Claire's CARE Evaluation & Initial Intake Appointment

Claire was all ready for her intake evaluation at CARE, California Animal Rehab, after nearly two solid months of strict crate rest! We saw Dr. Debra Voulgaris on August 25th for the intake, but the rehab appointments will be led by a physical therapist rather than a veterinarian.

(waiting)

The vet met with us in a separate room to get a picture of what's going on, then took us into the main open therapy area to do the physical exam. Claire was a little overwhelmed with all the goings-on, with so many people and other animals around. It made her uncertain with the examination itself, but she still did great.

(measuring the girth of Claire's muscles to see if the sides of her body are even)

(checking range of motion)

(checking Claire's reflexes)

The doc did a full neurological assessment, but as usual Claire was quite stoic, and she only yelped once, though she did pull back a bit when her mid-back was pressed.

Dr. Voulgaris ultimately said that though she doesn't deny that there is or was some level of back injury, the pain Claire presented with on Thursday was more muscular, in the Iliopsoas muscle, which wraps around her leg from the hip, and perhaps sciatic pain. Her shoulders were also quite tight. The yelp came when the vet was examining the Iliopsoas.

(nervous licking)

Dr. Voulgaris formulated a plan for Claire's physical therapy based on once a week visits to CARE, and twice daily homework. The exercises seem quite thorough but not easy to do by myself. I've put them up in a separate post so I can refer to them easily. There will be a halfway check by the vet after four weeks, and an outtake exam at the end of the eight weeks. The total will come to somewhere above $1500. Modalities covered in Claire's on site care plan include laser therapy, acupuncture or acupressure, and physical exercises.

The one exercise that makes me nervous is traction. I've heard all kinds of prohibitions against this for dogs with spinal injuries as it's too easy for them to twist in a wrong direction and end up doing damage. I'll be giving that one some thought before I decide to proceed with it.

I mentioned I was excited to see how they would acclimate Claire to hydrotherapy or the water treadmill since she's not particularly fond of baths even in our tiny kitchen sink. When I checked out, the front desk person said the Dr. wanted to hold off on water therapy until she re-evaluated at the halfway point. I need to drop her an email to find out her reasoning. I was really surprised since she hadn't mentioned that when we were talking together. Hydrotherapy is one of my main reasons for seeking out therapy for Claire, since I don't have that kind of equipment at home. If it's not warranted given her injury, that's one thing, but I can't imagine she wouldn't benefit from it.

She's also added a few supplements to Claire's diet that I'll cover in a separate post, and put Claire back on Gabapentin, a nerve pain killer, since I mentioned she'd been licking her sides quite a bit. We'll be adding these things once at a time so we can see how Claire's reacting.

Recommendations were absolutely no jumping up or down, no walking her, no sudden movements, but more supervised open crate time with gentle motion around home allowed. I can pick her up, properly and carefully, but can't yet bathe Claire as we don't want her rolling around and running actively as dogs often do to dry off. A harness is preferred over a collar by Dr. Voulgaris, and I'm going to have to continue to find a way to do Claire's nails without flipping her over on her back. Chance can sleep or stay in the same crate with Claire at this point as long as there is no roughhousing going on.

One of the first things I did after our visit was to make calls to vet techs & pet walkers we know to see who would be able to assist us in doing Claire's therapy at home, at least some of the time. I need one person to hold Claire on her side while another does the physical manipulations. It looks like I will be paying for help three times a week for about $50 per week; just one more factor adding to the cost of Claire's ongoing care.

Claire's CARE PT Exercises for Home

These are the therapy exercises recommended for Claire to do at home. Each dog is individual. Please consult a professional before beginning any therapy with your dog. I am not a veterinarian and the obvious risk for damage without proper knowledge is huge. The order is arbitrary but for my own ease I tried to group them to have as few changes in position for Claire as possible. I duplicated some exercises that said "repeat each side" and listed them again so that I wouldn't forget to do them when I flipped Claire over. Click on any of the images to enlarge to a readable size.

(dog lies on tummy first)

(dog lies on one side to work on dog's left side)

(flip dog to lie on other side to work with dog's right side)

(pick up dog)

(standing dog exercises)

A Very Cool Book about A Very Cool Dog

I saw a wonderful book at CARE yesterday: Murphy Meets the Treadmill, by author Harriet Ziefert.

From the description off PaperbackSwap:

Murphy is a simple dog with simple pleasures. He's happy just to lie on the porch and watch the people go by, especially if they have treats for him to eat! All those treats add up, though, and even Murphy has to admit that maybe he's not such a fine example of his breed after all. But what's a dog to do? Cheryl says he has to diet, and that's just the beginning. One day a delivery van arrives with a strange machine. Murphy puts up quite a fight, but Cheryl is determined to get him trim and fit. Soon, the neighbors can't stop talking about Murphy's new activity. Who says you can't teach an old dog new tricks! Readers will delight in the familiar battle of wills between pet and owner, hilariously portrayed through Harriet Ziefert's witty text and Emily Bolam's warm, expressive illustrations.

CARE Evaluation Questions

I made a list of questions to ask the vet when Claire is evaluated at CARE for possible physical therapy. I posted these on facebook to see if anyone had anything to add, but didn't receive any responses. The Dodgerslist site has several vet question lists which I also reviewed but none that specifically address rehab. In completely random order, here they are:

What is your case load per month treating IVDD and what is your success rate/complications rate?
Do you recommend acupuncture, chiropractic or other alternative treatments?
What do you think of laser therapy with a Class IV laser?
Do you recommend the use of supplements? Which ones? How much?
When do you recommend that the dog starts physical therapy and what kind?
What exercises will you do in-clinic?
What exercises can you teach me to do with Claire at home? How often and how long should she do these exercises?
What will be the signs that Claire has overdone therapy? What should I do if I see her acting this way?
What about wearing the brace?
Can you tell me the specific vertebra that has herniated? Which are the two that the neuro thought were bulging?
Can Chance be with Claire in the same crate?
Can Claire have a bath? How should I dry her?
What's the best way to clip her nails?
What about non-anesthetic teeth cleaning?
Do you know what LDA is? Do you recommend that for Claire?
Can I split her therapy program into two parts, before and after the Laser Disc Ablation?
How do you limit jumping?
How best to teach Claire to only use the ramp to get up/down from couch?
Do you recommend harness over a collar?
What are your concerns about Claire's gait?
What are your concerns about Claire's squat?
Claire is not stretching her back legs as far as she used to. How can I encourage that?
Should we bring a life vest for any water therapy? Do we need to bring treats with us?
Do I need to elevate her food dishes? Talk about the way she eats like she's starving.
Can I pick her up as much as I want?

Can I pay in installments?
I'm low income. Do you have any assistance programs?
What do I need to do to set up donations coming in via phone?

Research, research, research meds!

It's so important to be your dog's educated advocate. I can't thank my holistic vet enough for setting us on the right path with supplements, but I knew I needed to do my own research on side effects and on pricing. I'm so glad I did, because I just found the exact same product on Amazon for half what the vet is charging me, and right now, everything for Claire is really adding up. This is only one of the meds she's been taking but I now have my source for it!

If your pet is taking Dismuzyme Plus, look for it here.

Pet First Aid

While I've done lots of reading, and gained a ton of experience through vets over time, I have yet to take a pet first aid course. I can't believe how long I've been a dog owner without getting this done. I just registered to take the Dog & Cat First Aid Course offered by the Red Cross in my area.

I've discovered how to access their schedule and registration page--here. If you don't know the chapter in your area, there's a search function here. The course I found will be offered in September for $70, and is a four hour class session, double the class time in other courses I saw listed.

Have you taken a pet first aid course? Who taught it and how did you find out about it? What was the most useful piece of information you took away from it? Please give me some feedback in the comments section of the blog.

A Weekly Update

(Claire Sept 2006, within 2 weeks of adopting her)

Things here are settling into a routine somewhat as we wait out Claire's crate rest till the end of the month. I've formulated a basic plan that looks like physical therapy at CARE in September, and if Claire's a candidate, Laser Disc Ablation at OSU in Stillwater, Oklahoma in October. I'm still doing a bit more research on the side effects of LDA.

We got a mesh harness like this for Claire that we tried out over our weekend trip to see my parents. I had her wear it 24-7 to eliminate the movements of putting it off and on, and that turned out to be a mistake. I haven't been looking at her underside much as I shouldn't be flipping her over right now because of the spinal manipulation. But when I did finally have the chance, I noticed she'd given herself light rugburns in her armpits from the harness! They still haven't completely faded. She's not getting walked right now anyway, but a leash is recommended when taking IVDD pups out for potty breaks to limit their movement, and my parents have a huge yard, so I thought it appropriate. My yard is only about five steps square, so I haven't been using one here. So we have a couple weeks to work out another solution.

I bought a retractable ramp for our car off of craigslist. Used, it cost me only $40 cash. I found it online here new for $99 plus $20 shipping! I think the nonskid surface it came with is pretty abrasive, so I want to get a piece of carpeting or a runner of some kind for it. Hoping I can find that at the dollar store. I still need to work out a ramp situation for the couch and bed in our house, but again, I still have a couple weeks to pull it all together before she's off crate rest.

I've made some changes to Claire's diet. I've started covering her dry kibble in water to get more liquids into her, and she still gobbles it up--especially when I mix in a generous tablespoon of plain canned pumpkin to help her digestion. Claire's always had control of her bowels, but I do think it's been taking her longer or not as easy. She's off all pain meds so this should have gone away, but I know her squat isn't as deep so I'm wondering if that has something to do with it. She's up to three Dismusyme tablets a day. Occasionally I'm throwing in a 1/4 tsp of fish oil too.

Claire's getting more impatient with the crate, which I'm thrilled to see! Her personality is slowly coming back. I'm keeping the line though, and she does generally listen to commands when I ask her to "Go Crate" after a potty or meal break. Yesterday she scratched the ground after a poop for the first time in a long time! You have to be the parent of a disabled pet to know how much joy can come from a dog's potty habits. The day before that she was chasing her tail, something she did often when I first got her. Looking back, was that neropathic pain?

I've been checking back with the donation cans at Pet Haven, C&C Pets, & Zoom Room Culver. Claire's fund is now at $2075! Thanks again to all who have helped support her. I'm still leaving the money in her savings account until she goes to physical therapy or surgery, and meanwhile covering the cost of acupuncture, laser therapy, vet visits, and meds myself. These funds allow me to make decisions in Claire's care based on her best interest, rather than my financial situation. Thank you from the bottom of my heart for making that choice possible. Please keep her in mind as this saga is ongoing. CARE has said they will accept donations towards Claire's physical therapy as well, once we're a patient there.

Claire's Acupuncture Treatment

Since I went on a long bumpy car ride to see my grandpawrents, mom paid almost $200 for me to have both acupuncture and laser therapy this week on my return (we did it the day we left too). Even though I was in my crate the whole time, the car is still a little jostl-y. Mom put big rolled up blankets on each side of me to help stabilize my back, but that just made me hot so I laid across them.

This is my fur-rend Mary. I loves her lots. She holds me and talks to me while I have treatments, then she gives me treats (shhh! Don't tell Mom!). I think this is a grreat picture of Mary. I only shuts my eyes because I don't like that camera flashing at me. I figured out when this little red light blinks the flash is gonna happen right after so I closed my eyes every time.

This is how Dr Gray does the Acupuncture on me. I don't like needles so I get all squirmy, especially around my Mom, so she started handing me off to the vet techs to get it done in Back of the Clinic. This means Aunt Mary gets to hold me more.

Mom had them take pictures so she'd know what's going on and I could tell you about it too.


Even though Dr. Gray started on my back and then moved upward, I was trying to tell everyone I could how much I hate needles.

In the end I had one needle behind each ear, and one on my forehead. I had to stay this way for about fifteen minutes, then they did the laser therapy, which felt sooo good that I relaxed. I told mom I only want laser from now on.

Onyx & Breezy Foundation Denial Letter

If you care to read the denial letter, click on the image to enlarge it to a readable size. I'm posting it to demonstrate that I am doing everything possible to obtain care for Claire. I fully expect this to be a team effort from many sources, and am not expecting major funding from any one source. I know that times are rough for many, but I'm disappointed that the foundation couldn't give even a token amount to keep me encouraged with my fundraising efforts. We fit their ideal grant recipient mold perfectly, so I'm deflated by the letter I received in Thursday's mail.

From my conversations with the program administrator, I feel the Onyx & Breezy Foundation denied us because we are eligible for Care Credit. But as a freelancer, I have no assurance I'll be able to pay back a Care Credit loan in a timely fashion, and missing even one payment triggers a 30% interest rate. Knowing this, I can't in good conscience utilize this form of financing.

If you have any other foundations or grant sources I should be contacting, please leave a comment here on the blog or reach out to me directly by email at "etrets(at)gmail(dot)com"

If you're able to help out directly, bless you. Even re-posting and spreading the word about Claire is a huge help. The ChipIn can be found on the blog at: http://sponsorclaire.blogspot.​com/

on Facebook, find Claire at:
www.facebook.com/sponsorclaire

To sponsor by check: send me an email at etrets(at)gmail(dot)com and I'll respond back with our mailing address.

2nd Opinions from OSU (Oklahoma State)

I'm making plans for a 2nd opinion towards the end of the month when Claire's crate rest is complete.

The vet out here in Los Angeles is absurdly expensive. Our surgery (hemilaminectomy) is estimated at nearly $6,000 and that did not include the $2,000 MRI that was done to diagnose in June. I'm looking at other options without sacrificing quality.

If you're interested, I've posted the surgery estimate on Claire's blog at
http://sponsorclaire.blogspot.com/2011/07/claires-surgery-estimate.html

I also have Claire's MRI films on a disc to take with me, along with her records.

I've searched the Dodgerslist database, but didn't find any info, so I was wondering what type of experience folks have had with the vet school/hospital at OSU (Oklahoma State University). I have a friend in Stillwater and another with airline miles to burn and am considering flying Claire out there for evaluation and surgery if warranted. I'm hoping a teaching hospital will serve us better, and I've seen/heard stories of OSU being on the forefront of IVDD treatment.

I just spoke for a half hour or so with a Dr. Moorer at OSU, a second year surgical candidate, who ran over the kinds of treatments they specialize in there. He encouraged me to pursue physical therapy till Claire is stabilized for a month or so following the crate rest, then consider Laser Disc Ablation as a preventative measure. So much to think about!

Any feedback? Please post comments on the blog or email me directly.