Persuading a client to dedicate time and money to a pet’s potentially lifelong arthritis rehabilitation isn’t easy, experts say. But educating owners to be proactive can delay the onset and severity of the disease and lead to a more therapy-receptive client. A dog receives electrical muscle stimulation after arthroscopy for arthritis. More modalities than ever are available for patients suffering from arthritis pain, certified veterinary rehabilitators say. The key to maximizing the benefits, they say, lies in veterinary and client education along with an appropriate diagnosis. “Arthritis rehabilitation is a multimodal process,” says Janet B. Van Dyke, DVM, CCRT, CEO of the Canine Rehabilitation Institute in Wellington, Fla. “Veterinarians interested in expanding this area of their practice should consider becoming certified in rehabilitation. A lot can be learned in the three to four months it takes to complete the certification process.” Veterinarians looking to provide rehabilitation services need a general understanding of the available therapies, Dr. Van Dyke says. Back to School Deep-water swimming strengthens muscles and improves aerobic fitness without taxing the joints. More veterinarians are educating themselves on the best practices in animal rehabilitation through the Canine Rehabilitation Institute. The school has had 750 graduates. “About 85 percent of our classes are composed of veterinarians and the rest are veterinary technicians, physical therapists and physical therapist assistants,” Van Dyke says. “There are regional strengths and weaknesses in finding a therapist, and in some areas rehabilitation is really taking off. Rehabilitation offers the final piece to the puzzle that makes drugs work better.” Using nutraceuticals first for pain control is very popular, says Christie Carlo, DVM, of Avondale Veterinary Healthcare Complex in Des Moines, Iowa. Using prescription medications long term can raise the risk of side effects and can be financially taxing. “I try to use nutraceuticals like glucosamine and chondroitin as much as possible, which can be given to dogs and cats,” Dr. Carlo says. "Dasuquin works well for dogs as does Adequan Canine (polysulfated glycosaminoglycan), an FDA-approved intramuscular injectable given twice a week for up to four weeks.” Arthritis in cats is more difficult to diagnose, complicating rehabilitation efforts. Veterinarians say the first apparent clinical sign of feline arthritis is the animal’s inability or lack of desire to jump onto elevated surfaces. “We see a lot fewer cats than dogs,” says Sherman Canapp, DVM, MS, CCRT, Dipl. ACVS. He is owner and chief of staff at the Veterinary Orthopedic & Sports Medicine Center in Annapolis Junction, Md. “Cats are so good at masking their pain while dogs limp and show their discomfort much more freely than a cat does,” Dr. Canapp says. “Veterinarians have to be detectives to find what’s wrong with cats sometimes.” Manage the Pain Before physical therapy is effective, arthritis pain must be managed medicinally to reduce inflammation and make limb manipulation possible, Carlo says. Properly diagnosing the cause of arthritis is equally vital. “I’m a strong believer in having a working diagnosis and treating the underlying cause of arthritis first,” Canapp says. “If a dog has a forelimb lameness and pain isolated to the elbow, there could be an undiagnosed fragmented medial coronoid process. Arthroscopically removing these fragments and cleaning up the joint would decrease pain, improve function and make rehabilitation efforts and medical management much more effective.” Giving a pill may be convenient for owners, but it’s a Band-Aid approach and can lead to further medical problems, some specialists say. “As humans, we would be appalled if our doctor didn’t send us to rehab after surgery or after reporting severe arthritis pain, but owners often need encouragement to proceed with rehab,” Carlo says. “Veterinarians who do not offer in-house rehabilitation should refer to a practice that does offer some arthritis-control modalities and have rehabilitation literature to send home with the client.” Rehabilitators are always open to new drug options, says Nan Boss, DVM, owner of Best Friends Veterinary Center in Grafton, Wis. While rehab encompasses gradual, new additions to the regimen, drugs are needed for more immediate pain relief. “We are participating in a multiple-center FDA clinical trial evaluating the efficacy of a subcutaneous injectable called Pentosan Sulfate,” Canapp says. “This product is being used to treat canine arthritis in Australia and has been reported to have positive effects on joint health and function.” Therapies Hydrotherapy—either on an underwater treadmill or in a pool—can be a valuable tool in veterinary rehabilitation. “Underwater treadmill therapy utilizes the buoyancy, resistance and hydrostatic properties of water to promote an increase range of motion of joints in a regulated environment,” Canapp says. “Swimming also uses these properties to strengthen muscles and promote aerobic fitness without impact on joints. “These two modalities are useful when used correctly and at the proper time in injury and post-surgical situations. It is important that the rehabilitation therapist properly assesses the dog’s healing process and schedules these more vigorous therapies at the appropriate time of healing. “The most common indications for use of hydrotherapy include improving muscular strength and improving range of motion in joints with restrictions, conditioning, weight management and supporting return to function. We have successfully used underwater treadmill therapy for cats despite the assumption that they will not tolerate water.” Another rehabilitation modality is laser therapy. “Both warm and cold can be effective as part of the arthritis rehabilitation process,” Dr. Boss says. “This therapy can be used temporarily or for the remainder of the animal’s life.” Veterinarians who have taken the plunge on therapeutic lasers say the treatment is easy on patients and takes minimal time. “We use Class IV lasers,” Carlo says. “The first session is only about 30 seconds per arthritic joint. We work our way up to a few minutes per treatment area, which makes walking easier and other rehabilitation exercises less painful.” Knowing the treatment goals before choosing a modality is important, Carlo adds. “Ask the client if they are simply interested in their dog being able to go outside to the bathroom unaided or if they want the pet to go for long walks,” Carlo says. “The aggression with which you approach rehabilitation depends on what the owner will allow and is able or willing to contribute to.” Manual therapy is something that can be done at the practice or at home, veterinarians say. Massaging joints and bringing joints through the full range of motion helps an animal while it is lying down. Making sure the joints are well lubricated is crucial before owners perform this therapy. Homework Experts say home care is an essential step in maximizing rehabilitation. “There is no cookbook approach to rehabilitation therapy. Each patient will respond differently and the treatment plans should be adjusted accordingly,” Canapp says. “Having owners actively work with the patients at home is crucial to obtain the best outcome. A home therapeutic exercise program is created and practiced with the owners during each session with the therapists.” Make physical therapy a game for the pets and they’ll be much more likely to participate. “Getting an owner to come in on a weekly basis for rehabilitation on a long-term basis can be difficult,” Carlo says. “Getting the animal comfortable and starting it on physical therapies and therapeutic modalities in-house will make the pet more receptive to the owner continuing care at home.” This article first appeared in the February 2010 issue of Veterinary Practice News. <HOME>
