North Kent Canine Hydrotherapy

04/11/2024

Degenerative myelopathy (DM)

Also known as Chronic Degenerative Radiculmyelopathy (CDRM) is a disease that affects the spinal cord resulting in a slow progressive hind limb weakness and paralysis.
DM is a genetic abnormality, it's an inherited neurological disease that generally affects dogs 8 years and older.
DM causes gradual muscle wastage and incoordination of the hind limbs which progresses to paralysis of the hind limbs. The muscle wastage can also extend to the forelimbs as the disease progresses.

Certain breeds of dogs are more predisposed to DM such as German shepherds, Boxers, Pembroke Welsh corgis and Bernese mountain dogs.

Clinical signs of DM
- Difficulty rising
- Hind limb weakness
- Incoordination
- Muscle atrophy (wastage)
- Scuffed hind limb nails

They're are no specific tests to reveal DM but you can have neurology exams, MRI, CT scans, blood work and spinal fluid analysis to rule anything else out.
Genetic testing can reveal if the dog has one or two copies of the variants associated with the development of DM.

Treatment
Unfortunately there's no cure for DM and it's about managing the condition such as

- Physical therapy to help slow clinical progression and help maintain muscle mass
- Maintain a healthy weight
- Using rugs, non slip mats on slippery floors at home
- Adding pet ramps and steps where required
- Wearing booties to decrease damage to paws
- Using a sling and harness to assist with support and walking
- Considering the use of a wheelchair
- Addressing factors such as arthritis that can contribute to mobility issues

Degenerative myelopathy isn't curable. DM in most breeds are caused by a mutation of the gene SOD1 (SOD1A Variant).
Dogs with two copies are at a higher risk of developing the disease but it doesn't mean they will. A dog that's a carrier (possessing one copy of the gene) may still have a risk of developing DM but the progression is slower that those with two copies of the gene.


Photo Animal ortho care

01/11/2024

Fireworks

So it's that time of year again and it's coming close to bonfire night. Some fireworks could be happening this weekend or potentially even next weekend.
Some tips to be prepared and keep your pets safe
- keep all pets safe and secure inside your home.
- give them a den or somewhere they can hide that feels safe if they need to
- use a radio or TV to try and mask the noises
- make sure microchip is correct and id tags are also
- stay with them or have someone sit with them if you need to go out
- have toys ready to distract them like kongs/licki mats etc
- walk your dog just before it's dark so they won't need a toilet break until after fireworks have finished
- have curtains and blinds drawn so it keeps all the flashes etc from being seen
- try not to over fuss them. If they come to you talk to them normally to settle them. Over fussing can reinforce the fearful behaviour. Continue your normal evening routine such as watching TV and don't react to any noises and bangs.

29/10/2024

29/10/2024

Obesity management

Although this isn't necessarily a condition we do see these cases in hydrotherapy. Sometimes it's simple - a dog has not been able to exercise due to injury and they have put on extra weight, a previous undiagnosed condition or simply over feeding. Whatever the reason is getting your dog on a balanced diet and exercise plan is the best solution. Exercise can now be limited due to putting extra strain on the joints so this may need to be built up. This is where hydrotherapy can come in its low impact on the joints and better still the joints are cushioned with the water properties. Due to the natural resistance of water they work harder than on land but all whilst supporting the joints. The resistance will aid in the build up and toning of the muscles.
Due to its low impact, the underwater treadmill provides buoyancy which is gentle and supports joints and muscles which is exceptionally important in overweight dogs as these joints are under strain daily. This will make overall exercise more intolerable as they progress in their fitness journey. As they progress the dogs metabolism will improve which will help the overall fat burning process.


Photo pet protect

20/10/2024

Only 11 days until Halloween or Howl-o-ween!
Scroll to the end for a few safety tips ready for the spooky day
🎃🧟‍♀️🧛🏻‍♀️🎃

13/10/2024

Spondylosis

Spondylosis in dogs can also be known as spondylosis deformans. This is a degenerative spinal condition when bone spurs (osteophytes) develop along the vertebrae. This generally affects older dogs but maybe in response to injury. A bony spur may develop in a single spot on the spine or most commonly in multiple bone spurs in several locations. The most common bone spurs are seen in the thoracic (chest) , lumbar (lower back) and lumbosacral (around the hips and pelvis) vertebrate. In some cases the spurs grow so large that they appear to form a complete bridge between vertebrae bones.

What causes spondylosis?

It's a chronic condition that is associated with old age. Research indicates it is a secondary problem related to another degenerative disease of the intervertebral discs.
In a normal spine the vertebrae are joined by ligaments to form a protective column around the spinal column. Between each vertebral bone is an intervertebral disc, these discs act as shock absorbers and cushions. The series of joints that make the spine give flexibility to the spine whilst providing protection.
The Intervertebral discs become damaged or degenerate the joints between them become unstable resulting in abnormal motion.
Spondylosis isn't associated with inflammation, it's generally associated with aging, microtrauma through activity, major trauma and genetic predisposition.
The formation and growth of the spurs is triggered by instability and it appears they grow as large as necessary to reinforce the diseased joint.

Spondylosis is generally more common in large breeds but any middle aged to older dogs can be affected. The degenerative condition will begin to develop by 10 years old. Flat coat retrievers, boxers and German shepherds ate more predisposed.

Symptoms
Most dogs are free of symptoms but because of the bone spurs they restrict movement so the dogs can appear:
- Stiff
-Back pain
- Reluctance or difficulty to rise from a lying position.
- Reluctant to exercise and play
- Difficulty jumping and going up/down stairs
If any symptoms are shown then a veterinary consult would be recommended.

Diagnosis

After a physical examination, x-rays of the spine may be taken. The x-rays can determine the location and severity of bony spurs (osteophytes) and can assess the severity.

Treatment

The goal for spondylosis is pain management and to improve the quality of life.
1. Weight control - maintaining a healthy weight will stop access pressure on the spine
2. Exercise - moderate and controlled exercise is super important to maintain muscle tone and flexibility. Hydrotherapy can be a good option to exercise while supporting the joints.
3. Nutrition - a good well balanced diet to support overall health
4. Anti inflammatories - NSAIDS (Non steroidal anti inflammatory drugs) can help control pain and inflammation
5. Analgesics - these can act on the nervous system to relieve pain (such as gabapentin).

Dogs can still continue to have a good quality of life with this condition when managed with the above. But it will continue through life.



Photo pet medic center

01/10/2024

IVDD Intervertebral disc herniation type 1

This is very common in dachshunds, French bulldogs, Beagles and shih tzus but can be seen on your larger breeds.
Type 1 normally has a sudden onset.
Type l IVDD occurs when jelly like nucleus (imagine the jam coming out of a donut) of the disc extrudes through the fibrous outer layer of the disc and presses on the spinal cord. As time goes on the nucleus degenerates and hardens.
Which then stops its shock absorbing abilities. It can vary from pain to complete paralysis.

IVDD Intervertebral disc herniation type 2
This type of herniation is where the disc bulges out in the spinal cord. This type is progressive and is sometimes painful. The chronic spinal cord compression with this type often causes atrophy of the spinal cord. Most animals present acutely but some can be progressive.

Common signs of IVDD apart from yelping are posture changes such as hunched back with head down. Shivering, panting, unwillingness to move, difficulty going up/downstairs, a drunken gait. In severe cases paralysis on hind limbs, occasionally all 4 limbs affected. These cases tend to have no bladder or faecal control.

Treatment
MRI scans are generally performed to specify the exact area/s that's effected. Conservative management can be a success.
Animals that have lost pain sensation are a surgical emergency and are extremely unlikely to respond to conservative management. Normally to start the animals are crate rested and allowed out for short toilet breaks only. Eventually physiotherapy will begin and progress to hydrotherapy. The dogs natural healing process can repair the damage to the spinal cord depending on severity and results of the MRI. If they're suffering from paralysis then surgery is the best prognosis. The animals are most likely to regain walking function and be pain free.

Surgery depends on what type of IVDD they have but they tend to the nucleus pulposus are removed. The disc material in the spinal cord isn't removed. This is called fenestration and may or may not be done with decompressive surgical technique.
Decompressive surgery is removal of the extruded disc material from the vertebrae canal.

After surgery the animal will stay under the specialists care until ready to go home.

Picture from Django

26/09/2024

Happy national animal therapists day.

Today is National Animal Therapist Day
🐴🐶🫏🐘🐱🐰🐷🐮🦁🐧🦆🫏🦒🐄🐑🐕🐈

A day to celebrate and be thankful for the hard and passionate work of all animal therapists.

Massage therapists, physiotherapists, osteopaths and other specialist complimentary therapists work hard to keep our pets and working animals fit and healthy alongside owners and veterinarians – internationally. 🌍🌎🌏

How are you celebrating today? Tag us in your posts and use

23/09/2024

IVDD (Intervertebral disc disease)
The IVD (Intervertebral disc) is an important part within the spine. The function is to provide stability and absorb shock during jumping, running and minor trauma. The IVD structure comprises of the annulus, nucleus pulposus and vertebral endplates.

The nucleus pulposus is located in the IVD space formed by the annulus and endplates. Its health depends on the nutrients and oxygen coming from the endplates and is the largest avascular structure in the body.
The function of the nucleus pulposus is absorbing shock which is possible due to matrix composition rich in proteoglycans containing sulphate molecules and collagen. The sulphated molecules attached to proteoglycans have a great affinity which they bind to water and keep the nucleus well hydrated. The water disperses during the loading phase of the disc allowing deformation and the absorbing of shock.
The hydration of the nucleus pulposus produces enough pressure to keep the disc well separated.

Degeneration
The first step of IVD disease is the degeneration of the nucleus pulposus. The normal composition is altered and the hydration is lost due to the proteoglycans and collagen changing. In some breeds of dogs especially chondrodystrophoid dogs (short legs and long bodies). Such as Dachshunds, Shih-tzus and Beagles, the process starts a short time after birth. The degeneration or dehydration of the nucleus pulposus may never cause problems. The IVDD can cause more serious problems which will cause herniation. The herniation of the disc occurs due to weakness and rupture of the annulus. The nucleus pulposus escapes and impacts the spinal cord. Sometimes trauma is caused and might have a role in intervertebral disc extrusion.
This includes:
- Acute Non Compressive disc extrusion
- Acute hydrate intervertebral disc extrusion
- IVDD - Intervertebral disc herniation type 1
- IVDD - Intervertebral disc herniation type 2
We will be posting each of these individually look out for Acute Non Compressive disc extrusion this week.

18/09/2024

This is the beautiful Lola who has begun her weight loss journey with us. Her weight at the start was 30.9 kg. She has not only started hydrotherapy with us but has also changed her diet. Keep an eye out for updates on Lola's progress.

12/09/2024

This is lovely Reggie. Reggie has been coming to us for hydrotherapy for nearly a year and a half. He has myelopathy which he has treatment to slow deterioration.

07/09/2024

Patella luxation
What is patella luxation?
The patella is a small bone at the front of the stifle joint (knee cap in humans).
The Patella is positioned between the quadriceps muscle and a tendon that attaches to the shin bone (tibia). Also known as the quadriceps mechanism.
The patella will glide into a groove at the end of the thigh bone (femur) as it's flexed and extended.
Occasionally the patella can slip out of the groove. This is known as Patella luxation. Generally it's the medial aspect of the knee (inside) but can happen laterally (outside).

Why does the patella luxate?
This happens because the Patella doesn't align properly with the underlying groove (trochlea). The result is abnormal tracking or movement so it slips out of the groove.
The cause of abnormal alignment is sometimes complex, involving varying degrees of deformity of the femur (thigh bone) and tibia (shin bone). If the case is very severe the femur can be bowed due to abnormal growth. They can have a bowed leg or knock kneed appearance.
This is common in poodles, Yorkshire terriers, staffs and Labradors. It's normally bi lateral and genetic.
Luxation due to trauma (injury) is uncommon.

What are the signs of Patella luxation?
A skipping action with the hind leg being carried for a few steps. This occurs when the patella slips out of the groove and back in again. If both patellas slip at the same time the dog or cat may struggle to walk and have a crouched action.

A vet will examine your dog and may find some atrophy (muscle wastage) over the quadriceps. Manipulation of the knee joint can detect the level of instability in the patella as it slips in and out of the groove.
The severity is then scored 1-4 with 4 being the most severe.
X-rays will provide more information about the presence of osteoarthritis and how severe it might be.

Treatment
Some dogs with Patella luxation can be managed without surgery. The milder the grade and smaller the dog the better chances of being successful. Hydrotherapy is often beneficial but normal exercise should be restricted. There are 3 types of surgery Quadriceps realignment surgery, trochlea deepening and femoral Ostetomy.

Quadriceps realignment surgery

This surgery involves moving a small piece of bone (tibial tuberosity) at the top of the shin that's attached to the patella and repositioning it so the patella is aligned with the groove. This procedure is called tibial tuberosity transportation. The bone that's transported is then attached with one or two small pins with it without additional support of a figure of 8 wire.
Following this surgery exercise must be restricted for the first few weeks until the bone and soft tissues heal. Keeping them on lead is best to keep them fully restricted. Confinement is recommended and no jumping or stairs. Hydrotherapy will be recommended.

Trochlea groove deepening surgery

This is a surgery that involves removing a wedge of bone or cartilage from the groove, to then deepen the groove and then replacing the block or wedge. This is a recession technique since they recess the surface of the groove and make it deeper. Whilst protecting the surface (cartilage) of the groove.

Femoral Ostetomy surgery
This surgery involves changing the shape of the deformed bone, cutting it and stabilising it in a new position with a plate and screws. This may be all that's needed to stabilise the patella but sometimes a tibial tuberosity transportation is performed.
Exercise needs to be restricted until the cut bone has healed. Lead exercise is recommended to avoid strenuous activity. Jumping and climbing should be avoided. X-rays are performed 6-8 weeks later following surgery to ensure bone is healing with no complications. Exercise can be increased in a controlled manner and hydrotherapy can begin.
Photo PDSA

06/09/2024

This handsome boy is Logan he has been having hydrotherapy with us for 10 months due to having spinal issues. Logan has ANNPE (Acute Non Compressive Nucleus Pulposus Extrusion) in L1-L2 and IVDD (Intervertebral disc disease) L7-S1.
Logan enjoys pieces of broccoli 🥦 after his reps in the underwater treadmill. A very healthy choice.

23/08/2024

Elbow dysplasia
What is elbow dysplasia?
Dysplasia means abnormal development of a tissue or organ. Elbow dysplasia therefore means that there has been abnorminal development of the elbow joint.

Due to the abnormal development of the elbow the consequences are that the 3 bones of the joint (humorous, radius and ulna) do not fit together which leads to abnormally high contact pressure. This will eventually lead to one of a number of different problems. One or more may occur in the same joint and at the same time.
- Fragment medial coronoid process (FCP)
-Osteochondritis dissecans (OCD)
-Ununited anconeal process (UAP)
Any-Medial compartment disease

Elbow dysplasia is more like an umbrella term for a number of different conditions of this joint.
It's much more common in dogs than cats. This condition may need a specialist vet in orthopaedics.

What are the signs of elbow dysplasia?
The symptoms will be the same for any of the above four conditions. Affected dogs may show signs in one or both fore limbs. Stiffness is generally seen as well as reluctance to exercise. Often the paws appear laterally (turned out). Coming downstairs is often very hard for them as they are forward loading and the elbows are sore. The most common age for signs to appear are between 6-10 months but some dogs can present when they're middle aged or even older dogs when they have advanced arthritis.

In most cases orthopedic examination will reveal elbow swelling and pain with a restricted ROM (Range of Motion) as the joint becomes thickened with the arthritis. A small number of dogs elbows are painful but not swollen and the diagnosis in these cases are challenging.
Diagnostic imaging is needed to confirm the diagnosis and x-rays are normally the first point. UAP is normally confirmed by x-rays. The other conditions FCP, OCD and MCD cannot always be distinguished by x-rays. A CT scan can be performed and this is a reliable non-surgical test.
Arthroscopy is a minimally invasive surgery to be performed when indicated.

Surgery isn't always recommended. The underlying problem is abnormal joint and surgery will not reverse the process and make the joint normal. All dogs with elbow dysplasia will develop arthritis to some degree. With or without surgery. This must be taken into consideration when deciding on surgery.
Many dogs can manage well with conservative measures.
1. Careful bodyweight control
2. Controlled exercise, avoiding boisterous activity, such as running, turning at speed, chasing a ball, rough and tumble with other dogs, breaking sharply and jumping down to land on their fores.
3. Hydrotherapy is very beneficial and efficient in working the muscles without overload. Which will help keep them fit and weight controlled
4. Dietary supplements like omega 3 fatty acids, chondroitin and glucosamine. Can relieve some discomfort and stiffness.
Special diets to help weight control may be required.
5. Anti inflammatories might be prescribed as a daily or when needed basis.

Fragmented medial coronoid process (FCP)

Surgery is needed to remove fragments of bone this will lead to a good improvement in the dog at about 60/70% but not all dogs respond to this treatment.
Arthroscopy is recommended rather than open surgery as it's not the best way to inspect the joint and is minimally invasive. Both elbows can be operated under the same anaesthetic.

Because the joints don't fit together properly does mean that arthritis will develop on cases as the dog gets older. If there is a step between the joint surfaces of the radius and ulna then it may be necessary to cut the ulna 'Ulna Osteomy' which will improve the alignment of the bones and minimise the ongoing cartilage wear.

Osteochondritis dissecans (OCD)

In this condition an area of cartilage on the bottom of the humerous 'humeral condyle' does not develop properly and lifts off. This is also associated with abnormal development of bone underneath the affected cartilage.

Removing the flap of cartilage will improve lameness in some cases but like FCP not all cases will improve. The cartilage will not grow back so there will be a gap in the normal joint surface.
Arthritis will develop in most cases. Arthroscopy is recommended to look and remove these fragments this is relatively non-invasive under arthroscopic guidance.

Ununited anconeal process (UAP)

The anconeal process of the ulna is part of the elbow joint . This part of the bone develops from a separate centre of growth to the rest of the ulna the two part join together around 4 months old. Elbow dysplasia can lead to pressure on the anconeal process which stops it joining the rest of the ulna. In most cases this will show up on x-ray.

If the diagnosis is made with a dog under 8 months then UAP can be fixed back with a screw. In these cases the ulna needs to be sectioned to take the abnormal pressure off the anconeal process and allow it to heal.
Arthroscopy is recommended as many dogs with UAP have FCP. In older dogs the UAP rarely joins back to the ulna even with surgery and may need to be removed. In mild cases it's best to leave it in place.

Medial compartment disease (MCD)

In some dogs the abnormal pressure of the joint surface of the other leads to the cartilage being worn away. The underlying bone is then exposed and the joints become very inflamed and arthritic. Several surgical procedures have been developed to help remove the forces of weight bearing away from these areas (proximal dynamic ulnar Osteomy and sliding humeral Osteomy). These are last resort.

13/08/2024

Hip dysplasia
Hip dysplasia is a condition where there's abnormal development of the hip joint. The condition leads to joint laxity (slackening of the soft tissue around the joint). The condition can happen as early as 7 weeks old.
The hip joint is a ball and socket joint which means the two sides of the joint don't fit together properly (incongruent) which leads to abnormal shaping of the joint.
The ball joint will flatten and the socket widens and becomes saucer like. Secondary arthritis will eventually develop (sometimes it develops quickly). Generally both hips are affected.

What causes hip dysplasia?
The condition is generally genetic (multiple genes are involved). Genetics are from either or both parents and therefore the dogs DNA.
However some environmental factors can be involved such as diet and body condition.

What are the signs of hip dysplasia?
The most common sign is limping in the hind limbs. This can be one or bilateral. The dog can appear worse after rest and upon rising. Lame in walks. Reduced tolerance to exercise, and a swaying hind limb gait (wiggly back end). The condition generally presents at 6-12 months of age. Older dogs can present when osteoarthritis becomes deliberating. Some dogs have the condition and show no obvious clinical signs. Young dogs tend to feel pain due to stretching of the joint soft tissues which contain nerve fibres. With older dogs it's due to loss of cartilage in the joint.

Diagnosis
The diagnosis is when clinical signs mentioned above with a combination of clinical examination and x-rays are performed.
These are done under general anaesthesia because when under sedation the vet can detect any laxity in the joint during hip manipulation.

Treatment

This is based on the severity of condition and the clinical signs.
If more mild the non surgical/conservative route can be body weight control, exercise control, antiinflammatory medication, physiotherapy, hydrotherapy and supplements. Other options may need to be discussed of the condition worse but they're are many positive results following this option.

In the more severe cases then surgery is the only option. Each surgery will alter the anatomy of the joint.

Juvenile p***c symphysiodesis (JPS)
This surgery has the best chance of working on dogs under 5 months. The surgery involves prematurely fusing a portion of the growing part of the pelvis this is performed to improve the femoral head (ball) and acetabulum (socket). If successful this alters the hip anatomy and will help to stop the hip trying to luxate. The surgery is relatively straightforward and involves electrical cauterisation of the p***c symphysis (part of the underside of the pelvis). Dogs with severe signs should not have this surgery as they are unlikely to respond to this procedure.

Double or triple pelvic osteotomy ( DPO/TPO)
These surgeries also try to change coverage of the femoral head and socket by making two or three cuts in the bones on the pelvis.
The fragments are then fixed into their new placement using a bone plate and screws which alters the pelvic shape. Again both of these procedures are better in dogs with more mild laxity which is still confirmed with x-rays. Older patients with OA (osteoarthritis) will not where the hip joint is removed and rrespond favourably with this procedure.

Total hip replacement (THR)
This is a techniqueeplaced with a metal ball and plastic cup. This can be performed on Chuihahas to Great Danes thanks to recent developments in the implant technology.
Cats can also have this surgery.
Although the disease can be in both joints sometimes only the procedure will need to be done in one joint to significantly improve their quality of life. Others will need both operated on. The THR success rate is 90% and most patients are comfortable within a few days of surgery.

Femoral head and neck incision (FHNE)
This procedure involves removing the hip joint and a false hip joint will develop from scar tissue. Where a THR is not a viable option due to financial constraints or individual anatomy the FHNE is a good option. Most patients will be left with a limp or gait abnormality but with adequate pain relief can have a good quality of life. Hydrotherapy and physiotherapy can help maximise limb function for the patient.

Hydrotherapy in a controlled manner can really help these patients improve muscle mass and strength to the limb. While supporting the rest of the joint and body as a whole.

06/08/2024

Cruciate ligament disease or injury
Cranial cruciate ligament (CrCL) is the same as an ACL (Anterior Cruciate Ligament) in humans.
CrCL is a band of fibrous tissue that attaches femur (thigh bone) and the tibia (shin) to prevent the tibia from shifting forward.
It also helps to prevent the stifle (knee) joint from rotating or over extending.
When the ACL ruptures in humans it's generally due to an injury from a sport activity sick as football, rugby etc. However Cruciate Ligament Disease in dogs is different rather than the ligament breaking due to excessive trauma like a twist playing football, it's slowly degenerates. In the vast majority of dogs the CrCL ruptures due to long term degeneration. The ligament weakens over time. Although we don't know exactly why this happens genetic factors are important.
Like any genetic factors they can be more common in certain breeds. Which tend to be Labradors, Westies, Rottweilers and Boxers.
The genetic link has been confirmed by assessing family lines. Generally rupturing early on in life.
Other factors are conformation in the dog, obesity, inflammatory conditions and hormonal imbalances can play a role.

So what are the signs that you may see?
Limping - sometimes it is sudden and others it's progressive and intermittent. Dogs can often find it difficult to rise after long periods of sleep or rest. Showing signs of pain which can be seen as nibbling at the area/limb including paws and licking lips.

Once diagnosed by the vet. The steps would be for the way to decide the best procedure depending on the severity and weight of the dog. Along with surgery hydrotherapy is a great way to help recover from the operation (once the vet has cleared them). Physiotherapy and weight management are all good tools to help encourage healing after surgery.

Types of surgery
Tibial Plateau leveling osteotomy (TPLO) - the tibia is cut at the top and the Plateau segment is rotated until the previous slope of the bone is no longer present.
Then plate and screws are used to fix in place.

Tibial tuberosity advancement (TTA) - a cut in the tibia but this time it changes its geometry that will render the CRCL redundant. Again neutralising the femur slipping down tibia.

Bone healing is more efficient than ligament healing. Most dogs will be weight bearing (WB) in 1 - 3 days after surgery so a quicker return to function which is so important especially in the larger breeds.
At Meopham veterinary hospital we recognise how important therapy is for the recovery and offer hydrotherapy and physiotherapy as part of the package with surgery.

Occasionally the vet will also need to perform meniscal surgery. Meniscal is cartilage and are shock absorbers and improve the joints fit. They can occur in 50 to 90% of CrCL cases and rarely isolated injuries but may be more likely in canine athletes due to trauma.