Claire's 3rd Hydrotherapy Session 10-28-11

Videos taken at Claire's third hydrotherapy session at CARE in Santa Monica! Her therapy this time was upped to a total of six minutes. It's always divided into three bursts of activity, with two rest periods in between in which she stays in the water but the treadmill is not running. The last video is of the water draining from the tank after her session, so that we could open the door to get her out.

Claire doesn't particularly like baths, which we do in the kitchen sink, so I was surprised at how quickly she took to the water treadmill! Of course, someone is standing at the head of the tank offering her cookies the entire time, so she has a reason to be distracted from the water. In fact, it's quite funny--rather than keeping a nice even pace on the treadmill, she'll run up to me for a treat, then stop walking while she chews it. The treadmill takes her backwards, away from me, so she then has to run up to me for the next treat!

The hand in these videos is the male tech who runs the tank. He kindly left me free to run the camera, and he was better at teasing her with the food to stretch it out. She's only going to CARE once a week, so her progress with the length that they'll give her has been slow. I'll have to start figuring out how to do hydrotherapy in the tub at home as she has just two CARE visits left.

A Friend at PT

Claire had an admirer this week at physical therapy. The therapists used her as bait to motivate a dog who was learning to use a wheelchair, and she was happy to help!

(attempting nose-to-tail exercises)

(doggy traction)

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)

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?