OrthoPets Blog

Patient Feature: Thebault

10295424_10154049366753070_1546401641221682990_oMeet Thebault, a nine year old Sheltie who has suffered from intermittent left front limb lameness since he was a puppy. As he got older, he started to struggle with routine things like walks, stairs, slippery surfaces and even standing up from a sitting position. He was diagnosed with carpal hyperextension and DJD (degenerative joint disease), with a possible but unconfirmed diagnosis of rheumatoid arthritis. 

Thebault’s owners initially went through our partner clinic, Pawsitive Steps Rehabilitation & Therapy, located in Rochester Hills, Michigan, outside of Detroit. Dr. Kern has trained extensively with OrthoPets in our process and works on a number of cases with us regularly in addition to being certified in canine rehabilitation and other pain management modalities. In Thebault’s case, she was able to help him acclimate to his device and, in conjunction with rehab techniques, learn to use it appropriately and comfortably in preparation for a big family move to Alaska.

Dr. Kern and Silver, Thebault’s OrthoPets Case Manager, selected an articulating carpus, articulating paw, “Carter”-style device design for Thebault. This device has a cranial (front) shell, as opposed to our non-articulating and fully caudal (back)  shell device. Thebault didn’t need his device to act as a non-surgical arthrodesis and completely stop all motion the way a non-articulating device would. He just needed help to control some of the movement and laxity in his limb that was making him uncomfortable.

Thebault received his device in early April 2016, and in spite of some shyness at his fitting appointment and even acting at first like the device was chasing him, he took to his orthosis (dog brace) very quickly. Because of the laxity of his digits, Thebault initially tended to supinate in the paw segment of his device which caused some irritation to his lateral 5th digit. This eventually necessitated the device coming back to OrthoPets to have the paw segment heat flared slightly to accommodate this tendency without encouraging it too much. His owners found that he tended to lick that area when his device was removed even after the adjustment, but were able to prevent him licking and further irritating it by putting a baby sock on the foot both to protect it and to distract him from licking as soon as the device came off.

Thebault and his family moved to Alaska in May and by the time they made the move, Thebault was so happy in his device that he actually raises his paw to have it put on. Because of his history and age, Thebault will likely require another orthotic device for his right front limb eventually, but for now he’s doing great with one device and is able to run and play and enjoy walks with his family again!

A Spot Blog Follow Up Share: Followup: Canine Cruciate Ligament Disease

Please read this follow up to the previous blog we shared of Dr. Nancy Kay from Spot Speaks blog. Please visit her site at www.speakingforspot.com.

Followup: Canine Cruciate Ligament Disease

Photo Credit: OrthoPets

In response to my recent blog post comparing surgery of canine cruciate ligament disease to treatment with a brace (orthosis), I received several excellent comments, one of which I want to be sure you have the opportunity to read.

The comment contains detailed information about orthoses (knee braces), how they work, how they are fitted, and when they should be considered. The comment was submitted by Dr. Ilana Strubel, a veterinarian who is certified in the fields of integrative veterinary physical rehabilitation, veterinary orthotics and prosthetics consultations, chiropractic, acupressure, nutrition, and animal behavior.

Not only did Dr. Strubel’s comment provide insights from her own experience, she also included material written by the folks at OrthoPets whose vision is, “to improve our patient’s quality of life through innovative prosthetic and orthotic solutions.” Before writing this, I spent some time on this company’s Facebook page. I invite you to scroll through their many photos and videos. I think you will say, “Wow!!” just like I did.

Here is what Dr. Strubel had to say:

Thanks for posting this well written piece featuring the first real published information about the use of stifle orthosis (knee brace) for conservative treatment of the ruptured cranial cruciate ligament in dogs. I am a veterinarian certified in canine rehabilitation, and I work very closely with OrthoPets. Together, as a team, we select who would be a good candidate for a stifle orthosis, and make very careful measurements to design custom stifle orthotics (as well as many other types of veterinary orthotic and prosthetics).

 

If the orthotic measurements and fittings are done by a more experienced and trained rehabilitation professional, the outcome is usually better. Also, in my experience, the level of skill and knowledge of orthotics manufacturers vary widely. This too will greatly affect the outcome for both fit and function.

A custom medical device usually does require acclimation and adjustment for both the dog and the caregiver who must learn to don the device correctly. But once the fit and function is good, the patients do really well!

 

Here are some more considerations written by OrthoPets for individuals thinking about a stifle orthotic solution as an alternative to surgery for the dog.

Is a stifle orthosis the right solution for you and your dog?

Injury to the cranial cruciate ligament (CCL, also called the ACL) is the most common orthopedic injury in the dog. This injury is due to a partial or complete tear of a ligament inside the stifle (knee). The resulting instability leads to pain and arthritis.

Stabilization is recommended for best short and long-term function, quality of life, and comfort. Stabilization is traditionally done surgically, either with a joint realignment surgery (TPLO or TTA) or with a pseudo-ligament surgically placed outside the joint (tight rope or lateral suture). These procedures are considered the standard of care, in general. In the past 10 years, the use of custom orthosis (brace) has become available as an alternative to surgery when surgery is not appropriate for any reason. These reasons may include other health issues, unacceptable surgical or anesthesia risk, advanced age, and financial constraints, among others.

Because an orthosis is not the correct therapy for all patients, before choosing an orthosis the following points are important to keep in mind:

  1. The device MUST be put on every morning and removed every night. The device is to be used all day everyday, but must be removed at night. It is NOT like a human knee brace, worn only for sport. The orthosis stabilizes the stifle from the outside only when ON, while surgery does so from the inside permanently. Because of this, it must be used whenever your dog will be standing and/or moving about. The device is not used at night and your dog must not be allowed to move about at night (jump on or off bed, wander the house, go outside through a dog door, etc.).
  1. Adjustments are expected and are a normal part of the custom orthosis process. The device is custom-made for your dog. Every effort is made to accurately fit the device and 2 complimentary adjustments are included in order to meet the requirements for an appropriate fit. Your veterinarian will coordinate these adjustments. Importantly, your dog is much more active at home than at the veterinary clinic. Increased activity and activity intensity can expose fit issues requiring further adjustment. Additional adjustments, if needed, are most commonly required in the first few months and as time goes on (see importance of follow-up #4). Please follow all instructions with regard to monitoring the leg and contact your rehabilitation veterinarian promptly if you have concerns.
  1. Follow-up is critical to success. An orthosis is considered a “durable medical device.” This means that proper use is necessary to meet therapeutic goals and to ensure its safe application over the lifetime of your dog. During the first few months of fitting, your rehabilitation veterinary team with the help of your OrthoPets-trained veterinary case manager will work with you, coaching with regard to device use and rehabilitation. Annual to twice annual appointments are advised depending on age and activity of your dog. At these appointments your doctor will thoroughly assess your dog’s orthopedic condition and evaluate the condition and fit of the device. Recommendations will be made for continued success in the device. If adjustments are required, it will be necessary to ship the device to OrthoPets with a turnaround time of 1-3 business days excluding shipping time.
  1. Even with an orthosis, surgery may be required. When the cranial cruciate ligament is torn sometimes the meniscus is also torn. The meniscus is a comma shaped cushion on the inside of the stifle. There are two, one on the middle and one on the outer side of the stifle. The middle or medial meniscus is most commonly injured, and this may occur at the time of the initial cranial cruciate injury or any time later due to too much activity on an unstable joint. A torn meniscus is very painful and if not treated it will cause continued lameness despite stabilizing the joint with surgery or an orthosis. If this occurs, a surgical procedure called a partial medial meniscectomy is required.  It can be done by itself or with a surgical stabilization (see first paragraph). A torn medial meniscus is diagnosed either at surgery, by MRI (rarely), ultrasound where available, or based on clinical judgment with or without use of an orthosis. If your veterinarian suspects a meniscus tear please see our handout on options available for your dog.
  1. The Role of Rehabilitation: Whether your dog undergoes surgical or orthosis stabilization for a torn cranial cruciate ligament, and whether or not surgery is required for a torn medial meniscus, it will take time to recover to full, comfortable function. If an orthosis is part of therapy most dogs adapt quickly to wearing an orthosis. Behavioral techniques can facilitate this. Also, your dog will need to learn basic skills while wearing the device. These include: transitions (sitting, lying down, and getting up), stairs, getting into vehicles safely, and managing on different types of surfaces (ground, carpet, hardwood floor, etc.). Finally, orthopedic injury leads to compensatory abnormal movement and associated muscle strain and weakness. The best way to ensure the highest level of success is to follow recommended rehabilitation schedule and techniques. Each patient’s condition and abilities are unique and, as such, an individualized rehabilitation program is needed. It is important to work with a certified canine rehabilitation therapist (CCRT) who will custom design your dog’s physical therapy program.

Orthotics (braces) for dogs is a new solution to an old problem. Modern medicine moves forward at a rapid pace. It takes a lot of time and many tens of thousands of dollars to perform a controlled clinical trial to compare a new therapy to the standard therapies in common use. As such, there is limited published data directly comparing use of a stifle orthosis to surgical stabilization for CCL injury in the dog. As the industry leader using our unique, anatomically aligned, and mechanically sound custom design, OrthoPets provides stifle orthoses for nearly 1,000 dogs per year. This level of experience allows us to carefully select the patients best suited for a stifle orthosis, design appropriate rehabilitation protocols for best success, and troubleshoot interesting individual patient challenges. This is not a substitute for clinical data, but is referred to as empirical (or experiential) data. This is the current state of orthotics for animals. OrthoPets continues to work closely with university professionals at Colorado State University College of Veterinary Medicine to develop studies to prove and improve the use of orthotic devices in animals.

If your dog tears a cruciate ligament, will you consider a brace rather than surgery as a first treatment?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available athttp://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

A Spot Speaks Blog Share: Cruciate Ligament Disease: A Comparison of Surgical and Nonsurgical Treatment Outcomes

Please read the following blog by Dr. Nancy Kay of Spot Speaks! You can read all of her blogs at: www.speakingforspot.com

Cruciate Ligament Disease: A Comparison of Surgical and Nonsurgical Treatment Outcomes

SFSBlog_cruciateligamentI was intrigued by the results of a recently published study in which the researchers focused on cranial cruciate ligament disease (CCLD) in dogs. Specifically, they evaluated owner satisfaction with outcomes of two very different treatment options, one involving surgery and the other using a custom fitted brace (orthosis).

An all too common injury

The cranial cruciate ligament is vital for maintaining stability within the knee joint (stifle). Tearing of this ligament is ridiculously common, particularly in medium and large sized dogs.

In most cases, the tear occurs abruptly, often in association with exercise or activity. It results in a sudden onset of lameness with the dog often unwilling to bear any weight on the affected leg. More and more, we are learning that neutering before one year of age predisposes to cruciate ligament disease, at least in some breeds. This association has been clearly documented inLabradors, Golden Retrievers, Vizslas, and German Shepherds.

Traditional treatment recommendations

As far back as I can remember, surgical repair has been the primary recommendation veterinarians make for treatment of CCLD in medium and large sized dogs.

The recommendation for nonsurgical management (restricted activity, a knee brace, anti-inflammatory drugs, pain medications, the tincture of time) is usually reserved for smaller dogs with the thinking that, the lighter the load carried by the knee, the less there is a need to restore “perfect” function. For medium and larger sized dogs nonsurgical management is typically the “go to” when there are extenuating circumstances such as financial constraints, anesthesia risks, advanced age, concurrent diseases, opposition to surgery, or an inability to successfully manage post-operative care. And, these extenuating circumstances commonly arise.

Study design

The researchers distributed online surveys to people whose dogs were treated for CCLD. The questions were developed to evaluate their overall satisfaction with treatment outcomes. All the dogs were medium to large sized dogs and all were treated via one of the following two methods:

  1. Surgical treatment with tibial plateau leveling osteotomy (TPLO) procedure

Of the many types of surgeries used to repair torn cruciate ligaments, the TPLO has long been regarded as a gold standard. This surgery has an excellent track record for restoring normal function and minimizing development of arthritic changes within the knee.

TPLO surgery is performed almost exclusively by veterinarians who specialize in surgery. The operation is quite pricey, particularly for dogs who end up tearing ligaments in both knees (happens approximately 50% of the time). TPLO post-operative care is laborious involving a lengthy period of confinement and controlled activity for the dog. (I know this to be true from much personal experience!) The TPLO complication rate is reported to be less than 7%, and most of the complications resolve with appropriate treatment.

  1. Nonsurgical treatment with a custom made knee joint orthosis (brace)

With the recent rise in access to canine rehabilitation therapy (the equivalent of physical therapy in the world of human medicine), the use of custom fit orthoses (braces) to treat dogs with CCLD has grown in popularity.

Study results

Of the 1,022 surveys distributed, 309 were completed- 203 from the orthosis group and 76 from the TPLO group. There were no significant differences between body weight, size, and age of dogs between the two groups.

Factors influencing treatment decisions

The factors that most influenced the decision to treat with an orthosis rather than surgery were cost, convenience, and personal preference. Amongst the TPLO respondents, veterinarian recommendation was stated to be the most influential factor.

Treatment outcomes

The proportion of respondents who reported that their dog’s treatment outcome was excellent, very good, or good was higher (98%) within the TPLO group compared to the orthosis group (86%). The percentage of respondents who reported that their dogs had either mild or no lameness following treatment was also higher in the TPLO group (98%) than in the orthosis group (88%).

Complications

Forty-six percent of respondents in the orthosis group reported that medical attention was required for skin problems caused by the brace. The need for multiple orthosis adjustments was commonly reported. By comparison, only 4% of respondents from the TPLO group reported complications requiring medical attention.

Customer satisfaction

Overall satisfaction ratings were pretty much identical with 85-90% of respondents from bothgroups reporting that, given the chance, they would choose the same treatment again.

Conclusions

Plenty of prior studies have evaluated CCLD surgical outcomes. This study is one of the first providing well-researched data pertaining to a nonsurgical treatment option.

The results are thought provoking for me on a few different levels:

  • I was surprised that, despite the fact that reports of a normal gait (no lameness) and ratings of outcomes were significantly lower in the orthosis treated group, these respondents reported a high level of satisfaction and willingness to make the same choice all over again.
  • I was surprised that, in spite of the very high complication rate associated with orthosis treatment (46%), respondents reported a high level of satisfaction with this treatment plan and a willingness to make the same choice again.
  • Prior to reading this study, I would have assumed that nonsurgical treatment for CCLD would have resulted in lower customer satisfaction. I would have been wrong. My notion is that the high level of satisfaction within the orthosis group was related to good communication between veterinarians and clients about realistic expectations.

So, how is all of this information relevant to dog lovers and the veterinarians who advise them? It makes a strong case for veterinarians spending time in the exam room discussing all CCLD treatment options with their clients rather than focusing solely on surgery.

Despite the sentiment that surgery is the best treatment choice for CCLD, in many cases, this option simply isn’t feasible. Kudos to the researchers involved in this study for choosing to evaluate a nonsurgical alternative.

Has your dog ever torn a cruciate ligament? If so, what did you opt to do and what was the outcome?

Best wishes,

Nancy Kay, DVM

Diplomate, American College of Veterinary Internal Medicine
Author of Speaking for Spot: Be the Advocate Your Dog Needs to Live a Happy, Healthy, Longer Life
Author of Your Dog’s Best Health: A Dozen Reasonable Things to Expect From Your Vet
Recipient, Leo K. Bustad Companion Animal Veterinarian of the Year Award
Recipient, American Animal Hospital Association Animal Welfare and Humane Ethics Award
Recipient, Dog Writers Association of America Award for Best Blog
Recipient, Eukanuba Canine Health Award
Recipient, AKC Club Publication Excellence Award
Become a Fan of Speaking for Spot on Facebook

Please visit http://www.speakingforspot.com to read excerpts from Speaking for Spot and Your Dog’s Best Health.   There you will also find “Advocacy Aids”- helpful health forms you can download and use for your own dog, and a collection of published articles on advocating for your pet’s health. Speaking for Spot and Your Dog’s Best Health are available athttp://www.speakingforspot.com, Amazon.com, local bookstores, and your favorite online book seller.

July 2016 Email News from the Canine Rehabilitation Institute

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In Our July 2016 Issue …unnamed-1.jpg

  • Register Now for Fall / Winter and January Classes!
  • Save the Dates for Our 2017 Classes!
  • Interested in Our Continuing Ed Classes? Contact Us!
  • Register Now for Canine Sports Medicine in Germany!
  • Our Introduction Course in Australia Is Almost Sold Out!
  • We’re Headed Back to the UK in 2017.
  • CRI Students: Remember to Back Up Your Files … and more!

read more…

Patient Feature: McKayla

Meet McKayla, a 9 year old Pit Bull cross who works as a therapy dog. McKayla initially came to OrthoPets with a history of degenerative osteoarthritis, torn cranial cruciate ligaments, and possibly torn menisci in both knees. McKayla’s owner Angie wanted to explore non-surgical options for McKayla, and McKayla was so painful that Angie was even experimenting with using a wheelchair to support McKayla’s mobility when she found OrthoPets. Her stated goal for McKayla’s orthoses was for McKayla to “be a dog again.” 

read more…

June 2016 Email News from the Canine Rehabilitation Institute

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Robbie the “Robo-Dog” wearing his first boot. Read more below.

 In Our June 2016 Issue

  • Register Now for Our August Veterinary Orthotics and Prosthetics Class!
  • Coming in October … Aquatic Therapy and The Business of Canine Rehabilitation
  • Our 2016 Courses Are Filling Up! Register Now!
  • Register Now for Canine Sports Medicine in Germany!
  • Registration Is Open for Our Introduction to Canine Rehabilitation Course in Australia!
  • We’re Headed Back to the UK in 2017
  • CRI Students: Remember to Back Up Your Files … and more!

read more…

May 2016 Email Newsletter from the Canine Rehabilitation Institute

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 In Our May 2016 Issue …

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  • Join Us in August for Orthotics and Prosthetics!
  • Coming in October … Aquatic Therapy and The Business of Canine Rehabilitation
  • Registration Is Open for November and December Classes in Florida!
  • Fear of Heights? You May Want to Skip This Story!
  • Register Now for Canine Sports Medicine in Germany! We’re Excited to Return to Australia in October!
  • We’re Headed Back to the UK in 2017 … and more!

read more…

Parker

Parker

Since retirement, our family now consists of Charlie and Parker and the two of us. Charlie and Parker are Golden Retrievers and we will be talking about Parker primarily with a little bit about Charlie thrown in. Parker is 12 years old and Charlie is eleven. The two of them are best buddies. Last summer they spent glorious days at our daughter and son-in-law’s home on Lake Kellogg. It’s their idea of Heaven no doubt about it. Wonderful swimming, boat rides and running with abandon! But summer ended and their activity level decreased. A little later we noticed a distinct limp affecting Parker’s left front leg. The first thing we did was take her to our Vet. To start, he had x-rays done and gave us a script for medication that would keep her comfortable. That was the first of multiple trips to the vet. She was not responding to any approach that we tried. We literally said “stop” when the medication she was on had her sleeping all the time. Her discomfort level was all too obviously, at an all time high. Charlie sensed this also when she refused to play and have little to do with him. She was miserable and it was so obvious that she found getting around and putting her weight on that leg a real trial. The vet., in frustration because he tried everything, re x-rayed her. This time there was a huge arthritic deformity in the elbow joint. We had a choice. Stronger medication or surgery. We did not make a decision at that moment. When we got home I went to the Internet. I started with a link to find a splint for that elbow. The Company that I tried was nice enough to say that they didn’t make splints for the canine elbow. They referred us to OrthoPets for evaluation for a brace. It was the best advice we got for Parker. I contacted OrthPets for information after viewing their web site and talked to LiLen who became our case manager. She led us through the project step by concise step. Perfect information and she was very up front about the cost of our project and what was expected from us in order to get the brace done. She was so professional and kind to two people starting out with a completely foreign subject and nothing more than our love for our dogs. LiLen has always been available to us with answers to questions through the whole process, and right up to to-day. We took all the information talked about it and decided to give it a go! Now great care was given by LiLen as to instructions for the procedure. First an assessment of Parker had to be done and this was accomplished through close up photographs of the leg in different positions and instructions given on how they were to be taken. Their assessment of Parker was done with the photographs and documentation from our vet and we live about 2000 miles from Denver. Their assessment and conclusion was 100% accurate! Measurements of the affected limb were done by our vet (who by now was so enthused and interested in our project) When OrthoPets received the information, they sent the casting kit directly to our vet. He in turn called us and set up a time to cast the leg. LiLen told us the amount of time it would take to make the brace and it was right on time. They sent it directly to the vet. for proper application and any possible adjustments he would recommend by OrthoPets. It was perfect!.Parker accepted the brace immediately and had no problem trying it out by walking on it. She has not chewed on it or shown any signs of discomfort. Parker will come immediately when she’s called in the morning to have it applied. She even lets her Groomer apply it without fuss.She has mastered the stairs and the grounds of our home with ease. As time went on, she progressed in her abilities. Charlie has his play partner back, which he is so happy about.

The brace, coupled with appropriate arthritic pain medication, has given Parker a new lease on life. She’s a happy, happy camper!

Let me tell you just a little more about Parker. Aside from the surgery she had when she was spayed, she later underwent surgery for a malignant Mast Cell tumor on her chest. It was done at Michigan State University. She survived! Surgery for a torn ACL (Parker loves to run) She survived!

Later she had surgery for a torn ACL in the other leg. at Michigan Veterinary Hospital. She survived!

Later she developed a lump on her shoulder. After it was biopsied, surgery was performed to remove it. It was malignant. She survived! Parker is a survivor with all the love and class of a lady! She is a wonderful, loving, warm part of our family and Community. Everyone knows Parker.

We thank OrthoPets for providing the ability for her to enjoy her Senior years while she plays and lives almost like a puppy again.

If Charlie ever has the same problems, we will be on the telephone to OrthoPets in a heart beat.

Thank you one and all——especially LiLen.
Sincerely
Judith and Les Harding
Parker and Charlie
May 7th, 2014

Jack the Border Collie

Meet Jack an 11 year old Border Collie who just was fitted with his stifle orthosis at our partner clinic, Pawsitive Steps Rehabilitation & Therapy for Pets. Over the next few months Jack will be participating in their rehab program so that he can learn how to use his orthosis correctly as well as work on specific exercises to strengthen him while he is recovering from his Crucuiate tear. Our partner clinic does a phenomenal job rehabbing their patients in all of our orthotic and prosthetic devices. If you are near Rochester Hills MI you should check them out!jack