Laurie's Blogs.

Over the last few weeks (and years really), I’ve had a number of encounters as it pertains to conservative management of a variety of different cases.  As members are aware (or should be), if you go into the Articles section on FourLeg, you’ll be able to find a number of protocols for conservative management of – Hip Dysplasia, Patellar Luxation, Cruciate Insufficiency, Wobblers, & IVDD, for example.  They’re there to guide you and provide a logical rationale for treatment!

Occasionally, I take a bit of heat for being controversial, for going against convention, for saying that things can be done conservatively when the veterinary norm has been to offer surgery.  I get it.  I’m an ‘outsider’ to the industry, saying things that are contrary to what’s been taught in vet school or what research shows.  But here’s the thing, a little common sense goes a long way!

Firstly, not all dogs are surgical candidates (due to age, breed, medical conditions, etc.).  Secondly, some people just don’t want to do surgery or can’t do surgery.  So shouldn’t there be an option other than surgery or euthanasia?  And before folks say, ‘oh that’s terrible, I would never give just those two options!’  I’ve heard this MANY times!  And I’ve even known of dogs that have been put down because the owners couldn’t or wouldn’t do a surgery and rehabilitation wasn’t presented as an option!

Common sense 101: 
If you have a healthy young or middle-aged dog with a torn cruciate, then surgery followed by rehab is likely to yield the best result.  I’m sure we can all agree on that point.  However, if for any reason surgery would raise some red flags from a health standpoint, or owner standpoint, then conservative management is an option.  And it should be presented as such!

If a dog has a patellar luxation and minimal pain or just a mild luxation, then why not try conservative management.  Many dogs with patellar luxation are walking around quite happily.  Strengthening can do a lot for these cases.  Why not give it a try?  Surgery is always an option if conservative management cannot improve the function of an animal.

Many of the surgeries for juvenile dogs with hip dysplasia aren’t great!  I’m not a fan of the juvenile symphiodesis, or the triple or double pelvic osteotomy.  A femoral head excision is a bit drastic, but can be undertaken at any point along the dog’s development.  So why rush into it? A total hip replacement could be considered the gold standard, but the dog needs to be skeletally mature, and the owners need a lot of money to afford it.  So, here is another place for conservative management.

Intervertebral disc disease (IVDD), especially with severe neurologic signs tends to warrant an immediate referral for surgical intervention.  Yet again, some dogs may not be candidates due to health or finances.  And clinically, we’ve seen some miracles here!  IVDD cases with mild to moderate signs, should absolutely, positively, inarguably be offered rehab as a first intervention.  Period.

Lastly, the geriatric version of Wobblers has been shown to have same progression (36 months) whether managed by medication or by surgery.  So why not add rehabilitative therapies to those meds to extend and improve the outcome?  This is a case that I believe should be managed by rehab before surgery should ever, ever be considered. (Another Period!)

What about the research?
Here’s the kicker!  Most research that is looking at conservative management of ‘anything’ in the veterinary world is describing medical management or no treatment… NOT rehab.  So when you analyze research that compares surgery to ‘conservative management’, really study what was meant by ‘conservative management’.  Is it what you would do with your rehab training & knowledge?  Likely not!

Do we need more research?  Yes.  Absolutely yes!  And I would recommend that all rehab persons consider writing up their case reports and case series.  It’s the first line of research, and can provide the stepping-stone to higher levels of research.

Conclusion
So to conclude this little piece, rehab is not just about post-operative care.  It is also an option for non-surgical care.  And that care (rehab) is better than no care and in some instances better than surgery!  So be proud to offer your conservative management as a choice and let your referral sources know that your rehab services are available as conventional and non-conventional options!