Canine Rehabilitation course tomorrow.

I am very excited to be attending the first Canine Rehabilitation course for occupational therapists tomorrow. It's going to be a great day with hands on training. I feel like I will come back with greater insight into OT's role in canine rehabilitation as well as tools for continuing Sierra's rehabilitation.

The last few weeks have been tough for her. She tore open a nail on a walk around town and has been limited to the backyard and house. She seems to have lost some muscle mass and stability. I am glad swimming season is just around the corner.

Coming fall

The weather is quickly changing and swimming is coming to an end. I am hoping the cooler weather is easier on Sierra. She has not gotten back to eating 100% as she was before the antibiotics, but she is doing better and starting to eat her pills again. I have to come up with an alternate plan to swimming for the fall/winter. I plan on taking her for accupuncture, walking with weights and I guess I should get back to my home exercises. She is doing pretty good and I don't want to lose ground. I had a vacation and need to get back into a DM routine.

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.

Swimming

Sierra went swimming on Thursday and the family seemed to love her. She wanted to play with their dog, but I was worried about the exertion of playing and swimming. Wise, as she was very fatigued after swimming. She swam about three circles in each direction around me before we got out of the pool. I was very thankful to have her lifevest on as it helped me direct her. Her plan as to swim in and back to the steps to get out. I am working on teaching her some words to association with swimming, so she will understand the process and feel less stressed. She was pretty tired after her short swim. She will go back on Monday (tomorrow). After swimming she had some trouble getting up/down the outside steps. She also threw up her dinner at 11pm that night. I am not sure if the vomiting was from drinking some pool water or from being fatigued. Luckily, she'll now swim in the morning and get fed in the evening, so hopefully no more vomiting. I need to get a battery for my stopwatch so I can measure her initial endurance and build her up from there. We're just going to do two days per week to start.

Pool

I have a lead on a local neighbor that may allow me to use their pool. We are going to meet them on Thursday. I bought Sierra a new doggie lifejacket as she has not been swimming in awhile and she is pretty deconditioned. I wanted to give her some extra buoyancy to start with. If we get the "all clear" from the neighbor then I will work out a program to built strength and endurance throughout the summer. I think that walking her in the fall and winter will work out okay, since it's cooler, but the hot weather is killing her. I really need someone to remind me to take the last measurement and send it to Eddie's Wheels to see if they have anything refurbished for her. Wish us luck for Thursday.

Daily DM

Sierra has been holding steady and has improved from her physical status at her original evaluation. I have been especially careful to protect her from the heat and over exhaustion. I have had to make some very hard decisions about leaving her home rather then taking her on longer walks or hot car rides- walks and car rides have been some of her favorite activities. However, the physical toll these activities take on her requires a day or more of recovery time. I worry that much like human MS, these stressors could send her into an exacerbation.

I continue to do exercises with her a few times a week. These exercises address range of motion, strength and endurance, sensory stimulation and balance.

ROM, strength and endurance- stabilize metatarsal and distal to the stifle, bring hind leg through anterior/posterior range of motion while dog stabilizes with contralateral HL. I feel a significant amount of spasticity when doing range of motion with Sierra's HL, this makes it harder for her to walk and clear her HL over rough terrain and contributes to knuckling

Strength and endurance- HL is held in dynamic flexion requiring co-contraction of trunk and contralateral hip, gluteal and biceps femoris stability, position is held until Sierra begins to fatigue

Sensory stimulation- HL is ranged to toe touch position in anterior/posterior plane, hind limb lifted to flexion and brought to floor with firm contact to increase proprioceptive input to joints, paw touching to contralateral HL, tail stroking. These exercises help Sierra recieve more information about her HL's. Also use of Linda Tellington Jones "promise wrap" for 20 minutes twice a day when she is having increased difficulty. I have also noticed that Sierra does her own form of sensory stimulation when she goes down the three stairs to go outside. She does not walk down the steps with her HL, but instead bunny hops off with a significant concussion upon landing.

Balance- I provide balance challenges through pelvis at the ishium in an anterior direction and watch for co-contraction and stabilization through trunk and scapula. Balance challenges are provided laterally on point of hip to increase stabilization of latissimus dorsi and oblique abdominals. Sierra has a significant right and left difference on her reactions to balance challenges with difficulty stabilizing her left side when a balance stimulus is applies through R hip. I would like to use a header or handler with her for these exercises to help keep her straight and symmetrical, as she often likes to turn to look at me.

Hopefully I will get some pictures of Sierra doing her exercises soon. I re-stuffed her begs about two weeks ago and this has provided her with increased comfort. I have one additional measurement to call into Eddies' Wheels to see if they might have a cart that would fit her. I want to have her transitioned onto a cart by fall before the weather gets too bad. I am still looking for a swimming option for her.

Diagnosis

Sierra is my 8y7m old Harlequin Great Dane. She received a rule-out diagnosis of Degenerative Myelopathy (DM) on Saturday 5/30/09.

She had been having symptoms for the last three months.

I am an occupational therapist and have been researching canine rehabilitation since learning of her diagnosis. I feel that I have a lot to offer my girl Sierra as well as others going though a rehabilitation with their pet. DM is degenerative as the name suggests- she will not recover from this- it will take her life eventually, but it's what we do between now and then that will matter most for her.

Sierra has had a full life. She has traveled many places with her people, she's hiked, swam and ran alongside my horses when I rode. She has many people who love her.

Here she is at Christmas time with her little brother, a chinese crested, Poe.