In the human world, I was taught, that as a physiotherapist, my goal was to treat a patient with the goal to get them to ‘discharge’. Maintenance was frowned upon. Perhaps it was just because insurance companies didn’t want to pay for maintenance. Health care (private or public) is still very much about treating ‘disease’ as compared to fostering health and preventing disease. I think this attitude and approach needs to change in human health care.
Veterinary medicine encourages a yearly checkup. This makes good sense, especially since animals can’t speak for themselves. It is beneficial for someone that can evaluate animal signs and symptoms to be able to check up on that animal to detect changes in health status and implement treatments and plans accordingly. Animal rehabilitation practices and practitioners are well suited to serve as maintenance and tune up check points / checkers as well.
A few examples of late:
1. I saw an agility dog last month. The owner has a regular appointment ever 2 to 3 months. This time, she noted that dog ‘looked funny’ after practice one day the previous week. What I found was some very slight swelling at the stifle joint (pain to palpate the posteromedial joint line sulcus). Full ROM, just some discomfort at very end range. No drawer and no pain to test drawer. The tiny swelling and end range findings allowed me to advise to owner that I was concerned that her dog has “tweaked her cruciate ligament” (owner language so as not to alarm, but be specific enough that she would listen to my advice.) I advised no agility, no ball play, no house-mate play, yes to walks, basic obedience, and ‘nose-work’. Last week was 3 weeks later, and I think she’s good to return to agility. It was the regular checkup that in my opinion likely prevented a more serious injury.
2.I have new clients with a Silken Windhound (gorgeous dog) with a medial shoulder hypermobility. They had gone through a number of tests, nobody could tell them what it was or what to do… so they finally get referred to my clinic and their vets begs me personally to see the dog. Now, the case is not complicated and the issue is not severe or acute. It’s basically what I see day in and day out with my sporting dogs… they all have one or two medial shoulder hypermobility issues. So, I give them some exercises and allow them to get back to longer leash walks (and mobilize a SIJ issue, lumbar spine issues, some ribs too, and laser the shoulder) . Fast forward a month, and the dog returns and is checking out fantastic, I’m authorizing much longer walks (which the owner is leery of, because the last time they did longer, she relapsed). I explain that this shoulder condition is the dog’s new normal. We can’t ‘unstretch’ the medial shoulder ligaments – she will pop up lame periodically, and I’ve shown them shoulder wobbles to do, and if she needs more, she comes in for a tune up! No different than you or I having a troublesome knee, back, neck, shoulder, or wrist. It is what it is. We don’t stay ‘perfect’ throughout a lifetime. We manage our bodies and the insults we hurl at them! We all require a periodic checkup, tune up, and some maintenance work!
3.The next case is a surprise success story. She’s a Chesapeake Bay Retriever that had some ‘odd’ head wobbles / tremor that the neurologist couldn’t quite figure out, but decided that without any other differentials, the issue must be epilepsy. However, the episodes started to come on after a traumatic injury where the dog was tied up and tried to run out to get to the owners (who were getting a boat ready to launch). She hit the end of the line and was flipped off her feet. It happened not once, but twice! When the dog finally makes her way to my treatment room, I look at the atlanto-axial joint and the atlanto-occipital joint, where I find dysfunction. I’ve treated her once or twice a month (mobilizations and laser) for about 8 months. In the beginning, she’d do well unless she rough-housed with another dog, or one day a man at the park ‘aggressively petted her on the head’. After those incidents, she’d have an episode or two of head tremours. Fast forward and the last 3 months she’s had no episodes! The owner is delighted and insists that she wants to continue with periodic ‘maintenance’ to catch any joint issues as they arise and before they become problems!
Honestly, the majority of my case load is maintenance (because I typically have a closed case load) so that I can treat all of my regulars. They’re regulars because they’ve seen the times I’ve found things that they didn’t know about, but when ‘fixed’ made a difference to performance, or because they know their dog has an issue and needs a tune up here and there, or because they witnessed their dog have a crash or a mis-step and they figure I might find something that needs to be addressed.
While getting a dog through a post-surgical recovery is fantastic, and teaching a dog to walk again is extremely rewarding, I do love my maintenance clients. The sporting dogs, the show dogs, and the much loved pet dogs with overly doting owners. I have learned so much from them in that I just check them out from head to tail. Sometimes I find a correlation with things the owner is noticing. Sometimes I invent new treatments because they challenge me to think outside the box. And I get to practice new techniques on them and their owners are always happy to give me feedback on whether or not they noticed anything new or different afterwards.
So, my suggestion is to collect a bunch of ‘regulars’ in your practice! Tune ups, checkups, and maintenance are fantastic preventative health care!
On that note, have a pro-active week ahead!