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We’ve recommended a Help 'Em Up Harness for your dog. What is it, why do you need it, and why can’t you just use a regular harness? Unlike a regular harness you might buy from a pet store or online which might be comparable to clothing, the Help 'Em Up harness is a medical device , like crutches or a wheel chair. You’d want your crutches to be designed in a way that is comfortable for you to use, will withstand day to day wear and tear, and will not cause injury to other body parts during use. Using the Help 'Em Up Harness makes it much easier to help Nalu stay on his feet during an exercise meant to challenge his balance and stamina. Why This Harness? This harness is a fantastic tool to help your dog be more mobile. Whether old age and weakness is making getting in and out of the car more challenging, or they have a neurological condition requiring that they relearn how to walk again, your dog needs physical assistance. The thought behind assisting them to do normal activities rather than just carrying them everywhere is a sort of “use it or lose it” concept. They can’t ever regain strength if they’re not using those muscles. They won’t get the chance to regain neurological function if the opportunity to get those nerves firing isn’t there. The hope is, that by assisting your dog to do basic things, like walking or using the stairs, they can eventually regain the ability to do it on their own. So where does that leave you and your dog? You can physically lift and hold them in the positions, postures, and paw placements necessary for these activities - prepare for your own back pain! You can use a towel, leash, or sling to hold your pet up. These are appropriate tools for short term but they don’t disperse your dog’s weight in a comfortable way and aren’t the most comfortable for you to use every day either. There’s often too many straps to easily manage, you have to remember to grab it before any activity, they can impede your dog’s normal range of motion, and they put most if not all of your pet’s weight on their belly – ouch! The Help 'Em Up is designed to be easy for you to use and fitted for your dog’s anatomical needs. The padding is strategically placed so that your dog’s body weight is evenly dispersed under their chest and hips, instead of their neck or belly while also allowing your dog to move their legs normally. They even have pieces specifically designed for male dogs to be able to urinate while still getting the support they need to stand. No more pee covered slings or towels! But why does it have to be this harness specifically?  Over the years, we have seen countless attempted knock offs of this device. We understand; they’re not cheap and pet parents are trying to do the best they can for their pups while keeping themselves afloat; it’s a delicate balance. Unfortunately, we’ve yet to see a knock off that offers the same benefits and we’ve seen many that are dangerous to use. Some of the knock offs we have seen put dogs at risk for a dislocated hip or a slipped disc! Yikes! While we do offer a service to custom fit a Help 'Em Up Harness for your dog, the cost of this service only covers the expense to provide it (meaning we make no money by offering it) and we do not receive any sort of kick back from the makers of the harness. We recommend this product exclusively because it is the best we have found and tested. Common Conditions that Benefit from a Help 'Em Up Intervertebral Disc Disease (IVDD) Fibrocartilaginous Embolism (FCE) Geriatric Onset Laryngeal Paralysis & Polyneuropathy (GOLPP) Degenerative Myelopathy (DM) Osteoarthritis (OA) Hip Dysplasia Post-Op Amputation Most recovering recumbent patients Proper Use of the Help 'Em Up You might ask, " why is a harness fitting appointment necessary? ". The Help 'Em Up can be a bit tricky to fit to your pet the first time and improper use can cause skin irritation or failure to support your pet as intended. There are many adjustment points and this device needs to be well-fitted to your pet. Using the size chart to pick out your pet's harness can be deceiving as well as we have found that they often need a slightly different size from what the chart indicates. These harnesses are also unable to be returned, to us or the manufacturer. By letting CROC Professionals take care of this for you, you'll know that your pet is comfortable and well supported in their new harness the first time around. It is important for the harness to be snug. You should not see huge gaps between your pet and the harness. The Help 'Em Up is designed to be worn all day, but it must still be cleaned on a regular basis. Harnesses left on 24/7 and unwashed can cause skin infections/abrasions, especially for pets with urinary or fecal incontinence. If you notice that your pet's skin is irritated from the harness, remove the harness and wash it before putting it back on your pet. It is machine washable and we recommend placing it in a garment bag or large pillow case tied up before machine washing it. Ask the CROC Team If you have questions about using a Help 'Em Up with your dog, feel free to reach out to us! We’d love to help make sure that your dog is properly outfitted with the correct components, as several different combos of the harness and accessories exist, and that they are properly sized and fitted. We also help with adjustments later on as the buckles can move a bit over a longer period of time or your pet may need different settings as their body changes.

If your pet is unable to rise, stand, or walk, they are considered a recumbent patient or sometimes referred to as a “down dog”. If your dog can rise and stand but can’t walk, they’re considered non-ambulatory. Either way, caring for a dog that cannot move about on their own is a challenging endeavor which can be more difficult due to your dog’s size, temperament, and level of debilitation. Pending the reason for your dog’s condition, you may be responsible for some or all of your dog’s most basic bodily functions – eating, drinking, urinating/defecating, maintaining Range of Motion, minimizing muscle atrophy, preventing bed sores, and even mental stimulation.  We’re diving into all the basics you’ll need to know as you care for your pet at home, as well as common problems so you’ll know what to watch out for, why it happens, how to prevent them, & what to do if they occur.  While the information in this article is focused on recumbent pets and particularly those that suffer from neurological conditions, it can also be applied to any pet with compromised mobility. Conditions commonly in need of recumbent/non-ambulatory care include: Intervertebral Disc Disease (IVDD) Fibrocartilaginous Embolism (FCE) Acute Non-Compressive Nucleus Pulposus Extrusion (ANNPE) Degenerative Myelopathy (DM) Geriatric Onset Laryngeal Paralysis & Polyneuropathy Geriatric Sarcopenia Nutrition & Body Condition The recumbent dog’s body condition can be tricky to maintain and there may be some trial and error to meet their nutritional requirements. To set your pet up for success, you will need to adjust their diet to match their activity level and rehabilitation needs.  Why Nutrition Matters Dogs that aren’t moving on their own quickly begin to experience muscle atrophy, where the muscle wastes away from disuse. Inactivity also means that they are prone to gaining weight in the form of fat. More weight to haul plus weaker, wasting muscles is not an equation for recovery. However, inadequate nutrition can be just as harmful. The body cannot heal or build muscle if we don’t give it the building blocks it needs to do so. In addition, muscle and fat act as cushioning for the body. The more that is lost, the more prominent skeletal features become, and the higher the risk for decubital ulcers (bed sores). Lastly, if your pet has lost bowel control, diet can mean the difference between a quick clean up or a bath and full bedding swap out. Everything your pet eats, including treats, table scraps, dental chews, and anything else in addition to their regular food must be factored into their daily caloric allowance and nutritional requirements. Pro tip: All calories count! Treats are not nutritionally balanced to provide your dog with everything they need, so the majority of your dog’s calories need to come from an AAFCO approved diet to avoid any nutritional deficits that could cause serious illness. As nutrition is part of your pet’s Rehab Consultation, the CROC medical team will provide you with a clear outline of how much food and water your dog will require each day and how many feeding sessions to split that amount into. On occasion, we will recommend adding a veterinarian prescribed muscle building supplement to a patient’s diet, as it can help prevent muscle loss and promote muscle growth. Visit our article Body Condition Score & Canine Weight Loss to learn more about maintaining your pet's weight. You can also reach out to your primary veterinarian or a veterinary nutritionist for guidance and prescription diets.  How to Feed Your Pet If your pet is unable to eat or drink on their own, they may require hospitalization for intravenous fluids and possibly even a feeding tube. Sometimes, when patients are otherwise stable, owners can be taught how to feed their pet using the feeding tube and can continue to do so at home with the goal being that the dog will eventually be able to eat on their own so the feeding tube can be later removed. If your dog is able to swallow or chew, then you may be able to hand or syringe feed them at home, but refer to your veterinarian to ensure your pet’s safety. If your dog is able to eat and drink on their own, your job is to make sure that they can access food and water easily. Some pets may need different bowls or extra bowl stabilization if incoordination or weakness makes it difficult to reach or use their bowls without spilling. If your pet is up to the challenge, offering their meals in food puzzles, snuffle mats, or frozen lick mats can have the added benefit of mental stimulation, which can help release pent up energy & boost your pet’s mood.   Hydration Monitoring your dog’s hydration is especially important. There are a couple simple observations you can make to assess if your dog is well hydrated.  Gum Color & Moisture While some dogs have extra pigment that can make this observation more difficult, the hydrated dog will have wet gums of a nice bubblegum pink color. Dry gums are an easy indicator that your dog is experiencing dehydration. If your dog’s gums are dry and pale in color, you should contact your veterinarian right away , as your dog may need more urgent veterinary care. Skin Turgor Gently pinch the skin (gentle enough that this should not hurt) in between your dog’s shoulder blades and pull it away from the body, then quickly release. In a well hydrated dog, the skin should snap right back against the body immediately. If the skin is slow to return to position, your dog is dehydrated.  If your dog’s skin is slow to return to position AND their gums are pale/dry, absolutely contact your veterinarian immediately as your dog will need more advanced care right away . Urine Color Monitoring the color of their urine can help indicate hydration but is not always a reliable indicator on its own, so it is best to use this only in conjunction with the above methods. Darker, more concentrated urine can indicate dehydration, but it can also indicate other serious conditions so you should always consult with your veterinarian. What Goes In Must Come Out We won’t sugarcoat it. Loss of bladder and/or bowel control is no fun for you or your dog. Your dog has a strong instinct to relieve themselves away from their resting area and no one likes cleaning up soiled bedding. Over the years, we’ve discovered some of the best methods and products to keep this aspect as easy as possible.  Potty Pads & Easily Washable Bedding Invest in some quality potty pads! These are excellent for containing any mess and easy to throw away and start fresh. Bigger is better because the more pads you have to use to cover an area, the more edges there are where urine or feces can leak through. Since your dog will be spending a lot of time in one area, they will need plenty of soft, cushioned bedding and that bedding is likely to become soiled at some point. Make your life easier and choose bedding/padding that can be layered and is easy to clean! For a more detailed breakdown and real life examples on this aspect of your pet’s care, visit our article How to Set Up a Recovery Pen . Diapers & Belly Bands Diapers are great for female dogs with fecal or urinary incontinence, but are really only helpful for males with fecal incontinence. Disposable or reusable versions are readily available for purchase. Getting the right fit can be tough and your dog’s tail may complicate things. Even with the perfect fit, diapers tend to slide down and fall off, especially as they become full, which can be frustrating. Pro Tip - If you’re battling falling diapers, have your dog wear a comfortable harness & use pacifier clips to hold their diaper in place. Wrap the loop around the harness & attach the clips to the diaper’s edge that sits over your dog’s back. Metal clips tend to work best.  Belly bands are super helpful for male dogs that have bowel control but are urinary incontinent. These wrap around the dog’s abdomen to hold an absorbent material over the penis so that urine is contained within the band. These come in both disposable and reusable versions. We find that the reusable ones tend to stay on better and are often more cost effective. We’ve prepared links for many of these items on our Gear & Resources  page. Pro Tip - Line your pet's reusable belly band or diaper with human menstrual or incontinence pads! It's super easy to switch out pads rather than having to wash the band/diaper every time your dog urinates. Regardless of what type of diaper or belly band you choose to use, you must be extremely careful to use them properly or you risk injury and infection . Just like human babies, your dog’s diaper needs to be correctly sized and changed promptly once it has been soiled. All areas of skin that come into contact with the diaper must be closely monitored. The skin around the groin area is particularly sensitive so a soiled diaper (bacteria) that is too tight (abrasive/cuts off blood flow) and is left on for too long (prolonged exposure to moisture) is the perfect storm for painful, infected wounds. Incontinent dogs are already at a higher risk for Urinary Tract Infections, but sitting in a dirty diaper will exponentially increase that risk. When Possible, Get Outside If your veterinarian deems it safe to do so, try to help your pet urinate and defecate outside as often as possible. It can be emotionally helpful to give them a break from the monotony of life in the recovery pet in favor of some sunlight and fresh air. Even if you are manually expressing your pet’s bladder, try to do it outside where your pet would normally potty whenever you can. Your pet will always prefer to eliminate in a separate space from their den area Washing Up Regular, prompt changing of bedding and diapers/belly bands is a great place to start, but you’ll need to address their skin and coat as well. If your dog has a long/thick coat, shaving the hair around their anus & genital area, aka a Sanitary Trim, makes clean up much easier! Unscented baby wipes work well in a pinch but soapy washcloth is often more effective. Frequent wiping or washing can irritate your pet’s skin so we recommend using an oatmeal or sensitive skin pet shampoo to prevent overly dry skin. Pro Tip - If you intend to use wipes on a regular basis, make sure to buy wipes that are formulated specifically for dogs, as their skin pH is different from ours. Sometimes, a complete bath may be necessary. If so, just make sure your dog cannot slip or fall in the bath and that they are thoroughly dried after. Skin that is allowed to remain dirty and/or moist for too long is likely to develop a rash or infection.  Pro Tip - “Waterless” shampoo, often sold as a blue liquid spray product, can be somewhat helpful for very minor messes, but doesn’t actually wash your pet’s skin or coat since there’s no rinsing after! It does not replace actual bathing, can create skin irritation with frequent use, & can even stain your pet’s coat blue. Keep in mind that dogs have a primal need to maintain some level of cleanliness and for their den to be free of waste. Dogs that are left in dirty bedding/diapers can develop significant stress, anxiety, and even depression. None of these are conducive to healing, so remember that keeping your dog clean and comfortable will also help keep their mental state healthy which will help support their physical recovery and Quality of Life . Neurogenic Bladder & Urinary Tract Infections Dogs with spinal cord injuries often experience urinary dysfunction as well and the more time the pet spends unable to urinate normally, the higher their risk for developing Urinary Tract Infections (UTI). For some patients, the bladder becomes flaccid and the pet urinates involuntarily, however that doesn’t mean they are completely emptying their bladder. Often, the bladder remains partially filled and requires manual expression to completely empty, else “old” urine is left to sit and the bacteria within it will proliferate. Other patients may have too much urinary sphincter tone, preventing the bladder from emptying. These pets must receive timely medical intervention or serious complications like kidney damage, bladder rupture, or even death can result.  Depending on your pet’s needs, your veterinarian may teach you how to express your pet’s bladder so that you can do it as often as needed at home but you should never attempt to do this without instruction from your pet’s veterinarian . If you believe for any reason that your pet may be unable to urinate & you are unable or have not been instructed how to express their bladder, you should seek veterinary care immediately. Keeping your pet clean and dry will go a very long way to help reduce risk, but you should remain vigilant for common signs of UTI. These signs include: Excessively stinky urine, especially a fishy odor Urine that is darker in color Pink tinged or bloody urine Discharge from the urethra Pain while urinating Excessive licking of penis/vulva Increased thirst UTI is diagnosed via Urinalysis and if possible, it’s best to have a Culture & MIC performed as well, as this specifically identifies the type of bacteria that caused your pet’s infection and the antibiotic that is mostly likely to kill it. You should never assume that your pet’s UTI is gone just because they finished a course of antibiotics.   Should your pet be diagnosed with a UTI, always be sure to completely finish the prescribed course of antibiotics AND have a follow up Urinalysis performed to ensure no infection remains.  Their symptoms may have improved enough for you to believe they’ve been cured but the initially prescribed course of treatment isn’t always enough to completely eradicate the bacteria that caused the infection. If any of that bacteria remains when you’ve finished giving antibiotics, it will repopulate and your pet’s symptoms will return. Worse yet, the bacteria that survived and repopulated is significantly more likely to be resistant to first line antibiotics, meaning that your pet will require stronger medications that may have more side effects for a longer period of time to be cured of their UTI.  Protecting Skin & Paws Urine Scald When the skin is exposed to urine for a prolonged period of time, the ammonia and other components of urine will damage the skin’s protective barrier, causing it to become raw and painful. Urine scald is 100% preventable by ensuring that your pet’s skin & coat is kept clean & dry. The longer the skin remains moist and exposed to irritants, the weaker it becomes, the higher your pet’s risk for infection and open wounds. Accidents or soiled diapers must be addressed promptly and the skin should be allowed to breathe on a regular basis. Urine scald is easily identified, as the skin becomes very obviously inflamed and the pet’s coat develops staining and odor that are difficult to remove. Many pets will begin licking the area in an attempt to remove the source of their discomfort, which can also result in staining of the coat and introduce infection.  If your pet develops Urine Scald that doesn’t quickly resolve from improved hygiene practices, your pet may also need oral and/or topical medication to address infection and pain. If your pet’s coat is particularly long or thick, shaving or trimming it back can be immensely helpful to make clean up faster and easier in addition to allowing more air flow to reach the skin, helping to keep it dry. Sometimes, an e-collar (the cone of shame!) may be necessary to prevent your pet from licking the skin while it heals. Failure to treat and prevent urine scald can also contribute to our next topic, Decubital Ulcers. Decubital Ulcers (aka Bed Sores) More commonly referred to as Bed Sores or Pressure Sores, Decubital Ulcers are painful wounds and a serious concern for the Recumbent Dog. If the body remains in one position for too long, the soft tissues in the areas where bones are most prominent will experience too much pressure and too little circulation. These tissues then begin to break down, forming open wounds. Combine open wounds with urinary/fecal incontinence and we’ve got a recipe for a nasty infection. If allowed to continue, these wounds can become so deep that they expose muscle, tendon, or even bone.  Common Decubital Ulcer Locations Decubital ulcers are most likely to form on the bony parts of the body that experience the most pressure when laying on their side. Commonly affected areas include ankles, hips, elbows, shoulders, and eyebrow area, but these can occur anywhere that experiences prolonged pressure. Early stages can look like patches of hair loss or pink skin. If pressure is not relieved, the skin will begin to break down. You may also see redness, swelling, and discharge from the developing sore. Decubital ulcers that are allowed to worsen can eventually become full thickness wounds that expose muscle, tendon, or even bone. Decubital Ulcers can be very difficult to heal once they form, but they are very preventable! Make sure your dog has plenty of cushy padding (see our Recovery Pen  article) and most importantly, that they are repositioned every 4 hours if they cannot do so themselves. If your dog urinates or defecates on themselves or their bedding, they should be washed promptly and their bedding should be changed out right away. Again, make sure they are thoroughly dried before being returned to their resting place. Skin that is kept moist for a prolonged period will also be more fragile. If your dog cannot reposition or roll themselves over to their other side, you will need to reposition them every 4 hours.   When repositioning your pet, make sure to rotate between multiple positions and regularly switch sides of the body. Use rolled up towels or limb spacer pillows to help support your pet’s body and prevent them from rolling over. Not all positions are appropriate, so be sure to consult with your Rehab specialist for specific recommendations. If deemed safe for your pet, sternal positioning is a great alternative to always laying on their side & makes it easier for them to eat, drink, & interact. When laying your pet on their side, make sure to provide extra cushioning between their legs so that they are parallel to each other. This will help prevent decubital ulcers & overly tight muscles that could hinder their return to mobility. Abrasions If your dog is dragging themselves around, they are at high risk of developing wounds, even if it's on a soft surface. If your pet’s veterinarian has deemed it safe for your pet to drag themselves around, you’ll need to protect the areas of their body making the most contact with the ground to avoid injury. There is a common misconception that it is safe for dogs to drag themselves on soft surfaces like carpet, but we see many patients that are allowed to do so develop abrasions over their pubic bone or paws and they often present with excessively worn toenails that bleed. Drag bags are a great tool for these situations and can help contain any mess that results from a slipped diaper. When assisting your dog with a sling or Help ‘Em Up Harness , you’ll still need to mind their feet. There are many different booties on the market, and like us, every dog’s feet are unique so you may need to try a few different kinds to find which ones work best for your dog. As with anything you put on or around your pet, take care to ensure your pet doesn’t eat them and that they are not left on for too long.  All of these items are found on our Gear & Resources  page, but we’re always happy to provide personalized recommendations to CROC clients. For more information about getting your recumbent pet up and moving, including choosing the right gear for your circumstances, visit our upcoming article Rehabbing the Recumbent Pet . How to Lift & Carry Your Dog  If your dog can’t walk because of a spinal injury, it is imperative that you lift and carry them in a specific manner so as to avoid any further injury or pain. The most important thing is to make sure their spine remains parallel to the ground at all times. This is most easily accomplished using both arms to do the “lamby lift”or using a Help ‘Em Up Harness . Both methods provide equal support under the chest and pelvis and keep the pet’s legs directly underneath them. You should never pick up your pet by their armpits or allow their spine to twist or hang in any direction. Put them down in the same manner, keeping their spine parallel to the ground. Harnesses & Slings A good harness will be one of the most important things to help you safely move and restrain your dog, but it can be tough to pick the right one out of the millions of options because many aren’t made with ergonomics or safety in mind. Look for one that has a Y-shaped front and the leash attachment point should be on your dog’s back. Be sure to avoid harnesses with a strap horizontal in front of the chest, step-in style harnesses, and “no-pull” harnesses or those with a section that tightens with pressure. Our favorite harness for dogs that are unable or struggle to walk on their own is the Help ‘Em Up Harness  because it supports the entire body - no sling required - and it’s more comfortable for long term use. It can be tricky to find the right size and then adjust all the straps to fit your dog, but check in with our team and we can help you with that! Our Gear & Resources page also includes examples of traditional harnesses that we've found work well for our patients. A sling can be as simple as a towel or a neck tie but dog specific slings are also available online or in big box pet stores. No matter what you use, just make sure that it is made with soft material & does not inhibit movement - if your dog can move their back legs even a little, we don’t want anything getting in their way! Some male dogs can find it difficult or impossible to urinate with certain slings, so you may need to try one that sits farther forward or backward on their belly. That’s another reason we like the Help ‘Em Up! Almost all sizes have the option of a U-band for male dogs that cannot comfortably urinate with a sling. Lastly, make sure you choose a sling with handles that can be adjusted to your height. Your ergonomics matter too! Collars can be worn as an accessory to hold identification tags, but should never be used to move the recumbent pet or any pet with a history of or predisposition to spinal injury. When using a harness and/or sling to move your dog outside to potty, follow the same rules as when lifting them. Support the entire body and keep their spine parallel to the ground - do not allow their spine to twist in any direction. Walk slowly and allow them to move their legs/paws as much as they are able. Even if their legs aren’t moving at all, as long as their feet are protected from injury, just the act of imitating walking is very helpful in working towards recovery. To learn more about getting your pet moving and additional gear to make life easier, visit our upcoming article Rehabbing the Recumbent Pet . Quality of Life for All We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for recumbent dogs. Especially if their paralysis becomes more advanced or they lose control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. At any time during your pet’s journey, we completely understand and support humane euthanasia as an option. When deciding “when it’s time”, it’s always best to go weeks or even months too early than a day too late. Make sure to be realistic with your resources (finances, time, and energy) and frequently check in with yourself. Are you still enjoying your dog’s company? Are they happy and still enjoying their favorite activities? At any point, are you building resentment for the amount of work your dog now requires? It is important to note that for any end of life evaluation, the fact that an animal continues to eat is NOT a significant enough reason to delay euthanasia if other aspects of their life are filled with suffering. If you would like more information about how to properly evaluate Quality of Life for you and your pet, please feel free to reach out to us for assistance or read our article discussing Quality of Life . We're here for you & your dog Overall, caring for the recumbent/non-ambulatory dog is a tall order. There's a lot to consider when deciding how to move forward, but having realistic expectations for yourself and your dog can help make the situation a bit easier to manage. The CROC team is here to support you and offer advice at any time during your pet's journey but it's also a good idea to find support with your regular veterinarian and others within your household.

Please note: This article does not replace your veterinarian’s medical advice or prescribed veterinary medical physical rehabilitation, but it can help you with the basics you’ll need to know to understand and support your pet’s journey towards mobility. If you haven’t already, we recommend that you start with our other articles discussing recumbent care: If your pet is unable to rise, stand, or walk, they are considered a recumbent patient or sometimes referred to as a “down dog”. If your dog can rise and stand but can’t walk, they’re considered non-ambulatory. Either way, caring for a dog that cannot move about on their own is a challenging endeavor which can be more difficult due to your dog’s size, temperament, and level of debilitation. Not all hope is lost though! With the right care at the right time, many pets regain some amount of independent mobility.  Your Pet’s Diagnosis Physical Rehabilitation for the recumbent or non-ambulatory dog will look different for every condition and patient. What may work well for one diagnosis may be extremely harmful to another, so the more information about why your pet is down the better. Getting your pet up & moving is a necessary part of their recovery, but doing so incorrectly, too much, too soon or too late can completely derail their progress. There is no one size fits all recovery plan, so you should always refer to the treatment plan prescribed to your pet by the CROC team or your veterinarian. Generally speaking, our goal is to help your dog regain the muscular strength and neurological function to be able to get up and walk on their own again. Some conditions will recover faster or better than others and some will never recover despite our best efforts. Results & the time it takes to achieve them can’t be predicted or guaranteed. For dogs experiencing Neurological conditions like Fibrocartilaginous Embolisms or Intervertebral Disc Disease , there’s a good chance we can improve function and mobility with dedicated, consistent therapy that begins promptly. For dogs experiencing progressive conditions, like Degenerative Myelopathy or Geriatric Onset Laryngeal Paralysis & Polyneuropathy , we know that we will not be able to restore function but we can slow down the effects of these conditions and help patients maintain comfortable mobility longer than without therapy. Once they are Recumbent, it’s time to pay close attention to Quality of Life for everyone involved. Timing Can Make or Break Recovery! Waiting too long to start Rehab is the most common reason a patient does not achieve optimal results.  Starting therapy too soon could risk further injury to your pet, but starting too late is highly likely to delay or prevent their recovery. The longer your pet remains inactive, the more muscle mass and flexibility they will lose and the more likely they are to gain weight - all major contributors to poor recovery. For patients affected by neurological conditions like Intervertebral Disc Disease , there is a very limited window of time (around 6 months from symptom onset for most patients) to encourage the nerve tissues to heal and the longer those patients wait for therapy, the lower their odds of recovery. The sooner we start, the more time we have to get those nerves firing again and the more likely that pet is to regain function. However, unstructured activity, over-activity, or in appropriate activity can worsen your pet’s condition & potentially significantly impact their ability to recover. For this reason, it’s imperative that your pet’s therapy is closely monitored by credentialed and experienced Physical Rehabilitation specialists, especially in the early stages of their recovery. Patients that begin Rehab at the earliest safe opportunity recover better & faster than those that wait. own content We understand that the idea of challenging your pet’s body after everything they’ve been through can be nerve wracking and we agree that everyone should be cautious with their care. We are proud to say that we are the most accomplished, licensed, certified, & skilled Physical Rehabilitation specialists in Orange County, with more than 10 years experience treating medically fragile patients. You can trust in our expertise as we evaluate your pet’s case and determine the earliest safe opportunity for your pet to begin Rehab. Their prescribed therapy plan will evolve as their medical condition changes to prioritize their safety while maximizing recovery. Don’t wait to get your pet’s Rehabilitation journey started! We recommend that you call us as soon as you think your pet might need therapy, even if your veterinarian hasn’t mentioned it as an option yet or you’re not sure that it will be necessary. It’s super easy to book a Consultation several weeks in advance and cancel if your pet doesn’t end up needing therapy, but waiting until the last minute may mean losing weeks that could have been spent recovering just waiting for the next available Consultation appointment. We never want patients to wait any longer to get started than they absolutely have to and once you have completed the Consultation with our medical team, our schedule for therapy sessions is very accommodating. Effort Rehabbing the recumbent/non-ambulatory pet is rarely an easy or quick process, but can be highly successful and rewarding in many cases. More often than not, you get out what you put in. Recumbent pets will require more time and attention than when they were able bodied and be reliant on you to fulfill their basic needs, often for an extended period of time. To give your pet the best chance at regaining independent mobility, consistency is key, so you should be prepared to commit to the treatment plan for weeks to months. Work smart, not hard! The right tools can make it much easier to commit to longer term care & after more than a decade of rehabbing recumbent pets, we’ve tried out a wide variety of equipment. Check out our Gear & Resources  page to see our favorites! Your pet may need round the clock supportive care at home in addition to multiple therapy sessions each week. Our medical team also prescribes a custom homecare program complete with recommendations for massage, PROM, stretching, target exercises, nutrition plans, home modifications, and if appropriate, alterations to your pet’s medication regimen. It is integral to your pet’s recovery to adhere to that prescribed homecare program every day if you want your pet to achieve the best possible recovery. Skipping the “homework” or only partial compliance will significantly impact how much progress your pet will make. Your pet’s recovery journey may take several months. If you are unable to perform your pet’s prescribed treatment plan for any reason, let us know so that we can better assist you and your pet. If your schedule makes it difficult to stick to your pet’s homework, we also encourage clients to book extra appointments so that our medical team can perform those tasks for you and help keep your pet’s progress on track. Ultimately, just do your best to stick to the treatment plan and keep your expectations realistically aligned with the amount of effort and consistency you are able to maintain. Before We Jump In… The following techniques should not be attempted without being prescribed by a veterinarian as some of these may be harmful for your dog depending on their condition or if performed incorrectly. Many of the therapies described below cannot be legally performed by anyone other than licensed and experienced veterinary professionals. Keep Them Limber You know how after a long drive, you get out of the car and your body aches from sitting for so long? Recumbent dogs feel something very similar but on a larger scale. Their muscles simultaneously tighten and shrink from disuse and their joints become stiff and achy. Since they cannot move their body as they normally would, that task now falls to you. Thermotherapy Stiff and atrophied dogs need some loosening up before they can stretch and move. Thermotherapy therapy, or heat therapy, reduces inflammation and pain while increasing blood flow and improving the extensibility of tendons and ligaments. When properly warmed up, these tissues are more likely to stretch rather than strain or rupture. The metabolic rate of cells within heated tissue is improved, increasing oxygenation and better cellular recovery. Chronic injuries heal more quickly, joints experience a greater range of motion, and flexibility is maximized.  Thermotherapy is typically provided via microwavable heat packs applied directly to the patient. For optimal penetration into the muscles, ligaments, and tendons, apply moist heat rather than dry. Your dog should be in a relaxed position and heat should be applied for about 10-15 minutes. Cryotherapy (cold therapy) may be more appropriate for your pet so you should always refer to your pet’s prescribed treatment plan before proceeding. Wrap the heat pack in a pillow case or thin towel before putting it on your dog. Massage can be performed simultaneously while stretching and passive range of motion exercises should follow immediately after heating. Beware of Burns ! Always check that the heat pack is at a safe temperature before applying it to your pet! If you cannot comfortably hold the heat pack to your inner arm or neck, it’s too hot! Therapeutic Massage When your pet’s soft tissues are tense from inactivity, overexertion, or pain, blood flow is restricted which then deprives the cells within those tissues of vital oxygen. Reduced oxygenation reduces the metabolic removal of waste products and further impairs performance and healing. Lack of use causes your pet’s muscles, tendons, & ligaments to become short & tight, progressively limiting their range of motion. Massage Therapy relieves tension while restoring circulation and oxygenation to the tissues, thereby improving your pet's comfort and making it easier for them to participate in the exercise necessary for recovery. Muscles with good circulation will perform better, maximizing your pet's ability to increase their strength and stamina. Tendons and ligaments that are warm and relaxed will stretch farther and be less prone to injury. To top it off, massage releases endorphins that further promote your pet’s physical and emotional recovery. Your pet will need massage techniques specifically prescribed to them to avoid injury or other complications with their recovery. Refer to your pet’s prescribed treatment plan before proceeding. Tips to Maximize the Magic of Massage Less is more! The most effective massage is soothing and gentle, using slow kneading and gliding strokes similar to swedish tissue massage. This soft approach allows your dog to truly relax into the massage instead of bracing or tensing up in response. Choose a quiet, comfortable space with minimal distractions and make sure you are calm and relaxed before beginning.  One hand massage is less intimidating than two hands. To avoid feelings of being grabbed, be sure to use a flat, open hand and start the massage without using your thumbs.  If your dog is not used to having their body touched, start with light stroking, then work up to gliding and kneading. If they are particularly fussy and try to move away, let them! You are asking your dog to trust you with their weakened and/or painful body, so don’t make them feel trapped. Try again later with a lighter approach. The more you practice this type of touching, the easier it will become. The shoulders and neck are often the easiest areas to start with. Your dog’s muscles should not feel tight or banded in a relaxed state. If you can strum the muscle like a guitar string, there is tension and pain in that muscle. Do your best to massage both sides of your dog's body equally. To learn more, check out our video How to Massage a Dog . Passive Range of Motion & Stretching Beginning with thermotherapy and therapeutic massage to relieve tension and increase circulation will help make Passive Range of Motion (PROM) exercises and stretching more comfortable and more effective. Attempting to skip thermotherapy & massage can, at best, be ineffective at treating your dog’s condition, & at worst, cause pain or even injury.  Your pet will need PROM & stretching techniques specifically prescribed to them to avoid injury or other complications with their recovery. Our team provides all clients with a custom Treatment Plan to follow at home that has been prescribed to best address the pet’s specific needs. By following a customized Home Care Plan, you’ll know that the stretches and exercises within are not only safe for your dog, but also handpicked as the most beneficial for their recovery. PROM exercises involve moving your pet’s joints back and forth several times within its range of available movement. This promotes blood flow to the soft tissues and acts to lubricate the joint in order to maintain your pet’s overall range of movement. Stretching returns tight muscle fibers to their natural, elongated state to restore and maximize range of motion. Both assist in preventing tension and improving flexibility, which can then translate to an increase in your dog’s strength, stamina, and comfort. For stretching to be physiologically beneficial, start with warm, relaxed muscles and make sure stretches are performed slowly and held for a longer period of time. It is best for your dog to be laying down but they must be relaxed and muscle groups being stretched should not be weight bearing or engaged in any sort of work. If a muscle is not relaxed during PROM or stretching, there is a higher risk of injury to the muscle fibers or cells (pulling a muscle). Slowly moving the limbs to their maximum reach reduces risk of monosynaptic stretch response, which will tighten the muscle fibers and contract the muscles in reaction to moving the limb too quickly. There are different types of stretching but passive stretching, where you move your dog’s limbs for them, is the most beneficial for easing tension, increasing blood flow, and elongating the soft tissues.  All movements should be smooth & performed while stabilizing and supporting the joints. Apply gentle pressure to the muscles to manipulate your dog’s body into each stretch; NEVER pull! “If my pet doesn’t have feeling in their legs, is thermotherapy, massage, or stretching still necessary?” YES! Lack of sensation does not negate the need to keep your pet’s tissues healthy. For example, you can’t feel your liver but as a vital organ, it's important that we support liver health and function. The better your pet’s tissues are supported, the more likely they are to regain function. Avoiding Muscle Contracture Thermotherapy, Massage, Passive Range of Motion, and Stretching is a lot to get done every single day (and often multiple times a day) but the alternative is far worse. When a dog’s leg experiences long periods of disuse, the muscles not only waste away, but also contract and tighten, locking the dog’s leg into one position. This process is called Muscle Contracture & is both painful & difficult to reverse, so the goal is to avoid it entirely by keeping your dog flexible & moving. Once Muscle Contracture takes hold, it will take several months of intensive Physical Rehabilitation to have any chance at reversing it and there is no guarantee that it will be reversible. If your pet is already compromised by a neurological condition or poor musculature, Muscle Contracture will be a significant hindrance and may ultimately prevent your pet’s recovery. Change Requires Challenge Rest and pain relief are not enough for recovery! Thermotherapy, Massage, Stretching, and Range of Motion are passive treatments that improve comfort, maintain flexibility, and prepare the tissues for work, but when it comes to muscle and nerve function, it’s a “use it or lose it” situation. We know what some of you are thinking - “How am I supposed to exercise a dog that can’t walk?” Exercise comes in many forms and the custom treatment plan we prescribe to your pet will include several Target Exercises that are meant to safely maximize the function your pet still has and encourage the return of function they lost. Often, exercises for recumbent pets don’t appear to be exercise at all, when they are in fact powerful contributors to your pet’s recovery. Many are intended to “remind” the body how it’s supposed to work. The connection may be interrupted, but keeping the functioning nerves firing and trying to connect the tissues to the brain encourages nerve tissue to repair and regrowth. Even if a pet can’t move its legs or feel their feet on the ground, the nerves in their feet are still receiving information & trying to communicate that information to the brain. Other exercises are intended to harness the power of reflexive movement. Think of how your foot will curl if the underside is lightly tickled. You didn’t consciously tell your foot to do that, but those muscles were still activated and the movement happened without you even thinking about it. The same concept applies to your dog! With the right approach, we can stimulate your pet’s nerve function AND activate their reflexes to encourage muscle contraction, which can then later translate into kicking, standing, preventing falls, and hopefully walking. Of course, actively using muscles in the way we usually associate with exercise will always result in better and faster muscle growth, but any movement is better than none. While there’s no way to guarantee it, this reflexive movement can eventually become conscious movement for some patients. For recumbent/non-ambulatory dogs that are expected to make any kind of recovery, the first stages of exercise often appear tedious and insignificant. We start by re-teaching the dog to be able to lay sternally, where its legs are underneath them and their head is up, and after that, sitting up. These might seem like simple things, but strength, stamina, proprioception, and balance are crucial to be able to do these simple things and when we start, your dog may have very little strength, stamina, or balance and they may not have any proprioception at all. Once they are able to sit unassisted, we start working on standing. Your dog has likely spent a noteworthy amount of time just laying down, not supporting their own weight, so we have to retrain the body to be able to hold itself up again. This is where weight management plays a huge role in the level of difficulty your dog experiences during recovery. Getting to the point of standing may take weeks to months and during that entire time, you will still be responsible for all the movement and maintenance that your dog cannot do on their own and we will be working/supporting all aspects of your dog’s body to encourage healing and recovery. Fortunately, while conscious movement is the best case scenario, it isn’t always required for walking. Not all patients can regain conscious movement of their legs but many 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 and if we’re given the choice between paralysis and a goofy looking walk, we’ll take goofy any day of the week! Electricity, Needles, Lasers, & Sound Waves We utilize a mixture of clinically proven therapy modalities to help our patients feel better and recover faster. Our facility is outfitted with a variety of medical grade equipment including two Class IIIB Therapeutic Lasers, a Transcutaneous Electrical Nerve Stimulation (TENS) unit, a Neuromuscular Electrical Stimulation (NMES) unit, and a Therapeutic Ultrasound machine. For your pet’s safety, these medical devices should only be used by experienced veterinary professionals. Electrostimulation Neurological injury or disease are the most common reasons for pets to be recumbent or non-ambulatory as they interfere with nerve signal transmission & can result in phantom pain, incontinence, incoordination, weakness, and/or paralysis. Your pet cannot regain their ability to walk if their muscles aren’t working, & muscles won’t move if nerve signals to initiate movement aren’t getting delivered. Electrostimulation involves shaving small patches of your pet’s fur to place small, sticky electrodes over areas where motor nerves enter the muscle or the muscle belly itself, then introducing gentle electrical currents to help the nerves "practice" transmitting signals again. The more the neural pathways "practice", the more likely they are to heal or regenerate, potentially restoring your pet's mobility . E-stim also causes involuntary muscle contraction, helping to maintain musculature, improve circulation, & relieve tension. Voluntary movement will always be superior to the involuntary movement made by E-stim, but some movement is better than none.  E-Stim can be combined with PROM or target exercises for greater effect or used to amplify other treatments such as with Electroacupuncture. Replicating normal limb use or additional tactile stimulus, like tickling the toes, can be particularly helpful to maximize nerve activation & retrain muscle fibers. Acupuncture Acupuncture originates from Traditional Chinese Medicine & the concept of Qi. It is believed that placing needles in specific points along the body's Meridians unblocks disruptions to Qi flow that might cause illness. Modern science found that modifying this technique to stimulate specific nerves & muscle groups initiated endorphin release, increased blood flow, & increased nerve activity resulting in pain relief & improved healing. It can also be combined with E-Stim to enhance the benefits of both modalities as the acupuncture needles allow gentle electrical currents to bypass the skin, giving direct access to the nerves & muscle beneath. Many animals tolerate Acupuncture quite well. The needles used are sterile and extremely thin, so while the tissue's response to the needle can feel a little funny at first, it is generally not painful. The biggest factor for success is a pet's ability to sit still so that we can safely place the needles & keep them in place for the duration of the session. Plenty of pets relax or even fall asleep once they recognize the comfort that Acupuncture provides. Laser Therapy Laser is an acronym for L ight A mplification of S timulated E mission of R adiation and Laser Therapy involves applying that focused light into the tissues to achieve Photobiomodulation (the alteration of cellular function). Photobiomodulation can help with tissue repair, most notably in patients with chronic pain and/or injury. S tudies have also shown that Laser Therapy promotes accelerated nerve regeneration and improved functional recovery of peripheral nerves. Pain relief from Laser Therapy may be dramatic & substantial, lasting for hours, days, or weeks. Therapy is commonly described as a very soothing, warm sensation. Many patients feel a significant reduction in pain with just one treatment, but some patients need multiple treatments before they start feeling the effects. The effects of Laser Therapy treatment are cumulative, so patients that get successive treatments will benefit more than a patient that only gets one treatment every once in a while. It’s important to note that we exclusively utilize veterinary medical grade Class IIIb "Cold" Therapeutic Lasers to maximize efficacy & safety. Lasers of this caliber are not available for purchase by the general public & the devices that are readily available do not have enough power to achieve the same results. Check out The Low Down on Laser  for more information. Therapeutic Ultrasound We typically think of Ultrasound as the diagnostic imaging machine doctors use to see inside the body, such as during pregnancy. Therapeutic Ultrasound is not for diagnostic imaging but uses the same technology to create heat deeper into the soft tissues than external sources, like heat packs, can reach, thus facilitating tissue healing & reducing pain. Ultrasound is particularly useful for patients that have developed Muscle Contracture. Tissues that are warm are better oxygenated & more flexible, allowing for optimal stretching that makes it possible to safely regain range of motion more quickly. Ultrasonic waves can't travel through air, so it is best to shave off a small patch of fur at each area to be treated & apply a generous amount of ultrasound jelly. Treatment lasts several minutes for each area & causes a painless, warming sensation. Many patients relax & snuggle while they wait. For most cases, stretching & exercise commences immediately after treatment. Underwater Treadmill Hydrotherapy Once we’ve utilized our other modalities to prepare your pet’s body and deemed it safe for them to participate, initiating Underwater Treadmill Hydrotherapy is immensely helpful in supporting their return to mobility. In addition to providing low impact, high resistance exercise, the buoyancy the water provides gently lifts your pet’s body, allowing them to move more than they could on land. The more movement they can manage, the more their muscles can regrow and the more their nerves can heal or regenerate. Patients often start to demonstrate regained strength & coordination in the water long before they do on dry land. Many patients that don't like baths or swimming find Hydrotherapy in our Underwater Treadmills enjoyable thanks to the gentle introduction to the water. Your dog will walk onto a dry treadmill belt, then warm water slowly & quietly rises to their customized specifications. Throughout your dog’s Rehab journey, we'll alter the water level, belt speed, duration, & reps to perfectly tailor their hydrotherapy session & maximize their recovery. Pro Tip: Swimming is NOT safe or effective therapy for most recumbent/non-ambulatory patients! Swimming requires fast, intense motion that causes the spine to move in a twisting motion, overworks some muscle groups while underutilizing others, and can be very hard on your pet’s joints - all things your pet needs to avoid if they are to recover . Using an Underwater Treadmill provides a controlled hydrotherapy environment that encourages the slow, deliberate movement required to safely build muscle and improve coordination without causing excess strain to any other areas of the body, making it the safest option for fragile patients. Check out our article, The Deep Dive into Swimming  for more details. A New Set of Wheels Some clients elect to pursue a cart (sometimes referred to as a wheelchair) for their dog, but this option is highly dependent on the individual dog’s condition.  Pro Tip: We strongly advise against the use of a cart for any dog that has the potential to regain mobility, as it is likely to prevent recovery. If it is not possible to pursue physical rehabilitation therapy or your pet’s prognosis for return to independent mobility is poor, a cart may be a good option. Not all dogs are good candidates for this and it’s quite the investment so it’s important for pet parents to approach this with realistic expectations.  Carts for animals do not work the same way as a wheelchair for humans & require significant physical strength & stamina from the dog. While using a cart, dogs are forced to rely on the functional parts of their body to move their entire body weight AND the weight of the cart with fewer opportunities to rest as, unlike human wheelchairs that allow the user to sit and recover, dogs are unable to sit or lay down until removed from their cart . This means that cart candidates must be physically fit enough to withstand the challenge. Dogs that are good candidates should be fitted for a custom-built cart. Barry was professionally measured by the CROC Team & his rear wheel cart was built specifically for his body shape & size. This cart is a popular online purchase, but comes in a limited range of sizes. It rarely fits well & can result in pain & even injury. Dog bodies come in every shape, size, and proportion, so their medical devices should be chosen with great care and/or custom made for them. The only company we recommend for carts is Eddie’s Wheels whom we regularly collaborate with by performing cart measurements and providing long term cart support to the pets we measure. Over the years, we have seen many other carts and found serious flaws in all of them, with some even causing severe pain for the dog using it. For this reason, we recommend approaching To learn more about carts for dogs Visit our articles The Wheel Deal: Let’s Talk About Carts  & The Wheel Deal Part 2: You Got the Cart; Now What? . Keep Them Healthy Lean! It’s important to find and maintain just the right balance of nutrition and exercise so that your pet has enough fuel for healing and exercise without adding unnecessary weight. We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the less strain is imposed on their already weakened body. Many recumbent dogs are also old enough to have developed arthritis, so all the more reason to reduce any extra work on their joints. For more information visit our article Body Condition Score & Canine Weight Loss . Pain Medication & Supplements Since there are many reasons a dog may become recumbent, it can be difficult to recommend any medications or supplements across the board but it is important to treat any sources of pain as pain will inhibit your pet’s ability to heal. CROC does not prescribe medications, but we can help evaluate your pet’s current pain management plan  and give you the information you need to discuss it with your regular veterinarian. Check out our article Pain Meds & Supplements  to learn more. Medical Marijuana & CBD CROC strongly discourages the use of marijuana products for canine patients. While emerging research shows some promise for cannabis based treatments in veterinary medicine, there is still much more to be done to prove safety and efficacy. The lack of regulation is highly concerning as there have been countless reports of harmful, even life threatening, ingredients being used in products marketed for pets . Lethargy and incoordination are common side effects of marijuana so recumbent and non-ambulatory patients that are already weak and have diminished coordination make poor candidates for these products. Cannabis products marketed for pets are not currently regulated in California & multiple incidents of harmful, even life threatening, ingredients in these products have been reported. Chiropractic Manipulation We know this is can be a soft spot and that many people enjoy chiropractic for themselves. 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. Human Chiropractic has been practiced since the late 19th Century but is still in contention regarding its efficacy today. 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.  CROC does not offer Chiropractic services because not a single one of the many Board-Certified Specialists we’ve consulted with will approve or recommend Chiropractic therapy. 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. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate or safe treatment for Veterinary patients. If your pet has a spinal condition such as Intervertebral Disc Disease , the force of Chiropractic can cause serious injury up to and including permanent paralysis. 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 and osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first. There are certainly better and safer options for pain relief available. We're here for you & your dog Overall, caring for the recumbent/non-ambulatory dog is a tall order. There's a lot to consider when deciding how to move forward, but having realistic expectations for yourself and your dog can help make the situation a bit easier to manage . The CROC team is here to support you and offer advice at any time during your pet's journey but it's also a good idea to find support with your regular veterinarian and others within your household.

Therapeutic Laser is an immensely helpful tool to accelerate healing and relieve pain, but as it has become more popular, low quality devices have flooded the market. So how do you know if your dog is getting the real deal or just a flashing red light? Do any of these devices actually work? Read on to find out! How Does Therapeutic Laser Work? In order to distinguish snake oil from legitimate medical treatment, you’ll need a good understanding of what Laser Therapy does to the tissues it is applied to. Laser is an acronym for L ight A mplification of S timulated E mission of R adiation and Laser Therapy involves applying that focused light into the tissues to achieve Photobiomodulation (the alteration of cellular function). When Photobiomodulation is achieved, healing is accelerated, circulation is improved, and inflammation is reduced, all of which decreases pain and stiffness.  Pain relief from Laser Therapy may be dramatic and substantial, lasting for hours, days, or weeks. The primary effects of Photobiomodulation are increased circulation, the release of more oxygen from the bloodstream, and enhanced utilization of that oxygen to increase ATP production. Adenosine triphosphate (ATP) provides energy to drive and support living cells. Mitochondria are a likely site for the initial effects, leading to increased ATP production, modulation of reactive oxygen species, and induction of transcription factors. These effects lead to increased cell proliferation and migration, modulation of cytokines levels, growth factors and inflammatory mediators, and increased tissue oxygenation. Cell permeability is also enhanced/increased.  In short, Photobiomodulation can help with tissue repair, most notably in patients with chronic pain and/or injury. Studies have also shown that Laser Therapy promotes accelerated nerve regeneration and improved functional recovery of peripheral nerves. What Does Laser Therapy Feel Like? Laser Therapy is commonly described as a very soothing, warm sensation. Since our lasers are Class IIIb devices, your pet’s skin will get warm during the treatment. Many patients feel a significant reduction in pain after the first treatment, but some patients need multiple treatments to start feeling the effects. Most owners report their pets are relaxed or even sleepy after laser therapy. The effect of Laser Therapy treatments is cumulative, so patients that get successive treatments will benefit more than a patient that only gets one treatment every once in a while. Classes of Laser Devices Before pursuing Laser Therapy for your dog, find out what class of Laser Device will be used. This is one of the easiest ways to confirm that your dog will be getting safe and effective treatment. The wavelength that the Laser Device emits determines its ability to penetrate and achieve photobiomodulation, but also the potential hazards of using a device. Class I & II These are considered safe for everyday use such as barcode scanners and laser printers and pose no more hazard than regular light. Because they are such low power devices, they would take an extremely long time to achieve Photobiomodulation if they can even manage to penetrate deeply enough into the tissues, therefore they are not utilized for therapeutic purposes. Class IIIb Sometimes referred to as “Cold Laser” this is the best studied and most commonly utilized class. They can heat tissues and materials but are considered a low risk for burns. This class can cause eye injury and depending on the device’s power level, protective eyewear may be recommended. Because they are powerful enough to achieve Photobiomodulation while being a relatively safe device, they are the device of choice for human Physical Therapists and Veterinary Physical Rehabilitation Practitioners, including the CROC Team.  Class IV This powerful class of lasers deliver treatment more quickly than lower classes, but they also have a much higher risk for injury and must be used with extreme care . Protective eyewear is required as any eye exposure will cause significant injury. In addition to therapeutic purposes, this class also includes surgical lasers used to cut soft tissues. Why Does the Class Matter? The power required to effectively penetrate the tissues can only be produced by Class IIIb & IV lasers, but these devices can only be purchased and utilized by licensed medical professionals because they can be hazardous when used incorrectly. Lasers that are available over the counter (typically Class I) are generally safe enough for someone without medical training to use, but this also means that they often do not provide any benefit as they are too weak to achieve Photobiomodulation. We have met with many pet families who were sold expensive over the counter lasers to use on their pets. By an overwhelming majority, their feedback was that they spent hours applying these devices to their pets but saw no improvements in their pet’s comfort or mobility. They have been extremely frustrated and their faith in Therapeutic Laser as a modality completely undermined. Unfortunately, this also means that many patients who would greatly benefit from a medical grade Therapeutic Laser never get that opportunity for pain relief and healing. Contraindications Because Therapeutic Laser alters and accelerates cellular function, it can be problematic in certain situations. If Therapeutic Laser is applied to a puppy’s growth plates, it can cause those cells to stop growing. The rest of the puppy’s growth plates will remain open and continue to grow like normal while the lasered growth plate closes prematurely, causing permanent skeletal deformity.  Cancer cells are cells that replicated incorrectly from normal cells, then continued to proliferate. Therapeutic Laser stimulates cellular function and increases blood flow to support those cells so if it is used on cancerous cells, it can encourage those cells to spread and proliferate more quickly. For this reason, any lumps or bumps on your pet should be examined before Laser Therapy commences. Pregnant animals are chock full of rapidly reproducing cells growing new life in their wombs, but those new cells are also extremely sensitive to the effects of laser. Risks include deformities or even miscarriage, and due to these risks, there are limited studies as to safety of Laser Therapy in pregnant animals, therefore it is avoided as much as possible. End of Life Care During a dog’s senior years, it’s important to start prioritizing quality of life over length of life. If a senior dog is suffering from pain that cannot be adequately controlled with medication, other modalities should be considered in conjunction with pain medication. These modalities include Thermotherapy, Massage, Stretching, Acupuncture, and Laser Therapy. If the dog in this example also has a history of cancer, Laser Therapy should only be pursued with the understanding that it can increase the risk of cancer returning or spreading and that choosing to move forward with Laser Therapy is choosing to address the pain the dog is definitely feeling now rather than worrying about the possibility of future cancer . These are tough decisions and should only be made after thorough discussion with your dog’s medical team. Key Takeaways Class IIIb and IV Therapeutic Lasers used by licensed medical professionals to achieve Photobiomodulation offer significant healing and pain relief effects. Lasers that are safe enough for anyone to buy are not powerful enough to make any real impact on your pets comfort or mobility. If Laser Therapy has been recommended for your pet, be sure to ask what class of device will be used to ensure your pet receives effective treatment. Pets that receive Laser Therapy on a regular basis will benefit more than pets that only get Laser Therapy occasionally.  Laser Therapy should not be used on pregnant animals, animals with open growth plates, or those with a history of cancer or untested masses. In special circumstances, such as end of life care, Laser Therapy is a viable and effective pain relief option as long as it is understood that it may increase risk of cancer returning or spreading. If you have any questions about Laser Therapy, you are welcome to reach out to the CROC Team. We are happy to share our knowledge and help you to make educated decisions for your pet’s medical care.

If your pet is unable to rise, stand, or walk, they are considered a recumbent patient or sometimes referred to as a “down dog”. If your dog can rise and stand but can’t walk, they’re considered non-ambulatory. Either way, caring for a dog that cannot move about on their own is a challenging endeavor which can be more difficult due to your dog’s size, temperament, and level of debilitation. Depending on their diagnosis, you may be responsible for some or all of your dog’s most basic bodily functions – eating, drinking, urinating/defecating, maintaining Range of Motion, minimizing muscle atrophy, preventing bed sores, and even providing mental stimulation. If your pet is expected to get better, these responsibilities may be temporary, but other conditions may require you to continue providing this level of support for the remainder of your pet’s life. While the information in this article is focused on recumbent pets, it can also be applied to veterinarian-directed crate rest, regardless of your pet’s mobility status. Conditions commonly in need of recumbent/non-ambulatory care include: Intervertebral Disc Disease (IVDD) Fibrocartilaginous Embolism (FCE) Acute Non-Compressive Nucleus Pulposus Extrusion (ANNPE) Degenerative Myelopathy (DM) Geriatric Onset Laryngeal Paralysis & Polyneuropathy Geriatric Sarcopenia Until your dog can resume independent mobility, you’ll need to make some adjustments at home in order to keep them safe, clean, and comfortable so we’re sharing all the best tips and tricks for creating a recovery pen for your dog with real life examples and options to fit your dog’s size and medical condition.  Why Does Your Dog Need A Recovery Pen? The short answer is that it will help your dog recover faster, reduce risk of complications, and make it easier for you to properly care for them. 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 allowed to be more active than their condition allows, they are likely to re-injure themselves or otherwise worsen their condition. Similarly, if they don’t have enough room to move and stretch, they can quickly lose muscle mass and range of motion that are integral for any chance of recovery.  If they cannot reposition themselves on their own, they are at risk for complications like decubital ulcers aka “bed sores” which can severely impact their health and ability to recover. If your dog is incontinent, you’re going to want to make cleaning up as fast and simple as possible to reduce the burden of care on you and reduce your dog’s risk of skin and urinary tract infections. Preventing free access to your home helps avoid serious safety hazards. Sometimes, other pets in the household can be a danger to your recumbent dog, whether it's an unintentional jostle or outright aggression. If your dog is recovering from a spinal injury, a fall down the stairs or even just traversing the furniture can mean the difference between permanent paralysis and successful recovery. If you have to clean up potty accidents all over the house, you are likely to develop compassion fatigue much more quickly, reducing your ability to effectively care for your pet, your family, and yourself. Influential Factors The reason for and severity of your dog’s loss of mobility will directly influence how you’ll need to prepare their recovery pen, as well as how that space might evolve in the coming days, weeks, or months. These questions will help guide you through the process: Is your dog expected to get better? Can they keep themselves upright, sit, or stand? Do they make any attempts to walk? Can they eat and drink on their own? Can they control when and where they urinate or defecate? How much supervision are you able to maintain? Does your dog respect boundaries like baby gates or pens? Keep your answers in mind as we delve into the details. Other influential factors to consider include your dog’s breed, age, body weight, if they’ve had surgery, and your physical capability to care for them.  Early vs. Late Stages of Rest 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 and comfort while still providing enough space to encourage movement as appropriate. Early Rest  is generally considered the period of time when your pet is the most delicate and/or debilitated. During this stage, the recovery pen will be small and require that you can move your pet in and out of it in a manner that is safe for you and your pet.  Late Rest  can vary pending your pet’s condition and your veterinarian’s recommendations, but this typically begins a few weeks after your pet’s initial injury or surgery. You should not switch to a late rest recovery pen until your veterinarian advises you to do so.  During this stage, your pet is likely making more attempts to move and we want to encourage them to continue doing so while preventing potential complications from over activity.  Recovery Pen Basics Your dog’s recovery pen will be their own little world for most of the time and they will use this space for eating, drinking, rest, and eventually, attempts at walking. Regardless of the stage of rest, your pet’s recovery pen should always: Rest on a flat, level surface Be in a temperature controlled space Be lined with easily cleaned materials that provide good traction & padding Have clean water available in a bowl that can’t be spilled Securely contain your recumbent pet while keeping other pets & small children out Be located in a spot that is neither too isolated, nor too overstimulating Include some element of privacy for your dog Be kept clean, dry, & free of pet waste Have a floor level entry so your pet doesn’t have to step over anything Allow you to easily get your pet in & out without twisting or pulling on their body Early Rest Pen NO walking space! J ust large enough that your pet can lie fully stretched out, sit, stand, turn around, and eat/drink with ease but no larger. Late Rest Pen Slightly expand upon the Early Rest Pen to add a standing area just large enough for your pet to take 2-5 steps away from their bed, but no larger. While expandable pens work well for most pets, special considerations may need to be made for some pets. If your dog is an escape artist, you may need to utilize a crate instead of a pen and then use a larger crate once they have entered late stage rest.  Giant breeds may benefit from a small recovery room instead of trying to squish them into a pen that is too small or short. Should that be the case, ensure that all furniture is removed and that the doorway can be securely closed or blocked off. Recovery rooms are only appropriate for dogs that are too large to use a pen & should still follow all of the rules for a typical recovery pen. Linings, Layers, & Linens When lining your pet’s recovery pen, it's a good idea to utilize multiple layers of varying materials, especially since many recumbent pets have some form of incontinence. All layers should be chosen with consideration for your pet’s comfort and safety, their stage of recovery, as well as ease of cleaning or replacement.  Protective Layers This first layer is intended to prevent any damage to your floor and stop the pen from sliding around. Commonly used materials include plastic sheeting, rubber/yoga mats, and waterproof blankets. Absorbent Layers If there is any chance your dog will urinate, defecate, vomit, or spill water in their recovery pen, absorbent layers are a must. Options vary widely depending on budget and what is easiest for you to use. If you don’t mind frequent washing and drying, thick towels or blankets may work well for you. Alternatively, disposable potty pads make for quick and easy clean up, are available in a variety of sizes, and can be purchased in bulk. If your pet has trouble controlling their bowels or bladder, be prepared to change linings out multiple times a day regardless of what material you’ve chosen or if your pet is wearing a diaper. Early Rest Bedding Because early rest pens should only be wide enough for your pet to lie fully stretched out, the entire floor of the pen can be considered a bed and should be relatively level. At this stage, our primary goal is to ensure there is enough padding to support your pet’s body & protect them from injury if they roll over or stumble. At minimum, bedding should be 1-2 inches thick for every 40 lbs of body weight. Since there should be no room inside the pen for your pet to get off the bedding, you are free to make the bed as thick as is needed for comfort and safety. Additional padding around the edges of the pen is strongly recommended to keep your pet from getting stuck up against a wall.  The easiest way to do this is to place rolled towels or crib bumpers around the inner perimeter of the pen. Similarly, rolled towels or bolster pillows can be placed directly against the body to prevent pets from rolling over or otherwise changing position. Insufficient padding can result in stiffness, soreness, facial injuries, & decubital ulcers (bed sores). In addition, pets that get stuck between their bed & the pen wall frequently panic & injure themselves. Late Rest Bedding & Walking Area Late rest patients still need a bed area that adequately cushions their body and is large enough for them to lay fully outstretched upon, but now that movement is encouraged, we’ll need to add room for them to walk around inside their pen. First and foremost, there should be minimal height difference between your pet’s bed and walking area. This is to ensure they can get on and off with ease and reduce risk of falling. Generally speaking, beds should be no more than 2 inches high for small dogs or 4 inches high for large dogs. For the walking area, you’ll need to provide a soft layer that provides good traction on top of the protective and absorbent layers. Avoid anything that wrinkles easily or slides. Common materials include terry towels, fleece blankets, low pile rugs with rubber backing, and yoga mats.  Special Considerations for Linings & Bedding If your pet is frequently soiling their dog bed, it can be helpful to wrap the inner filling in plastic, then put the outer bed covering back on. It’ll be much easier to clean, especially if you have more than one cover for the bed. Even soft materials can still cause injury Be mindful that soft materials can still cause injury. Skin abrasions and excessively worn toenails can occur if your pet is dragging themselves across carpet or rough towels. Blankets and towels with holes can be a serious safety concern. It’s not uncommon for animal toes and nails to get stuck in those holes and as the pet tries to get free, that fabric can get twisted around the toe and cut off circulation. For this reason, it's best to avoid knit/crochet blankets and replace any towels or blankets that have torn. If your pet tends to chew up bedding, you will need to find alternative ways to provide adequate padding while preventing your pet from eating anything they shouldn’t. Sometimes, it’s enough to have the layers laid flat and extended beyond the walls of the bed so that there are no edges for your pet to grab. It can take a little trial and error to find what works for you and your pet. You might try out different beds or layer materials in a different order than our examples. As long as your method is equally safe and comfortable, you’ve succeeded! If you’re not sure about an alternative option, reach out to us or your veterinarian first. What else goes in the Recovery Pen? Food bowls can be removed as needed, but water should always be kept available. It’s best to secure all bowls by surrounding them with towels or using bowls that can be clipped to the side of the pen. Some pets benefit from having their bowls slightly elevated off the ground, but always ask your pet’s veterinarian or Rehab specialist before doing this to ensure it is appropriate for your pet and to confirm what height is safest.  Regardless of the method you choose, just make sure it’s easy for your pet to access and that any spills are cleaned up quickly. While you might be inclined to include your pet’s favorite toys, take care with what you choose to add and when. Toys can bring your pet joy, but they can also be a tripping hazard or encourage more activity than is safe. If your pet has a delicate spinal condition, such as Intervertebral Disc Disease, no tug toys or vigorous toy shaking should be permitted. As with any pet, be mindful of leaving toys unattended with your pet. Life in the recovery pen can get boring, especially if you’re not around to keep your pet company. If there’s a risk your pet might eat their toy, only give it to them when you are available to supervise. Emotional Wellbeing Pets experience significant distress when their mobility is compromised and for some pets, this can be compounded by being confined. Fortunately, there’s a lot you can do to make the experience more pleasant for your dog and promote the relaxation and rest they need to heal. Start Positive Your dog is an emotional creature and looks to you for guidance on how to respond to new things. Seeing your furry best friend struggle with pain or lack of mobility can instill feelings of sadness and frustration for you, but we can’t overstate how important it is for you to keep your attitude positive when around your pet. When you introduce your pet to their recovery pen, make sure it’s a good experience! Use their favorite bed or blankets. If you can time the introduction to align with their next meal, have that waiting in the pen for them. Spend some time with them as they check out their new space and calmly use lots of praise to help them understand that this is a good thing. Visit with them often and don’t make a big show when you walk away from the pen. Just calmly go about your day so you don’t emphasize that you’re leaving. If your dog is particularly food motivated, it might be helpful to give them a little snack every time you put them back in the pen. Just make sure that you never reward anxious behavior (such as whining or barking) and always include those calories when measuring their food for the day as any excess body weight will drastically impact your pet’s ability to get back on their paws. If you’re not sure how much they can have, ask the CROC team or your primary veterinarian. Pen Location & Privacy The location of your pet’s recovery pen can have a huge impact. You don’t want to leave your pet feeling isolated from the family but you also don’t want them to get overly excited from too much going on around them. The goal is for your pet to rest, which requires a calm, peaceful environment that promotes as much sleep as possible. If your pet is the type to follow you around the house wanting to be involved in everything you’re doing, they’ll probably appreciate their pen being in the area where you and your family spend the most time. Some even appreciate having multiple pens around the house so that you can bring them along to whatever area you’ll be in.  If your dog is more aloof or nervous, they might do better in a quieter part of the house where they don’t feel so overstimulated and exposed. Keeping the TV or music playing at low volume can help drown out any noise that might overexcite your pup, like the doorbell or other dogs barking nearby. If your pup is doorbell reactive, you may want to put up a “shhh, please don’t ring the doorbell” sign at your front door. Even if your pup is shy in nature, make sure to visit with them often so you can make sure they have everything they need and don’t feel completely alone. Dogs are social animals after all, even if some are more introverted than others! As den animals, most dogs appreciate some semblance of privacy. Covering part of the pen with a bed sheet or blanket can help them feel like they have a little den of their own to retreat to. Choosing a spot with a consistently comfortable temperature also goes a long way to helping your pet relax, so make sure to avoid drafty areas or places that warm up with a lot of direct sunlight. Mental Stimulation Since your pet can’t burn through pent up energy with exercise, this energy can manifest as anxiety and frustration. Keeping their brain busy not only helps release that excess energy, but it's also a significant contributor to cognitive & emotional health for all dogs. You can provide mental stimulation with new toys, games, food puzzles, and teaching or practicing tricks that require minimal movement. Delivering their meals to them in novel ways is a super easy way to do this and can be as simple as freezing it inside a kong toy, using a snuffle mat, or making them work through a food puzzle to get it. If the weather allows and your dog can remain calm, some dogs really appreciate some supervised time in a pen outside to get some fresh air and sunlight. Just make sure that the outdoor pen follows the same rules as the recovery pen and your pet is not left out in overly hot, cold, or wet weather. Questions? The CROC Team is always happy to help you with your pet’s recovery pen! Feel free to share pictures of your recovery pen set up so that we can provide more detailed recommendations. Remember that every pet is different and it might take you a little bit to find the exact configuration that works best for you and your pet. The goal is to make sure your pet only moves as much as is safe and they are comfortable enough to rest so they can heal.

Hip Dysplasia is a common condition, especially in large breeds, that often leads to pain and lameness. Given its prevalence and considerable impact on a dog’s life, it should be taken seriously. Fortunately, there are many things you can do to help keep your dog active and comfortable despite the condition. What is Hip Dysplasia? The hip joint consists of the acetabulum (the concave socket in the pelvis) and the femoral head (the ball on the femur), as well as cartilage to ensure easy movement and several muscles to support and move the joint. A normal hip joint has a snug but smooth fit, allowing for pressure to be evenly distributed throughout the joint. Dysplastic hips develop abnormally, leading to laxity between the acetabulum and femoral head which then causes excess wear and tear. The body tries to stabilize the joint by developing Osteoarthritis but this further contributes to the pain a hip dysplasia patient experiences. Who is Affected? Hip Dysplasia is most common in large and giant breeds, especially Labrador Retrievers, Golden Retrievers, German Shepherd Dogs, Saint Bernards, Old English Sheepdogs and Bulldogs, but it can occur in any breed or mix. It is a genetic condition, but there are additional factors that can increase risk or severity such as nutrition, exercise, and weight. Body weight has been shown to be the most significant variable. Early spaying/neutering may also increase risk. How is it Diagnosed? Some dogs will show symptoms of Hip Dysplasia at a very young age, while others won’t until they are much older. Signs of Hip Dysplasia include: Stiffness Weakness Limping Abnormal gait Difficulty rising, laying down, or sitting Reluctance to use stairs Thigh muscle atrophy Enlarged shoulder muscles Pain Radiographs (x-rays) are the easiest way to assess a dog for Hip Dysplasia, but proper positioning and the age of the dog can impact the accuracy of hip radiographs. If the radiographs are not definitive, sedation may be recommended to get better quality images and having the radiographs performed by a Veterinary Orthopedic specialist can be helpful as well. Ask your veterinarian if they regularly perform OFA (Orthopedic Foundation for Animals) and/or PennHip ( University of Pennsylvania Hip Improvement Program)  radiographs , as the technique for these has been proven to be the best for accurate imaging.  Your veterinarian should evaluate your dog’s gait, range of motion, and musculature. As the hips become more painful, dogs will use their front legs to compensate by shifting more of their weight forward and off the hind legs. It is also common for them to have an exaggerated sway of their rear end because they are using their back to swing the rear legs forward instead of the hip muscles. When they avoid moving their hips due to pain, their Range of Motion will decrease and the muscles of the hind legs will atrophy.  Treatment varies pending the severity of dysplasia and level of pain it causes. Some dogs can get by with Physical Rehabilitation Therapy and Non-Steroidal Anti-inflammatory Drugs (NSAIDs) as needed , while others require orthopedic surgery to address their pain and loss of mobility. Symptoms usually worsen as the dog ages because more osteoarthritis will have formed and increased pain leads to less activity and thus atrophy of the muscles that support the joint. Surgical Treatments Surgery isn’t always required for a dysplastic dog to have a comfortable and happy life, but it can be a game changer for dogs with moderate to severe Hip Dysplasia. There are 3 surgeries available to treat this condition. Femoral Head Ostectomy (FHO) This is the most commonly performed Hip Dysplasia surgery because it is less complicated, less expensive, and has a good success rate with few complications. An FHO consists of removing the femoral head, or the ball part of the joint. The muscles and ligaments around the joint will then take over, creating a “false joint”. Since the limb will be supported exclusively by soft tissues, Physical Rehabilitation Therapy will be of utmost importance in order to maintain strong hip muscles. Recovery from this procedure is typically around 6 weeks, with active pets often recovering better than inactive ones. As FHO patients age and normal age-related muscle loss occurs, they often return to Physical Rehabilitation Therapy to rebuild those hip muscles that are essential for mobility. Total Hip Replacement (THR) This is now considered the Gold Standard procedure for Hip Dysplasia. Our local Orthopedic specialists are finding that "95% of dogs that undergo this procedure regain normal function and maintain it for life". THR used to be limited to dogs that were fully mature and finished growing, but newer developments make this procedure more accessible for a variety of ages and the array of implant sizes means that surgeons can mix and match for the perfect fit for each patient. Previous techniques and hardware for this surgery were not as successful, so if you are interested in pursuing this procedure for your dog, make sure to utilize a board certified veterinary surgical specialist that is experienced with newer methods. Much like the human hip replacement, this surgery involves removing the dysplastic parts of the joint and replacing them with artificial implants. A metal implant is used to replace the femoral head and a plastic implant replaces the acetabulum. Recovery from this procedure is typically around 3 months, with exercise restriction being integral to boney healing in the early stages. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature so they can return to their favorite activities more quickly. Double or Triple Pelvic Osteotomy (DPO/TPO) Because hip dysplasia causes excess laxity in the joint, the femoral head can dislocate from the acetabulum. The pelvis consists of four bones that fuse together at maturity. This surgery involves 2-3 incisions and 2-3 cuts into the pelvis to manipulate those bones before they have fused to better surround the femoral head, thus preventing it from dislocating. Because this surgery must be performed before the pelvic bones have fused together, it can only be used on young dogs with minimal osteoarthritis formation. Recovery from this surgery can take around 4 months and activity restriction will be extremely important while the pelvis is healing. Physical Rehabilitation Therapy will improve this patient’s recovery by safely reintroducing exercise and rebuilding lost musculature. Juvenile Pubic Symphysiodesis (JPS) If Hip Dysplasia is diagnosed at a very young age, this surgery can be performed to improve joint stability and reduce osteoarthritis formation for both hips at once. This procedure involves cauterizing the growth plate of the pubis in order to stop growth in that area of the pelvis. As the dog matures, the acetabulum will end up in a better position to enclose the femoral head, thus avoiding the laxity that then leads to osteoarthritis. Because this procedure’s success depends on interrupting growth, it should be done before 5 months of age and ideally no later than 4 months of age for maximum benefit.  Medication We'll briefly cover commonly prescribed medications here but encourage you to visit our Pain Meds & Supplements article to learn more about how they work, side effects to watch out for, and how to choose quality supplements. Adequan (Polysulfated glycosaminoglycan) is a series of injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. NSAIDs like Rimadyl (carprofen) and Metacam (meloxicam) are commonly used to relieve pain caused by osteoarthritis and hip dysplasia. These are usually well tolerated, but bloodwork should be performed to ensure that your dog has normal liver and kidney function before using these medications long term and it is good practice to regularly check bloodwork during use. Some dogs can experience gastrointestinal upset with these medications, so they should be given with food and discontinued if symptoms continue. If a dog cannot tolerate Rimadyl or Metacam, Galliprant (grapiprant) is another NSAID option that functio ns differently and should be better tolerated. However, because it is a newer drug, it does not yet have a generic available and is often more expensive than other NSAIDs. Neurontin (gabapentin) is a human medication that is commonly used off-label for dogs and cats to manage pain and anxiety. It’s not entirely known how it works, but it is thought to block nerve cells from communicating pain signals. Lethargy is a common side effect, but after some time, most dogs will acclimate and no longer experience lethargy while still benefiting from the pain relief Gabapentin offers.  A Quick Note About Librela Librela (bedinvetmab)  is the newest Osteoarthritis treatment in the US; a once monthly injectable medication only for use in dogs. It must be administered by your veterinarian and may take up to 6 weeks for observable results. It can be extremely effective for the right patient , allowing dogs to return to their favorite activities while potentially reducing the need for daily medications. However, the adverse effects reported with this new medication are highly concerning and side effects are still being discovered. Due to potentially severe side-effects, we recommend that your pet be thoroughly evaluated before starting Librela . This should include bloodwork and radiographs at a minimum and may require evaluation with a neurological or orthopedic specialist. To learn more, visit our article A Look at Librela . Dogs with neurological conditions, auto-immune conditions, breeding dogs, or dogs that are skeletally immature should not be given Librela. Librela does not cure Hip Dysplasia. Dogs on Librela sometimes feel so good (since they can’t feel the pain) that they overdo it and cause further injury to themselves. It is best to introduce Librela alongside a structured exercise plan to avoid injury and only after thorough diagnostic screening to rule out auto-immune and neurological conditions. Supplements We'll briefly cover supplements here, but we recommend that you visit our Pain Meds & Supplements article to learn more about how they help and how to pick quality supplements. Dasuquin Advanced with MSM is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. Weight Management Keeping your dog at a lean body weight is the most important aspect of managing this condition. Fortunately, it’s also one of the easiest! Sometimes, it’s as simple as adjusting their meal portions. Other times, a complete switch to a new food is necessary. These days, there are a wide variety of AAFCO formulated Weight Management or Weight Loss diets readily available for purchase. Some are even specifically formulated for Senior Pets or for those needing extra Joint Support. Be sure to look for diets that are high in Essential Fatty Acids. Generally speaking, your goal Body Condition Score for a dysplastic dog is a 4 out of 9, a little on the skinny side. If you'd like more information about managing your dog's weight, be sure to read through our article, Body Condition Score & Canine Weight Loss . Exercising at Home As part of your Consultation with us, you will be provided with Veterinarian Prescribed Rehab Exercises (your dog’s Homework). These exercises will help keep your dog limber and improve their strength and stamina while maintaining their range of motion. Always have your pet warm up before exercise and cool down after exercise. There should never be sudden changes between inactivity and exercise. Osteoarthritis flare-ups are common and can even be caused by changes in the weather. Regular walks, tailored to your pet’s abilities are an important part of keeping those arthritic joints moving, reducing stiffness. Make sure to do shorter, more frequent walks instead of one long walk every day. Avoid becoming the “Weekend Warrior” as over-exercising and acrobatic activities such as ball and Frisbee chasing are recipes for pain and stiffness later. Unfortunately, this also applies to rough play with housemates and other animal friends. Your dog may have once been the rough and tumble, go-go-go type, but it’s important to think of a Hip Dysplasia dog as an antique luxury car. They’re still wonderful and should be taken out to enjoy the world, but great care should be applied when doing so. Regular maintenance and preparation will make all the difference for your dog’s experience. Our article, Motion is the Lotion , discusses the importance of consistent but safe exercise in maintaining range of motion and muscle mass. Swimming is frequently thought of as a low impact and helpful exercise for Hip Dysplasia dogs, however it commonly causes significant abuse to the elbows, shoulders, and hip joints leading to inflammatory flare-ups. The act of swimming can also put a lot of stress and extra movement on the spine. Opt instead for walking in warm water at your dog’s armpit level. Do this at very slow intervals to decrease the repetitive grinding of any arthritic joints. Swimming exercises typically do not help pets become better or stronger at walking outside of the water. To learn more, check out our Medical Library article, The Deep Dive into Swimming . Physical Rehabilitation Participating in Physical Rehabilitation Therapy at CROC allows your dog to get exactly the exercises and pain relief that they need on a regular basis to keep them comfortable and mobile, while also slowing the progression of their osteoarthritis and atrophy. Our team closely monitors your pet’s abilities and adjusts their sessions as needed while also keeping you updated as your pet progresses. Therapy Sessions at CROC include multiple pain relief modalities like Thermotherapy, Cryotherapy, Laser Therapy , Therapeutic Ultrasound, PEMF, E-Stim, and Massage Therapy to be used as appropriate for your pet’s condition. Veterinary Medical Acupuncture is another option CROC offers to provide pain relief and increase circulation. Prescribed Target Exercises and Underwater Treadmill Hydrotherapy build muscle and maintain good range of motion while avoiding soreness or pain associated with other types of exercise. Daily participation in at-home exercises wearing you down? Let us do some of that work for you and take your pet home feeling better than when you dropped them off. As your pet ages, it will be even more important to maintain a lean body weight and good musculature to support their dysplastic joints. Resuming therapy before their mobility declines will help keep your pet strong and mobile well into their senior years. For FHO patients, this will be of particular importance since musculature is the only thing keeping their hind limbs functional. Environmental Modifications Use a good quality dog bed! Memory foam is an ideal material. Your dog’s bed should be at least 1 1⁄2 times as long as your dog and at least 1-2 inches of thickness for every 40lbs of body weight. Encourage your dog to change position frequently, such as switching which side of their body they lay on. Laying in one position for extended periods of time will lead to significant stiffness and pain once they go to get up. Slippery, hard floors are tough on Hip Dysplasia dogs. Rugs, yoga mats, and the like are extremely beneficial to help keep your dog on their feet and avoid slips and falls. Can Hip Dysplasia Be Prevented? Hip Dysplasia is the most common inherited condition, so efforts to reduce a dog’s risk of developing it begin with the breeder. A responsible breeder will have their dogs’ hips evaluated using OFA and/or PennHIP standards and will only move forward with the breeding if both dogs have healthy hips. PennHip radiographs can only be performed by a veterinary professional that has been certified by the PennHIP program and sedation/anesthesia is required but it has been proven to be accurate for dogs as young as 4 months old. OFA requires that a dog be at least 2 years of age and while sedation/anesthesia is recommended, it is not required.  A puppy’s risk for developing Hip Dysplasia can also be heavily impacted by exercise, nutrition, and body weight. Puppies under 3 months old that exercise on hard, slippery floors or have access to stairs as well as dogs under 2 years of age that frequently play fetch are at higher risk. Excess body weight puts unnecessary strain on the body and during periods of growth, can negatively affect skeletal maturity. For this reason, it’s important to feed measured portions and to use puppy food that is nutritionally balanced and appropriate for your breed. Large breed puppy foods are formulated specifically for the immense growth they experience to give them the support they need without causing inappropriately accelerated growth. To Summarize Responsible breeding is the first step of reducing a puppy's risk for Hip Dysplasia and dogs should be evaluated using OFA or PennHIP standards before being bred. Body weight, activity level, and nutrition are significant variables for dogs of all ages. Hip Dysplasia can impact your dog's life, but there are options to relieve your dog's pain and keep them active such as medications, Physical Rehabilitation Therapy, and/or surgery. It can be difficult to know which are the right options for your pet but the CROC team is always available to discuss your pet's case specifically and to help you find a management plan that fits your lifestyle and your dog's needs. Thank you to Izzy's mom, Dina, for permitting us to share Izzy's pre- and post-operative Total Hip Replacement radiographs! We wish her well on her recovery journey! <3 the CROC Team

How often have you seen a little dog walk along with an extra skip in their step? It might look cute until you learn that the most common cause for that skip is pain from Medial Patellar Luxation. If your dog is experiencing patellar luxation, it’s important to address it promptly because the sooner it's treated, the less damage is incurred and the less invasive measures will be required to fix it. How Does Patellar Luxation Happen? Medial Patella Luxation is a hereditary condition, most common in small and toy breeds, and typically affects both legs. The patella (aka the kneecap) is held in place by the patellar tendon, which connects the thigh muscles to the tibia (the main lower leg bone) and sits within the trochlear groove of the femur. As your dog’s leg moves, the patella slides up and down in that groove.  If the patella is too thick, the trochlear groove is too shallow, the patellar tendon’s attachment points aren’t quite right, and/or the dog’s femur or tibia are malformed, the patella gets pulled to the side which causes it to grind up against one side of the trochlear groove. For dogs with MPL, the patella will get pulled inward to their midline - think towards your dog’s belly button. Over time, that grinding erodes that side of the trochlear groove, allowing the patella to luxate (slide out) of the groove when the leg is in movement and then slide back into the groove in the next step. This hurts, hence the skipped steps. The longer MPL is allowed to occur, the more bone erosion takes place, the more pain the dog experiences, the less they want to use the leg, and the weaker the tendon becomes, all of which continue to exacerbate the issue. The Four Grades of MPL Grade 1:  This is the earliest stage of MPL and can be tough to catch unless your veterinarian is looking for it. At this point, the patella will only luxate when pressure is applied, but it returns to normal position once released. This stage can be addressed with physical rehabilitation. Grade 2: At this stage, the patella will sometimes luxate when your dog flexes (bends) their leg and will remain out until the leg is fully extended (straightened) again, at which point it will slide back into place. This stage can be addressed with physical rehabilitation to decrease to a Grade 1. Grade 3: The patella now spends more time luxated than not, but it can be physically manipulated back into place. Surgery is required once your dog reaches this point. At CROC, we do not wish to cause more pain or suffering to a pet. Though you can find places that will exercise your dog on a dislocated kneecap, we believe that if your dog is a surgical candidate at grade 3, your time and resources are better spent on surgery than Physical Rehabilitation . Grade 4: This is the most severe stage of MPL. The patella is now permanently luxated and unable to be manipulated back into place. Surgery is required once your dog reaches this point. At CROC, we do not wish to cause more pain or suffering to a pet. Though you can find places that will exercise your dog on a dislocated kneecap, we believe that if your dog is a surgical candidate at grade 4, your time and resources are better spent on surgery than Physical Rehabilitation . Diagnosing MPL A change in your dog’s gait (the way they walk) is often the earliest outward sign that there’s something wrong. They might skip a step, intermittently limp, or you might see them struggle to bend the leg until they stretch it out to get the patella to pop back in place. Gait analysis is included in exams for all CROC patients because it can tell us so much about a dog’s pain, structural abnormalities, or neurological deficiencies. MPL can be diagnosed by your veterinarian after brief palpation of your dog’s stifle. They will move the leg to feel for any palpable changes in the bone structure or reduction in range of motion and apply pressure to the patella to see if it moves abnormally. If there are any abnormal findings, your Veterinarian will likely recommend radiographs (x-rays) to evaluate how much bone damage has occurred and if your dog’s legs have any other structural abnormalities. Sometimes MPL isn’t identified until a patient presents with pain elsewhere in the body. For example, a dog that is compensating for MPL may experience back pain or stiff front legs from trying to reduce the workload on the MPL leg.  Contributing Factors   Selective breeding may help decrease a dog’s risk for MPL, but it cannot otherwise be prevented. However, there are multiple controllable factors that can increase your dog’s chances for luxation. Weight: This is the easiest way to decrease risk! Every ounce of excess weight puts extra strain on an already compromised joint. That means more pressure on the patellar tendon, making luxation more likely. Diet is the most impactful influence and it’s easy to not realize how the treats and table scraps add up. Your dog should be on a measured amount of an AAFCO approved diet and if they’re getting treats too, their main meal should be reduced to account for those extra calories. Take a look at our article, Body Condition Score & Canine Weight Loss , for tips and tricks to help your pup get to a healthy weight. Exercise: Of course, this goes hand in hand with diet to maintain a healthy body weight, but there’s a less obvious culprit here. If you do not exercise, you do not build muscle. In fact, muscle starts to degrade after just 72 hours of inactivity. If your dog’s leg muscles are underdeveloped, their stifle (knee joint) will not have the support it needs and it will be that much easier for luxation to occur. Maintaining beefy quads (thigh muscles) help pull the patella tightly into the patellar groove, making luxation less likely and less severe. Plus exercise is just good for overall physical and mental health! Read our article, Motion is the Lotion  to learn more. Time: We frequently hear from owners that they were told about their dog’s MPL when they were young but it wasn’t a problem until they got older. The truth is that the dog has been dealing with MPL their whole life, but it only became apparent to the owner once the dog could no longer hide the pain it was experiencing and the physical deficiencies that were compensated in youth are no longer able to be ignored. By addressing this condition early, you save your dog from irreversible orthopedic injury and pain while also potentially sparing you from the cost of surgery. How long you wait to address this condition will directly influence the severity of your dog’s symptoms because the longer the patella is allowed to luxate, the more permanent damage occurs. MPL & Cranial Cruciate Ligament Rupture (CCLR) There is a correlation in risk between MPL and CCLR because the CCL and the patellar tendon are both extremely important structures that work alongside several others to stabilize the stifle. When the patella is not in the correct position, there is an increase of rotational forces on the stifle, which over time can lead to CCL rupture. If your dog has MPL, they are also more likely to develop a CCL injury. Addressing the MPL sooner rather than later can help decrease that risk. To learn more, read our article about Cranial Cruciate Ligament Injury . What about Lateral Patellar Luxation (LPL)? When a dog has LPL, the mechanics are very similar to MPL but the patella is being pulled outward away from the body. This condition is less common than MPL and can be hereditary or acquired after trauma. While LPL can occur in any dog, it is most common in large and giant breeds, especially Labrador Retrievers, Great Danes, Boxers, and St. Bernards. So, your dog has Grade 1 or 2 MPL. What do you do now?   You’re in luck! Surgery is usually not required. Physical Rehabilitation Therapy can reduce a Grade 2 to a Grade 1 and a Grade 1 can be reduced to nearly zero. A Rehab treatment plan for the MPL patient consists of multiple modalities to address the entire body; not just the MPL leg(s). Your dog has been compensating by walking and/or standing differently and putting more weight on their other legs. This often means that their other legs are overworked and sore. Back pain is not uncommon after spending so much time walking with poor ergonomics. Therapy often begins with Thermotherapy, Massage, and Stretching. Thermotherapy and Massage help to relax tense muscles and increase blood flow to the tissues. Stretching is necessary to maintain your dog’s full range of motion in all joints, but should not be performed until after Thermotherapy and Massage. Stretching should only be performed with great care as inappropriate stretching can make MPL worse, but prescribed stretches will help keep the Patellar Tendon soft enough to work with. Laser therapy is an excellent tool to promote healing and relieve pain and inflammation.  However, recovery takes more than just the “feel goods”. The goal is to restore your dog’s comfort and mobility by improving how the patella is held in place. This will only improve with careful exercise! Low impact Target exercises that avoid any twisting movements will be prescribed to your dog in order to address any deficiencies and encourage normal limb use. You will be instructed to have your dog do some of these exercises at home on a daily basis. Hydrotherapy using an Underwater Treadmill provides a high resistance but very low impact workout, encouraging muscle growth needed to support the joint. Take note that Hydrotherapy in an Underwater Treadmill is recommended, but due to less benefit and 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 already strained front legs and barely working the back legs that actually need the exercise. If they do kick their back legs, it is generally in a quick, spastic movement that does not encourage muscle building but does put more stress on a compromised joint. .  So, your dog has Grade 3 or 4 MPL. What do you do now? Sadly, the patella’s displacement is now so significant that surgery is required. Rehab for Grade 1 or 2 MPL is focused on building muscle, but because the Grade 3 or 4 stifle is so painful and/or completely luxated, exercise would be excruciating and unethical to pursue . We recommend getting a consultation with a board-certified veterinary orthopedic surgeon and making sure your dog gets some pain relief in the meantime. Your dog’s condition will likely get worse the longer you wait and as your dog ages, their anesthetic risks often increase. Remember that they are also compensating for their luxating patellas by putting extra strain on other parts of their body, which frequently leads to pain or even injury of those parts. For these reasons, we recommend having your dog’s MPL corrected as soon as possible. Initiating therapy after surgery can improve your dog’s recovery by addressing their muscle atrophy, increasing their range of motion, stimulating healing, and relieving any pain that might remain. Your dog’s surgeon will decide when your dog can begin therapy, but they may want to take follow up x-rays to confirm appropriate healing beforehand. Every case will be different, so recommended commencement of therapy can range anywhere from 2 to 8 weeks after your dog’s surgery. Can I brace my dog’s knee instead of pursuing surgery? We absolutely understand the desire to avoid surgery but for most cases, we will strongly advise against the use of a brace. While a brace might provide some degree of stabilization, it does so by restricting movement of the joint, reducing the knee’s Range of Motion. A joint without its full Range of Motion will become more stiff, more inflamed, and more painful. This restriction in movement also causes significant muscle atrophy. Muscles that aren’t exercised waste away. Just like if you have your leg in a cast for several weeks, when the cast finally comes off, your leg muscles will have atrophied from lack of use. Reduced musculature will only make your dog's situation worse because the joint will have even less support when it needs it most. Surgical Options   Tibial Tuberosity Transposition (TTT) or Tibial Crest Transposition (TCT) The Tibial Tuberosity is an attachment point on the tibia for the Patellar Tendon. If the Tibia is malformed or the Tibial Tuberosity just isn’t in the right spot, it ruins the alignment of the stifle joint and the Patella can get pulled off to the side when the Quadriceps flex. This surgery involves cutting into the bone to release the Tibial Tuberosity, then uses pins and wire to reattach it in the new position to restore the joint’s alignment and redirect the forces from the Quadriceps. Trochlear Wedge Recession or Trochlear Block Recession The Trochlear Groove is the “valley” of the femur that the patella slides up and down in. The groove is lined with cartilage to ensure smooth movement. A Trochlear Groove that is too shallow is a common cause of MPL so this surgery aims to deepen the groove, making luxating less likely. First, part of the cartilage is temporarily removed to allow access to the bone underneath. Some of the bone is removed to carve a deeper groove, then the cartilage is put back in place followed by the patella. Lateral Capsular Imbrication This surgery is often used in conjunction with the other surgical procedures. The soft tissues on the inside of the stifle can become tight over time and continue to pull the patella medially (toward your dog’s belly). Similarly, the soft tissues on the outside of the stifle can become overly stretched from chronic luxation. This technique creates an incision to release the tissues that are too tight on the inside and uses overlapping sutures to tighten up the loose tissues on the outside.  Post Operative Recovery   Recovery from stifle surgery can be challenging as it typically requires several weeks of strict exercise restriction to allow the bone to heal. Limiting your dog’s activity according to the surgeon’s recommendations is not optional.   Too much activity too soon can be devastatingly destructive to a bone that is healing; potentially causing failure to heal, fractures, or even requiring additional surgery to repair the leg. Use of an e-collar (aka the cone of shame) is incredibly important as any licking of the incision/stitches is likely to cause a serious infection of a fresh orthopedic surgery site. Your dog’s surgeon will tell you when the e-collar is no longer needed. Pain medications and antibiotics are typically prescribed and should be given as directed. Do not stop or decrease these medications without consulting with the surgeon first. Some pets benefit from sedating or anti-anxiety medications during the recovery period to help keep them calm and less likely to over exercise. It may be helpful to use baby gates to block off certain parts of your home during the recovery period, especially stairs or areas with slick floors. Good traction and controlled movements are key elements for safety and smooth recovery. If you have other pets in your home that typically play together, it is best to keep them separated during the first few weeks. Just like when we have a freshly broken bone, your dog will need to avoid any high-impact activities which sadly includes play time with housemates. Your surgeon may provide instructions for low-impact exercises as your pet heals. This may include Passive Range of Motion or standing exercises. Walks are typically restricted to slow and short outings, but can be increased each week as your surgeon recommends. Sticking to your pet’s prescribed exercises is important, not only to prevent over-stressing the surgical site, but also to maintain what muscle mass and flexibility they currently have.  Prolonged disuse of a leg can cause Muscle Contracture, a condition where atrophy has become so severe that adhesions form between the bone, periosteal tissues (a thin layer of tissue that surrounds the bone), and quadriceps muscles, essentially locking the thigh muscles down and preventing normal movement of the leg. Atrophy and reduced range of motion is the most common post-operative complication that we treat.   Muscle contracture is very painful and extremely difficult to resolve, often requiring multiple therapy sessions a week for several months to give a patient the best chance at regaining normal limb use. Long Term Care The most impactful thing you can do at home to keep your pet comfortable and active is to maintain a lean body weight and good musculature. Even with surgery, your pet will develop Osteoarthritis (albeit slower than a dog that did not have surgery) and as they get older, it will only become more challenging for them to build muscle and lose weight. By keeping them lean and well-muscled from the start, you are giving your dog a solid foundation for a longer, more active, and healthier life. For more information, check out our article Crunchy Doggos - Managing Osteoarthritis . If your dog has only had MPL diagnosed in one knee, you should prepare yourself for the likelihood that your dog’s other knee will also be affected and potentially require surgical intervention. Some activities are more likely to aggravate patellar luxation than others, so we recommend removing them from your routine or reducing them as much as possible. Fetch involves a lot of twisting movements to quickly turn and run for the ball, then turn and rush back so fetch should be replaced with a safer game. Jumping on and off furniture or in and out of vehicles forces your dog’s joints to absorb a hefty impact, so we recommend assisting your dog or providing stairs or ramps. Slow, controlled exercise will always be preferred. What If Surgery Is Not An Option?   Because surgery is the only way to resolve a Grade 3 or 4 MPL, it will always be the top recommendation. However, there are some circumstances that make surgery a poor choice. Often, financial constraints are the first to come to mind. We get it; it’s an expensive option! However, without surgery, your dog will require long term treatments like medications and pain relief focused Rehab. If your dog is a young dog, you will likely spend at least the same, but likely more money on these “band-aids” than if the surgery was performed at the beginning. If your pet is a senior or geriatric pet, it may not make sense to put them through anesthesia and a big surgery. Pets with co-morbidities like heart disease, liver shunts, or clotting disorders can also be high-risk anesthetic candidates. Certain auto-immune conditions may complicate your pet’s ability to heal or fight off infection. In these cases, your goal will be to maintain your pet’s comfort and mobility as best as possible. As the damage to the bone worsens, they will begin to experience more pain and therefore be more likely to rely on their other legs instead, setting them up for compensatory injury. Pain medications, supplements, and Rehab are all good options for relieving pain and inflammation. Check out our Pain Meds & Supplements article for more information regarding commonly prescribed pain medications, our favorite supplements, and how to choose quality products. To Summarize   MPL is painful but it doesn’t have to keep your dog on the sidelines forever. Utilizing services from a board-certified veterinary surgeon and a certified veterinary rehab specialist is likely to give your dog the best results. While the expense of surgery may be off-putting, in the long run, it is usually cheaper to invest in the surgery early on rather than paying for a lifetime of pain relief. While braces and medications might be appealing solutions, they will not resolve your pet’s condition and are likely to make it worse.  With the right home routine and/or surgery, your dog can enjoy good, pain-free mobility. For dogs that cannot undergo surgery, there are options to help control their pain and increase their limb strength which, depending on the severity of luxation, may resolve their symptoms. However, surgery is still the most effective solution for grade 3 & 4 MPL cases. If you still have questions about Medial Patellar Luxation, our team of licensed veterinary professionals at Canine Rehab of Orange County is happy to consult with you. The CROC Team is Here for You! MPL is among the most common conditions that we see and we aim to help you find the best options for you and your dog. In some instances, we start therapy before surgery to maintain comfort and muscle mass as much as possible. We frequently see MPL patients after surgery to help them achieve the best and fastest recovery. Feel free to reach out to us with any questions or if you would like to move forward with a consultation, visit our New Patients page to get started.

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

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