L ibrela is the newest osteoarthritis treatment in the US and of course, everyone is excited about a once monthly treatment to treat your dog’s pain. It can be extremely effective when used appropriately. However, in addition to the benefits, we are also seeing some concerning trends with the use of this drug and want you to be aware of the potential risks before pursuing it for your dog. What is Librela (bedinvetmab)? Librela is a monthly canine monoclonal antibody injection that must only be administered by your veterinarian and may take up to 6 weeks for observable results. A monoclonal antibody is a biological agent, a medical product that is isolated from a living creature rather than a chemical, that has been engineered to bind to a single target. Examples of biological agents include gene therapy, vaccines, and blood components.¹ Librela targets Nerve Growth Factor (NGF) to help reduce pain caused by Osteoarthritis. NGF is necessary for neurological development and maintenance though as an animal matures, it becomes part of the body’s sensation of and response to pain. NGF also contributes to healing and cardiovascular health. Librela works by stopping the healing, growth, or maintenance of nerve tissues in the body. The dog’s pain stops when the nerves don't work and can no longer send pain signals to the brain.  What Librela Can’t Do It does not cure osteoarthritis. While it can lessen the sensation of pain caused by osteoarthritis, it does not stop the inflammation and physical damage that is present and occurring within the joint. In fact, we frequently see dogs that feel so much better on Librela that they return to more intense activity which then contributes to accelerated osteoarthritis formation. To learn more, check out our article Crunchy Doggos: Managing Osteoarthritis . It should not be used to address any other conditions. This includes chronic or post-operative pain, like that associated with Cranial Cruciate Ligament (CCL/ACL) rupture or Tibial Plateau Leveling Osteotomy (TPLO). It cannot help those conditions and should not replace conventional methods of pain relief in those cases. It should not be used in any case where nerve growth is required such as dogs that are breeding (including males), pregnant, or lactating. It should not be used in dogs that are physically immature and still growing. Keep in mind that many large or giant breed dogs do not reach physical maturity until 2-3 years of age. Neurological Side Effects Because Librela targets Nerve Growth Factor, it typically results in poorer nerve tissue health. The veterinary community is becoming increasingly aware of neurological adverse side effects associated with Librela including: Generalized weakness Inability to control bladder and/or bowels Stumbling Knuckling Dragging paws Inability to walk Seizures In many cases, a dog may have had very mild neurological dysfunction that had gone unnoticed by their family until they were given Librela. That neurological dysfunction can worsen as soon as hours to weeks after a dose of Librela.  Should your pet experience any of these symptoms, Librela should not be given again until your pet has been evaluated by a Veterinary Neurologist. It may take up to 3 months for a patient to recover from a Librela-induced neurological decline although patients with Degenerative Myelopathy are extremely unlikely to regain any lost ability.  If your dog has any sort of neurological condition, such as Intervertebral Disc Disease , Degenerative Myelopathy , or Geriatric Onset Laryngeal Paralysis & Polyneuropathy , they should not be given Librela as it is likely to worsen their symptoms. The Blood Brain Barrier is a semi-permeable membrane that protects the brain by filtering out harmful substances within the body while allowing oxygen and nutrients in. If it is intact, Librela should not be able to affect brain tissue or cognition, however the Blood Brain Barrier weakens with normal aging and its break down can be accelerated by other age-related disease.  The affects of Librela on the brain are not yet known, but given Librela's effects on nerve tissue and that senior dogs who are likely to have a compromised blood brain barrier are most common patient to be given this medication, there is the potential for harm to the brain. Autoimmune Side Effects There are anecdotal reports of Librela worsening autoimmune conditions. This is especially concerning when it comes to conditions like Immune Mediated Polyarthritis (IMPA). Dogs with IMPA can present identically to dogs with “normal” osteoarthritis/degenerative joint disease but require very different treatment. For example, dogs with osteoarthritis are commonly prescribed NSAIDs like Rimadyl to address their pain, but dogs with IMPA require immunosuppressant drugs to control their pain. If a dog goes to the vet for pain, stiffness, or limping and thorough diagnostics are skipped in favor of jumping straight to medication, a dog with undiagnosed IMPA might be given Librela, then experience an increase in pain and inflammation. Autoimmune side effects are still being discovered, so we recommend that dogs with any autoimmune conditions should not be given Librela. Unknown & Long Term Safety Concerns Safety and efficacy studies on Librela were only 84 days long (less than 3 months!) and were performed on young dogs free from other health conditions. Consider that senior dogs struggling with arthritis pain are the most likely patients to receive Librela and are also nearly guaranteed to have other conditions that may be complicated by Librela.  There are no long term safety studies. We are discovering long term side effects only after Librela was approved for widespread use in the US. It is not known what will happen to dogs that are on Librela long term. A 2025 study published in Frontiers in Veterinary Science found that “ Ligament/tendon injuries, polyarthritis, fractures, musculoskeletal neoplasia, and septic arthritis were reported nine times more frequently in Librela-treated dogs ”.² The same study compared Librela’s reports of adverse effects between November 2020 (its european release) and 2024 against a 20 year period for other, better established drugs. Most shockingly, Librela accumulated 3 times more reports of adverse effects than all comparator drugs combined. “Librela has accumulated 20 times more reports [of adverse effects] than the highest-ranking comparator drug (Rimadyl)”. NGF Inhibitor Treatments in Humans Monoclonal antibodies are used in human medicine for many different applications, but development of those that target NGF in humans were halted by the FDA from 2010-2012 due to significant reports of Rapid Progression Osteoarthritis (RPOA) and Osteonecrosis (bone death). “RPOA is characterized by an accelerated deterioration of joint structures, leading to severe pain and functional impairment."³ Incidence and severity increased the longer a patient was on an NGF inhibiting treatment , but some patients developed symptoms after only one dose. The concurrent use of NSAIDs like Advil or Aleve, the most common treatment for OA, may have also been a contributing factor. Research and development later resumed, but RPOA and adverse neurological side effects have continually been observed in studies on multiple variations of human NGF inhibiting treatment. In 2021, the FDA rejected Pfizer’s human NGF inhibitor tanzumab  because there was no evidence that it was more effective than traditional painkillers like Ibuprofen and it posed too great a risk for RPOA . 4 Teva & Regeneron’s fasinumab  is currently in development and a December 2024 study still shows an increased risk for neurological and musculoskeletal adverse effects that increased with higher dosage. 5 As of August 2025, Librela is being further investigated due to case reports of Rapid Progression Osteoarthritis (RPOA) in dogs given Librela. As of September 2025, there are no NGF inhibiting treatments approved for use in humans. How to Use Librela as Safely as Possible Try Other Treatments First Studies have shown that NSAIDs are equally effective at treating osteoarthritis pain when compared to Librela. All medications have some level of risk but at least NSAID related side effects are well documented and can be reduced if your dog’s bloodwork is checked on a regular basis, which is recommended for all senior dogs anyway. Commonly used NSAIDs include Rimadyl (carprofen), Metacam (meloxicam), and Galliprant (grapiprant). Some patients respond better to one than the other, so be prepared to potentially switch to a different NSAID if your dog doesn’t tolerate the first one you try. Other non-NSAID medications, like Gabapentin or Adequan, are also good, well-established options. Read our Pain Meds & Supplements article to learn more about commonly used medications. Physical Rehabilitation Rehab is recommended with or without Librela! A prescribed Rehab treatment plan may even be enough to avoid using Librela all together. Dogs on Librela still need the other aspects of their osteoarthritis attended to including weight management and safe exercise. Weight management is the most impactful aspect of treating osteoarthritis. CROC’s treatment plans include an evaluation of your dog’s diet to make sure all nutritional requirements are met while optimizing weight and muscle mass. Safe exercises, like those prescribed by CROC’s medical team, will help improve musculature that is integral for supporting your dog’s joints and preserve range of motion, all of which helps your dog remain comfortably mobile.  Don’t Skip Diagnostics! Electing to give your pet Librela without prior diagnostic screening is a big gamble! Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated to rule out auto-immune and neurological conditions before starting Librela. This should include a nose-to-tail physical exam, bloodwork (chemistry + complete blood count) and radiographs at a minimum. Depending on the results of those initial diagnostics, your dog may require evaluation with a neurological or orthopedic specialist instead of Librela. To Summarize While Librela can be a very effective method of pain relief, it is not well studied and serious side effects are still being discovered. Studies show that well established drugs like Rimadyl or Metacam are equally effective at treating pain and have fewer reports of adverse effects. Librela doesn’t treat inflammation or the physical damage that occurs within the joint, so it should not be used as the only treatment for your dog’s osteoarthritis. Weight management and safe exercise are still integral to your dog’s comfort and mobility. Dogs with neurological or autoimmune conditions should never be given Librela. Dogs that are breeding (even males), pregnant, lactating, or still growing should not be given Librela. The FDA has not approved any human equivalents to Librela because the risk of patients developing Rapid Progression Osteoarthritis (RPOA) was too great. RPOA is being reported in Librela patients now. Librela should not be a first line treatment and before starting Librela, your dog should be thoroughly evaluated and have comprehensive bloodwork and x-rays performed.  References Enomoto, M., Mantyh, P.W., Murrell, J., Innes, J.F., Lascelles, B.D.X., (2019). Anti-nerve growth factor monoclonal antibodies for the control of pain in dogs and cats. Veterinary Record of the British Veterinary Association . https://bvajournals.onlinelibrary.wiley.com/doi/10.1136/vr.104590 Farrel, M., Waibel, F.W.A., Carrera, I., Spattini, G., Clark, L., Adams, R.J., Von Pfeil, D.J.F., De Sousa, R.J.R., Villagra, D.B., Amegual-Vila, M ., Paviotti, A., Quinn, R., Harper, J., Clarke, S.P., Jordan, C.J., Hamilton, M., Moores, A.P., & Greene, M.I. (2025). Musculoskeletal adverse events in dogs receiving bedinvetmab (Librela). Frontiers of Veterinary Science, volume 12 . https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2025.1581490/full Mobasheri, A., Hanson, P., Larkin, J., (2025). Rapidly progressive osteoarthritis (RPOA) in companion animals treated with bedinvetmab (Librela™): an expected pathophysiological phenomenon or a cause for concern?. Frontiers of Veterinary Science, Volume 12 - 2025 . https://www.frontiersin.org/journals/veterinary-science/articles/10.3389/fvets.2025.1640217/full Jimenez, D., (2021). FDA panel votes against Pfizer’s tanezumab for osteoarthritis pain. Pharmaceutical Technology . https://www.pharmaceutical-technology.com/news/fda-pfizer-tanezumab-safety/ DiMartino, S.J., Mei, J., Schnitzer, T.J., Gao, H., Eng, S., Winslow, C., Ho, T., Turner, K.C., Hassan, H.E., Patel, Y., Davis, J.D., Trinh, N., Manley, A., Manvelian, G., Fetell, M., Braunstein, N., Geba, G.P., Dakin, P., (2024). A phase III study to evaluate the long-term safety and efficacy of fasinumab in patients with pain due to osteoarthritis of the knee or hip. Osteoarthritis and Cartilage Open, volume 6, issue 4 . https://www.sciencedirect.com/science/article/pii/S2665913124001006 Bimonte, S., Cascella, M., Forte, C.A., Esposito, G., Cuomo, A., (2021). The Role of Anti-Nerve Growth Factor Monoclonal Antibodies in the Control of Chronic Cancer and Non-Cancer Pain. National Library of Medicine . https://pubmed.ncbi.nlm.nih.gov/34234542/ Dakin, P., DiMartino, S.J., Gao, H., Maloney, J., Kivits, A.J., Schnitzer, T.J., Stahl, N., Yancopoulos, G.D., Geba, G.P., (2019). The Efficacy, Tolerability, and Joint Safety of Fasinumab in Osteoarthritis Pain: A Phase IIb/III Double‐Blind, Placebo‐Controlled, Randomized Clinical Trial. National Library of Medicine . https://pmc.ncbi.nlm.nih.gov/articles/PMC6900077/

With the plethora of pet products available, it can be difficult to make choices for your pet. While CROC does not prescribe medications, our medical team is here to help you understand your options so you can work with your Primary Veterinarian to find what works best for your pup. The following information regarding these medications and supplements is sourced from our many years of Veterinary Medical education and experience. We have no affiliation with any company that produces the medications or supplements discussed herein. Prescription Pain Relief Adequan (Polysulfated glycosaminoglycan)  Adequan is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication . If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team.  Non-Steroidal Anti-inflammatory Drugs (NSAIDs) Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their generics are Non-Steroidal Anti-inflammatory medications that can be extremely helpful for managing pain and inflammation and since many generics exist, it can be easier to find one that fits your budget. They can have long term side effects to the liver and kidneys so regular bloodwork is strongly recommended to catch any change in organ function early. They must also be given with food! Some pets don’t tolerate these medications well and can have GI side effects like stomach ulcers and gastrointestinal bleeding, but these typically resolve when the medication is stopped and sometimes its just a matter of switching to a different NSAID. It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. Some pets REALLY like the taste of the flavored tablets so store these medications with caution, securely out of reach of your pet. These NSAIDs work similarly to human Advil (ibuprofen) but human medications like Advil are extremely dangerous for animals and should never be given to your dog. Galliprant (grapiprant)  Galliprant is a newer type of Non-Steroidal Anti-inflammatory that has less side effects than the more widely known NSAIDS listed above. It is reported to have less effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Because it is newer and a more specific medication, it is generally more costly than the above listed NSAIDS that have been around longer.  Neurontin (gabapentin) Neurontin is a medication primarily used to treat nerve pain, though it can also help with anxiety. Many pets experience some level of drowsiness when they first start this medication, but they usually become accustomed to it and return to their normal energy level after some time. Besides temporary sedation when first started, other side effects are extremely rare. This medication is a good option for pets that cannot tolerate NSAIDS and it can also be used alongside NSAIDS and many other medications.  Tramadol Tramadol is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs. Newer studies on this medication show that it may be less effective than previously thought, with only a small fraction of dogs getting any pain relief from it. Side effects from Tramadol include sedation, vomiting, diarrhea, constipation, and loss of appetite. Librela (bedinvetmab)   Librela is the newest Osteoarthritis treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. Librela is a monoclonal antibody (a protein that has been engineered to bind to a single target) that targets Nerve Growth Factor which helps reduce pain caused by Osteoarthritis. It can be extremely effective for the right patient but can have serious neurological and/or autoimmune side effects. To learn more, check out our article, A Look at Librela . Regenaflex K9 We recently became aware of this injectable medication and researched it thoroughly to see if it might be another good option for our patients. The lack of documentation on this product is highly alarming. This medication has not been FDA approved and lacks a non-proprietary drug name which is required for most drugs before they can be introduced to the US market. The manufacturer boasts that Regenaflex K9 can improve healing of a wide variety of conditions because it is made using tissues collected during a horse’s birth (likely umbilical cord and placenta) but there are no peer reviewed studies that prove efficacy or safety . The only study they have published lacks a date of completion/publication, involved just 25 dogs, and was uncontrolled, unblinded, and had very minimal objective assessment. This means that the placebo effect cannot be ruled out and it is completely unknown if any of the dogs suffered systemic side effects because they did not perform any labwork or imaging before or after injecting their test subjects. In addition, this study lasted just 60 days, meaning that there was no follow up to confirm that these dogs did not suffer long term side effects. Until it is FDA approved and peer-reviewed evidence of its safety and efficacy is made public, we strongly advise against use of Regenaflex K9 . A Note on Supplements Unfortunately, supplements are not regulated like medications are, so it can be difficult to choose a quality product. Supplements go to market without FDA oversight and cannot be removed from the market without the FDA proving that they are harmful. The company that makes the supplement is responsible for making sure their product is safe but they do not have to prove that it is effective. Generally speaking, companies that make both medications and supplements are more likely to have their supplement processes up to FDA standards. One thing you can look for is the National Animal Supplement Council (NASC) seal. To be permitted to use the seal on their product, a supplement company must adhere to NASC’s quality standards, pass random third party testing of their products to confirm they are accurately labeled, and pass a third party audit every two years. NASC does not verify efficacy or evaluate product studies. If you can find a product that has performed a random controlled clinical study, that would be ideal. Bonus points if they have multiple! It’s also important to keep in mind that supplements are intended to support health and wellness; not treat disease. Vitamins and supplements do not replace medical treatments or prescription drugs. If the patient is being fed an AAFCO approved diet that is appropriate for their age and breed, there is often no need for supplementation. In addition, the more supplements that a patient is on, the more likely they are to have an adverse reaction . About 10% of pet poison control cases are related to supplements. Supplements can have negative interactions with other supplements or medications that your pet is on, so you should always consult with your Veterinarian before giving your pet a new supplement. Make sure that you can accurately relay the brand, ingredients, and strength of the supplement so it can be adequately evaluated.  If you choose to use a supplement intended for humans, you’ll need to be extra wary. It’s not uncommon for human supplements to include ingredients that would be harmful to a pet. For example, a dog given a human supplement that has Vitamin D in it can overdose on Vitamin D since human dosage is higher. We often see CBD products, both pet and human products, that have ingredients in them that are extremely toxic to animals like xylitol.  Our Favorite Supplements  Joint supplements may be helpful to stimulate cartilage matrix production and inhibit enzymes that break down cartilage. Dasuquin Advanced with Egg Shell Membrane (made by Nutramax) is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, Omega-3 fatty acids, peptides sourced from egg shell membrane, and several herbal extracts all formulated to work together and maximize their impact. We like that Nutramax is made in the US, performs rigorous testing of all ingredients before they are accepted into their facility, has strict procedures for manufacturing, and frequently tests their products to confirm safety and accuracy. Dasuquin comes in a tasty, chewy treat, making it an easy addition to your daily routine but you will also need to make sure that it is stored correctly as some dogs like them a little too much and will eat the whole bag! Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. We don’t have any specific brand to recommend but you can use the recommendations above to select a quality product. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Studies have shown that Fortetropin improves muscle health, reduces muscle loss (atrophy), and promotes muscle growth after surgery or other disease processes. It has also been shown to help skin, coat, cognitive, and bone health. We like this supplement for senior dogs and those recovering from surgery. As dogs age, they tend to lose muscle mass more quickly and it is more difficult for them to regain muscle. Dogs recovering from surgery typically require exercise restriction (remember that muscle atrophy begins after just 72 hours of inactivity) and they may have already been losing muscle before surgery. For example, if a dog is favoring a limb for weeks or months before surgery. Myos Muscle Formula comes in a powder that is sprinkled on their food and most dogs really enjoy it. It is very rich so if your dog has a sensitive stomach, we recommend starting slowly and working your way up to the recommended dose over several days/weeks. There are anecdotal reports of dogs with chicken allergies being able to tolerate this supplement if started on very low quantities that are slowly increased. While not yet NASC certified, as of October 2025, it is expected to complete the auditing process in 2026. We were able to secure a discount code for CROC patients! Use " CROC20" to get 20% off. In Summary While CROC does not prescribe medications, our medical team is here to help you understand your options so you can work with your Primary Veterinarian to find what works best for your pup. Before using Librela, your dog should be thoroughly evaluated to rule out any neurological or autoimmune conditions as Librela can significantly worsen these conditions and those side effects don’t always reverse when Librela is stopped. At this time, we strongly advise against the use of Regenaflex K9 because there are no peer-reviewed, controlled studies to prove safety and efficacy. We will continue to monitor this drug and update our recommendation as more information is made public. Because supplements are not regulated like medications are , it is necessary to research the company and make sure that you are purchasing a safe and effective product. Look for the NASC seal and efficacy studies! Always discuss new supplements with your Veterinarian before giving them to your dog. The more supplements and medications your pet is on, the more likely they are to experience an adverse reaction.

Hip Dysplasia is a common condition, especially in large breeds, that often leads to pain and lameness. Given its prevalence and considerable impact on a dog’s life, it should be taken seriously. Fortunately, there are many things you can do to help keep your dog active and comfortable despite the condition. What is Hip Dysplasia? The hip joint consists of the acetabulum (the concave socket in the pelvis) and the femoral head (the ball on the femur), as well as cartilage to ensure easy movement and several muscles to support and move the joint. A normal hip joint has a snug but smooth fit, allowing for pressure to be evenly distributed throughout the joint. Dysplastic hips develop abnormally, leading to laxity between the acetabulum and femoral head which then causes excess wear and tear. The body tries to stabilize the joint by developing Osteoarthritis but this further contributes to the pain a hip dysplasia patient experiences. Who is Affected? Hip Dysplasia is most common in large and giant breeds, especially Labrador Retrievers, Golden Retrievers, German Shepherd Dogs, Saint Bernards, Old English Sheepdogs and Bulldogs, but it can occur in any breed or mix. It is a genetic condition, but there are additional factors that can increase risk or severity such as nutrition, exercise, and weight. Body weight has been shown to be the most significant variable. Early spaying/neutering may also increase risk. How is it Diagnosed? Some dogs will show symptoms of Hip Dysplasia at a very young age, while others won’t until they are much older. Signs of Hip Dysplasia include: Stiffness Weakness Limping Abnormal gait Difficulty rising, laying down, or sitting Reluctance to use stairs Thigh muscle atrophy Enlarged shoulder muscles Pain Radiographs (x-rays) are the easiest way to assess a dog for Hip Dysplasia, but proper positioning and the age of the dog can impact the accuracy of hip radiographs. If the radiographs are not definitive, sedation may be recommended to get better quality images and having the radiographs performed by a Veterinary Orthopedic specialist can be helpful as well. Ask your veterinarian if they regularly perform OFA (Orthopedic Foundation for Animals) and/or PennHip ( University of Pennsylvania Hip Improvement Program)  radiographs , as the technique for these has been proven to be the best for accurate imaging.  Your veterinarian should evaluate your dog’s gait, range of motion, and musculature. As the hips become more painful, dogs will use their front legs to compensate by shifting more of their weight forward and off the hind legs. It is also common for them to have an exaggerated sway of their rear end because they are using their back to swing the rear legs forward instead of the hip muscles. When they avoid moving their hips due to pain, their Range of Motion will decrease and the muscles of the hind legs will atrophy.  Treatment varies pending the severity of dysplasia and level of pain it causes. Some dogs can get by with Physical Rehabilitation Therapy and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) as needed , while others require orthopedic surgery to address their pain and loss of mobility. Symptoms usually worsen as the dog ages because more osteoarthritis will have formed and increased pain leads to less activity and thus atrophy of the muscles that support the joint. Surgical Treatments Surgery isn’t always required for a dysplastic dog to have a comfortable and happy life, but it can be a game changer for dogs with moderate to severe Hip Dysplasia. There are 3 surgeries available to treat this condition. Femoral Head Ostectomy (FHO) This is the most commonly performed Hip Dysplasia surgery because it is less complicated, less expensive, and has a good success rate with few complications. An FHO consists of removing the femoral head, or the ball part of the joint. The muscles and ligaments around the joint will then take over, creating a “false joint”. Since the limb will be supported exclusively by soft tissues, Physical Rehabilitation Therapy will be of utmost importance in order to maintain strong hip muscles. Recovery from this procedure is typically around 6 weeks, with active pets often recovering better than inactive ones. As FHO patients age and normal age-related muscle loss occurs, they often return to Physical Rehabilitation Therapy to rebuild those hip muscles that are essential for mobility. Total Hip Replacement (THR) This is now considered the Gold Standard procedure for Hip Dysplasia. Our local Orthopedic specialists are finding that "95% of dogs that undergo this procedure regain normal function and maintain it for life". THR used to be limited to dogs that were fully mature and finished growing, but newer developments make this procedure more accessible for a variety of ages and the array of implant sizes means that surgeons can mix and match for the perfect fit for each patient. Previous techniques and hardware for this surgery were not as successful, so if you are interested in pursuing this procedure for your dog, make sure to utilize a board certified veterinary surgical specialist that is experienced with newer methods. Much like the human hip replacement, this surgery involves removing the dysplastic parts of the joint and replacing them with artificial implants. A metal implant is used to replace the femoral head and a plastic implant replaces the acetabulum. Recovery from this procedure is typically around 3 months, with exercise restriction being integral to boney healing in the early stages. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature so they can return to their favorite activities more quickly. Double or Triple Pelvic Osteotomy (DPO/TPO) Because hip dysplasia causes excess laxity in the joint, the femoral head can dislocate from the acetabulum. The pelvis consists of four bones that fuse together at maturity. This surgery involves 2-3 incisions and 2-3 cuts into the pelvis to manipulate those bones before they have fused to better surround the femoral head, thus preventing it from dislocating. Because this surgery must be performed before the pelvic bones have fused together, it can only be used on young dogs with minimal osteoarthritis formation. Recovery from this surgery can take around 4 months and activity restriction will be extremely important while the pelvis is healing. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature. Juvenile Pubic Symphysiodesis (JPS) If Hip Dysplasia is diagnosed at a very young age, this surgery can be performed to improve joint stability and reduce osteoarthritis formation for both hips at once. This procedure involves cauterizing the growth plate of the pubis in order to stop growth in that area of the pelvis. As the dog matures, the acetabulum will end up in a better position to enclose the femoral head, thus avoiding the laxity that then leads to osteoarthritis. Because this procedure’s success depends on interrupting growth, it should be done before 5 months of age and ideally no later than 4 months of age for maximum benefit.  Medication We'll briefly cover commonly prescribed medications here but encourage you to visit our Pain Meds & Supplements article to learn more about how they work, side effects to watch out for, and how to choose quality supplements. Adequan (Polysulfated glycosaminoglycan) is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. NSAIDs like Rimadyl (carprofen) and Metacam (meloxicam) are commonly used to relieve pain caused by osteoarthritis and hip dysplasia. These are usually well tolerated, but bloodwork should be performed to ensure that your dog has normal liver and kidney function before using these medications long term and it is good practice to regularly check bloodwork during use. Some dogs can experience gastrointestinal upset with these medications, so they should be given with food and discontinued if symptoms continue. If a dog cannot tolerate Rimadyl or Metacam, Galliprant (grapiprant) is another NSAID option that functio ns differently and should be better tolerated. However, because it is a newer drug, it does not yet have a generic available and is often more expensive than other NSAIDs. Neurontin (gabapentin) is a human medication that is commonly used off-label for dogs and cats to manage pain and anxiety. It’s not entirely known how it works, but it is thought to block nerve cells from communicating pain signals. Lethargy is a common side effect, but after some time, most dogs will acclimate and no longer experience lethargy while still benefiting from the pain relief Gabapentin offers.  A Quick Note About Librela Librela (bedinvetmab)  is the newest Osteoarthritis treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. It can be extremely effective for the right patient , allowing dogs to return to their favorite activities while potentially reducing the need for daily medications. However, the adverse effects reported with this new medication are highly concerning and side effects are still being discovered. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela . This should include bloodwork and radiographs at a minimum and may require evaluation with a neurological or orthopedic specialist. To learn more, visit our article A Look at Librela . Dogs with neurological conditions, auto-immune conditions, breeding dogs, or dogs that are skeletally immature should not be given Librela. Librela does not cure Hip Dysplasia. Dogs on Librela sometimes feel so good (since they can’t feel the pain) that they overdo it and cause further injury to themselves. It is best to introduce Librela alongside a structured exercise plan to avoid injury and only after thorough diagnostic screening to rule out auto-immune and neurological conditions. Supplements We'll briefly cover supplements here, but we recommend that you visit our Pain Meds & Supplements article to learn more about how they help and how to pick quality supplements. Dasuquin Advanced with MSM is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. Weight Management Keeping your dog at a lean body weight is the most important aspect of managing this condition. Fortunately, it’s also one of the easiest! Sometimes, it’s as simple as adjusting their meal portions. Other times, a complete switch to a new food is necessary. These days, there are a wide variety of AAFCO formulated Weight Management or Weight Loss diets readily available for purchase. Some are even specifically formulated for Senior Pets or for those needing extra Joint Support. Be sure to look for diets that are high in Essential Fatty Acids. Generally speaking, your goal Body Condition Score for a dysplastic dog is a 4 out of 9, a little on the skinny side. If you'd like more information about managing your dog's weight, be sure to read through our article, Body Condition Score & Canine Weight Loss . Exercising at Home As part of your Consultation with us, you will be provided with Veterinarian Prescribed Rehab Exercises (your dog’s Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. Always have your pet warm up before exercise and cool down after exercise. There should never be sudden changes between inactivity and exercise. Osteoarthritis flare-ups are common and can even be caused by changes in the weather. Regular walks, tailored to your pet’s abilities are an important part of keeping those arthritic joints moving, reducing stiffness. Make sure to do shorter, more frequent walks instead of one long walk every day. Avoid becoming the “Weekend Warrior” as over-exercising and acrobatic activities such as ball and Frisbee chasing are recipes for pain and stiffness later. Unfortunately, this also applies to rough play with housemates and other animal friends. Your dog may have once been the rough and tumble, go-go-go type, but it’s important to think of a Hip Dysplasia dog as an antique luxury car. They’re still wonderful and should be taken out to enjoy the world, but great care should be applied when doing so. Regular maintenance and preparation will make all the difference for your dog’s experience. Our article, Motion is the Lotion , discusses the importance of consistent but safe exercise in maintaining range of motion and muscle mass. Swimming is frequently thought of as a low impact and helpful exercise for Hip Dysplasia dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups. The act of swimming can also put a lot of stress and extra movement on the spine. Opt instead for walking in warm water at your dog’s armpit level. Do this at very slow intervals to decrease the repetitive grinding of any arthritic joints. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. To learn more, check out our Medical Library article, The Deep Dive into Swimming . Physical Rehabilitation Participating in Physical Rehabilitation Therapy at CROC allows your dog to get exactly the exercises and pain relief that they need on a regular basis to keep them comfortable and mobile, while also slowing the progression of their osteoarthritis and atrophy. Our team closely monitors your pet’s abilities and adjusts their sessions as needed while also keeping you updated as your pet progresses. Therapy Sessions at CROC include multiple pain relief modalities like Thermotherapy, Cryotherapy, Laser Therapy , Therapeutic Ultrasound, PEMF, E-Stim, and Massage Therapy to be used as appropriate for your pet’s condition. Veterinary Medical Acupuncture is another option CROC offers to provide pain relief and increase circulation. Prescribed Target Exercises and Underwater Treadmill Hydrotherapy build muscle and maintain good range of motion while avoiding soreness or pain associated with other types of exercise. Daily participation in at-home exercises wearing you down? Let us do some of that work for you and take your pet home feeling better than when you dropped them off. As your pet ages, it will be even more important to maintain a lean body weight and good musculature to support their dysplastic joints. Resuming therapy before their mobility declines will help keep your pet strong and mobile well into their senior years. For FHO patients, this will be of particular importance since musculature is the only thing keeping their hind limbs functional. Environmental Modifications Use a good quality dog bed! Memory foam is an ideal material. 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 position frequently, such as switching which side of their body they lay on. Laying in one position for extended periods of time will lead to significant stiffness and pain once they go to get up. Slippery, hard floors are tough on Hip Dysplasia dogs. Rugs, yoga mats, and the like are extremely beneficial to help keep your dog on their feet and avoid slips and falls. Can Hip Dysplasia Be Prevented? Hip Dysplasia is the most common inherited condition, so efforts to reduce a dog’s risk of developing it begin with the breeder. A responsible breeder will have their dogs’ hips evaluated using OFA and/or PennHIP standards and will only move forward with the breeding if both dogs have healthy hips. PennHip radiographs can only be performed by a veterinary professional that has been certified by the PennHIP program and sedation/anesthesia is required but it has been proven to be accurate for dogs as young as 4 months old. OFA requires that a dog be at least 2 years of age and while sedation/anesthesia is recommended, it is not required.  A puppy’s risk for developing Hip Dysplasia can also be heavily impacted by exercise, nutrition, and body weight. Puppies under 3 months old that exercise on hard, slippery floors or have access to stairs as well as dogs under 2 years of age that frequently play fetch are at higher risk. Excess body weight puts unnecessary strain on the body and during periods of growth, can negatively affect skeletal maturity. For this reason, it’s important to feed measured portions and to use puppy food that is nutritionally balanced and appropriate for your breed. Large breed puppy foods are formulated specifically for the immense growth they experience to give them the support they need without causing inappropriately accelerated growth. To Summarize Responsible breeding is the first step of reducing a puppy's risk for Hip Dysplasia and dogs should be evaluated using OFA or PennHIP standards before being bred. Body weight, activity level, and nutrition are significant variables for dogs of all ages. Hip Dysplasia can impact your dog's life, but there are options to relieve your dog's pain and keep them active such as medications, Physical Rehabilitation Therapy, and/or surgery. It can be difficult to know which are the right options for your pet but the CROC team is always available to discuss your pet's case specifically and to help you find a management plan that fits your lifestyle and your dog's needs. Thank you to Izzy's mom, Dina, for permitting us to share Izzy's pre- and post-operative Total Hip Replacement radiographs! We wish her well on her recovery journey! <3 the CROC Team

*** The tips and 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.*** To help reduce your Canine Athlete's risk of injury, check out our first three Canine Sports Medicine articles! We understand that pet diets can be a highly contentious subject. The information included here is based on clinical studies & without influence by commercial or alternative dog food/supplement companies.  Proper nutrition is vital for the performance, recovery, and healing of the Canine Athlete's body. The type, quality, and amount of calories required will vary between dogs based on their activities, lifestyle, and any medical conditions. Sprinting dogs need more carbohydrates while endurance dogs need fat as the major fuel for exercise. Most athletes are kept lean to reduce strain of excess weight, so if more weight is desired, that weight should be gained in muscle rather than fat. Home-Cooked Diets High protein, non-commercial dog foods, typically including fresh, high quality meats and vegetables prepared at home, have become increasingly popular. Unfortunately, the majority of these diets are wildly unbalanced and lacking essential vitamins and amino acids that must be ingested as they cannot be made by the body. These nutritional deficiencies can lead to long term consequences. Calcium is often a problematic ingredient. Too little and a dog may become inappetent, weak, and potentially even have seizures. Too much and a dog may experience increased thirst and urination, inappetence, & bladder or kidney stones. To ensure that your Canine Athlete is getting all the nutrients they need, it is advised that home-cooked diets are supplemented with an AAFCO-approved commercial dog food for a minimum of 25% of a dog's meals. If possible, consult with a board-certified Veterinary Nutritionist to make sure your dog’s diet is balanced and complete. Our Gear & Resources page also includes links for fresh ingredient diets. All Meat Diets Like home-cooked diets, feeding primarily or only meat is not recommended due to nutritional deficiencies. While not likely to be detrimental over short periods of time, extensive studies have shown that Canine Athletes perform better with a diet composed of 30% protein, 50% fat, and 20% carbohydrates. Carb-loading is a human sport principle that has been applied to Canine Athletes in multi-day events. Protein & carbs are given post-exercise as protein helps curb muscle loss & carbs replenish glycogen within the muscles to prevent the body from breaking down lean muscle. A plethora of studies have proven that this combination is best achieved with a commercial dog kibble. Grain Free Diets These diets were heavily marketed by boutique food manufacturers that lacked food laboratory feeding trials & research. It has become abundantly clear from overwhelming evidence that diets touted as high in legumes/pea proteins & grain free result in Cardiomyopathy, a serious & sometimes fatal heart condition. You can visit our Research & Trusted Sources page for links to peer-reviewed studies and published works from esteemed veterinary professionals. Grain free diets are, thankfully, becoming less popular as pet owners are in favor of safer, healthier alternatives. Look for wheat, corn, barley, oats, millet, or rice in the ingredients when selecting your Canine Athlete’s diet to ensure the formula is grain inclusive. Sporty Poops Even seasoned Canine Athletes can experience diarrhea related to competition stress or exercise. In humans, it’s referred to as “Runner’s Diarrhea”. Exercise can increase gut motility, making for loose and more frequent stool and stress or excitement can release hormones that loosen stool as well. The binding properties in supplements or commercial dog foods containing Chicory Root, Beet Pulp, or Psyllium Husk Fiber will help improve fecal quality. Canned pumpkin is also known to firm up softer stools & loosen hard stools. To balance bowel movements, use 1-2 tablespoons per meal for several days. Your Canine Athlete should have access to fresh water at all times, but hydration will be especially important if they are experiencing diarrhea on a big working/sporting day. When to Feed the Canine Athlete Food is fuel but when & how it's offered can affect performance. When feeding your Canine Athlete, do so with timing & frequency in mind to reduce fecal bulk while aiming to maximize metabolites. Field studies have proven that sprinting dogs running for less than 10 minutes in a single event benefited most from a 20% reduction in feed during the 24 hours prior to the event. It was previously common practice to "Carb Load" prior to burst exercise but that has been proven to be unhelpful for these Athletes. If Canine Athletes that participate in multiple bouts of exercise throughout the day are expected to perform again after 2-3 hours of rest, they benefit most from small amounts of carbohydrates immediately after exercise. However, if they are expected to perform within 2 hours of their initial event, food should be avoided to prevent regurgitation. During multi-day events or work assignments, carbohydrates should be provided within 30 minutes of the last exercise of the day in order to replenish glycogen in the muscle & reduce muscle break down. Gastric Dilatation & Volvulus (GDV) Due to high risks of GDV, it is not advised to feed large meals within 2 hours before or immediately after exercise, especially for large breeds with deep chests. Colloquially referred to as Bloat, a twisted stomach, or stomach torsion... GDV is life threatening if not identified and treated right away. It is most commonly associated with eating quickly or exercising on a full stomach of food/water. It initially begins with the stomach expanding to accommodate the food/water and dogs will display signs of discomfort like drooling, retching without producing anything, stretching, and restlessness.  As things worsen, the stomach can become so enlarged that it flips over on itself, which then cuts off vital blood supply to the stomach and spleen and interferes with circulation throughout the body . As the stomach continues to expand, this puts pressure on the diaphragm, making breathing difficult, further reducing oxygenation to the entire body. Abnormal heart beats are common as the lack of oxygen worsens and the stomach can sometimes rupture. Some dogs can be particularly stoic and not show any obvious signs of GDV until they have collapsed. Emergency medical care is required for this condition and at a certain point, surgery will be required for survival. GDV patients often go into shock and will need extensive care to stabilize them as they go into emergency surgery and will require hospitalization afterwards. While any breed or mix can experience GDV, Great Danes, Standard Poodles, German Shepherds, Irish Setters, Irish Wolfhounds, St. Bernards, Akitas, Weimaraners, & Boxers are most commonly affected. Middle aged and senior males are at the highest risk and there is an increased risk for dogs with deep chests, are fed once daily, or are related to a dog that has experienced GDV. Feeding from elevated food bowls, history of splenectomy, eating a diet with oils among the first four label ingredients, and stress are suggested as additional risk factors. There is a high rate of recurrence, so consistent and careful management will be required for any dog that has experienced GDV. Gastropexy, sometimes referred to as “tacking the stomach”, is a procedure in which the stomach is sutured to the abdominal wall to prevent the Volvulus (twisting) part of GDV, but it cannot prevent Dilatation (bloat).  Supplements Canine Athletes are more likely to develop chronic joint pain due to early or chronic osteoarthritis associated with their lifestyle. Long-chain Omega 3 Fatty Acids and other nutraceuticals can help reduce inflammation and improve mobility in joints affected by osteoarthritis. The most common source for these are commercial diets with Palmitic, Oleic, Linoleic, Alpha-linoleic, & Arachidonic acids as these are all Omega 3 or 6 Fatty Acids associated with mitigating inflammation & joint disease. Protein powders for dogs also exist! Supplements like Myos Muscle Formula (Fortetropin) have been proven to help enhance muscle growth & in addition to supporting the Canine Athlete’s peak fitness, it can also be used to restore muscle lost to injury or disease. Myos Muscle Formula can sometimes be quite rich for sensitive stomachs, so we recommend introducing this supplement slowly and over several days to weeks. For more information on these supplements and how to choose quality products, check out our Pain Meds & Supplements article. Hydrating Your Hound When we humans sweat, we lose water & electrolytes that require replenishment. Since dogs sweat very little & only from their feet, they lose the most water when panting. Replenishing lost electrolytes is good for us, so should Canine Athletes be given electrolytes on working days? No! If you add electrolytes to your dog’s water, the charge of the electrons will pull water from the tissues in the body into the intestines. This means taking hydration away from the muscles & other organs needed for their current activities & only contributes to their overall dehydration. Instead, fresh water without any additives should be available to your Canine Athlete at all times. Canine Rehab OC offers custom Fitness Plans by appointment. 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. 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 4 of our 5 part Canine Sports Medicine series! Other articles include: Part 1: Peak Performance & Injury Prevention Part 2: Cross-Training Part 3: Common Conditions & Injuries Part 5: Bad Dogs, Bad Medicine  (Effects of Behavior on Quality of Care)

*** The tips and 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.*** To help reduce your Canine Athlete's risk of injury, check out our first two 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. 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  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. This injury is common in water sports, like swimming and dock diving, as well as frequent jumping down or even poor landings in fly sports. Mild shoulder lameness is usually the first sign, followed by pain on extension of the shoulder joint.  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 and 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 and 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, and dogs that live exclusively on hard surfaces like tile and 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 and focus on building strength in the forearms and 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. 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.  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.  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 and 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 and 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 and 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.  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) 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. Canine Rehab OC offers custom Fitness Plans by appointment. 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. 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)

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. 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 and often paired with pacing, whining, barking, and/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, and a “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 . 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.   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. A dog suffering from a neurological condition 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.   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. 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. 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. 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 and 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 and 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), and 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 and varied exercise is also very stimulating when done with care and 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 arthritis pain will be treated, often with modalities like 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 and 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 and 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 and 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 and keep in mind that the first, even second or third plan, may not be the right one for you and 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 and 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 and 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 and consider each patient as if they were our own beloved pet, drawing on a wealth of knowledge and 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 and 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. Check out our upcoming Pain Meds & Supplements article for more information on commonly prescribed medications, our favorite supplements, and how to choose quality products. 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. 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 and 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 and 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 and stiff joints begin to warm up and loosen with the dog’s movement and increased circulation, motion then becomes easier and 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 and your dog will find it easier to get up and 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 and joints in motion on a consistent basis will also aid in maintaining their mobility and 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?   The most obvious 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 and 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 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. 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, and heal throughout their healing journey while interspersing periods of structured activity. 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 often influences your pet’s ability to exercise. When it’s cold and rainy out, arthritic joints tend to ache and swell, making exercise painful. When it’s hot and sunny, every dog is at risk for heat exhaustion, heat stroke, sunburns and 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 and supplements recommended; these things will likely 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.   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 and enhancing your pet’s strength, stamina, and mobility to reduce their pain and maximize their life’s quality is what drives us.

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, and end any pain our furry family members might experience. It doesn’t matter if your dog is still 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 and 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. Some obvious signs of pain include limping, inappetence, whining or crying, or even growling and biting at housemates or humans. Less obvious signs include panting, drooling, teeth grinding, reduced mobility, decreased interest in play time or other favorite activities, change in gait, difficulty sleeping, hiding, or having urinary or fecal accidents around the house, but every dog is different and some may have different signs of pain. Continuing to eat is NOT a significant determining factor for your dog’s Quality of Life. Even dogs in obvious and 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, Stretching, Massage, Passive Range of Motion, and Acupuncture may help relieve pain in conjunction with prescribed 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 and cutting your time with your dog short. As Veterinary Professionals, we take an oath to do no harm and 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 and 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 changes in vocalization like 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 and 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 and this situation can quickly spiral into feelings of bitterness and 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 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. Natural death in animals can take an extremely long time to occur, during which your pet is likely to be scared and in pain. 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. The definition of Euthanasia is “Good Death” and that’s exactly why we’d recommend it over allowing your pet to pass naturally. 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. You can make sure that your dog’s last moments are full of joy and love, instead of fear and 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 and 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 and 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 and more research is being done into the human experience of losing a beloved pet and 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. 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. It is our purpose as Veterinary Professionals to speak up for your pet’s needs; to advocate for their treatment. We never want to take priceless time away from you and 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 and 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 and 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. General Practice Veterinarians can perform blood tests and radiographs to rule out other conditions but cannot confirm FCE using those diagnostics. Ultimately, FCEs are diagnosed by Veterinary Neurologists using Magnetic Resonance Imaging (MRI). 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. What Does Rehab for Fibrocartilaginous Embolism Look Like? 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. Pet’s 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 Change up some 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 is rarely recommended for FCE patients. 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. 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. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their patients undergoing Chiropractic treatments. 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. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body. Your dog’s spinal cord is trying to heal and 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 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 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 and 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 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 your dog starts getting around without using their legs, that pretty much seals the deal that they never will. 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 . 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. It’s essential that you keep Quality of Life for you both as a top priority. If your dog is not recovering well and you are not prepared for years of intensive care, it’s time to start discussing the reality of the situation. 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. Tools To Make Your Lives Easier We've gathered links and examples of the following tools on our Gear & Resources page. 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 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! 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. Our Help 'Em Up Harness article covers this device in greater depth. 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. Laying in one position for extended periods of time can lead to decubital ulcers (bed sores) and 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. The less weight there is for them to haul around, the easier it will be to start lifting and moving their own body. 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 . 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. 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. To Summarize 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.

GOLPP is a progressive, degenerative disease that unfortunately does not have a cure. There are, however, things you can do to help your dog with the different aspects of living with the disease and many dogs can still maintain good quality of life and lifespan with proper care. What is Geriatric Onset Laryngeal Paralysis & Polyneuropathy? GOLPP is the term used to describe a grouping of three interconnected conditions caused by degradation of the dog’s nervous system: Laryngeal Paralysis, Megaesophagus, and Paraparesis, usually starting with the hind legs. The Larynx’s (aka the voice box) main functions are to protect the airway when we are eating and drinking, to open up wider when we need to take bigger breaths, and of course to make vocal sounds. It does this by opening and closing folds of cartilage on each side of the opening to the trachea, the primary airway to the lungs. Normal Dog Larynx Laryngeal Paralysis causes the Cartilaginous Folds to collapse inward, blocking the airway. When the muscles controlling those cartilaginous folds start to fail due to Laryngeal paralysis (aka LarPar), they no longer open and close like they used to. They might cough or just have louder breath sounds with even minimal exercise. Sometimes, a change in the sound of their bark is the first thing a pet parent notices. Dogs in severe respiratory distress will have pale or blue coloration of their gums and may completely collapse. Dogs in this state require emergency veterinary care immediately. LarPar dogs struggle to breathe normally, have difficulty cooling themselves in hot weather, and are at higher risk for aspiration. Megaesophagus occurs when the esophagus (the tube that connects your mouth to your stomach) loses its strength and elasticity. As food slides down, instead of being pushed along to the stomach, it builds up in the esophagus, causing further distention and enlargement. Because there isn’t enough muscle strength to move the food along, dogs with Megaesophagus often regurgitate their food. Since dogs with GOLPP aren’t able to protect their airway as a normal dog would, this significantly increases their risk of aspiration which can then turn into pneumonia. Hind Limb Paraparesis means that the dog’s hind limbs become weak and uncoordinated due to neurological deficits (the nerve pathways between the brain and the legs stop conducting signals). They may stumble or even knuckle over their paws and will progressively lose strength and muscle mass. This part of GOLPP is often misdiagnosed as arthritis, hip dysplasia, or “just getting old”. Who is at Risk for GOLPP? Labrador Retrievers certainly seem to be the breed most commonly affected by GOLPP, but Golden Retrievers, Borzoi, Newfoundlands, Greyhounds, German Shepherd Dogs, Siberian Huskies, and other large breeds, as well as mixed breeds, are known to be affected. While there is a congenital form, GOLPP typically affects middle-aged to senior and geriatric dogs, with the average age of onset at 11 years old. Diagnosing GOLPP In the beginning stages of reaching GOLPP as a diagnosis, there are other conditions that must first be ruled out. This is done by performing comprehensive bloodwork and radiographs. Megaesophagus may be visible on your dog’s x-ray, but sometimes requires more specialized imaging to clearly visualize. Your vet should also perform a thorough neurological exam to identify any delays or deficits in your dog’s reflex responses. If your dog’s blood work is within normal limits for their age and no other life-threatening conditions are discovered with radiographs, they will recommend sedating or anesthetizing your dog so they can examine their laryngeal function. Unfortunately, you can’t ask a dog to open up and “saw ahhhh” while a scope is used to look down their throat, so sedation or anesthesia is required to properly perform this exam. During this sedated exam, the veterinarian will watch how your dog’s laryngeal folds behave as they breathe to determine if one or both sides of the larynx are affected. Additional diagnostics like Nerve biopsies and Nerve conduction tests may be recommended as well. Treating GOLPP While there is no cure for GOLPP or even one single treatment, there are ways to treat the symptoms to keep your dog more comfortable. Post-Op Tie-Back Surgery For Laryngeal Paralysis, the Gold Standard treatment is a surgery called a Laryngeal Tie-Back, which should be performed by a Board-Certified Veterinary Surgical Specialist. Most General Practice Veterinarians are not equipped for this specialized surgery. The procedure involves anchoring at least one of the Laryngeal Cartilage folds open, so that the dog can breathe more easily. The downside is that this also means that the larynx cannot properly close to food or liquids, so dogs that enjoy swimming or tend to eat/drink very quickly are at high risk for aspirating (breathing in) water or food into their lungs. Aspiration pneumonia is a serious, potentially life-threatening condition that requires strong antibiotics, sometimes multiple courses, to treat but fortunately it usually responds well to medical treatment. The goal of Laryngeal Tie-Back surgery is to improve quality of life for the affected dog, but it will not improve laryngeal function. Dogs that are unable to get Laryngeal Tie-Back surgery will continue to struggle to breathe, remain at risk for heat stroke during warmer weather, and they still have an increased risk for aspiration. Both surgical and non-surgical patients will need to live in a calm environment, as stress can also instigate respiratory distress. For Megaesophagus, there is no treatment. Instead, changes to the dog’s feeding routine are key for reducing food regurgitation, therefore improving Quality of Life. Many patients with this condition do better with a softened or liquid diet over kibble. They also need a little help from gravity to get the food where it needs to go. This might look like raising your dog’s food bowl or even feeding your dog on stairs with the bowl at the highest step. For the worst cases of Megaesophagus, a Bailey Chair is an excellent option. The Bailey Chair is sometimes called a dog high chair and it certainly looks like one. The concept is that by feeding the dog in an upright position and then keeping them in that position for a short time after feeding, gravity helps pull the food down out of the esophagus into the stomach, after which the dog can safely resume normal activity and retain all the nutrition of the meal. Your veterinarian may also prescribe medications to support the gastrointestinal system. For the hind limb paresis, Physical Rehabilitation is the best course of treatment to maintain strength and coordination in those limbs for as long as possible. By using exercises and treatments specifically designed for GOLPP patients, CROC can slow down your dog’s muscle wasting and neurological decline. Because Physical Rehabilitation at CROC is performed by experienced and licensed veterinary professionals, our team knows how to handle medically fragile patients, carefully challenging your dog’s body without overworking them or putting them at risk for heatstroke. What Does Rehab for GOLPP Look Like? First, our team will evaluate your dog to determine how far their GOLPP has progressed so that we can truly tailor your dog’s therapy to their condition. You will be sent home with target exercises specifically prescribed for you and your dog to do together between Rehab Sessions. Generally, in-clinic Physical Rehabilitation for GOLPP includes: Target exercises to work on balance, coordination, and strength Hydrotherapy for safely improving stamina and maintaining muscle Thermotherapy, Therapeutic Massage, and Laser Therapy to soothe sore, overworked muscles Veterinary Medical Acupuncture to stimulate the nervous system and reduce pain Because CROC utilizes an Underwater Treadmill for hydrotherapy sessions, your dog is at significantly lower risk of aspiration than if they were swimming in a pool since we have precise control over the water level and your dog will remain on their feet for the session. Underwater Treadmill therapy is also more effective for strengthening the back legs than swimming. Lastly, CROC maintains the water at a therapeutic temperature to help support arthritic joints and relax tight muscles, while the buoyancy helps your dog get all the benefits of a high-resistance work out with little to no impact. Through their treatment plan, 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. As your dog’s physical abilities change, CROC continues to adjust their therapy as needed at every single session to make sure they get the most benefit out of every visit. Fortunately, while your dog will be predisposed to pain from compensating for their weak back legs, the disease process itself is not painful. Safety for GOLPP Patients Changing Habits: Remember that GOLPP is a chronic, progressive disease; it never goes away and will continue to worsen. At home, some simple changes can make all the difference to help your dog maintain good quality of life. The goal with home modifications is to make mobility as easy as possible, reduce falling injuries, reduce risk of aspirating food or water, and to reduce risk of heat stroke. Adding rugs or yoga mats to hard slippery floors will help your dog grip the ground better and stay on their feet when getting around their home. Assisting your dog up or down stairs, or even just blocking them off from your dog altogether, will be necessary for safety reasons. Ramps may be helpful for them to traverse small sets of stairs or make it easier to get in and out of the car, but these should also be used under supervision. Raising the food and water bowls may help reduce regurgitation from the megaesophagus, but you may also need to have a schedule for access to these resources or start using a Bailey Chair depending on your dog’s symptoms. Lastly, temperature control will be incredibly important at home. Your dog will not be able to cool themselves on a hot day like a normal dog can. Avoiding strenuous exercise and maintaining cool temperatures inside with Air Conditioning and/or fans is a non-negotiable part of living with this condition. Swimming: Sadly, swimming is NEVER appropriate for GOLPP patients. 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 overworking their already strained front legs while barely working the back legs that actually need the exercise. Swimming also puts immense stress and twisting movements on the spine. Most importantly, swimming puts a GOLPP dog at extremely high risk of aspiration on dirty pool water. Aspiration Pneumonia: The GOLPP dog will forever be at increased risk for aspiration pneumonia, so it’s important to familiarize yourself with the signs and symptoms. Catching aspiration pneumonia early will make it easier and cheaper to treat and get your dog breathing easier sooner. Signs of pneumonia include lethargy, coughing, sneezing, nasal discharge, inappetence, and/or fever. If you even slightly suspect that your GOLPP dog may be exhibiting signs of aspiration pneumonia, have them seen by a veterinarian as soon as possible. This is usually confirmed by radiographs of their lungs and then antibiotics are sent home, as well as appetite stimulants if needed. Regarding Chiropractics... We know this is a soft spot and that many people enjoy chiropractic for themselves. In our industry, it 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 for GOLPP patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one 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. Here's an example of the dangers of Chiropractics: T his is the normal healthy spine of a young dog. Notice that the vertebrae and 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 and 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, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and 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 keep your pet as independently mobile as possible for as long as possible. We can’t stop GOLPP from progressing, but we can slow it down and have multiple methods of treating your dog’s pain and weakness. Because Physical Rehabilitation at CROC is performed in a controlled environment, your GOLPP dog can also come in for therapy on a day that might otherwise be too hot for them to get any exercise. Tools To Make Your Lives Easier We've gathered links and examples of the following tools on our Gear & Resources page. As your pet’s neurological condition declines, they will frequently drag their hind legs, 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 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! Use of any collars around your dog’s neck will no longer be safe so a good harness is a must! Your dog will increasingly 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 GOLPP 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 may not need the back half, but as their coordination and strength declines, the back half of the harness will become 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. To learn more, check out our Help 'Em Up Harness article. Is There Anything Else? One of the best things you can do for your GOLPP 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 continue lifting and moving their own body. Many GOLPP dogs are also old enough to have developed osteoarthritis , so all the more reason to reduce any extra work on their joints. Check out our article to learn more about 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 GOLPP dog and is available online. For more information regarding medications and supplements, such as side effects to be aware of or how to pick a quality product, stay tuned for our upcoming article Pain Meds & Supplements . CROC strongly discourages the use of marijuana products for GOLPP patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and GOLPP patients are already weak and have limited coordination, making them poor candidates for this treatment. Rear-wheel carts are sometimes an option for GOLPP patients, but this is not commonly recommended. By the time your dog might benefit from the mobility assistance a cart could offer, they are no longer strong enough to be able to pull the cart and the weight of the back half of their body. To learn more about carts, check out The Wheel Deal: Let's Talk About Carts . 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 GOLPP dogs. The hope is that Physical Rehabilitation will help your dog maintain independent mobility for as long as possible, reducing the amount of effort you will need to put into their care as much as we can. For dogs whose GOLPP 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. GOLPP can be particularly difficult to come to terms with, as these patients generally maintain mental acuity and brightness despite their physical decline. 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. If you are considering euthanasia, visit our Quality of Life article for more information on when and how to make the decision and what you can expect.