ACL INJURY, Limping dogs, conservative treatment often better than surgery.

To contact us Click HERE


ACL Injury and Limping DogsThe following is an article from Veterinary Practice News Oct 2012 written by Dr. Narda Robinson. Dr Robinson oversees complementary veterinary education at Colorado State University Cruciate Surgery, which means she teaches vets how to think and evaluate whether what they are doing is helpful. Here she questions the benefit of surgery to fix the knee ligaments, (canine cruciate ligament)  in lame dogs. She notes that the surgery does not stop arthritis; 1/3 of the dogs have complications from surgery, and there is no research that shows dogs do better if they have surgery than if they are treated conservatively. In addition, there are cases of dogs developing cancer at the site of surgery, perhaps due to the use of metal plates and screws.
The article is available at the Veterinary Practice Website: http://www.veterinarypracticenews.com/vet-practice-news-columns/complementary-medicine/questioning-canine-cruciate-surgery.aspx
Questioning Canine Cruciate Ligament Surgery
By Narda Robinson, DO, DVM
Posted: Oct. 15, 2012, Veterinary Practice News
Imagine you twisted your knee and your doctor diagnosed an injured anterior cruciate ligament. What if she offered you only surgery or euthanasia (hypothetically legalized for humans)? Would you explore alternatives or accept this false dilemma? Would it change your mind if you discovered that more enlightened surgeons are exhorting their colleagues to stop cutting cruciates at least until patients have undergone a month or more of conservative care?
In the same vein, why do some veterinary surgeons limit options for dogs, forcing clients to choose between breaking their hearts and breaking their banks? Yes, canine and human stifles differ, but the chronicity and persistence of canine cruciate disease argues in favor of a long-term, rehabilitative and integrative approach, not for bone saws.
Moreover, far from being a slam-dunk diagnosis and treatment, confusion lingers. Unknowns persist about whether a lameness is indeed due to cruciate injury and if so, what caused it. Furthermore, “The ideal treatment modality for cranial cruciate ligament (CrCL) injury has yet to be determined...”¹
Consumers want options.^2-6 Many in our profession insist that only surgery or euthanasia allows dogs to avoid a life of disabling pain, arthritis and poor quality of life.
What does the evidence say about their claims?
Claim No. 1
“A chance to cut is a chance to cure.”^7,8 False.
Cutting does not cure cruciate disease. In fact, about half of Labradors rupture the contralateral CCL within six months after tibial plateau leveling osteotomy.⁹ Evidence indicates that TPLO does not halt the progression of osteoarthritis in dogs.^10,11 TPLO outcomes vary widely and long-term clinical trials are lacking.¹² In fact, three studies show that radiographic signs of OA significantly worsen after TPLO. This concurs with human evidence indicating higher OA morbidity following surgery as opposed to conservative care.¹³
Claim No. 2
“Studies with force plates demonstrate the superiority of the TPLO.” False again.
“There is little good scientific evidence that any one surgical procedure is better than any other,”¹⁴ even though many surgeons advertise or teach that TPLO is the “gold standard.”^15-17 Also, force plate analyses paint an incomplete picture, especially for dogs with naturally occurring disease and multi-limb lameness. Kinematic parameters differ between breeds, arguing for the establishment of normative data in healthy dog populations before making inferences about injured clinic patients.¹⁸
Claim No. 3
“Pelvic limb lameness is cruciate injury until proven otherwise.” Untrue.
Who hasn’t stumbled off a curb or strained a muscle after a run? Dogs’ paws, too, may slip and injure soft tissue.¹⁹However, most injuries do not require surgery for their successful resolution. Rest and wrap, massage, acupuncture, laser therapy and proprioceptive retraining may produce a full recovery for many problems whereas cruciate surgery never restores the limb to normal function.²⁰ Who pays for the diagnostic error when the surgeon finds an intact ligament? The dog and the client.
Claim No. 4
“The canine stifle differs from the human stifle; therefore, comparisons cannot be made.” This statement merely reinforces the case for conservative care.
The chronic, unrelenting course of cruciate disease in dogs emphasizes the need to try a multifaceted non-operative strategy first. Even in humans who usually acutely rupture their cruciate, many advocate rehabilitation: “At present, there are no evidence-based arguments to recommend a systematic surgical reconstruction to any patient who tore his ACL.”^21-23
Claim No. 5
“Don’t look for things that you don’t want to find (a surgeon’s aphorism).”
It is difficult to ignore the long list of complications from TPLO. Up to one-third of dogs experience complications, many require a second surgery to address them, amplifying post-operative pain that much more.²⁴ TPLO risks include osteosarcoma (with Slocum or non-Slocum plates),²⁵ soft tissue injuries (lacerated blood vessels, patellar tendon, medial collateral ligament, or long digital extensor tendon); severe intra-operative hemorrhage; tissue reactions to sponge retention; swelling; bruising; infection; and seroma formation. Surgeons may inadvertently fracture the tibia or fibula. Hardware can travel into a joint or break. Additional complications include osteomyelitis, internal tibial torsion, delayed union, ring sequestrum, screw loosening, Kirschner wire loosening, implant failure and draining tracts.²⁶
Claim No. 6
“Your dog will be as good as new after TPLO.” No.
All surgical approaches for cranial cruciate ligament insufficiency result in some lameness and restricted limb use in the first two weeks. Four to six weeks after that, as the osteotomy heals, muscle mass and thigh circumference typically decrease. While some recovery of TC takes place over time, it likely will not recover fully, and stiffness in that stifle can last five or more years.²⁷Alternatively, continued instability of the stifle following TPLO may result in persistent lameness.²⁸
Claim No. 7
“There is no evidence that acupuncture benefits patients with OA of the stifle (or knee).” Untrue.
A systematic review and updated meta-analysis of acupuncture for patients with OA of the knee showed “significantly better relief from knee OA pain and a larger improvement in function than sham acupuncture, standard care treatment, or waiting for further treatment.”²⁹ Thus, those dogs that do develop OA, with or without TPLO, may benefit from acupuncture, shown to be a safe and effective method to improve physical function, quality of life, range of motion and pain control.^30,31
Claim No. 8
“Conservative options have no evidence; strict crate rest for six to eight weeks is the only other option.” False on both counts.
While research on non-surgical approaches to cruciate disease is growing for humans and for dogs, no evidence supports confining dogs in crates for weeks on end. Between dogs who did and did not have stifle surgery, research shows no differences in scores for lameness, stifle instability, OA, and/or force plate outcomes.^32,33Conservative management consists of weight loss,³⁴omega-3 fatty acids,^35,36electrotherapy, cryotherapy,³⁷massage,³⁸ acupuncture, laser therapy, ^39,40 and more, and can be tailored to dogs’ specific diagnosis and athletic performance requirements.⁴¹
Conclusion
The integrative medicine credo “primum non nocere” (“firstly, do no harm”) compels us to consider why, given the facts, clients are forced to choose between surgery or euthanasia and not provided with alternatives. This problem exists in other areas as well, such as the treatment of disk disease, where the case for conservative care rivals or outcompetes that for surgery, for both humans and dogs. Now that 94 percent of Americans feel closer to their dogs than they may to their mothers (87 percent), cat (84 percent) or father (74 percent),42 let us honor this bond by providing clients options and answers, not just surgery or euthanasia.
Dr. Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University.
 
 

Puppy Socialization Period, Weeks 3-12

To contact us Click HERE

We’re discussing puppies and the development of their brains and bodies. Puppies go through periods during which different aspects develop.

1. Neonatal Period	-	0 days to 10 days
2. Transition Period	-	11 days to 21 days
3. Socialization Period	-	3 to 12 (-14) weeks
4. Fear Period	-	8 to 10 (-12) weeks
5. Juvenile Period	-	3 to puberty
6. Second Fear Period?	-	3 weeks between 4 and 11 months?
7. Adolescent Period	-	Puberty to social maturity

 We’ve discussed the Neonatal and Transition Periods, covering the first 3 weeks. Now, time for fun: the socialization period.
Puppy socialization occurs first to the other puppies and the dam (weeks 4-6) then to people (weeks 6-12). During socialization period, dogs learn to be comfortable with other dogs and people. Puppies that aren’t socialized during this crucial period grow up to be fearful.
To promote lifelong comfort with dogs and humans, expose pups to a wide variety of dogs & humans. For example, expose  puppies to friendly dogs with wide chests and big heads. This helps the pups not react fearfully to the bully breeds. Expose the pups to friendly dogs with upright tails; this helps them not react fearfully to Beagles & hounds. Without this type of exposure, pups assume that dogs with big chests, big heads, and erect tails are puffing themselves up prior to attack. Expose puppies to dogs with different ear shapes and different coat colors least they grow up to assume dogs that are different than themselves are from outer space.
Socialization also occurs to other animals, including parrots, pigs & ponies. Herding dogs should be introduced to ducks & sheep; working dogs to cattle & horses. Hunting dogs to quail, ducks, & pheasants. All dogs should meet cats.
During the socialization period, puppies should also meet a wide variety of humans: cane-using grannies & grandpas, wheelchair-bound kids, postal carriers, Santa Clauses, babies & toddlers. When pups don’t have this type of exposure to humans in the first 3 months of life, you’ll be able to tell it. These are the dogs that bark, bite or hide whenever they’re around strangers. These are the dogs you’ll find on PetFinders sporting the decals declaring, No Kids, No Cats. 
If you’re raising puppies, you can prevent this; and the world will love you for it.

Puppy Developmental Period, Fear; Weeks 8-12

To contact us Click HERE


The Puppy Fear PeriodPuppies go through seven different developmental periods during which brain and body matures. The first 3 periods are neonatal, transition, and socialization. The 4th period is the Development of Fear. The Fear Period occurs in the 2nd month of life, from week 8 through week 10 or 12. This is the same time during which puppies become socialized. If pups experience a traumatic event while being socialized, they can be fearful for life.

Puppy's first vet visitAmong the normal activities during the pup's 2nd month of life is the pup’s first visit to the veterinarian. Puppies will associate the smell of the vet clinic with their experiences. Forever after we have dogs that tend to be fearful, aggressive or happy at the vet's office based on this first experience.  When I handle puppies, I'm careful to cradle them and talk to them. I examine their eyes (reaction to light), mouths (abnormal dentition?), bellies (hernia?), chests (heart beat & respiration?), skin (fleas or infection?), bottoms (clean?). Then, the pup reveives a great treat reward, such as dried liver.
ShippingIn addition to visiting the veterinarian for the first time, some puppies are shipped from breeders during this period. These interstate or transcontinental travellers can learn that flying is not so bad or they can develop permanent fear of a crate, cargo hold, and car ride.  Preventing FearTo prevent pups from becoming fearful during the first vet visit or during shipping, use Adaptil pheromone spray in the crate and flower essences (Star of Bethlehem, Rock Rose, Impatience). The pup should have a chewie, such as a beef tendon, chew toy, or treat ball. Make sure it is so large the pup cannot possibly swallow it. If necessary, drugs such as Cerenia can be prescribed to help prevent nausea & anxiety. The pup is fed a light meal, and an hour later Cerenia is given with a small treat. Then, in 2 hours the Cerena will be maximally effective, and the trip can start.
 Sure taking all these steps require a lot of effort, but everything you do to prevent fear during this 8-12 week period will last the pup for life. The puppy and the world will thank you for it.

Puppy Development, the Neonatal Period, Days 0-10 and Adaptil

To contact us Click HERE
In a few weeks, puppies learn essential behaviors to last for a lifetime.

The first 10 days of a puppy’s life is the neonatal period, during which the pup is deaf and blind. So how do they find milk? Puppies are born able to smell and taste.  During the neonatal period pups are dependent on the dam for warmth, food and elimination. While it's important not to upset the dam, it's essential that pups are introduced to humans during this period.  Gentle handling, which is slightly stressful, allows pups to learn to tolerate stress. Pups learn to associate gentle handling with the smell of humans. They learn to tolerate small fluctuations in temperature.  Because the dam produces oxytocin pheromone when the pups nurse, little pups learn to associate this pheromone with feeling of wellbeing. The calming pheromone Adaptil is based on oxytocin and can be used as a spray to help ease stress in older dogs because it will subconsciously return the dog to its safe, warm first few days of life.
 

Puppy Transition Period: Days 11-21

To contact us Click HERE
During the puppy transiton period, about the 3rd week of life, puppies eyes and ears begin to function so that vision and hearing develop. The more novelty that pups are exposed to during this time, the more capacity they have all their lives to accept as nontreatening, various sights and sounds.
After hearing develops, pups can be exposed to potentially frightening sounds in such a way that they are desensitized to them rather than frightened by them.

As sight develops, pups should be exposed to different shapes and lines, including lines that are horizontal & vertical  The pup's visual cortex needs this stimulus in order to develop capacity to see things that are vertical and horizontal. If a pup’s eyes are covered up during this transiton period, some vision cells never develop and the pup will lack the ability to perceive objects we take for granted, such as stairs and chair legs.

Dogs & Cats With Depression

To contact us Click HERE
Ever been depressed? Lost a sibling to illness? Gotten sick yourself? Been alone in a new place? Pets go through the same experiences that we do, and are just as likely to run the gamet of emotions, including depression.

How would a depressed dog or cat look?
Depressed dogs & cats may:
• lose their appetite and lose weight
• decline treats
• stop interacting with their toys
• stop vocal communication
• wander as though searching for something
• sleep excessively.

Ways to help depressed dogs & cats
• provide pheromones, such as Feliway for cats and Adaptil (Oxytocin) for dogs.
• stimulate with walks down different paths, different toys, new music
• crunch great treats on top of their food for delicious variety
• offer acupuncture, which in research has been shown effective with depression when given 30 min twice a week for several weeks.
• increase socialization at dog parks or by bring another dog into the family.
• go for rides and let your pet put its head out the window or look through a mesh window on a pet stroller
• take a vacation with your pet. So many pets come back happy from vacations.
• be happy yourself.

The research on depression & acupuncture
Complement Ther Clin Pract. 2012 Nov;18(4):216-20. doi: 10.1016/j.ctcp.2012.06.003. Acupuncture and Chinese herbs as treatments for depression: An Australian pilot study. Lyons Z, van der Watt G, Shen Z, Janca A. School of Psychiatry and Clinical Neurosciences, Univ of Western Australia, 35 Stirling Highway, Crawley WA 6009, Australia.

Shea, My New Foster Dog

To contact us Click HERE


 Every dog I foster is the best dog in the world, so let me tell you about the latest foster dog. She was rescued from an Indian reserve near Burns Lake, BC by Turtle Gardens. I was told to expect Shea, a 2 year old, 35 lb border collie who had a litter of pups that all died. Well, the name was right because she answers to Shea, but this girl is a 50 lb husky cross who had never been pregnant and is probably less than one year old.  
Isn’t she beautiful!
This girl would love a home with children (not sure about toddlers). She loves people and most dogs. She is not frightened by men, or people with hats, or trucks that backfire, but she does not like riding in the car—except with her head out the window. She would like to chase rabbits. Not sure about cats.
Shea loves to run, moves beautifully, will chase after thrown apples and toss them in the air. Shea loves playing with other dogs, loves wading into the sea, but I have not seen her swim. She doesn’t love, but willingly accepts bathing. She does love being touched, but she’s not a “sucky” dog.
Shea’s coat is beautiful and has a glow. She has a glorious tail that she carries high and curled over her back. She does not shed excessively. Her teeth are gorgeous. Her nails are light and easy to trim. She is eye-catching.
When folks ask how I can foster a dog and not keep her forever even when I love her, I tell them it’s like being a kindergarten teacher. My job is to get Shea grounded and open her to a world of possibilities. She deserves even more than I can provide, so like a good teacher I’ll watch her graduate to another home, an even better home.
For now, Shea is beside my side throughout the day, which means coming to the clinic. She is learning to tolerate all the dogs & cats that visit us, and when necessary she sits out the client’s visit from her crate in the exam room. Come by and visit and meet the best foster dog in the world.