© 2023 MJH Life Sciences™ and dvm360 | Veterinary News, Veterinarian Insights, Medicine, Pet Care. All rights reserved.
3 remarkable stories of veterinary rehab recovery
What do a pit bull suffering from fibrocartilaginous embolism, a Labrador retriever with chronic severe elbow dysplasia, and a beagle with ventral slot decompression have in common? These precious pooches are rehabilitation success stories that teach us to never give up hope.
In my years of working to help rehabilitate dogs, I've seen many amazing canines overcome seemingly insurmountable illnesses and injuries. The following rehabilitation success stories teach us that all pet owners need to understand their options to improve their pets' quality of life. Whether a pet is struggling with arthritis or just underwent surgery, there's always a need for physical rehabilitation. All three of these amazing pets have amazing owners who dedicated a lot more than just the cost of the rehabilitation.
Case No. 1: Lola Warren
Have you ever heard the eye-watering, cringe-worthy cry of an unhappy beagle? Imagine that, multiplied by 10. That's what Lola did every time we even looked at her. She was just 10 days post ventral slot decompression and very unhappy. And honestly, who could blame her? She couldn't sit, stand, walk or even shift positions from side to side. On top of that, her neck hurt and she was surrounded by new people who wanted to mess with her—or in my case, help her.
Her anticipation of pain seemed to stress her out the most, causing her cries. She even cried when her owner was around. Fortunately Lola's owner was receptive and understood that the cries weren't necessarily pain-related.
We formulated a plan to move slowly and begin with some shoulder and neck massages and standing exercises. Her owner had a very busy home schedule, with two young boys and a husband who was out of town. We agreed that Lola's best option was to board with us for the week so we could work with her every couple hours throughout the day. (See "Sample script: Creating a rehabilitation schedule with clients".)
Creating a rehabilitation schedule with clients
Lola's lack of interest in moving her legs 10 days after surgery concerned everyone. If she didn't start using her legs, she would need an MRI to rule out a nerve sheath tumor. So we started to help Lola walk again.
Photo 1: On her first day of rehab, Lola worked on learning to lie down and build her core.
Every day we worked with her on the exercise equipment and in the water. She was not a huge fan of the peanut-shaped exercise balls, but they were so important in helping her regain her core strength and stability. We would use this piece of equipment by positioning Lola in lays, sits and stands on top of the ball. Doing this helped with joint awareness and worked her overall balance. For the first five days or so, she didn't show any signs of wanting to use her forelimbs and she couldn't figure out how to use her hindlimbs when we supported her with a vest for walking. She was very insecure, but after about a week of aggressive, yet gentle, daily rehabilitation, she started showing improvement. She was able to push herself up into a sit, and she even stopped screaming. Before we knew it, she was walking in the water and on land unassisted, and she was only a few weeks out from surgery. We were all ecstatic.
Photo 2: Lola warms up under blankets after spending time in the underwater treadmill.
The owners were able to continue her home exercises and bring her in three times a week for a month, and she continued to get stronger and less ataxic with each visit. She was also about five to six pounds overweight when we started, so her owners committed to helping her lose weight. They took it seriously and understood that both in her current state and in the future getting Lola to a healthy weight was the best thing for her.
Photo 3: Team members propped Lola into more comfortable positions for her neck.
After two months of pretty intense rehabilitation three times a week, we weaned her down to two times a week, then one time a week, and, finally, graduation. So within just three months, we took a dog that had a possible guarded prognosis to ever walk again to being able to run, jump and play. She even gained muscle mass and got a waistline in the process.
Photo 4: At two weeks post-op, Lola still needed assistance in the water.
Lola is now living it up at home with zero pain. Her owner continues to update us on how well she's doing, stopping by for visits and sending pictures. Today, you'd never know she had surgery. She's a spunky beagle that likes to thrash her toys all around, slinging them from side to side. Neck surgery? What neck surgery?
Photo 5: By three weeks post-op, Lola was walking without a vest and without assistance.
In every new-client appointment, we discuss home life and realistic goals to create a rehabilitation schedule. I usually give my owners the perfect world scenario—they don't work or have any other responsibility other than their pets—and then break it down from there. Each case I see has a different level of necessity when it comes to rehabilitation.
Photo 6: "Before we knew it, she didn't even need the bumpers on the side to help keep her straight," says Jodi Beetem. "And she even looked thinner."
For example, would I like to see a dog that just underwent knee surgery three times a week for eight to 12 weeks? Sure. Is it realistic? Not for most owners. And this example might do fine with one to two visits a week, as long as the owner commits to daily home walks and so on. However, in Lola's case, and most other critical neurologic cases, she needed much more attention and care.
Photo 7: Lola relaxes in her favorite spot-the couch.
Not every owner is easy to work with. Many times we must comfort and reassure owners that we're not trying to hurt their pets and that we must get past that scared moment when their pets squirm or cry out for help. Usually once the owner relaxes, the patient does too. If you've ever had physical therapy yourself, you know that sometimes it hurts a little before it gets better.
Weight-loss conversations can be an important part of rehabilitation. Many times you can start the recommendation with a simple opener, like, "There are a number of good weight-loss foods for dogs. We can call your veterinarian to find out what she recommends and then come up with a plan for the proper amount of calories Jake should eat."
Lola's case showed me the importance of patience. Sure, it was frustrating when I was trying to help her and she screamed at me. But slowly over time, her screams turned to tail wags, and I was able to watch her run around the yard pain-free—and that was one of my favorite days in my career.
Case No. 2: Batista Hessman
Picture coming home from work one day to find your 95-pound pit bull lying outside, unable to get up. Imagine the feelings of worry that run through your body. That's what happened to Tracy Hessman one September day in 2010.
Batista suffered from a fibrocartilaginous embolism (FCE). FCEs typically affect one side of the body, and, in Batista's case, his entire left side was affected. While there are no surgical treatments for an FCE, ruling out a disk problem, tumor, infection or another condition with an MRI and neurologic examination is always recommended. Once the diagnosis is confirmed, it's on to medical management and a lot of physical rehabilitation. There is also no guarantee that a patient suffering from this injury will make any type of recovery. It depends on the severity of the injury and how much neurologic function has been lost.
Photo 1: Batista receives neuromuscular electrical stimulation to his triceps.
As you can imagine, for many owners the decision whether to pursue treatment can be difficult for many reasons. Finances, schedule, home life and the owner's lifestyle all play a huge part in this decision.
Photo 2: To help with his recovery, Batista wears a life jacket to make it easier for his owner lift him up or down.
Lucky for Batista, his owner was willing to do whatever it took to help him walk again—even with the understanding that there was still a chance he wouldn't make a good recovery.
Photo 3: Initially, Batista needed assistance in the underwater treadmill.
I saw Batista for his initial consultation on September 17, 2010, three days after his injury. After his examination I was concerned about his left forelimb, as it wasn't showing much response to stimulation. There was no withdrawal or conscious proprioception. His left hindlimb, however, showed subtle signs of response during his neurologic examination. The right side of his body appeared within normal limits neurologically. However, he had a thinning hair coat and his left stifle joint was thickened on palpation. A veterinarian later diagnosed chronic bilateral cruciate tears and hypothyroidism.
Photo 4: Soon, Batista could stand on his own with no assistance in the treadmill.
After his examination, the owner and I discussed the items that Batista would need at home to help with his recovery. This included plenty of soft bedding, a belly sling, a life vest and boots for his feet to protect them from dragging. I also recommended therapy three times a week until he was walking. Keep in mind, this 95-pound dog couldn't sit, stand or walk on his own. So we started to address these challenges first.
Photo 5: One month into rehab, Batista still wore a life vest for support but didn't need assistance in the underwater treadmill.
Batista's owner purchased a life vest to help her lift him up and down. Canine life vests offer good abdominal support and feature a nice handle on the back. This was a staple in his recovery at home because she could not lift him on her own without it.
Photo 6: Three months into rehab, Batista no longer needed a life jacket.
Batista came in on a Friday afternoon. After the first weekend at home with his new exercise program, he was already able to shift his body from lateral to sternal position—huge progress—and he was moving his left hindlimb. His left forelimb continued to concern the veterinary rehabilitation team, so we started neuromuscular electrical stimulation and assisted water walking and standing. For almost two months, we saw Batista and his owner, Tracy, three times a week—getting in the water with him, helping him move his legs and using passive range of motion, neuromuscular electrical stimulation, low-level laser and any therapy we could think of. Every week he improved. He even started showing signs of movement in his left forelimb. I actually teared up a little while I was in the water with him because I was so excited.
Photo 7: Batista receives laser therapy to his stifles.
Then after three months of slowly weaning him from sessions three times a week to two times a week to, finally, once a week, we hit a plateau. His neurologic status was static. But he could walk, and that's all that mattered. He's not normal by any means, but he can use all four of his limbs and move himself about the house unassisted—except on stairs—which is a great improvement.
Of course, we still looked for additional ways to help Batista. However, his neurologic state meant he wasn't a candidate for surgery to help correct his bilateral chronic cranial cruciate ligament tears. So we turned to NSAIDs, exercise sessions in the underwater treadmill and low-level laser on both of his knees.
Batista continues to visit weekly with that big pit bull smile and stutter step. Someday I hope Batista doesn't always need my assistance as much as he does now, but given the nature of his diseases, I suspect he will always have a spot on my schedule. Without rehab there's no telling where he might be in his recovery. He's definitely one of my favorite success stories.
Discussions about whether to pursue treatment are very difficult conversations that usually take place between the owner and the referring veterinarian. However, there will be times when a client will look to a team member and ask for guidance. In those cases, it's important to remember to leave your judgment at the door. You also need to be careful with what you say and how you say it. Explaining to clients that there's no right or wrong answer is usually a good place to start. They need to be the ones to make the decision, and they have a lot to think about. They need to do what's not only right for their pets but also for their families. However, with suspected FCEs most clients will at least try and go forward with post-injury care in the hopes that their pets land in that higher percentage of those that recover.
All owners need to understand that nothing is guaranteed when it comes to FCEs. Explaining the successes of rehabilitation is important, but I always follow up with something like, "However, since we don't know the extent of injury, there's still no guarantee. This can be frustrating, I know, but I'm going to do everything I can to ensure we give Jake the best chance he can have to make a recovery. Then we'll just take it day by day."
A pet's needs during rehabilitation vary by case, but we often recommend items like raised food dishes to promote better posture when standing, head collars (e.g., Gentle Leader—Premier) to promote better posture when walking, life vests (e.g., Web Master Harness—Ruffwear; Help 'em Up Harness—Blue Dog Designs) for patients needing assistance walking and rising, gel packs for hot and cold therapy and rubber booties to protect paws and to help with traction.
Batista's case is a good example of teamwork within the veterinary team and with the owner. Having good communication with his regular veterinarian helped us plan his medication regimen for his FCE, get to the diagnosis of hypothyroidism and receive the surgical referral. Batista has even started seeing another veterinarian who practices holistic medicine and acupuncture. Building open lines of communication with all the team members who take care of Batista—no matter which hospital he's at—is important to his owner and for Batista's well-being.
Case No. 3: Baxter Flynn
Baxter, an 8-year-old, castrated male black Labrador retriever, had been slowly becoming less active over the last year, until he was struggling to stand up.
Photo 1: Near Christmas, Baxter visited us wearing his Santa outfit.
Watching him walk into our office, his severe head bob and stilted gait in both of his rear limbs were apparent. He also has a number of lipomas on his body, with a predominant one over his left hip, which may or may not be the cause of his abnormal rear limb gait. His most current ailment related to his elbows. Baxter had been living with chronic severe elbow dysplasia that had become debilitating.
Photos 2: Baxter receives some low-level laser therapy to his elbows. Low-level laser therapy in arthritic joints helps decrease inflammation and pain.
After his examination I talked with the owner, and we decided to begin in-house rehabilitation two times a week, consisting of underwater treadmill walking and low level laser for his elbows. His home exercises used warm packs on his elbows before walks and then started with slow controlled 10-minute walks twice daily on days that he didn't visit for therapy.
Photos 3: Baxter receives some low-level laser therapy to his elbows. Low-level laser therapy in arthritic joints helps decrease inflammation and pain.
Baxter was a natural with the underwater treadmill, and he loved it—especially when he got to lay in the Jacuzzi jets, allowing the warm water to massage his joints.
Just three sessions into his rehab program we were already seeing improvements. Baxter's head bob was less pronounced and he was able to get around more easily at home. His home exercises were staying steady as he was still getting a little sore after his walks, but he soon passed that phase and started increasing his land walking time as well. But, like any arthritic dog, he still had the occasional bad day with lameness. It was always consistent with days he didn't get enough exercise or got too much. There's a fine line between too much and too little with arthritic dogs, and it's a trial-and-error process for each patient.
A few months into his rehab, he hit a plateau. He wasn't getting worse, but I talked with the pet owner and she agreed that referral to a surgeon for additional options would be a good idea.
The first thing that was recommended by the surgeon was to add polysulfated glycosaminoglycan injections to his current rehab schedule before considering surgical options. Baxter responded to the treatment, and he returned to enjoying consistently good weeks at home. After months of weekly exercise sessions and low-level laser therapy, we've been able to stretch Baxter's rehab sessions to as little as twice a month.
Photo 4: Baxer enjoys life at the farm with his owner.
Baxter has always loved spending his Saturdays at the horse farm with his mom, but now he's less painful and more able to get around the terrain. He'll always have those up and down moments—I call it the osteoarthritis roller coaster—but they aren't as frequent and don't last as long.
Baxter will probably always need rehab given his age and disease, but for now he's happy to get his twice-a-month "spa" time and at-home rehab walks with his owner.
Lola, Batista and Baxter have a lot in common. They have dedicated owners, a great extended veterinary team and an improved quality of life with the help of physical rehabilitation.
Remember that every veterinary team member plays an important role in client communication and education. Ensuring that our clients and patients receive the best care there is should be our No. 1 priority. For every postoperative case like Lola, acute injury like Batista or arthritic geriatric patient like Baxter, it's important to discuss physical rehabilitation. Even if clients decide rehabilitation isn't right for them, you'll know that you've done everything you could to ensure the best quality of life for your patients.
Jodi Beetem, RVT, CCRP, helped launch the small animal rehabilitation program at University of Missouri Veterinary Teaching Hospital. In 2010, she joined Atlanta Animal Rehabilitation and Fitness and Veterinary Referral Surgical Practice.
Just like in people, there's no cure for osteoarthritis (OA). And unfortunately, with each year that passes the OA progresses. So it's important to explain to pet owners that each patient with OA is likely to have good days and bad, but with the help of physical rehab, medications as needed, weight management, chondroprotectives and daily controlled exercises at home, we hope to make the good days last longer and the bad seem less difficult.
Baxter is a classic case of old stiff dog syndrome. In these cases it's always important to remember that too much is just as bad as too little when it comes to an exercise regimen. Cases such as Baxter's are very common to the general practice team, so it's important that team members who are responsible for client communication educate themselves on arthritis and ways to help their patients.
If you as a team member suspect a patient needs a referral to a surgeon, it's important to watch your words. Since you're not the doctor, you can't make the referral.
If I see a plateau or if I notice a case where the opinion of a specialist would be helpful, I usually start with, "I've noticed that Jake is doing well but isn't progressing. Since we've tried all our tricks here, have you ever thought of getting the opinion of a specialist?"
Many times people assume that if they go to see a surgeon, the surgeon will recommend surgery, so I reassure them that going for the consultation can be beneficial to know their options. If they show interest—or even if they hesitate—I say, "Talk it over with your veterinarian the next time you see her and see what she thinks. Then, if she agrees, she can call in a referral."