Hydrotherapy pre-op Cruciate?

RE: Hydrotherapy pre-op Cruciate?

Clive Ansell — Fri, 04 Mar 2016 17:58:19 GMT

I would want to (re)see the dog and establish a diagnosis and treatment plan before being willing to sign (i.e. putting my signature and professional reputation on the line). I would also want to exclude other differentials or complications such as septic arthritis etc (A colleague recent had a case of a Bull mastiff, very painful and unstable stifle, which was admitted for cruciate surgery without any work up or radiographs, which turned out to have a chondrosarcoma in its stifle joint)

I would also consider asking the owner to sign a disclaimer if they refuse or go against what I consider to be best clinical practice, and my advice. I would want to be absolved of any and all responsibility should hydrotherapy turn out not to be a miracle cure. As old Grumpy said, it needs investigation and treatment, not a bath.

RE: Hydrotherapy pre-op Cruciate?

Martin Atkinson — Fri, 04 Mar 2016 12:03:43 GMT

[quote user="Karen Young"]in people - breast stroke movement causes severe pain.) Advice I have had from a physio is no such swimming for cruciates - so would not recommend.[/quote]I know, been there got the tee shirt etc! But dogs don't do breast stoke or even thrash thier legs about doing crawl. I don't see how doggy paddle could cause an issue and the use of muscle groups, cardiovascular work out and potential weight control could be very beneficial.

RE: Hydrotherapy pre-op Cruciate?

Hannah Wynne Richards — Fri, 04 Mar 2016 11:56:14 GMT

The 1st thing is to work out why she is refusing to have an operation done. It may be financial, or it could be a genuine fear of operations.

The trouble is that after this delay, an operation is unlikely to result in 100% soundness, and, if it isn't then the owner will claim it's worse - and its your fault.

My sympathy. This is one of those cases where owners are put in the world to hinder veterinary surgeons.

Wynne

RE: Hydrotherapy pre-op Cruciate?

Will McMullan — Fri, 04 Mar 2016 10:38:37 GMT

+2 to Karen

RE: Hydrotherapy pre-op Cruciate?

Catriona MacIntyre — Thu, 03 Mar 2016 23:33:23 GMT

+1 to Karen's comment

RE: Hydrotherapy pre-op Cruciate?

Karen Young — Thu, 03 Mar 2016 22:10:58 GMT

Would be very careful with "hydrotherapy" - treadmill probably do no harm but swimming with cruciate injury certainly not good (as in people - breast stroke movement causes severe pain.) Advice I have had from a physio is no such swimming for cruciates - so would not recommend.

RE: Hydrotherapy pre-op Cruciate?

David Mills — Thu, 03 Mar 2016 17:29:50 GMT

Problem with clients like these is that they are deluded, and self-deluding. I'll bet a healthy wager that she thinks the hydro improves the leg (it won't), and it'll be somehow your fault for not recommending it earlier, instead trying to make money out of her with a TTA. Sadly, the amount she has f'd about buying all sorts of rubbish, she could have probably saved a decent chunk towards the sx. As said, the other cruiciate will go soon enough, hopefully for your sake she'll be at someone else's practice by then.

RE: Hydrotherapy pre-op Cruciate?

Sarah Mark — Thu, 03 Mar 2016 16:43:37 GMT

Thanks everyone. I told her last year to have a TTA and she was all for it until she got home and googled. Since then the dog has had leg braces, herbal tablets and who knows what else from the internet. I did actually say at the time how nice it was to see a 'fresh' cruciate for once, with little DJD on the rads, and a good candidate for a TTA!! Shame that has all be lost now. I've written on the hydrotherapy form that the dog has an unstable stifle, and I need to get at least monthly feedback. There is no way she will have a referral, I was expecting to do the TTA myself, but now, heh, no way. She does know the other leg could go as well but I expect that will be forgotten too.

RE: Hydrotherapy pre-op Cruciate?

Virginia Campbell — Thu, 03 Mar 2016 15:08:41 GMT

What Eamon said!! Make it clear to her and on the notes, that although a TPLO or TTA is probably still the least-worst option for this leg, the good ship Best Outcome sailed 6 months ago and - due to her faffing about- the dog has been left with a chronically crap arthritic stifle. Don't downplay the sorry state of affairs or facilitate her wishful thinking. Definitely offer surgical referral. Oh, and tell her to start planning what to do if and when it blows its other cruciate - which will not be your fault.

RE: Hydrotherapy pre-op Cruciate?

Eamon McAllister — Thu, 03 Mar 2016 13:55:17 GMT

No harm in hydrotherapy. If she changes her mind and wants surgery then I would refer it because I think that it might be too late to significantly improve stifle function. The owner sounds like trouble - without doubt the op should have been done six months ago. I wouldn't want to get the blame for "failed" surgery and find myself in the middle of a sh!tstorm when in reality she is the one at fault and totally responsible for the dogs current predicament. Probably taking advice from Breeder / Google / Man in the Park.

RE: Hydrotherapy pre-op Cruciate?

Lucy Fleming — Thu, 03 Mar 2016 12:30:31 GMT

[quote user="Sarah Mark"]the dog is about 3/5 lame and has a swollen thickened stifle now[/quote]

Sounds like conservative management would not necessarily be inappropriate now (though I'm sure you have discussed that surgery might still lead to a better outcome). I wouldn't necessarily see any harm in hydrotherapy, but I would be wary depending on the experience/ qualifications of staff at your local centre - done inappropriately it could potentially worsen the problem. A 'proper' rehab plan including appropriate analgesia and ongoing monitoring of response to managed exercise is needed really.

We are a bit spoiled/ lucky though as we have recently started working with chartered physiotherapists...

RE: Hydrotherapy pre-op Cruciate?

grumpyoldman — Thu, 03 Mar 2016 09:33:00 GMT

The problem is that the hydrotherapy becomes a substitute they can afford for the surgery they could not or would not afford. Instead of a post op add -on to rehab which is where it should stay.

Dog needs a TPLO if its not too late ,and analgesia ,not a bath.

RE: Hydrotherapy pre-op Cruciate?

Martin Atkinson — Thu, 03 Mar 2016 09:14:44 GMT

I can't see any harm being done, if the owner isn't going to have surgery the dog may at least benefit in maintaining some muscle mass and keep its weight under control. I would however advise her that it is not my preferred method of treatment and I'm not responsible if the dog fails to respond.