Category: Business & Marketing

16 May 2012

The Underwater Treadmill Question

The UWT Question…

 

QUESTION:

I am looking into starting my own rehab practice within a referral/emergency hospital. We are debating on whether the purchase of an UWTM is necessary to have or not. All of the local competitors have them. I figure that you can rehab dogs just as well without one and they are so costly to purchase. Is the cost justified? I think the perception of the non-rehab-certified veterinarians is that you NEED a treadmill to do rehab and if we don’t have one, they may not refer to me. I think it would be great to help the older, overweight, or arthritic dogs and get them moving in the water.  Of course the neuro cases would also benefit.  So, my big question is, ‘Do these machines pay for themselves and how long does that take generally?’  Thanks!

 

 

ANSWER:

Well this really is a big question!  I worked in this field for 10 years before getting an underwater treadmill… and yes, I did get dogs better without it!  However, I do think that the perceptions account for something intangible, which is why, when my business partners and I created The Canine Fitness Centre, we put in an UWTM.  All in all, I think it boils down to – IF you are going to have a physical facility, then the UWTM / pool is a real and perceptual benefit.

 

From a real perspective, when you have a physical facility located within a referral & emergency hospital, you are likely to be referred many of the more difficult cases (neurological cases, post-operative cases, and cases with significant mobility issues).  These cases all benefit from UWTM therapy.  From a perceptual benefit, I’m afraid that referring veterinarians and even the public might think that a clinic that has access to an UWTM is better prepared to treat their animal in need of rehabilitation.

 

The unfortunate thing is that these machines don’t pay for themselves quickly, as not all cases SHOULD go to the UWTM.  I think that many clinics try to make the UWTM pay for itself by putting inappropriate cases into the UWTM!  I think that you need to plan on 5 or more years to pay it off (if you are not treating it like a ‘magic dishwasher!)

 

Now, if you have a small in-house practice or a mobile practice, then an UWT would be overkill.  Small facility or mobile rehabilitation practitioners would do well to niche themselves appropriately – either keeping to in-house referrals, sporting dogs, or geriatric cases for example.

 

Let me know your thoughts at Laurie@fourleg.com.

 

Cheers!

 

Laurie

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22 Jun 2012

To Brace or Not to Brace?

There is always a hot debate on whether or not to brace an ACL-deficient knee or not.  Right up front, I will tell you that I am not a supporter of bracing dogs with cruciate tears – outside of unforeseen circumstances.  Here is what I found in regards to bracing in HUMAN literature.

 

Chew et al (2007) review:

o    Biomechanical studies by Wojtys and coworkers (1996) of ACL-deficient knees have shown decreased anterior tibia translation in braced knees under low loads, which was similar to daily activities. Beynnon and colleagues (2003) had concerns of anteroposterior shear when compressive loads were applied. Significant reduction of anteroposterior laxity was found during non-weight bearing and weight bearing, but not in transition between the two.

o    It has been shown that functional bracing may be effective in controlling anteroposterior translation in ACL-deficient knees under low loading conditions, but it may not be effective under high loading conditions that occur during athletic activities. Subjective improvements in knee stability and function are frequently reported, but objective evidence has yet to prove its effectiveness. The effectiveness of the functional brace in ACL-deficient knees depends heavily on appropriate rehabilitation programs

 

Birmingham et al (2008 Am J Sports Med) was a post-op use study and stated:

o    “We found no significant difference in self-reported disease-specificquality of life, ligament laxity, hop distance, or activitylevel at 1 and 2 years postoperatively in patients who underwentprimary ACL reconstruction and wore a functional knee braceor neoprene sleeve during return to physical activities. Confidenceintervals for group differences were narrow and excluded clinicallyimportant differences. Subgroup findings were minimal and inconsistentamong outcomes. Current evidence does not support the recommendationof using an ACL functional knee brace after ACL reconstruction”

 

Regarding ACL-reconstructed knees:

·         Beynnon et al 2002 found:

Application of a functional brace or neoprene sleeve to the ACL-deficieint limb does not improve the threshold to detection of passive knee motion; however, application of an elastic bandage to a knee with an ACL tear improves joint position sense.

·         Muellner and coworkers (1998) evaluated the effects of functional bracing compared with bandaging after ACL reconstruction and found no differences between the two groups in terms of strength and stability. Free range of motion was achieved significantly earlier in the bandaged group. The sensorimotor performance of the knee after ACL reconstruction has been studied by Wu and coworkers (2001), who found that bracing improved proprioception. The study involved comparison between the functional knee brace, placebo knee brace, and no brace after ACL reconstruction. Similar improvements in proprioception were found in the brace and placebo brace groups, suggesting that the apparent improvement was not attributable to the mechanical restraining action of the functional brace.

·         A 2007 systematic review of Level 1 evidence (Wright & Fetzer) found 12 RCTs. They found no evidence that pain, range of motion, graft stability, or protection from subsequent injury were affected by brace use post-operatively.

 

Back to ACL-deficient knees:

 Theoret & Lamontagne (2006) found:

  • Bracing significantly reduced total range of motion in the frontal and transverse planes (P<0.05). Muscle activity at heel-strike showed a consistent trend to increase for the hamstrings and decrease for the quadriceps under the braced condition when compared to the unbraced condition. Our findings indicate that bracing the ACLD knee alters the kinematics of the injured leg while running. Tendencies toward reductions in quadriceps and increases in hamstrings activity at heel-strike indicate that bracing might have resulted in added stability of the injured knee. The adaptations to bracing found in this preliminary study further support the potential mechanical and proprioceptive contributions of the functional knee brace to protect the ACLD knee.
  • However: Quadriceps weakness has been identified as common problem after ACL injury, and this weakness was persistent in patients with poor functioning knees.(Tagesson et al 2008).  So should we not be concerned about the reduced quadriceps functioning with bracing?

 

 

These finding were contrary to Ramsay et al (2003 Clinical Biomechanics) 

o    RESULTS: With brace, semitendinosus activity significantly decreased 17% prior to footstrike whereas bicep femoris significantly decreased 44% during A2, (P<0.05). Rectus femoris activity significantly increased 21% in A2 (P<0.05). No consistent reductions in anterior translations were evident.

o    What tends to be seen in ACL-D knees (Ciccotti et al 1994) is:

 

Table 1:  EMG Activity in Muscles of ACL-D Knees as Compared to Normal and Reconstructed Knees in Humans

Muscle Activation

Implication

Increase in vastus lateralis  activity at loading

Vastus lateralis resists internal rotation of the tibia

Increase in rectus femoris activity at pre-swing

This may indicate a decrease in knee flexion

Increase in biceps femoris activity at terminal swing

This may be to prevent anterior tibial translation with quadriceps contraction at loading

Increase in tibialis anterior activity at terminal stance

Tibialis anterior creates a dorsiflexion and inversion which also externally rotates the tibia (hence resisting internal rotation forces)

So, if semitendinosis and biceps femoris are decreased (in this study) with bracing, then there is a reduced ability to prevent anterior tibial translation...

  • All and all, we can see that these two studies (Theoret 2006 and Ramsey 2003) are contradictory...and neither of them relate to function.

Regarding mechanical stoppage of anterior translation:

  • Ramsey et al (2001 Clinical Biomechanics) found: “CONCLUSION: In this study, no consistent reductions in anterior tibial translations were observed as a function of the knee brace tested.”
  • So, we can gather from this that SOME braces may mechanically reduce anterior drawer while others do not. 
  • Do we have any idea what the dog stifle braces are doing for certain?

SUBJECTIVE tests:

o    Swirtun et al (2005 Clin J Sports Med) showed:  “RESULTS: When using the brace the subjects in the brace group experienced less (P = 0.047) sense of instability, evaluated with visual analogue scale, than the control group. However, bracing had no effect on any of the variables in Knee Osteoarthritis Outcome Score or Cincinnati knee score and no effect on quadriceps or hamstring muscle peak torque. Subjectively, the brace group experienced a positive effect of the brace on rehabilitation. CONCLUSIONS: Nonoperated acute ACL-deficient patients experienced a positive effect of the brace regarding sense of instability and rehabilitation. However, these findings were not supported by objective outcomes.”

 

But if we go back to the tests comparing functional braces, placebo braces or neoprene braces or bandaging...  then we can gather that simply the contact around the knee assisted with proprioception (awareness of joint position)...not the kind or type of brace or any mechanical properties of said brace.  (www.woundwear.com has a simplistic brace that would do nothing to stop the forces, but is a circumferential brace that goes over the back of the dog and will therefore stay ‘on’ the dog… and might just mimic bandaging or a neoprene sleeve.  Food for thought!)

  • So, maybe we bandage the canine stifles or simply instruct owners on proprioceptive inputting, which could even include petting, brushing and massage, and weight shifting with the therapist/owners hand circumferentially around the stifle – or both.
  • Would we get the same results with dogs and putting on a bandage/brace/etc or would that impact their desire to even use the limb effectively?  How do we measure joint kinaesthesia in dogs?  What are the EMG pattern comparisons in dogs with ACL-reconstruction, ACL-Deficiency, and ACL-D braced stifles? 

 

I have not found literature describing bracing’s ability to do the following:

·         Permit the injured limb to relax

·         Reduce fatigue in the injured limb

·         Provide mechanical protection against impact

·         Slow things down to allow muscles time to react and control 

 

I think we come down to the conclusion of Smith et al 2003 Arch Phys Med Rehabil: 

CONCLUSIONS: Brace use in this population did not consistently result in more favourable muscle firing patterns during the single-leg hop maneuver. Inter-individual responses to brace-use indicate the need for further research to investigate the multiple strategies that may exist to stabilize the ACL-deficient knee. In the meantime, functional knee brace use among ACL-deficient patients remains empirical.

 

These patients require a thorough rehab program, but we don’t tend to recommend bracing. I advocate for neuromuscular rehab instead. Either way, more research needs to be done to make definitive claims.

 

Those are my thoughts anyways!  Let me know what you think!  I’d love to hear what other people are finding to work. 

 

Cheers,

 

Laurie

Laurie@Fourleg.com

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06 Jul 2012

Your Comments - TMJ & Bracing

June TMJ Comments

So funny to mention TMJ for the month of May!

I had a case as well, a cat from Bide-A-Wee rescue group that had it’s jaw wired for a period of time by our dentist, Dr. XXXXX.  As cat’s are not as cooperative as our dog patients, I did gonio measurements pre LLLT (under sedation), daily LLLT and then a post gonio (under sedation) - got 10* improvement in ROM and he seemed much more comfortable and was able to eat dry food 2 days after implant removal and 2 laser treatments :))

Giuliana G. Lerch, LVT,CCRP

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June Bracing Comments

Hi Laurie, 

Great idea, these blogs! I hope you get a lot of feedback, it could be e very effective way to discover how our colleagues work. Science and practice is not always the same.

About the brace-issue for the dog with an ACL-deficient knee:

It would not be my choice to give a dog a brace without neuromuscular rehab. A while ago I got a patient the surgeon wouldn’t operate on, because the dog is too fat and the ACL is not completely through. When I saw the dog (Appenzeller Sennenhond) for the first time, she already had a brace. I began training her in the UWT for stability and muscle strength and now the dog walks completely without a limp. I felt at ease with the brace because of the overweight of the dog, although I know it may be just the idea. This is my first experience however with the combination ACL-deficient knee and brace. 

I hope you get more reactions!

Your book list could have been taken from my bookshelf. I only have 2 books in German to add. Not your favorite language I suppose…

Cheers, 

May Römer-Bartels

dierenfysiotherapeut

Vaartweg 163 A

1217 SP Hilversum

035-6280162

www.dgcromer.nl

fysio@dgcromer.nl

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Hi Laurie,

I find your blog and website an amazing resource and I wanted to thank you for both of them.  I practice animal massage and it is a very small scope that we are allowed to work in here in the states, but I have had a little bit of dealing with acl/ccl injuries.  In two of the cases I’ve worked with both dogs had minor tears with no meniscus damage that could be seen (x-rays are the only form of pre-surgical diagnosis for these two dogs).  Both dogs went through 6 months of Conservative Management with massage, stretching and range of motion exercises along the way.  Both dogs were also labradors, one was 2.5yrs. and male ~70lbs and at a healthy weight, the other was 7yrs. and female ~55lbs and about 10lbs overweight.  Neither dog used a brace during rehab. 

The third dog I worked with I only saw once.  He was 5yrs old and at least 15lbs overweight at 85lbs.  He was huge.  It was a pretty bad tear, probably with some meniscus damage, and one of the owners was against surgery altogether.  I gave them everything I could, rehab places to go to with therapy pools and lasers, and physiotherapists like yourself, but in the end the only thing they did for this dog was what I had showed them and it worked.  I told them to have the dog lose weight (they weren’t measure the food this lab was getting), start slowly very slowly, and I showed them range of motion and stretching exercises.  That was it.  I saw this dog after it had been lame for 5 weeks and still couldn’t put any weight on the affected leg.  The wasting of the muscles in that lame leg was horrible.  I had an update from a sibling of theirs (2 years after I first saw this dog) and this dog has completely healed and has no limping.  They did not do surgery, and unfortunately no rehab beyond what I just described.  They also did not use a brace.    Dogs’ ability to heal amazes me, and this dog must be something special or have a very committed owner. 

Thank you again for all of the information you have put together and I look forward to buying your book.

Take care,

Karen Lashenske

503-805-6027

www.therapeuticanimalmassage.com

Karen@therapeuticanimalmassage.com

Therapeutic Animal Massage Blog

Therapeutic Animal Massage Facebook

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BTW love the brace blog. I even used some of your CrCL protocol to convince a recent client to not drive to CO and get a brace for her 3 year old Boxer with a heart problem! Thanks for that:)

Robby

Robert J Porter III

Certified Canine Rehabilitation Practitioner

Louisiana Veterinary Referral Center

Animal Rehabilitation Center

Mandeville, LA

70448

Main Hospital: 985 626 4862 ext. 208

lavrc.com

twitter.com/LAVRC

facebook.com/LAVRC

youtube.com/user/LAVRC

facebook.com/louisianaCOP

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18 Jul 2012

Staying Motivated & Productivity Management of Self!

Any great accomplishment does not happen overnight!  There is no such thing as an overnight success.  Rome was not built in a day!  Etc. Etc.

Today’s’ topic is all about creating an action plan to achieve something big by taking baby steps!  I have to admit that when confronted with a big project or a big goal, that I have troubles getting started.  I clean my house… I check e-mails neurotically… I do anything to avoid starting on that big project, because it’s just so daunting.

So in order to get started on achieving something ‘big’, here are some ideas on how to get started:

  1. Make a ‘To Do’ list.  But make sure you add some small tasks on there to get you started.
  2. Write out your Big Picture Goal, then break it down into subcategories, and THEN come up with one or two things that you could do TODAY to move forwards towards your goal / project
  3. I want to introduce the concepts of a Productivity Manager.  I learned about this from Brendon Burchard (www.highperformanceacademy.com).  Firstly identify a couple of projects or goals, and then list 1, 2, or 3 things that you could do TODAY towards each project or goal.  Secondly, list out people that you may need to help you and could reach out to today or perhaps people you are waiting on.  Lastly, write out your priorities, your ‘must do’ activities for today (not everything… not your big list… but only the ‘must do’ items).  Get them done…but don’t forget to get a little something done towards your big projects.

Ideas as they relate to your learning / relearning of canine rehab / physio:

  • Take your ipad to the gym to read or watch a video
  • Print off an article and read it the old fashioned way!
  • Try finding a ‘partner’ to learn with or to teach
  • Practice one particular skill all day or each week (i.e. check 3 dogs everyday for a week to practice medial shoulder instability assessments)

Basically this is the key to success of any kind!  Pick your goal; break it down into manageable steps; select one or two things to do each day that will move you towards the goal; do them!   It will work for learning, for building a business, for weight loss, even for cooking dinner! 

Break it down and then systematically attack it!  You can do this! 

Cheers,

Laurie

PS if you have a great ’stay motivated’ strategy, please comment below or send me an e-mail (Laurie@fourleg.com).

 

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01 Oct 2012

The Evolution of Relationship Marketing

Relationship marketing refers to all marketing activities directed toward establishing, developing, and maintaining successful relational exchanges.  Papers that describe and engage in the study of relationship marketing seem to have roots in the early 1990s.  The term relationship marketing encompasses relational contracting, relational marketing, working partnerships, symbiotic marketing, strategic alliances, co-marketing alliances and internal marketing.  Commitment and trust are key variables critical to the success of relationship marketing. 

Morgan & Hunt (1994) successfully validated 13 hypotheses regarding relationship marketing:

·      There is a positive relationship between relationship termination costs and relationship commitment

·      There is a positive relationship between relationship benefits and relationship commitment

·      There is appositive relationship between shared values and relationship commitment

·      There is a positive relationship between shared values and trust

·      There is a positive relationship between communication and trust

·      There is a negative relationship between opportunistic behavior and trust

·      There is a positive relationship between relationship commitment and acquiescence

·      There is a negative relationship between relationship commitment and propensity to leave

·      Thee is a positive relationship between relationship commitment and cooperation

·      There is a positive relationship between trust and relationship commitment

·      There is a positive relationship between trust and cooperation

·      There is a positive relationship between trust and functional conflict

Their paper went further to define that commitment and trust develop when firms attend to relationships by (1) providing resources, opportunities, and benefits that are superior to the offerings of alternative partners; (2) maintaining high standards of corporate values and allying oneself with exchange partners having similar values; (3) communicating valuable information, including expectations, marketing intelligence, and evaluations of the partner’s performance; and (4) avoiding malevolently taking advantage of their exchange partners. 

An expose in Harvard Business Review (1998) challenges businesses to do better at understanding the core values behind relationship marketing: “There’s a balance between giving and getting in a good relationship.  But when companies ask their customers for friendship, loyalty, and respect, too often they don’t give those customers friendship, loyalty, and respect in return.”  The authors challenge that marketers may not understand how customers’ trust and intimacy factor into the connections they are trying to forge.  There are several fundamental rules of friendship.  They include: provide emotional support, respect privacy and preserve confidences, and be tolerant of other friendships.  To value and adhere to these rules can build the intimacy that results in truly rewarding partnerships.

Yet another study set forth to identify a set of relationship marketing activities that were appropriate in managing membership relationships of professional associations in regards to retention, participation, and coproduction (Gruen, Summers, & Acito, 2000).  The largest direct effects were simply from core services performance, which affected both retention and participation.    Membership behaviors in regards to commitment were affected by two management activities: dissemination of organizational knowledge and recognition for contributions.

Marketing has changed extensively over the last couple of decades.  Advertising is no longer effective because of clutter, lack of trust, increase parity among competitors, and the fragmentation of the media (Godin 2006).  Now the best marketing tactic is to create remarkable products that consumers choose to tell stories about, and to deliver anticipated, personal and relevant messages, and treat consumers with respect.  Permission marketing works far better than blindly marketing to strangers.  This would mean that you target your marketing to those that are genuinely interested in your services (i.e. those that have signed up for your newsletter, entered your contest, liked your Facebook page, read your blog posts, or follow you on Twitter, etc.).  How do you embrace this ‘new marketing’?  Godin suggests first building a ‘permission asset’ – creating a group of people that want to hear from you who will invariably spread your word & message and second, invent AUTHENTIC stories that your customers will want to tell themselves and their friends.

Currently, social media is the most visible form of relationship marketing.  If you take Facebook as the example, experts offer the following advice:  Don’t be boring (Facebook will bury your content – and if your readers see it, they will be bored).  The best updates will be helpful, creative and may include something personal or fun tossed in now and then.  They should be relevant, compelling and charming.   When posting online, ask open ended questions to invite discussion, create updates that offer real value as opposed to sales messages, post at different times of the day (and week – don’t forget weekends), and limit your volume to no more than one or two posts a day (Handley 2012).

What are we to conclude from this?

You must build commitment and trust with your consumers, which may be achieved by providing resources, benefits, and valuable information.  The atmosphere created within business should provide and subsequently generate friendship, loyalty, and respect between the provider and the customer.  While core services are essential to client retention, ‘new marketing’ analysis tells us that we should be delivering remarkable products (or services) that our clients will want to talk about and share with their friends, and that if we gain their permission to market to them, that our strategies will be that much more effective.  Social media is one avenue in which businesses can build their relationships with existing and potential consumers. 

So now it’s your turn to share your experiences…

What have you found works for your business in regards to developing a strong relationship with your consumers? 

I’m eager to hear about your experiences, and compile the answers to share with everyone!  So please e-mail me!

Cheers,

Laurie

Laurie@FourLeg.com

 

References

1.     1.Morgan RM & Hunt SD. (1994), The commitment-trust theory of relationship marketing.  J Marketing 58 (3): 20 – 38.

2.     2. Fournier S, Dobscha S, Mick DG. (1998), Preventing the premature death of relationship marketing. Harvard Business Review Jan-Feb: 42 – 51.

3.     3. Gruen TW, Summers JO, Acito F. (2000), Relationship marketing activities, commitment, and membership behaviors in professional associations.  J Marketing 64 (3): 34 – 49.

4.     4. Godin S. (2006), Viewpoint: Seth Godin The New Marketing, in Business The Ultimate Resource.  A & C Black Publishers Ltd, 71 – 72.

5.     5. Handley A. (2012), Getting personal with B2B marketing.  Entrepreneur March: 66 – 67.

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06 Oct 2013

What I learned this week

So, if you have been following my e-blasts and/or Facebook posts, you will be aware that I have spent the last week in Germany and then Austria.  I was shown wonderful hospitality and friendship… and I would not hesitate to return!  I even learned new phrases!!  

But all of that aside, I thought, that I should put my own self to the test to think:  What did I learn from my latest adventures, travels, & teachings… So here are my thoughts  (mind you I have had 1 glass of wine and 2 glasses of "stürmen"… which is not what was written on the bottle, but what I was told in English as a translation of "storm" - basically the fermented fruit juice, just before it becomes wine… sweet, tasty, alcoholic, and VERY drinkable…but not quite wine!  The kind of thing you could drink by the pitcher!!!).  So here is what I learned:

 

  • We all are having similar issues (all over the world):  General practice veterinarians do not understand rehab or when they need to refer or how to work with non-veterinarians or other vets with 'different training' (other than surgeons… because most vets are trained by surgeons when in vet school).  
  • We still need to work together… no ONE practitioner knows it all
  • We need to better educate the surgeons and our (potential) referring general practice vets.
  • We need to get CLINICAL research published… because the researchers in the universities don't perform rehab or adequately understand what needs to be researched that will be clinically relevant.
  • Savvy dog owners want our services and need our services and deserve our services… and we cannot let them down!
  • Adversity and being able to deal with unscheduled changes in plans can oly make you stronger… like missing your buss and having to figure out not only where you have to get to, but how!!
  • I should only be photographed from the shoulders up!

 

So, that's it!  I need to get to bed now… I have a 6:20 am flight to catch!  I really enjoyed meeting everyone over the two courses this week… perhaps another time, I will have to add additional learning learning... about a new hip joint mobilization, new eccentric exercises for supraspinatus and subscapularis and about the coracobrachialis muscle.

 

Until next time... Cheers!

 

Laurie

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01 Dec 2013

Issues International

As you may be aware, I just returned from a whirlwind trip to England. I had 4 different teaching ventures, and got to mingle with physiotherapists, veterinarians, and hydrotherapists.  It was a great trip, but a common theme emerged, that fits in with the dozens of e-mails that I get in a day, and conversations that I have had all over the world with various animal rehab / physio practitioners.  And that is…

 

Acceptance is slow to establish, and veterinarians don't always refer, or don't refer when they should, or don't refer the kinds of cases that they should!

 

The problem is universal!  And it doesn't seem to matter whether you are a veterinarian or a physiotherapist… So here are some of my thoughts on the issue.

 

Why are we all experiencing this?

and

What should we do?

Inter Professional Collaboration is not taught in vet school.  It is drilled into us on the human-side of medicine, however, we have had decades of multiple professionals working in unison for the goal of betterment of the patient.  Now, that is not to say that human medicine is perfect in this regard… not at all… however, we at least know that we are supposed to get along in the sandbox, and that the patient is at the centre of our decision making.  I don't mean this idea to be inflammatory to the veterinarians out there, however I do think that this plays a part in resistance to non-veterinary professionals working in the field, and also factors into inter-veterinarian relationships as well. Why won't the vets down the street refer to your rehab services if it is in the best interest of their patient? Perhaps the time has come to add classes on inter professional collaboration in vet school.  Want to read more on this topic… check out the Free Stuff page on www.FourLeg.com.  I have an article there that a rehab vet and I did as part of a presentation at the Canadian Physiotherapy Association Congress in 2012. 

 

Case Studies and Case Series need to be presented in veterinary journals.  Aren't we all a little sick of hearing "Show me the evidence that this works?"  My reply is always to point out that all of the basic fundamental scientific research that backs up what we do in humans (manual therapy, modalities, and even exercises) can find it's roots in animal research.  However, that doesn't always satisfy the nay-sayers.  My thoughts are that we need CLINICAL research & reports out there.  If you have even done Masters or PhD-level research as a clinician, then you too have felt the frustration of having to dissect your original research idea into a minuscule measurable piece of the original.  What I learned from doing my Master degree was that plenty of scientific research simply does not have a clinical application.  So, I would propose that more of us write up case reports for submission.  While this kind of evidence is low on the empirical research scale / scoring system… it IS the stuff that allows scientific researchers to spring from (i.e. to get them to do research that matters), and it is what clinicians like to read in a scientific journal.  So why not start there???  We should all think about doing this!

 

Balls!  Or rather, the lack thereof is a real threat to the physical therapists engaged in animal rehabilitation.  Physical therapy is a female dominated profession, and we tend to put our families first (sometimes taking years away from professional practice), try to be peace makers (appease the other person / party), and not stand up for ourselves (hoping we'll be noticed, instead of standing up and saying "Here I am, this is what I know and do, I'm bloody brilliant at it, and you need me!").  I'm delighted that there are more men in the PT profession.  It is a highly technical and intellectually demanding profession, and I would find it fascinating to know where the profession would be (or could go) if more men were involved!  If you have a chance, the book Lean In by Facebook CEO Sheryl Sandberg is a great read on this subject!  In having taught both vets and physios for over a decade, I will maintain that it is MUCH easier for the physiotherapist to learn how to apply the physio skills and knowledge to the animal patient, than it is for the veterinarians to learn to practice the profession of physiotherapy in a 2 week course.  I am not saying that they shouldn't try… but it will take more than a 2 week course to learn the application of physiotherapy as a professional skills set (and one reason why my website was created).  So… back to physio-balls (fun play on words there!). The PTs / Physios need to stand up for themselves, and I would hope that the pro-physio vets would help initiate political processes to start allowing PTs / Physios to legitimately practice - as professionals… because, I feel strongly that THAT is how the practice of animal physiotherapy will grow!  I remind everyone involved, that vets did not create this field of practice… the physios did… an for knowledge translation and transference, the physios need to be heavily involved moving into the future.

 

Support for the Technicians.  I do have concerns that our vet techs are not adequately supported in practice.  If the our technicians do not have a vet or PT that can help to direct therapies (especially for complex cases), or help sort out cases that are not quite so straight forward, or offer additional teaching / training / mentoring, or provide advanced level manual therapies, then their successes could suffer.  And that's not a win-win situation.  Now, there are some exceptions to this finding… where a technician has gone on to take multitudes of continuing education to expand upon his/her rehab training basics… but this requires either the technician to self-direct their learning (and often have to pay for it out of their own pockets), or have an employer who is willing to pay for continuing education in rehab-related (or rehab-adjacent) areas.  So I wonder if perhaps a technician would better enjoy working in a practice with other rehab practitioners.  Additionally,  the general practice vets need to have a better understanding of what is rehab, what is appropriate to refer, and why more advanced rehab-specific assessments, direction of therapy, and respect for rehab practice is needed in order for a rehab service to fully succeed. 

 

Ground Swelling.  I believe that the general pubic will be our greatest ally in moving us forward - politically, clinically, and from a business perspective.  So, to that end, it is to the public that we have to market.  I don't mean taking out advertisements,  I mean provision of information.  Blog posts, replies on dog-owner chat groups, magazine articles, newspaper articles, lectures, courses… etc.  Educate the public and they will start to demand the services that we offer!  Looking for more marketing ideas?  Check out my e-book:  The Marketing Manifesto for Canine Rehab Practice e-Workbook.  It's available for purchase on FourLeg.com as well… because I think we all need more education in professional marketing!

 

So now it's your turn!  Give me feedback on this blog post.  Tell me your thoughts on the subject.  Pass along your tips.  Lets grow this thing together!

 

Cheers to your success!

 

Laurie

 

Laurie@FourLeg.com

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08 Dec 2013

Responses to the 'Issues International' Blog

Following are the responses I received regarding the last blog post.  I include them because I think it's interesting and important to open discussions and provide unique thoughts and perspectives.  That is my intention in passing them along...

 

One PT wrote:

Hey Laurie,

I just had to tell you you’re blog on Physio’s needing balls cracked me up! Only you could get away with that…you are too funny.

 

One Vet wrote:

Yes, yes, and yes, Laurie. Agreed with all of your blog! Certainly wish I had a little more testosterone at times, but my motto currently is " I don't care how long or what it takes, I am not going away." I am certain rehab will become the standard of care soon!

 

A Physio wrote:

Word of mouth in the "general pubic" still the best...walk the talk then the population will KNOW and seek this type of help...it is true though that it seems that canine chiros may have the marketing advantage yet again!  They are walking billboards most of them! LOL

 

And another vet wrote:

At the risk of sounding unflattering to my colleagues, “It’s not you, it’s us.”  Here is my fully biased, unproven opinion:

  • First off, I heard about the ACVSMR’s recent policy statement about only wanting to recognize vets for rehab.  I am embarrassed on behalf of their short-sightedness and inflated sense of self worth.
  • Vets don’t like hearing that other professionals are on par with them when it comes to animal related knowledge; we’ve owned the kingdom for too long and are very protective of it - above all other considerations - just like chiro’s and their thoughts on whether anyone else should ever be allowed to do adjustments.
  • To that end, I think vets would feel less threatened if physio’s presented themselves more like technicians, someone less threatening, under veterinary command, doing useful things that vets don’t want to be doing anyway.  I say that knowing how demeaning such a stance would be for a qualified professional to take, and don’t know if I could do it myself (my ego isn’t down with shit like that), but it might be the way to get your foot in the door.  Once reasonable vets see the results, and see you making clients happy over a problem they couldn’t solve themselves, but they still get the credit anyway for referring the client to the right person, I would think things would snowball from there.
  • “Reasonable vets” aren’t as easy to find as you might think.  I suspect this will get better when it becomes a more female dominated profession.
  • Show the vet you can make them money without them lifting a finger.  This would only work for physio’s working out of a vet hosp, not as a separate entity.  I think separate facilities face a steeper uphill battle getting vets on board (go back to the spiel on “feeling threatened”).
  • Papers need to get published and then talked about at conferences.  Not just abstract concepts, but practise-ready papers that show how applied physio techniques produce measurable improvement in dogs.  If people lecturing at conventions can say that evidence based medicine shows rehab works, then minds will start to change.  This would be especially useful if techniques that regular vets don’t know how to do, or don’t have time for, are proven to work.  Then they can delegate accordingly (go back to paragraph on acting like a technician and not the qualified professionals that you are in order to cow-tow to some pretentious buffoon that should have retired years ago).  Similarly, it needs to be talked about in practise management lectures so that vets learn they can make money from it.
  • Separate yourselves from the "woo-woo cum-bai-ya" crowd (I'm talking to you, flakey chiros, and homeopaths), by talking science to the western mentality vets, and emphasize holistic health when talking to the "new age" clinics.

Hope that helps. 

So these are all of the responses that came back in!  Food for thought!

Cheers,

 

Laurie

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15 Dec 2013

Clarifications on 'Issues International' Blog

Hi Everyone,

 

Well, my blog post on Issues International, certainly did stir up some controversy and commentary.  I must say that all of the commentary that came back to me was supportive or constructive regarding my original post, however I did receive two e-mails this week that asked for clarification on some points.  So instead of posting a few more responses to the blog, I thought I would publicly clarify some of my comments in the original blog.

 

The commentary about lack of inter professional collaboration education in veterinary medicine is a truth.  For an expanded view on that subject, see the full paper (presented at the 2012 Canadian Physiotherapy Congress, available at: http://www.fourleg.com/media/LEH&SB_IPC_written_document.pdf).  As was pointed out, in one of the two letters asking for clarification this week, PT's are not taught to consult or collaborate with veterinarians - especially as it may pertain to communicable diseases and public health matters.  This is very true.  The One Health initiative has been a veterinary industry-led charge and PT's can educate themselves on this concept at www.onehealthinitiative.com.  MY purpose to pointing out lack of formal inter (or intra) professional collaboration education in veterinary medicine as a factor to why vets may not refer to non vets (or other vets or techs with rehab training), was to elucidate a potential difference in mindset of the non-rehab-trained veterinarians.  The rehab vets have already had exposure to PT's and their knowledge base.  Most of them seem to be ready, willing, and eager to collaborate for the good of the patient.  And the PT's come out of their rehab training with a respect for the depth of the veterinary knowledge base as well.  However, if we are to try to understand the non-rehab-vet's reservation (or simple lack of thought) to referring to a rehab professional (vet, vet tech, or non-vet), then we need to identify factors that may be contributing to this collective experience.  From this understanding is the only way in which we might work to address this issue.  I once had a candid conversation with one of the founders of the ACVSMR (American College of Veterinarians in Sports Medicine and Rehabilitation).  He said to me, "Laurie, you have to realize that PTs are the first group of human health care professionals that have approached the vet boards wanting to work together.  Other groups have not, and the vets don't know how to react."  This was truly enlightening for me to hear!  So, by bringing up the lack of formal inter-intra-professional collaboration education in vet medicine, MY point was that we need to have a certain amount of understanding of and for the veterinarians out there that don't know what to with with us (any of us!).  How do we do this?  That is up for discussion… but do read the paper mentioned above… as much has been researched on this topic in human health care.  I suggested that the time is right for adding this topic / subject to veterinary training.

 

Support for our Technicians, was commentary pertaining to practices where there is no rehab-trained veterinary (or PT) on staff to support the practice of rehabilitation by a veterinary technician (or PTA) with rehab training.  This is concerning from a couple of standpoints, 1) The practice of animal rehab can be very lonely.  Any solo-rehab-practitioner is left to sort out treatment planning, management of complicated cases, set backs or lack of progress on their own.  It can be frustrating and at times detrimental to not have anyone else with a rehab background, with whom to discuss a case.  2) When we did our clinic statistics over a 3-year period, we noted that over 1/3 of cases referred to our clinic were coming without a veterinary diagnosis, thus leaving the PT's to make the physical therapy diagnosis.  The majority of these non-diagnosed cases turned out to be soft tissue injuries or axial skeleton joint dysfunctions.  The PTs on staff were able to identify and address these issues directly and communicated back to the referring veterinarian.  So if these two problems exist, then the position holds true, we need to better support out technicians that are working in isolation.  In fact FourLeg.com is one such way to support further education for technicians.

 

My discussion points about 'Physio-Balls' was intended to rally the PTs / physios to stand up for themselves, sing their own praises now and then, and acknowledge their own unique skills and knowledge.  This was based on observations (and discussions) within the HUMAN field in general, which may be impacting our existence (or slow decline) in the animal healthcare world.  One of the e-mails that came in this week had the following to say:

As a female who entered the veterinary profession when it was still a male-dominated profession, I understand the challenges to face to be accepted. It is a fine balance that is needed to be accepted as a woman in a leadership and professional role without being seen as being "bitchy" - this also happened in the business world. That balance comes when, I believe, you challenge yourself to learn everything you can about your area of interest, speak with your colleagues and step out of your box to help educate your colleagues (including other health care professionals) and lay people who may be involved in doing things in your area of practice as to how YOU can help THEM help THEIR patients / animals be the best they can be. Antagonism won't work, in my opinion. It can be frustrating, but I have found the approach works.

I believe we really are on the same page with this discussion point, so I will not elaborate further.

 

At the end of the original blog, I asked for comments and feedback.  I reprinted one e-mail from a veterinarian that seems to insight a great deal of controversy.  The following line in particular requires some background and an update.

First off, I heard about the ACVSMR’s recent policy statement about only wanting to recognize vets for rehab.

This comment was in reference to a position statement  that was recently published by the board of the ACVSMR without passing it by the membership for comments or edits.  It was in reference to the term 'direct supervision' of allied health professionals and the lack of definition for this term (and the potential ramifications of it's use in various States).  Apparently the ACVSMR board is revisiting this statement.

 

I do hope that this blog helps to shed some light on my intention with the original blog, Issues International.  I was hoping to incite discussion regarding ways for all of us to collaborate with the non-rehab veterinary community, and generate more referrals to our respective rehab practices.

 

As always, I wish you all good things and success in your practice!

 

Laurie

 

 

Laurie@FourLeg.com

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12 Jan 2014

Snippets from Successful Practitioners in Canine Rehabilitation & Physiotherapy

I am so excited to tell you that my latest book Successful Practitioners in Canine Rehabilitation & Physiotherapy is officially available!  It can be purchased on Amazon.com (and .co.uk, but not .ca for some reason)!  I do have a limited time special offer for the first 50 people that purchase the book through www.fourleg.com - a special reduced price…  so go check it out!

 

Here are a few snippets from the book:

 

The question:  Do you have any advice for new or existing practitioners in the field?

 

Beth Williams

USA

"If you want to grow your business, find a niche and be prepared to donate some of your time to attract new clients. Give a free class on conditioning and exercise for an agility club, provide pro bono or discounted therapy for animals at the local shelter, have a booth at animal friendly community events. Offer to write an article for local publications on “safe exercise in hot/cold weather,” or “how therapy for geriatric animals helps keep them moving well.” If you work out of a veterinary clinic, create relationships with veterinarians in the area so they are comfortable referring their clients/patients to you for therapy services without fearing that they will lose their clients completely."

 

Cajsa Ericson

Sweden

"Do good work and get results! Get to know "important people" that can help with your learning and/or can help to get you started. Get to know and visit with individual vets and vet clinics. Ask if you can shadow them for a day. Be patient, it takes time!"

 

Carrie Smith

Canada

"My advice:

  • Get all your credentials first (Certificate or Diploma) before you start to practice.
  • Vets should spend at least one day in a human practice with a PT, because human patients can give them feedback about hand pressure and joint glides when doing manual therapy.
  • Don’t overcharge! Look at what human clinics around your area charge for a rehab treatment. Animal rehab should not be more expensive, as the practitioners are basically “new grads.”
  • Spend a lot of time on assessment and re-assess at every treatment. It seems that some practitioners are doing the initial assessment, and then having the tech perform several treatments. If you don’t re-assess on each visit, you will have no idea how the patient is doing. If there are no changes after the first two treatments, you are not treating the right thing, or your treatment is not effective, so don’t keep doing it!  The tech does not have qualifications to do your re-assessment.
  • Use the “Three Treatment Rule.” I tell all of my humans and owners this. If there have been no improvements after the third treatment, you are not being effective, so re-evaluate!  Owners will really respect this. This does not mean that the patient is completely healed in three treatments; it just means you know you are on the right track."

 

Julie Mayer

USA

"You have to promote both yourself and this discipline. Reach out and approach veterinary hospitals and give presentations on your services and case studies. Host seminars and CE events at your facility. Get out into the community and attend animal-related sporting events. Learn how animals move and study anatomy. The better a practitioner and diagnostician you are, the better you can serve your patients, which leads to better outcomes and a great reputation! Those of you who are veterinarians, I would get certified in chiropractic. It really helps to understand the musculoskeletal system. In addition, acupuncture is also a great tool for pain management." 

 

And back to me:

I hope that these stories get you hungry for more!  I simply cannot believe the wealth of information, insight, and advice that all of the contributors shared, and there is so much that we can learn from each other!  In case, I'm not clear… go buy the book!  I guarantee you'll benefit from at least one story or piece of advice. Carpe Diem!!

Cheers,

Laurie

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16 Feb 2014

Learning by Failure

Aloha my friends!

 

Two different items have come to my attention of late, and both with the same topic - Failure.  Now the word failure tends to have negative connotations to it, but both of these sources of information took a different slant to that.

 

The first failure-related piece I want to discuss came in the form of an audio CD put out by Success Magazine.  It contained the stores of 3 people who have failed in some aspect of business.  Most importantly (and most relevant), within each story were the lessons learned from the event and how each person dealt with the failure.  Did they give up, pack it in, take a job as a Walmart greeter?  No!  They dealt with the failure.  They picked themselves up.  They became introspective and they learned from the failure.  The 'preamble' to the CD discussed trying to find people willing to talk about their failures.  Not surprisingly, several people declined the request to participate in the project.  They feared it would negatively impact their reputation.  That's a shame, because what the stories truly highlighted were the elements of learning, courage & overcoming.

 

They say that one of the things a person can do to help them become more successful (or shorten their learning journey) is to read the stories of others.  Emulate what successful people have done and learn from their failures or mistakes.

 

The second failure-related item I came across is the book by W. Brett Wilson entitled Redefining Success Still Making Mistakes.  Brett is / was a successful entrepreneur in Calgary's energy sector, co-founding a company the was able to provide start-up funding to smaller oil and gas companies.  However, Brett became better known as the 'generous dragon' on Canada's popular TV show Dragon's Den (akin to the US & UK's Shark Tank).  While Brett was very successful in his business life, he is very open about how his family life and health suffered due to lack of attention in those areas.  So in reading the book, not are you inspired by his business success, but you also learn from his failures and subsequent actions and advice to rectify those short-comings.

 

Subsequently, two things strike me as relevant to you:

1) Think about reading Successful Practitioners in Canine Rehabilitation & Physiotherapy, because the stories talk of both success and failure. (Book available at amazon.com, amazon.co.uk, and fourleg.com)

2) Who amongst you might be brave enough to tell me of your failures (business, personal, academic, whatever) that I might compile and share them for the benefit of FourLeg members?  Just drop me a short e-mail - letting me know that you'd be willing to share your story and I'll draft a questionnaire or list ofguidance points to help you convey your story.

 

Until next time… just keep on your learning journey!

 

Mahalo!

 

 

Laurie

Posted in: Business & Marketing Tags: failure

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13 Jul 2014

Success is Relative

I have an animal-rehab friend who asked me recently, "Do you have 1000 subscribers on your FourLeg site yet?"  And I gasped, "No! Not even close!"  "But it's amazing!  How come everyone who does this isn't a member?" she asked.  Really, I don't know the answer why everyone isn't a member.  But even without 1000 subscribers, I am happy with the success of the site and that so many people are continuing to benefit from the library of information.

 

Another friend (who shall remain nameless because some of you might know her) is able to read palms.  So when I last saw her and she read my palm, she told me that my palm indicated I will be 'successful enough' and have 'enough money… not rich, but enough money.'  You know, I'm totally okay with that.  There's plenty of things I don't need… they might be fun to have, but I don't NEED them!  I'm okay with having enough.

 

And I just finished reading the 4 Hour Work Week by Tim Ferris.  The premise of this book is to find a way to work less, enjoy life now, travel and out-source tasks as much as you can.  Essentially, you don't need to work like a slave, save mega-bucks and wait for retirement to enjoy life… do it now!  Nice concept, but is't not as 'do-able' for those of us in a service industry.  However, there are some poignant take-away's from the book… so it is worth the read.

 

Which takes me to the point of this blog… What defines success for you?

  • How rich do you need to be?
  • What defines success in your personal life?
  • What defines success in your work life?

 

So tell me…

Do you have a story to share of a time or incident where you felt successful?  What was it?  What was it about that made you feel successful?  Have you replicated that feeling in other areas of your life?  Was the sacrifice (assuming that all success requires sacrifice) worth it?  Talk to me!  Tell me your stories of success (to you personally) big or small.  Let's keep sharing and learning from each other!

 

Until next time… Cheers!

 

Laurie

Posted in: Business & Marketing Tags: success

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23 Nov 2014

Blog - If I build it, will they come?

Hello Laurie!

 

I have recently found your website and it has been very useful to me as I am a recently graduated CCRP. I am in the process of working with a clinic to establish a sustainable rehabilitation program in their hospital and was hoping you might be able to give some advice or point me in the direction of a previous blog about this information. The hospital’s major concern is not being profitable. Do you have any advice on how  to create a profitable, but reasonable price list and how you go about creating packages? In terms of clients, the hospital is very busy doing orthopedic and neurologic surgeries, but how do you go about starting the conversation for rehabilitation post-op? Some people I know would be interested, but do you have any advice for those clients that are hesitant to spend more money? Thank you so much for your blog and Facebook! They are truly great resources! 

 

Sincerely,

CP

-- -- -- -- 

Hi C,

 

I'm glad you found the website!  

 

Now in regards to profitability... it's a bit multi-factored!

Yes, you can worry about price, and packages, or charging for the service or by modality, etc.

But the number one issue I hear is a lack of buy-in and referrals from 'in-house'.  The owner of the clinic might be supportive etc, but if the other vets don't refer and don't 'sell it' well (ethically and with all good intentions of course), then your service won't be full and won't make money.  People just need to be given the option and the vets telling them about it need to believe it.  THERE's the downfall.  Do all vets in the practice BELIEVE!?  

If it comes down to making money... well to be honest, adding another surgical suite would make more money.  But adding rehab makes the whole of the clinic more well rounded and could actually be a draw that bolsters the surgical side of the practice.  At a minimum, they should at least include a rehab consult with the surgical discharge and at the check up.  That way you can give some exercises and on your own let them know that a full rehab program would be available if they wanted more guidance and structure to their dog's recovery.

 

Additionally... just because you build it doesn't mean they will come.  You'll need to diligent about marketing... and not just any marketing - but smart marketing.  (I cover details in the Marketing Manifesto (e-workbook) and many of the Business & Marketing Audios.)  It is even more important to work on the marketing if you don't have full buy in from the staff veterinarians.

 

So, to recap... pricing and packaging won't matter if the vets aren't willing to sell the concept.  And your marketing will have to be very strategic to fill in any gaps!

 

I don't know that this is what you were hoping for / looking for... but I think it's more of a reality factor that you need to add into the equation.

 

All the best!

 

Laurie

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04 Jan 2015

Goal setting or Intention-based value living

In last week's blog, I reviewed my year and took note of goals accomplished and goals "denied".  This week's blog is a discussion and instruction in a novel way to 'set goals' or rather, identify a method to create 'intention-based value living.  It's what I'm trying for this year anyways!  If it resonates with you, then come along for the ride and give it a try!

 

(Note, Members have access to the audio where I discuss this in more depth and fill in the blank worksheets to get started.) 

 

So, this concept belongs to a marketing guy (Dave Dee - GKIC Marketing) whose information I follow.  He brought up that traditionally when you set goals, they are supposed to be SMART goals:  Specific, Measurable, Attainable, and RelevanT… (or the T could stand for 'Time-bound' or 'Timely').  However the information that this marketing guy discussed was that goal setting in this way could have unintentional deleterious side effects. (And I googled that and found an interesting article from Harvard Business School that was well referenced and cited the following issues...) 

 

Problems related to goal setting:

•Can create an increase in unethical behaviour (especially if the goal is primarily money-based)

•May result in an over-focus on one area while neglecting other areas

•Can distort a person's risk preferences

•May corrode corporate culture 

•Has the potential to reduce intrinsic motivation and increase stress (especially if the goals don't 'resonate' with a person's values or if it becomes evident that goals might not be met).

Additionally, NOT setting goals could help a company to be more agile in adapting to the external factors as they arise.

 

So a NEW PHILOSOPHY is that of *Intension-Based Value Living*

 

If we were to sit back and really think about it, we'd all realize that the things that are most important to us, cannot be 'measured' or 'specific'.  What if my goal was simply to do the best I could in the areas of my life that I value?  

 

But how? And this is where you get to work!

 

Step 1:  Define your core values.

Ask yourself, what's important to me in life?  What are my real values?  (Make a list.)

Eg.  Be a good mother.  Be a good wife.  Be in excellent health.  Engage in continuous learning… etc.

 

Step 2:  Write down your definitions for each value.

Ask yourself things like 'What does being in excellent health mean to me?'

Eg.  To be strong and flexible, to weigh XXX lbs (or kgs), and to have minimal aches and pains.

 

Step 3:  Identify what you need to do to LIVE each value (on a daily, weekly, & monthly basis).  Don't be too crazy… make these realistic.  Maybe pick 3 in each category.

Eg.  So to be a good mother, perhaps 3 things that I could do to live this value would be to 1) Be encouraging about homework and exams - and acknowledge any small improvements, 2) Spend more time talking with and having discussions with each kid, 3) Make enough money to send them to university / college.  

 

(NOTE:  Ah ha!  Do you see where money comes in… it doesn't have to be your core value, but there is a reason why you still need to work in some capacity!  But now you can tie it into a core value!)

 

Step 4:  Create rituals & habits (note, a series of rituals will eventually become a habit).  Doing this will help you to begin to automatically live your values.  Think of monthly, weekly, and daily rituals.  Keep them simple and realistic and only institute one or two new rituals per month.  So write out the rituals that you'd like to instate in each area.

Eg.  Spend time every Sunday creating my weekly plan.  Walk the dogs at least once a week WITH one or both kids.  Consistently eat a diet high in veggies and protein with zero to minimal simple carbs.  

 

Bear in mind that you can create a list of rituals in each category… but you'll only pick a handful that you will want to tackle daily, weekly, monthly.  And make a checklist of the rituals that you want to start with (maybe add in some that you are already pleased with yourself for doing already, just so that you can check things off and feel successful right off the bat).  Make your rituals last 30 days for them to become an ingrained habit.  And remember that when you 'fall off track', don't beat yourself up, just get back on track.

 

NOW, create your Monthly Plan  (Maybe get a nice hard bound journal to put this in!)

•Review your previous month

•Remove non-relevant tasks

•Carry over important uncompleted tasks

•Identify you most important tasks that you are CHOOSING to do

•Update your calendar, day timer, scheduler

 

NEXT, create your Weekly Plan

•Review your previous week

•Review your values

•Review your listing of rituals

•On a blank page write your values

•Then write down one BIG ROCK (as it relates to your rituals and/or ways to live your values) in each of your value areas

•Write down your additional roles / tasks that you need to do

•Then schedule these things into your calendar

 

LASTLY, if it works for you, do a Daily Plan

•Write one thing you're grateful for

•Write your 3 most important tasks for the day

•Write our your miscellaneous tasks to complete

•Now schedule your day

 

There you go!  A big long blog to help you reframe your actions and move forwards into 2015 with intention and your values!  Have a great year everyone!

 

Cheers,

Laurie

Posted in: Business & Marketing Tags: goals

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08 Feb 2015

Convincing the Surgeon!

Hi Laurie,

 

I have another question.  I am having difficulty convincing our surgeon to send me cases.  He fitted a down dachshund with no deep pain for a cart, but did not talk with him about seeing me for rehab. That is just one of many instances.  The cases he has sent me have gotten better, so I do not know why he won't send them to me.  I have asked him, and the answer comes down to money most of the time.  For post-op TPLO's he won't sent them to me because he wants them to save their money for the other leg when it goes.  To get him and the other doctors to send me more cases, I need to provide them with facts and studies showing the benefits of rehab.  Can you give me suggestions of papers that I could use to make my point?

 

Thank you,

LW

-- -- -- -- -- 

Hey LW

 

So frustrating about your near-sighted surgeon...

 

1) Print off each of the FourLeg Newsletters and leave one on his desk every couple of weeks...  

More papers are coming out... but it's slow, and as per research, you can't get to the big juicy, high quality papers, until the groundwork is done with the little ones that are easily measured and have little confounding variables.  (Rehab / Physio is never just a 'do one thing and see if it makes all the difference'.  We always incorporate a multitude of things!  AND, when people are paying for services out of pocket, you can't very well put them in a 'placebo' group... and if you are a clinician, you can't afford to give away time and treatment for free to do such a study either!  ARGggghhh!)

 

2) Go above or around.  Make the clients ask for it, demand it.  Facebook page, Newsletter info, E-blasts, Lectures, Big poster display in the waiting room, etc.  Make the clients light the fire that forces him to refer... make THEM demand it.

 

3) It reminds me of a story I read about the beginning of physiotherapy in Canadian hospitals.  The 'indominable' Enid Graham would go on rounds with the doctor, and point out in each case what things she could suggest or provide for each patient.  She was relentless (or so the story goes...), to the point that the doctor would just let her do her thing... and slowly she proved herself (and the concept of physiotherapy).

 

4)  Pubmed is my best friend to finding abstracts.  

http://www.ncbi.nlm.nih.gov/pubmed  

Type in searches like "Dog physiotherapy rehabilitation hip"  (or something like that... try different words & combinations.  After a while it's like a game to see how you can 'outsmart' pubmed into showing you something that it hadn't shown you before!)

 

5)  "Fugget about im"... i.e. concentrate elsewhere!  Get referrals from you existing clients.  Make a poster for in your rehab room that talks about referrals.  Have a newsletter for your rehab clients & ask them to share it!  Collect e-mails of your rehab clients (check out my Marketing Manifesto e-book for other ideas).

 

I hope this helps… hang in there!

 

Cheers,

 

Laurie

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22 Mar 2015

Tibial Tubercle Avusion

Laurie:

I tried searching the Yahoo Rehab group for previous discussions for recommended rehab for post op avulsion fractures of the tibial tuberosity in a puppy, but couldn’t find any.

We have a patient that was boarding with us.  He’s a Maltese-X approx 3-4 months old (not actually my patient).  He suddenly came up lame while here.  We are presuming a traumatic incident while he was in the group area playing with the other dogs, but no one actually witnessed the event.  Rads show an avulsion fracture with a small bony fragment from the diaphysis of the tibia, with minimal displacement, but obviously pulled cranially.  Our surgeon associate was to perform the surgical repair today.  I’m not working today so am unsure of the outcome but presume it went well.

I wanted to make recommendations for rehab but couldn't find specifics.  Icing, gentle range of motion, e-stim, joint compressions, laser initially are my thoughts.  I also thought weight bearing exercises with full support so no shifting, but getting use through hips, stifle, hocks.  Tickling, scratching, peanut butter in the groin - to get the proper motion but with initially no weight bearing?  At time of suture removal, start with weight bearing and some weight shifting?  Is that proper timing?  I don’t want to go too quickly, or not enough. 

Thanks for any and all comments and suggestions.

D.U.

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Hi D.,

Sorry for my tardy reply.  I'm so behind since coming home from Hawaii!

So I have seen two of these (both Borzoi's... my breeder - who brings all injuries to me first - I know... not the right way around... but she 'sneaks them in on me').  I found pin-point tenderness on compression over the tibial tuberosity and pain when then trying to put a transverse pressure on the tibial tuberosity as well.  With these findings, I then recommend a radiograph.

So in both accounts (both puppies... with minimal displacement - when she took the to her vet down in Montana - older vet, does a lot of surgeries & has all sorts of higher end diagnostics)... she was advised to do nothing.  Kept them quieter.  They both healed perfectly.

Rehab for this sort of surgery... think of it like a patellar surgery - tibial tubercle transposition.  

No crazy running, but just go with any generic post-op protocol (i.e. my post-op cruciate protocol).

Totally do-able... progress as per what the dog is 'showing you' it can do next... or progress / push a little if there isn't progress!  If the dog is willing to weight bear.  Let him weight bear!  No rough-housing... that's your biggest thing to control / contain!  Beyond that.. slow and steady use.

Cheers!

Laurie

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Laurie:

Thanks so much for your response!  This helps me so I know where to start, and how to proceed.

Take care!

 

D.

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26 Apr 2015

Amputee prosthetic limb use

Hi Laurie,

Another request for any insight you may have.  I am seeing Lexi who had her RFL traumatically amputated just below the elbow while in an abusive situation in May 2014.   Since then, she has (thankfully) been rescued, brought to VT and now is part of a wonderful and dedicated family.

I started seeing Lexi  pro bono in November 2014 about 5 months ago. A local human prosthetist made her a prosthesis (also pro bono) and the ultimate long term goal has been for her to learn to use it for functional ambulation.  When I first saw her in November,  she would carry the prosthesis mostly as a “wing”, not a limb, ie, she would flex the shoulder behind her and hold the prosthesis almost parallel to the ground totally NWB along her trunk and use a 3 leg hop to ambulate.  Behaviorally, she’s a bit wary (understandably given history) but otherwise sweet and responsive to treats and healthy and not overweight.

Both hind limbs and the LFL are strong and painfree.  There are no problems with the stump.  The elbow is held in relative extension while in the prosthesis and in general seems to fit well and not cause her any pain.  She doesn’t seem to like it/never has – seems she perceives it as more problematic than helpful. She did ‘walk’ via hopping pattern for ~ 6 months until she got her prosthesis.

Her musculoskeletal system shows some of the typical compensations you would expect to see with almost 6 months of  3 leg hopping – kyphotic lumbar spine and LFL  compensations.   We have been addressing those on a regular basis  (including stretching scapula on rib cage) and Lexi has a carpal wrap for the L and  she has remained remarkably painfree, flexible and strong in trunk/spine/LFL .  Owners regularly carry out a home exercise program that addresses preventing/minimizing these issues.  Initially, she had severe atrophy on the stump side but has now developed sufficient muscle mass to even do a ‘shake paw R”  in sitting/stand and can WB through the prosthesis to do a ‘shake paw L”.   She does many exercises for trunk/LFL/BHL strengthening and she does well  using donut and rocker board for balance and weight shifts.

While she has improved with individually being able/willing to do WB through prosthesis and also in swinging it forward – getting her to combine these two basic movements into a walking pattern has not happened.  I have recently been having her walk CCW in a semi-circle and over some low poles duct-taped to the ground.  I’ve used clicker training to get her to place prosthesis on yellow targets on the ground  as she ‘walks’ and we’ve even started her recently using her FLs only on a land treadmill.  We also just do a lot of slow walking  with me trying to encourage her to weight bear and me assisting her swing forward  with the prosthesis.  Even though we slow her down, it’s still very hard to get her to NOT hop.  And, she never spontaneously uses the RFL (prosthesis side) in gait – she will turn, and even back up using a hopping pattern.  That darn hopping pattern just seems so ingrained, we can’t seem to change it.  She no longer holds the prosthesis in a total ‘wing’ pattern parallel to the floor as she did initially when walking – the limb hangs lower  now, almost perpendicular to the ground – but she still hops.   I  originally thought I would work to  try and change this pattern for as long as she had been hopping (ie about 6 months).  We are now rapidly approaching that landmark and while Lexi has improved in a million different positive ways, the ultimate goal of using the prosthesis in functional walking has not been achieved.    Owners are a bit disappointed as am I.  However, I also feel need to be realistic.

So… I guess I am reaching out to see if you have any other ideas I might try – or maybe I should just face fact that she may never accept its functional use.  I really can’t find any ms/sk reason why she can’t transfer her skills – no pain, no joint limitations, no muscle length/pain problems, good fit of prosthesis, etc.

Thanks a lot for any input you might have!

Nancy

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Hey N,

Interesting case!  Poor thing!

So, I would try getting her to walk in any direction on the treadmill - forwards, backwards, sideways.  And in forwards motion... slowly increase speed to see if you can get her to use it... (eventually).

On land (or maybe on treadmill) try walking with a boot on the left front leg... maybe put some tinfoil in the bottom of it.  Or maybe tape on the bottom of that foot.

Maybe try using a tensor bandage / ace bandage wrap (loosely tie the left front and right hind leg together...)

Maybe try slow walking up hill (or if your treadmill has incline, crank it way up)

Will she use it walking up stairs (slow / on leash)?

Clicker train at a walk... on treadmill... front legs only?

Since it's not sounding to be pain related... then it is likely just a learned non-use.  I first wondered if it had anything to do with the abuse... but as you describe what you've done and how she will use the leg to balance etc... I go back to learned non-use.

Worth a bit more trying... (with fingers crossed)

Let me know if you figure out the magical solution!  Good luck!

Laurie

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L.,

Will do - I so would like to see it happen.  Tried all 4's on land treadmill today - was a bit of a disaster.  Treadmill I have at its slowest is 1 km/hr - not sure if that is a factor or not.  Today, think it was more of a matter of Lexi being very surprised that she had to move ALL 4 limbs at same time (we've only been doing FLs on the treadmill with HLs off so far and I have to help move the RFL [prosthesis side] fwd for her.)  I think it also showed me how difficult that 4 leg/trunk integrated motor pattern really is for a dog who has been 3 leg hopping for so long.  I'll try to get a third person in to help next time - I just couldn't coordinate all the limbs, keep her upright at same time (owner is busy uses some peanut butter in cup in front of her and he also has to do machine controls which are up front of machine  - it's a donated one, not perfect, but works!).

I did have Lexi also try just putting BHLs on treadmill with FLs on ground - which meant she was walking backwards.  She also seemed a bit shocked at first, but got used to this after a little while with less disaster!  And then, when we went back to the 'easiest' original method - BFLs on treadmill, BHLs off, walking fwd with me helping move prosthetic side fwd - she actually had several times when she actively was making attempt to bring that RFL fwd - Yay!  I'm going to count that as a success.

What a pleasure to be able to even try to help these animals - and so appreciative of all you do to keep us all motivated and educated in this effort!  Thank you.

N

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Thanks for the update.  

Ideally, slower than 1km/hr would be preferable... but you go with what you've got.  

Often time, and especially when the dogs are learning the treadmill, I just straddle the treadmill, hang onto them around the middle and let them sort it out.  If you were co-ordinated enough, you could hang on around the middle with one arm and use the other one to place the leg... be sure to bend your knees to help support your back!!  It's not pretty, but it works!

I would agree that it sounds like a success!  Congratulations and keep it up!

Cheers,

Laurie

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03 May 2015

You're good at what you do… so what? (Business Discussion)

So as many of you were aware of, I was at the STAAR Conference the week before last… and I promised to offer some insights into what I took away from it all.

Firstly, it was fabulous to meet / reacquaint with so many rehab folks that are dedicated to providing quality care (as evidenced by the fact that they were there doing some continuing education).  That in and of itself is amazing!  And what I love about the STAAR Conference is that there is so much hands on time and/or collaborative discussion time.  So, you may have THOUGHT that you were properly assessing iliopsoas before, but when someone shows you again, you may have realized that you were missing it (or parts of it).  Or, you thought that there was nothing more to learn about running and working a dog in the underwater treadmill, but then you saw someone doing some really cool stuff and creating some super nifty gadgets that make things even better.  Or you learned some training tricks that could be used for rehab patients.  Or you were inspired to do a little bit of clinical research.  Awesome stuff!!!

But just because you are becoming more amazing by the day, does not necessarily mean that clients are flocking to your doors, or that they they even know you exist!  What I found fascinating when talking to people in my two clinical workshops (Introduction to Craniosacral Therapy & Managing Canine Hip Dysplasia Throughout the Lifespan), was that I was always asked a little bit of something about business or marketing.  "Hurray!"  (…because I love business & marketing - well, mostly marketing!)  And one of the fun 'off the cuff' things that I was able to participate in during the STAAR Conference was co-leading a round-table discussion on Building your Rehab Business.

Firstly let me say that if you think 'Wow, I'm not much into business or marketing.  I don't know about that stuff'.  Then I'd have to say 'You HAVE to be into business & marketing, and that you're not alone in not knowing about it.'  After all, we're healthcare professionals!  What were we taught about business?  Nothing!  But unless you learn, then you cannot 'control', 'change', or 'influence' your financials!  So, I guess, the real purpose of this blog is to inspire you to start to learn these things… because I can't get you all 'caught up' in one blog post.  Here are some resources… start to subscribe to these peoples blog posts, e-blast mailing lists, online courses, educational products, books, etc!

  • •Dan Kennedy - www.gkic.com
  • •Brendon Burchard - www.brendonburchard.com
  • •Jeff Walker - www.jeffwalker.com
  • •Danielle Lambert - www.snoutschool.com
  • •Tad Hargrave - www.marketingforhippies.com
  • •Ali Brown - www.alibrown.com
  • •Mara Glazer - www.maraglazer.com

Just check them out… see what resonates with you.  Sign up for their free info (you can unsubscribe at any time later). Just start learning.

And of course,  if you are a FourLeg.com members, look in the AUDIO section on the Member's side of the website… I have 15 different audios on the subject of business & marketing.  If you want more, then check out my e-book:  The Marketing Manifesto (available under Products on FourLeg public page - or Discounts on the FourLeg Members's side).  And if you are looking for inspiration from others in the field then check out the book Successful Practitioners in Canine Rehabilitation & Physiotherapy - available in both places on the FourLeg site or from Amazon!

Again, just start learning about this side of your rehab business and little by little you will start to see your practice grow… (to the point that your marketing is almost unnecessary, but you keep doing it because it's fun!!)

Okay, so that is all for this blog post!  Check out these resources… because even if you are a person on staff… you may have some influence in how your caseload grows by implementing some simple strategies yourself.  And have fun with it!

Cheers!  

Laurie

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10 May 2015

Help! I can't get my charts done!

My last question is, were you ever bogged down in your medical records? I end up spending all my free time completing them and never have time any more to keep up on journals, your website, etc.  maybe there is a section on the website you can direct me to.

L.

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As for the medical records... I find that I have to do them almost immediately after the patient is gone - or I am left with 10 - 15 charts to do at the end of the day when my brain is fried!  Sometimes I will stop what I'm doing in the treatment, give the dog a break and write some stuff down.  The owners are usually okay b/c I tell that that if I don't write it down now that I'll forget by the end of the day... and the dog sometimes needs a break anyways.  And I confess that sometimes to just get away and a bit of time to myself, I'll take a chart to the bathroom and do it in there between patients!  (Too much information???)

Lastly, you might be surprised at how basic my charting is.  In my case, it's just me (or occasionally one of the other therapists) that needs to see my charts... and the rule of thumb in physio is that you assess and treat what you find that day anyways.  So looking at the chart to see what was done last just provides a 'guideline' for the treatment you may do that day.  For example:  

S: Going up and down stairs now, Still won't jump into car

O/E: Decreased tenderness iliopsoas.  Pelvis level, mild tenderness L7 with transverse pressures

Rx: Laser 10 J/cm2, 50% multiple sites to iliopsoas & L/S, PEMF 15Hz x 30min, Mobs L7, Myofascial release iliopsoas, Home Ex: Feet up stretch forward for cookie.

Simplify!  When I have an intern that's shadowing for their rehab certification, I tell them to tell me which patients they want to copy the notes for and that I will do an extra detailed job of the notes... otherwise, what I wrote above is about all that I do.

Beyond that... we also build in buffer time between patients.  We know we're going to run late.  So while we have the appointments set up to be 1/2 hr appts, we schedule them ever 40 minutes.  That way we don't get behind, and there's a chance we'll get charts done.

Hope that helps!!

Laurie

 

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14 Jun 2015

Mental health benefits of canine rehabilitation

While searching for blog topic ideas to ‘steal’ for my clinic’s blog, I found a great blog / article that I wanted to summarize and expand upon for you.

The blog I found was about how canine rehabilitation is healing for both the body and the mind.  Now this is a topic that I feel strongly about as well.  We have tons of dogs that come into the clinic delighted and happy to see their therapist or our UWT staff or to greet anyone in the vicinity.  Many owners exclaim that they simply tell their dog… “We’re going to see Auntie… [Insert name of staff member here]” and their dog gets all excited!  P.S.  I am Auntie Laurie to all of my patients… owners call me this, I get e-mails or Facebook messages addressing me as ‘Auntie Laurie’… I love it!

So perhaps the visit to the clinic is about more than the therapy and feeling good afterwards… but also about the ‘outing’.  We know that senior citizens are encouraged to get out, get a hobby, volunteer, go play bingo, get on the bus to go to the casino (I never understood that one), or when living in a care facility, to go to the recreational activities.  Why?  Because social outings make for good mental health!  And happiness and feeling connected to others helps us to deal with chronic pain and may even prevent some illnesses.  So why not for our dogs too?  I once had a client with a 13-year-old Golden Retriever with chronic musculoskeletal pain and kidney disease.  The dog was finding it hard to move, so he purchased one of those bicycle carts that you put kids in, and he would drive her around to her favourite spots: the park, the ice cream shop, and around the neighbourhood.  She loved it, and at each stop, she’d get out and make her rounds!  Mental health benefits?  You bet!!!   And we know that a happy mind is able to deal with stress much better than an unhappy mind!  So for some of your chronic patients, be sure to make a fuss, give treats, and take some time to attend to their mental health as well!

But I went off on a tangent already with that last paragraph.  What the original blog was getting at was more about how rehabilitation itself can provide unintended mental benefits.  For example being able to suggest or provide mobility aids (i.e. braces, wraps, carts, etc.) could be enough to give someone’s pet a little freedom once again.  Suggesting home adaptations (i.e. ramps, steps up to a bed or couch, strategically placed runners for slippery floors, booties, or ToeGrips) could help an animal to maintain a positive outlook on life.    Moving around their environment independently, exploring, or return to activities that had once been too difficult is a huge boost in quality of life for any animal! 

And then of course there is the benefit to the human.  I don’t think that this can be overlooked.  I have received countless hugs and expressions of gratitude for not just helping a pet with his or her physical ailments, but for also being a support for the owner as well.  We know that animals are an intimate part of many people’s lives.  And many people have a good deal of sadness, grief, guilt, or anxiety about seeing their pet in pain or struggling to function.  Not only can we help with these physical issues, but we can also provide hope, support, empathy, understanding, encouragement, and friendship to the owners as well.  And that is a wonderful gift!

So my main messages with this blog:

  • Empower the pets by helping them with their pain & decline in function
  • Think to suggest mobility aids or home environment adaptations to allow for some independence at home
  • Make a fuss over every dog
  • Be sure to talk with the owners and be a support for them as well

 

(Want to see the original blog post for my inspiration? Check out: 
http://www.havenlakeanimalhospital.com/blog/tag/canine-rehabilitation/ )

 

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21 Jun 2015

ToeGrips Commentary

Dear Laurie,

Thank you so much for including ToeGrips in your training series!  I loved hearing your take on ToeGrips vs booties and appreciate the opportunity to share some of my thoughts. 

A client of mine came up with the idea for ToeGrips, and for me, it was love at first sight.  Since dogs use their nails for traction, I was instantly attracted to the idea of working with the dog’s natural biomechanics. 

I see the product as superior to booties in 5 areas:

1. Unlike booties, they don’t interfere with conscious proprioception.

2. Dogs sweat through their paw pads. ToeGrips rest only on the nails and don’t cover the paws.

3. Because ToeGrips don’t cover sensitive tissue, most dogs never seem to notice them.  Even dogs who won’t tolerate boots/socks often tolerate ToeGrips.

4. Unlike booties, which much be taken on and off at frequent intervals, ToeGrips can be worn for 1-3 months (though we stress the importance of a daily visual inspection for positioning—detailed below).

5.ToeGrips aren’t bulky and don’t interfere with “break over” (to borrow a term from the the equine world).

I really liked your description of how to position ToeGrips, and in fact, it’s really the only way to do it.  The bottom of the grip must be in contact with the ground to work. It’s illustrated in the directions inside each package. So if the ToeGrip is sitting on the nail shaft, and not resting on the caudodistal nail tip, it becomes a decoration (a nail ring) instead of an assistive device.  I’m attaching a diagram to elaborate on this common placement error.  And like you, I “angle back” the dorsal aspect of the ToeGrips.

ToeGrips Placement

As you said, sizing is key to success.  We are in the process of improving our sizing process, Dental floss is accurate, but not the most user friendly.  We do have a breed chart, but it’s not practical for mixed breed dogs, nor purebred dogs who are on the edges of the bell curve. But it’s a good general guideline. A ToeGrips sizing app is our ultimate goal.

You referenced your staff member’s dog’s nail that sloughed a couple years ago. I have now received a few reports of this occurring.  In these cases, we have found 2 things:

1.  the dog’s nails were long

2.  the owners were not monitoring

My hypothesis is that the ToeGrip migrated toward the nail bed and affected blood flow to the nail.  Also, the long nails were already prone to being snagged.  To my knowledge, this has never occurred in a dog where the ToeGrips were being used as directed/in their proper position.

I take “Above all do no harm” very seriously.  Here are the only two ways I know of for ToeGrips to cause harm:

1.  I don’t worry about ToeGrips ingestion in a dog.  The material is FDA rated non-toxic and passes through.  However, in the 3 years we’ve been on the market, we’ve had 2 cats obstruct on ToeGrips.  One was a small kitten who ate 6 size large ToeGrips and the other was an employee’s cat who is known foreign body eater.  This petite cat obstructed on one XXL ToeGrip.  In our packaging, we now advise keeping out of the reach of human children and cats. 

2.  It is important to instruct clients to daily monitor the dog’s nails/grips/toes.  This can be accomplished in a quick visual inspection for positioning. We certainly hope that message is clear on our website and in our product packaging. This is why I sell ToeGrips through my colleagues, and not through PetSmart.  I believe client education on the product is very important.  Though it is not a common occurrence, if a ToeGrip migrates up into the nail bed/skin it can cause complications like ulcerative sores, infection, and nail removal.

I personally don’t trim nails with the ToeGrips in place, but I know of other practices who do.  I think it’s harder to “pull” the ToeGrips into position over the nail tip, vs pushing it onto the nail, so I prefer to remove the grips, trim the nails, then reapply/reuse the grips.  I find it challenging to pull the grips down over the lip of the nail tip after a pedicure.

I love that you pointed out that ToeGrips are not the solution for every dog.  I agree! To that end, if someone purchases ToeGrips and they are not effective, we offer a money back guarantee. We stand behind our product 110%.

In the video, I was surprised that Tank was an XS.  Typically, the XS size fits 3-8# dogs.  XS are certainly the hardest size grip to work with from an application stand point for obvious reasons—tiny nails, tiny dogs, tiny grips!

I laughed when you suggested saliva for lubrication during application, because that was what the inventor also used.  He is a former farrier and Western woodsman, and spat in the grips before applying each one.  I elected to change that for marketing purposes.  Little did I know, eventually a world-renowned rehab expert would also be recommending spit!  :)

One little tip I’d share with your readers, which is probably common sense and preaching to the choir—It’s important to stabilize each toe when pressing on the ToeGrips so we don’t torque the (often arthritic) toes of these dogs. In my experience, dogs mind the ToeGrips application much less than a nail trim, especially if the dog and leg are appropriately “restrained.”

Generally, the hind nails of dogs are shorter than the front nails, and the hind limbs are more important with respect to engagement/propulsion.  Even if the nails don’t contact the ground while standing (which I’d be happy about! I’m a huge advocate of short nails in dogs for posture and gait), if the dog engages his paws while gaiting, the ToeGrips can still work.  This dog had short nails, but you can see her “flatten” her feet through flexion and use her grips:  

https://youtu.be/F-IdweUMGtQ

Finally, though the classic application is to apply with rubbing alcohol and have the ToeGrips stay on simply through friction (aka a vacuum on the nail), I do super glue ToeGrips in extenuating circumstances, such as tripawd dogs and dogs with CP deficits who drag/scuff.

We are always available by phone, email, or social media for product support!

Thank you again, Laurie!

Sincerely,

Julie Buzby, DVM, CVA, CAVCA

 

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28 Jun 2015

SIJ Instability Commentary

Laurie,

I loved the SI tutorial and I love the fact that we chiropractic vets and physios are crossing more and more over. I am also a victim of unstable SI but all well for now with regular adjustments by brilliant chiropractor, and yoga did cause it to flare up big time. Pilates is way forward for me.

Veerle Dejonckheere

Bath or Bristol, UK

www.chapelfarmrehab.com

www.integratedveterinarycare.co.uk  

 

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 Laurie, I loved your SI video, it is exactly what I do with tensor bandages (ace bandages / elastic bandages), and for iliopsoas releases, lumbosacral releases.  I hold the tensor when I first start exercising them to keep that pressure on. I have tried doing more wraps - TTouch style - both sides tail and under, actually crossing in front of symphysis pubis to provide a bit of support there and then up sides, tied on the back.   I really like the straightforward anchor type thing. I will try and let you know what I find. Try using a tensor and do the snug tie. It works easily, and I have all different widths, to find the best match.

Again, when I have someone who will video for me with an iPad or iPhone, both which I don't have, I can continue the video, and show the front-end wrap stuff I do with it. I do have them exercise with it. A little elasticity in the fabric is better for movement in agility. Belts and laces may be abrasive.

Silvia Lavallee

Winnipeg

http://physio-sil.webs.com/

 

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Laurie,

Thank you for your video presentation on SIJ problems in dogs and mentioning my name with respect to strapping.

I want to share photos of what I have come up with in conjunction with a client. Java is an 8 year old GSD cross that was hit by a car, sustaining a fractured left ileum. The radiographs taken at the time of the accident also showed spondylosis at L6-L7. We used a neoprene strap with a piece of velcro at the one end. These are sold as "thigh slimmers" at discount stores. We cut out the fabric at the hips to enable the strap to fit far enough back over the lower spine and SIJ areas. For male dogs, you can also cut out a section for the penis.  The inside of the neoprene fabric "sticks" to the dog's coat, so there is no movement of the strap at all. The dogs seem to find the fabric very comfortable and there is a nice stretch to it.

Since Java, I have also used the design for a dog with L7-S1 problems and another dog with L7-S1 and SIJ issues.

After watching your video, I wondered about securing a second strip of neoprene in a caudal fashion as well. I will have to experiment further.

Happy to share this with your broader audience. 

Lorna Clarke

Canine Rehab Saskatoon 

http://caninerehab.ca/

 LornaWrap1      LornaWrap2

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25 Oct 2015

Marketing statistics you should know!

Here are some statistics as they relate to marketing that I've come across lately.

  • Companies that acquire customers from Facebook is 77%l
  • 30 million businesses now have a Facebook Fan Page.
  • Facebook is the most popular social network in the USA.
  • 70% of adults are Facebook users. 

 

  • 46% of people read blogs more than once a day.
  • Nearly 40% of US companies use blogs for marketing purposes.
  • Marketers who have prioritized blogging are 13X more likely to enjoy positive ROI (return on investment).

 

  • 80.8% of users report reading e-mail on mobile devices.
  • Over 50% of respondents say they read most of their emails.
  • "Secrets" is the most clicked lead nurturing subject line word.

 

  • 75% of content marketers release new content at least monthly, and 16.52% put new content out daily.
  • Nearly 50% of companies have content marketing strategies.
  • Social marketing budgets will double over the next 5 years.

 

  • Customers are 1.8 x more likely to buy after viewing video as compared to non-viewers.
  • 57% of consumers report that video increase their confidence in a purchase decision.
  • Utilizing the word "video" in email subject lines boosts open rates 19%.

 

  • Social media sites and blogs reach 8 out of 10 of all US internet suers and account fro 23% of all time spent online.
  • Interactive content, such as apps, assessments, calculators, configurations and quizzes, generate conversions moderately or very well 70% of the time, compared to just 36% for passive content.

 

And why should you care?  Because you can be the most gifted practitioners, but if nobody knows it, knows about you, or hears of you, then they won't become your client and you won't have the opportunity to show them how great you are (and in our case, be the 'miracle worker' for their dog)!  Everyone in a business (staff as well as owners) should have a vested interest in marketing themselves, their services, and the practice they're at!

Think about what you can do to bring in more business… check out the Marketing 101 Video Training offered this week (and last), and the Business & Marketing Audios, all on the Member's side of FourLeg.com.  Stand out from the crowd, have them beating down your door, and create raving fans (past, present & future)!

Cheers to your success!

Laurie

 

References:

http://www.hubspot.com/marketing-statistics

http://webdam.com/2014-marketing-statistics-infographic/

http://www.memorytree.ca/16-up-to-date-video-marketing-statistics-why-video-is-an-essential-part-of-your-marketing-strategy/

http://kapost.com/content-marketing-facts/

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13 Dec 2015

Chihuahua contracture

Hello Laurie,

Thanks for the great resource in the website!  I have a question; I am currently working with a 6 y/o mn Chihuahua who had bilateral extracapsular luxating patella surgery about 4-5 months ago.  Between complications and his being a weeny, he has major contracture and muscle atrophy of the hamstrings.  I am massaging the legs to normal or closely normal position, joint compressions and attempting to place him in standing position.  We have tried underwater work, (in the kitchen sink) and he refuses to do anything but look pitiful.  He weighs about 4#, do you have nay other suggestions? 

Thanks,

L

--- --- --- --- --- 

Hi L,

Thank you so much for joining my website.  I'm delighted that you are finding it useful.

So... these little guys are tough nuts to crack.  I don't think they have much incentive to use a leg if they don't have to / want to.

What I would actually suggest for the contracture, is a dynasplint to gain the ROM and THEN you can get him to use it!

Here's the link I found specific to small animals... they're a 'human' company that has branched out into animals:

http://www.dynasplint.com/divisions/veterinary/small-animal/

Will he do any stepping?  Any placing?  Any attempt to extend the leg himself and/or try to use it for balance?

If not... then there isn't much you can do until you get ROM back passively... 

And owners of these little guys simply don't / won't stretch them to the degree they need to be stretched, nor will they be able to bring the dog in every day / twice a day - as would be needed... so I think you need a splint that can be put on and dialed into extension for several hours at a time...

He'll have to start with 20 - 30 minutes or up to an hour and if that was okay (i.e. no skin breakdown, etc) then increase time to a couple of hours, then several hours, and then perhaps overnight or during the day (with the Chihuahua in a cone or supervises so at not to chew it off).

Seeing as you have tried everything including the kitchen sink... Ha ha... I just had to say that... then it's time to change it up a bit!

Hope this helps!

Cheers,

Laurie

 

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14 Feb 2016

Starting in a new practice - questions to ask

Hi Laurie,

Hope your new year started well. I need direction and guidance. 

I sold my practice up north and moved down south. I would like to focus on rehab and acupuncture. I thought of starting a house call business but I have two specialty practices looking for a full time rehab therapist.  Neither place had a full time rehab therapist. They've both just managed with part time rehab. They both think they will or have clients to support a full time therapist. 

So I have options but I want to figure out which is best for me. It is a little different talking to surgeons... 

In general, there is a lot to consider.

Any questions you would recommend for me to ask them? Both practices have pluses and minuses. They are so different. 

Any idea on how compensations on salary are generally done?  I do not know how to negotiate and what to expect.

I do not know how to formulate appointments and treatments throughout the week.

This is whole new adventure for me. I'm a little overwhelmed. 

Any encouragement is appreciated :)

See you at STAAR in April!

Take care,

Excitedly Overwhemed

-- --- -- 

Hi Excitedly Overwhelmed

You have exciting opportunities indeed!

Okay... so, as far as which clinic to choose, it could come down to personalities of the vets involved.  The head surgeon may be bought in, but the others might not be... which could be tricky!

Questions:

1.  Willingness to add a $ amount to their Ortho & Neuro surgical fees that includes a certain amount of rehab sessions

2.  Willingness to give you your own monthly marketing budget for the rehab-side of the practice

3.  What kind of space is available / size of the space / flooring / etc

4.  Will they provide the equipment (laser, e-stim, exercise equipment, etc) or do you need to supply it

5.  Willingness to revamp their post-op instructions to include rehab

6.  Willingness to let you look at, update & approve these post-op instructions

7.  Ask to meet all of their surgeons, and get an idea of their interest in rehab

8.  Ability to hire an assistant if the caseload gets busy or if UWT is being utilized

9.  Ability to set your own prices for services

10. Would you be responsible for doing your own booking, or would the front desk take care of that

11. Would you be limited to internal referrals (i.e. post-ops), or could outside vet clinics refer directly for rehab &/or acupuncture

12. Do they have any issues with you doing acupuncture (some vets / surgeons think it's voodoo)

Compensation

They may be wanting to put you onto a commission (vs a salary).  Since rehab is very labour intensive and lower in pricing (as compared to surgery), you will want to ask for at least 45 - 50% commission.  But I'd ask for even higher and then negotiate down to that level.  IF you were required to bring all of the stuff yourself, then your commission should be higher anyways!

Alternately, you may want to think about asking for a base salary plus a lower commission rate... that way you are guaranteed a salary even if they are slow to start to refer.

Formulating appointments

I do 30 minute rehab appointments... but book off 40 minutes of time so that I can transition between the two and do my charts, and talk to owners more if I like them!  We do the same for the UWT.  UWT appts usually start with the dog being in the water for 15 minutes and can go up to 30 minutes in a session, but we always book 40 minute slots.  There is more clean up, filling, draining, drying, etc between the dogs.

Hopefully this gets you started!

Good luck!

Laurie

 

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06 Mar 2016

Supporting the 'good' leg after a brachial plexus lesion

Hi Laurie,

  I would love some guidance on a new patient, if you would be so kind.  Patton is a 3 yr old MN Golden mix, about 40 pounds, who was found in an abandoned home with a brachial plexus injury of unknown origin or duration on his left thoracic limb.  He was taken in by a local rescue group and recently adopted by a family.  While I feel pretty good about my plan for working with the injured limb, I'm also very concerned about his right thoracic limb.  When checking range of motion to the right carpus, I can get to 215 degrees of extension, so 35 degrees past 180.  In active weight bearing, watching his video in slow motion, I would guess that goes to almost 240-250 degrees when walking.  He has sensation to the lateral paw of the affected left thoracic limb, so I'm hopeful he will make improvements and ideally be able to do more than just the very brief toe touching he is currently doing on that limb.  My concern is the length of time it is going to take to get to a more functional left limb and the effect it will have on his right carpus.  Searching through Four Leg (which I love, thank you very much!), I read/saw that you like the TheraPaw CarpoFlex X brace.  Do you have a "cut off" point of severity of hyperextension that you will opt for a more rigid support, like a hinged OrthoPets orthosis?  Does that depend of whether he will potentially live in this for the rest of his life?  If the dog is essentially going to be a tripawd for the foreseeable future, is there any hope that the hyperextension will improve with a brace/orthosis or is the goal now just to protect it from breaking down further?  I'm feeling a bit lost as how to best protect his "good" limb.    Do you see any benefit to doing the TheraPaw custom carpal support vs the CarpoFlex X?  Thank you for your time and any advice you might have...

Best, 

LP

--- -- --- -- ---

Hi L,

Great question!  So just to touch on the brachial plexus injury first, sensation to that side of the paw would constitute innervation of the C8 nerve root.  The biggest unknown in a brachial plexus injury is whether or not there was a complete nerve lesion or an avulsion of the nerve roots from the spinal cord.  So keep checking the other side of the foot, and for function of the triceps which tends to have more innervation from the C7 nerve root.

But back on topic now - I would absolutely think about supporting that right carpus given the clinical picture you describe. So here's the thought process I would go through in order to decide what's best.

  • Short term vs long term:  In all likelihood, this is a long-term project, and in which case, you need to think about 'acceptance' of the device (will the owners use it, will the dog tolerate it), and skin breakdown (in whichever / whatever device you choose).  The carpal wraps don't really let the area 'breath' - so long term use could result in some skin breakdown.  The rigid braces, would have more pinpoint areas of pressure that could cause skin breakdown.  Both would need to be monitored and managed.
  • Price: The carpal wrap is going to be substantially less expensive than a rigid brace.  However, this fact alone should not be the driving force behind making the decision on which option to use.
  • Your Involvement & Owner compliance:  These clients will need to know that they may need to check in with you on a semi-regular basis to assess how things are going.  Checking for skin breakdown, fit of the device, alterations needed for the device, compensation issues, a need for a different solution on down the road, etc.  As an example, you may want to add foam padding to a carpal wrap, and that foam will squish and break down over time, hence needing replacing.  Another example could be that with a rigid brace, the animal's leg may change in shape over time (increase in muscle mass or decrease), so you'll want to check on it periodically to ensure a continued good fit.

So, in your case specifically, I'd first try a wrap.  I'd get the Therapaw Carpo-Flex X, order padding (foam), and maybe a sheet of thermoplastics to have on hand (you may not need it now, but you'll have it for future if need be).  This model will firstly get you knowledgeable with the product (or first line of product) and will be a way of testing the dog's acceptance of an 'external contraption' on the leg.  It will be the most economical way of assessing the situation.  See how the dog does with it.  See how the owners do with it.  Maybe teach tricks to get the dog to accept it (i.e. rewarding the dog when the wrap gets put on).  Monitor the skin.  Monitor movement.  Monitor secondary compensations.  If more support is needed, try adding the thermoplastic part (check out the FourLeg video on that!), and if it seems to be working but needs just a little more support, then check out the custom carpal support by Therapaw.

Now, if you don't think the wrap provides enough support, or the dog is resistant to the wrap, then start looking into orthotic companies.  I've used goherogo.com and orthopets.com.  Ask them questions first, give them the information about the dog, and see what they recommend.  I'd be a bit concerned that if the dog is resistant to the wrap that he/she may not accept a brace either, but perhaps it might depend on the type of hinge that could be used.  As I said, ask them.  They want their product to be successful and to be the 'right' product for the case, and as such, I think you would get an objective opinion.  If you do go down the route of a more rigid brace, then watch the casting video on FourLeg, and be sure to have the dog come in for visits to work on 'using the limb' properly with the brace on.

And lastly, you need to educate the owners that this is a 'long-haul process', and that you are there for them throughout this dog's life as need be.  Let them know that what you are recommending now is 'step one' but that the recommendation could change on down the road depending on the factors discussed above. Reassure them that you have lots of ideas on how to help them now and in the future, and that you are willing and able to help them through this process.

I hope this helps, and thanks for asking!

Cheers!

Laurie

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24 Apr 2016

Cool stuff from the STAAR Conference 2016

So, firstly, I have to say that the STAAR Conference is the most fun and most educational canine rehab conference that you could ever plan to attend!  This year was no exception!  Already there have been so many e-mails and posts about the fabulous time had, and what struck me was how many of the dog-volunteer-owners were right in on it being so appreciative of having their dogs participate!

So, as an instructor, I get very little time to see anyone else’s workshop, but what I can tell you about are some of the interesting cases I saw!

One of my workshops was entitled Interactive Case Management – What is it now and what do you do?  Maybe that was a bad title.  Anyways, it was a really fun workshop.  It was a short lecture (assessment tips, goal setting tips, treatment tips) and then we have a number of dogs come in – some for me to assess in front of everyone, and some that everyone had the chance to assess.  Great on the spot learning!

One case was a fascinating little dog – history of being brought into rescue unable to stand, and taken in by a very determined couple.  He’d undergone rehab and can now walk on is own, but this little fellow was the ‘wonkiest’ little thing I’ve ever seen.  He was ataxic in all four limbs, had a strange head bobble, and legs that just seemed to be screwed in wrong!  So the first place I wanted to look was at his neck.  His upper cervical spine to be exact!  There are tests that can be done to test the alar ligaments, transverse ligament of the dens, and integrity of the dens (odontoid process).  I was very careful, in fact, I didn’t test these structures looking for the typical signs, instead I just assessed for resistance within the range that I would expect to feel resistance.  Well, let’s just say that I don’t think that this dog has a full dens or perhaps there’s laxity in all of his little ligaments.  He’s doing great though, and I hope that his therapist will keep me updated!

Another case was a pit bull that had been rescued from a dog-fighting ring (he was a bait dog and had notable scarring over his neck).  His owner had noted that he had had surgeries for bilateral patellar luxations, but that his rear end weakness seemed to be progressive.  Additionally, there was an account of this dog having troubles and being panicky when he would lie on his side or roll on his back – seeming to be unable to get his feet under him.  On evaluation, his neck and back were unremarkable, and one therapist did some craniosacral work on his cranium, and he has been in the massage class where they did some scar massage / mobilization, both of which seemed to help a bit.  Since his issues seemed to be localized to his brain, and his strange behaviour when on his back seemed to implicate his vestibular system, we decided to try the Dix-Hallpike Maneuver to see if we could ‘set off’ some nystagmus and/or trigger the vestibular system.  Well, ‘hot dang’, we set him up, flipped him back onto me, and ‘voila!’ Nystagmus!  So, with this dog, his history does not really indicate the ‘otolith’ theory as being the root of the issue, but rather a processing disorder.  And while I’m not an expert in vestibular rehab, I was able to provide some ideas for home therapy for this dog, but better yet, there was a local therapist (who specialized in human vestibular rehab) at the conference that was going to be able to offer some more detailed treatment advisement.  So exciting!  Again, I’m hoping to be updated on that case as well!

In the spine courses, we saw many dogs with axial skeleton dysfunctions that were helped with manual therapy.  And, owners that were ecstatic for their dogs to be receiving treatment.

In my Hip Dysplasia Workshop, we saw a 9-week old puppy with hip pain (already!!!) – likely from playing too rough, and a number of old dogs with hip arthritis.  Everyone was given some treatment and advisement.

And lastly, in the Business & Marketing round table, we had a great discussion on creating a multi-step plan for marketing to your referring veterinarians.  (It’ll make a great FourLeg audio one day!)

All in all, it was a really fun & fabulous conference!  Thanks to everyone that attended and I hope to see even more of you next year!

Until next time… Cheers!

 

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22 May 2016

GetPT1st on June 1st

This blog is just an all out cut and paste of another blog I found.  I heard about this movement and I’m passing it along as it pertains to all of us – human PT’s and those doing ‘physio’, ‘PT’, & rehab on animals.  Join the movement!
Cheers!  Laurie
-- -- -- -- --

GetPT1st on June 1st
Have you heard about the social media event coming up on Wednesday, June 1st? Here are 5 reasons why you should get involved.

1. It helps to promote the profession.  What are the things we do in physical therapy that you wish more people knew about? Why should people see a PT? What is your story?

2. It's easy to do. You're online already since you're reading this. You probably clicked the link while you were on social media. It takes less than a minute to make a post on Facebook, Twitter, Instagram, Pinterest, whatever you like.

3. It actually works! If you haven't yet, watch the video on Facebook. Over 300,000 people have watched it and close to 1 million people have seen the post. This isn't the result of paid advertising, it's the result of people who love this profession sharing and getting involved.

4. It's free. You aren't being asked to donate. It doesn't cost you anything. There is no "catch."

5. Be part of a grassroots movement. I've done a lot of asking around. People have been hoping that our profession would get more assertive and involved. Don't wait for someone else to do something, get involved. You have no right to sit on the sidelines and complain if you can't bother to spend one minute promoting physical therapy.


Want to learn more about the upcoming event? Let's get physical therapy trending on social media.
https://www.facebook.com/events/1124636837561085/
If we don't support our own profession, who will?
-- -- -- -- --

Original sources: 
http://www.themanualtherapist.com/2016/05/top-5-fridays-why-you-should-support.html

https://www.facebook.com/GetPT1st/videos/1060997533945977/

http://getpt1st.com/2015/10/01/get-physical-therapy-first-social-media-events/

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19 Jun 2016

Discharge from rehab, and then what?

The yoga class I go to is friendly and chatty.  It’s a great group of (mostly) ladies (now and then we get a fellow that joins us), and the premise of the class is to ‘workshop’ a different pose (break it down so that we are doing it properly) as well as do a flow sequence. Today the gal beside me was having issues with her ‘hamstring’ on one side.  She was describing how it felt when she was stretching and in different poses.  As she continued to describe it, she mentioned that it had happened once before, and that time one of her ribs was 'out'. So within her discussion, she figured it out that she needed to go to physio again!

 

As well today, another physical therapist / canine therapist friend had commented that she had noted that her dog’s ear was a bit crooked.  It had been that way for a couple of weeks.  So she just checked out his C1 and found that it was rotated and side bent.  He had displayed no symptoms at all, and was actively competing in agility and doing his conditioning exercises etc.  Fortunately, because my friend was a PT with the canine rehab training, she questioned the asymmetric ear posture, knew what to look for, and fixed that problem.  But what about all of the dogs out there whose owners don’t know what to look for?  What about the dogs that don’t show much in the way of symptoms and so never get brought in for treatment?

 

My point?  My point is that I hear it time and time again from the PT profession that the goal should be to discharge a patient when you get them better.  (The most recent spin on that theme was that the ‘best advertising’ was people who were better and ‘fixed’ singing your praises.)  While that is all well and fine and a very altruistic goal, I wonder about that cases as described above.

 

Humans have the advantage of feeling their own aches and pains and can seek remediation for them.  Even so, it would likely be beneficial to have check ups and tune-ups on a regular basis for the multitude of aches and pains that most people experience on a regular basis.  Yes, a person could go to physio on a more frequent basis when they have an acute injury, but perhaps for those that otherwise feel ‘okay’, maybe a monthly check up would be smart?  A physio could check on spine, pelvis, ribs, muscle strength, posture, etc.  There would always be something to work on!  Perhaps we’d all feel better if we did that.

 

Now dogs on the other hand can’t tell us when something is sore or not quite right.  Subsequently, one could say that even more than a human, a dog should have a regular check up.  Traditional vet medicine recommends a yearly check up.  From a physical standpoint, I recommend seeing ‘normal dogs’ quarterly, or at minimum twice a year.  There’s a lot that can happen to a dog.  The sporting dogs likely need a monthly treatment.  More is being asked of them on a more regular basis.  Geriatric dogs could easily be seen once a month as well!

 

So, I’ve said it before and I’ll say it again:  There’s no such thing as a normal human body!  Very few dogs have nothing to worked on either.  Your job is to sell the routine check-up and to find the problems!  So, yes, have your goal be to discharge your patients from active treatment, but then progress them to a maintenance schedule.  

 

The bonus with maintenance is that you find issues early, before they become bigger problems.  That’s good for the dog!  But also seeing the dog owner on a regular basis is good for your client-therapist-patient relationship.  I cannot say enough good things about establishing a strong relationship with your clients.  It’s good for your business and it’s good for your mental health (and the owner’s & dog’s as well).  So get those dogs coming back!  It’ll do wonders for everyone all around!

 

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02 Jul 2016

What is the value of the ENERGY in your MEDICINE?

This week I had some interesting discussions with my clients.  They started with, “So, you don’t have anyone shadowing you this week!”  

Now we don’t have tons of interns, but we do likely have more than average.  As well, we don’t mind having interns, but it does change the dynamics within the clinic and the appointments.  What was interesting about my conversations this week is what the dog owners noticed!

Firstly, let’s set the stage.  At my clinic, 99.9% of the time, owners bring their dogs to their appointment and stay with them.  That leaves us with roughly 30 minutes for me to do the treatment and talk with the clients.  My hands feel what’s going on, I ask questions about how the dog has been doing, and I go to work, but as I do, I am visiting with the clients the entire time.  “Do you have any plans for the summer?”  “How did your daughters wedding go?”  “Did you go to the dog show in Cochrane?”  “Did Xena get pregnant?” “What cool photos have you taken lately?” “Is that fire still burning up in Fort Mac, and what’s the air quality like?” “What is the housing market doing these days?”  “Ohhh, I see you got a pedicure!”  And so on!  It sounds a bit like a ‘soap opera’, but these are real things I said to my clients this past week!  People are so interesting!  I love the chance to learn about and catch up on people’s lives, 1) because it’s interesting, and 2) because I care!  Turns out, they miss that interaction as much as I do, when the dynamics are changed at the clinic.

So when you have an intern, there is more time spent showing, teaching, answering questions, supervising, and discussing with the intern.  It’s just more ‘clinical’ when there’s an intern.  The dogs receive the same great treatment, maybe even better than normal because in some cases four hands are working at the same time!  But the clients miss out!  They missed ME and our conversations, and they missed the ‘energy’ that normally surrounds the treatment!

One of my clients is a really interesting woman who does energy healing work and crystal singing bowl performances (which are amazing)!  Typically we get into some really cool philosophical discussions.  So this time we got talking about the ‘energy I create in the treatment room’.  She had noted that, ‘the energy was very special as evidenced by how much her dog loved to come see me and would just immediately lie on the mat as soon as he came in the room.’  She said he is normally very aloof with anybody other than family.  So what is it that’s going on?

I’ve always had a theory about healthcare practitioners.  There are some that are technically great.  You can go to these people, they can give you a massage, or fix your neck, or send you for further diagnostics based on their exam, but somehow you feel like something is missing from the interaction.  You don’t feel cared for or validated as a patient (or human being perhaps). There are some that have great interpersonal skills but are lacking the technical components.  You might really like them, and they can get you somewhat better, but their ‘toolkit’ is limited.  Then there are those that have both; great technical skills & interpersonal skills!  Having both is what you should strive for!  The Canadian Physiotherapy Association has a Leadership Division, which members can be a part of.  They focus on ‘soft skill’ acquisition, and it’s important to have that skill set!

But let’s get back to energy.  Have you consciously thought about what kind of energy you are putting into your treatments?  Everything is energy.  The laser, ultrasound, PEMF & shockwave transmit different kinds of energy.  The effectiveness of manual therapies can be explained in terms of neurophysiology, but what sets off the cascade of neurophysiologic effects?  The application of a mechanical energy to the body tissues!  So why do we not typically acknowledge the metaphysical energy that a healthcare practitioner can purposefully (or unconsciously) transmit to a patient or the energy that a practitioner (or clinic) can create as a general atmosphere?  Should this not also be a goal? Can it not make a different in the overall effectiveness?

Now I am not going to say that everyone should run out and take a course in reiki.  I don’t think you actually need to do that to transmit a healing energy. But I do think that people need to slow down a bit and be a little less clinical.  Talk to the dog, talk to the owner, pet the dog between the selection of different modalities, apologize to the dog if you find a sore spot, be empathetic, accept doggy kisses, breath deeply, create a calming energy within your own body, genuinely appreciate the dog in front of you, and set your intention for healing.  Every touch should be a transfer of energy – and yes, I am serious!  Try it!  If you are in the right state, your hands should feel warm and a little tingly!

Now in regards to the energy you create in the room.  Sure, we could talk about atmosphere and lack of clutter, and warm paint colours, but I don’t care so much about that! I do however want to talk about engaging with your clients.  Getting to know them and making the appointment something that they can look forward to as well!  Ideally everyone at your clinic should be making the effort to get to know the dogs and the people.  Make an effort to remember what people do for a living, the general age of their children or grandchildren, their hobbies, etc.  If your memory is shot, then put a sheet of paper in their file (or document it somewhere on their electronic file) and write in these little things.  I promise, it will make a difference!

So if 33% of any treatment success can be attributed to the placebo effect, and technical skills alone do not equate to full success, then perhaps the missing ingredient (or maybe the unspoken component) in any treatment, is the energy transfer!  So I challenge all of you to go out and make this week a ‘conscious energy transfer week’!!!  And let me know what you notice!

Until next time, CHEERS!

Laurie

 

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31 Jul 2016

The Negative Review

When trying to come up with a blog topic, I tend to review the past week at the clinic, go through a selection of weekly blogs, check my inbox for good Q & A’s, and just sit with the question of what to write and see what jumps out.  This week, the clinic had one distressing negative review on Facebook AND I found a blog that discussed ‘the benefits of the negative review’.  Well, I figured two pieces of ‘inspiration’ had to be a sign that I was meant to write on this topic.

So the story goes like this…  We had a bit of a high maintenance client book in wanting to get a stifle brace for her dog (full cruciate tear).  We accommodated the request, casted the dog, took all pictures, measurements, and payment.  The client was instructed that the process can sometimes take 6-8 weeks between mailing the cast, fabrication of the brace, and the mailing back of the brace).  So, long story short, we popped it in the mail and waited. Well, Canada Post had been threatening a postal strike, so our fingers were crossed that all would go well.  As it turns out, no strike was had, but it was quite evident that there were some ‘work to rule’ antics going on, and that cast sat in a Canada Post warehouse for 3 weeks before crossing the border!  This meant that the time delay for the brace was longer than desired, however still within the time frame given, and the issue was outside of our control.

However that was strike one against us according to the client.

Strike two came when the brace was taking longer than expected to arrive and the owner called the bracing company, obtained the courier tracking number to know when it would arrive at the clinic, and insisted that she book an appointment for the same day.  Normally we don’t do this.  We can’t guarantee the delivery, nor delivery time, and we also like to check over the brace to ensure everything looks correct and all parts are included before scheduling the fitting.  So needless to say, that part of things went awry.  The owner wanted the last appointment of the day on Friday (3pm), and was told that if the brace hadn’t arrived before noon, we’d have to cancel.  So that’s what happened.  Now, since the last appointment was canceled, the therapist and staff went home just after 3pm.  Low and behold, the courier showed up at 3:20 and delivered the brace to our neighbouring business since we were closed.  But the owner saw this when she went online to track the parcel and within a couple of hours posted a scathing review of my business on Facebook.  

So, when anything negative like this happens, it immediately ruins my day (and usually the next day, and sometimes the following week too)!  This particular review was really unwarranted because we could not control Canada Post, nor the delivery time of the courier, and beyond that, we let ourselves be bullied into giving this client an appointment on the intended delivery date even though it is against our standard protocol to do so.  It makes me want to let out a good old Charlie Brown ‘arrgghhh’!

That’s the story anyways… but the point of the blog is to talk about what to do in this scenario.  So one of my assistants drafted up a response and gave it to me to review.  I thought it was excellent.  It stated that we were sorry that she was disappointed with the service we were able to provide, and proceeded to explain the happenings. We ended with, ‘we look forward to seeing you on Monday for your appointment.’  (And guess what?  She arrived on Monday, had the brace fitting, was pleasant, and left the clinic without incident!  But that review is still online!)  

The blog I read on the subject, http://www.lifelearn.com/2016/07/29/the-benefits-of-negative-reviews/says that a negative review can be good.  You can analyze what’s going on in your clinic to see what could have been done differently or if there is a theme of complaints pointing towards an area of your business that needs attention, and deal with this issue(s).  Additionally, you simply reply to the complaint calmly, apologizing (as & where appropriate), and/or providing additional information (again, as or where appropriate).  In cases where your business was at fault, can you offer to make the situation right?  In cases where the complaint was unfounded, can you simply provide accurate information? – Not so much to appease the complainer, but more so for the people that read reviews to determine if they want to do business with you in the future.  People reading reviews don’t always expect 5/5 from everyone, so one oddball negative review along side of several positives is actually realistic, and the fact that the review was responded to in a calm professional polite manner is equally important to those reading it long after the incident has passed.

And what should you take home from this?  Two things:  1) Check out your reviews.  Search your business name and see what’s been said about your business on Yelp, Google, Facebook, etc.  Make it someone’s job to know what’s being said about you.  2) Do not shy away from the negative reviews.  Calm yourself, swallow a bit of pride, and either attempt to make it right, or explain what needs explaining for others to see.  Perhaps that negative review can have a silver lining!

Cheers!  Laurie

 

 

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07 Aug 2016

Reality Check

What do you do when the dog owner either can't see or is dissatisfied with the improvements their dog is making?  This is a bit of a tough dilemma.  On one hand you question yourself, your diagnosis, your treatment plan, and your assessment of the dog (this is where objective outcome measures come in handy).  On the other hand, you struggle with getting the owner to see that improvements are being made or have been made and to keep them encouraged and positive.

The inspiration for this blog came from a podcast I recently listened to( http://www.themanualtherapist.com/2016/07/untold-physio-stories-s2e1-being-tough.html )  where the story being told was of a PT/Physio treating a 16 year old girl whose mother seemed to be the biggest barrier to the daughters response to treatment.  It reminded me of some of my past human patients and of one particular dog-owner client.

So the dog in question is a large breed 12 year old male dog.  He had a TPLO with complications causing some degree of residual neurological deficits in the leg.  He was also found subsequently to have a brain tumour (radiation completed) and a lumbar disc (which I think is a non-clinical finding).  And did I forget to mention the elbow arthritis?  He's been a healthy, rarely lame, strong, big boy up until the stifle surgery.  With all that's happened to this dog, I've been fairly pleased with his rehab, but I think he's hit the ceiling of his recovery.  The surgical leg is not 100% but it improved more than I ever thought it would!

The trouble comes in the fact that the owner keeps asking, "What more can be done?"  Now, I'm all for providing every opportunity for healing, but I also think that there needs to be some amount of realism as well.  What does one do to help owners see the reality of the situation and to appreciate the blessings while not having them feel as though you are giving up on their dog?

So I think the answer comes in two parts.  The first part is to actually try different things to help with healing (within reason… for example, I'd not suggest a surgery as a 'guess' that it might help).  Any conservative management regime that can do no harm would be advocated.  By doing so, you are proving that you have tried, have thought outside the box, have exhausted your ability.  Perhaps you even make a referral to another complementary healthcare provided that can offer services different than yours.  Simply put, you put in the effort!  Secondly, you have the reality conversation.  But it's not a depressing conversation, it should be a conversation about seeing the blessings.  Seeing how much function their dog does have.  Seeing how the dog still has a great quality of life.  Helping the owner to appreciate the dog they have as compared to the dog he was when he was younger (or before an injury or ailment).  It can be hard for some people to come to this point.

I am reminded of another case.  I had told the owners that their dog likely had some arthritis in his knee.  They were devastated!  "He'll always have pain!  He'll never be able to go on day-long hikes with us!  He'll always need supplements and/or medication!"  My reply was, "There are far worse things in this world than arthritis.  I have it, you likely have it, and most people will get it.  It's manageable.  It's not life threatening."  These people were not convinced until we headed back out to reception and in the waiting room was a paralyzed dog that was happy as all-get-out to come for therapy with his equally happy owners, who were heralding, "Hi Auntie Laurie, look who's here to see you!"  I made a fuss over the paralyzed dog and then returned to my arthritis dog owners and gave them a 'see what I mean' look.  They actually said, "I see what you mean now.  Thank you!"

So my challenge to you is to think about the following: Given a similar situation, how might you facilitate that change in mindset for people?  How would you get an owner to be realistic and positive all at the same time?

I welcome your replies!

 

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21 Aug 2016

Olympic Realizations

         

Have you been glued to the television?  It’s been hard to pull away from all of the Olympic action!  Of course, I love watching the Canadians, but it’s been awesome watching some of the other countries do well.  I find that I’m also loving watching anytime that Brazil plays as well, because it’s awesome to watch and hear the crowd get so passionate about cheering for their home team.  But what I want to tell you is about how Canadians view Olympic medals.

Every night, my hubby and I watch highlights of the Olympics for the day and watch how the Canadians did.  So, if you look at the medal standings, nobody else can touch the number of medals racked up by the USA.  But does that make the rest of the teams failures or losers?  NO! They are still top in their country.  They are still competing with the very best in the world.  They still deserve to be celebrated.

Now what struck me was on day 5, when the TV announces exuberantly announced that Canada had won a medal EVERY day of he Olympics.  We were five for five!!!  And I found myself feeling so full of pride!  Then I went online to see where we stood in the medal standings, just to realize that we were #22 in the medal standings.  Hmmm.  But I found that I was still happy and proud and so delighted for our athletes.  As I write this, we are #10 in the total medal standings (#20 in gold medal counting), but this Olympics has seen Canada win more medals than we have EVER won in a Summer Olympics.  

So I wonder to myself, is this just a Canadian thing?  Are we just easy to please for a personal best?  As excited for a bronze medal as we are for a gold?  Delighted to have qualified?  Eager to announce that ‘Athlete so-and-so’ made the best debut in a certain sport as compared to any Canadian before him.  Proud to mention each and every athlete and how they did in their sport that day, even if it was a non-qualification?  This is how I found the Canadian Broadcast Corporation to be announcing the Olympics for Canadian viewers.  Is it just a Canadian thing?  No, ‘rah, rah, we’re the best’.  No leaving out athletes that didn’t medal.  Just a pride for what we did accomplish – no ego – no arrogance – just happiness.  And I thought to myself, ‘What can I take away from experiencing the Olympics in this way?’

This made me think about competition, and more specifically competition in business.  So one way of looking at competition is to believe that the goal is to win all the time:  “Be the best, destroy the rest.”   But whom does this serve?  It only serves your ego and your greed.  Now don’t get me wrong.  I do want you to be your best, and to do the best you can, and to continue to get better, and provide better and better services, and to grow your business.  These are all worthy goals to strive for!  Do not get complacent!  However, can’t there be more than one winner?  If all rehab facilities & practitioners delivered top quality service, wouldn’t it be the animals that are the real winners?

This leads me to the following:

1) I remember talking to a businesswoman a number of years ago, and she said, “I wonder if I would have as much passion for doing this if my competition didn’t exist?”   We discussed it for a while, and we came to the conclusion that ‘no competition’ might not be as exciting.

2) Another ‘new-to-rehab’ person just e-mailed me 2 nights ago.  She was tickled pink (aka. Happy) because at a recent agility trial, she had a booth and saw a number of injured dogs and had worked collaboratively with some massage therapists to treat the dogs in a very wholistic way.  She was over the moon (aka. Happy) with her success at the event and the collaboration she had with the massage practitioners.  

3) The last point I want to bring forth stems from the multitude of e-mails I’ve received over the last few years.  I’ve received dozens upon dozens of e-mails from practitioners thanking me for teaching them something, or for a piece of information learned on FourLeg that helped them to treat a particular patient of theirs.  “Without your teaching, I never would have known where to look or how to fix that problem.”  So, let’s put that into the achieving a ‘personal best’ for that practitioner.

And when we put it all together, here’s what the Olympics has made me realize.  

  • Be grateful for your competition.  They force you to strive to be better, and in the end, more animals are being served because you both (or all) exist.
  • Can you collaborate?  Can you make your services about ‘patient centred care’ and look at what others can bring to the table for the best interest of the patient?  Can everyone win?
  • Strive for your personal best.  Learn more.  Do more.  Be more.

On that note, Yah Canada!  Number 10 in the world (or #20 if you only care about gold) of the Olympic summer games!

Cheers!  Laurie

 

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13 Nov 2016

Business Lessons I Learned this Week

Business Sucess

This week I had the wonderful opportunity to attend a business workshop – Business Freedom Blueprint by Paul Wright.  Paul’s a physiotherapist-entrepreneur.  He owned several clinics, figured out the formula to success.  Sold them all and then went into business education.

It was a great workshop filled with physiotherapy clinic owners, practitioners, and some chiropractors.  Paul took us through 6 areas that lead to success and 9 action items to implement.

In this blog, I want to cover my favourite 3 ‘a-ha’ items from the talk:

1.The Written Report of Findings

How many of you actually write out your findings, treatment plan and recommendations for future therapy for your clients?  Do you give them a written page to take home?  Well that one piece of paper could be golden!  Most people don’t pay full attention to what you say.  They forget what you recommended.  So write it out!  So simple!  A piece of paper. Fill in the blanks. Tick the boxes.  Make a copy for the chart.  Hand the original to the client!  Include your findings / diagnosis, the treatment you did that day, your suggestions of what future treatments could include, and your recommendation for future bookings (how many appointments, how often).

THIS is concrete.  THIS shows that you have conviction in your assessment and treatment plan.  THIS conveys confidence and allows the owners to feel comfortable in their choice to entrust YOU with the care of their beloved pet.  So start writing out your Report of Findings.

2.Key Performance Indicators

What gets measured improves.  So what are you tracking?  

Do you have a Drop Off list, and do you call people back when they’ve failed to show up or return after a month?  If not, start!  This along can tap into untold dollars.  More often than not, people have forgotten, or gotten busy.  They just need a wee nudge to get back on track.  So call!  Check in on their dog.  The script should include asking how their pet is doing.  Is he / she 100% better?  If not, you’ like to help improve him / her.  

Maybe try tracking the number of new patient re-books, the time frame between rebooks, the patient visit average over a 3-month / 6-month / 12-month period.  How do each of the practitioners compare?  Can you improve your numbers?  Can you set goals for these numbers?

3.  Check Lists! 

Make them!  Make sure that there are check lists for all the things that happen with each new patient.  Did they get a copy of their Report of Findings, the clinic & therapist info, the cancellation policy, informed consent, etc.?  

What are the things that each therapist should be doing?  Patient call backs.  Tidy the treatment room.  Doctor reports.  The written report of findings.  New patient follow-up.

What things need to be done daily, weekly, monthly?  Write them out.  Create the lists.  Use them!

So, I’m going to bust my tail to start implementing some of these items and see where it grows my business.  THEN, stay tuned for a FourLeg / Laurie Edge-Hughes course on Business Strategies for Growth.  In the mean-time, try these 3 things on for size and see what it does for your practice!

Cheers!

Laurie

 

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01 Jan 2017

Marketing Review - My Clinic, Now What About Yours?

Time for Review

Hey Gang,

 

This week, I felt like I should write some kind of a year in review blog, or be inspirational, or something.  But I just wasn’t finding my inspiration, until I came upon the following blog:

http://www.themanualtherapist.com/2016/12/3-business-competencies-pts-need-to-know.html

 

The blog was about business competencies PTs need to know.  So, to cut and past the nitty gritty from the blog:

1. Marketing. A company’s website is the only digital footprint they have 100% control over. Many businesses rely upon social media, ads, or other outlets. Still, those are platforms owned by other companies. Beyond this, so very many physical therapy businesses have little regular content creation, do not advertise, rely upon word of mouth/digital media, and do little more than water the fickle referral source. Sadly, what we are finding is that there are a lot of sales behaviors going on… to get more people through the door. Little is being done to build the brand of a practice or even the brand of the Physical Therapist.

2. Public Relations. We tend to be quiet professionals — a feeling of weirdness comes across us if we are to promote what we do… as if it was the world’s greatest thing ever. Our most basic physical therapy content and knowledge base IS mind-blowingly-the-world’s-greatest-thing-ever to the general public as soooo many of them suffer from MSK concerns. If we don’t have community presence, we will have no community representation. If we are not well represented, then we will have little to no community engagement. We need to get out there!

3. Sales. Personally, I see sales as a customer centered conversation on presenting solutions for their needs. We need to recognize within ourselves that sales is presenting a solution & removing the “Nos” so that people can get to “Yes.” We never see top brands such as Apple or Disney, waver on their price points no matter what the market is doing. Why? Because, they stand strong in the value they ring.

 

Okay, now that alone is great information, but what I thought might be more interesting to you is to share what I do for marketing at my clinic, The Canine Fitness Centre.  This is an exercise that I do with each and every intern that comes through my clinic (because one of the self-evaluation questions for interns going through the final step of the Canine Rehab Institute program, is to ask / learn about what the clinic does for marketing).

 

As part of our New Client System:

•Each client’s vet receives the initial assessment report.

•(Soon to be implemented), each client will receive a ‘report of findings’ telling them what we found, what treatments we provided, what treatments we might use in the future and a recommendation of number & frequency of future appointments.

•The dog is then sent a letter in the mail welcoming them to the clinic, and providing them with a $5.00 “CFC buck” which they can use at the clinic for their next appointment or for product sold at the clinic.

•They are then added to our e-mail list so that we can contact them about promotions, blog posts, and clinic news.

 

Daily Marketing Systems:

•We try to post on Facebook daily… or schedule posts.  When the post is about something happening, or available at the clinic, then I’ll ‘promote or boost’ the post.  This means that I pay $5.00 to Facebook for the post so that it gets in-front of more of our FB viewers.

 

Monthly Marketing Systems:

•We try to post an informative blog monthly (and then promote it on Facebook and by e-blast)

•We send ‘lumpy mail’ thank you’s to the vets that sent us medical information or a referral for a patient to come to see us.  (Lumpy mail just has some small item in it (i.e. a package of gum) with a thank you note and ridiculous phrase related to the item.)

•Other referrals sources (i.e. groomers, daycare facilities, existing clients) will also receive a thank you note with a $10 gift card or something.

•Therapists are given a drop-off report every month to contact patients that stopped coming.

•For a year now, we have been instituting a monthly promotion.

  • Refer a friend
  • Free nail trims
  • ‘Fur-sibling’ new assessment discount.
  • Vet clinic staff initial assessment discount
  • Fluffy to Fit program (2-month program)
  • UWT Special pricing (2-month program)
  • Senior’s Exercise Class
  • Access to my online Preventing Hip Dysplasia course
  • Sale on my Massage Your Own Dog Online Course
  • Christmas ‘cookie’ give-aways 

Quarterly Marketing Systems:

•We have an informative Newsletter that goes out to most of the Calgary and area veterinary clinics

 

Periodic Promotions:

•We will periodically promote products (sale items, new items, novel items.)

•We have tried to target grooming shops to provide them information about our canine rehab clinic and about our human physio clinic as well.

•We also promote the human clinic to our canine owners (since the human clinic targets dog owners)… which means we can cross post the human clinic blog posts.

•Additionally, we have tried to have a few booths at different events over the year (a regional agility trial, & a canine Christmas market).  They take effort and man-power however! 

 

Online Presence:

•I have spent plenty of time working on our website. The goal was to answer questions, speak from the ‘you’ perspective (i.e. you will received…), providing information (articles, videos, & the blog).

•We have instituted an online presence manager (someone that checks that questions on FB are answered, comments on yelp are replied to, our google reviews are adequate.  We also have a sign in the clinic asking clients to review us on Google, Yelp, or Facebook.

 

Next year we have some new things we will be implementing.  From the business seminar I attended in November, we will begin using the One-Minute Practice Manager System.  This is an online system where you track new patients and ensure that all things are occurring… New Patient Register, Tracking promotions, Tracking expenses, Managing communications, Therapist Goal Setting, Admin checklists, etc.  There is another program that I am considering.  It is a little box attached to the phone lines, and it monitors and measures the answering rate.  So, I had my clinic assessed, and we are answering 80% of the calls that come in (PT clinic average is 73%.  The goal is 95%).  It also measures time to answer calls.  Ideally you want all calls answered before 3 rings.  Of the calls we answered, only 50% were answered within the first 3 rings.  So actually, I’m not too disappointed in this, but according to the call evaluator, there is room for improvement.  This could be an area to look into as well!

 

Beyond this I a believer that customer service is critical to a good business. The customer’s experience should be exceptional – from how the owner is greeted and how they are interacted with at every point of contact, to how their dog is treated (as a dog and as patient).

 

And off the top of my head, that’s it (or most of it)!  That has been my business marketing in review.  Looking for marketing ideas as well, check out my workshop at www.staarconference.com!

 

Have a wonderful 2017!  Cheers!

Laurie

 

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11 Jun 2017

Do you use SOAP? Not me! No SOAP for me!

No SOAP

I hate SOAP. I don’t use SOAP.

I use my own charting categories, and I’ll suggest you might like to do the same!

Did I make you raise your eyebrows at the title?  Just a little?  Likely not!  Ah, disappointing…

 

Okay, so when we have interns come to our clinic, they are asked to provide an example of a SOAP note.  I always tell them, we don’t use traditional SOAP notes.  I don’t think they fit an outpatient practice.  Subjective and objective make sense.  Subjective is what the owner tells us happened, how things are going, what they’ve been doing, observing, etc.  Objective is what you find on your clinical evaluation of the dog (gait & movement analysis, what’s painful on palpation or ROM, or movement testing, what’s tight, atrophied, and your objective measures, etc.)  Sensible stuff!  But beyond that, I would like to make suggestions / alterations to the A & P parts of SOAP.

 

Classically, (and I dug out an old text book from 1990 to get this right… a whole text book on SOAP notes!!!), the A is for Assessment, where you would fill out a summarized list of the major issues from the S & O sections.  Okay, so this is likely dandy as part of your initial assessment, but it’s a pain in the butt to do with every charting input.  In our initial assessments, we use PT impression or PT Diagnosis.  That’s where I’d write out my thoughts 1) Suspect OA left shoulder and maybe put some bullets below:  Pain on end ROM flex / ext; Reduced end ROM flex; Off-loading LF leg.  And we’ll often have multiple findings i.e. 2) Rib and T/S dysfunctions, 3) abdominal motor control and timing deficit.  I could add in my goals etc. as well (in my initial assessment primarily).  But let me get back to a follow up treatment note.

 

In my follow up notes, I’ll use Subjective & Objective, and if there is something new that has come up or a change in my thinking of what’s going on (or a subtle nuance to what I think is going on), I’ll add in “I” for Impression.  Then I like to go with Rx (meaning treatment).  If you prefer you could use Tx for treatment.  Here I write what I did during the treatment THAT DAY.  I include therapy type, dosage, body part treated, etc.  Laser 2J/cm2 Superpulsed, Mobilizations T/S (dorsal glides and Transverse Pressures) – Grades 3 - 4.  (P.S.  I hate charting ‘amounts’ of manual therapy… it’s a ‘feel’ sort of a thing.  But that’s another topic.)  

 

If the dog had a fabulous response to my therapy (or in the case of a neuro dog) and I was to describe how the animal was after the treatment (or how he was during the session), then I’ll add a category for ‘Outcome’.  I think this is important.

 

Plan for me, means 1) What I plan to do next time, 2) What I’ve prescribed as homework, 3) When I want to see the patient again, 4) Anything else I PLAN to do (i.e. send note to referring doctor, email client exercise sheet, etc.)

 

All in all, I don’t use SOAP.  I use SOIRxOP!  And I feel ‘clean’ just the same!  If you’ve been struggling with SOAP, I hope this might work for you as well!

 

Cheers!  Laurie

 

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