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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.

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

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. 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. 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 - 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. 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.

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.

GOLPP is a progressive, degenerative disease that unfortunately does not have a cure. There are, however, things you can do to help your dog with the different aspects of living with the disease and many dogs can still maintain good quality of life and lifespan with proper care. What is Geriatric Onset Laryngeal Paralysis & Polyneuropathy? GOLPP is the term used to describe a grouping of three interconnected conditions caused by degradation of the dog’s nervous system: Laryngeal Paralysis, Megaesophagus, and Paraparesis, usually starting with the hind legs. The Larynx’s (aka the voice box) main functions are to protect the airway when we are eating and drinking, to open up wider when we need to take bigger breaths, and of course to make vocal sounds. It does this by opening and closing folds of cartilage on each side of the opening to the trachea, the primary airway to the lungs. Normal Dog Larynx Laryngeal Paralysis causes the Cartilaginous Folds to collapse inward, blocking the airway. When the muscles controlling those cartilaginous folds start to fail due to Laryngeal paralysis (aka LarPar), they no longer open and close like they used to. They might cough or just have louder breath sounds with even minimal exercise. Sometimes, a change in the sound of their bark is the first thing a pet parent notices. Dogs in severe respiratory distress will have pale or blue coloration of their gums and may completely collapse. Dogs in this state require emergency veterinary care immediately. LarPar dogs struggle to breathe normally, have difficulty cooling themselves in hot weather, and are at higher risk for aspiration. Megaesophagus occurs when the esophagus (the tube that connects your mouth to your stomach) loses its strength and elasticity. As food slides down, instead of being pushed along to the stomach, it builds up in the esophagus, causing further distention and enlargement. Because there isn’t enough muscle strength to move the food along, dogs with Megaesophagus often regurgitate their food. Since dogs with GOLPP aren’t able to protect their airway as a normal dog would, this significantly increases their risk of aspiration which can then turn into pneumonia. Hind Limb Paraparesis means that the dog’s hind limbs become weak and uncoordinated due to neurological deficits (the nerve pathways between the brain and the legs stop conducting signals). They may stumble or even knuckle over their paws and will progressively lose strength and muscle mass. This part of GOLPP is often misdiagnosed as arthritis, hip dysplasia, or “just getting old”. Who is at Risk for GOLPP? Labrador Retrievers certainly seem to be the breed most commonly affected by GOLPP, but Golden Retrievers, Borzoi, Newfoundlands, Greyhounds, German Shepherd Dogs, Siberian Huskies, and other large breeds, as well as mixed breeds, are known to be affected. While there is a congenital form, GOLPP typically affects middle-aged to senior and geriatric dogs, with the average age of onset at 11 years old. Diagnosing GOLPP In the beginning stages of reaching GOLPP as a diagnosis, there are other conditions that must first be ruled out. This is done by performing comprehensive bloodwork and radiographs. Megaesophagus may be visible on your dog’s x-ray, but sometimes requires more specialized imaging to clearly visualize. Your vet should also perform a thorough neurological exam to identify any delays or deficits in your dog’s reflex responses. If your dog’s blood work is within normal limits for their age and no other life-threatening conditions are discovered with radiographs, they will recommend sedating or anesthetizing your dog so they can examine their laryngeal function. Unfortunately, you can’t ask a dog to open up and “saw ahhhh” while a scope is used to look down their throat, so sedation or anesthesia is required to properly perform this exam. During this sedated exam, the veterinarian will watch how your dog’s laryngeal folds behave as they breathe to determine if one or both sides of the larynx are affected. Additional diagnostics like Nerve biopsies and Nerve conduction tests may be recommended as well. Treating GOLPP While there is no cure for GOLPP or even one single treatment, there are ways to treat the symptoms to keep your dog more comfortable. Post-Op Tie-Back Surgery For Laryngeal Paralysis, the Gold Standard treatment is a surgery called a Laryngeal Tie-Back, which should be performed by a Board-Certified Veterinary Surgical Specialist. Most General Practice Veterinarians are not equipped for this specialized surgery. The procedure involves anchoring at least one of the Laryngeal Cartilage folds open, so that the dog can breathe more easily. The downside is that this also means that the larynx cannot properly close to food or liquids, so dogs that enjoy swimming or tend to eat/drink very quickly are at high risk for aspirating (breathing in) water or food into their lungs. Aspiration pneumonia is a serious, potentially life-threatening condition that requires strong antibiotics, sometimes multiple courses, to treat but fortunately it usually responds well to medical treatment. The goal of Laryngeal Tie-Back surgery is to improve quality of life for the affected dog, but it will not improve laryngeal function. Dogs that are unable to get Laryngeal Tie-Back surgery will continue to struggle to breathe, remain at risk for heat stroke during warmer weather, and they still have an increased risk for aspiration. Both surgical and non-surgical patients will need to live in a calm environment, as stress can also instigate respiratory distress. For Megaesophagus, there is no treatment. Instead, changes to the dog’s feeding routine are key for reducing food regurgitation, therefore improving Quality of Life. Many patients with this condition do better with a softened or liquid diet over kibble. They also need a little help from gravity to get the food where it needs to go. This might look like raising your dog’s food bowl or even feeding your dog on stairs with the bowl at the highest step. For the worst cases of Megaesophagus, a Bailey Chair is an excellent option. The Bailey Chair is sometimes called a dog high chair and it certainly looks like one. The concept is that by feeding the dog in an upright position and then keeping them in that position for a short time after feeding, gravity helps pull the food down out of the esophagus into the stomach, after which the dog can safely resume normal activity and retain all the nutrition of the meal. Your veterinarian may also prescribe medications to support the gastrointestinal system. For the hind limb paresis, Physical Rehabilitation is the best course of treatment to maintain strength and coordination in those limbs for as long as possible. By using exercises and treatments specifically designed for GOLPP patients, CROC can slow down your dog’s muscle wasting and neurological decline. Because Physical Rehabilitation at CROC is performed by experienced and licensed veterinary professionals, our team knows how to handle medically fragile patients, carefully challenging your dog’s body without overworking them or putting them at risk for heatstroke. What Does Rehab for GOLPP Look Like? First, our team will evaluate your dog to determine how far their GOLPP has progressed so that we can truly tailor your dog’s therapy to their condition. You will be sent home with target exercises specifically prescribed for you and your dog to do together between Rehab Sessions. Generally, in-clinic Physical Rehabilitation for GOLPP includes: Target exercises to work on balance, coordination, and strength Hydrotherapy for safely improving stamina and maintaining muscle Thermotherapy, Therapeutic Massage, and Laser Therapy to soothe sore, overworked muscles Veterinary Medical Acupuncture to stimulate the nervous system and reduce pain Because CROC utilizes an Underwater Treadmill for hydrotherapy sessions, your dog is at significantly lower risk of aspiration than if they were swimming in a pool since we have precise control over the water level and your dog will remain on their feet for the session. Underwater Treadmill therapy is also more effective for strengthening the back legs than swimming. Lastly, CROC maintains the water at a therapeutic temperature to help support arthritic joints and relax tight muscles, while the buoyancy helps your dog get all the benefits of a high-resistance work out with little to no impact. Through their treatment plan, CROC continues to challenge your pet with a variety of exercises while also treating any pain that your pet experiences. Thermotherapy and Therapeutic Massage help to relieve tense muscles and increase blood flow. Therapeutic Laser therapy not only helps increase circulation to the tissues, but it also encourages healing at a cellular level. Veterinary Medical Acupuncture stimulates the nervous system while also releasing endorphins which helps with pain relief. As your dog’s physical abilities change, CROC continues to adjust their therapy as needed at every single session to make sure they get the most benefit out of every visit. Fortunately, while your dog will be predisposed to pain from compensating for their weak back legs, the disease process itself is not painful. Safety for GOLPP Patients Changing Habits: Remember that GOLPP is a chronic, progressive disease; it never goes away and will continue to worsen. At home, some simple changes can make all the difference to help your dog maintain good quality of life. The goal with home modifications is to make mobility as easy as possible, reduce falling injuries, reduce risk of aspirating food or water, and to reduce risk of heat stroke. Adding rugs or yoga mats to hard slippery floors will help your dog grip the ground better and stay on their feet when getting around their home. Assisting your dog up or down stairs, or even just blocking them off from your dog altogether, will be necessary for safety reasons. Ramps may be helpful for them to traverse small sets of stairs or make it easier to get in and out of the car, but these should also be used under supervision. Raising the food and water bowls may help reduce regurgitation from the megaesophagus, but you may also need to have a schedule for access to these resources or start using a Bailey Chair depending on your dog’s symptoms. Lastly, temperature control will be incredibly important at home. Your dog will not be able to cool themselves on a hot day like a normal dog can. Avoiding strenuous exercise and maintaining cool temperatures inside with Air Conditioning and/or fans is a non-negotiable part of living with this condition. Swimming: Sadly, swimming is NEVER appropriate for GOLPP patients. There is a video viewable in our article, The Deep Dive into Swimming , that provides a visual for this, but we’ll explain here too. When dogs swim, they generally paddle fiercely with their front legs while keeping their back legs tucked up alongside their body. This type of movement means they are overworking their already strained front legs while barely working the back legs that actually need the exercise. Swimming also puts immense stress and twisting movements on the spine. Most importantly, swimming puts a GOLPP dog at extremely high risk of aspiration on dirty pool water. Aspiration Pneumonia: The GOLPP dog will forever be at increased risk for aspiration pneumonia, so it’s important to familiarize yourself with the signs and symptoms. Catching aspiration pneumonia early will make it easier and cheaper to treat and get your dog breathing easier sooner. Signs of pneumonia include lethargy, coughing, sneezing, nasal discharge, inappetence, and/or fever. If you even slightly suspect that your GOLPP dog may be exhibiting signs of aspiration pneumonia, have them seen by a veterinarian as soon as possible. This is usually confirmed by radiographs of their lungs and then antibiotics are sent home, as well as appetite stimulants if needed. Regarding Chiropractics... We know this is a soft spot and that many people enjoy chiropractic for themselves. In our industry, it is a very controversial and divisive topic. We do not want to shame anyone for previous choices made with the intention of helping their pet. We do feel compelled as thoroughly educated Veterinary Medical Professionals to share our perspective. At CROC, we have treated multiple patients that were receiving chiropractic care and were in significant pain when they came to us, which resolved when chiropractic sessions stopped while proper Physical Rehabilitation Therapy continued. A good percentage of CROC patients arrive here after being referred by their veterinarian. Because of this, we have developed very close relationships with the local Neurological and Orthopedic Veterinary Specialists. CROC does not offer Chiropractic services because not a single one of these Board-Certified Specialists will support or recommend Chiropractic for GOLPP patients. Even when consulting with Boarded Neurologists outside of Orange County, we have yet to find one that would approve of their patients undergoing Chiropractic treatments. At this time, there are no Peer-Reviewed studies to substantiate claims that Chiropractic is an appropriate (or even safe) treatment for Veterinary patients. In addition, the American Veterinary Medical Association, America’s leader in advancing the science and practice of veterinary medicine to improve animal and human health, has not published any policies supporting Chiropractic. Here's an example of the dangers of Chiropractics: T his is the normal healthy spine of a young dog. Notice that the vertebrae and the spaces between them are very well defined. This is a senior dog with severe Spondylosis Deformans (spinal osteoarthritis). As intervertebral disks degrade, the spine starts to move abnormally and osteophytes (bone spurs) will form in an attempt to stabilize each joint. Eventually, osteophytes can become so severe that they bridge between each vertebrae. At this point, we have a spine that is poorly cushioned by degraded intervertebral disks and surrounded by extra bone. Bone rubbing on bone and nerve impingement become chronic sources of pain and stiffness. Pain and stiffness are common reasons that pet owners will pursue Chiropractic for their pet. Could you imagine applying jarring and intense force on a spine like this?!?! OUCH!!! If your dog is experiencing enough pain that you are exploring other treatments like Chiropractic, please check in with us or your regular veterinarian first . There are certainly better and safer options for pain relief available. The End Goal Ultimately, our goal is to try to keep your pet as independently mobile as possible for as long as possible. We can’t stop GOLPP from progressing, but we can slow it down and have multiple methods of treating your dog’s pain and weakness. Because Physical Rehabilitation at CROC is performed in a controlled environment, your GOLPP dog can also come in for therapy on a day that might otherwise be too hot for them to get any exercise. Tools To Make Your Lives Easier We've gathered links and examples of the following tools on our Gear & Resources page. As your pet’s neurological condition declines, they will frequently drag their hind legs, so it is key to protect their paws from the scuffing and abrasions that will happen. Lots of dog booties are readily available for purchase, but our favorite is a rubber variety called Pawz. We like these best because they protect the paw while still allowing your pet to feel the textures of the ground and providing extra grip. With any dog booties, care should be given to appropriately size your pet’s paws and to only leave them on when your dog is on a surface that is harmful to their skin to rub on. Booties left on for too long can cause skin infections, reduced circulation, or worst case – be chewed off and eaten! Use of any collars around your dog’s neck will no longer be safe so a good harness is a must! Your dog will increasingly depend on you for assistance, so your choice of harness makes all the difference in comfort for both you and your dog. Our favorite harness for GOLPP dogs is called the Help ‘Em Up Harness. It was created to help owners better assist their dogs without hurting their own backs in the process. It comes in two pieces, one to go around the chest and one to go under and around the pelvis. In the early stages, your pet may not need the back half, but as their coordination and strength declines, the back half of the harness will become necessary. It is comfortable enough that your pet can wear it for extended periods, and it is more ergonomic for you and your dog than just lifting them or using a sling. If you are interested in purchasing this harness for your dog, be sure to speak to us as sizing and fitting your dog can be trickier than it might appear. Please note that this harness still needs to be removed each day and kept clean to prevent any abrasions or skin infections. To learn more, check out our Help 'Em Up Harness article. Is There Anything Else? One of the best things you can do for your GOLPP dog is keep them lean! We generally recommend a Body Condition Score (BCS) of about 4 out of 9. The less weight there is for them to haul around, the easier it will be to continue lifting and moving their own body. Many GOLPP dogs are also old enough to have developed osteoarthritis , so all the more reason to reduce any extra work on their joints. Check out our article to learn more about Body Condition Score & Canine Weight Loss . Some dogs will need medication to control their pain. CROC works closely with you to make sure your dog is on the right pain control regimen. Joint supplements are also helpful to support their joints as the front of their body takes on the extra load, compensating for the weaker back end. A supplement for muscle growth/maintenance called Myos Canine Muscle Formula may be helpful for the GOLPP dog and is available online. For more information regarding medications and supplements, such as side effects to be aware of or how to pick a quality product, stay tuned for our upcoming article Pain Meds & Supplements . CROC strongly discourages the use of marijuana products for GOLPP patients. While emerging research shows some promise for marijuana products in veterinary medicine, there is much more to be done and GOLPP patients are already weak and have limited coordination, making them poor candidates for this treatment. Rear-wheel carts are sometimes an option for GOLPP patients, but this is not commonly recommended. By the time your dog might benefit from the mobility assistance a cart could offer, they are no longer strong enough to be able to pull the cart and the weight of the back half of their body. To learn more about carts, check out The Wheel Deal: Let's Talk About Carts . Quality of Life We touch on this subject for your sake as well as your dog’s. Compassion fatigue is a prevalent concern for clients caring for GOLPP dogs. The hope is that Physical Rehabilitation will help your dog maintain independent mobility for as long as possible, reducing the amount of effort you will need to put into their care as much as we can. For dogs whose GOLPP is more advanced or who don’t have control of their bowels and bladder, the strain on you to keep them clean and safe, as well as the physical strain of carrying them around, is enough to wear down even the most dedicated owners. We bring this up because we want you to know that we are available to you as you navigate your pet’s condition. We frequently support our clients through the big decisions and help them to find the plan that works best for them while keeping quality of life as high as reasonably possible for all involved. GOLPP can be particularly difficult to come to terms with, as these patients generally maintain mental acuity and brightness despite their physical decline. It can be a long, challenging road, but we are here to walk it with you and support you and your pup through the entire journey. If you are considering euthanasia, visit our Quality of Life article for more information on when and how to make the decision and what you can expect.

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

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. This healing surgery site may look okay, but a major infection was brewing beneath! 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.

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.

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.