My career as a physical therapist shifted dramatically 11 years ago after I adopted a dog named Teddy. Teddy came to me with a limp, so naturally, I wanted to help him. The first step was to find out what could be done. Several veterinarians later, the conclusion remained the same: rest and nonsteroidal anti-inflammatories (NSAIDs). As a licensed physical therapist, I knew there had to be something more; after all, bed rest and medication for the treatment of human conditions had fallen by the wayside decades ago.

After Teddy landed in a vet ER with a horrifying reaction to a prescribed NSAID, I was determined to help him myself. I began by going online to explore the comparative anatomy and biomechanics of canines and humans. During this search, I discovered a whole new avenue I could take to not only help Teddy, but also, to help his species: a canine rehabilitation certification program available for licensed physical therapists and veterinarians.

I enrolled in the program offered by the Canine Rehabilitation Institute (CRI), which is partnered with Colorado State University’s College of Veterinary Medicine. During my course of studies, I gained an appreciation for the differences and similarities in canine and human anatomy. The CRI program confirmed that all the methodology and expertise I had gained in physical therapy school and human clinical practice could transfer nicely to serving our four-legged friends. While there are certainly important differences between the two species, in general, the years of training I undertook to obtain my advanced PT degree proved to be a huge asset to the profession and practice of my animal rehabilitation career.

The goal of animal rehabilitation (aka rehab) is the same as the goal for humans: improve quality of life through restoration of function, increased mobility and reduction of pain. The best way to determine if your dog is a good candidate for rehab is to ask your primary veterinarian. If the vet is unfamiliar with the services these specialized professionals offer, do some research and become better acquainted with your options. Though the specialty practice of animal rehabilitation has been around for nearly two decades in some areas of the world, it is still in its infancy in the United States. Fortunately, the field is rapidly growing.

Rehab can help any dog with a musculoskeletal or neuromuscular problem, from young puppies to seniors. Some of my canine patients participate in agility, flyball, dock diving, rally, and search and rescue. Others are companions who prefer to hang out and get plenty of nap time. Because conservative methods have proven to be successful a high percentage of the time, the rehab therapist makes every effort to help the patient avoid surgery. When surgery cannot be avoided, post-operative rehab has also been shown to be beneficial for a faster reduction of pain and a quicker return to a more fully functional lifestyle.

PT CAN HELP

• Soft tissue sprains and strains

• Post-operative orthopedic recovery from cruciate ligament repairs such tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA)

• Congenital and degenerative joint disease (dysplasia and osteoarthritis)

• Neurological rehabilitation following spinal decompression surgery (hemilaminectomy)

• Other forms of non-operative neurologic insult, such as fibrocartilaginous embolism (FCE) or spinal cord contusion

Before trying physical therapy with your dog, clear it with your primary veterinarian to ensure that it’s appropriate. There are underlying medical conditions that can rule out PT as an option, so a referral/medical clearance is essential for your dog’s safety.

Your dog’s first visit with a certified canine physical therapist or a rehabilitation veterinarian will involve a fullbody musculoskeletal and neuromuscular evaluation. This specialized, comprehensive, hands-on examination gives the practitioner information needed to develop an individualized treatment plan for your dog’s specific problem(s).

Once the problems have been accurately identified, the practitioner goes to work to address them. A range of approaches is used: skilled manual therapy techniques (joint and soft tissue mobilization), therapeutic strengthening exercises, range of motion/flexibility exercises, and proprioceptive and balance exercises. Additionally, physical agent modalities—“techniques that produce a response in soft tissue through the use of light, water, temperature, sound, or electricity,” according to the California Board of Physical Therapy—may successfully address pain and accelerate healing.

While physical therapy methodology and techniques transfer nicely from the human to the canine patient, canine PT has some important specifics that are beyond the entry-level competencies of human physical therapy programs in the U.S. Similarly, not all veterinary schools include physical rehabilitation as part of their core curriculum. So, finding the right practitioner with the right education is important. Physical rehabilitation rendered by a certified canine physical therapist assistant (PTA) or registered veterinary technician (RVT) is also an option, but these practitioners must be supervised by a qualified PT or DVM with additional training in canine rehabilitation.

State regulatory bodies across the country are currently looking at establishing better laws and regulations to govern this particular specialty. These are needed to allow both non-vet rehabilitation professionals—certified and licensed canine physical therapists—to practice and to determine competency standards for veterinarians.

In California, for example, these regulations have been hotly debated; efforts are being made to allow properly qualified animal physical therapists to practice on their own premises with a veterinary referral. Historically, the California Veterinary Medical Board has wanted to put qualified practitioners under the direct supervision of veterinarians, who may or may not have training in this specialty niche. A legislative task force has been created to work on more appropriate language.

Everyone who’s a consumer of veterinary medical services has a stake in this discussion. Get involved by letting your legislators know that being able to choose a qualified canine physical therapist is important to you. Those who live in California can find out more at caapt.org.

An explosive, must-read article in Bloomberg Business Week looks at what happens when big business monopolizes the pet health business and how this corporatization might not be in the best interests for our dogs. 

Ever wonder why many veterinarians do not heed the 2003 American Animal Hospital Association’s recommendation for core vaccines to be administered every three years? Instead a number of vets still prescribe annual vaccinations—with boosters for distemper, parvovirus and adenovirus. According to the Bloomberg article the immunologist, Ronald Schultz, from the University of Wisconsin School of Veterinary Medicine, was one of those researchers who recommended this three-year protocol in the 1970s. He recalls that the AAHA Canine Vaccination Task Force, facing a revolt from vets about the decrease in their future vaccine incomes, struck a compromise at three years instead of the once-in-a-lifetime approach that he and others recommended. But yet you can find that annual vaccines are still being recommended by the 1,000 Banfield Vet Clinics in this country. Another surprising fact is that pet vaccines seem to be the only vaccines where one size, seemingly, fits all—the doses are the same regardless of weight or size of the animal, so the same 1 milliliter is given to a Chihuahua or an Irish Wolfhound—very little research has ever justified that approach. Bloomberg points to an example from Banfield's software program "Pet Ware," used to instruct the veterinarians in diagnosing and prescription advice:

“the book shows a checklist of therapies for a dog with atopic dermatitis, or itchy skin. Doctors are encouraged to recommend a biopsy, analgesics, topical medications, antibiotics, a therapeutic dietary supplement, an allergy diet, and a flea control package. They’re required to recommend antihistamines, shampoos, serum allergy testing, lab work, a skin diagnostic package, and anti-inflammatories. It’s a treatment course that might run $900 for symptoms that, in a best-case scenario, indicate something as prosaic as fleas. The manual reminds doctors: You cannot change items that were initially marked Required. They must remain required.

No wonder the pet health industry is booming and going through a period of rapid consolidations, Banfield, located in many PetSmart stores, was purchased in 2007 by Mars, the candymaker and pet food giant (the largest in the world with over $17 billion in sales from brands like Pedigree,  Cesar, Eukanuba, Iams, Natura brands, Royal Canin, Sheba, Nutro). Then in 2015 the Mars Petcare portfolio of vet clinics grew when they acquired BluePearl Veterinary Services, with an additional 55 locations.

Mars, seemingly, facing a slowdown in consumer purchases of prepared/package foods and sugary products, is acquiring even more veterinarian companies and it was announced that their newest acquistion that they are paying $7.7 billion is VCA, Inc., the veterinary and doggie day-care business based in Los Angeles. VCA owns 750 hospitals and employs 3000 vets and 23,000 people, and had a 2015 revenue of $2.1 billion. The Los Angeles Times noted that “VCA has used acquisitions to combine hospitals, diagnostic labs and veterinarians into its network. In 2014, the company even acquired a dog day-care chain called Camp Bow Wow.” 

And similar to Banfield’s approach, the Times notes that “VCA has been criticized at times by some customers for requiring tests that can be costly, but VCA maintains that it’s against its policy to sell unnecessary tests or treatments.” But 41 percent of VCA’s operating profits comes from their company’s Antech Diagnostics that also does bloodwork and other tests for more than half of the country’s hospitals, including their own of course. As Bloomberg reported, Tom Fuller, VCA’s chief financial officer, puts it this way when he speaks to investors: “Diagnostics is what grows the industry.” And the company’s business strategy has been “to leverage our existing customer base by increasing the number and intensity of the services received during each visit” (as found in their annual financial reports by Bloomberg reporting.)

Pushing tests unto clients is “good” for business, if not always for their clients’ pets,

"according to Wendy Beers, a veterinarian who resigned in 2014 from a VCA hospital in Albany, Calif. 'Every month they would print out things to say how many packages you sold, how many procedures you did,' she says. 'And if they came out and said, ‘This month we want everyone to do 20 heartworm tests,’ and you only did eight, well, next month you have to do better. I don’t feel when they’re lecturing us that their chief interest is to make sure animals get the best care.'”

According to Ken Shea, an analyst at Bloomberg Intelligence, who says that with Mars’ expanding presence in animal hospitals, the company will have an opportunity to use the facilities to sell even more of its pet foods. Is this troubling news for pet parents? A recent class action suit brought on behalf of consumers by a San Francisco law firm thickens the plot further when you consider that this suit contends that pet food manufacturers (including Mars) and retailers (such as PetSmart) are using "prescriptions" to justify overcharging consumers for food that contains no restricted ingredients. Neither the FDA nor any other government agency mandates such prescriptions.

Bloomberg clearly makes the case why all these things, like over vaccinations, unnecessary testing, false prescriptions for pet food matters is that veterinary medicine is largely unregulated. And one of the reasons why businesses like Mars find the pet industry a good investment strategy is that

“...pet owners pay cash: Vets don’t deal with insurers haggling for better prices or questioning whether that vaccine or ultrasound or blood panel is really necessary. (A small percentage of pet owners carry insurance, but they pay vets upfront, like anyone else, and then take on their insurers for reimbursement.) What’s more, when veterinarians make fatal mistakes, they face no real financial consequences. The law hasn’t changed to reflect the attitudes of the average pet owner; courts still treat pets as property. Damages paid to owners whose pets have been killed or injured are so low that a typical medical malpractice insurance policy for a veterinarian costs less than $20 a month. Damages are so low, in fact, that few pet owners can find a lawyer willing to take even the most egregious case of veterinary malpractice.”

So, yes, it should matter, and as always, it is good to understand what you are up against, what to expect if you use any of these services, to double check before you agree to over vaccinations, or receive a “prescription” for pet food, you are after all the only advocate your dog has and the better informed you are, the better decisions you will make. Nancy Kay, DVM, author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life, added that she “feels truly disheartened for my profession” about this expansion of Mars’ vet monopoly. Be sure to read the Bloomberg story and get the word out.

THE CANINE KNEE—known as the stifle—is a large, complex and vulnerable joint. Damage to one of its four main ligaments, most commonly the cranial cruciate ligament (CCL), results in pain and lameness and is the reason many dogs wind up in their vet’s exam room. The CCL connects the thigh bone with the lower leg bone and helps stabilize the knee. When it’s torn or ruptured, surgery may be required, particularly for large or very active dogs. In the U.S., the most common surgical repair techniques are the tibial tuberosity advancement (TTA) and the tibial plateau leveling osteotomy (TPLO), both of which require implanted hardware as well as cutting the bone(s) around the stifle joint, a procedure called an osteotomy.

However, an innovative technique utilizing a newly designed device—the Simitri Stable in Stride™—makes it possible to skip the bone-cutting. A Simitri stifle repair involves putting a small plate on the bones on each end of the knee (the femur and the tibia) and connecting them with an interlocking hinge.

Developed by Neil Embleton and Veronica Barkowski, Canadian veterinarians with extensive experience in orthopedic surgery, as a way to avoid osteotomy and preserve maximum joint motion, the device provides immediate joint support with minimal change to its form or biomechanics. It also offers a potentially quicker and less painful recovery.

Partnering with a U.S.-based veterinary implant manufacturer, New Generation Devices (NGD), Embleton and Barkowski developed and tested the Simitri in medium and large dogs. Although the procedure is too new to have good data on its long-term outlook, initial clinical trial results have been promising. (It’s worth noting that there’s also a shortage of evidence-based info on long-term TTA and TPLO results; most of the literature reflects information from their initial development.)

The current sizes of the Simitri Stable in Stride implants are most suitable for dogs 40 to 90 pounds (20 to 40 kg); per correspondence with Dr. Embleton, he is now trialing a device for dogs 15 to 35 pounds (7 to 15 kg), and a version for dogs more than 90 pounds (40 kg) is currently in development.

Interested in exploring this option for your dog? Dr. Embleton suggests that you ask your vet about it, or contact NGD to see if a vet in your area already has experience with the Simitri.

Next week is Thanksgiving, and for many families this means the tradition of spending the day preparing and enjoying a delicious turkey dinner with all of the trimmings. Us humans are not the only ones who look forward to this meal, and I see many dogs in the ER after they have decided to help themselves to a serving or two. While our pets may find this to be an initially satisfying (albeit naughty) indulgence, it can set them up for the development of pancreatitis, a potentially life-threatening disease.

What is the job of the pancreas?

The pancreas is an organ that sits cozily just under the stomach and along the first part of the small intestine. The pancreas is all about secretion and it has two main jobs. The first is the secretion of digestive enzymes to help break down food, and the second is the secretion of insulin and glucagon (to regulate sugar metabolism). The digestive enzymes are the part of the story that concerns us in pancreatitis.

Just what is pancreatitis?

Put simply, pancreatitis is inflammation of the pancreas that disrupts its normal integrity. Digestive enzymes that are normally safely stored are released prematurely, beginning to digest the body itself, and the result can be a metabolic catastrophe. As the tissue becomes further inflamed, the damage begins to involve its next-door neighbor, the liver. Toxins released from this progressive party of tissue destruction can circulate more broadly, causing a body-wide inflammatory response. If the pancreas is severely affected, its ability to produce insulin can be affected and diabetes can result.

The good news is that most commonly the inflammation is confined to the area of the liver and pancreas, and most pets make a full recovery with support.

What causes pancreatitis?

In most cases, we never find out what causes it but we do know some events that trigger it. These can include:

• Dietary “indiscretion” and ingestion of highly fatty foods (such as eating all the meat, skin and fat trimmings from the turkey!).
• Obstruction or “back flow” of the pancreatic duct.
• Hormonal imbalances including diabetes, hypothyroidism and high calcium levels.
• Use of certain drugs, chemotherapy and the anti-seizure medication potassium bromide. Exposure to organophosphate insecticides has also been implicated. Steroids have traditionally been thought to be involved but this appears not to be true.
• Trauma to the pancreas (such as a car accident or even surgical manipulation).
• A tumor or abscess.

Miniature Schnauzers are predisposed to pancreatitis as they commonly have altered fat metabolisms.

Signs of Pancreatitis

The classical signs are appetite loss, vomiting, diarrhea, painful belly, depressed attitude and fever.

Making the Diagnosis

Until recently, a reliable blood test has been lacking. A new newer generation option called the SPEC cPL (specific canine pancreatic lipase) test has come to be the lab test of choice. For dogs only, the SPEC cPL can be run overnight by a reference lab and is able to detect 83 percent of pancreatitis cases and exclude other possible diseases in 98 percent of cases.

This test should not be confused with the “in-hospital” pancreatic test, which resembles a “pregnancy test” and gives you an answer of “abnormal” or “normal.” I am personally not a huge fan of this test because other disease processes (such as liver or gastrointestinal disease) can cause an “abnormal” result.

Ultrasound detects 68 percent of cases and provides the opportunity to look at other organs. Since pancreatitis can be accompanied by a tumor near the pancreas, ultrasound is an important tool for catching such complicating factors. I discuss and recommend this diagnostic for all patients I suspect have pancreatitis.

Treatment

The passage of food through the intestine is a strong stimulus to the pancreas, which is what we want to avoid. Essentially, we want the pancreas to “rest.” This generally means no food or water for 2 to 3 days (in our very ill patients) using IV fluid support to prevent dehydration. Fluid support generally requires electrolyte supplementation and a critical patient will need 24-hour care with blood-test monitoring several times a day. A plasma transfusion represents a specific type of fluid therapy and may be of great help in severe cases.

Pancreatitis can be a very painful condition and pain management is of utmost importance in recovery and is a cornerstone of treatment. Untreated pain affects the immune system and has been shown to increase death rate. Medications to control nausea are also used. Antibiotics are used because even though pancreatitis is not a bacterial disease, bacterial invasion from the diseased intestine is a common occurrence.

Once the patient has started to eat again, a low-fat diet is important to minimize pancreatic stimulation. Since there is potential for the pancreas to always have a smoldering bit of inflammation, long-term use of a low-fat diet is likely to be recommended.

Pancreatitis can be a very severe disease to experience and treat and I hope this helps raise awareness of a potential source of calamity. Please remember to keep your countertops pet-safe: Take all garbage outside promptly and be extra vigilant of the fact that even the most well behaved pets can be tempted with all of the food festivities.

Here’s to a SAFE, happy and wonderful Thanksgiving!