Laurie's Blogs.

P.S. The picture is just a joke... but the rest of the blog is real!

This blog comes about as a result of an ever-present argument I see brought forth (mostly by vets and technicians) in regards to “PT’s needing to be supervised by a vet, because they might not recognize other issues or comorbidities in their animal patients.”  Now, flat out, I’m going to say that I don’t agree with this statement, especially as someone that has taught vets and techs how to recognize neuromusculoskeletal (NMSK) issues, and how to know when an issue IS NMSK and when it is not.  But, the point of my blog is to discuss with ALL canine rehab practitioners when to know to raise the red flag.  Quite frankly, because it’s all of us that need to know how to identify when something isn’t right!!  And that’s what it boils down to – is this right or not?

But first, a story.  Recently, one of my staff therapists raised a red flag.  She was treating a 12-year-old GSD that she and I both see from time to time.  The poor old boy has multiple issues, amongst which, one is known OA of his elbow.  He’s been lame on that elbow for years, but it’s gotten worse of late.  One might chock that up to a progression of his elbow pathology.  However, my colleague fully evaluated the limb and found bone pain.  We sent he and his caregiver back to their vet, requesting that an x-ray might be appropriate.  Sure enough, just as all of you would suspect at this point in reading, the x-ray shows what could be an osteosarcoma.  Interestingly, the referring vet and the specialists were all commenting on how EARLY we found it and that they were AMAZED that we picked it up with our palpation.  This is not just a one-off story, I could recount several.

The point is that all of us need to look at each patient that comes into our care, EACH TIME they come in and decide, is this case progressing like it should?  Is the suspected injury presenting as ‘typical’?  Has there been a decline in function for which the owner cannot explain (by way of, “He did xyz and has been sore since”)?  Has there been a decline in function for which you cannot pinpoint an exacerbation of pain at the site of the known injury or find a new injury?  Is there a change in mentation or attitude?  Are you not seeing results after (no more than) three treatments?  Is the owner telling you that ‘something has changed’ or ‘he’s not acting himself’, etc.?  Does the soreness or lameness not match what you find on palpation (i.e. you can’t find anything very sore, but the dog is very lame)?

They key to all of these questions is to know what’s normal.  When you know normal inside out and backwards, you can then better identify abnormal.  This is when clinical reasoning becomes paramount.  Check out the following clinical reasoning form.  It was what we had to do for our case presentations as part of my Master in Animal Physiotherapy degree.  http://www.fourleg.com/media/Clinical%20Reasoning.pdf Working through a case while thinking of all of these questions, can really help you to identify the cases that just don’t add up.  And those are the ones you refer back to your referring veterinarians for further diagnostics.