down. Proprioceptive exercises can help with some of these, but more than anything, your attention to the environment and your dog’s body will make the biggest difference in your dog’s safety. Torn toenails can happen to any dog but can be avoided by ensuring your dog’s nails are kept at an appropriate length and are free of any cracks or flaking. Pay attention to the surfaces that your dog will be performing on. Some dogs can be prone to paw pad avulsion (tears of the paw pad) just from too much intense exercise on concrete and we are all very aware of the painful burns dogs can experience just walking on asphalt. If your dog is too weak, tired, or spatially unaware to properly lift their paws over obstacles, they are likely to incur abrasions on the top of their paws. If your Canine Athlete is expected to perform on sharp, abrasive, or particularly hot/cold surfaces, they may benefit from booties to protect their paws. Most injuries of this type are not severe and can benefit from rest and standard wound care. For deep cuts or serious abrasions that keep bleeding after rest and compression, a vet visit is likely necessary for suturing or bandaging. Improper bandaging technique can result in permanent damage to or even complete loss of the limb. It sounds extreme, but it is sadly a very common occurrence and is a devastating result of good intentions. You should never attempt to bandage your dog’s legs or paws without veterinary medical supervision. When to Call the Professionals Even with all the training and conditioning in the world, accidents still happen. Sometimes rest and stopping all activities for several days is all it takes to recover. However, depending on the severity of the injury, your dog may need medical attention. Some injuries & conditions require prompt veterinary care to avoid long term pain or loss of mobility, so it's always best to have your Canine Athlete examined sooner rather than later. If there are clicking sounds, swelling, instability, limping, or pain, it’s important to speak to your Veterinarian right away. After speaking with your Veterinarian, formal Physical Rehabilitation services should be considered if: Activity is Limited Rehab can help your Canine Athlete stay conditioned while they recover by providing safe and controlled exercise. The body heals during periods of rest, so taking a break from sports is integral to recovery. The problem is that when the body stops working, its strength, flexibility, and stamina will decline. In as little as 72 hours, muscles that you've worked very hard to build can begin to atrophy, or waste away! Veterinary Physical Rehabilitation specialists have the medical knowledge to safely exercise your dog and help them heal better and faster than they would have without therapy. Once your dog is recovered enough to return to work, if their physical conditioning has not been maintained, they will have to slowly ease back into their work or risk re-injury. If their physical fitness has been safely maintained during their recovery period, they will be able to return to work sooner & be less likely to suffer a subsequent injury. Limb Use is Reduced Limping means pain! If there is lameness, limping, or changes in your dog’s gait or stance, your dog is in pain! Dogs will deliberately try to minimize use of a painful limb, so don’t ignore this crucial signal. In addition, when a dog minimizes use of one limb, that means they are transferring the load to the other 3 legs. At this point, the entire body becomes imbalanced and failure to resolve this imbalance promptly can result in even more pain and potentially additional injury. This imbalance may initially present as tension of the neck and back muscles as the body compensates. Long term imbalance will put excess wear and tear on the healthy limbs which can accelerate Osteoarthritis or Cranial Cruciate Ligament rupture. The sooner your Athlete’s lameness is diagnosed and treated, the less strain is put on the rest of the body. Pain is Not Well Managed No one can perform well while in pain and sometimes prescription medications aren’t enough to control pain. There are many options for prescription pain relief and its not uncommon for some trial and error to be required to find the right medications for your pet. To learn more about commonly prescribed medications, side effects to watch for, our favorite supplements and how to pick quality products., visit our Pain Meds & Supplements article. Canine Rehab of OC’s Veterinary Medical Physical Rehabilitation specialists utilize therapies originating from human Physical Therapy that have been modified and clinically-proven to be effective and safe for dogs. Laser Therapy, Acupuncture, Electrostimulation, & Therapeutic Ultrasound may be helpful options. Physical Rehabilitation should only be provided by licensed and certified Veterinary Medical Physical Rehabilitation professionals, as some therapies can be dangerous if used inappropriately. Chiropractics, in particular, are not recommended for use in animals. There are no peer-reviewed studies to support the safety or efficacy of Chiropractic & we frequently treat dogs that have suffered permanent injury as a result of Chiropractic treatments. If you are not convinced that Chiropractic is harmful and wish to pursue forceful spinal manipulations, we strongly recommend meeting with a Veterinary Neurologist first to confirm that your dog does not have any spinal abnormalities that could be made worse by applying force to their spine. Radiographs (x-rays) of the spine can help rule out conditions like Spondylosis or Intervertebral Disc Disease; both conditions that would be made significantly worse and more painful with the application of Chiropractic manipulations, potentially even resulting in temporary or permanent paralysis. Mobility is Compromised If your Canine Athlete is having difficulty getting around on their own, Physical Rehabilitation will be necessary to heal faster, get stronger, & restore mobility. Treating pain is always the top priority, but medication will not strengthen the body; only exercise will do this! Pending the severity of your dog’s condition, they may need to completely cease all work/sports activities and instead focus that energy on Rehab in hopes that they can recover enough to safely return to their sport of choice. The right exercise at the right time coupled with therapies to promote healing and reduce pain, will give your Canine Athlete the best chance of recovery. Qualifications to Look For When looking for Rehab services for your athlete, look for providers with any of the following certifications: Certified Canine Rehabilitation Practitioner (CCRP) Certified Canine Rehabilitation Therapist (CCRT) Certified Companion Animal Rehabilitation Therapist (CCAT) Certified Canine Rehabilitation Veterinary Technician (CCRVT) Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Looking For More? Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us! We love getting involved in the dog community and helping as many families as possible. This article is Part 3 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 2: Cross-Training Part 4: Nutrition for the Canine Athlete Part 5: Bad Dogs, Bad Medicine (Effects of Behavior on Quality of Care)

Degenerative Myelopathy is a debilitating neurological disease that causes progressive paralysis in dogs due to degeneration of the spinal cord, a process similar to the human affliction, Lou Gehrig’s Disease. This disease frequently leads to euthanasia, or eventually death, and there is no cure. However, there are things you can do to maintain your dog’s Quality of Life for as long as possible. We're very lucky to spend so much one-on-one time with our DM patients that we develop very close bonds with them. Apache, pictured here, was a much loved and very missed DM patient. Diagnosing Degenerative Myelopathy The diagnosis of Degenerative Myelopathy can be a shock to pet parents as dogs generally don’t show any signs of being at risk for the disease until symptoms appear around 8 to 14 years of age. The first symptom is usually scuffing of the hind paws or loss of coordination in the hind limbs However, this can be a sign of several other disease processes like Intervertebral Disc Disease, Geriatric Onset Laryngeal Paralysis & Polyneuropathy, Spinal Tumors, and even Osteoarthritis, among many others, so it’s important to investigate all possibilities early on. DM is usually a diagnosis of exclusion, meaning that all other potential causes have been ruled out, leaving DM as the most likely cause. To do this, a thorough Neurological exam is to be performed as well as Radiographs and Bloodwork to get the most obvious answers out of the way. Further diagnostics may include MRI, CT scan, or spinal fluid analysis. There is a genetic test available for pet owners to purchase online through the Orthopedic Foundation for Animals at https://ofa.org/degenerative-myelopathy/. This test is not used for diagnosis, but it can provide insight as to your dog’s genetic risk for DM. Dogs that have one copy of the gene are classified as Carriers and while it is still possible for a Carrier Dog to develop DM, they are significantly less likely to do so. Dogs with two copies of the gene are classified as At-Risk. They can only be interpreted as At-Risk as not all At-Risk dogs go on to develop DM. However, a dog showing signs that then tests as At-Risk can then be more easily diagnosed with DM and therefore given appropriate treatment. Once purchased, the OFA Genetic Test is shipped to your home where you will then use the included Foam-Tipped Applicator Card to collect a DNA sample from your dog. You can do this yourself at home, no vet visit required. Once collected, samples make their way to the University of Missouri College of Veterinary Medicine where they are processed by the Small Animal Molecular Genetics Lab. When results are available, the OFA will report to you. As of May 2025, the cost for this test is $65.00. While any breed or mixture of breeds can be affected, these breeds were proven to have genetic predisposition for Degenerative Myelopathy: American Eskimo Dogs Bernese Mountain Dogs Borzoi Boxers Cardigan Welsh Corgi Pembroke Welsh Corgi Chesapeake Bay Retrievers German Shepherd Dogs Golden Retrievers Great Pyreness Kerry Blue Terriers Poodles Pugs Rhodesian Ridgebacks Shetland Sheepdogs Soft Coated Wheaten Terriers Wire Fox Terriers What to Expect Patients in the earlier stages of DM will still be able to walk, albeit with progressively less coordination. They frequently struggle to rise on their own and will begin losing muscle mass in their hind limbs. Loss of strength and coordination in their hind limbs almost always leads to knuckling or dragging their paws, leading to abrasion wounds and worn down toenails. As the disease continues to take hold, DM dogs eventually lose all voluntary movement of their hind limbs. They will also lose control of their bladder and bowels. They will no longer be able to walk but some will try to drag themselves around, which comes with its own set of problems. Paralysis continues to ascend up the body, eventually affected the front legs and diaphragm. When Degenerative Myelopathy reaches the point where it affects the diaphragm, & therefore the pet’s breathing, there are no further options to maintain Quality of Life & euthanasia is strongly recommended. Dogs left to experience the final stages of the disease will experience great suffering and a slow, stressful death because they will struggle to breathe right up until the moment that they just can’t anymore. Ideally, a DM patient would have a kind & humane goodbye before their breathing is affected. Fortunately, there are a lot of options and tools available to you to maintain good Quality of Life for your pet for as long as possible. Life expectancy from time of diagnosis ranges from 6 months to 2 years. What Can We Do About It? Caring for the Degenerative Myelopathy patient will change as their symptoms progress, but there are things you can do! The good news with DM is that if your pet is otherwise well managed, it is a painless disease up until it affects breathing. We have even seen dogs with a history of chronic pain no longer feel that pain as DM moves up the body. More Good News! – You’re in the right place! With the help of Rehab at CROC, London's symptoms slowed down enough to buy an extra 2 years with her family. Physical Rehabilitation has been proven to be the most effective treatment to slow DM's progression. Underwater Treadmill Hydrotherapy (not swimming) has specifically been shown to maintain their strength, stamina, and coordination for as long as possible and slow the progression of the paralysis. Other Rehab Treatments such as Laser Therapy help relieve pain, like muscles in the front of the body becoming sore from overcompensating for the weaker back legs. For Physical Rehabilitation to have the most beneficial effect on your dog, they will need consistent & frequent therapy. We have seen DM patients lose significant ground with even a short vacation (1 week!) from rehab. Rehab cannot completely stop the progression of DM, but it can greatly increase the quality time you get with your pet. Tools To Make Your Life Easier Typical nail wear & abrasions from scuffing/knuckling. These can become quite painful & even get infected! We've gathered links and examples of these items on our Gear & Resources page! We also recommend checking out our article Recumbent/Non-Ambulatory Care for more detailed information. While your pet is still fully ambulatory on their own, it is important to protect their paws from scuffing & abrasions. Plenty 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! Adding rugs and ramps is a quick & easy way to help your dog get around the house more easily. Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling. 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, although care should still be taken to monitor your pet while using these. There will come a time where these obstacles are no longer safe for your dog to work around or over and should instead be avoided. A good harness is a must! Our favorite harness for DM dogs is called the Help ‘Em Up Harness. Your dog will continue to depend on you for assistance more and more as DM progresses, so your choice of harness makes all the difference in comfort for both you and your dog. The Help 'Em Up Harness was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet may not need the back half, but as their coordination and strength wanes, the back half of the harness will become your best friend. 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. 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. As your dog loses the ability to control their bladder & bowels, diapers & belly bands become good options to help keep your dog & your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a proper diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their Quality of Life. Disposable and washable options are readily available for purchase online or at major pet stores. Dogs left in dirty diapers for too long are at risk for skin & urinary tract infections. Always change soiled diapers promptly. Pro Tip! If your pet's diaper keeps falling down (especially common with short tailed dogs) try Baby Pacifier Clips! Anchor the clips to the top of your pet's harness, then run the straps under the rest of the harness to clip them to the top of the diaper. We find that metal clips work best! Some owners will pursue Rear Wheel Carts (sometimes referred to as a wheelchair) for their DM dog. Not all dogs are good candidates for this & it’s quite the investment so it’s important for pet parents to approach this with realistic expectations. DM dogs that are good candidates should be fitted for a custom-built cart while they can still use their back legs. When their cart arrives, they can get used to the cart by using it as support for their back legs, still moving their back legs and propelling themselves forward. As back leg function lessens, their hind limbs can be propped safely up and off the ground using either the padded bar or padded loops included in the construction of the cart. For more information, be sure to read our article The Wheel Deal: Let's Talk About Carts and The Wheel Deal Part 2: You Got the Cart; Now What? Is There Anything Else? One of the best things you can do for your DM dog is keep them lean! We generally recommend a Body Condition Score of about 4 out of 9. Many DM 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, visit our article Body Condition Score and Canine Weight Management. The less weight there is for them to haul around, the less strain is imposed on their already weakened body. While there are no medications to directly treat DM, your pet may likely benefit from treating any other sources of pain and inflammation like arthritis. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load. There are no clinically proven medications or supplements to treat Degenerative Myelopathy. For more information on pain medication and supplements, including how to choose quality products and minimize risk of side effects, check out our article, Pain Meds & Supplements. CROC strongly discourages the use of marijuana products for DM patients. While emerging research shows some promise for marijuana products in veterinary medicine there is much more to be done and DM patients are already weak and have poor coordination, making them poor candidates for this treatment. 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 DM dogs. As your dog’s DM progresses, the amount of effort you will need to put into their care will drastically increase. Especially when 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 DM journey, we completely understand and support humane euthanasia as an option. When deciding “when it’s time”, it’s always best to go even weeks 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 significant enough 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 and what to do next, check out our Quality of Life article. You are also welcome to reach out to us for assistance. We're Here For You Overall, Degenerative Myelopathy is an awful disease to contend with, though there are certainly worse. There's a lot to consider when deciding how to move forward once your dog has been diagnosed, but having realistic expectations for yourself and your dog can help make the process a bit easier to manage. The CROC team is here to support you and offer advice at any time during your pet's DM journey but it's also a good idea to find support with your regular veterinarian and anyone else in your household.

CROC commonly treats IVDD patients in an attempt to restore as much normal bodily function as possible. Patients can present at a variety of stages in their disease progression, from experiencing slight back pain to complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so. We’ll go over IVDD in depth so that you know exactly what to expect with your dog’s rehab journey from here on out. What is Intervertebral Disc Disease? While the spinal cord is mostly encased within the vertebrae, it is exposed in the Intervertebral Spaces and sits just above the Intervertebral Discs. This is why the spine is so flexible in so many different directions. Between each vertebra of the spinal column, there is a disc of semi-squishy material that helps absorb the impact of an animal’s daily life. The Intervertebral Disc is composed of a jelly-like inner material with a more rigid outer layer. With IVDD, this rigid outer layer of the disc starts to weaken and break down prematurely. Eventually, the outer layer breaks down enough that the disc ruptures and the jelly-like material herniates outside the rigid outer layer up, towards the Spinal Cord. This herniated material puts pressure on the spinal cord, restricting blood flow & damaging nerves. When the spinal cord is damaged, it can't transmit signals between the brain and body. In the best-case scenario, this results in mild to moderate neck or back pain and the dog can heal with strict cage rest and pain medications. In the worst-case scenario, this pressure causes pain AND blocks neurological signals traveling back and forth between the brain and the lower body, often causing partial or complete paralysis of the hind legs. Complete or partial loss of bladder and bowel control usually comes along with the paralysis/paraparesis. For the remainder of this article, we’ll be addressing the worst-case scenario since most of it still applies to best-care scenario as well. We describe the spinal cord as an unforgiving tissue, meaning that it does not tolerate or bounce back from injury very well and frequently requires quick (often expensive) diagnostics, treatments, or surgeries to have any chance of recovery. Failure to relieve significant pressure from the spinal cord in a timely manner will almost always result in permanent paralysis or paresis. Some patients with less severe disc herniation can recover to some degree without surgery, but there is no way to predict if your dog will recover without surgery. We do know that surgery increases chances that your dog will recover, but there are no guarantees there either. Who is at Risk for IVDD? Chondrodystrophic breeds (dogs with long bodies and short legs) like Dachshunds, Corgis, Shih Tzu, Basset Hounds, Cocker Spaniels, Pekingese, and mixtures of those breeds are at highest risk for developing IVDD. Anecdotally, CROC sees a significantly higher number of Dachshunds and French Bulldogs presenting with IVDD than any other breeds. Breed predisposition combined with body condition and lifestyle will determine risk factor for an individual dog. Diagnosing Intervertebral Disc Disease Many dog owners are not aware of IVDD until their dog suddenly can’t move their back legs. It is a common misconception that the paralysis is from an acute injury like a fall, rough play, or jumping down from furniture. In reality, the Intervertebral Disc had been degenerating for some time and then finally ruptured due to the extra stress on the disc from whatever activity the dog was engaged in. For the best chance at recovery, your dog should be seen by a Board-Certified Veterinary Neurologist as soon as possible. While radiographs (X-Rays) are helpful to rule out any fractures, identify narrowing disc spaces, and sometimes detect calcifications of the discs, these things frequently fail to correlate with the true location of the herniated disc. Therefore, radiographs are not sufficient to diagnose IVDD or Disc Herniation and Spinal Cord Impingement. Myelography, injecting a contrast agent and then performing radiographs, can provide more information but comes with significant risks that often outweigh the reward. Myelography and Computed Tomography (CT) have historically been used together to diagnose IVDD but have fallen by the wayside since they are not as effective as MRI. Magnetic Resonance Imaging (MRI) is the Gold Standard for diagnosing IVDD as it allows for detailed imaging of all soft tissue structures. While IVDD can go undetected with Myelography or CT, MRI has a diagnostic accuracy of 98-100%. Treating IVDD IVDD is staged according to its severity and while the earlier stages can recover without surgery, later stages have much lower rates of success. Prompt surgical correction by a Board-Certified Veterinary Neurologist is considered Gold Standard treatment for IVDD. The goal of surgery is to relieve the pressure from the spinal cord as quickly as possible. There are several surgical options from which to choose from, but your Veterinary Neurologist should advise you as to the best option for your dog. This can be where things get challenging for pet parents. At this point, you’ve gone through the stress and expense of rushing your suddenly paralyzed pet to a specialist for an expensive MRI, but you’re not done yet. Unfortunately, surgery can’t be postponed. The sooner your dog gets surgery to relieve pressure off their spinal cord, the better their chances of being able to walk again. Yet another aspect that can be difficult to swallow – even with timely surgery, there is no way to guarantee that your pet will regain the ability to walk or how long it will take. After surgery, your pet will likely need to be under strict cage rest for the first part of recovery and may be on multiple pain medications. Many IVDD patients are urine and fecal incontinent, meaning they will need to wear diapers to control the resultant mess. Some patients need to have their bladder manually expressed as they no longer have the ability to empty it themselves and it will continue to fill. If that’s the case with your pet, your Veterinary Neurology team should teach you how to safely do this at home. A regular schedule for bladder expressions is important to avoid infections or damage to the kidneys. Check out our articles regarding Recumbent Care for tips & tricks to help you support your pet's recovery. How to Set Up a Recovery Pen Recumbent/Non-Ambulatory Care As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of walking. It’s important to note that your dog’s recovery will require a significant commitment of your time and energy. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Recovery from paralysis & spinal surgery requires patience & consistent participation for at least 6 months minimum. What Does Rehab for IVDD Look Like? The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from surgery to Rehab your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pet’s that don’t have any movement or feeling in their back legs will be at a greater disadvantage than those that are just weak and uncoordinated. IVDD patients begin their Rehab journey with Target Exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the hind legs, we’ll step up our exercises to get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for IVDD patients are focused on improving proprioception or knowing where their body is in space. Because of the damage to the spinal cord, IVDD patients often can’t feel their environment and have no sensations to tell them where their legs and feet are. This is important because if we can get your dog to the point of consciously controlled leg movement, they have to know where to move their legs in order to stand and eventually walk. The initial stages of rehab are frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there! Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the underwater treadmill before we see it on land. The underwater treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements. Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser Therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. To learn more, visit our Rehabbing Recumbency article What about Acute Non-Compressive Nucleus Pulposus Extrusion (ANNPE)? ANNPE is a form of IVDD that occurs as a result of excessive force or trauma such as intense exercise or a significant fall. That trauma tears the outer layer of the intervertebral disc, causing the inner gel-like substance to shoot out at high velocity and hit the spinal cord, essentially bruising the spinal cord. This is very painful! ANNPE typically occurs in young to middle-aged dogs and can happen with any breed. MRI is necessary to confirm ANNPE but it can be treated based on suspicion formed from medical history and exam findings. When presenting to your veterinarian, it is common for NSAIDs to be prescribed and ice packs should be applied to your pet's back right away. Activity at home should be restricted for 4-6 weeks, but Physical Rehabilitation with prescribed exercises should begin promptly, about 2 weeks after the incident. The sooner Rehab is started, the better chance your dog has at maximum recovery because like all IVDD cases, there is a 6 month window during which the greatest healing occurs. Between 6 and 12 months post-incident, some recovery can be possible, but minimal in comparison to the first 6 months. The mildest cases of ANNPE can sometimes recover after just 2 weeks of exercise restriction. The Rehab Treatment Plan for ANNPE is nearly identical to other IVDD cases. Safety for IVDD Patients Changing Habits While your dog may have had surgical correction, that doesn’t mean that they won’t rupture another disc in another part of their spine. At home, some simple changes can make all the difference to protect your dog’s spine. Remember that IVDD is a chronic disease; it never goes away. Many IVDD dogs regularly sprint across their home, launching themselves on & off furniture with delight. Unfortunately, that’s also one of the number one ways they herniate a disc! Jumping on and off furniture or running down the stairs, even jumping out of the car is extremely risky for IVDD patients, so we strongly encourage you to stop your pup from engaging in those activities. Rough play with housemates or any sort of acrobatic activities puts them in great danger, so great care must be taken in multi-pet households. Swimming Sadly, swimming is NEVER appropriate for IVDD patients. There is a video viewable in our article, The Deep Dive into Swimming, that provides a visual for this, but we’ll briefly explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their already strained front legs and barely working the back legs that actually need the exercise. Swimming also puts immense strain & twisting movements on the spine which is one of the worst things for a patient that just had a spinal injury/surgery. Regarding Chiropractic We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for IVDD patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their spinal patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body, which is also one of the worst things for a patient that has spinal instability or just had spinal surgery. Your dog’s spine is particularly fragile & the force of Chiropractic can push your dog even closer to rupturing another disc. This is the normal healthy spine of a young dog. Notice that the vertebrae & the spaces between them are very well defined. ----------------- This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally & osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, the spine is poorly cushioned by degraded intervertebral disks & surrounded by extra bone. Bone rubbing on bone & nerve impingement become chronic sources of pain & stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring & intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available. The End Goal Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and regain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their back legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis & a goofy looking walk, we’ll take goofy any day of the week. What If They Still Can’t Walk? At CROC, we always want to give IVDD patients the full 6 months of treatment before throwing in the towel. If we've reached the 6 month mark & still haven't seen a significant improvement, that's when we start looking at a Rear-Wheeled Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to start using a cart too soon! Once a dog starts getting around without using their back legs, they often lose motivation to try, pretty much sealing the deal that they will never regain independent mobility. For more information regarding Rear Wheel Carts & what the process for getting one looks like, be sure to check out our in-depth articles, The Wheel Deal: Let's Talk About Carts & The Wheel Deal Part 2: You Got the Cart; Now What? Tools To Make Your Lives Easier We'll go over some basics for Recumbent Care here, but for a more detailed break down, visit our article Caring for the Recumbent Dog. We've also collected links and examples of the following tools on our Gear & Resources page. Protect Paws While your pet is re-learning to walk, they will frequently drag their hind legs, so it is key to protect their paws from the scuffing and abrasions that will happen. Plenty 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! Improve Traction Rugs and yoga mats make it easier for your dog to grip the floor, reducing their risk of falling. 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, although care should still be taken to monitor your pet while using these. Home modifications like adding rugs & ramps are quick & easy ways to help your dog get around the house more easily. Use a Harness A good harness is a must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for IVDD dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet will need the back half, but as their coordination and strength improves, the back half of the harness will become less necessary. 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. 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. Use Excellent Hygiene Practices If your dog doesn’t have complete control of their bladder & bowels, diapers & belly bands become good options to help keep your dog & your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections & skin infections. It’s also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores. Pro Tip! If your pet's diaper keeps falling down (especially common with short tailed dogs) try Baby Pacifier Clips! Anchor the clips to the top of your pet's harness, then run the straps under the rest of the harness to clip them to the top of the diaper. We find that metal clips work best! Provide Extra Plush Bedding Just like us, dogs certainly benefit from a quality bed. Orthopedic Memory Foam beds are ideal. 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 40 pounds of body weight. Encourage your dog to change position regularly, such as switching which side of their body they lay on. Laying in one position for extended periods of time can lead to significant stiffness and possibly pain once they go to get up. Is There Anything Else? One of the best things you can do for your IVDD 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 easier it will be to start lifting & moving their own body. Many IVDD 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 Body Condition Score & Canine Weight Loss. Some dogs will need medication to control their pain. CROC works closely with you to make sure your dog is on the right pain control regimen. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load, compensating for the weaker back end. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the IVDD dog and is available online. To learn more, visit our Pain Meds & Supplements article. We cover commonly prescribed medications, side effects to watch for, and how to pick quality supplements. CROC strongly discourages the use of marijuana products for IVDD patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and IVDD patients are already weak and have limited coordination, making them poor candidates for this treatment. 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 IVDD dogs. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have 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. If you are trying to decide whether or not to proceed with euthanasia, we suggest reading our Quality of Life article. We're Here For You The impact of IVDD on the lives of pets and their families can't be overstated. With so many variables, big decisions, and modifications to lifestyle and home environment, it's easy to get overwhelmed. We're dedicated to supporting the best possible recovery for our patients and with more than 10 years rehabbing IVDD patients, we've found the safest and most effective approach to their treatment. Owners of CROC patients are encouraged to reach out to us with any questions regarding their pet's care so that we can work together to optimize results.

The tips & recommendations within this article are made for dogs that are free from any health concerns & may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian or schedule a Fitness Consultation with the Physical Rehabilitation Specialists at Canine Rehabilitation of Orange County to discuss what is right for your dog. What does weight lifting have to do with playing tennis? Human athletes cross-train to ensure they are in peak physical condition and ready to perform at their best. They know that weight training and targeted exercises translate to bigger wins and reduced chances of injury. That’s why olympic swimmers can be found cycling and basketball players will practice pilates. Using low-impact, targeted exercises, cross-training will improve your Canine Athlete’s balance, endurance, flexibility, and strength in the same way as their human counterparts. Balance Balance is the ability to maintain uprightness and avoid falling, so we begin our work here before moving our focus to coordination and strength. You can’t focus on getting stronger if you keep falling over! Balance work also increases core strength; a weak core can cause hyper-mobility of the spine and predispose your dog to significant back injuries and chronic pain. Poor core strength puts excess force onto the limbs, increasing risk of compensatory injury. The goal with balance work is to gradually increase the challenge of each movement. If your dog is unsteady at a certain level and cannot hold a balance pose for extended periods of time, continue to train and repeat the exercise until it is no longer difficult for at least 5 sets of 15 seconds. Proprioception The foundation of good agility, proprioception is the brain’s awareness of the body’s position in space. Improving proprioception enhances your dog’s speed & precision of limb movement. Poor proprioception can mean the difference between 1st and 2nd place, but it might also be the variable saving your dog from serious injury. One paw in the wrong spot could lead to a nasty fall off an obstacle & potentially months to recover before they can resume their favorite activity. Strength In order to gain strength, exercises must be challenging enough to require cellular adaptation but not so difficult that the body has to modify or compensate in a counterproductive way. It takes an average of 8-12 weeks of strength training to achieve measurable outcomes. Remember that rest & recovery is vital as strength training too frequently can result in overly fatigued muscles, followed by catabolizing (breaking down) of the muscle tissue. At least 48 hours between strength training sessions is necessary for recovery, with the average Canine Athlete strength training just 1-2 times weekly. It’s also important to keep in mind that fast movements do not enhance muscle mass but slow, controlled movements do! A Quick Word on Overtraining The buildup of lactic acid is proof of muscle strengthening occurring but it can also result in Delayed Onset Muscle Soreness (DOMS). Sore and tight muscles can delay performance reaction times, so cross-training should be avoided in the two days prior to a competition or performance. Varied training will help decrease the risk of exhaustion and soreness, but it’s important not to overtrain your Canine Athlete. An example workout week might look like 1-2 days of cardio, 1-2 days of strength training, & 3 days of target training for the sport or job your dog participates in. If you note that your Canine Athlete stretches a lot the day after a workout or event, they are likely experiencing DOMS and would benefit from a good massage and stretching session. The application of Cryotherapy can help reduce inflammation and swelling in acute phases of tissue trauma (occurring immediately after an activity/injury) by reducing blood flow to the area, therefore reducing pain. Cold packs can be made at home using a sealable bag with three parts water to one part running alcohol. Wrap the cold pack in a thin towel and apply to your dog for 15 minutes, but no longer than 20 minutes. Target Exercises for the Canine Athlete The following target exercises can be helpful for working and sporting dogs, but please use your best judgement before attempting them with your Canine Athlete as these exercises may not be right for them. For a comprehensive & customized Fitness Plan that maximizes your athlete's safety & performance, schedule a Fitness Consultation with our Veterinary Physical Rehabilitation team. We always recommend checking with your Rehab Team or Primary Veterinarian before beginning any new exercise regimen with your dog. We strongly recommend using a harness during exercise so you have better control of your dog and can catch them more easily if they stumble. If your dog has not been properly warmed up for exercise, check out Part ONE of our Canine Sports Medicine series first! Step Up & Step Down Your dog will be standing still for this exercise. Have your dog step up a single stair, curb, or other raised surface & leave their back legs on the lower surface. While in this position, gently push one area of the body & then another. Vary the speed & direction of each push. Push enough to challenge your dog’s balance but not enough to make them take a step or fall. For a Step Down, have your dog stand with their back legs on the higher surface & their front legs on the lower surface, then repeat gentle pushing to challenge balance. For increased challenge, add a three legged stand or an unstable surface like a fitbone, or wobble board. Three Legged Stand Your dog will be standing still for this exercise. Lift one of their legs off the ground. When holding a front leg, bring the leg forward, holding the underside of the paw above the big pad. When holding a back leg, bring the leg backward by holding it at the ankle & pulling up & back so that the paw pads face up. Support the paw lightly so that your dog cannot use your hand to support their weight. For increased challenge, combine this exercise with a Step Up or Step Down, add an unstable surface, or for even more challenge, lift up a front leg on one side & a back leg on the other. Figure 8's Using a leash and harness, slowly walk your dog in a large, wide figure 8 pattern. It can be helpful to have objects for your dog to walk around. This exercise can be included as part of your dog's regular walks. Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Looking For More? Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us! We love getting involved in the dog community and helping as many families as possible. This article is Part 2 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 3: Common Conditions & Injuries Part 4: Nutrition for the Canine Athlete Part 5: Bad Dogs, Bad Medicine (Effects of Behavior on Quality of Care)

The tips & recommendations within this article are made for dogs that are free from any health concerns & may not be right for your dog. As all dogs are unique individuals, we recommend that you consult with your Veterinarian or schedule a Fitness Consultation with the Physical Rehabilitation Specialists at Canine Rehabilitation of Orange County to discuss what is right for your dog. Canine Athletes and Working dogs are the epitome of fitness for their species. K9 officers, service dogs, and sporting participants use their speed, precision, and exuberance to complete their physically demanding work. With years of training and financial investment poured into these dogs, it is essential to ensure that each athlete is conditioned and prepared for the tasks at hand to help them safely continue their sport or work for as long as possible. Canine Sports Medicine Human professional athletes have entire teams of medical and fitness professionals specialized in sports medicine to help them perform at their best and reduce their odds of injury; your Canine Athlete should too! Canine Sports Medicine is a branch within Veterinary Medicine that addresses the prevention, diagnosis, and treatment of injuries sustained by working and sporting canines. While risk of injury can never be completely eliminated, Canine Athletes that participate in structured and targeted work as part of their training are significantly less likely to be injured and will recover more quickly if they sustain an injury when compared to non-conditioned dogs. A Canine Sports Medicine performance plan consists of prescribed stretches, exercises, nutrition and supplements, and medications (only as needed) in order to optimize the physical potential of the Canine Athlete. Physical therapy techniques are administered to treat injuries and restore tissue loss or offset bodily imbalances to prevent injury and promote proper ergonomics. Who Needs to Be Involved in My Canine Athlete’s Performance Plan? It might sound silly, but as a finely tuned “machine”, anyone that interacts with your Canine Athlete on a regular basis should be included in their performance plan. In the household, everyone should know what the Canine Athlete can and cannot eat and when - don’t let the kids feed them then take them to run around outside immediately after. Your dog walker or pet sitter should be well aware of your Canine Athlete’s daily exercise routine in order to maintain physical conditioning, but also to ensure that your Canine Athlete is not overworked in your absence. Your groomer should know if trimming nails in a particular way interferes with your Canine Athlete’s performance or that jumping down from a tub or table should not be allowed. Your trainer and your veterinary medical team should be very well versed in your Canine Athlete’s performance plan. Deviations from the plan could mean that your dog is not adequately prepared for the work they are facing or that your veterinary medical team misses something because it is not a typical issue for a house pet. A Memo on Muscles A muscle’s job is to move joints, protect the body from harm, and to work alongside the neurological system to maintain balance and coordination. Muscles can’t push; they move joints exclusively by contracting and pulling, so muscles are attached on each side of a joint in order to pull it into various directions. When muscles contract, the muscle fibers shorten, causing the joint to flex or “close”. To extend or “open” the joint, muscles on the other side of the joint will contract. If muscles are overworked or have extensive tension due to repetitive movement, the muscle fibers will get progressively tighter, thereby reducing the joint’s range of motion (the totality of movement a joint is capable of doing). Overly tight muscles also negatively impact flexibility and the muscle’s ability to absorb stress and impact. These conditions make for the perfect opportunity to rupture the Cranial Cruciate Ligament (CCL), often compared to the human Anterior Cruciate Ligament (ACL). CCL rupture is the most common canine injury & can be devastating for the Canine Athlete. Joint disease and joint injuries almost always start out as overly abundant muscle tension. Releasing that tension will help keep the body healthy, active, flexible while reducing strain from stress forces and preventing poor ergonomics. Pre-Workout Considerations: Thermotherapy, Massage, & Stretching No professional human athlete runs onto the field without a pre-game plan because properly warmed up muscles, tendons, and ligaments will perform better, fatigue less, and be less likely to experience a strain, sprain, or rupture. Muscles will be less likely to cramp and will recover more quickly if they are heated, massaged, stretched, and lightly exercised using activities that complement the activity they are about to participate in. Thermotherapy Heat therapy reduces inflammation and pain while increasing blood flow and improving the extensibility of tendons and ligaments. When properly warmed up, these tissues are more likely to stretch rather than strain or rupture. The metabolic rate of cells within heated tissue is improved, increasing oxygenation and better cellular recovery from lactic acid build up or toxic wastes that accumulate during and after exercise. Chronic injuries heal more quickly, joints experience a greater range of motion, and flexibility is maximized. Always check that the heat pack is at a safe temperature before applying it to your dog! If you cannot comfortably hold the heat pack to your inner arm or neck, it’s too hot! Heating in Canine Sports is typically provided via microwavable heat packs applied directly to the patient. For optimal penetration into the muscles, ligaments, and tendons, apply moist heat rather than dry. Canine Athletes should be in a relaxed position and heat should be applied for about 10-15 minutes. Wrap the heat pack in a thin towel before putting it on your dog. Stretching and passive range of motion exercises should follow immediately after heating. Alternative thermotherapy modalities can include Therapeutic Ultrasound, warm water baths, and infrared heat lamps. Massage Overexertion, compensation for other issues, previous injuries, fear, and age-related muscular changes often result in muscle and soft tissue tension. When tissues are tense, blood flow is restricted, depriving the cells within those tissues of vital oxygen. Reduced oxygenation will also reduce the metabolic removal of waste products and further impair physical performance. This inevitably leads to a vicious cycle of pain, inflammation, muscle tension, followed by even more pain. Tips to Maximize the Magic of Massage Less is more! The most effective massage for muscle tension and fatigue is soothing and gentle, using slow kneading and gliding strokes similar to swedish tissue massage. This soft approach allows your dog to truly relax into the massage instead of bracing or tensing up in response. Choose a quiet, comfortable space with minimal distractions and make sure you are calm and relaxed before beginning. One hand massage is less intimidating than two hands. To avoid feelings of being grabbed, be sure to use a flat, open hand and start the massage without using your thumbs. Start light! If your dog is not used to having their body touched, start with light stroking, then work up to gliding and kneading. If they are particularly fussy and want to walk away, let them! You are asking your dog to trust and let go of their tension, so don’t make them feel trapped. Try again later with a lighter approach. The more you practice this type of touching, the easier it will become. The shoulders and neck are often the easiest areas to start with. Your dog’s muscles should not feel tight or banded in a relaxed state. If you can strum the muscle like a guitar string, there is tension and pain in that muscle. Massage both sides of your dog's body. Do your best to massage each side equally or you risk injury to the side that was not prepared for activity. Temporal Mandibular Joints This is the joint where the jaw attaches to the skull. Bite work, heavy chewing, & ball/frisbee activities increase tension of the muscles that attach the jaw to the skull. Osteoarthritis, inflammation, and pain can develop here, so it's a great place to massage. Neck & Base of the Skull This area absorbs a lot of force, especially with turning, twisting, & jumping down activities. All Canine Athletes can benefit from massage here. Shoulders & Chest The front legs are attached to this body exclusively by muscle and connective tissue between the trunk and shoulder blades. There are no boney attachments to the trunk! This allows your Canine Athlete to be fast, flexible, and agile, but it also means that the health of these tissues is absolutely vital for mobility. Dogs that do a lot of vertical leaps or swimming tend to gather excess tension & stiffness in this area. Many of these tissues connect to the cervical vertebrae, so any tension in these tissues can also translate into neck pain. Work your way from the neck down their trapezius, then move forward to the front of the chest, massaging the pectorals all the way down to the armpit area. Elbows & Upper Arm The Triceps muscles are the main antigravity muscles of the front leg & are stronger than the Biceps, though both are responsible for upper arm movement along with the brachiocephalic muscle. These muscles are prone to soreness from overuse & should receive extra attention, especially if the elbow’s range of motion is reduced. Metatarsals, Carpi, Forearms, & Front Paws Movement of front paws is facilitated by many tendons and ligaments from the elbow down to the toes. Along with the elbows, the carpi (analogous to the human wrist) experience a lot of strain over the life of an average pet dog, but Canine Athletes in particular will be testing the limits of these joints. Jumping down is the top reason for excess strain & injury to the carpal joints. For a thorough massage, feel for tight, banded tissues along the forearm and massage down the leg all the way to the toes. Make sure to massage both the top and bottom (or front and back depending on your dog's position) of the forearm. The digital flexors of the paw and carpus are located on the back side of the forearm, so soft kneading here can be very helpful to reduce tension. The metatarsals are the bones above the toes, but below the carpus. This location benefits from gentle massage at the area just above your dog's biggest paw pad. Mid-Trunk Compensation for any kind of forelimb discomfort will show up as tension from the base of the neck down the length of the longissimus dorsi and iliocostal muscles, which run down each side of the spine all the way to the pelvis. This leads to mid-back pain & limited, stiffer movements of the trunk. All Canine Athletes benefit from massage in this area. Athletes that do a lot of twisting movements (or ill pets that have been coughing) benefit from light massage along the ribs as well, working from front to back. Hips & Thighs The Quadriceps (the main muscles of the thigh) flex the hip, move the leg forward, & act as stabilizers to balance the body during side to side movement. The Sartorius muscle runs along the front of the thigh and is responsible for lifting the leg off the ground. When standing, it extends & stabilizes the stifle (knee). The Canine Athlete often experiences tension in this area. Overworking the hip flexor, hip dysplasia, or any change in gait can result in banding of the Sartorius muscle which can be very painful & may result in serious injury if not corrected. Several muscle groups are responsible for extending the legs backward to drive the body forward. As primary muscles for locomotion, all dogs benefit from regular massage in this area. Stifles (Knees) The Stifle is a hinge-type joint designed to move backward and forward. There is very little flesh to massage, but small movements along the inside and outside of the Stifle can ease tension & increase circulation. The Patella (kneecap) is held in place by the Patellar Tendon, which can become banded, swollen, or painful from overuse, potentially pulling the patella outside of its normal position. Tarsi, Metatarsal, & Rear Paws Below the Stifle, the Tarsus joint is the Canine equivalent of the human ankle, & below the Tarsus are the Metatarsals. This area is stabilized almost exclusively by tendons & is a major shock absorber during exercise & play. Just like the front legs, try to massage all the way down the leg to the toes and paw pads. Stretching & Passive Range of Motion Passive Range of Motion (PROM) exercises involve moving the joint back and forth several times within its range of available movement. This promotes blood flow to and from the joint and acts to lubricate the joint. Active dogs benefit from PROM exercises for their shoulders, elbows, carpi (wrists), hips, and stifles (knees). Stretching returns tight muscle fibers to their natural, elongated state. Tension is prevented or eased by stretching and flexibility is improved, which can then translate to an increase in your Canine Athlete’s speed, endurance, and agility. For stretching to be physiologically beneficial, start with warm, relaxed muscles & make sure stretches are performed slowly & held for a longer period of time. Ideally, your dog should go on a short walk or have several minutes of light activity before stretching as blood flow is reduced to tissues that have been inactive. It is best for your dog to be laying down but they must be relaxed and muscle groups being stretched should not be weight bearing or engaged in any sort of work. If a muscle is not relaxed when being stretched, there is a higher risk of injury to the muscle fibers or cells (pulling a muscle). Slowly moving the limbs to their maximum reach reduces risk of monosynaptic stretch response, which will tighten the muscle fibers and contract the muscles in reaction to moving the limb too quickly. All movements should be smooth and performed while stabilizing and supporting the joints. Apply gentle pressure to the muscles to manipulate your dog’s body into each stretch; NEVER pull! Each stretch should be performed 4-5 times & held for 30 seconds to the point of initial discomfort. There are different types of stretching but passive stretching, where you move your dog’s limbs for them, is the most beneficial for easing tension, increasing blood flow, and elongating the soft tissues. *** Reminder *** The stretches discussed below are only indicated for dogs that are physically sound & may not be right for your dog. Canine Rehab OC offers custom Fitness Plans by appointment. Have Your Athlete Evaluated If you are interested in a comprehensive exam, clinically-proven therapies, and prescribed exercises for your Canine Athlete, check out the New Patient section of our website to learn how to get started. Looking For More? Want to learn more about how to support your Athlete? Canine Sports Medicine events are coming to Canine Rehab OC soon and we'd love to see you there! These events include demonstrations courtesy of Dogtor Wilbur and a 30+ page Canine Sports Medicine booklet for each attendee. If you are part of a local Dog Sports group and interested in setting up an event, reach out to us! We love getting involved in the dog community and helping as many families as possible. This article is Part 1 of our 5 part Canine Sports Medicine series! Other articles include: Part 2: Cross-Training Part 3: Common Conditions & Injuries Part 4: Nutrition for the Canine Athlete Part 5: Bad Dogs, Bad Medicine (Effects of Behavior on Quality of Care)

Research and innovations in Veterinary Medicine, such as preventative care, nutrition, and new treatments for previously life-threatening conditions, has significantly increased the average lifespan of our pets. With more pets living longer, we’re also seeing a higher prevalence of age-related cognitive changes that are not caused by other medical conditions. As our four-legged friends get older, their bodies will become weaker and less able to repair itself which sadly, also includes their brain function. Sometimes referred to as “Doggie Dementia” or compared to human Alzheimer’s Disease, Cognitive Dysfunction Syndrome (CDS) can be heart-breaking to watch as it takes hold of our pets. There are some treatments for CDS that may be helpful, but it is a condition that has only more recently become a focus of research and many treatments are still in development. What happens to a dog with CDS? Neurons serve to conduct information in the brain and throughout the body. As a dog ages, these neurons begin to waste away, making the ability to learn and recall memories more difficult. CDS is typically progressive and irreversible. As the dog’s brain function continues to decline, subtle behavior changes can become extremely disruptive or even dangerous for them or their families. Common Behavior Changes The abbreviation DISHAAL can help summarize the types of behavior changes commonly observed in dogs with CDS, but it's important to note that some of these changes can also be caused or associated with other medical conditions. Disorientation Staring at walls or corners Getting trapped behind furniture that they previously navigated with ease Struggling to get around commonly used doors Getting lost in familiar surroundings No longer responding to previously stimulating things like doorbells or food containers being opened Interactions Spends more or less time with family or other pets in the home Unable to recognize family members New or increased aggression Easily irritated Sleep-Wake Cycles Sleeping more during the day Waking up in the middle of the night without cause & often paired with pacing, whining, barking, or howling House Soiling Failing to alert family when they need to go Begins urinating and/or defecating in places they previously understood were off limits which may even occur right after being outside Activity Restless behaviors such as wandering, pacing, or whining Less interest in activities they previously enjoyed such as play time, walks, or meals. Anxiety New or worsened separation anxiety New phobias Signs of anxiety can include: Shivering Licking Drooling Pacing “Wide-eyed” or “whale eye” appearance Learning Difficulty responding to previously understood commands Inability to learn new things Who is affected by CDS? According to a study done by Texas A&M College of Veterinary Medicine & Biomedical Sciences, “approximately 28% of 11- to 12-year-old dogs and 68% of 15- to 16-year-old dogs have CDS” and a similar study found that "22.5% of dogs over the age of 9 years show cognitive impairment”. Any breed of dog can be affected by CDS but there is a slightly higher risk for smaller dogs since they tend to live longer than large dogs. How is CDS diagnosed? Cognitive Dysfunction Syndrome is a diagnosis of exclusion; meaning that all other possible causes are ruled out before concluding that CDS is the reason for your pet’s behavior changes. There are many conditions that can share symptoms & behavior changes with Cognitive Dysfunction Syndrome. Limited by Pain A dog that is painful from Osteoarthritis or a soft tissue injury may not want to play like before. They may not respond to doorbells anymore because it hurts to get up and run to the door. They may become cranky or even aggressive because being touched by you or jostled by another pet in the home might be painful. They may not make it outside to potty because it’s too painful to traverse stairs or a doggie door. Decreased range of motion usually occurs alongside orthopedic and soft tissue conditions, further limiting their mobility and increasing the level of pain they experience. To learn more, check out Motion is the Lotion. Blindness A dog that is losing vision can appear confused and lost. They may struggle to recognize family members until they can pick up a familiar scent or hear a familiar voice. Dogs losing vision often rely on a consistent home environment and will memorize the layout of rooms and furniture to avoid collision. Even just moving some furniture around can make a blind dog completely lost in their own home. They may avoid going on walks or have separation anxiety because without their human to keep them safe, they are lost anywhere outside their home. Neurological Conditions A dog suffering from a neurological condition, such as Intervertebral Disc Disease, may stumble and struggle to navigate previously simple obstacles like furniture, stairs, or doggie doors because they cannot move their body like they could before. They may start having accidents in the house because the nerve signals that control their bladder and bowels may be disrupted. It’s not uncommon for dogs to develop anxiety or restless behaviors just because they are frustrated that they cannot do what they used to. Benign or Cancerous Tumors Masses, both cancerous and benign, are always going to be high on the list as a rule out for CDS symptoms. Even if a mass isn’t malignant, it can still cause problems just by being there. For example, if a mass is located in the brain or near the spinal cord or major nerves, severe neurological issues can occur as the nerves are impinged upon and will progressively get worse as the mass grows. To rule out these conditions, your veterinarian will begin with a thorough physical exam. There are some simple observations and manipulations that can help your veterinarian identify potential orthopedic or neurological conditions. Routine comprehensive bloodwork & urinalysis is always recommended for seniors because it gives a quick snapshot of the bodily functions & can identify subtle changes before symptoms develop. Radiographs (X-rays) are extremely helpful to get a general look at the organs, identify boney changes, and reveal any internal masses. If your dog is painful or agitated, sedating them for their radiographs is a kindness! Not only will they be less stressed, but since they won’t be fighting the positioning, the images will be of better quality and they are less likely to injure themselves or their medical team. Depending on the physical exam findings, your veterinarian may recommend further diagnostics/treatment. For example, if a heart murmur is discovered or structural changes to the heart are identified in radiographs, an echocardiogram would provide more information as to the overall heart function and if medications are recommended. If severe periodontal disease is found, it may explain any difficulty with eating or pain related behavior changes and an anesthetic dental cleaning with extractions may be warranted to address pain and infection. If diabetes is revealed, dietary changes and additional lab work will be required as insulin dosages are established. Because some conditions are best managed with more specific training, equipment, and medications, your vet may recommend that your pet be evaluated by a veterinary specialist such as a neurologist, orthopedic surgeon, or internist. How is CDS treated? The primary focus should be to address any other conditions your pet is afflicted by as your pet’s symptoms may be significantly improved upon doing so. There is currently no cure for CDS, and potentially helpful treatments are limited but research is ongoing. It may be worth trying the following treatments as they may help improve symptoms and/or slow CDS progression. Early research indicates that diet & exercise have the biggest impact on your pet’s brain function. There are a few commercial diets available with promising feedback from owners of CDS patients such as the prescription formulas Purina Veterinary Diets NeuroCare and Science Diet B/D, as well as the over-the-counter formula, Purina Pro Plan Bright Mind. These diets include various combinations of antioxidants, fatty acids, and medium-chain triglycerides, which preliminary evidence indicates are likely to support brain health. If your pet is unable to make a diet switch, these nutrients can also be found in over-the-counter supplements, but be sure to evaluate these products carefully since supplements are not regulated like food or medication is. Our article on Pain Meds & Supplements includes tips on picking quality products and choosing the right medications for your pup. Providing more mental stimulation can help reinvigorate brain function. Brain games that require a bit of problem solving can help exercise a “weak” brain. Examples include: Wrapping a favorite toy in a blanket or towel & inviting your dog to find it Placing high value toys or treats around a room for them to seek out Kong toys (freeze for more of a challenge), puzzle feeders (available in varying difficulty), & snuffle mats. Frequent cycling of toys; you can buy new ones or just switch them out every week, so they feel “new”. Variety is key! Teaching new or practicing old tricks. If new tricks are too difficult, practicing old tricks still gets the brain working. Increased & varied exercise is also very stimulating when done with care & this is where Rehab can be an excellent tool! At CROC, we frequently treat senior and geriatric pets with a wide spectrum of medical conditions, so our team is very comfortable handling dogs that need extra gentle care. Your pet will get calm and supportive interaction with a new group of people who will help them as novel exercises are introduced. Our approach addresses your dog’s entire body, not just the presenting complaint. In this case, it means that your pet’s diminished strength or Osteoarthritis pain will be treated, often with modalities like Therapeutic Massage and Laser Therapy, alongside provision of mentally stimulating exercises. Teaching your pet to safely navigate our obstacle course will be a workout for their brain and their body, which will hopefully equate to a brighter and more confident demeanor at home. Unique experiences, like Hydrotherapy in our Underwater Treadmill, offer immense mobility benefits as well as tactile, auditory, and visual stimuli in a safe manner. Acupuncture is sometimes used for CDS patients since it can stimulate neurological function as well as relieve pain with minimal risk. To top it off, all CROC patients are prescribed “homework” consisting of massage, stretching, and exercises to do at home, further stimulating brain function as well as supporting the aging body. Our article, Motion is the Lotion, discusses how regular movement is integral to reducing pain and stiffness. What else can you do at home? When we humans reach our golden years, we often look to make our home safer and more comfortable. The same can be said for our silver-faced pups and even more so for dogs affected by CDS. Ensure that your dog has a quiet and cozy “safe place”, similar to a den. A good quality bed is a must! Orthopedic memory foam is best since dogs at this age are almost guaranteed to have osteoarthritis and the discomfort that accompanies it. Some dogs just want a comfy bed to snuggle up in while others prefer a crate to use as a private space. Make sure your home has flooring with good traction. Hard floors are very popular these days and while they’re great for keeping clean, many older dogs struggle with slick floors. A senior pup that is weak and contending with arthritis is more likely to slip and injure themselves. Placing rugs or yoga mats around your home can make it easier for your dog to safely navigate the house. If there are stairs, balconies, or similar obstacles in the home, pet/baby gates can be a literal lifesaver. For dogs with diminished vision, keeping the home environment consistent can help them avoid walking face first into walls or furniture. As a dog loses their vision, they often memorize the layout of their home & other commonly visited places, allowing them to get around even as they become blind. Sometimes, they can be so skilled at this that you could be fooled into thinking they can see! In these cases, rearranging furniture can have them completely lost in their own home, so if your dog’s vision is worsening, try to keep this in mind. They may also need better lighting, especially to get outside to go potty when the sun is down. Turning a dim room’s light on or even just using a flashlight to guide your dog can make a huge difference in their ability to make it outside to relieve themselves. Blind dogs may struggle to recognize their own family, so voices and smells become more important than ever. Make sure your blind dog knows you are approaching them before touching them, so they aren’t frightened by sudden contact. When dogs are in a state of high anxiety or fear, a calm & patient family member can be a huge comfort. For example, should your dog have an accident in the house, do your best to keep any frustration to yourself and instead give your pet gentle support. Dogs can feel frustration & even embarrassment in these situations because they know that what they did goes against a lifetime of training, but their body failed them in some way they couldn’t control. Helping your dog make it to the yard and making sure they are clean will go a long way toward bolstering their confidence. If your dog becomes stuck behind furniture or seems lost in their home, announcing your approach as you come to aid them can help reduce fear. Try talking to them in steady and mellow tones to let them know it’s okay and you’re there to help them. Visit our Gear & Resources page for links and examples of helpful tools like harnesses, diapers, booties, and more. The Help 'Em Up Harness can be particularly helpful in assisting large dogs outside to potty or on walks. If your dog is waking up during the night and pacing, whining, or howling, exercise and pain management may be enough to prevent this behavior, but sometimes prescription medications may be necessary. Make sure your dog is safely exercised every day and provided with adequate mental stimulation so that any excess energy is spent before bedtime. Rehab can be an immense help here! If physical and mental exercise isn’t sufficient, your dog may benefit from anti-anxiety medications or calming pheromones. You will need to discuss this with your veterinarian and finding the right medication, the right dosage, and/or the right combination of medications can take some trial and error. Try to be patient with your pup during this process & keep in mind that the first, even second or third plan, may not be the right one for you & your pet. Possible Safety Concerns Senior dogs can become less tolerant of certain interactions just because of pain or loss of vision, but dogs with CDS are often also contending with confusion, inability to recognize four- and two-legged family members, and increased anxiety. It’s important to acknowledge that your dog may not only become a danger to themselves, but can also become a danger to others. Imagine going to pet your dog on an area of their body that you didn’t know was painful and your dog doesn’t realize who you are. A dog that is painful, scared, and surrounded by people they don’t recognize has a much higher likelihood of biting someone. It’s important to watch for any signs of fear aggression towards humans, especially children, as well as other pets they may share their home with. Some dogs are genetically predisposed to have a high prey drive, but have learned to live with the family cat, then one day they no longer remember the cat as belonging to their family so those genetics to hunt and chase kick in. Or they may prefer to avoid other dogs but made friends with their housemate, only to start fights with them once they can’t recognize them anymore. Some of these things can be prevented despite your dog’s CDS. If your dog doesn’t recognize or no longer has tolerance for furry housemates, they may need to be kept separate using baby/pet gates. Children should be closely supervised or, if children are just visiting, it may be safest to keep your dog in another room during their visit. Best vs Worst Case Scenario In a perfect world, no dog would suffer from CDS but since we cannot prevent it, we just have to do our best to manage. In the best-case scenario, your dog’s CDS symptoms are mild and easily manageable. They do not cause any significant impact to your or your dog’s life, nor are there any increased safety concerns. The worst-case scenario is a sad one, but it is one that some pet owners face. If a CDS patient is suffering from their symptoms or is becoming a danger to themselves or others, euthanasia may be recommended. If your dog is living in a constant state of fear and anxiety despite your efforts, it’s time. If your dog is constantly soiling themselves, causing them to feel shame and you resentment, it’s time. If your dog is injuring you or other people, it’s time. You & your pet should enjoy your time together. When your dog’s quality of life is declining or you are suffering from compassion fatigue, it’s a good time to speak with your veterinarian & make plans for the wellbeing of all involved. If things can be done to support good quality of life for you and your pet, that’s great! Of course, we want every good moment with our pet that we can get! But if you have exhausted your financial, time, or energy resources and still struggle to enjoy life with your pet, it’s okay to consider euthanasia. To learn more about evaluating Quality of Life for you and your pet, visit our in-depth article here. Lean On Your Veterinary Team Whether it’s our Rehab Team or your Primary Veterinarian, we veterinary medical professionals work in this field because we truly care about the health and wellbeing of your pet. We see ourselves in you & consider each patient as if they were our own beloved pet, drawing on a wealth of knowledge & experience to help guide you. We have all the tips and tricks to help keep life easy and pleasant for you and your pet, but we also have the compassion to support you when hard decisions need to be made. Our Rehab Team is happy to assist you both on this journey and hope to help you maximize the best parts of your relationship with your dog.

Pain relief is always the first focus in Veterinary Medicine. Patients with poorly managed pain don’t heal as quickly or as well as patients with adequate pain management in place. Pets with effective pain relief are happier and healthier, but exclusively addressing a patient’s pain without making improvements to their strength and stamina greatly disservices that pet and their family. Pain medication is ultimately a band aid to a more complicated problem; a VERY IMPORTANT band aid, but an incomplete solution nonetheless. The Disuse Pain Cycle Just like us, when your dog doesn’t exercise as much as they used to, their muscles atrophy and shrink. “Use it or lose it!” summarizes this issue well. Your dog’s joints become stiff from the lack of movement and exercise becomes more uncomfortable and more difficult, leading to further atrophy and stiffness. As they lose muscle mass, the risk of falls, slips, and other traumatic injuries greatly increases. If this cycle is not interrupted, the result is a weak, painful dog who loses the ability to get around on their own. When a stiff, atrophied dog needs to go outside to potty, but rising from the ground, navigating the home and then the process of using the doggie door, followed by the steps down from the patio to the grass becomes difficult and painful, that dog will choose to potty inside the house because it is easier than the alternative. Keep in mind that a dog with normal brain function has an incredibly strong instinct to keep its “den” clean, so the level of pain a dog experiences can be excruciating by the time they begin to potty inside. Sadly, this exact scenario is one of the most common reasons that senior dogs are euthanized. To stop the Disuse Pain Cycle, we must reintroduce movement but asking a weak and painful dog to exercise doesn’t exactly feel fair, does it? This is where pain medication, quality nutrition/supplements, and Physical Rehabilitation Therapy make their biggest impact. Pain Management Many owners come to us seeking to avoid pain medications, some even seem upset that their Veterinarian recommended pain medications at all. While we certainly agree that unnecessary medications should be avoided, the right pain medications at the right dosages are crucial for your pet’s comfort and quality of life. We should not exercise a patient that is experiencing moderate to severe levels of pain as it is considered cruel. Pain medications can help dampen the discomfort your pet feels during certain movements or activities while we work to enhance their mobility. Exercise is necessary to reduce pain & therefore reduce medications. Without exercise there is no muscle building. Continued lack of movement will result in further weakening and muscle loss and continued weakness and muscle loss causes further pain and immobility. It may take some trial and error to find which medication and dosage is right for your pet, but prescription pain medications are a valuable tool that should be used when appropriate. It is rare that a Veterinarian will recommend pain medications without valid evidence from your pet’s exam. Some of these medications may cause sedation or gastrointestinal upset in some patients, and this is where some trial and error may come in. CROC does not prescribe medications but we can help you assess if your pet’s pain management plan is working and as long as you are in good communication with your Veterinarian, side effects should be minimal. Regular lab work is also essential to avoid any negative effects to the liver or kidneys. Senior pets should have lab work on a regular basis to catch any age-related conditions, so your Veterinarian should already have the information needed to select the safest medications for your pet. Check out our Pain Meds & Supplements article for more information on commonly prescribed medications, our favorite supplements, and how to choose quality products. Where Does Nutrition Come In? If your pet is on the chunky side, their weakened muscles will struggle even more than those of a lean dog. On average, lean dogs live 2 years longer than overweight dogs. But it’s not as simple as getting them to lose weight either. Complete nutrition for an overweight & weakened pet is a delicate balance of losing weight while ensuring that the body has what it needs to build muscle. Your primary Veterinarian or the CROC Medical Team can help you choose the right diet and caloric intake for your pet so that they are getting the vital nutrients they need while helping them shed the excess fat. If your pet is already on an appropriate diet, they may benefit from supplements to provide the ‘extra kick’ needed for muscle building and joint health. We’re big fans of Myos Muscle Formula and Dasuquin Advanced for many of our patients but you should consult with your Veterinarian before starting any supplement. We discuss weight management at length in our article Body Condition Score & Canine Weight Loss. Getting Started If your goal is to minimize use of pain medications and help your dog improve their mobility and quality of life, Physical Rehabilitation Therapy should be your next step! It is usually best to start therapy while your pet is still on their current Pain Management regimen and then as your pet improves, we can try reducing medications and their potential side effects. How do we provide enough relief to replace those medications? We offer clinically proven therapies & use as many of them as needed to find the best combination for your pet’s comfort. We often begin with Thermotherapy to soothe achy joints and muscles, then move onto Therapeutic Massage. We all know how good it feels to get an excellent massage that hits all the right spots; You go home feeling like a new person. This is true for your dog too! Therapeutic Laser Therapy and Therapeutic Ultrasound help to reduce inflammation by increasing blood flow to the area and encouraging cellular healing. Veterinary Medical Acupuncture has been shown to enhance the release of corticosteroids and endorphins, helping to ease spasm pain associated with nerve tissue. As we track your pet’s response to these treatments, we monitor their progress and make any necessary adjustments to their prescribed therapy plan. Keeping Your Dog in Motion Like humans, dogs move more easily once they’ve been up and about. As the tight muscles & stiff joints begin to warm up & loosen with the dog’s movement & increased circulation, motion then becomes easier & more comfortable. This is why many pet owners report that their pets seem the most stiff first thing in the morning or after periods of rest but can “warm up out of it” with light activity. Pain relief in the form of medication, thermo/cryotherapy, and massage can help them get through that initial discomfort. Mobility is always easier to maintain than it is to regain & your dog will find it easier to get up & moving if they do so more frequently. If they are up and moving, their muscles are in action (and therefore less likely to atrophy) and their joints don’t have the chance to get stiff and creaky. Dogs that can move more comfortably are more likely to stay in motion. Motion helps keep them strong and limber. Motion really is the Lotion of the joint!!! The Weekend Warrior A theoretical situation – think of a professional athlete. They’re constantly training to stay in peak shape for their next competitive event. This helps them maintain strength, stamina, and flexibility which also helps them avoid injury as they push their body to the limit. Now imagine that athlete taking a few months off from their training regimen. They take it easy and don’t make any dietary adjustments despite their decrease in activity. They stop stretching and exercising daily. Then, after a few months of this laid-back life, they are suddenly asked to perform at the level they previously did when they were training daily. Not only will they struggle to achieve that level of performance, but they are also extremely likely to injure themselves trying. During their break from daily training, their muscles began to atrophy, they gained weight from the excess calories, and they are no longer as limber as they once were. At best, they will be sore the next day but in the worst-case scenario, they could be facing injuries such as muscle strain, ligament tears, or sprains. An athlete that experiences an injury like these must then rest and undergo very careful physical rehabilitation before attempting to resume their previous training regimen. They might not ever be able to perform at the level they once did. How does this relate to your dog? Many dogs spend their time hanging out at home, getting walked around the neighborhood and maybe playing with a housemate in the backyard or a game of fetch here and there. As beloved family members, we want to include our pups in all our activities and this often includes hiking, running, camping, beach days, etc, all of which are more physically demanding than a walk around the neighborhood. The sudden increase in activity or participating in an activity they normally wouldn’t, especially for a senior dog, will almost always lead to some kind of painful consequence. And as we learned earlier in this article, a painful dog does not want to be active, further contributing to atrophy and stiffness. Sadly, it only takes 72 hours of inactivity to result in measurable muscle loss. One outing of significantly increased exercise could mean days of pain for your dog and several weeks of recovery to return to their previous level of fitness. This doesn’t mean that your dog can never participate in these activities with you. But it does mean that they need to be physically conditioned before doing so. Just like you would train for a marathon, your dog’s body needs training before a big outing. And wouldn’t you know it? Keeping their muscles & joints in motion on a consistent basis will also aid in maintaining their mobility & comfort well into their golden years. To Change the Body, We Must Challenge the Body There are a million ways to move the body with some movements being better than others, but all exercise has some benefit. Even a bad workout is better than no workout. Many pet owners get excited when they learn of Hydrotherapy and while it’s true that this modality is helpful for many patients, most clients, and even Veterinarians, are surprised to learn that Target Exercises are the most transformative modality. They may not be as flashy as an Underwater Treadmill, but they’re the most important part of increasing a patient’s physical ability and therefore their comfort. Ultimately, if you’re only using one modality, you are not going to achieve the results you seek. Veterinary Physical Rehabilitation is about using everything in our toolbox to get maximum benefit for every patient. Massage and Stretching alone will not fix a patient. Hydrotherapy alone will not fix a patient and can even hurt a patient that has not been warmed up beforehand. Laser Therapy, Therapeutic Massage, and Acupuncture are great for pain relief, but will not restore a patient’s mobility since they do not challenge the body. There is no magic treatment that will make muscle stronger, stamina longer, or cardiovascular tolerances larger. Exercise alone will do this. What Other Factors Are at Play? Your Pet's Demeanor The most obvious variable is your pet’s demeanor. A calm and friendly dog will live longer because they get better medical care. Good pets have a closer bond with their families & health issues are noted sooner, allowing for earlier medical intervention. Dogs with behavioral issues are euthanized earlier than those without because their medical conditions or loss of mobility cannot be as well-managed as a friendly pet. Dogs that dislike being around other dogs may not have as much access to certain activities or exercises. Our couch potato pals often fail to achieve desired results because they lack the motivation to participate in prescribed exercises. Dogs with higher energy levels or those that are eager to do as their two-legged best friends have asked will achieve better outcomes than their couch potato brethren. Your Attitude Your demeanor also plays a large role. It’s easy to feel overwhelmed as your best friend loses their mobility or struggles with painful conditions, but maintaining a positive, “can do” attitude will help you both! Our team is there to encourage and support you through your dog’s Rehabilitation Treatment Plan by giving you simple, but impactful changes you can make to your pet’s routine. Don't Over Do It On the flipside, overly enthusiastic owners are more likely to overdo things and cause harm to their pet. There’s a balancing act to your pet’s recovery and rest is vital to recovery because almost all of the body’s healing hormones are active when the body is asleep. Pets must be allowed to rest, recover, & heal throughout their healing journey while interspersing periods of structured activity. Your Capabilities Your own physical fitness will directly influence your pet’s recovery. If your dog requires assistance to perform certain prescribed exercises but you are unable to provide that assistance, your pet will not achieve the desired results. If you are unable to get down on the ground to massage and stretch your dog, those muscles and joints will remain stiff and painful, making the prescribed exercises uncomfortable to perform. They may even refuse to participate at all. Of course, us humans are often dealing with our own medical challenges as well so in this situation, it is best to schedule more frequent in-clinic therapy sessions so that your pet gets the treatment they need to restore comfort and/or mobility. For the most part, our team is young, spry, and able-bodied Rehab Specialists who are ready to squat, lift, carry, kneel, and otherwise hoist your pet into the proper ergonomics to resculpt their body through exercise. Weather When it’s cold and rainy out, arthritic joints tend to ache & swell, making exercise painful. When it’s hot & sunny, every dog is at risk for heat exhaustion, heat stroke, sunburns & burnt paws. Both extremes will limit your pet’s exercise, thus causing them to lose comfort and mobility. More frequent in-clinic therapy sessions will help with combatting the weather since our building is temperature controlled and on the colder days, our pain-relieving modalities can help get your pet comfortable enough to resume much needed exercise. Rehab is a Journey There are some things we can control and some we cannot. We cannot undo Osteoarthritis formation and we cannot rewind a patient’s aging process. We can control their environment, exercise routine, nutrition, and medical treatment. You can work together with your pet’s Rehabilitation specialist to form the optimal conditions for your pet’s continued comfort and mobility, keeping them in motion for as long and as pain-free as possible. Frequency of therapy sessions, modalities used, exercises prescribed, medications & supplements recommended are likely to change as your pet progresses through their Treatment Plan. If they’re expected to improve, exercises may become more challenging, supportive devices may be removed, or your pet may be asked to participate for longer periods of time. If your aim is to keep your pet comfortable as they approach their last days, pain relieving modalities may begin to be the primary focus and rather than challenging the body, we may look to maintain its current status. Quality of Life should always be prioritized over length of life. Ask the CROC Team No matter which direction you and your pet are headed, the professionals at CROC will help you and your pet avoid the disuse cycle and restore your pet’s mobility to the greatest extent possible. After all, motion is the lotion your dog’s joints need to stay active & enhancing your pet’s strength, stamina, & mobility to reduce their pain & maximize their life’s quality is what drives us.

Congratulations on ordering your pet’s new, custom-built cart! There’s some pretty important details you’ll need to familiarize yourself with in order for your dog to get years of safe and comfortable use out of their cart. Most importantly, this is not a process that can be rushed! Jumping ahead too quickly can cause serious injury to your dog or make them too afraid of their cart to continue using it. Preparing Your Dog & Your Home Ideally, dogs who will be needing a cart will have Physical Rehabilitation Therapy beforehand to prepare their body for the physical demands of cart use. This is not a passive device like a human wheelchair. A human can pause and just sit and rest when they get tired. Your dog cannot and is stuck in a standing position as long as they are in their cart. Building up their strength and stamina before cart use can help them adjust to this new activity more quickly and ultimately set them up for better success long term. Dogs that are unable to participate in Physical Rehabilitation Therapy before getting their cart can still do well, but they will need much smaller increments of time and distance as they become accustomed to exercising in their cart. Dogs are emotional creatures so creating a positive environment for them to learn in is a huge contributing factor for your dog’s success. In addition, you may want to prepare your home for your dog’s new cart. Obstacles like furniture, doorways, and even small bumps on the floor are likely to be challenging for your dog to navigate at first. As they are learning to use their cart, hitting obstacles that cause sudden stops can be scary and obstacles that cause them to feel trapped can be frustrating. Flat open areas, free of furniture and tight spaces, are the perfect environment for practicing in the cart. Hard, smooth floors like tile, laminate, or concrete are the easiest to roll on with textured flooring like carpet being more difficult especially as your dog is still adjusting to their new device. It may also be helpful to be able to temporarily put other pets away while they’re practicing in their cart, so having a safe space for other pets is optimal. Without a careful introduction, some animals can view the cart as something terrifying or dangerous attached to their housemate and may act aggressively towards your wheeled pet out of fear. Good Vibes Only! As mentioned above, dogs are emotional creatures and positive reinforcement is the most effective training tool. We’re working together to train your dog to properly use their cart. We are asking them to be strapped into a moving, metal contraption that is going to “chase” them everywhere they go; some calm confidence is definitely needed here! To assist with this first introduction & make any remaining adjustments, we will have you schedule one last Cart Fitting appointment at CROC at no charge. During this appointment, we will introduce your pet to their new cart in a calm and positive environment. We teach them that the cart is not scary, what it’s like to get in/out, and how to make it move with them. We let them make their first, sometimes awkward, steps in the clinic where we can help them learn how to maneuver it where they want to go and what it’s like when they inevitably hit an obstacle. Some dogs are chomping at the bit to run right from the get-go and couldn’t care less about any speed bumps. Others are more reserved and need a lot of encouragement to take even a few steps. The shy pups can quickly shut down out of anxiety and refuse to walk any further, especially if they hit an obstacle. By having them go through this initial experience at CROC, we can ensure that their first time in their wheels is a positive experience, making your first time using the cart at home a smoother, easier process. You want to start the training session in a calm, but encouraging energy so that your dog feels relaxed and confident. While you might feel excited or even anxious about your dog’s first few times in the cart, you must focus on the task at hand. If you are anxious about the cart, your dog will be too! Even just having the cart nearby for them to inspect and do normal daily activities next to can help desensitize your pet and any housemates, so they feel that it is a safe thing to have near. When you’re ready to get started, be sure you have any and all tools you might need close at hand. You will want to have your dog harnessed and leash and you may want a bag of treats to encourage them with. Make sure you read the instructions included with your dog’s cart and are familiar with how to load/unload your dog into the cart so you can make your dog’s experience smooth and fear-free. Your confidence truly rubs off on them! Even if they show some initial signs of being nervous or fearful, it’s super important that you reassure them & calmly continue. You don’t want to panic or become frustrated. Move too quickly and your dog may become scared. Move too slowly, and they may be too excited or frustrated to stay still long enough for you to finish loading them in. It’s okay if you’re nervous! Sometimes you just have to “fake it until you make it” for your dog’s sake. Listen to Your Dog The first few sessions in the cart should only last about 5 minutes (unless directed otherwise by CROC) each & happen a few times each day, with plenty of time to rest in between sessions. Be sure to monitor for signs of fatigue. Dogs that lower down onto their front legs are trying to lay down. It’s important to give them a break when they ask for it. If your dog hesitates to walk, try to encourage them to take a few more steps before calling it quits. If the session has come to a complete halt, it may be best to recognize that your dog needs a break and try again later, keeping things positive and light the entire time. Over time, you can start increasing their cart sessions by 5 minute increments every few days to a week, as long as they are able to finish the session without being exhausted. If you increased your dog’s cart session & they are totally wiped out exhausted at the end, it’s recommended to revert to shorter sessions for a bit longer before attempting to increase again. If your dog is only moving backwards, this is often a sign that they are not strong enough to pull their cart forward as pushing backwards is much easier. For the best chance of successful cart use in this situation, your dog will need additional physical conditioning to become strong enough to pull themselves and the weight of the cart forward. If this is happening with your dog, follow up with the CROC team so that we can work together to create a plan to help your dog get rolling. Suggested Safety Measures Use extreme caution around stairs & pools A fall down the stairs or into a pool can cause serious injury or death. Ideally, these risky areas would have a physical barrier preventing your dog from getting to them. Use caution around other animals Not all animals are comfortable around carts and may even be terrified, making your dog a target for attack. When allowing your wheeled dog to play with other animals, it is best to prevent overly rough play, as most wheeled pets have conditions that can be worsened by the impact and twisting of rough play. You dog cannot defend themselves like a fully ambulatory dog can, so be very careful about which animals are allowed to interact with your wheeled dog. Practice good hygiene Keeping your dog’s cart clean and well maintained is imperative for comfortable, long term use. Your dog is able to urinate and defecate while in their cart and while it’s not common that the cart becomes soiled, be sure to watch for it and wipe down as needed. The pelvic support area can get dirty just from regular use, so make a good habit of cleaning it regularly and allowing it to dry fully before resuming use. Abrasions and worn nails are frequently seen when a dog's feet are not adequately protected. Protect those paws Depending on your dog’s condition, they may or may not have some use of their affected limbs. We always want to encourage whatever independent movement your dog can manage, so if they are able to move their legs with the support of the cart, you should let them do so. Either way, you will need to protect their paws from scuffing or dragging on the ground. If they are able to move their legs in any meaningful way, you may want to keep some booties on hand, such as Pawz, or keep them on soft surfaces like grass. Please note that even carpet can cause burns from frequent rubbing. If your dog does not have the ability to move their legs, please take care to use the included supportive pieces on your cart to hold their paws up off the ground. Some carts will have a padded bar along the back for the legs to rest on and others will have dedicated stirrups to secure their feet safely up and away from dragging. Visit our Gear & Resources page for examples and links to booties we like. When in Doubt, Call CROC! When we suggest a cart for your pet and begin preparing them, we use our Veterinary Physical Rehabilitation experience to ensure that your pet is a good candidate, that they get the right cart and the right fit and we stand behind our work. Patients who have undergone CROC’s Cart Fitting process are extended long-term support for their cart. You are welcome to call with questions any time or even schedule a follow up fitting if something seems off down the line. Some pets will need minor adjustments to their cart as they age or as their condition changes to ensure that the cart remains ergonomic and comfortable. On a regular basis, you will need to check that all screws & bolts are secure & that the wheels are spinning easily & evenly. More frequent maintenance checks should be performed for dogs that are particularly active in their carts. Unfortunately, CROC cannot offer any support for carts obtained outside of our guidance, even if they are obtained through Eddie’s Wheels. We know that the circumstances leading up to needing a cart are typically challenging and exhausting, but now that you've got some wheels, we hope that you and your dog get as much joy and freedom from your new cart as possible!

They say that the loss of a pet can be even more painful than losing a human family member. What family member follows you to the bathroom every time you pee? Who leaves their hair all over your clothes and your car, lest you leave the house without them and forget them? Who sleeps on your feet so they’ll know if you leave the room? Dogs aren’t always the center of their family’s world, but that family is absolutely the center of the dog’s world and they’ll spend every waking moment with you if they had it their way. Our relationships with our dogs are truly unique. Being responsible for another life, right up to their last moments, is a momentous duty but also a momentous gift. We can alleviate their pain, even free them from their debilitated body. The decision to say goodbye to such a valued friend can be incredibly challenging and the thought of life without them can sometimes result in having made that decision much too late. At CROC, we often treat patients in their senior and geriatric stages of life to help them maintain mobility and relieve pain so they can stay with their families as long as possible. We do our very best to support our clients as they navigate the changes age or disease can bring to their best friend while also adhering to one of the most important promises Veterinary Professionals make – to be an outspoken advocate for the wellbeing of those who cannot speak for themselves. Is Your Pet in Pain? If your pet is in pain that cannot be reasonably controlled with medication(s) or other medical therapies, then the big question has already been answered. Our greatest gift as pet owners is to prevent, treat, & end any pain our furry family members might experience. It doesn’t matter if your dog is eating well or still wags their tail when you come home. Those behaviors are just minutes out of the day, during the remainder of which, they are stuck experiencing pain & discomfort that they can’t understand. Pain can be hard to determine with some pets. We must remember that instinct tells our pets to hide their pain so that another animal doesn’t pick up on their weakness and attack them. Common Signs of Pain limping inappetence whining or crying growling or snapping at family Easily Missed Signs of Pain panting drooling teeth grinding decreased interest in favorite activities reduced mobility change in gait difficulty sleeping hiding pee/poop accidents Continuing to eat is NOT a significant determining factor for your dog's Quality of Life Even dogs in obvious & excruciating pain have been known to eat right up until their very last moments of life. Medication can be a simple way to treat pain, but this isn’t always an option, especially for our older patients. As the body ages, organs stop working as well as they used to. Specifically, the liver and kidneys, which are responsible for metabolizing everything that goes into your dog’s body. Several common pain medications used for dogs can cause increased strain or even damage to the liver and kidneys. Other medications may make your dog too drowsy to participate in the activities that make their life worth living. And some, while effective for others, may not help your dog at all. Physical Rehabilitation may be helpful for the painful pup. Therapies like Laser, Ultrasound, Acupuncture, Stretching, Massage, and Passive Range of Motion may help relieve pain in conjunction with prescribed Target Exercises or Hydrotherapy to improve your dog’s mobility. However, there is a limit to what Rehab can help. If we feel that your dog is too weak or sick to safely work with, we may recommend that you take them home and focus on making their remaining time as comfortable and enjoyable as possible. We will provide you with information on how to manage your dog's pain and other symptoms, and we encourage you to spend as much time as possible with them. CROC does not turn away patients due to age. Our assessment focuses on the safety of our patients. Can your dog participate in therapy without experiencing further pain or injury? Can your dog’s heart or lungs handle the strain of exercise? Can any of our therapy modalities provide meaningful pain relief for your dog? If the answer to any of those questions is “no”, we will not offer in-clinic therapy. If your dog’s medical condition is that fragile, we cannot in good conscience risk performing therapy & cutting your time with your dog short. As Veterinary Professionals, we take an oath to do no harm & that also means refusing treatment if it is not in the best interest of the animal. Is Your Pet Enjoying Life? Dogs are emotional creatures and their mental health can play a big role in their physical health too. They can experience anxiety and depression as their body changes and it becomes difficult to do the things they’ve done their whole life. For example, choose your dog’s top 5 favorite activities. It could be getting a special chew treat, playing fetch, wrestling with housemates, going for hikes, or just snuggling on the couch. When your dog stops doing any of those favorite things, or maybe isn’t as excited for them as they used to be, you have to consider that they just aren’t as happy as they used to be. They might be experiencing physical pain or other physical ailments like blindness or deafness that make their favorite activities difficult or even painful which can then lead to frustration. Remember that dogs don’t understand why their body is failing them, only that they want to do a thing they like & doing that thing is now harder or more painful than they remember. Signs of Stress/Anxiety whining or barking pacing drooling or panting excessive licking diarrhea change in appetite hiding aggression or destructive behavior difficulty sleeping Signs of Depression decreased energy level decreased appetite decreased thirst avoiding socializing avoiding playtime hiding changes in grooming habits becoming quieter or less communicative Keep in mind that dogs can also experience Canine Cognitive Dysfunction or “Doggie Dementia”, which can be difficult to cope with since there is little to no treatment for this condition. There is emerging evidence that certain diets or supplements could potentially help support cognitive function for senior and geriatric dogs, but this is still very much in early stages of research. Visit our Canine Cognitive Dysfunction Syndrome article to learn more. Is Your Pet a Danger to Themselves or Others? Some dogs experience an unfortunate combination of symptoms. For example, a dog that is going blind, has Osteoarthritis, Muscle Atrophy, and Canine Cognitive Dysfunction. This is actually a very common combination of conditions for our geriatric patients. These patients become a danger to themselves because they may not understand where they are, can’t see very well (if at all), are weak and uncoordinated, and their body hurts with every movement. They are at significant risk for falling or injuring themselves on furniture or walls they may bump into. They may even snap at their family members out of fear because they don’t remember who they are or can’t see the person coming before they’re suddenly being touched. This can get dangerous for owners, especially with large dogs, when they try to help their furry friend and end up with a serious bite wound. Sometimes, modifications to the home environment can help with some of these problems. Adding extra grip to the floor like yoga mats or well secured rugs can help your dog stay on their feet and provide some cushion in case your dog falls. Blocking off access to stairs or furniture may help prevent injury. Good lighting and sometimes even night lights can help dogs with diminished vision get around a bit more comfortably. Dogs that have gone completely blind often memorize the layout of their home, so any changes such as moving furniture or changing the texture of the floor may throw them off and leave them lost, confused, and scared. Care should be taken with housemates, as compromised seniors and geriatrics often get inadvertently beat up by the more enthusiastic young pup because they can’t see them coming or move out of the way fast enough. Are Resources Being Used in a Sustainable Manner? As our pets become more and more integral to our lives, us humans have begun to spend more and more resources on their care and most of the time, that’s perfectly wonderful. We encourage our clients to expend their resources in a healthy & sustainable way. Can you physically perform the tasks needed to help your dog without throwing out your back or otherwise getting injured? Do you have the time necessary for your dog’s care? What if that means waking up multiple times every night or coming home from work in the middle of the day? Are you willing to put off vacations because your dog requires intensive care throughout the day? Is caring for your pet taking away from your other responsibilities such as other pets, children, your job, or your own self care? Finances can be the most heart-breaking aspect of decision making. Sometimes, there is more advanced medical care available to treat the pet’s condition but the owners just don’t have the funds to pursue it without putting themselves at risk of being unable to pay their rent or bills or even to buy groceries. It’s important to remember that you must continue to care for yourself even after your pet is gone. Hard as it may be, you may have to call it quits before your pet’s financial burden puts you in a risky position. Over the years, we have seen clients sell their car or go without power in an effort to save their pet. When their pet inevitably passes, they are then without the resources they need to keep their job or live with reasonable comfort. There is also the possibility of futile medicine. This is when the pet’s condition cannot be reversed or reasonably treated, but medical care is continued anyway because a client is willing to pay for it. As Veterinary Medical Professionals, we have all seen patients continue to be poked, prodded, and hospitalized for days or weeks on end (which is often quite expensive) when we know that these attempts to save the patient are futile and a waste of client money as well as time with their pet. We would much rather see that patient spend some quality time with their family, comfortably at home, before a prompt but peaceful euthanasia. Are You Enjoying Life With Your Pet? Dedication to your pet’s care is an amazing thing and we certainly don’t wish to discourage that. We do however, encourage a healthy balance of dedication and self-care. As your dog’s needs continue to become more demanding, it can be exhausting trying to keep up. You might be carrying your dog everywhere, constantly cleaning up after their accidents, or losing sleep when they’re up all night. Many owners feel guilty when they reach this stage. They continue to overwork themselves because they feel that if they don’t, it means they’ve given up on their pet or otherwise let them down. That couldn’t be farther from the truth! If you are not at your best, you are not providing your dog with the best care either & this situation can quickly spiral into feelings of bitterness & resentment. It’s okay to be tired. It’s okay to say that enough is enough. Our goal is for you to be comfortable identifying the situation before the relationship with your dog is damaged. We want you and your dog to enjoy your time together for as long as possible and as soon as that starts to be affected, it’s time to start thinking about euthanasia. Natural Death vs Euthanasia Natural death in animals can take an extremely long time to occur, during which your pet is likely to be scared & in pain. Everyone wants their loved one to die peacefully in their sleep, cozy in their bed. The unfortunate reality is that this is highly unlikely to be the way your pet will go. Not to mention, it can be heart wrenching for an owner to watch their pet go through the process. Many animals retreat from their family and hide. It’s not uncommon for them to cry and whine, spasm and twitch, and go back and forth through many different levels of mental acuity. We have seen many owners decline euthanasia in favor of natural death only to later rush in as their pet is going through the agonizing dying process, begging the veterinarian to end this suffering. During the process of dying, your pet will feel their body giving out, become weaker and sicker. Conditions that affect the heart and lungs mean that those patients slowly suffocate to death. In addition, their pain may be so significant that there are no longer any medications you can give at home to soothe their suffering. With euthanasia, you get to choose how your pet goes. You can choose to let them go on a high note, before the worst bouts of suffering have taken hold. The definition of Euthanasia is “Good Death” & that’s exactly why we’d recommend it over allowing your pet to pass naturally. You can make sure that your dog’s last moments are full of joy & love, instead of fear & pain. In Orange County, there are many different Veterinarians who will come to your home to perform the euthanasia in the place that your pet is most comfortable, which is a great option for pets that get stressed going to the Veterinary Hospital. The Euthanasia Process & What To Expect During the Euthanasia procedure, an IV catheter may or may not be placed depending on your pet’s condition and the veterinarian’s assessment. When you are ready to begin, the veterinarian will first give a short acting injection to soothe your pet’s pain and help them relax until they fall asleep. Once your pet is adequately sedated, they will administer the euthanasia solution, Pentobarbital. This drug is a strong anesthetic that slows brain activity which will cause the heart and lungs to slow and eventually stop. Because your pet is unconscious while this drug takes effect, they do not feel any pain or fear. The time from injection to death is usually just minutes or even seconds. Your veterinarian will use a stethoscope to listen and confirm that there is no longer any heartbeat or breathing. While your veterinarian will always do their very best to make this process as peaceful as possible, every animal reacts to drugs differently. They will choose drugs and dosages based on how most pets respond to them, but sometimes a patient needs more drugs than the average or a different drug entirely. Even when things go perfectly, it’s important to know ahead of time that the body’s reflexes can cause some unsettling reactions. This is because for a short time following cardiopulmonary arrest, neurons in the brain or central nervous system can intermittently fire. These last random neurological reflexes can look like gasping for breath, vocalizing, blinking, or even moving a leg or tail but these are not voluntary movements and the patient is very much deceased. These events can be compared to when you turn off an old Television and an image is still partially visible on the screen for a few seconds, but the TV is definitely off and the image disappears. Preparing for Euthanasia Once you know that it’s time, you’ll want to figure out all the details ahead of time because the day of is likely to be an emotional rollercoaster. If your pet is suffering, euthanasia cannot wait & should be pursued as soon as possible. If your dog is currently stable and comfortable but you know that they are on track to continue declining, you can schedule the appointment out a bit. Some people like to use the time before the appointment to take their dog to their favorite places and activities, take some extra special photographs, visit with family and friends. Some like to treat their dog to cheeseburgers or chocolate cake which is fun but must be done with care. Fatty or toxic foods will still cause serious discomfort and illness for your pet, so if this is something you’d like to do, you’ll want to do it in the minutes before the euthanasia drugs are given. Otherwise, your dog will spend its last days or moments feeling sick, possibly experiencing diarrhea, vomiting, or even organ failure. You’ll also want to make plans for your pet’s aftercare, or what happens to your pet’s body once they have passed on. In Orange County and most urban areas of California, it is illegal to bury a euthanized pet. This is because the euthanasia drugs are still present in the body after death and those drugs can leach into the ground or be ingested by other animals. For this reason, the most common aftercare in utilized in Orange County is Cremation. Other options include Aquamation or burial at a Pet Cemetery. Most Veterinarians will have some sort of partnership set up with a local Cremation facility and can arrange transport for your pet’s once the euthanasia procedure is over, but you should confirm that when scheduling the appointment. Many facilities will give you options like if you wanted your pet’s ashes returned to you, if you would like their paw print in clay or ink, even save some of their fur. Everyone processes their pet’s passing differently & there is never judgement for how you choose to have your pet’s remains handled. Last, but certainly not least – Make sure you have what you need. Especially if your appointment is taking place at another location, we always recommend having a friend or family member there to support you and get you safely home. We have seen owners leave the Veterinary Hospital in severe emotional distress just to get into a car accident leaving the parking lot. Stock your home with your favorite foods, movies, books – whatever will bring you some comfort while you emotionally process. More & more research is being done into the human experience of losing a beloved pet & in many instances, we humans are not getting the support we need to properly grieve. This is likely because historically, losing a pet wasn’t considered to be as traumatic as losing a person so the mental health aspect of pet loss was largely ignored. Now that we are discovering that to be false, time away from work and professional counseling is more widely accepted and advised. Lean On Your Veterinary Team We know - This decision is immensely difficult. We have assisted with thousands of euthanasia procedures over our Veterinary Medical careers and felt the emotional weight of every single one. We’ve also watched countless animals suffer through their last moments, wishing that we could have relieved their pain. It is our purpose as Veterinary Professionals to speak up for your pet’s needs; to advocate for their treatment. We’ve had to make this decision for our own animals, walking the line between concerned pet parent and cognizant Veterinary Professional simultaneously. We want you to know that we would never recommend evaluating Quality of Life or pursuing Euthanasia lightly. We never want to take priceless time away from you & your pet, because we know how it feels when that time is gone. Whether you’re at the beginning of this process or you’ve already made the decision, your Veterinary Team (CROC included) is there to support you and your dog. Whether you need questions answered or just a confirmation that you’re making the right decision, we’re available to you if you need it. Additional Resources Quality of Life Assessments https://vetsocialwork.utk.edu/wp-content/uploads/2016/03/Quality-of-Life.pdf https://journeyspet.com/pet-quality-of-life-scale-calculator/ https://www.lapoflove.com/quality-of-life-assessment Home Euthanasia in Orange County https://www.lapoflove.com https://www.homepeteuthanasia.com/ https://orangecounty.inhomepeteuthanasia.vet/ https://apetsfarewell.com/ Aftercare Services in Orange County https://www.onlycremations.com/ https://pawsaquamation.com/ https://www.westcoastpetmemorial.com/sea-breeze-pet-memorial-park-huntington-beach/ https://pawsintograce.com/orange-county-pet-cremation-aftercare-memorial-services/ Pet Loss & Grief https://www.lapoflove.com/pet-loss-support-resources https://resources.bestfriends.org/article/pet-loss-and-grief-resources

CROC commonly treats FCE patients in an attempt to restore as much normal bodily function as possible. Patients can present with a wide range of symptoms, from mild limping or incoordination all the way to near complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so. Check out Marley's recovery from her FCE! She presented with the most severe symptoms CROC has ever seen & was successfully rehabbed! What is a Fibrocartilaginous Embolism? Fibrocartilaginous Embolism, or FCE, is when a piece of connective tissue enters the blood supply to the spinal cord and blocks the flow of blood to the spinal cord tissues. This lack of blood supply causes part of the spinal cord tissues to die from lack of oxygen and nutrients, leading to neurological deficits for the patient. It is still not known exactly how this connective tissue enters the bloodstream. This condition is also referred to as a Spinal Stroke or Spinal Cord Infarct. While it is rare for a dog to experience more than one FCE, it is absolutely possible. Symptoms of FCE occur quickly. Often during exercise or play time, FCE dogs generally experience significant acute pain & some will cry out from discomfort.  They may limp, struggle to walk, or even experience complete paralysis immediately or within hours of the FCE. Usually, the worst of the symptoms have appeared within the first 12-24 hours and patients will start to improve from that point, with pain subsiding within 24 hours. Severity of symptoms is dependent on the location of the embolism along the spinal cord. Patients with embolisms higher up the spinal cord (closer to the head vs the tail) or those that cause larger sections of spinal tissue to die off tend to be the worst affected.  FCE’s typically affect one side of the body more so than the other, but they are known to occasionally affect both sides. Severely affected patients are unlikely to return to completely normal function, but with dedicated and intensive care, they can regain the ability to walk independently and relieve themselves appropriately. In the best-case scenario, an FCE dog will only experience mild neurological deficits in one leg and never lose sensation in the affected limb. These dogs often make a full or nearly full recovery to normal function. In the worst-case scenario, the FCE will cause paralysis and loss of sensation in all four legs. While certainly a challenge, patients in this scenario are not without hope! CROC has successfully treated cases of FCE in which the patient is unable to even lift their head or swallow. Who is at Risk for Fibrocartilaginous Embolism? FCEs most commonly affect large and giant breeds like German Shepherds and Irish Wolfhounds, though it sometimes occurs in small breeds like Shelties and Miniature Schnauzers and can happen with any breed or breed mix . It can occur in dogs of all ages but is most frequently seen in young to middle aged dogs. FCEs are not predictable or preventable. Diagnosing Fibrocartilaginous Embolism Because FCE symptoms can look like many other serious conditions, FCE patients often undergo several diagnostics to reach the correct diagnosis. Ultimately, FCEs are diagnosed by Veterinary Neurologists using Magnetic Resonance Imaging (MRI). General Practice Veterinarians can perform blood tests and radiographs to rule out other conditions but cannot confirm FCE using those diagnostics. MRI allows the Veterinarians to see the loss of perfusion to the spinal cord, therefore definitively diagnosing FCE. Treating Fibrocartilaginous Embolism There is no surgery or medication for FCE. Instead, treatment is focused on supporting the dog while they heal, encouraging limb use, and preventing muscle atrophy. They may need pain relief during the first 24 hours, but they are generally not painful after that initial period. Dogs with minimal symptoms may just need some assistance getting up or walking around but dogs that cannot walk will need more intensive care including assistance to relieve themselves and frequent repositioning to avoid the development of Decubital Ulcers (bed sores). The worst affected patients will need additional veterinary care to support hydration and nutrition if they cannot eat or drink on their own. This may look like hospitalization for several days with intravenous fluids and medications, after which, the dog will still require dedicated, round-the-clock care once back at home to ensure that they are kept clean, hydrated, and regularly repositioned. As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of maximum recovery. It’s important to note that dogs with minimal neurological deficits may recover fairly quickly, but those experiencing profound paralysis will require a significant commitment of your time and energy over at least the next 6 months, sometimes more. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Failure to participate in Home Care Exercises will severely impede your dog’s level of recovery. Rehabbing FCE The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from the time of injury to Rehabilitate your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pets that don’t have any movement or feeling in their legs will be at a greater disadvantage than those that are just weak and uncoordinated. Generally speaking, we can get a good idea of your dog’s potential for recovery within the first few weeks of Rehabilitation Therapy. FCE patients begin their Rehab journey with Target Exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! Please note that E-Stim therapy requires us to shave small patches of your pet’s fur to allow electrical conduction through the tissues. We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the legs, we’ll step up our exercises to get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for FCE patients are focused on improving Proprioception or knowing where your body is in space. Because of the damage to the spinal cord, many FCE patients often can’t feel their environment or have no sensations to tell them where their legs and feet are. This is important because if we want to get your dog to the point of consciously controlled leg movement, they have to know where  to move their legs in order to stand and eventually walk. This initial stage of rehab is frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab Sessions without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there! Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the Underwater Treadmill before we see it on land. The Underwater Treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements. Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. Safety for FCE Patients Changing Habits Since many FCE patients rarely make a complete return to the level of function they had before the FCE, some simple changes at home can make all the difference in making it easier for them to get around. Rugs or yoga mats strategically placed around the house will help your dog to grip the flooring better, which reduces their risk of falling. 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, although care should still be taken to monitor your pet while using these. Some pets will no longer be able to navigate stairs safely, so you might need to block them off entirely. Especially in the earlier stages of recovery, it can be beneficial to keep resources like food, water, bedding, or outside access closer to your dog and easier to get to. Closely supervise play time with housemates or other doggie friends since your dog will be weaker and more prone to falling. Swimming There is a video viewable in our article, The Deep Dive into Swimming , that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their front legs and barely working the back legs. Swimming also puts immense strain and twisting movements on the spine, the last thing a patient with a spinal cord injury needs. Regarding Chiropractic... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for their patients.   We have yet to find a Boarded Neurologist that would approve of their patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a Basic Level Chiropractic treatment involves applying jarring & intense force on the body. Your dog’s spinal cord is trying to heal & is particularly fragile so the force of Chiropractic can push your dog to further injury. If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are better & safer options for pain relief available. The End Goal Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and maintain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis & a goofy looking walk, we’ll take goofy any day of the week. What If They Still Can’t Walk? We always want to give Neurological patients the full 6 months of treatment before throwing in the towel. If we’ve reached the 6-month mark and still haven’t seen significant improvement, that’s when we start looking at a Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to jump into using a cart too soon as once a dog starts getting around without using their legs, they lose motivation to even try walking & that seals the deal that they never will.  The good news is that CROC rarely, if ever, sees FCE patients require wheels. However, not all FCE dogs regain independent mobility and the task of caring for a physically debilitated dog is a hefty one. For more information regarding Carts and what the process for getting one looks like, be sure to check out our in-depth article, The Wheel Deal: Let's Talk About Carts . Tools To Make Your Lives Easier We'll briefly cover tips & tricks below, but you can visit the following pages for more detailed recommendations: Gear & Resources How to Set Up a Recovery Pen Recumbent/Non-Ambulatory Care Rehabbing Recumbency Use a Recovery Pen The purpose of the recovery pen is to limit your pet’s activity, reduce overexcitement or stress, & provide a clean, comfortable environment that maximizes healing. If your dog is expected to get better, your recovery pen will need to be modified as their abilities and needs change. The goal is to maximize safety while still providing enough space to encourage movement as appropriate. Protect the Paws While your pet is re-learning to walk, they will frequently drag their legs and/or paws, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like Pawz 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 & eaten! A Good Harness is a Must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for FCE dogs is called the Help ‘Em Up Harness . It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. Depending on your dog’s abilities, your pet may or may not need the back half, but if they do, as their coordination and strength improves, the back half of the harness will become less necessary. 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. 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. Keep Things Clean If your dog doesn’t have complete control of their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It's also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores. Use a High Quality Dog Bed Orthopedic Memory Foam beds are ideal. 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. Encourage your dog to change positions, such as switching which side of their body they lay on. Insufficient padding & laying in one position for extended periods of time can lead to decubital ulcers (bed sores) & significant stiffness. If your dog is unable to reposition themselves, it is recommended to move them from one side of their body to the other every 4 hours to prevent ulcers from forming. Once formed, decubital ulcers are difficult to heal, extremely painful, and highly prone to infection so prevention is best! 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. Some FCE dogs are also old enough to have started developing arthritis, so all the more reason to reduce any extra work on their joints. For more information, read our article Body Condition Score & Canine Weight Loss . The less weight there is for them to haul around, the easier it will be to start lifting & moving their own body. CROC works closely with you to make sure your dog is on the right supplement and pain medication regimen. Joint supplements, like Dasuquin w/ MSM, are helpful to support their joints as some parts of the body will be compensating for the weakness of other areas. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the FCE dog and is available online. To learn more, visit our Pain Meds & Supplements  article, where we cover commonly prescribed medications, side effects to watch for, and how to pick quality supplements. CROC strongly discourages the use of marijuana products for FCE patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and FCE patients are already weak and have limited coordination, making them poor candidates for this treatment. 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 FCE dogs with severe Neurological deficits. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have 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. If you are considering euthanasia, our Quality of Life  article may help you to evaluate all aspects and know what to expect should you proceed. It’s essential that you keep Quality of Life for you both as a top priority. If your dog is not recovering well & you are not prepared for years of intensive care, it’s time to start discussing the reality of the situation. We're Here For You Fibrocartilaginous Embolisms are a serious condition, but not a death sentence. Many dogs show signs of healing quickly after the incident, but those that don’t will require consistent and intensive rehabilitation for several months. CROC has had great success rehabbing our severely affected patients back to independent mobility but cannot make any promises that we can do so for every dog. It can be a long, challenging road, but we are here to walk it with you and support you and your pup through the entire journey.