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

CROC commonly treats FCE patients in an attempt to restore as much normal bodily function as possible. Patients can present with a wide range of symptoms, from mild limping or incoordination all the way to near complete paralysis. While no one can guarantee that your pet will regain 100% normal function, there’s plenty to be done to give them the very best chance of doing so. Check out Marley's recovery from her FCE! She presented with the most severe symptoms CROC has ever seen & was successfully rehabbed! What is a Fibrocartilaginous Embolism? Fibrocartilaginous Embolism, or FCE, is when a piece of connective tissue enters the blood supply to the spinal cord and blocks the flow of blood to the spinal cord tissues. This lack of blood supply causes part of the spinal cord tissues to die from lack of oxygen and nutrients, leading to neurological deficits for the patient. It is still not known exactly how this connective tissue enters the bloodstream. This condition is also referred to as a Spinal Stroke or Spinal Cord Infarct. While it is rare for a dog to experience more than one FCE, it is absolutely possible. Symptoms of FCE occur quickly. Often during exercise or play time, FCE dogs generally experience significant acute pain & some will cry out from discomfort.  They may limp, struggle to walk, or even experience complete paralysis immediately or within hours of the FCE. Usually, the worst of the symptoms have appeared within the first 12-24 hours and patients will start to improve from that point, with pain subsiding within 24 hours. Severity of symptoms is dependent on the location of the embolism along the spinal cord. Patients with embolisms higher up the spinal cord (closer to the head vs the tail) or those that cause larger sections of spinal tissue to die off tend to be the worst affected.  FCE’s typically affect one side of the body more so than the other, but they are known to occasionally affect both sides. Severely affected patients are unlikely to return to completely normal function, but with dedicated and intensive care, they can regain the ability to walk independently and relieve themselves appropriately. In the best-case scenario, an FCE dog will only experience mild neurological deficits in one leg and never lose sensation in the affected limb. These dogs often make a full or nearly full recovery to normal function. In the worst-case scenario, the FCE will cause paralysis and loss of sensation in all four legs. While certainly a challenge, patients in this scenario are not without hope! CROC has successfully treated cases of FCE in which the patient is unable to even lift their head or swallow. Who is at Risk for Fibrocartilaginous Embolism? FCEs most commonly affect large and giant breeds like German Shepherds and Irish Wolfhounds, though it sometimes occurs in small breeds like Shelties and Miniature Schnauzers and can happen with any breed or breed mix . It can occur in dogs of all ages but is most frequently seen in young to middle aged dogs. FCEs are not predictable or preventable. Diagnosing Fibrocartilaginous Embolism Because FCE symptoms can look like many other serious conditions, FCE patients often undergo several diagnostics to reach the correct diagnosis. Ultimately, FCEs are diagnosed by Veterinary Neurologists using Magnetic Resonance Imaging (MRI). General Practice Veterinarians can perform blood tests and radiographs to rule out other conditions but cannot confirm FCE using those diagnostics. MRI allows the Veterinarians to see the loss of perfusion to the spinal cord, therefore definitively diagnosing FCE. Treating Fibrocartilaginous Embolism There is no surgery or medication for FCE. Instead, treatment is focused on supporting the dog while they heal, encouraging limb use, and preventing muscle atrophy. They may need pain relief during the first 24 hours, but they are generally not painful after that initial period. Dogs with minimal symptoms may just need some assistance getting up or walking around but dogs that cannot walk will need more intensive care including assistance to relieve themselves and frequent repositioning to avoid the development of Decubital Ulcers (bed sores). The worst affected patients will need additional veterinary care to support hydration and nutrition if they cannot eat or drink on their own. This may look like hospitalization for several days with intravenous fluids and medications, after which, the dog will still require dedicated, round-the-clock care once back at home to ensure that they are kept clean, hydrated, and regularly repositioned. As soon as your veterinarian deems it safe, starting Physical Rehabilitation Therapy as soon as possible will significantly increase your dog’s chances of maximum recovery. It’s important to note that dogs with minimal neurological deficits may recover fairly quickly, but those experiencing profound paralysis will require a significant commitment of your time and energy over at least the next 6 months, sometimes more. CROC will guide you through all the steps, stages, and details of this recovery but it will be up to you to follow through with the Prescribed Homecare between Rehab Sessions. Failure to participate in Home Care Exercises will severely impede your dog’s level of recovery. Rehabbing FCE The maximum healing of neurological tissue takes place over approximately 6 months. This means that we have 6 months from the time of injury to Rehabilitate your pet to their maximum physical ability. Some pets will regain independent mobility before then, but it’s important to stick with the 6-month plan, as many pets quickly lose ground if they stop Rehab too early in the recovery process. Success of Rehab does depend on your pet’s condition at the time they start Rehab. Pets that don’t have any movement or feeling in their legs will be at a greater disadvantage than those that are just weak and uncoordinated. Generally speaking, we can get a good idea of your dog’s potential for recovery within the first few weeks of Rehabilitation Therapy. FCE patients begin their Rehab journey with Target Exercises intended to kickstart neurological activity. The nerves must be firing to be able to tell the muscles what to do. CROC often uses Electrostimulation Therapy (E-Stim) to help with this process. E-Stim uses low doses of electricity to stimulate nervous function but it doesn’t hurt. It can feel strange, like a tickle or in the best case, a big muscle twitch! Please note that E-Stim therapy requires us to shave small patches of your pet’s fur to allow electrical conduction through the tissues. We’ll also start simulating the body’s normal movement to help your pet “remember” what that feels like and to work on maintaining good Range of Motion in all the limbs. Once we start to see any sort of muscle contractions in the legs, we’ll step up our exercises to get that muscle moving as much as possible, while also stimulating more nerves and muscles to join in. We’ll practice weight bearing, essentially re-teaching your pet how to stand on their own. Many exercises for FCE patients are focused on improving Proprioception or knowing where your body is in space. Because of the damage to the spinal cord, many FCE patients often can’t feel their environment or have no sensations to tell them where their legs and feet are. This is important because if we want to get your dog to the point of consciously controlled leg movement, they have to know where  to move their legs in order to stand and eventually walk. This initial stage of rehab is frequently the hardest for pet parents. It can be discouraging to be a few weeks into Rehab Sessions without seeing obvious improvement. Meanwhile, us Rehabbers are getting super excited over the tiniest little muscle twitch or spontaneous kick or even a few seconds of weight bearing. We’re excited about these seemingly insignificant improvements because they are big indicators for what your pet will eventually be capable of, so hang in there! Hydrotherapy can be an exciting phase of their recovery. The buoyancy of the water allows for more movement with less effort, so we often see legs moving in the Underwater Treadmill before we see it on land. The Underwater Treadmill also allows them to feel the ground beneath them, so that continues to stimulate nervous function. Because they are walking in the water, instead of swimming in it, exercise in the Underwater Treadmill is low-impact, high resistance with slower, more controlled movements. Through their recovery process, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. Safety for FCE Patients Changing Habits Since many FCE patients rarely make a complete return to the level of function they had before the FCE, some simple changes at home can make all the difference in making it easier for them to get around. Rugs or yoga mats strategically placed around the house will help your dog to grip the flooring better, which reduces their risk of falling. The softer surfaces also make abrasion wounds on their paws less likely, although rug burn is certainly a possibility for some dogs. Ramps can make obstacles like stairs less challenging, although care should still be taken to monitor your pet while using these. Some pets will no longer be able to navigate stairs safely, so you might need to block them off entirely. Especially in the earlier stages of recovery, it can be beneficial to keep resources like food, water, bedding, or outside access closer to your dog and easier to get to. Closely supervise play time with housemates or other doggie friends since your dog will be weaker and more prone to falling. Swimming There is a video viewable in our article, The Deep Dive into Swimming , that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their front legs and barely working the back legs. Swimming also puts immense strain and twisting movements on the spine, the last thing a patient with a spinal cord injury needs. Regarding Chiropractic... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for their patients.   We have yet to find a Boarded Neurologist that would approve of their patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a Basic Level Chiropractic treatment involves applying jarring & intense force on the body. Your dog’s spinal cord is trying to heal & is particularly fragile so the force of Chiropractic can push your dog to further injury. If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are better & safer options for pain relief available. The End Goal Ultimately, our goal is to try to get your pet as independently mobile as possible. We hope that your pet can regain the ability to walk or even run and maintain control of their bowels and bladder. This isn’t possible for every patient and the ones that do… well, sometimes they learn how to do it in a different way than pet parents might have expected. Not all patients can regain conscious movement of their legs but instead learn something called a “spinal walk”. Spinal Walking is when a dog still doesn’t have sensation or proprioception in their legs, but they develop a reflexive walk. Since the signals aren’t getting through the spinal cord to the brain (and vice versa), they are instead relying on more basic reflex signals to get their legs moving enough for them to be able to walk. This reflexive walk isn’t always pretty but it is functional. If we’re given the choice between paralysis & a goofy looking walk, we’ll take goofy any day of the week. What If They Still Can’t Walk? We always want to give Neurological patients the full 6 months of treatment before throwing in the towel. If we’ve reached the 6-month mark and still haven’t seen significant improvement, that’s when we start looking at a Cart, sometimes referred to as a Doggie Wheelchair. It’s important not to jump into using a cart too soon as once a dog starts getting around without using their legs, they lose motivation to even try walking & that seals the deal that they never will.  The good news is that CROC rarely, if ever, sees FCE patients require wheels. However, not all FCE dogs regain independent mobility and the task of caring for a physically debilitated dog is a hefty one. For more information regarding Carts and what the process for getting one looks like, be sure to check out our in-depth article, The Wheel Deal: Let's Talk About Carts . Tools To Make Your Lives Easier We'll briefly cover tips & tricks below, but you can visit the following pages for more detailed recommendations: Gear & Resources How to Set Up a Recovery Pen Recumbent/Non-Ambulatory Care Rehabbing Recumbency Use a Recovery Pen The purpose of the recovery pen is to limit your pet’s activity, reduce overexcitement or stress, & provide a clean, comfortable environment that maximizes healing. If your dog is expected to get better, your recovery pen will need to be modified as their abilities and needs change. The goal is to maximize safety while still providing enough space to encourage movement as appropriate. Protect the Paws While your pet is re-learning to walk, they will frequently drag their legs and/or paws, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like Pawz best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off & eaten! A Good Harness is a Must! Your dog will depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for FCE dogs is called the Help ‘Em Up Harness . It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. Depending on your dog’s abilities, your pet may or may not need the back half, but if they do, as their coordination and strength improves, the back half of the harness will become less necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. Keep Things Clean If your dog doesn’t have complete control of their bladder and bowels, diapers and belly bands become good options to help keep your dog and your home clean. Some dogs lose urinary control before fecal, so in those cases, belly bands are a nice alternative for male dogs over a full diaper. Just as with humans, good hygiene when using diapers and belly bands is a must! Dogs left in dirty diapers for too long are at risk for urinary tract infections and skin infections. It's also important to note that dogs instinctively want to avoid their waste, so being stuck in it is not great for their mental health. Disposable and washable options are readily available for purchase online or at major pet stores. Use a High Quality Dog Bed Orthopedic Memory Foam beds are ideal. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change positions, such as switching which side of their body they lay on. Insufficient padding & laying in one position for extended periods of time can lead to decubital ulcers (bed sores) & significant stiffness. If your dog is unable to reposition themselves, it is recommended to move them from one side of their body to the other every 4 hours to prevent ulcers from forming. Once formed, decubital ulcers are difficult to heal, extremely painful, and highly prone to infection so prevention is best! Is There Anything Else? One of the best things you can do for your dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. Some FCE dogs are also old enough to have started developing arthritis, so all the more reason to reduce any extra work on their joints. For more information, read our article Body Condition Score & Canine Weight Loss . The less weight there is for them to haul around, the easier it will be to start lifting & moving their own body. CROC works closely with you to make sure your dog is on the right supplement and pain medication regimen. Joint supplements, like Dasuquin w/ MSM, are helpful to support their joints as some parts of the body will be compensating for the weakness of other areas. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the FCE dog and is available online. To learn more, visit our Pain Meds & Supplements  article, where we cover commonly prescribed medications, side effects to watch for, and how to pick quality supplements. CROC strongly discourages the use of marijuana products for FCE patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and FCE patients are already weak and have limited coordination, making them poor candidates for this treatment. Quality of Life We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for FCE dogs with severe Neurological deficits. The hope is that as your dog progresses through rehab, the amount of effort you will need to put into their care will decrease. For dogs whose paralysis is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. If you are considering euthanasia, our Quality of Life  article may help you to evaluate all aspects and know what to expect should you proceed. It’s essential that you keep Quality of Life for you both as a top priority. If your dog is not recovering well & you are not prepared for years of intensive care, it’s time to start discussing the reality of the situation. We're Here For You Fibrocartilaginous Embolisms are a serious condition, but not a death sentence. Many dogs show signs of healing quickly after the incident, but those that don’t will require consistent and intensive rehabilitation for several months. CROC has had great success rehabbing our severely affected patients back to independent mobility but cannot make any promises that we can do so for every dog. It can be a long, challenging road, but we are here to walk it with you and support you and your pup through the entire journey.

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. Laryngeal Paralysis 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. 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. Normal Dog Larynx Laryngeal Paralysis Laryngeal Paralysis causes the Cartilaginous Folds to collapse inward, blocking the airway. LarPar dogs struggle to breathe normally, have difficulty cooling themselves in hot weather, & are at higher risk for aspiration. 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. Megaesophagus 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. Paraparesis 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 & 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. Sadly, there is no treatment for Megaesophagus. 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 more severe 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 & 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. Physical Rehabilitation for GOLPP typically 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 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. Remember that GOLPP is a chronic, progressive disease; it never goes away & will continue to worsen. 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. Temperature control will be incredibly important. 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. 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. Signs of pneumonia include lethargy, coughing, sneezing, nasal discharge, inappetence, and/or fever. 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. We have yet to find a Boarded Neurologist that would approve of their patients undergoing Chiropractic treatments. 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. 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: This is the normal healthy spine of a young dog. Notice that the vertebrae & the spaces between them are very well defined. ------------------------------------- This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally & osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks & surrounded by extra bone. Bone rubbing on bone & nerve impingement become chronic sources of pain & stiffness. Pain & stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring & intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are better & 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 & have multiple methods of treating your dog’s pain & 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 & 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. Is There Anything Else? 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. 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. 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 often 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 also recommend checking out our Recumbent/Non-Ambulatory Care article to learn more tips & tricks to make this phase easier and more comfortable for you both. In addition, while none of us want to think about it, it's important to learn how to evaluate your pet's wellbeing (as well as your own) and start thinking about what you want their end of life to look like. We strongly recommend that you visit our Quality of Life article for more information on this phase of your pet's life, when to consider euthanasia, & what you can expect. It's best to be prepared well ahead of time so that you can maximize your quality time with your pet and avoid the limitations often imposed by last minute decisions. We're Here For You 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.

What's the problem with swimming? When is swimming the right exercise? We'll discuss the mechanics of a dog's body when they are swimming and why it isn't the best exercise for most Physical Rehabilitation patients. But first, let's start with a quick visual: Thanks to Dexter's examples, we can clearly see some big differences in how a dog exercises while swimming versus walking in an Underwater Treadmill. Now, let's get into some details! What Swimming IS Good For: Swimming is a great choice for dogs needing to exercise their front limbs that have no other injuries or conditions that would be aggravated by vigorous exercise. For example, puppies that have developed Swimmer Puppy Syndrome often benefit from swimming because, at least at first, they are unable to use the Underwater Treadmill. Swimmer's Syndrome Puppies develop splayed legs and flattened chests early in life and must be rehabbed as soon as possible to have any chance of being able to walk. Swimming, used alongside other Rehab Modalities, encourages them to work their front leg and chest muscles, helping to bring their splayed legs underneath their body instead of out to the side. Swimming can also be beneficial for dogs that refuse to bear any weight on a front leg and continue to hold the leg up in the Underwater Treadmill. Great care must be used in these cases to ensure that these patients don't overwork or further injure themselves while swimming. At CROC, when utilizing swimming for a patient, they are outfitted with a life vest and held in place the entire time so that we have complete control over their session. It is important to note that 1 minute of swimming is equivalent to 5 minutes of vigorous dry exercise. Dogs that are free of any health concerns certainly benefit from varied exercise to challenge different aspects of the body. But it is easy to accidentally overdo it when they're having so much fun in the water. Regardless of medical status, knowing your dog's physical limits and slowly introducing them to new forms of exercise is imperative to prevent overexertion or injury. What Swimming is NOT Good For: When dogs swim, their front legs are paddling almost violently, in fast and poorly controlled motions. These intense movements can be hard on joints, especially those with osteoarthritis. Arthritic joints are missing the normal lubrication to protect the bones from grinding against each other and may even have bone spurs. Think of that crunchy, painful joint experiencing high-intensity, high-speed exercise - OUCH! Arthritis patients frequently have muscular atrophy, where the muscles waste away, and therefore need careful, controlled exercise to avoid overworking their weakened body. With swimming, you can't tell a dog to swim slowly; there's swimming or not swimming and no in-between. While they're paddling in the front, dogs tend to tuck their back legs up close to their body, rarely kicking. Therefore, the stress of holding the back half of the body up is placed on the neck and back muscles, as well as the spine itself. Along with the added strain, the spine experiences quick, twisting movements when the dog is swimming. For our patients with spinal conditions or injuries, like Intervertebral Disc Disease, increased straining and quick, twisty movements are a perfect recipe for re-injury and pain. Families of spinal surgery patients or those hoping to medically manage a spinal condition without surgery should never permit swimming as an activity. The little bit of kicking that the rear legs do while swimming is generally periodic, spastic, and forceful, therefore not beneficial for the strengthening and coordination training that is sought after in Rehab Therapy. Swimming does not allow for the loading and unloading cycle the muscles experience when a dog bears weight on their leg. This loading cycle is what causes the muscles to strengthen, addressing the muscle atrophy and weakness most patients present with. The mechanics of swimming can actually cause increasingly severe pain in arthritic joints or even re-injure healing surgical sites. For example, dogs participating in swimming exercise after a TPLO knee surgery have been known to displace the surgical plate and even snap off surgical screws during the forceful kicking motion. Lastly, because you cannot control how deep the dog is in a swimming pool and pools are extremely difficult to clean and sanitize, swimming is not safe for dogs with any sort of respiratory compromise. For example, a dog with Laryngeal Paralysis would be at extremely high risk for aspirating (breathing in) the water they are swimming in. Worse - that water is full of fecal particulates, urine, dirt, hair, and large amounts of chemicals to try to compensate for that. Now our Laryngeal Paralysis patient has aspirated water and all of those contaminants into their lungs - YIKES! Why Underwater Treadmill Therapy? Hydrotherapy is incredibly beneficial for a variety of medical conditions, so Veterinary Medicine had to find a way to make it safer. Using an Underwater Treadmill allows us to have control over all variables a dog might encounter while participating in Hydrotherapy. Water Quality: Starting at the most basic level, the water is cleaner. Because the Underwater Treadmill is drained and filled between each patient, we can ensure that every patient gets fresh, clean water in which to exercise. Many Rehab Patients have trouble controlling their bladder or bowels, so accidents happen. When they happen in the Underwater Treadmill, the entire batch of water is drained and the treadmill is sanitized from top to bottom before another patient hops in. Before a patient ever uses it, our water is also filtered and heated to the perfect temperature to soothe aching muscles and joints. Pools are rarely, if ever, drained to be scrubbed & disinfected but our Underwater Treadmill is deep-cleaned & sanitized at least daily, if not more frequently. Customized Exercise Environment: At the beginning of an Underwater Treadmill Therapy Session, our patients walk into a dry, empty treadmill which for dogs that don't like water, is much less scary than being instantly submerged in a pool. The water is then slowly allowed to fill from the bottom up and stopped at the exact height for that dog's needs. Exercising in water has the benefit of offering increased resistance, but also increased buoyancy. Because we can precisely control the water level a dog is standing in, we can fine tune exactly how much buoyancy and resistance any one patient needs. Slow & controlled exercise in a low-impact, high-resistance environment allows our medically fragile patients to build muscle & improve stamina without overworking or re-injuring themselves. For patients needing a more intense workout, the water level can be decreased so that the water no longer supports their body but still provides increased resistance. We can also control exactly how fast or slow the dog walks in the Underwater Treadmill by controlling the speed of the treadmill belt that they walk on. For dogs needing more intense exercise or exercises focused on shifting weight to their back legs or lower back, CROC also has an Underwater Treadmill that has the ability to incline so that the patient can walk uphill while in the water. Spine Safe Exercise: Because the dog is standing or walking in the Underwater Treadmill, there is never a time where one part of the spine is under more stress than another. In fact, because of the buoyancy the water provides, dogs in the Underwater Treadmill experience even less strain on their back than they would outside the water. They also don't have to work as hard to move their body, which is a game changer for dogs suffering from paralysis or paraparesis. These patients have decreased or no voluntary movement of their legs outside the water, but in the water, they may be able move their legs a tiny bit since it takes less effort. A little movement means a little muscle growth and a little more nerve conduction which eventually builds to more independent movement. Lastly, because they are on their feet, there is no additional twisting motion on the spine. How Do You Know Which One to Use? At CROC, all exercises are prescribed by a Veterinarian & performed by Licensed Veterinary Professionals with years of experience treating a wide variety of Medical Conditions. When a patient comes to see us for Physical Rehabilitation, we thoroughly evaluate them beyond the presenting complaint. A deep understanding of canine anatomy and physiology, as well as how various conditions affect the body, means that we can then custom design a patient's treatment plan to address their weaknesses without causing further pain or injury. Your dog should be evaluated by Licensed Veterinary Professionals that have also been formally educated in Veterinary Physical Rehabilitation before starting any Physical Rehabilitation exercises.

Getting old is no fun! Although, dogs of any age can develop Osteoarthritis, especially if they've had an injury such as Cranial Cruciate Ligament Rupture (CCL/ACL), a congenital issue like Hip Dysplasia, or participated in Canine Sports. Included below are some tips, tricks, warnings, and other info to help you keep your pup mobile and comfortable. Should you have any questions on any of this information or would like more details, feel free to ask the CROC team. We are here to support you and your best friend! 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 an arthritic 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, including tips on diet changes and safe exercise, be sure to read through our article Body Condition Score & Canine Weight Loss. Supplements We'll briefly cover our favorite supplements here and frequently used medications below, but to learn more about supplements, such as how to pick a quality product, visit our article Pain Meds & 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. It has also been shown to help skin, coat, cognitive, and bone health. Medications 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. 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. Common 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 serious GI side effects like stomach ulcers and gastrointestinal bleeding. 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. Galliprant (grapiprant) 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) 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 sedation, 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 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 A Quick Note About Librela Librela (bedinvetmab) is the newest OA 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, 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 out 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 OA. 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. Other Options If the above options aren’t working well with your dog, be sure to speak to your regular veterinarian about other medication options for pain relief. While CROC does not prescribe medication, we do help you improve your dog's pain management plan as needed as part of their prescribed treatment plan at CROC. There are new medications coming out frequently that might be a better fit for your pet. Stem Cell Treatments are now available for pets and may be something that could potentially help your pet. There are also other, non-medication treatments which we will discuss below that might help reduce your pet’s pain Exercising at Home As part of your Consultation with us, you will have been provided with Veterinarian Prescribed Rehab Exercises (your Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. 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. Our article Motion is the Lotion discusses the importance of frequent but controlled exercise to maintain the joints' range of motion and musculature. There should never be sudden changes between inactivity & exercise. Always have your pet warm up before exercise & cool down after exercise. Avoid becoming the “Weekend Warrior” 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 an OA 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. Osteoarthritis Flare-ups Flare-ups are common & can even be caused by changes in the weather. It can be tempting to call off therapy sessions when your dog is having an OA flare up, but more often than not, that's actually when they need Rehab the most! Don't forget that their treatment plan is geared towards treating the pain and inflammation associated with their osteoarthritis in addition to building muscle to better support the joints. Let us know when you see changes in your pet's symptoms and our Medical Team will adjust their therapy session to best address your pet's condition so they can go home feeling better than when they came in. The Problem with Swimming Swimming is frequently thought of as a low impact and helpful exercise for OA dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups. 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 about hydrotherapy, such as when swimming is appropriate and medical conditions that would make swimming unsafe, visit our 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 arthritis 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, Electrostimulation, 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. Daily participation in at-home exercises wearing you down? Let us do some of that work for you & take your pet home feeling better than when you dropped them off! Regarding Chiropractics... We know this is a soft spot and that many people enjoy chiropractic for themselves. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. In Veterinary Medicine, Chiropractic is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic therapy for IVDD patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their spinal patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Reviewing Chiropractic on a basic level - Chiropractic treatment involves applying jarring and intense force on the body, which is also one of the worst things for a patient that has spinal instability or just had spinal surgery. The spine is particularly fragile under the forces of Chiropractic & there is a risk for severe pain & neurological injury. This is the normal healthy spine of a young dog. Notice that the vertebrae & the spaces between them are very well defined. ------------ This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally & osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks & surrounded by extra bone. Bone rubbing on bone & nerve impingement become chronic sources of pain & stiffness. Pain & stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring & intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are better and safer options for pain relief available. 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 OA dogs. Rugs, yoga mats, & the like are extremely beneficial to help keep your dog on their feet & avoid slips & falls. Be sure to keep your pet's nails short too! Doggie Doors need to be large enough for your dog to walk through without having to stoop or crouch. The bottom lip must also be low enough for your dog to easily step over. Minimize how often your dog has to climb stairs, especially if they are shallow and tall. If you live in a home with multiple levels, you may need to carry your dog up and down the stairs. If you are unable to carry your dog, it may be necessary to contain your dog to one level of your home. Don’t allow your pet to jump on and off furniture or in and out of your car. Especially jumping down, these types of movements put extreme stress on the body and are a very common cause for injury. Use ramps whenever possible. Change the location of certain resources. Some dogs need to have their food, water, and bed close together to avoid over-exerting themselves to reach basic necessities. Others need these resources placed farther apart to encourage more movement during the day. Be sure to ask what would best suit your pet’s needs. Engage in activities that require more mental participation from your dog. Whether it’s toys that have treat tucked inside or playing a game of hide and seek, mind games help keep your dog bright, engaged, and active even when their body may need a bit of a rest. Ask the CROC Team There are so many options to manage your dog's Osteoarthritis, it can be difficult to know which are the right options for your pet. 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. Our arthritic pups got that way from a lifetime spent at our side, so it's only fair that we return their dedication by treating their aches and pains to the best of our ability.

You might have seen the abbreviation BCS on your pet's medical records or seen the charts on the wall at your Veterinarian's office, but what does it mean and where does your dog need to be? The Body Condition Score (BCS) is a scale used to describe body fat level & determine proper body condition in animals. The BCS is often used on a scale of 1 to 9 or 1 to 5. To provide as much information as possible, CROC utilizes a scale of 1 to 9, with 1 being extremely underweight and 9 being extremely obese. Since dogs come in all shapes and sizes, determining their BCS is more about evaluating certain parameters of their body condition instead of focusing on just the numbers on the scale. Some quick ways to assess your dog's BCS include: Does your dog have an hourglass shape when you stand behind/over them and look down at them? Do they have a tuck at their waist? Can you easily feel their ribs? If any of your answers to the above questions are “no”, there’s a good chance your dog needs to lose weight. Dog owners don’t always recognize when their dog is out of shape. Maybe that’s why approximately HALF of all dogs in the United States are overweight or obese! An overweight dog is at severely increased risk for serious health concerns, with even just a few extra pounds contributing to: Shortened Life Span Diabetes Cancer Arthritis Heart & Respiratory Conditions Skin Infections Pancreatitis Increased Surgical & Anesthetic Risk and many more scary things! So my dog needs to lose weight.... Now what? Just like humans, weight loss for dogs really comes down to two things: food and exercise, with food being the easiest and quickest thing to change. For successful weight loss, a reduction of caloric intake is not optional. We know. We wish it worked differently too! Get Specific With What You’re Feeding Here’s where things can go sideways. Humans may or may not choose to count calories as a guide for what they’re eating, with some opting for other methods of keeping to a healthy regime (Do my pants fit? Cool or Yikes!). But when it comes to the long term management of your dog’s weight, it’s essential to establish a concrete benchmark for how much to feed, meaning we need to determine the number of calories your dog needs each day. Unfortunately, feeding guidelines on the average pet food package are generally too broad or vague and many owners end up over feeding. The feeding guidelines on pet food packages are loosely based on active adult dogs of all ages, breeds, & sexes. Spaying or neutering, as an example, reduces energy requirements by 20-30%, so if your pet is spayed or neutered, you can already be overfeeding by 20-30% or more. To determine the ideal caloric intake, we need to consider your dog’s Body Condition Score, muscle mass, lifestyle and any medical conditions. For at home calculating, you can use the Resting Energy Requirement (RER) Formula (or just ask us and we'll calculate for you!). RER Formula Example Equation Using a 30lb Dog a. Start by taking your dog's weight in pounds & dividing by 2.2 to get your dog's weight in kilograms. 30lb divided by 2.2 = about 13.6kg Multiply weight in kilograms by 30. 13.6kg X 30 = 408 c. Add 70 408 + 70 = 478 d. You can then factor in Metabolic Energy Requirements (MER) based on things like weight loss or spayed/neutered. For healthy, intact (not spayed/neutered) adult: Multiply the RER by 1.8 478 X 1.8 = 860.4 calories per day For healthy, spayed/neutered adult: Multiply the RER by 1.6 478 X 1.6 = 764.8 calories per day For an overweight adult to lose weight: Multiply the RER by 1.0 478 X 1.0 = 478 calories per day These formulas provide an estimate, but every dog’s metabolism is different so be sure to monitor your dog’s weight as you adjust their diet. CROC weighs our overweight patients approximately every 2 weeks to make sure they are safely losing weight and if we need to make any changes to their weight loss plan. Another easy change is to start utilizing a diet formulated for weight loss. Many diets exist to help dogs feel fuller while eating less calories. Some even have extra benefits like joint support! Trick or Treat? Our bond with our dogs is priceless and every dog owner wants to see the joy and excitement a treat brings to their best friend. However, it’s easy to forget that those treats are also part of your dog’s daily caloric intake. Even if you’re following the above formula perfectly at meal times, any treats your dog gets throughout the day are adding to their caloric excess. This doesn’t mean that you can’t give any treats! What it does mean is that you must calculate the additional calories of the treats you are giving and feed that much less of your dog’s regular meal. While commercially prepared, AAFCO approved diets are nutritionally balanced to provide your dog with everything they need, treats are not! The majority of your dog’s daily calories needs to come from a balanced diet to avoid any nutritional deficits that could then cause serious illness. Dogs also get the same joy and excitement from healthier or smaller treats. Many of our clients report success switching to fruits or veggies as treats. There are also commercially prepared low calorie treats readily available, some as low as 2-3 calories per treat. At the end of the day, there are many ways besides food to show our pups that we love them. Safely Increase Exercise Now that your dog’s diet has been addressed, it’s time to start adjusting their exercise routine. The most obvious and important activity for your dog’s weight loss is walking. The amount of walking your dog needs depends on their breed and general health, but unless recovering from life threatening trauma, all dogs need to move regularly. Our article Motion is the Lotion discusses the importance of regular movement in maintaining your dog's musculature, range of motion, and comfort. Regular walks exercise your dog’s body & provide mental stimulation like the vital opportunity to sniff! If you’re already doing regular walks, try lengthening your walk by 10-20%. Remember to work in your Home Care exercises to improve coordination, stamina, and strength. Muscle burns more calories! Unless your dog has been trained and physically conditioned for sports or other vigorous exercise, you’ll need to avoid overly strenuous or repetitive exercise, or you will risk injury. Weather conditions, such as high heat, will also need to be kept in mind to avoid paw pad burns or heat stroke. Physical Rehabilitation is an excellent tool to safely exercise your dog and speed up their return to health. Hydrotherapy in an Underwater Treadmill Therapy is a great option for overweight pets since the buoyancy of the water reduces strain on their already overworked joints while providing resistance to build their muscle mass and improve their stamina. While swimming is often touted as a good low-impact exercise, it is not recommended for most compromised pets as it does not build muscle as effectively and puts excess strain on overworked joints. Read the Deep Dive into Swimming to learn more. Our Rehab Practitioners & Veterinarians will prescribe a weight loss exercise plan specifically for your dog to achieve maximum results while making sure your dog isn’t overworked or injured. On the topic of overworked joints, overweight pets often experience accelerated osteoarthritis formation and considerable joint pain due to the extra force applied to them daily. Rehab treatments like Laser Therapy can help reduce that pain and inflammation, therefore keeping your pet more comfortable as they work through their weight loss plan. Rule Out Medical Conditions If caloric boundaries have been established and strictly followed, your dog is getting regular and balanced exercise, but you’re still not seeing results, a visit to the vet could be in order to rule out medical reasons for your dog’s weight. Weight gain & lethargy can be symptoms of conditions like Hypothyroidism or Cushing’s, among many others. These conditions often occur in middle-age to older dogs and can be treated with medication once properly diagnosed. Other symptoms to watch for include frequent urination, hair loss or poor coat condition, weakness, and delayed healing. Keep Track! Sometimes, it feels like you're doing everything right, but your dog STILL isn't losing weight. Often, the devil is in the details! To help figure out the culprit, we suggest keeping a food diary to track everything your dog is eating. This goes beyond just what goes in the bowl day after day. Owners of CROC patients are welcome to bring their completed food diary in for discussion any time. We are here to help get your dog to optimal body condition! Your food diary should include treats, table scraps, supplements, random things they found outside - literally anything that goes into their mouth! Feel free to download & print our food diary form ---> We're here for you! Navigating your pet's healthcare isn't always easy but we're dedicated to our patient's best possible outcome. At any time during our patients' treatment plan, we are happy to reassess their diet and weight to ensure they are on the safest and most efficient path to healthy body condition.

Amputations are never a pleasant option and obviously we’d all prefer to keep our legs but, there are situations where this is the best option for a patient to live longer or more comfortably. We often see dogs that required amputation due to trauma, cancer, or congenital defects and each of these situations need unique approaches for optimal recovery. Generally speaking, most dogs do quite well post-operatively, but all of them can benefit from rehabilitation therapy. While dogs still have the 3 remaining legs, they’re not much different from human amputees in that there are significant changes to how they do even the most basic things and it is of utmost importance to keep the functioning legs at their best. How did your dog become a Tri-Pawd? Birth Defects Dogs with congenital defects have spent their entire life up until amputation compensating for the affected limb. While their body still has to make up for this limb, its also had time to build muscle in the functional limbs and to adjust balance to remain upright and mobile. Dogs in this situation often arrive at amputation when prosthetics are not appropriate or not financially possible and the leg has become more of a hindrance than a help. The musculature of the affected limb is often atrophied and depending if and how the dog uses the limb, wounds and infection are a chronic problem. These patients usually recover from amputation quite well since they’re already accustomed to relying on their stronger legs and now they are free from the dead weight and chronic wounds associated with the deformed leg. Rehab helps these cases keep the three remaining legs as strong and sound as possible, as they are likely to have compensatory repercussions like arthritis or muscle fatigue from having to make up for the lost leg. Traumatic Injuries Dogs that lose a limb due to trauma are a bit more complicated. Up until that point, they have been fully mobile with all four legs but now they’re suddenly depending on three to get the same job done. There is usually little to no preparation for these patients and it is crucial to get them into rehab therapy as soon as they are healed enough to participate. Therapy for these patients usually entails teaching them how to correctly stand and walk as well as overall strengthening while soothing the now overworked muscles and joints. Just like us, poor posture can significantly affect how the body feels and operates. Cancer Dogs that lose a limb to cancer are often at the greatest disadvantage. Not only are they suddenly having to depend on three legs, but more often than not, they are senior pets with decreased muscle mass, likely arthritis, and overall poorer body condition from cancer and/or chemo as well as any other medical conditions they might have developed over their lifetime. Again, getting them into rehab right away can give them a better chance, but these patients have the longest road ahead of them. Goals are similar to the other cases in that we are focused on building muscle and soothing the overworked remaining legs, but special care is given to ensure these patients aren’t over-exerted. Too much too soon can quickly wear them out and make their creaky joints even more painful. Variables Affecting Successful Recovery For all amputees, the leg in need of amputation is a significant variable. Dogs carry approximately 70% of their weight on their front legs, so patients that require a front limb amputation are most at risk for compensatory injury. However, since dogs come in all shapes and sizes, sometimes the leg in question isn’t the problem. For example, heavier bodied dogs like English Bulldogs or longer bodied dogs like Dachshunds can have a particularly difficult time recovering from an amputation, and even more so if it’s a front leg. Dogs that are long and heavier bodied, like a Bassett Hound, are essentially twice as disadvantaged. Cases like this can be ethically challenging for all involved and thorough consideration for Quality of Life post-operatively is a must. Whether there is time to prepare for amputation or not, weight management is the other huge variable for how these patients recover. Your dog’s skeletal and muscular systems are only built to carry and propel their lean weight. Now we’ve removed a leg and the remaining three are operating at 133% of their normal workload so any additional weight is even more of a burden than it would be for a normal dog. Factor in front vs rear limb and if there are any other comorbidities like osteoarthritis , and your dog could be set up for failure. Even a perfectly healthy, younger dog that undergoes a leg amputation will be putting extra wear and tear on their remaining legs, so as your Tri-pawd ages, it will become even more important to manage their weight, treat their pain, and keep them as strong as possible. Rehabbing the Tri-Pawd For our amputee patients, we focus on making sure they are at a healthy weight, that any sources of pain are well managed, and that the remaining legs are well equipped to take on the extra strain of Tri-pawd life by teaching them better ergonomics and improving overall strength and stamina. Generally speaking, once sutures are removed, therapy can begin but if your pet has other injuries or conditions, they may need further care before it’s safe to begin treatment. Thermotherapy and Therapeutic Massage helps to improve blood flow to overly strained muscles, helping to reduce tension and pain. Stretching is extremely important for the Tri-Pawd to retain full Range of Motion of their remaining limbs but should only be done as prescribed and after Thermotherapy and Massage. Laser Therapy and Acupuncture are excellent tools for pain relief and improved circulation. Pain relief is important but the body will not improve without exercise! Hydrotherapy using an Underwater Treadmill is particularly effective to help teach better ergonomics since their speed is controlled by both the treadmill belt settings and the resistance of the water. The buoyancy and warmth of the water helps reduce strain on sore joints and muscles. Take note that Hydrotherapy in an Underwater Treadmill is recommended, but due to less benefit & higher risks, swimming is not. Our article, The Deep Dive Into Swimming ,  provides a visual and more detailed explanation for this, but we’ll briefly explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are over-working their front legs and barely working the back legs. If they do kick their back legs, it is generally in a quick, spastic movement that does not encourage muscle building but does apply more stress to the limb. Since the Tri-pawd is already experiencing extra strain on their 3 remaining limbs, they should not be subjected to the additional stress from swimming. Target Exercises also provide an incredible impact on their recovery since we are improving their strength, stamina, and balance while also teaching them how to safely navigate obstacles common to daily life. Things to Do at Home Changes to their home environment are in order as well. Stairs and slick floors are especially dangerous for your pup, especially in the early stages of recovery. It is best to avoid these at first, then slowly introduce them in a controlled manner where you can slow them down and support them using a harness. Remember that a slip & fall on stairs or hard floors could seriously injure your already compromised pet. If your dog enjoys high impact exercise or wrestling with other dogs, these activities will also need to be restricted until your pet has been cleared to resume. Unfortunately, there are some cases where these activities will never be safe to resume. Extra supportive orthopedic foam beds (Big Barker is our favorite!) ensures a comfortable resting place that also avoids any undo pressure on overworked joints and insulates from cold flooring that can cause stiff muscles and joints. The addition of rugs or yoga mats around the house makes a huge difference in your pet’s ability to safely traverse their home. Even after they have learned to use stairs or traverse slick floors, it’s still a good idea to use a harness ( Help ‘Em Up is our top pick) to provide support as needed. Your pet is at higher risk to trip or slip and injure themselves but you can safely offer assistance with a harness whereas a collar will provide zero support and is more likely to cause additional injury. Check out our favorite products on our Gear & Resources page. Special Considerations for Tri-pawds Because the leg opposite from the amputation is now the only one supporting that half of the body, you'll want to take great care to avoid any unnecessary risks that could cause injury or infection to that leg. If your Tri-pawd needs injections or an IV catheter placed, you may need to ask your veterinary team to use a different leg since this one doesn't have back up. This is particularly true for intravenous chemotherapy treatments. If you notice anything off with the remaining leg, even if it seems small, make sure to have your primary veterinarian check it out right away! Some Tri-pawds may require long term pain medications to address compensatory pain. Many benefit from dietary supplements to support muscle growth and joint health. To learn more about commonly prescribed pain medications and how to choose quality supplements, check out our article Pain Meds & Supplements . To Summarize Many Tri-pawds go on to live fulfilling lives with their families and yours can too! It’s likely to be a big adjustment at the beginning but once the basic activities of daily life are mastered and your pet’s body condition maximized, you and your pet can still enjoy good quality time together. Rehab is particularly helpful in the beginning but remember that your dog’s body will now be experiencing more wear and tear than a dog with four legs. For this reason, we recommend circling back to Rehab as your Tri-Pawd ages to help keep them strong and comfortable for as long as possible. We’re here for you and your Tri-Pawd now and in the future, so don’t ever hesitate to reach out to us!

As our four-legged friends become more and more integral parts of our lives, us humans are getting better at finding ways to keep them comfortable, mobile, and having fun despite physical limitations. Using a cart can allow an otherwise immobilized dog the chance to go on their favorite walks, play with their friends, even play fetch! Sometimes, these activities are the difference between a stimulated, happy pup and a depressed, lethargic one. Is Your Dog a Good Candidate for a Cart? Bella was given more time to be mobile and active after Degenerative Myelopathy made her rear legs too weak to walk or stand on her own. First, we have to point out that dog carts don’t function like a human wheelchair. When a human is in a wheelchair, they are usually sitting – a passive position that requires little effort to maintain. They are not holding up their own weight and depending on the type of wheelchair, they may not have to put in much physical effort to move the chair. For simplicity’s sake and since they’re the most common, we’ll be using a rear-wheel cart as the main subject of this article, though there are many configurations available. A rear-wheel cart requires the dog to be in a standing position & does not allow for them to sit or lay down. Imagine being a physically compromised human & being forced to stay on your feet all day without rest! ---- AND ---- A rear-wheel cart requires the dog to have the strength in the front half of their body to not only hold up their front half, but to also pull the weight of the rear half of their body AND the weight of the cart. That’s quite a lot to ask of a weakened or injured pup! Well then, what’s the point? Rear-wheel carts are usually recommended for dogs that have normal strength and ability up front but whose back legs are too weak to walk or are being dragged. Dogs with Intervertebral Disc Disease (IVDD) or Degenerative Myelopathy (DM) who have no chance at regaining the ability to walk but are otherwise in good health are commonly referred for a cart. But even the perfect cart patient needs some preparation before they start using a cart. This is where rehab comes in. We’ve heard people say, “rehab can’t fix my dog’s legs so why do I still have to bring them?”. Firstly, we’ve had numerous patients come in for a cart fitting only for us to see that the dog still has a chance at walking again if the clients want to try. This is HUGE! If you take a dog that still has potential to regain the ability to walk & put it in a cart, you have sealed their fate & taken away that chance at independent mobility. If you haven’t seen it yet, we suggest watching the video about our patient, Nalu, as he was an exact example of this situation. If we hadn’t turned down the idea of a cart for him, he likely never would have walked again. Thanks to Rehab, he went back to running on hiking trails with his mom, his favorite activity! Secondly, remember how the dog has to remain standing and pull the weight of their body plus the weight of the cart? That’s going to take some serious strength and stamina to do comfortably. Rehab sessions for these patients are aimed at getting the front legs, neck, and back as strong as possible and building your dog’s cardiovascular stamina to meet the demand of using the cart. Not only that, but this extra strain on the front causes significant compensatory pain and possibly injury. Therapy can physically prepare & maintain your dog for the strain of using the cart while also keeping those overworked muscles & joints happy & comfortable. Purchasing Your Dog's Cart Example of a poorly constructed and ill-fitted rear wheel cart. At this point, we’ve established that our patient is a good candidate for a cart and they are being physically prepared for the cart. Now, we just need a cart! This is another spot where many pet parents get caught up and their dog suffers. Carts are quite the investment. Even the cheapest carts are several hundred dollars. But much like anything else, you get what you pay for and with a medical device, you never want to cut corners. Cheaper carts are often made with cheaper materials and in only a few cookie cutter dimensions but dogs come in all shapes and sizes! We have seen lower quality carts cause significant back pain because they were not properly fitted for the dog and serious skin injuries where poor craftsmanship caused damage from regular use. A properly fitted cart should allow the dog to stand in an ergonomic position, provide good support without injuring the body, and be as easy for the dog to use as possible. Barry's low quality, poorly fitted cart Barry getting measured by the CROC Team Barry's new custom built, high quality cart What DO we recommend then? CROC exclusively recommends Eddie’s Wheels and we can perform the measurements for you so you know that when you invest in your dog’s equipment, it will be custom built for your dog to use safely and comfortably for years to come. We’re so confident in their carts, that when our clients get their dog’s cart through our Cart Fitting process, we offer continuous support for the cart long after the initial ordering process. Most of our clients never need this follow up support but sometimes a dog will need small adjustments as their condition or ability changes. We begin by meeting with our clients to make sure that their dog is a good candidate for a cart, then anywhere from 2-5 CROC team members are utilized to position, measure, photograph, and record all details required for the cart to be perfectly custom built. We send in our part and the client takes the rest and orders their pet’s cart directly through Eddie’s Wheels. Lead times vary, but it usually takes at least a couple weeks for the cart to be shipped. We don’t stop there though! Next, we have our clients bring in their cart at their dog’s next therapy session so we can put together any unassembled parts and make any small adjustments to ensure a perfect fit. Introducing a dog to a cart can be a delicate process. Dog’s generally don’t like the concept of something being stuck to them or “chasing” them and some can get spooked when a wheel hits a bump or a wall. We make sure your dog has a calm, positive introduction to the cart and then start acclimating them to being in the cart and walking with it. Then, we teach you how to use the cart at home. Unfortunately, because of how much effort is required for your dog to use their cart, they can’t just jump in and go back to their 2 mile long walks. Like any new exercise, they need to be slowly introduced to it and then gradually increase the length of time in the cart. This process starts with just a couple minutes at a time, a few times a day. Dogs that have been physically prepared in the weeks leading up to receiving their cart will move through this process much quicker. Often, dogs using carts benefit from continuing rehab therapy to keep the functioning limbs as pain-free and strong as possible. To learn more about life with a dog on wheels, check out our article The Wheel Deal Part 2: You Got the Cart; Now What? Ask the CROC Team There’s nothing quite like seeing a previously immobile dog absolutely take off in their brand new cart! They always seem so proud of themselves and their spirits instantly lifted. If you think your dog might benefit from a cart, give us a call to schedule a Cart Consult. We’ll go over all your options and give you the real facts about if your dog needs a cart, what kind, what the process will be, and how to set you both up for success.

The Iliopsoas (pronounced like ill-ee-oh-soh-az) is a grouping of muscles comprised of the Iliacus and Psoas Major, which originate in two different spots but then fuse into one common tendon way up in the groin and attach to the femur. Their job is to flex the dog's hip (bringing their knee forward and up to their belly), rotate the hip outwards, and stabilize the lower spine. Highly active or sporting dogs frequently experience Iliopsoas Injury since the activities they participate in are high intensity like jumping, sprinting, or rough play and are more likely to overstretch the Iliopsoas. Dog sports are very similar to human professional sports in that structured and staged exercises are done to work up to a certain level of ability. Human professionals also routinely warm up and stretch before exerting themselves to their full potential but this is all too often overlooked in our canine athletes. Just like us, if a dog’s body is not properly strengthened & cross-trained for these activities before attempting, they are more likely to overwork the body & incur an injury. 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 Tear/Rupture (sometimes incorrectly referred to as an ACL) but a dog’s overall fitness level and lack of preparation for high intensity activity can also be primary causes. Even if they are otherwise very well-muscled & fit, a dog that has poor flexibility & core strength will be significantly more likely to experience Iliopsoas injury than a dog that has been cross-trained & warmed up before exercise. Symptoms of Iliopsoas Injury Signs and symptoms of Iliopsoas injury vary, with some being extremely difficult for dog parents or even veterinarians to notice. Sometimes, a mild change in the dog’s gait is the only outward sign. Dogs with significant injuries/pain often stand with their lower back rounded and their hind legs brought closer to their front legs in an attempt to avoid the painful stretch their normal posture requires. This injury is usually diagnosed by palpating the dog’s groin muscles along with evaluating symptoms, though it can also be identified via Ultrasound Imaging or Magnetic Resonance Imaging (MRI). Rehabbing Iliopsoas Injury Just like human medicine, Physical Rehabilitation is the treatment of choice for muscle strain. Previously, clients were advised to keep their pets on strict crate rest, but this is no longer recommended. Instead, treatment starts by managing the dog’s pain including pain in other areas of the body caused by compensating for this injury. Pain management is key, as a painful dog will not be able or willing to participate in the exercises necessary to recover. As part of your consultation, we will discuss all current medications that your dog is on and if their pain is not adequately managed, we will refer you back to your regular veterinarian to adjust their medication as needed. In addition to medications, Thermotherapy, Therapeutic Ultrasound, Therapeutic Laser, Massage, & Stretching are excellent modalities to relieve the pain your dog is experiencing. We will alert you to any signs of pain seen in clinic, but make sure to keep us updated on your dog’s comfort level at home with daily routines as well. Once we feel that your dog is comfortable enough to start exercises, we will create a customized plan of foundation exercises to carefully reintroduce the Iliopsoas to normal movements and functions. It might seem counterintuitive to work this injury, but specific exercises are integral to bring blood flow and movement back to this tight and overstrained muscle group. As your dog starts to tolerate more of these exercises, we will introduce more challenging exercises to strengthen not only the injured muscles, but also other supporting muscle groups. This balance is essential to return to normal function. Consistent rehab sessions are best, but the custom homecare plan we create for you & your pet to do at home is also an essential part of your dog’s optimal recovery. These controlled and measured exercises will help your dog get better, but if your dog is allowed to return to normal exercise, free play, or even their sport too soon, they are likely to quickly re-injure themselves and lose any progress gained by the previous weeks or months of therapy. Sticking to the prescribed exercises and patience with the process are a necessity. Remember that every dog is different in how their body heals, so the length of time required to heal from this injury is unpredictable. The goal is always to prevent injuries like this, but once they occur, we can help get your dog feeling and moving better, faster. If left untreated, Iliopsoas injuries can become a chronic source of lameness and pain, so professional rehabilitative services started directly after diagnosis are always recommended for this type of injury. Ask the CROC Team Think your pet might have an Iliopsoas Injury? Let’s get you in for a consultation to find out! Give us a call at (949) 444-2451 to schedule with our Certified Canine Rehabilitation Practitioners and Veterinarians so we can get your best friend back to doing what they love most.