Laurie's Blogs.

My last blog ruffled some feathers. (Fair enough.)  But, it allowed for an intelligent conversation back and forth, which I'd like to share below.

Laurie:

I have been subscribed to your emails since I attended your roundtable discussion on cruciate disease at the last STAAR conference.  I find it informative and enjoyable.

Unfortunately, I did not find your latest blog so enjoyable.  I guess my feelings have ranged from angry to insulted to annoyed.  I guess perturbed is probably the most accurate term.

I assume that the manual therapy class to which you are referring is the one being offered through the University of Tennessee that is being taught by Drs Levine, Gross and Burke.  Although I agree that the language being used to describe manual therapy to be the “hottest up and coming topic” in canine rehabilitative therapy is a bit silly and sensationalist (and probably written by the marketing department and not the instructors), I do feel it is inappropriate for you to attack the training program at UTenn and those of us who do not currently provide manual therapy on our patients.

To say that those of us who went through this program “went through the wrong place to train” is down right insulting to me and all of our colleagues who became Certified Canine Rehabilitation Practitioners.  I don’t feel that I am “failing my patients” because I do not perform manual therapy on them, and it is quite rude of you to insinuate that I am.  There are many many patients who are walking around with no, or greatly reduced, pain because of the treatments that have been provided in my hospital.

When going through my training, there was an online lecture presented by Dr Gross on manual therapy.  Although I am sure it is common knowledge to Physical Therapists, it was all a foreign language to me.  Unfortunately, we did not receive any hands on instruction in this.  I did approach both of the PT’s with whom I did my externships about manual therapy, but quickly realized it was NOT something I was going to pick up quickly in a few days.  Besides, there was more than enough to learn initially when I first started providing rehabilitative services.

I think we can both agree, there is always more to learn.  Since the day I started offering canine rehabilitation, I have constantly been trying to learn as much as I can as quickly as I can.  Being the owner of a small animal veterinary practice, my time is not restricted to just learning about rehabilitation, however.  I’ve got cats to spay, cruciate surgeries to perform, ear infections to treat, and deal with all of the other maladies that pets can have.  I don’t think I am “failing my patients” because I don’t know every rehab therapy available.

I don’t accuse you of failing your patients because you don’t perform PRP or stem cell therapy or prescribe medications to help them.  I realize you use the tools available in your toolbox to help your patients.  We can’t know it all.

Over the past few months, I have realized that I just can not provide the hands on care that my rehab patients should have and still run a veterinary practice.  Because of that, I hired a PT/CCRT to do the actual treatments.  This has dramatically helped our patient care, and she and I are in constant communication on the status of each patient.  She is much more “hands on” than I have ever been with these cases.  Although she readily admits she is not very experienced in manual therapy on dogs, she will be attending one of your workshops in California in the upcoming months.

I thank you for indulging me by reading my “rant”.  I greatly respect your knowledge, energy and enthusiasm. I would just ask that you please be a bit more respectful of others who do not share your training path.

[I am leaving the name annonymous, as I have not asked permission to share this, but felt that the content was very useful... any other identifiable information has also been changed. - Laurie]

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Dear [veterinarian],

Thank you for taking the time to write and express your disappointment with my latest Four Leg blog.  I appreciate you taking the time to do so.

I wrote the blog before the firestorm of e-mails started to surface on the VetRehab chat group.  If you have seen them, you can see the wealth of emotion that the Certification Course in Canine Manual Therapy has created.

My blog should not have said, “if you took training in canine rehabilitation and didn’t learn the fundamentals of manual therapy… then you went to the wrong place to train!”  You’re correct, that wasn’t a fair comment.  I am however, very upset that Tennessee does not teach adequate manual therapy techniques.  I didn’t actually know that it was just a lecture without any hands on.  CRI has slashed the manual therapy training their students receive by ½ in the last couple of years since I left their faculty.  It is such an important part of rehab.  So, this saddens me greatly.

As a bit of history, there used to be ‘old school’ physical therapists that practiced ‘HUM’r therapy’ (i.e. hot pack, ultrasound, & massage only).  As our profession grew in knowledge, skill, and reputation, these HUM’r clinics gave physical therapy a bad name. It was drilled into up-and-coming PT students, younger therapists, and those attending continuing education courses that just doing hot pack, ultrasound, and massage was not considered comprehensive rehabilitation.  We were told that to do so was to do a disservice to our profession and was letting down not only our patients, but all other physical therapists that we were now also representing.

The physical therapy profession has grown exponentially over the last 50 years, and manual therapy is a huge part of that growth.  (As has been research into physical therapy techniques and evidence based practice.)  So, when I practice and teach canine rehabilitation I look at it in the same way.  All patients should get comprehensive care (modalities, manual therapy, exercise, and education).  Since there are dog owners who may not have first-hand experience with physical therapy themselves, they only know physical therapy to be what their dog receives for rehabilitation.  As such, I always hope that everyone performing canine rehab is providing comprehensive care which mirrors the quality of care that one should expect when going to a physical therapist for themselves.

So, my true disappointment is with the programs that do not teach manual therapy as a fundamental part of rehab.  The lack of teaching manual therapy skills is a huge disservice to the students they teach.  If it can’t be fit into the current time allotted to the curricula, then make the certification courses longer!  Not shorter!  There is so much to learn, but manual therapy, at least the basics, needs to be taught within certification programs.

I commend you for taking rehab certification, and I further commend you on realizing that to do it well, you need to be dedicated to that area of practice.  In your case, that meant hiring a PT.  For others, it could be dedicating their practice to rehab.  For those in between, those ‘dabbling’ in rehab, they are providing better assessments and can give better suggestions for managing a case (i.e. some therapeutic exercises for a soft tissue lesion or a better post-op cruciate rehab protocol), but it is not comprehensive rehab without the manual therapy. Physical therapy and rehab does not include PRP or stem cells.  It’s not prescribing medications. It’s not doing surgery.  It is manual therapy, modalities, therapeutic exercise, and education.  Those are the fundamental underpinnings of the rehabilitation / physical therapy profession. 

I do apologize for not doing a better job at expressing myself without being inflammatory or insulting.  I’m sorry for offending you.

Sincerely,

Laurie

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Laurie:

Thank you very much for your thoughtful reply.

I see the threads on Yahoo, and I’m staying out of that mess!

It does sadden me to see people who I greatly respect, and have taught me so much, fighting and arguing with each other.  I would hate to see this turn in to a PT vs DVM mess.

You make a good point that PRP, stem cell and medications are not rehabilitation.  I guess I don’t really have a good definition of the term.  I just want to get my patients up and walking and free of pain using whatever methods are available to me!  I am starting acupuncture training this spring and I think I may need to continue practicing until I am in my 70’s (56 now) until I am able to take all of the CE I want to take!

I do agree that manual therapy should be a big part of what we do.  Since I hired a PT I dramatically changed how we handle rehab cases.  Instead of telling a technician to have the pet do 10 sit to stands and get on the wobble board for 5 minutes, I just let her know what we want to accomplish and then I let her go to town.  Her PT skills are amazing and are a big help to my patients.  I am very hopeful that she will be able to add additional skills to her toolbox after attending your manual therapy session in the future.

Signed,

[Veterinarian]