Blog

Physical Exam

ROM Testing 2Performing a systematic physical examination and visual observation of the patient’s mobility will provide an initial assessment on where the potential issue(s) may exist. A thorough orthopedic exam allows for palpation of the limbs and joints while moving them through their range of motion to draw attention to changes within the tissue and help assess if the patient seems painful. Additionally, it is important to complete a neurologic evaluation and consider running additional diagnostic tests to look for any underlying disease processes that could affect treatment options.

Pain Evaluation

According to the Summary of 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats, the most accurate method for evaluating pain is through observing any changes in the pet’s behavior. A pain score is considered the fourth vital sign after temperature, pulse and respiration.1 A patient’s pain should be evaluated in the clinic and by the pet owner to paint a full picture of how the pet is acting.

Pet Owner

Feedback from the owner is vital in understanding where, the length of time and severity of how the pet has been affected to determine the next steps for evaluating if arthritis is present. He or she should be asked a series of questions about any changes in behavior and given a pain scale form to fill out based on whether it is an acute or chronic problem. This will provide valuable insight into the pet’s everyday activities and how they vary.

Standing Evaluation

Stance Analyzer Golden Retriever SmallGathering data on how a patient is bearing weight while standing can provide objective numbers to determine which limb or limbs are effected. It has been shown that bathroom scales can be used as a reliable way to measure static weight bearing in canines2; therefore, a free-standing platform with built-in sensors, such as the Stance Analyzer, can visually show where a potential lameness exists. This sort of tool takes up minimal floor space and can be a cost-effective option in helping obtain a diagnosis, as well as measuring patient outcomes. Recording this sort of information can help guide treatment plans and provide owners with a better understanding of the source of their pets’ complications.

Gait Analysis

Objectively measuring a patient’s gait can be performed via force plate or a commercially available portable walkway. Force plate is considered the gold standard for evaluating gait by calculating the ground reactive forces of a cat or dog while standing, walking or jogging over the plate. The portable walkway is a mat that allows a pet to stand, walk or jog providing information on gait symmetry, stride length and the amount of pressure placed on each paw. These types of devices are expensive and take up a lot of floor space, thus they are not as common of an option for general practice.

Imaging

It is very important to obtain a picture of the joints suspected of having osteoarthritis. Radiographs are most commonly taken to assess the bony changes associated with OA. MRI and CT offer additional diagnostic capabilities, though less commonly used to assess OA, with MRI showing how the soft tissues are involved, while CT can offer better detail for the bony changes in more complex joints.

Arthrocentesis

Collecting a sample of the fluid in a swollen joint or joints suspected of having arthritis can help rule out what is causing the swelling or pain, especially in younger patients, or in those with a more complicated clinical history. The color, consistency and cellular make-up of the synovial fluid can provide clues as to what changes are occurring within the joint and why.3

 

References

1. Epstein, M. et. al. (2015). 2015 AAHA/AAFP Pain Management Guidelines for Dogs and Cats. JAAHA, 51(2), 67-84. doi: http://dx.doi.org/10.5326/JAAHA-MS-7331.
2. Hyytiäinen, H.K. et. al. (2012). Use of bathroom scales in measuring asymmetry of hindlimb static weight bearing in dogs with osteoarthritis. Veterinary and Comparative Orthopaedics and Traumatology, 25(5), 390-396. doi: https://doi.org/10.3415/VCOT-11-09-0135.
3. Degner, D. (2014, August). Arthrocentesis in Dogs. Clinician’s Brief. Retrieved from https://www.cliniciansbrief.com/article/arthrocentesis-dogs.

 

Posted in Blog, Featured News | Leave a comment  

Read more

Currently, professional human athletes are benefiting from the use of laser (photobiomodulation) therapy delivery platforms. In fact, more and more professional sport franchises and Olympic teams are utilizing this modality to not only treat performance-related injuries, but to enable improved performance while minimizing potential tissue damage.

Laser Therapy for Canine Athletes Bog Post Image 2There is a growing number of performance athletes in the canine world, in multiple disciplines such as agility, fly ball, and Shutzhund, to name a few popular ones. These canine athletes deserve the same amount of respect and care as their human counterparts. A performance athlete will by definition face a greater risk of event-related tissue injury due to excessive or extended demand of use.

The therapy laser will be beneficial in several stages around an athlete’s performance schedule. In order to set up the tissues for success, it is beneficial to treat the patient prior to a performance event. This preemptive approach is imperative when the individual has a history of specific performance-related injuries, as there will be a predisposition for potential injury. If the event involves demanding activity, such as with agility courses, it is best to do this treatment a day prior to the event. This timeframe will allow for the tissues to fully respond to the cascade of events that happen with photobiomodulation therapy. However, when dealing with a more restrained performance of a slower tempo, such as with dressage, it may be better to do this treatment just prior to the event so that we benefit from the ensuing neural blockade and endorphin release to allow for a cool, calm, collected ability to deliver.

Laser Therapy for Canine Athletes Bog Post Image 1It is wise to provide post-event treatment as well. Even if the individual did not sustain any visible tissue injury, it makes sense to treat these sites since these structures have been worked excessively and been subjected to a higher demand of function. Inevitably, there is always some level of post-event tissue inflammation with such events, so it is important to treat after each event. A single treatment is sufficient to maintain a sound athlete, but a short course of treatments may be needed if there was an actual injury sustained during the performance. If an acute injury happens mid-event, the patient’s injuries should be treated as soon as possible.

Human athletes receiving this modality have shown an ability to perform better, with increased endurance and less injury. The canine performance athlete can benefit in a similar fashion, and should be offered the benefits that photobiomodulation therapy will provide.

Posted in Blog, Featured News | Leave a comment  

Read more

Previously, we have looked at a general treatment approach, as well as treatment frequency for acute conditions in particular. Here, we will look further into treating chronic conditions. As opposed to acute conditions where our goal is resolution, the goal in treating chronic conditions is essentially to prevent an active decline with an incurable condition.

A complete recent physical examination is crucial when addressing a chronic condition, as it is likely that there have been compensatory changes in secondary or even tertiary biomechanically associated sites. For example, lumbar spine degeneration and iliopsoas muscle strain are often seen with the primary issue being degenerative joint disease of the pelvic limb (like with CCL rupture). Thus, a recent physical exam is a must as the progression of chronic disease can be quite dynamic and multifaceted. Not addressing all of the patient’s areas of pain or discomfort may lead to unsatisfactory results and difficulties managing client expectations. The natural progression of arthritis can be better assessed and addressed by reading and understanding the subtle symptoms that the patient develops as their condition continues to deteriorate.

It is just as important for the laser operator to have a thorough knowledge base in anatomy. Using the iliopsoas as an example, the operator must be able to visualize the target structure, from its origin at the lumbar spine to its insertion point at the lesser trochanter of the femur. The same principle applies to skeletal structure and neural pathways.

Elderly Dog Arthritis Treatment_SmallThe third important aspect of treating chronic conditions lies in setting realistic goals and expectations prior to initiating a treatment regimen. Age is not a disease, but it is a consideration. Each case will have individual factors, which will be taken into account when establishing these goals. The adept operator will keep in mind that geriatric patients have a slower rate of response to therapy, partly due to a slower metabolic rate, but also potentially due to concomitant disease.

Primarily, promoting quality of life via a sustained palliative response is always the primary goal. Secondly, it is our long-term expectation to be able to prevent an active decline by slowing the progression of the disease. Lastly, we may also be able to taper pharmaceuticals or even discontinue them. There are so many unique factors that each case must be handled as a separate entity.

Once these three factors have been addressed, we can proceed with a complete picture and a common goal for the case. Typically, a chronic condition will need an extended induction (or initial) phase of treatments. This induction phase is usually around 6 treatments, but with these cases, it may extend up to 9 or 12 treatments before an effective and sustained clinical response is seen.

Unless the patient is in established pain, an every other day frequency is typically applied when starting laser therapy for these cases. Once significant clinical improvement is seen, the operator should consider tapering the treatment frequency so as to promote a continued response. In this fashion, the patient is expected to undergo several treatment phases, from frequent “induction”, to less frequent “transition”, and then long term “maintenance” phase treatments.

Elderly Dog Arthritis Treatment 2_SmallSometimes, a client will report the patient seemed a little stiff after the first few treatments. Although this may seem unsettling, this is actually an encouraging sign of active tissue remodeling taking place. Remember, part of the cascade of events that happens with photobiomodulation is vasodilation and angiogenesis. It can be easily explained to the client by making the analogy of blood flow returning to a foot after it went numb from kneeling for too long. This is similar to the “pins & needles” feeling we get with reperfusion of tissues after an ischemic event. When noted, it should be transient and low grade, and is usually seen early after initiating the modality. If it is not seen, that does not mean that the patient is not responding effectively, it just means each patient is an individual and not a statistic.

As the patient progresses through treatment phases, we are able to maintain a clinical response while periodically tapering on the frequency of treatments. It is important for the client to be aware that regardless of the current treatment schedule, they are to return as soon as possible if there are any setbacks or sudden decline. Photobiomodulation offers the operator a certain flexibility in order to enable not only a long-term response, but be able to address acute to chronic events as well.

Many patients will benefit from long-term photobiomodulation therapy. Our patient base will also continually grow as we enable longer life spans via the advancements in the medical field. The savvy laser operator will also be dedicated to keeping an eye out for patients predisposed to arthritic changes, such as working dogs/athletes, chronic NSAID/opioid users, breed predisposed for DJD, patients with surgical implants or a history of traumatic injuries, etc.

Posted in Blog, Featured News | Leave a comment  

Read more