Managing Hind End Weakness in the Geriatric Dog.

Laser therapy can help manage painful elbows that carry much of the body weight in dogs with hind end weakness.
Lasering aching elbows that are caring much of a weaker dog’s body weight.

As a veterinary rehab therapist  I have seen my fair share of hind end weakness in older dogs. This loss of function can be from a variety of causes. A thorough exam is a great place to start to rule out issues such as tick diseases, weakness from anemia or endocrine imbalance, and to localize any areas where pain may play a factor.  Arthritic joints and orthopedic injury can lead to a pet that doesn’t want to move because of pain and discomfort. 

Do We Really Know the Cause of the Weakness?

The hind end weakness that I am referring to is the generalized geriatric hind end weakness that we often see in senior aged dogs. Several of my patients go through a progressive decline in function that is not arthritic in nature but rather a neuromuscular degeneration. We can be quick to call this neurological decline Degenerative Myelopathy (which is a truly terrible disease similar to ALS in people) and set ourselves on a negative course of doom and gloom for the patient. In my rehab career I have seen many dogs with hind end weakness but only a few of them actually had true DM (diagnosed by DNA testing and/or MRI screening). The DM dog’s  journey of decline to complete dependency was fairly quick (months) and very heartbreaking because their bodies gave out well before their spirit did. So let’s just agree that dogs can have many other neurological things happening to their body (age related muscle loss, spondylosis, lumbrosacral disease, degenerative disks to name a few) besides DM to bring them to their weakness issues. Why is this distinction important? In short, TIME. Many of these non-DM related causes have a much slower rate of decline and that makes all of the difference when keeping a dog on their feet. Can we manage this hind end weakness, whatever the cause, and give these dogs a good quality of life? Sure we can!

Needs and Goals: Let’s Be Realistic

The first place to start is with setting realistic goals. In the case of age related progressive hind end weakness, we will never restore full function in our pets. Rehabilitation therapy will slow the process of weakness and decline but won’t change its course.  My rehab goal is to improve quality of life, teach families how to manage a changing pet, and keep my patients on their feet for as long a possible. In the older patient, I usually find that once we begin rehab therapy we are maintaining where they are now in function and may be able to get back some activities such as being able to climb stairs again or getting on the bed without help. If they are currently able to just walk around the block before tiring out, rehab therapy will not get them back to that three mile walk that they used to do a few years ago. Rehab therapy will realistically keep the weakening dog walking that block for as long as possible with the least amount of help and secondary issues. They can still play ball or tussle with their canine buddies, but with some modification to avoid over fatigue and injury.

 I like to have my owners identify some things that their dog used to enjoy doing but  are not able to do any more. These lost activities can be markers for improvement if they return or goals to achieve with therapy. It is also important to find out what actions an owner needs their pet to be able to do (like get in and out of the car, up and down entry stairs) in order for the owners to feel comfortable taking care of their pet at home. There is a delicate balance between the level of care that a person is able to give and the level of care that a disabled pet actually needs. 

Managing Hind End Weakness: The Plan

  1. Manage any source of pain. While the neurological decline leading to weakness may not be a painful process, there is often secondary pain in some of the joints and muscles because of how a pet is moving or compensating. If they use their front legs to push themselves to their feet or to carry most of their weight, maybe the elbows and surrounding muscles are sore. Often times the muscles of the spine are affected by changes in posture, falling over because of instability, or slipping on some surfaces.  Oral medication such as NSAIDs and supplements as well as laser therapy and/or acupuncture are great resources for pain control. Massage or a warm compress on aching muscles can bring relief and comfort as well. Let’s not forget home care devices such as the Assisi Loop for portable pain control.
  2. KEEP THEM LEAN!! These dogs are having a hard time lifting their body mass and staying on their feet. Carrying excess weight will make the loss of strength and mobility even worse and eventually shorten the amount of time that they have with you. 
  3. Consistent home exercise. Shorter walks twice daily are a great way to keep a dog moving and grooving. Mix it up with changing terrain by walking on grass, pavement, sand, and other surfaces to increase the feedback your pet gets from their feet to their brain. Challenge stability by adding in wide circles or figure 8s to a walk. Encourage pets to step over things like tree branches to lift their feet. Walking on a low unstable surface such as an air mattress can help to strengthen core muscles and promote body awareness for stability.  Avoid the long hikes or play activity that may cause over fatigue that takes days to recover from. 
  4. Acupuncture. I like to think that this modality is great for helping what does work to work a little better. Acupuncture will help to strengthen the nerve-muscle connection and is our go-to therapy when there are incontinence issues along with the hind end weakness. With acupuncture there is an increased circulation to problematic areas, nerve and muscle stimulation, and usually a general sense of well being for the patient. 
  5. Formal Rehabilitation Therapy. Adding in aqua therapy and targeted exercises can work to strengthen muscles and build endurance for home exercises and activities. About half of my rehab session with a patient and their people is spent talking. Each session is therapy for the pet and the owner because watching a pet change can be hard. Use your rehab therapist as a valuable resource to help with solutions for home care needs. We are reassessing needs and goals all of the time and having someone to guide the way can reduce anxiety for both the owner and their pet. 
  6. Environmental Changes. Slick, slippery floors are a huge problem with the hind end weakness pets. They can lose their footing and then not be able to get themselves back up without assistance. Placing throw rugs over slippery surfaces  will help your dog to navigate at home without falling. Block off stairs if the pet can not go up and down them without some issue such as slipping or falling. Ramps to get in the house or car have their place but you need to find the right size and fit that works for your situation. 
  7. Mobility Aids. There are so many products out there when you look online or in stores that picking one for your needs can be a bit overwhelming. My advice is to look at the reviews, see what worked and did not work for that particular item, and think twice before purchasing anything. I have a box full of items that people bought on their own that ended up not working at all. For the larger dogs, I do have one product that I consistently recommend and that is the Help Em Up harness system. You can use it to help a dog get into the car, up the stairs, get onto their feet, and to stabilize them during other day to day activities. This harness system is not for everyone but seems to be helpful to the majority of my families that use it.

We Are Here For You!

It can be a very difficult thing to watch a beloved furry family member age and decline in mobility, among other things. It is important to remember that this journey of age related change is inevitable, but we can make it a whole lot more comfortable for everyone. There is help out there for you and your pets. You just need to take that first step with your veterinary professional to start your journey of management and support.

Successfully Managing IVDD, A Conservative Approach

Inter Vertebral Disk DiseaseAcupuncture for disk disease (IVDD)

There are some dog breeds that seem to be more predisposed to back issues that others. You have the Daschund (poster child for IVDD, right?), Basset Hounds, Corgi and any mix making a long backed/short legged dog. There are also Pugs and French Bulldogs to round out the smaller dog list with Dobermans and German Shepherds having a solid representation for the large breed dogs. Some of their spine issues stem from congenital or developmental defects, but primarily in the veterinary hospital we see dogs with type I or type II disk compression.

 

When a disk (the shock absorber between vertabre) changes to put pressure on the spinal chord, we usually see pain and loss of function in our pets. It can happen gradually over a few days to months or all of a sudden. The pain can be excruciating and dogs can become completely paralyzed and lose control of body functions. When this issue presents itself, it is important to seek out medical intervention as soon as possible for the best outcome.

My Dog May Have IVDD. Now What?

What are my options if I have a dog that suddenly looses the use of their legs or seems to be really stiff and can’t turn their neck? At the very least, an exam by a veterinarian would be a great place to start to localize where they think a disk lesion may be and to rule out other possibilities such as tick diseases.

The next step could be a visit to a neurology specialist to evaluate the symptoms and recommend a treatment plan that may include an MRI +/- surgery. Sometimes this option is not the best one due to the cost of the procedures or a patient’s age. If this is the case, does that mean that an owner should consider euthanasia as a treatment option? That really depends on the pain factor. If we can not effectively manage a dog’s pain and surgery is not an option, euthanasia may be the only way to humanely treat the issue. In particular, cervical lesions can be one of the most painful and difficult IVDD places to manage without surgery in some pets.

I strongly feel that if a pet’s pain can be controlled and the owners are committed to the intense home care needs of their dog, trying the conservative management strategy is definitely worth it. Time and good care can lead to partial or full recovery in some dogs. You just have to be willing to try with an unknown outcome possible. Recovery is not guaranteed but it is possible. Continue…

Canine Rehabilitation Reality Check: Passing on a Few Pearls of Wisdom

So What Have I Learned?

I have spent an exhausting yet rewarding 23 years in the veterinary field as a technician. During the last four years, my time has been devoted to the area of animal rehabilitation therapy (doggie physical therapy but we can’t call it that due to rules and regulations, blah, blah, blah). This has been a rewarding and challenging area of focus with some triumphs and flat out failures. As a perfectionist at heart, the reality of my new field has humbled me with it’s ups and downs and uncertain outcomes. The technician’s rehab experience will be different than that of a veterinarian or human physical therapist. In my rehab case, I went from being a worker bee (carrying out the doctor’s orders) to being a decision maker and treatment planner. The patient’s outcome rested mostly on my shoulders with the rehabilitation plan that I designed. Talk about a whole new level of stress! Upon reflection of theses last few years, I have come to a few conclusions about rehabilitation therapy.

Pearls of Wisdom That I Have Learned

 dog rehabilitation evaluation
1. The classes and text books are only small part of the learning process when trying to develop a rehab program or protocol. The real learning begins when you are on your own and managing your own cases. Reality can be harsh but a great teacher. Make your mistakes, learn from them, move on.

2. There are way more tools and modalities then you will ever need or use in general on a daily basis (this is just a practical truth). Pick the ones that you feel will allow you to achieve the most reliable results in the best amount of time. For me, laser and aqua therapy are my core modalities with land exercises (using Fitpaws equipment) coming in third.

3. Your eyes and hands are the most valuable assessment tool that you have. Place your hands on every patient and learn to trust yourself.

4. Some dogs just don’t get better. Rehab is not guaranteed to always have a positive outcome. There are a variety of reasons that this may be true such as surgical complications, progressing disease process, and/or overall body condition. Except this and find a good solution for their needs.

5. Rehab (specifically the underwater treadmill) can’t fix everything. Sometimes surgery or (gasp) plain old rest is a better solution to the problem. In a few cases such as disk disease, exercise can even make the symptoms worse. Continue…