Guest Post by Matt Brunke, DVM, CVRPP, CVA, CVPP
I am a big proponent of rescue groups. There are many “discarded” dogs and cats, most of which are absolutely wonderful pets. I have worked with Peppertree Rescue for many years and really appreciate their dedication to dogs with medical needs. Peppertree will find out about them and screen them, and then have them transported to the Albany area where they can be attended to. This was the case with Glinda, a sweet, 8-ish year old Golden Retriever cross.
Upon physical exam, I found some areas of concern. While Glinda weighed in at a reasonable 74 pounds, her body condition score was abnormal. She had poor muscle mass in her back legs and was carrying more fat than she should. I also noted that she had decreased extension in both of her hip joints and was uncomfortable when I manipulated them. As I palpated her knees, I found chronic thickening in both the left and right knee with discomfort and mild instability. These findings are consistent with arthritic change in both the knees and hips.
Often times the hip arthritis is a consequence of hip dysplasia, while the arthritis and instability in her knees was consistent with chronic damage to her cruciate ligaments. I discussed this with the owners and we started with a conservative management program. I prescribed a course of therapy for her in the Rehabilitation Program’s Underwater Treadmill and an Adequan injection series for her. The buoyancy the underwater treadmill provides would allow Glinda to exercise and lose weight, while the Adequan injection series would be twice a week for 4 weeks, then one injection a month thereafter. This would help to improve her joint fluid in all of her joints, as well as reduce the damage to her cartilage.
Over the next 3 months, Glinda worked in the underwater treadmill twice a week, gradually increasing her time and distance with each session. Her comfort level improved and she lost 9 pounds. While she was moving well, I noted further instability in both of her knees. It was time for a sedated orthopedic exam and radiographs. Peppertree Rescue agreed to help with her costs and a short while later we had our answers.
Glinda had partially torn the cruciate ligament (ACL) in both of her knees. The right was not as stable as the left, and both had moderate arthritic change. She also had hip dysplasia, characterized by poor coverage of her femoral heads, and consequently had developed arthritis in her hips as well. The right knee needed stability. With hip arthritis in both legs and arthritis in both of her knees, the instability in the right needed surgical correction. My plan was to correct that with a procedure called a TPLO: TIbial Plateau Leveling Osteotomy. This would eliminate the need for the cruciate ligament and allow stability in the knee that would allow her to walk on the leg appropriately and slow the progression of arthritis forming in that knee. I was unsure if her left knee would need the same correction down the road.
Surgery was a success for Glinda. The TPLO gave her right knee the stability her body needed. She did very well in her post-operative rehab program, going through laser therapy treatments and underwater treadmill sessions. During her therapy she was always a smiling, happy patient. After 12 weeks of restricted activity, her tibia healed and I started to increase her overall activity. We would manage the arthritis in her knees and hips as an ongoing condition.
She has become an avid hiker with her owners. She goes for 30-45 minute walks every day and enjoys being outside. While her arthritis has progressed, her multimodal pain management regimen has kept her from having any further surgeries at this time.
The application of laser therapy to sites containing surgical implants is perfectly safe. These implants will not heat up or be affected in any negative way when the treatment is carried out appropriately. Laser therapy is used to decrease postoperative pain while enabling the patient to experience a shorter convalescence period before returning to function.
Let’s consider what happens with tissue sites that have metal hardware. The laser light will be reflected from the implant and sent back through the tissues. Thus, if a bone surface has a metal implant over it, the tissues between the surface of the implant and the surface of the tissues will be exposed to more photons than the rest of the target site. To account for this, the laser operator simply needs to 1) increase their scanning speed when they are treating over an implant overlaying a bone and 2) treat 360° around the limb to ensure light penetrates to underlying fracture lines or osteotomy sites.
Target sites with cerclage wire and IM pins can certainly be treated as well. Because cerclage wire will cause minimal reflection, there is no need to increase scanning speed with these sites. The same is true for IM pins since they are located inside the bone itself, not on its surface.
Regardless of the specific case, the laser operator will constantly monitor the patient for any signs of discomfort and may possibly adjust the power settings down and/or increase scanning speed accordingly, as some very superficial implants (or very small patients with little soft tissue overlying the implant) may be uncomfortable.
The conscientious laser operator will be mindful when treating any patient with surgical implants, as these sites often develop arthritic changes as time goes on. In this manner, the presence of surgical implants actually predisposes patients for laser therapy in their later years.
Icing an area after tissue trauma is one of the longest standing forms of physical therapy available to canine patients. In addition to icing, combining it with compression helps take cryotherapy to a whole other level of efficacy. Let’s take a look at what icing with compression can do for your patients.
Cold
Applying cold to a dog’s skin for approximately 20 minutes reduces blood flow, thus decreasing tissue damage and increasing analgesia. It is most effective within the first 72 hours after injury due to surgery or trauma but can also be utilized with chronic issues such as arthritis. Some methods of delivery for cryotherapy include ice packs, cold baths and frozen gel packs.
Compression
Compressing the tissue around an area that has been injured aids in decreasing the amount of edema that can accumulate. Minimizing the swelling will make the patient more comfortable, thus improving mobility earlier for a speedier recovery. The types of compression that are available are static compression, utilizing bandages or wraps that stay in place, and/or intermittent pneumatic compression, utilizing wraps that cycle between inflating and deflating for a period of time.
Combination
Combining the efforts of compression with icing allows the pet to get the best of both worlds. The alternating expanding and contracting motion of the wrap creates a massage effect for the area being treated in addition to helping concentrate the cold around the entire area. And, an added benefit of the cold compression blend is that oxygenated blood gets pumped into the injured tissue to enhance healing as well. This method works by attaching a wrap, with icing capabilities, to a pump that will rotate between inflating and deflating over time.
The effects of icing and compression provide excellent benefits for pain management and range of motion post-surgery or injury. Decrease pain, improve exercise, and heal injuries faster when combining cryotherapy with compressive therapy for canine patients. Learn more about post-surgical use of this technology in the video below.
