Rehab is hard work

Most vets and canine rehab therapist say that for dogs with DM that rehab is only maintenance. There is some truth to that in the fact that DM will still "win" in the end. However, Sierra's rehab has been REHABILITATIVE, meaning she is building muscle strength, endurance, coordination and improved functional skills for walking and playing.

The swimming is going really well. I am now timing her, rather then measuring her swimming by laps. We are doing 10min 2x/week. When we get to 20min 2x/week then I will add another day. I am just not sure how long the weather will hold out for me. I am not sure I can find a place to swim her through the winter.

I can still see a right sided weakness in her hind limb. It is apparent when she swims, walks and stands for long periods of time. I am able to do AAROM in the water to gain more range. This also seems to cue her to generate more force with this extremity.

It appeared that she had a setback that corresponded with the antibiotic use for her infected foot. The infection in her foot was mild and the swelling had begun to go down prior to starting the antibiotics. However, taking antibiotics with meals three times a day was a challenge for all of us. She didn't want to eat and I was force feeding her the medicine more often then not. After the course of antibiotics I have seen a gradual return of her hind limb function. I am not sure what the interaction was for her between the antibiotics and the DM, but it sure did scare me.

• Rehabilitation Tips
o It is important that all exercise be performed in moderation. Fatigue will only increase your weakness and rob you of energy that you need for your daily routines and the activities your pet enjoys.
o Passive range of motion exercises can be performed standing or in gravity eliminated position (such as laying down)
o Utilize light massage, regular exercise, and keep your dog mentally active. These are extremely valuable in maintaining muscle function and bringing about remission of symptoms. Deep tissue massage can stimulate muscle spasms.
o Swimming is the best activity, or other exercises in the cool water, because increased body temperatures can decrease the function of the nerves involved and make symptoms worse.
o Acupuncture has been effective for many dogs with DM
o (from : http://neuro.vetmed.ufl.edu/neuro/DM_Web/DMofGS.htm)
Rehabilitation is best achieved by an increasing schedule of alternative day exercise. Running loose on the owner's property is not adequate; regular periods of programmed continuous exercise are the most important. It is equally important that the patient with DM be allowed to rest on the day when exercise is not programmed. This will allow strained muscles and tendons to heal and increase the build up of muscle strength. The dogs do not have to be confined, only that they are not encouraged to do strenuous exercise on the "off" day. I recommend starting with 5-10 minutes of walking or swimming every other day for 2 weeks. Then, increase the length of exercise time to a goal of 30 minutes twice a week and a long walk of 1 hour once a week.

Bad Day

Sierra had a really bad day today. She refused her breakfast and lunch. She spit up what little antibiotics I tried to give her this morning. She ate some oatmeal and part of her dinner. I skipped her other doses of antibiotics today as she just won't eat. She was looking really weak behind during dinner and then tried to make it down the steps. I didn't have her collar on her from swimming yesterday and so her hind legs gave out on the steps and I had nothing to hold her with. I had to call my boyfriend to help her front end while I fixed her hind legs so she could get down the rest of the steps. She is now "locked" in the basement with us to prevent her from trying to get up and down the steps for the rest of the night.

DM TIPS

· Stress and Fatigue

o Avoid stress and anxiety. For anxiety use of aromatherapy oils included lavender, Roman chamomile and neroli (orange) oil has been successful.

o Fatigue is often among the first difficulties faced by people with MS and fatigue management is a vital area for occupational therapy intervention because of the impact of fatigue on all areas of daily living. In our pets with DM fatigue manifest in various ways. We may see fatigue that prevents our pets from doing things the love or appear to want to do, we may see them stop in the middle of a walk or ball game because they are fatigued. We may also see fatigue at the end of the day and our pet may be more likely to have an injury, fall or incontinence when fatigued.

§ Why fatigue is a problem: Because of damage in various areas of the brain, thoughts and actions require more energy than before. Think of the areas of damage as roadblocks. Each roadblock forces the messages in the brain to take a detour, so movements and thought take increased effort. Muscles with spasticity work against each other, so more effort is needed to complete a task. Depression is a major cause of fatigue for many reasons. Involuntary and poorly-controlled movements force the body to do more work than it otherwise would. Spasticity, depression and tremor are treatable causes of fatigue and should be discussed with the rest of the multi-disciplinary team.

o Fatigue management: here are ideas to limit fatigue in your DM pet

§ Take frequent rest breaks, do not allow your pet to “overdo” it on a good day- you may not see the after effects until a day or two later.

§ Keep your pet cool and comfortable

§ Help them relax through massage or just being close to them

§ Conserve energy, do not let your pet follow you around the house when you are busy doing chores or otherwise engaged. If you have stairs in your home, limit the times the dog is walking up or down the stairs.

§ Keep an activity diary of the things your pet does throughout the day, where he/she walks, sleeps and eats. Log any play time, exercise or therapy. Monitor activity in relation to fatigue.

o Depression is closely linked with fatigue in people with MS. Consider if this may be impacting your pet. Attempt to spend more time with your pet and provide comfort or activities that your pet enjoys. Help him/her conserve energy while lifting his/her spirits. Sitting out in the yard under a shade tree with his owner may be just the boost to decrease fatigue.

o Other symptoms, such as depression, being in pain, or sleep disturbance from bladder problems or spasms, can all worsen fatigue. Fatigue may also occur as a side effect of medications or be the result of inactivity, poor diet, stress or an infection.

o If necessary, ask your vet about medication for fatigue, there are several medications used in treating fatigue in humans related to MS.

Healing

Sierra's foot is healing and she is mostly not licking it anymore. I think we are through the worst of it. I felt all the old frustration come back- I've not felt that way since before her diagnosis. It was really hard to force her to eat the antibiotics and then fight with her not to lick her foot, while she is ripping off bandages and waking up at 3am to go lick her foot.

This means we'll be able to go back to swimming again this week. I will be putting some vaseline over the area with the sore to hopefully prevent it from become irritated again.

I haven't seen much change with her DM over the last two weeks. She has tired days and days where she is stronger, but it appears that she is holding steady.Standing during dinner time it hard work- I've been watching to see if she is sinking as much in the back lately and it looks like she might be standing taller during dinner these days.

I am going to be attending an introductory course for Occupational therapists interested in Canine Rehabilitation- and it's going to be taught by an OT I know!!

Sierra Walking Mid-July


Sierra needs a napkin- or why the grass works just fine.