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

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

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

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

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 the 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.

You might have heard about a human athlete that tore their ACL and how it took them out for the season. The ACL (anterior cruciate ligament) is responsible for stabilizing your knee, especially during high intensity activities that require your legs to twist or pivot. In dogs, this ligament is referred to as the CCL (cranial cruciate ligament) and the knee is referred to as the stifle, but it’s the same ligament with the same job and it can be just as devastating.   How Does This Happen?   The canine CCL often degenerates over time, leading to a partial or complete tear, though trauma to a healthy ligament from high impact twisting of the leg or hyperextension of the knee, can have the same result. In most cases, the dog’s CCL will slowly weaken until it eventually ruptures completely. Within 1 year of injury, approximately 60% of dogs will rupture their other CCL. In early stages (partial tears), your dog’s discomfort may be very subtle, such as putting less weight on the leg when standing or intermittent and very mild limping. As the ligament continues to degrade, your dog may start limping more, especially after activities like running or jumping. Your dog may take longer to rise up or sit down. Osteoarthritis, the gradual wearing away of cartilage, begins in the joint and can eventually lead to bone rubbing on bone. Dogs with painful, arthritic, unstable stifles often sit on their rump with the affected leg held out to the side to avoid bending the stifle as they would with a normal sitting position. As it becomes more and more painful to use the injured leg, they are likely to lose muscle mass on that side and put additional stress on their other legs which can cause further compensatory injury.    Who Is At Risk? There are several variables that can increase a dog’s risk for CCL disease. Obesity and poor body condition play a huge role , so keeping your dog at a lean, healthy weight and regularly exercised can help prevent this type of injury. “Weekend Warriors” and high intensity activities, such as wrestling with other dogs or agility sports, are common contributors to CCL rupture. Some breeds, like Labrador Retrievers, Staffordshire Terriers, Rottweilers, Boxers, and Mastiffs are predisposed, but any dog can be affected. Anecdotally, CROC has seen a high incidence of CCL disease in Labradoodles, Goldendoodles, and similar crosses. The Weekend Warrior spends most of their time hanging around the house with minimal exercise but then goes all out with high intensity and/or long bouts of exercise only every once in a while. This might look like being a couch potato during the week while parents are working and then going on a 10 mile run alongside a bicycle on Saturday. A recipe for trouble! There is emerging research regarding the time of spaying or neutering and the correlated risks for orthopedic conditions like CCL disease. The hormones produced by the sex organs are largely responsible for telling the growth plates when to close at physical maturity. When these hormones are removed before the growth plates close, there is only a very small bit of hormones being produced elsewhere in the body, so the bones continue to grow long after they were supposed to stop. Dogs spayed or neutered at a young age are frequently lighter in build, taller and leaner, with narrower skulls. The theory of how early spaying/neutering causes increased risk for CCL disease is that due to the bones growing beyond their intended size, the knee joint becomes unbalanced, therefore putting abnormal strain on the Cranial Cruciate Ligament.   So, your dog has a CCL tear. What do you do now?   When the ligament is damaged, the knee is no longer stable and bones start to move and rub in ways they were not meant to, causing significant pain, difficulty walking, and osteoarthritis to develop. The meniscus, a cartilaginous structure between the tibia and femur, is often damaged from the abnormal strain causing significant pain. For this reason, it is best to surgically correct this condition as soon as possible.   Surgery is often a scary and expensive endeavor, so why is it the Gold Standard (how veterinary medicine labels the best course of treatment)? Once the CCL has ruptured, there is no fixing it. The joint’s condition will only continue to worsen as osteoarthritis sets in and increased strain is placed on the other ligaments, causing increased pain. Partial tears may be medically managed for a time, but will more than likely progress into a full tear. Osteoarthritis will form in the joint regardless of surgery, but patients who have surgical correction sooner rather than later will have less pain and arthritis than those who went without surgery or even those who pursued surgery months or years after the CCL ruptured. Keep in mind most dogs with a CCL tear are likely to tear their other CCL. Preventing undue stress on the uninjured leg can potentially give you and your dog more time before the other CCL ruptures.   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 that is 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 Solutions   Example of TPLO First and foremost, make sure your dog’s surgeon is a board-certified veterinary surgeon that specializes in orthopedics. The official credential of a board-certificated veterinary surgeon is Diplomate, American College of Veterinary Surgeons, often presented as DACVS or ACVS Diplomate. These veterinarians perform complicated surgical procedures every day and have all the unique tools and years of experience to give your dog the very best chance of successful surgery and an excellent recovery. There are 3 surgical techniques to address CCL ruptures. Based on your dog’s anatomy and any concurrent problems, your dog’s surgeon will choose which technique will work best.   Tibial Plateau Leveling Osteotomy (TPLO)   The TPLO is the Gold Standard (best available) solution for a CCL tear. This surgery involves cutting a portion of the Tibia (the shin bone), rotating it, and securing it in the new position using a metal plate and screws. The new position will prevent the abnormal movement that occurs with a torn CCL.   Tibial Tuberosity Advancement (TTA)   As the TPLO has proven to be the most effective technique for CCL tears, TTA is falling out of favor because some dog’s bones are shaped in such a way that would make this surgery inappropriate or less likely to succeed. Like the TPLO, the TTA involves cutting into the tibia and using metal hardware to secure it. The tibial tuberosity is moved to change where the quadriceps muscles attach in conjunction to the knee to stabilize the joint. Since both surgeries are equally invasive and the TPLO has better success rates, we would not recommend use of this technique.   Extra-Capsular Suture Stabilization This procedure can also be referred to as a Lateral Fabellar Suture Stabilization or the Fishing Line Technique. Rather than cutting into the bone or using metal hardware, this procedure attempts to “replace” the CCL with a strong suture. Premature breakdown or failure of the suture is a very common complication with this technique, leaving a post-surgical patient with a painful and unstable stifle despite the cost and effort of the surgery. While this approach is usually less expensive and less invasive, it is also best reserved for smaller breeds and older, less active dogs because there is a high rate of failure when used with medium or larger breeds and more active dogs. We generally do not recommend this technique because the body will eventually break down that suture material. The hope is that during the time that the suture was in place, the stifle will have developed enough scar tissue and bony changes to stabilize the joint. Unfortunately, osteoarthritis will form in the stifle, which will cause pain, limit full range of motion, and decrease functional use of the joint.   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.   This dog has severe muscle atrophy on the left leg 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. Atrophy and reduced range of motion is the most common post-operative complication that we treat. 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. 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.   Supplements Dasuquin Advanced with MSM  is an excellent daily joint supplement that many of our team members choose to use for their own pets. It includes Chondroitin, Glucosamine, and other ingredients to support joint health and it comes in a tasty, chewy treat, making it an easy addition to your daily routine. Fish Oil  added to your pet’s meals is another easy addition to help keep joints happy (and it helps their coat too!). Start with 500-600mg per day, then increase to 1000-1200mg per day. It is important to start slow with this as some pets may be sensitive and have GI symptoms if started too quickly. Myos Canine Muscle Formula  is a supplement containing Fortetropin, a natural bioactive supplement made from fertilized egg yolk. Myos has been credited with improving muscle health, helping to reduce muscle loss (atrophy) and helping regain muscle after surgery or with other disease processes. It has also been shown to help skin, coat, cognitive, and bone health. Medications Adequan (Polysulfated glycosaminoglycan)  is a series o f injections that stimulates cartilage healing, slows the progression of osteoarthritis, and decreases pain and inflammation. It begins with an initial series of 8 injections with one injection given every 3-4 days. Once that is complete, many pets can drop down to a maintenance schedule of one injection every 1-6 months. For larger dogs, this can be a costly investment to get started, but we have seen significant improvement for many dogs using this medication. If you have concerns about giving your dog injections, be sure to speak to your veterinarian for options like an in-person demo or having their staff perform the injections for you. You can also speak to the CROC team. Common NSAIDS  - Rimadyl (carprofen), Metacam (meloxicam), Deramaxx (deracoxib), and their Generics are Non-Steroidal Anti-inflammatory medications that can be extremely helpful for managing pain and inflammation and since many generics exist, it can be easier to find one that fits your budget. They can have long term side effects to the liver and kidneys so regular bloodwork is strongly recommended to catch any change in organ function early. They must also be given with food! Some pets don’t tolerate these medications well and can have serious GI side effects like stomach ulcers and gastrointestinal bleeding. It is important to monitor your dog for any signs of vomiting, diarrhea, or dark stools while on these medications. Some pets REALLY like the taste of the flavored tablets so store these medications with caution, securely out of reach of your pet. Galliprant (grapiprant)  is a newer type of Non-Steroidal Anti-inflammatory that has less side effects than the more widely known NSAIDS listed above. It is reported to have less effects on liver, kidneys, and GI tract and can be safely used alongside a wider selection of other medications. Because it is newer and a more specific medication, it is generally more costly than the above listed NSAIDS that have been around longer. Neurontin (gabapentin)  is a medication primarily used to treat nerve pain, though it can also help with anxiety. Many pets experience some level of drowsiness when they first start this medication, but they usually become accustomed to it and return to their normal energy level after some time. Besides sedation, other side effects are extremely rare. This medication is a good option for pets that cannot tolerate NSAIDS and it can also be used alongside NSAIDS and many other medications. Tramadol  is a synthetic opioid that has been commonly used to treat moderate to severe pain in dogs. Newer studies on this medication show that it may be less effective than previously thought, with only a small fraction of dogs getting any pain relief from it. Side effects from Tramadol include sedation, vomiting, diarrhea, constipation, and loss of appetite 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. 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. Side-effects and adverse reactions from Librela are still being discovered. Dogs with neurological conditions should not be given Librela as it is likely to worsen neurological conditions. Some Owners are not aware that their dog has a neurological condition until their dog has an adverse reaction to Librela. Adverse neurological reactions may include: generalized weakness, inability to control bladder and/or bowels, stumbling, knuckling, dragging paws, and/or inability to walk. 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. Dogs with inflammation caused by auto-immune conditions should not be given Librela as it is likely to make these conditions worse. Studies on Librela 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 but are also nearly guaranteed to have other conditions that may be complicated by Librela. 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. Electing to give your pet Librela without prior diagnostic screening is a gamble! Librela is not indicated to treat CCL disease or post-operative pain, nor is it labeled for treating pain related to any other types of chronic pain other than Osteoarthritis. Librela does not cure Osteoarthritis. 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. What About Rehab?   Remember that Rehab cannot fix a CCL rupture. However, initiating therapy after surgery can improve their 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 from 2 to 8 weeks after your dog’s surgery. Post-operative Rehab consists of multiple modalities to address the entire body; not just the surgical leg. Your dog has been compensating for the affected leg by walking 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. 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, which will not improve without exercise. Low impact Target exercises 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 and keeping the unaffected leg strong. 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 fresh orthopedic surgery. The CROC Team has treated multiple post-op patients with severe complications caused by swimming, such as migrated surgical screws and avulsion fractures of the tibia.   Long Term Care 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. 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. Visit our article Body Condition Score & Canine Weight Loss to learn more. Joint supplements with Fish Oil, Glucosamine, Chondroitin, and MSM may be helpful to stimulate cartilage matrix production and inhibit enzymes that break down cartilage. For more information about Osteoarthritis care, check out our article Crunchy Doggos - Managing Osteoarthritis .   If this is your dog’s first CCL injury/surgery, you should prepare yourself for the likelihood that your dog’s other knee will also be affected and require surgical intervention. The above-described care tips may also help your dog’s intact CCL stay that way longer, but ultimately there is no way to prevent a tear.   What If Surgery Is Not An Option?   Because surgery is the only way to resolve a CCL injury, 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 (Rehab, medications, etc) to try to control their pain. 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 cartilage in their knee degrades, 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 or rupturing their other CCL. Pain medications, supplements, and Rehab are all good options for relieving pain and inflammation. More information on these options is available in our above mentioned “Crunchy Doggos - Managing Osteoarthritis” article.   To Summarize   CCL ruptures are painful and can be expensive to resolve but they don’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. Whil e bra ces and medications might be appealing solutions, they will not resolve your pet’s condition and could potentially make it worse. With surgery and the right home routine, your dog can enjoy good, pain-free mobility even after a CCL injury. For dogs that cannot undergo surgery, there are options to help control their pain but surgery is still the most effective solution for this condition.  If you still have questions about Cranial Cruciate Ligament injuries, our team of licensed veterinary professionals at Canine Rehab of Orange County is happy to consult with you. CCL injuries are 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 CCL 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.

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