Rehabilitative care for senior pets

Hydrotherapy treadmill therapy can be effective for senior patients. Photo courtesy Patterson Veterinary While there are many joyful moments in a lifetime of pet ownership, aging, weight issues, and genetic characteristics can lead to late-in-life chronic pain and mobility issues. It can be an emotional time for a pet’s family, who is faced with a heartbreaking choice between supporting a pet that is living in discomfort or increasing medication and engaging in complicated treatments. Not only is it difficult for owners, but it can also be one of the most stressful parts of the job for veterinarians and their staff. According to Dr. Elizabeth Strand in the American Veterinary Medical Association’s JAVMA News, top sources of stress in the profession include giving bad news and managing adverse events. As the founding director of Veterinary Social Work at the University of Tennessee, she has studied these effects closely and has seen their impacts in the profession. Both a pet’s family and healthcare providers would welcome other solutions to naturally extend a pet’s life, health, and happiness. In recent years, many providers have seen rehabilitative therapies as a possible answer. Similar to its place in human medicine, rehab is being used by skilled, experienced professionals to work either along with, or instead of, surgery or medication. The practice rebuilds patient strength that has been lost through age, injury, overuse, or illness. The future of pain and mobility treatments “We didn’t use to have anything to offer when a client would come in for a routine visit and say something like ‘Oh, Sophie’s slowing down.’ Now it’s a different story. When we hear that, it’s not just a case of slowing down being normal. There are more things we can do about it. We can intervene,” said Jennifer Vitucci, DVM, CCRT. Dr. Vitucci graduated from the Ohio State University and is a certified canine rehabilitation therapist with more than a dozen years of experience. She became interested in her specialty because her husband was a veterinary orthopedic surgeon and a focus on rehab therapy fit with their vision for a practice. Since completing her education, she has appreciated working with older dogs and seeing firsthand the results that rehabilitative care can create. “The geriatrics are my babies,” Vitucci says. “Helping them prolongs their life. There are many older, bigger dogs that get put down because of mobility. Not everyone has the means or the information to know that they can do something.” Rehabilitation therapy techniques and equipment There is a range of techniques that Vitucci and other rehabilitation specialists have at their disposal to support older dogs. Some are as simple as hands-on body manipulation designed to provide stretching and therapeutic motion to joints and muscles. This activity works well because it improves circulation and helps an animal relax. Along with manual manipulation, physical exercises completed with or without equipment can be part of a larger therapy program. Just as with human rehabilitative exercise, a workout can take place either at a therapy location or at a client’s home. It can use a range of supportive items including balls to balance on, blocks, and elastic exercise support bands. A more extensive option for therapeutic support can be done using hydrotherapy, which offloads a patient’s weight using water so that their body can more easily practice repetitive movements. According to the American Kennel Club (AKC), the practice was first used in the animal racing industry with horses and greyhounds and migrated to applications in canine care. For older pets using hydrotherapy as part of a broader set of treatments, sessions often take place on treadmills where animals walk or run in water. Another tool veterinarians have been using for physical therapy is a hyperbaric chamber, which uses pressurized oxygen to calm inflamed tissues and provide relief. The equipment itself looks like a miniature submarine, takes up a 4-feet x 3-feet space, and provides a cozy environment where animals rest and feel at home. In fact, many dogs approach the machine much as they would any other denning space, and they climb in the machine willingly. Andrew Turkell, DVM, CVA, CCRT, CHT-V, of Calusa Veterinary Center in Boca Raton, FL., practices hydrotherapy, along with a range of other rehabilitation protocols. He explained the equipment gives dramatic results. “Using oxygen as a drug has been helpful in a variety of disease modalities. Everything that’s inflamed, everything that’s hypoxic and everything that’s ischemic will benefit,” he says. While first experienced by humans, acupuncture is a nonsurgical modality used in canine therapy. According to the AKC, it works best for musculoskeletal problems such as hip dysplasia and arthritis, as well as allergies, bladder problems, and gastrointestinal disorders. In addition to traditional acupuncture needles, there are devices available that use lasers to treat specific areas of the body. Cold laser therapy is another treatment option used in rehab, which Dr. Turkell has used to help canines with arthritis, wound care, and everyday aches and pains. His program uses beams of light to stimulate damaged cells to produce more energy and increase function. The laser is typically applied directly to a patient’s skin, and contact is usually painless. Sessions can last for a few minutes or extend to half an hour. Laser therapy is another rehabilitative treatment option for older animals. Photo courtesy Patterson Veterinary Will canine rehab become mainstream? Vitucci appreciates all possible modalities and is glad that clients and providers are beginning to consider rehabilitation as one of a group of treatment tools deployed to help animals feel better. “Rehab isn’t mainstream yet, but it’s close,” she says. “The time when there’s going to be someone in your area who does it is coming soon. So many people have had their own PT for whatever reason; it’s easier for them to consider it as something that could help their pet.” Specialists conduct equipment-free floor exercises but also use a variety of tools including balance balls, inflatable disks, underwater treadmill therapies, hyperbaric chambers, acupuncture, and lasers. The goal is to strengthen muscles, provide pain relief, and help a pet enjoy life without relying on medications heavily or at all. One of Vitucci’s favorite success stories involved an 11-year-old black Lab named Lillie. “When I had my first appointment with her, she was so weak they were using a sling to bring her into the exam room. For a couple of months, she had barely walked unassisted.” Vitucci recalled talking to the owners and preparing them for a poor outcome. Fortunately, Lillie responded to treatment much better than expected and the results were slow but ultimately satisfying. “When we started, all we could do was put her in the underwater treadmill, let her stay in it, and then drain it after three minutes because she started to fall,” Vitucci says. “She came to me once a week and we couldn’t turn the treadmill on for six visits. But eventually that changed. Now, two years later, she goes on half-mile walks twice a day with her owners. They’re so happy.” Rehab works with other pain management treatment Rehab therapies can also be used together with drugs and natural supplements, or they can reduce the need for medicines with unwelcome side effects. When Vitucci saw that she could give owners another option to help their pets outside of heavy medication or euthanasia, the experience changed her perspective on rehab’s potential. She noted the approach is not always simple or easy and, just as with human rehabilitation, progress does not happen in the therapy room alone. True success requires a partnership between a practitioner and a pet’s owners to maintain follow-up exercise between appointments and to stay open to other therapies that complement what happens during in-office sessions. Vitucci credits Lillie’s dedicated owners, who were willing to work outside of weekly therapies. As part of their work between sessions, they conducted follow-up exercises as simple as encouraging her to move toward her food. They also agreed to carefully chosen medications including a joint supplement and gabapentin. In his Florida practice, Turkell offers a range of rehab therapies for patients. In addition to oxygen therapy in a hyperbaric chamber, he encourages clients to consider hydrotherapy for their pets and maintains a full aquatics center on site. He also educates clients on the benefits of both acupuncture and cold laser therapy treatment. Rehab resources Below is a list of resources for providers who are seeking to enhance their knowledge of canine rehabilitative therapies or who want to become certified themselves. These organizations offer practice certification for a range of position levels. The American College of Veterinary Sports Medicine and Rehabilitation: vsmr.org The Canine Rehabilitation Institute: caninerehabinstitute.com The American Association of Rehabilitation Veterinarians: www.rehabvets.org The University of Tennessee Canine Rehabilitation Certificate Program: Identifying dogs that need help When identifying an animal that could benefit from therapy, help pet owners know what to look for. At the same time, seeing the need is not always easy—especially for owners. “It’s such a slow change, and hard to notice unless you’re specifically thinking about it or asking about it,” says Vitucci. “It’s not until your veterinarian asks those questions and clients start nodding their heads.” Specifically, Vitucci says owners may tell providers about differences in their dog’s walk on a hardwood floor, notice their dog has become slower going up a flight of stairs or shortened the amount of time they want to go on a walk, or experience differences in how their dog likes to play or to be touched. Considering these differences together can provide a picture of a dog’s state of health. Practices can make a habit of advising their clients who have older dogs about what to look for, and about what signs might indicate their pet is a good candidate for a rehab program. Behaviors to mention to clients include: Moving more slowly, not choosing to run or swim as often Indication of pain through wincing or maintaining an uneven gait Reluctance to engage with stairs, go on a walk, or jump to a favorite spot on furniture Engaging in more downtime and sleeping Trouble getting in and out of a car without assistance Differences in eating habits that may be due to pain Less inclination to play or engage with a favorite toy Reluctance to be touched, petted, or scratched, or wincing motions when this happens It is important to remind owners most dogs are inclined to conceal pain, which makes it more difficult to identify. If there are any concerns, or if a client has questions, encourage them to call the clinic to discuss what they’re seeing. Considerations when making referrals Once a veterinarian has diagnosed an issue, if they don’t provide canine rehabilitative services in-house, they can make a referral to a qualified specialist. These services are often available as a stand-alone practice, as part of a university practice setting, within existing veterinary care practices, and even as mobile rehabilitation specialists that come directly to a client’s home. A list of available practices can also be found online, such as by searching for industry-qualified practitioners through agencies that specialize in supporting rehab treatment. For example, the “Find a therapist” function offered online by the American Canine Rehabilitation Institute and the American Association of Rehabilitation Veterinarians. Regardless of how services are identified and where services are offered, making the decision to engage in canine rehabilitation therapy can make a large difference in the health and well-being of a pet experiencing pain. It is because of this potential for relief, above all others, that availability of services is likely to only increase in the years ahead. Sharaya Guerrero has worked for Patterson Veterinary since 2017 and supports the company’s equipment and technical service offerings to veterinary clinics and other customers. Prior to that, she was a certified veterinary technician in general practice and emergency medicine.

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Rehabilitative care for senior pets

How to reduce pain and increase mobility

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