Category Archives: Physical Therapy/Rehabilitation

Ah, moving…does it ever go smoothly?



I am happy to report that the move went very well! Except for the unfortunate accident I had involving a beer bottle, my wrist, and a lot of blood. No, I wasn’t drunk! I wasn’t even drinking. I swear. I was unloading my van, trying to get Ali’s big orthopedic bed out, when an errant 6-pack started tumbling toward the door (in that weird combination of slow and fast motion). A couple bottles hurtled past me to the ground and smashed in the gutter and in my panicked attempt to keep more from falling somehow I caused another one to crack open and the jagged pieces hit my wrist on the way down. What a mess…glass and beer everywhere (hi, new neighbors)! Once the blood started gushing and I saw where the three main cuts were (one was right in the suicide place, scarily near my vein, and the other was so deep it would more accurately be described as a “gash”), I started to get faint and called my roommate Maggie at work, just so someone would know where I was in case I passed out and bled to death, and she came immediately with our dusty ALDF first aid kit and bandaged me right up. She is awesome!! Why is this relevant to my Ali blog? Well, it was my right wrist and it was really painful (not to mention disgusting) for a couple days and I need both my hands and arms to deal with Ali without hurting us, so it was tricky. But a little over a week later I am completely healed and trying to be much more careful around glass. Although I think I may be accident prone.

To get to the raison d’être of this blog, Ali is doing really well and has settled nicely at our new place in Petaluma. He is using the ramp successfully and the park across the street is very convenient for us. I take him there 3 times a day (2 on work days) to exercise, go potty, and do ten minutes of standing exercises in his cart. He and Rita, Maggie’s dog, are getting along great and I couldn’t ask for a better canine roommate for him right now. She is pretty low key which is good, because he wanted to play immediately when he met her, and when Ali plays he throws his whole body into and even likes to spin around (his infamous “play spins”), so I had to watch him pretty carefully to make sure he did not overexert himself. It has been interesting adjusting to life outside of one room, because of course he sometimes wants to travel from room to room, or greet Maggie and Rita when they come home, and meet new people when they come over. I have to watch him so he does not drag himself, which he definitely was trying to do a lot at first (and still does sometimes) and when he wants to get up I run over and grab him by his Walkabout rear harness (aka his “shepherd handles”), which I leave on him all day until we go to bed, and assist him by lifting his rear legs so he can walk where he wants using his front. The rest of the time he is on one of his beds. Getting to and from work has been a challenge (obviously compared to the convenience of living in my office, ho, ho, ho). Everything takes so much longer, getting him in and out of the car is kind of tricky (and making sure he doesn’t get himself into some weird position while I am driving), but we are getting into the new routine. Last week we were able to join in our first staff dog walk since his surgery over two months ago, which was great. The other dogs were not quite sure what to make of his wheelchair at first, but it didn’t stop Alec from his favorite activity while walking with a group dogs – trying to pull to the head of the pack so he can be the first one in what must appear to onlookers like a dog parade.

I still need to keep his walks short and it’s better for his joints if he walks on grass (hence the park across the street being so convenient), but Juli, his rehab therapist, says eventually he can take long walks in the cart. For now though, she emphasizes that physical therapy is the most important thing I can do with him in the cart, more important than going on walks, and I need to keep doing his exercises throughout the day. She showed me a new exercise where I assist him to sit and then stand several times throughout the day for one minute. She came by last weekend to help with his cart problems and showed me a way to get him to urinate in the cart and it is working so I am very happy about that! Moreover, she believes she see some slight movement at the top of his back legs, where they meet the rest of his body (this is called “proximal motor”). She also believes he has deep pain perception (I pinched his tail once in front of her and she saw him react – the reaction I could not get for the neurologist during our initial re-check exam back in March). Since Juli believes Ali is showing some improvement, she suggested I make an appointment at Animal Care Center with the Dr. Tieber for another re-check. She said because she is not a doctor she can only “assess” Ali’s condition but not “diagnose” and thinks I should get a neurologist’s opinion on what she believes she is observing (i.e. some return of motor function).

After we see the neurologist, Dr. Tieber, we are going to have a rehab appointment with Juli and put Ali in the hydro-therapy tank for the first time. I really hope Dr. Tieber confirms what Juli is seeing. I feel like he is improving too – it seems like I can see his legs moving slightly sometimes in the cart – but I am afraid to get my hopes too far up. Our appointment is on Friday morning. Wish us luck!!!

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Filed under At-Home PT Exercises, Bladder Expression/Urination, Doggie Wheelchair, Milestones/Progress, Physical Therapy/Rehabilitation, Ramp, Relocating

Cart is here…and it fits!

Juli, the rehab specialist, brought Ali’s cart by yesterday and I am SO happy to report that it fits perfectly!! I have been on pins and needles all week worrying about that and I am so relieved!!! (If it didn’t fit, we would have had to send it back and wait over three weeks for another cart.) After getting him used to the cart inside, we walked him outside around the building and he loved it – he looked so happy. He was definitely ready to go, go, go but he can only be in it for short, ten minute walks at first until he builds up his strength and endurance. He has been “down” for about two months now, which is a long time. Maggie videotaped everything and we will put footage of his first steps with his new wheels on the website as soon as we figure out how.

The best part, however, is the fact that Juli said she saw his legs moving a little bit while he was walking in the cart (yes, his back legs!). Her exact words: “He’s got motor!” Obviously, this is really exciting!! Next step is she is going to check on him in a couple weeks, after we are settled into our new place, and if everything is going well, we will schedule him for a hydro-therapy session (which was not on the table until his legs started moving), where we get into a water tank and see if he will move his legs, I guess (I’m not entirely sure but I have to be strong for it apparently!). So now we are planning to move at the end of the week, after he has a few days to get used to his wheels. At my new place there will be lots more to get used to – including loading in and out of my van and getting up and down the porch ramp. I am nervous about all that but I hope it will become routine, just like living in my office eventually did! Everything was so hard at the beginning – there were times when I really thought I couldn’t do it – but we made it through that and things got easier. Obviously, things improved tremendously when he started going to the bathroom outside. I really can’t overempashsize how much that changed things. I feel so fortunate.

Anyway, I must say it was really great to see him walking again – even if it was just around the building. It was a very good day!

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Filed under Doggie Wheelchair, Milestones/Progress, Physical Therapy/Rehabilitation, Ramp, Relocating, Underwater Treadmill

New medications.

I started Alec on Rimadyl and Ciproflaxin today. The Ciproflaxin is an antibiotic for a urinary tract infection – which I knew dogs in his condition were prone to but I was kind of bummed he contracted one so soon – and the Rimadyl is an anti-inflammatory to help with his front legs, which are becoming swollen and painful from his putting so much weight on them. He is already showing signs of arthritis. I can’t wait for his cart to arrive since that should help balance out his weight more evenly. The good news is that Dr. Leavey (my amazing local vet from Animal Hospital of Cotati) just had a bunch of Rimadyl donated and she said we could have it for free! I had just ordered another brand of anti-inflammatory from PetMeds.com that was going to cost $100 for just a few weeks supply (why are all the medications he needs so expensive??), but luckily I was able to cancel the order after talking to Dr Leavey, who was has truly been our angel throughout this ordeal. She has been making house calls to check on Alec ever since his surgery and has not charged me once (in the beginning she was coming almost everyday). I am so grateful for her compassion! I really don’t know how we could have managed this far without her, especially during those first difficult weeks after surgery when I was struggling so much with expressing his bladder and had no idea if I was doing it right.

The photo: Juli the rehab therapist brought by a p-nut ball (aka physio-roll) to try to help with Ali’s standing exercises. Someone (in this case, Maggie, my friend, co-worker, and future roommate) holds a peanut butter kong while I (try to!) hold his back legs in position and gently rock him back and forth to try to stimulate his nerves to “remember” walking. It’s harder than it looks.

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Filed under Medications, Physical Therapy/Rehabilitation, Relocating

Blog post on ALDF website.

My friend and co-worker, Paula, posted a sweet blog about me and Ali on the Animal Legal Defense Fund website. You can read it here.

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Filed under Bladder Expression/Urination, Doggie Wheelchair, Paralysis, Physical Therapy/Rehabilitation, Relocating, Trans-Species Bond

Going to the bathroom outside!

I started walking Alec outside briefly with a sling to support his back end 3-4 times a day and it has been working! He is actually going to the bathroom outside and he has not soiled his bed once (knock on wood!) since I took him outside for the first time Tuesday evening after our re-check appointment. I couldn’t be happier and I know Alec is too. As soon as he got outside and started sniffing, he began to go all on his own… I couldn’t believe it! This is going to make things so much easier for us if he is able to continue. I also started feeding him three times a day, standing up at an elevated food station (cardboard box I found in the supply room), and this has been working great. Thankfully, he has been excited about his food (before, he was more of a picky eater), and having him stand while eating and drinking is good therapy, as he should be standing and bearing weight on his back legs for several minutes a day. Then about 10 minutes after he eats I sling-walk him outside and he goes to the bathroom. I have been trying to keep to a strict schedule each day so that he gets into a regular routine. It is so much easier not having to change his bed several times a day – not to mention trying to keep him clean and dry! I am so happy about this. My back has been hurting quite a bit (the hind end of a paralyzed shepherd is heavy!!) but I am hoping the pain will subside and/or i will get stronger.

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Filed under Milestones/Progress, Physical Therapy/Rehabilitation

First re-check appointment:

Alec had his re-check appointment today; this was the first time he was back at Animal Care Center since he was discharged on 2/21. My wonderful friend April helped me load him into my van, which we did by sling walking him up a ramp, and the nurses wheeled him inside on a gurney when we got there. We saw the neurologist who performed his two surgeries, Dr. Lisa Tieber, and the canine rehabilitation specialist, Juli Dell’Era. Although I had sworn he felt it a few times when I pinched his tail recently, Alec would not react to pinches from Dr. Tieber so his prognosis was deemed “poor for return to normal function” based on his “persistent absence of deep pain.”

Today marks four weeks after his surgery and I know that most dogs who are going to regain deep pain perception (DPP) do so within a few weeks of surgery. Still, I also get the feeling from the studies I have read that there may not be a preponderance of long-term data. In one article I read* the authors studied 70 dogs with intervertebral disk disease (IVDD) and of this 70, six were euthanized at the time of the initial examination at the owner’s request and nine more were euthanized within one month after surgery. Although seven of these nine were euthanized because of suspected or confirmed ascending myelomalacia (a terminal condition in which the paralysis spreads throughout the body), the remaining two dogs were euthanized within three weeks after surgery at their owners’ request because of a lack of improvement. So in just this one study eight of 70 dogs (approximately 12%) were euthanized very early on either before surgery or soon after because they had not improved. Combined with the fact that large dogs represent the minority of cases of IVDD and take longer to recover, I would surmise that there is not a ton of data out there about dogs like Alec. The doctor herself said she has seen amazing things happen with physical therapy, so I am going to try everything for him.

Now, there is this phenomenon called “spinal walking” or “reflex walking,” which I think I mentioned in another entry. Without regaining DPP it is unlikely (impossible?) that a dog will recover normal function – meaning conscious control of their back legs. However, some dogs develop reflexes that allow them to walk without knowing they are doing it. I guess it relies mostly on muscle memory rather than conscious control. Dogs who develop this ability walk with a “drunken” or wobbly gait – not quite normal – but it’s enough to get them around. I asked Juli, the rehab therapist, if she had ever seen this ability develop in big dogs and she said she had a Doberman that became a “spinal walker.” So it is not impossible in large dogs. The study I referenced above included a few large breed dogs, including one German shepherd, but the vast majority were dachshunds and other small breeds, so it’s hard to draw conclusions based on Ali’s size, but in this study 37 of the remaining 64 dogs developed DPP and the ability to walk. Among the dogs that did not develop DPP, four were euthanized 2, 4, 9, and 36 months after surgery, again, due to a lack of improvement and one dog died as the result of an attack by another dog 6 months after injury (how awful!).

Of the remaining dogs, seven regained the ability to walk despite a lack of DPP (although the authors don’t call it this, I believe they are describing “spinal walking”). They don’t differentiate the breeds of these seven dogs so I don’t know whether any large breeds were represented in this number. All seven dogs who regained motor function had a voluntary tail wag one month after injury, and Alec started wagging his tail when I walked in the room about 2-3 weeks after surgery. The fact that I noticed he wagged his tail is what prompted me to hunt down this study, which has been very informative and also given me some hope that even with a lack of DPP, Alec could one day walk. The authors of this study believed the voluntary tail wag was a good prognostic indicator: “Persistent loss of DPP did not preclude recovery of motor function, and dogs that did recover motor function developed a voluntary tail wag within 4 weeks after the injury” (Olby et. al., 2003, p. 768).

Additionally, according to this study, the average time for dogs without DPP to develop motor function was 9 months. So whatever happens, this is going to be a long road. It also made me realize I absolutely could not go back to my place in San Francisco. Even though I knew this was likely, I was holding onto hope that somehow it could work and we could go home…but it’s impossible. After the appointment I told my roommates I am definitely moving out. We are all sad, but this is the only option right now. Besides the stairs in my place in SF, it makes sense for us to be up here in Sonoma County, closer to Alec’s doctors and he will be doing his physical therapy up here too. I guess I had known this for of a couple weeks, but it became final in my mind today. And today was the day I started saying it out loud. Good-bye San Francisco.

Something kind of cool: During the re-check exam, even though Alec did not demonstrate DPP, Dr. Tieber noticed that he started peeing on his own when we stood him up. She said “look he’s doing that on his own! I’m not touching him.” And she seemed excited about this fact. She asked if he had done this at home and I said I didn’t know; I never take my hands off his bladder when he starts peeing! I get so excited when I find the spot I don’t want to ease the pressure until he stops. She said this means he is perhaps developing a “reflexive bladder” where they can go on their own somewhat but still need to be expressed. I told her about our ongoing problems with him pooping in his bed, especially overnight, and trying to squat (which he can’t do because his legs don’t work) but only flattening it and rubbing it into his fur and bedding (gross, I know – but try cleaning it up everyday!) and she suggested walking him outside in a sling for 5 minutes after his meals. She said for some dogs just moving and being outside stimulates them to go to the bathroom. I am skeptical but I will try it!!

Finally, I really like Juli, the rehab specialist. She is very knowledgeable and also really nice. She said she treats all patients as if they will walk again so the therapy will be the same for Alec whether he has DPP or not. Like I mentioned above, Dr. Tieber said she has seen amazing things happen with physical therapy…so we have to try, right? If we forego physical therapy, it is virtually guaranteed nothing will change, but with therapy there is a chance we could see improvement. Another neurologist said early on after Alec’s surgery, in response to my question about physical therapy, “Well, if he has no DPP there is no point in doing physical therapy.” Now that I have educated myself some more, this doesn’t make sense to me. Even without DPP, according to the study I keep referencing, some dogs recover motor function. I asked Dr. Tieber why he would say that and she just said “well, we have different philosophies about that.”

The next step is to get Alec measured for a cart (doggie wheelchair). Juli said they can be great rehab tools as well a means of mobility. It will be awhile before he can really run around with his wheels since he is still recovering from surgery, but in the interim we can use it for his rehab exercises. Currently I am doing physical therapy with him at home a few times a day, including passive range of motion (PROM) and standing exercises to get him to bear weight on his back lets. The latter are hard to do by myself (wiggly, heavy German shepherd!) and Juli said the wheelie cart will really help with this. The problem is Alec is starting to overcompensate, putting too much weight on his front legs (unfortunately I wasn’t discouraging this because I just thought he was getting stronger up front – woops), and he is already developing arthritis so it is very important he distribute his weight more evenly. She said the cart will really help with this, balancing out his weight. The measurements for the cart have to be very precise (if you make a mistake in measuring and the cart doesn’t fit, you have to pay for a whole new one to be made! And they are around $600) so she wants to come to us to do the measurements so he will be as relaxed as possible. We will do that this weekend. Oh, and I suspect he has a urinary tract infection (malodorous urine) so we started a urine culture on that. We will see. I came home from this hours-long appointment with my head buzzing. I feel like it was a lot of information to take in all at once!

As an aside, Alec has gotten very “vocal” since this all happened, barking at everyone much more than he used to, louder and without stopping when I tell him to. He used to bark occasionally when he heard something (or saw another dog across the street), but nothing like this persistent barking. I think he is overcompensating because he can’t move and feels vulnerable. Well, today I left the exam room to use the restroom and when I came back Dr. Tieber walked in and he started barking like crazy. She told me she had come in only a moment before when I was not there and he hadn’t made a sound! Apparently there is a protective element to his barking, which I did not know because I am always there with him when he barks so I just assumed he did it all the time. Either way, I will have to figure out a way to get it under control. He was reasonably well-trained before this happened, but now it’s almost like I have to start all over again with certain things…

* Olby, Natasha, et. al., 2003, “Long-term functional outcome of dogs with severe injuries of the thoracolumbar spinal cord: 87 cases [1996-2001],” JAVMA, Vol. 222, No. 6, March 15.

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Filed under Doggie Wheelchair, Long-Term Data (Lack of), Milestones/Progress, Paralysis, Physical Therapy/Rehabilitation, Protective Behavior, Relocating