LIBRELA - WONDER DRUG OR CAN OF WORMS?

Posted on February 26, 2024

What is Librela?

Librela is a fairly new licensed treatment for osteoarthritis in dogs. The active component is called Bedinvetmab, and it is a monoclonal antibody treatment which works by blocking something called ‘Nerve Growth Factor’. It is available in the UK and the rest of Europe, as well as in the USA, Canada and Australia. Librela is a drug which is injected, under the skin, on a monthly basis, to alleviate the symptoms of osteoarthritis, one of the most common conditions of dogs, such as inflammation and pain. In the short time that Librela has been on the market, it has made quite an impact on the quality of life for many dogs, but not always in a positive way. This article sets out the pros and cons of a drug like Librela, which will hopefully make it easier for you to decide whether to consider using it for your dog!

What are monoclonal antibodies?

Monoclonal antibodies are artificially made antibodies which target very specific cell receptors or molecules like certain proteins. They bind only to those particular receptors or proteins, causing various effects, depending on the location and the function of the receptors. In the case of Librela, the antibodies bind to and block the effect of another protein called ‘Nerve Growth Factor’ (NGF). NGF has many functions, one of which is to attach to and influence receptors on nerve cells, causing the transmission of pain signals. As such, it is part of the inflammatory response in an arthritic joint, which causes pain. However, NGF has many other functions: it is essential in the formation, growth and development of nerve cells in a young animal and the maintenance and repair of nerve cells in the adult animal; it is important in the regulation of the animal’s immune system, and it is involved in the maintenance and survival of cells in the pancreas (where Insulin is produced). Receptors for NGF are found, not only in joints, but throughout the body, in various types of tissue.

Does Librela work?

Librela does indeed work for most cases of osteoarthritis. In studies done in dogs, both in Europe and the USA, more dogs responded to Librela than to ‘placebo’ treatment. However, the results were not quite as overwhelmingly positive as some people would make you believe. It often takes several monthly injections to reach an obvious positive effect, and, overall, the benefits are no greater, and often less, than that of some more commonly used non-steroidal anti-inflammatory drugs (NSAIDs). In clinical practice, we often see a positive effect though, but this is partly due to careful case selection and partly due to ‘caregiver placebo effect’, where the dog’s guardian will expect it to work beneficially. As described above, NGF has many different functions and, as a consequence, treatment with Librela can cause adverse effects to a patient too. These include painful injection sites, lethargy, anorexia, excessive drinking, urinary incontinence, vomiting or diarrhoea, skin infections, neurological deterioration such as weakness, ataxia or even seizures. In humans, an equivalent drug has been shown to cause a rapidly progressing osteoarthritis (RPOA), possibly due to a lack of joint awareness, causing laxity and excessive joint movement. We are not sure whether this would potentially happen in dogs too.

What dog would or would not be a good candidate for the use of Librela?

In general, Librela would be a good option if other osteoarthritis medications are not possible, for instance due to things like liver and kidney disorders, or gastro-intestinal sensitivity. It would also be good for dogs who have difficulty taking oral medications. It can also be used for dogs where oral medications no longer seem to have their beneficial effect. However, it should probably not be considered as the first line treatment for osteoarthritis, as better, safer and more effective treatments are available.

As far as contra-indications are concerned, we would have to be careful in using this drug when patients are suffering from any type of neurological disorders, such as Degenerative Myelopathy (DM), Inter-Vertebral Disc Disease (IVDD) etc., as well as in cases where there is joint instability or laxity, like in cases of cranial cruciate ligament (CCL) rupture, or shoulder instability.

Finally, it should be remembered that Librela has ONLY been licensed for the treatment of pain due to osteoarthritis in dogs and not for any other painful condition.

So how should we treat osteoarthritis in dogs?

There are so many different ways in which we can help dogs with osteoarthritis nowadays, that we always need to do a very thorough and careful examination of the patient and come to a full and accurate clinical diagnosis. Then we should try and use a multi-modal approach to treatment and pain relief. This may include things like weight and body condition management, exercise control, home environment alterations, joint supplements, herbal treatments, rehabilitation/physiotherapy, laser therapy, hydrotherapy, acupuncture, medication (such as NSAIDs, Opioids, Gabapentin, Ketamine, Paracetamol and others), shockwave treatment, intra-articular injections, stem cell therapy and even surgery.

If you would like to know more about what might be the best possible treatment protocol for your dog, why not contact us at PeRiHab? We specialise in chronic pain- and osteoarthritis management and have at our disposal nearly all of the above-mentioned treatment modalities!

References:

Dr Mike Farrell discussed all pros and cons of using Librela and all the scientific background here:

https://www.facebook.com/UpwardDogRehab/videos/1182246132753648/

More information by Dr. Darryl Millis you can also find here:

https://www.mylamedog.com/post/what-about-librela-anti-nerve-growth-factor-antibody-treatment

BALLS -UP!

Posted on June 25, 2023

We all know that dogs, generally, like to play with balls. Some more than others, in fact, some dogs are absolutely ball-obsessed, but most dogs at least enjoy some ball play. And so do their owners. And why not? It’s easy, it’s cheap, it doesn’t require too much from the owner (especially if they use the ‘chucker’!) and it gives the dog a lot of exercise and fun! And surely it must be good for a dog’s physical fitness, strength and endurance. Right? Well, let’s see. Perhaps ball play isn’t quite as good as you think it is. Please see below for what we, at PeRiHab, think about ball play, especially with dogs that have some kind of health issue, such as orthopaedic or soft tissue injuries, congenital or developmental joint problems, osteoarthritis or other chronic pain conditions.

Anatomy and physiology

To understand why we think ball play can have a detrimental effect on a dog, we must first understand the anatomy and physiology of the dog, at least to some extent. Dogs are ‘quadrupeds’, meaning they walk on four legs, unlike people, and the function of and forces through their legs are very different than in people. Dogs carry about 60% of their bodyweight on their front legs and 40% on their rear legs. Most of the driving power in straight line movement comes from the rear legs, whilst most of the slowing down/braking, and directional change, comes from the front legs. In dogs, these front legs are not connected to the rest of the body by bones or joints, but merely by muscles. On top of that, the shoulder joint is relatively shallow and weakly supported by ligaments, unlike other joints, like the hip or knee joint. Of course, there are also massive differences between various dogs, in size, body shape, height and weight, depending on their breed (their genetics/DNA), their fitness and body condition, their nutritional status, their sex and age, as well as their training and exercise levels.

What do dogs do when chasing and retrieving balls?

When chasing balls, dogs typically go ‘from 0-100mph’ in a matter of milliseconds, putting enormous forces through their bodies. Then, when they reach the ball, they brake hard, often whilst twisting or turning at the same time, again putting huge forces through their joints. They may skid, slip or slide, or, worse, jump high in the air if the ball was thrown high into the air. When landing, again huge forces go through their joints. This kind of exercise puts forces through the dog’s musculoskeletal system which are far greater than those caused by normal, or natural, exercise. Their bones, joints and muscles can only withstand these forces if they are used to this type of exercise, and their bodies are fit and healthy. In some dogs, this kind of explosive exercise can cause acute trauma, such as ligament ruptures and bone fractures. In addition, this, often repetitive, kind of exercise commonly causes microtrauma of skeletal structures, which, over time, might lead to strain and sprains, tears and ruptures, or even stress fractures.

Why is ball chasing even more detrimental for dogs with existing issues?

As you have seen, even for totally fit and healthy dogs, repetitive, high energy, exercise can cause damage. If a dog already has an issue, like osteoarthritis for instance, the structures on which the forces work, are less able to deal with the increased demand and are more likely to be damaged even further. Also, dogs with any kind of injury will often try to ‘protect’ their injury, for instance by altering their stance, their weight distribution or their use of a particular leg, thereby again increasing forces onto certain structures, and consequently increasing further injury risk.

Why are dogs so keen to chase balls?

Ball chasing, or chasing and catching in general, is a highly exciting and rewarding, and, in fact, addictive, kind of exercise and behaviour, which usually leads to increases in various hormones in the dog’s body. These include adrenaline and cortisol. On a short-term basis, this is not a huge problem. But if these hormones stay at elevated levels for prolonged periods of time, they can negatively influence various processes and functions in the body, as well as behaviours. Dogs can become frantic, obsessed, restless and even aggressive, and dogs also often lose their sense of self-preservation, especially with regard to pre-existing injuries.

But he/she loves the ball so much!

We totally understand that some dogs are absolutely besotted with balls and will drop the ball in front of your feet at any given opportunity. If you feel that you can’t resist playing with balls, try at least to minimise the impact that this can have on your dog. Firstly, make sure your dog is physically fit enough to do so, in the first place. Secondly, make sure you have done some warming up first, like at least 5 minutes of walking or running. And then, if you do throw that ball, make sure it’s on a dry, flat and grippy surface, and do only a few times in a row. Make sure your dog doesn’t get too excited and do a cool down walk at the end as well.

Alternative exercise / play

There are lots of forms of exercise and play which are equally fun, for both you and the dog, but which are less likely to cause excessive stress on your dog’s body, and are therefore less likely to cause or aggravate injuries. Examples are scent work / sniffing, ‘find-it’, obedience type tasks, changing the usual routine and area of exercise, trick training and more. For sporting and athletic dogs, specific task-related exercises and specific fitness and endurance training, as well as balance and coordination training exercises are suitable.

We, at PeRiHab, are happy to advise you on what exactly is a suitable exercise for your dog, whatever their health status, and whatever their usual sport or ‘job’ is. As you have seen, there are plenty of reasons why ball play is not necessarily a great idea for dogs in general, and especially for those dogs with pre-existing conditions. We hope that this article has given you some scientifically based information to support that statement.

There is nothing more enjoyable than to have a great time with your four-legged friend, out in the countryside, but just be careful that you don’t cause your dog any harm!

A CAT’S TRIATHLON

Posted on February 10, 2023

Recently, at the vet practice where we both locum, we saw a little kitten, of only 2 weeks old, affected by ‘Swimmer Syndrome’. This is when the legs, in this kitten’s case the hind legs, are positioned, or splayed, outwards / sideways, rather than straight down underneath the body, making ‘swimming’ movements (photo 1). This little kitten, whose eyes and ears had only just opened, didn’t know how to move around, he wasn’t even able to get to his mother’s nipples to drink, and he got left behind by his litter mates.

Swimmer’s Syndrome is a congenital condition, of unknown origin, and most of the time, kittens affected by this condition are put to sleep, as they are unable to have a normal life. Often, multiple kittens in the same litter are affected, but in this case, it was only one kitten.

Having read up about this rare condition, not often seen in clinical practice, we decided to give this little kitten every possible chance to improve and have a normal cat’s life. We found that early intervention, involving daily physiotherapy (photo 2), can make a huge difference. We simply could not resist trying to give this kitten the very best treatment available, with the best chance to improve. Before we started, we named the kitten ‘Michael Phelps’, after the famous Olympic swimmer!

The physiotherapy consisted of various components:

• We bound the hind legs together, shackled, using medical tape at two levels, to prevent them splaying. This would be worn all the time, apart from when the exercises below were performed (photos 3 and 4).

• We performed, and asked the owner to perform, daily exercises, moving the hind legs through their natural range of motion, for instance by making flexion and extension, as well as cycling movements of the legs. We also placed the feet underneath the body, as much as possible and tried to encourage the kitten to move in a straight line, with help (photo 5).

• We did, and asked the owner to do, gentle massage of the hind leg muscles, whilst being held in the most natural position.

We subsequently saw Michael Phelps on a daily basis, helping the owner (who was a human physiotherapist herself!) to care for the kitten as much as possible. Within two days, the kitten was starting to improve already! The hind legs were less splayed, and he was trying to move around a little better (photo 6). We reduced the shackles to being only at one level on the third day. Another 3 days on, Michael was trying to walk now, displaying a more natural position of his hind legs already, and growing steadily. A further four days down the line, we saw a totally different Michael Phelps. Now he was walking confidently, hind legs tucked underneath his body, moving towards a treat or simply with encouragement (photo 7). He had caught up with his brothers in the litter, was moving as well and as much as the others and was discharged from our care.

It was incredibly satisfying to see that with the right knowledge and expertise from a rehabilitation vet, great nursing care from the veterinary nurses and total commitment from the owner, these little swimmers can be turned around, in a relatively short time too, to ensure that they have a happy, healthy life.

We've never thought that a cat, starting out as a swimmer, and then doing cycling, would end up walking and running, just like in a proper triathlon! Go Michael Phelps!!!

SPECIAL HALLOWEEN OFFER

 Posted on October 25, 2022

We would like to introduce you to our new handmade Pumpkin Dog Paw Balm! This is a limited edition of our successful PeRiBalm dog paw balm, but this time it is a special Halloween version, called ‘Pumpkin Touch’. It is a perfect gift for Halloween!

This amazing long lasting, moisturising and luxurious dog paw balm is perfect for every furry friend. It is made carefully and freshly to order with organic ingredients of the highest quality. Most importantly, it contains pumpkin oil, not only because of its essential fatty acids, which help to moisturize your pet’s skin, but also for that added special autumnal Halloween touch! And remember, it is lick safe!

This Halloween, remember to treat your dog. The dry fall air is rough on paws. Make sure you have enough of our PeRiBalm to keep them soft, warm and ready for the cold winter months ahead! Contact us now to place an order, through our website or by email or phone!

Happy Halloween from PeRiHab!

P.S. If you would like to read more about our PeRiBalm - Natural Healing, please scroll further down ↓

PAIN

‘THE STRAIN OF PAIN LIES MAINLY IN THE BRAIN!’

Posted on August 25, 2022

Introduction

One of the main things we do at PeRiHab is ‘Pain Management’. But what is this exactly? What is pain really? How does it work, from an anatomical and physiological perspective? Why is it different for each individual? What is the difference between pain and suffering? And, most importantly, how can we manage it? What treatment options are available?

What is pain?

First of all, pain comes in different forms. We recognise two different main forms of pain, with their own individual characteristics: acute pain and chronic pain.

Pain is frightening because, at least in the acute phase, it signals actual or potential damage. It can be threatening to the patient, whether human or animal, and even affect survival in some cases.

Acute pain is ‘adaptive’, meaning it is useful. For instance, feeling acute pain due to heat, when touching something really hot, and the subsequent withdrawal of a hand or paw protects from severe burning. It also prevents the development of a chronic pain state. A person or dog that never feels pain will eventually get severely damaged and die of the consequences.

Chronic pain is ‘maladaptive’ and has no biological use for the patient. So why do we have it? It is to do with the mechanisms protecting us from a physical threat becoming problematic when pain becomes chronic or fear becomes anxiety (anticipation of fear). There is an altered central processing of pain in these cases. Nobody dies of chronic pain, but it can cause severe suffering and chronic stress. The signs may be subtle, but the effect on the patient can be massive!

Is it all ‘in the head’?

The short answer is YES, it is! Let’s consider the neurophysiology and neuroanatomy of pain for a moment: it might all sound slightly complicated but it is important to realise how pain ‘works’.

There are several steps in pain perception:

1. Nociception: this is the activation of pain

receptors, peripherally, for instance in a joint itself.

2. Transduction: this is the conversion of the stimulus to an electrical signal.

3. Transmission: this is the transmission of the signal via peripheral nerves to the dorsal horn area of the spinal cord, part of the central nervous system. There are nerve fibres for ‘fast pain’ perception, called A delta fibres, and for ‘slow pain’ perception, called C fibres.

4. Modulation: this is where sensory inputs from the periphery, as well as descending inhibitory pain pathways from the brain either inhibit or facilitate the transmission of noxious stimuli at the dorsal horn of the spinal cord.

5. Projection: neurons (nerve cells) in the spinal cord send the signal on to the brain.

6. Perception: this is when neurons in the brain project to cortical areas, causing conscious perception of pain.

So, this is why ‘pain is all in the head’!

Types of pain

1. Nociceptive and nociceptive-Inflammatory pain: this is for instance pain from an inflamed joint, as in osteoarthritis.

2. Neuropathic pain: this is pain originating directly from nerves, for instance when nerves are under pressure due to spondylosis or a protruding intervertebral disc, or with nerve tumours.

3. Central Sensitisation (sometimes called ‘pain wind-up’): this is when a small, but persistent pain signal becomes magnified, causing an expanded and exaggerated pain field. This is especially important in chronic pain.

4. Mixed pain: this is where several types are at play at the same time.

Pain has various ‘components’, making it all even more complicated! This is important, as we need to address all components of pain, when thinking of appropriate treatment methods.

Components of pain

1. SENSORY component: this is when we need to address the actual nociceptive pain sensation itself, for instance in an inflamed joint. We might use drugs, acupuncture and laser.

2. EMOTIONAL component: this is to do with how the patient ‘feels about the pain’. We might use drugs or acupuncture and more.

3. COGNITIVE component: this is to do with how the patient ‘thinks about the pain’. It is more important in humans than in animals, we think. Treatment centres on ‘taking the patient’s mind of the pain’. We might use activities and games.

4. MOTOR component: this is to do with how the pain affects the movement and behaviour of the patient. We might use techniques to manage the environment of the patient, or the diet, and perhaps use assistive devices.

Pain versus suffering

Pain has been described above, with all its types and components. This is a physiological process, which is similar to all patients. Suffering is to do with how this pain is perceived, which happens in the brain. Suffering is the emotional side of pain. It is different for everybody, which is why a similar problem can be experienced very differently in different patients. In human medicine, it is now said that ‘Pain is what the patient says it is’! and it is generally accepted that people have different experiences of pain. We need to recognise that this will also apply to animal patients. Dogs will worry less than we do about what pain means and probably even less about how it influences their future. One important thing to remember is that you cannot teach your dog to NOT be scared of pain!

Central sensitisation

This is also called secondary sensitisation, and is the process of pain being amplified over time. Many receptors, chemical interactions, hormones and other signalling molecules are involved in this process. Ultimately, a small but persistent pain signal can become magnified, leading to an expanded and exaggerated pain field. It bears little relation to the initial pain stimulus. An animal suffering from this central sensitisation can present as a painful, frightened and worried individual, whilst an examination often doesn’t reveal any particular area of pain, even on imaging studies.

The gut microbiome

It is becoming more and more clear nowadays, that the gut, its health and its microflora, or microbiome – the plethora of bacteria living there – can have a big influence on many bodily functions. We now know that neurotransmitters are produced in the gut, as well as elsewhere in the body of course, and this can influence the whole process on pain perception. When we assess a patient for the purpose of pain measurement and subsequent treatment, the health of the gut and the patient’s diet should always be taken into consideration. We hope to learn more about this relationship in the near future.

Assessment of pain

We all know that it is very hard to establish when an animal is in pain. Different animals experience pain differently, with great variation between species and between individuals within one species. It is often said that dogs, for instance, can ‘disguise’ or ‘hide’ pain, but, actually, they are simply very good at coping with pain, especially compared to people. And we, as humans, are generally very bad at picking up the signals of pain in dogs, which are mostly behavioural, rather than vocal, as in our species. And it is even harder in cats! It I therefore no surprise that, in general practice, often clients are unaware that their pets are in pain. So how do we know?

Assessing pain is inherently difficult. People all experience pain differently, especially with regard to the emotional component of pain. Previously, some people would ask (human) patients to use a visual analogue scale (like a siding scale), a numerical rating scale (like 6 out of 10) or a simple descriptive scale (explaining in words), but they are all insensitive, inconsistent, subjective and operator dependent and they don’t take the ‘quality of pain’ into consideration. Over the years, lots of people have tried to develop more objective, reliable and consistent pain assessment tools, to better compare pain levels between individuals, as well as in the same patient, over time. Some of these have been developed specifically for the assessment of pain from osteoarthritis, others are more general. Some are more specifically for acute or peri-operative pain, others more for chronic pain. Some of them take into consideration the emotional and behavioural effect of pain on the patient, other less so. Each clinician has his or her favourite tool.

Some of these tools are the following:

1. ACUTE PAIN: the most commonly used ones are the Glasgow Composite Pain Scales, for dogs and cats.

2. CHRONIC PAIN: the most commonly used ones are: Canine Brief Pain Index (CBPI), Liverpool Osteo-Arthritis in Dogs (LOAD), Canine Osteo-Arthritis Staging Tool (COAST) and the Feline Musculoskeletal Pain Index (FMPI).

Treatment of pain: ABCDE

Luckily, there are nowadays many ways in which we can treat, control, or modify pain and pain perception in animals. Hence, there is no reason at all to let patients suffer from pain and the subsequent stress on the patient’s body, both physically and mentally/emotionally. To simplify the ways in which we can help animals in pain, we can use the ABCDE acronym (originally devised by Stuart Carmichael), which explains the various treatment categories. They are:

A: ANALGESIA: this is the treatment of pain with drugs or analgesic techniques, such as laser and acupuncture, TENS and PEMF therapy.

B: BODYWEIGHT: we already know that excess bodyweight can have a massive influence on how much pain animals experience, not only due to the extra weight onto the joints, but also because fat directly causes chronic inflammation due to the production of pro-inflammatory cytokines. We can help patients with diets, exercise and hydrotherapy for instance.

C: CONTROL, COMFORT, COMPLIANCE, COMMON SENSE, COMPLICATIONS, CORE TERRITORY: this section contains lots of ways in which we can help animals in pain, for instance by modifying their environment, their sleeping area, their collar/lead/harness (see our separate blog about harnesses!), therapeutic massage and much more.

D: DISEASE MODIFICATION: there are several ways in which we can change the process of osteoarthritis, for instance nutraceuticals, joint supplements, intra-articular injections, surgery, stem cell treatment and more.

E: EXERCISE: modification of the type and amount of exercise a dog has can have a big influence of the levels of pain experienced. This forms a big part of ‘rehabilitation’ and can include a home exercise program, but also hydrotherapy and more.

Now we will go through each of these groups in detail in the next paragraphs.

 A is for ANALGESIA

Analgesia means ‘without pain’, from the Greek for without (‘an') and pain (‘algos’). Analgesics are drugs or methods which can establish this.

Analgesic drugs:

Over the years, many drugs have been found, or developed, which can achieve analgesia. They are often called ‘pain-killers’. They come in various groups, and we will discuss the most commonly used ones here.

• Non-Steroidal Anti-Inflammatory Drugs – NSAIDs. This is the biggest, and most well-known group of drugs used for pain relief. They, generally, reduce pain, swelling, redness and heat. They mainly act in the periphery, where inflammation is present, for instance in an injured joint. Most NSAIDs inhibit the cyclo-oxygenase enzyme group, thereby reducing the production of inflammatory mediators. They are often called COX inhibitors. They are further divided in COX-1 and COX-2 inhibitors, which gives rise to the differences in how they act on the gut, for instance. Most of the drugs in this group can cause vomiting or diarrhoea as a side-effect, but, having said that, they are very well researched and both safe and efficacious. Drugs in this group include meloxicam (‘Metacam’), carprofen (‘Rimadyl’), robenacoxib (‘Onsior’), firocoxib (‘Previcox’), mavacoxib (‘Trocoxil’) and many more. Often, the maximum effect of a NSAID will only be seen after many weeks of use.

• Grapiprant (‘Galliprant’). This is a drug which works on a specific peripheral pain receptor. It is similar to an NSAID and has no less side effects, nor is it proven to be better. There is not much evidence for its efficacy.

• Bedinvetmab (‘Librela’ for dogs) / Frunevetmab (‘Solensia’ for cats). This is a specific monoclonal antibody which targets nerve growth factor, one of the inflammatory mediators. It is given as a monthly injection, for the management of pain associated with osteoarthritis, but it can also help for cancer pain, disc problems and other painful conditions.

• Paracetamol / Paracetamol-Codeine (‘Pardale’). Even though this is a very old drugs, the precise action has only recently been established. The drug has to be metabolised in the liver before the active ingredient is released. It has few side effects, but the correct effective dose can vary from individual to individual. It is severely toxic for cats!

• Opioids. Codeine is an opioid, or a ‘morphine-type-drug’. It works mainly directly on the central nervous system. Oxycodon and Buprenorphine are other opioid drugs which can be used for analgesia.

• Amantadine. In people this is an antiviral, but in dogs it works as a pain killer, being an NMDA antagonist. This particular drug is often used alongside NSAIDs causing a synergistic effect. It is particularly good for central sensitisation.

• Memantine. A similar drug to Amantadine. Used for senility in people.

• Tramadol. This is a synthetic drug, similar to codeine, thus an opioid type drug, although not classified as a true opioid. There is some controversy surrounding this particular drug, with some people saying it isn’t very effective, especially in dogs. It may make the patient ‘feel better about their pain’, and this is due to its effect on serotonin. It helps mainly with the control of the emotional component of pain.

• Gabapentin. Originally an anti-epileptic drug, the exact mode of action in analgesia isn’t yet clearly known, but it works on the spinal cord, where it modulates transmission. It is particularly good for central sensitisation. It can be used alongside many other analgesics and has few side effects, other than mild sedation or ataxia (‘wobbliness’) in the initial stages, although this often resolves within a few days.

• Pregabalin. Similar to Gabapentin, but more potent.

• Others. Other drugs can also be used, such as Amitriptyline, Ketamine, Topiramate, Tapentidol and Duloxetine. At this moment in time, not much is known about their exact mode of action, efficacy, safety and dosing. With current research going on all of the time, this may well change in the near future.

• Cannabidiol (‘CBD’). This is a drug which works on the endocannabinoid system, for which there are receptors everywhere in the body. CBD reacts with different receptors than THC (the psycho-active part of actual Cannabis!) does. Currently, there are studies underway to establish the exact mechanisms of CBD, as well as the best dosage and formulation to advise. Beware of products advertised which contain CBD, as some also contain THC and there is, as yet, no standardisation of the manufacturing process, nor control on efficacy and safety standards. From a legal point of view, the Veterinary Medicines Directorate (‘VMD’) has made a statement that products containing CBD are a ‘Veterinary Medicine’, needing a marketing authorisation. There are currently no such products on the market, which means that, currently, nobody can advertise, sell or use such a product legally on an animal without a veterinary prescription!

Analgesic methods

Apart from the previously mentioned drugs, there are other ways in which we can achieve analgesia.

These include the following:

• HERBAL MEDICINE

There are many herbal preparations which can have analgesic effects. After all, most drugs originate from herbs and plants in the first place. Commonly known herbal preparations include things like Devil’s Claw, for instance. PeRiHab is trained in Western Veterinary Herbal Medicine and can advise further on this subject. We will also only ever use products which are made containing therapeutic grade ingredients and produced using ‘good manufacturing practice’.

• PHYSIOTHERAPY

There are many different physio-therapeutical interventions possible, which may have an analgesic effect. These include things like transcutaneous electrical nerve stimulation (TENS), laser treatment, therapeutic ultrasound, shockwave therapy, hot and cold therapy, hydrotherapy, therapeutic massage (or better called ‘myotherapy’), TTouch and more. It goes beyond the scope of this article to go into much more detail with respect to these various techniques. Suffice to say that some or all of these are, generally, part of a rehabilitation programme, such as those set up by PeRiHab.

• ACUPUNCTURE

Acupuncture, in its simplest way, works by tricking the brain in relieving pain, through releasing various neurotransmitters and other modulatory factors. It does so in 4 different ways: locally, segmentally, hetero-segmentally and generally. Some animals are better ‘responders’ than others, and, generally, the benefit of acupuncture increases with subsequent treatments. There is nowadays a plethora of evidence for the positive effect of acupuncture, both in the treatment of acute and chronic pain. PeRiHab is trained in Western Veterinary Acupuncture and can advise further on this subject.

B is for BODYWEIGHT

Excess bodyweight can have a detrimental effect on an animal’s health, wellbeing and even lifespan, exactly as in humans. This is mainly due to two different mechanisms: firstly, there is the purely mechanical effect on the joints, muscles and bones. Secondly, excessive fat, especially white adipose tissue (‘WAT’), can produce excessive amounts of chemical factors which cause chronic inflammation. So, it’s not just about total bodyweight in general, but also about the body composition, similar to in people. A ‘body-score’ (like the often used 1-to-9 scale seen in veterinary practices) is probably more useful and informative than the weight per se.

We need to encourage pet owners to ‘optimise their pet’s body condition’, rather than simply to ‘lose weight’. Just working on a pet’s body condition can often lead to a reduction in the need for analgesic drugs, thereby reducing possible side-effects too! 

C is for CONTROL, COMFORT, COMPLIANCE, COMMON SENSE, COMPLICATION AND CORE TERRITORY

• Control: a pet’s owner should ideally be ‘in control’ of the pet’s activity levels, to aid in the process of pain management. This may include taking on board the vet’s advice regarding levels of exercise and types of exercise to avoid. For instance, owners are often told to not let the dog do any ‘slipping and sliding, twisting and turning, running and jumping, going up and down stairs’ etc. This may then, obviously, limit the amount and type of exercise a dog can do. To avoid boredom, owners may choose to play games, use puzzle feeders, use grooming and massage as distractions and much more.

• Comfort: it is very important that any pet, especially one suffering from chronic pain, is comfortable at home. This may necessitate home environment changes, such as putting down rugs, runners or carpets, to help to avoid your dog from slipping. It may mean you lift their food bowl up for easier access. You may need to get a thicker, softer and more comfortable bed for the pet to sleep on. You may have to block access to the stairs.

• Compliance (perhaps better called ‘concordance’): it is utterly important that you keep to any medication regime, advised by your veterinary surgeon. It will have been individually designed to be of greatest benefit to your dog, taking into consideration many different factors. This also means not to change the dosage of a drug, or add any other drug, without discussing this with your vet. Even supplements and complementary treatments should ideally be discussed, as many can have interactions with drugs, or change their efficacy.

• Common Sense: this may include things like doing a similar routine each day of the week, instead of being a ‘weekend warrior’ where dogs get much longer periods of exercise during the weekend than during the week. Using things like car ramps and small ramps to help the dog getting in and out of the garden are other ways in which we can help struggling dogs. Use a small soft step for dogs who have difficulty climbing onto toe sofa, or use a stair gate to prevent dogs from going upstairs.

• Complications: many drugs can have side effects, or long-term effects on the liver or kidneys and other organs. Your vet is best placed to advise you on these, but, in general, it is a good idea to have a regular check up at your vets, for instance at least every 6 months, with regular blood tests to check internal functions, for instance at least once yearly. It is always a good idea to read up on any possible effects and side effects of any drugs prescribed to your dog.

• Core Territory: this is more important for cats than for dogs. Cats need hiding places, they need food and water positioned in separate areas, they need a litter box away from a feeding or watering station, they need an escape route, they need somewhere to sit and observe from a height, but also an easy way to get there. They need various entry and exit areas and strategies. All of this is particularly important when cats are in pain or discomfort, as they mainly react to pain by altering their behaviour and habits.

D is for DISEASE MODIFICATION

There are various ways in which we can attempt to modify the actual disease process of, for instance, osteoarthritis, the biggest cause of chronic pain in dogs. In principle, osteoarthritis is a chronic, progressive and incurable condition, but there are definitely some ways in which we can at least try to influence the severity, the speed of progression and the effect of osteoarthritis onto the dog. They include:

• NUTRACEUTICALS: this is a group of products, officially classed as ‘food supplements’, often used to try and influence the joint cartilage. There is limited scientific evidence for their efficacy, but they are widely used, especially as they have little to no negative effects. These include glucosamine, chondroitin sulphate, turmeric, green lipped muscle extract, omega 3 fatty acids, polysulphated glycosaminoglycans, Boswellia, Devil’s claw, avocado/soybean unsaponifiables, MSM, and many more.

• PENTOSAN POLYSULPHATE (‘Cartrophen’): this is a drug, which is given by subcutaneous injection (under the skin), often once weekly for 4 weeks, and is used to modify the metabolism of cartilage and the production of synovial (joint-) fluid.

• PLATELET RICH PLASMA (‘PRP’): this is a fraction of blood, or a product produced from the patient’s own blood, after processing. It has high levels of specific factors which are thought to positively influence the environment inside a joint, when injected into that joint. It is often used alongside other types of joint injections, such as adipose derived mesenchymal stem cells (‘AD MSC’), hyaluronic acid preparations or steroids. PRP can also be used to help healing in soft tissue injuries, such as tendon and muscle injuries, as part of the rehabilitation process.

• HYALURONIC ACID PREPARATIONS and other ‘hydrogels’: these can be injected directly into an affected joint, where they not only increase the viscosity of the joint fluid, thereby increasing ‘lubrication’ of the joint, but they also deliver or stimulate factors which can have an inhibitory effect on the process of osteoarthritis.

• STEM CELLS: these are cells derived from the patient’s own body, often from fat, which, after culture and activation, can be re-injected into areas such as joints (but also soft tissue after injuries), where they help to reduce inflammation, modulate the immune response and stimulate regeneration of tissue. Stem Cell treatment is often combined with PRP treatment.

E is for EXERCISE

In the past, many patients, both human and animal, were often advised to ‘rest’ when affected by things like arthritis and other painful conditions. Clearly, when an animal is in pain, rest seems a sensible approach. However, rest can also lead to stiffness, muscle weakness, muscle wasting, reduced flexibility, weight gain and even frustration and boredom. This can actually exacerbate painful conditions. Obviously, we need to modify an animal’s level and type of exercise in most cases of chronic pain, but this doesn’t necessarily mean total rest. A well-designed exercise programme can lead to an improvement of the clinical condition, as well as an improvement of the mental status of the individual patient. In canine rehabilitation, especially, it is of utmost importance that an individualised home exercise programme is designed and adhered to for the best results.

Conclusion

Clearly, pain is a difficult and complicated subject, in all its facets. In this blog we have tried to outline the most important scientific information, available to us at this moment in time, in an easily digestible format. We, at PeRiHab, are ideally placed to advise on (chronic) pain management, having all the necessary knowledge, skills, expertise and equipment to help you and your pet.

References

‘Neurophysiology and neuroanatomy of pain’ – Samantha Lindley – 2022

‘Analgesia’ – Matt Gurney – 2022

 HIP DYSPLASIA - A BRIEF HISTORY OF HIPS

Posted on 16 March, 2022

Hip Dysplasia (Dysplasia meaning abnormal development) is a genetically based developmental condition of dogs (and other animals, even humans!) which affects the hip joints. It causes an abnormal development of the hip joint, can start very soon after birth and leads to a laxity, or looseness, of the joint due to weakening of the structures which normally make the hip joint a firmly held together ball-and-socket joint. These structures are mainly: the ligament between the ‘ball’ of the joint, the head of the femur (or thigh bone), and the ‘socket’ of the joint, the acetabulum (part of the pelvis); the joint capsule, surrounding the joint on all sides. Both the ball and the socket will, over time, become misshapen, flattened, mal-fitting and deformed. This will, in turn, lead to excessive wear and tear, causing osteo-arthritis, which is a painful and lifelong condition.

The most important factor in the development of Hip Dysplasia, or HD, is genetics. Dogs with the genetic predisposition to develop HD will also be affected by other factors, especially during their physical development within their first year of life. These factors include their sex, their bodyweight, their rate of growth, their nutrition, their level of exercise and possibly more. HD is not a congenital (meaning ‘born with’) condition, as all puppies are born with normal hip joints. But it can show at only a few months of age already in some dogs.

Because genetics play such a big role in the development of HD, a breeding scheme was developed, many years ago, supported by the Kennel Club and the British Veterinary Association, to try and reduce the occurrence of HD. Dogs, intended for breeding, can be screened for the health of their hips by taking radiographs, or ‘xrays’, often under general anaesthetic, when they are over one year of age. They then get a ‘Hip Score’, based on the radiographic appearance of their hips, and only dogs with scores, better than average, should be used for breeding. Over the last few decades, average scores have come down for most breeds.

Most dogs with HD will show some, or all, of the following symptoms: stiffness, pain, exercise intolerance, a shortened stride, a hopping gait (especially when going up- or downstairs), a swaying gait, a limp, sitting sideways instead of straight, difficulty getting up from lying down. Most dogs are affected in both hips, but some are much more affected in one hip only. Most dogs will start to show signs when they are young, often at 4-10 months of age. On clinical examination, vets may find pain on hip pressure or manipulation, restricted range of movement of the joint, looseness of the joint, muscle wasting around the hip and more.

To confirm the diagnosis, most vets will advise that radiographs are taken, under heavy sedation or general anaesthetic. During this examination, several special body and leg positions may be used for full evaluation of the hip joints and any joint laxity. In some cases, further advanced diagnostic imaging may also be advised, such as CT or MRI scans. The vet may also do certain special manipulative tests, such as the Ortolani test, which assesses joint laxity. Radiographs give an indication of both the severity of the HD, as well as the subsequent secondary changes, such as bone shape changes and osteo-arthritis, which will always be a long-term consequence of HD.

Treatment of HD will depend on many factors, which include the age, sex and breed of the dog, the stage of HD and any possible secondary consequences, such as osteo-arthritis, the expected lifestyle of the dog, access to orthopaedic specialist services and, not in the least, financial considerations.

In some cases, non surgical treatment is indicated, for instance in very young dogs, in dogs with very few symptoms, or in cases where surgery is not feasible for various reasons. Treatment will usually consist of medications to reduce or prevent pain, exercise modification, weight management, as well as rehabilitation techniques, such as massage, physical modalities, hydrotherapy, acupuncture and an individualised home exercise programme. PeRiHab is ideally placed to offer you and your dog all of the above treatment modalities!

If surgery is indicated, post-operative rehabilitation, using some or all of the modalities mentioned above, is essential to obtain the best results. In fact, some of these are also indicated before any surgery is performed (‘pre-hab’). There are many different surgical techniques which can be used for the management of HD and it depends on various factors which is the most appropriate in each individual case. In most cases, an orthopaedic specialist will be best places to make this judgement.

Surgical techniques include:

• Juvenile Pubic Symphysiodesis: in this surgery the shape and position of the pelvis is changed, by fusing an as yet non-fused part of the pelvis, to give better ‘coverage’ of the hip joints. This technique is mostly considered in very young patients only, e.g. less than 5 months of age, with mild to moderate HD and without any secondary changes.

• Double or Triple Pelvic Osteotomy: in this surgery the shape and position of the pelvis is also changed, by cutting the pelvic bones in 2 or 3 places and fixing it in a new position with plates and screws, to give better ‘coverage’ of the hip joints. However, this surgery is mostly performed in slightly older dogs, but still only those who have not got any major secondary changes yet.

• Total Hip Replacement: in this surgery the entire hip joint is replaced with an artificial hip joint, just as in humans, made of both metal and plastic. There are many different systems on the market and most give very good results. Some dogs will only need one hip replaced, even if they have both hips affected by HD. This surgery can be done at any age, but it mostly restricted to those dogs who are physically mature. Some dogs can go back to full levels of activity, even sporting activity in some cases!

• Femoral Head and Neck Excision: in this surgery the top of the femur (thigh bone), which makes up the ‘ball’ of the hip joint, is removed, leaving the hind leg suspended in muscle support only. A ‘false joint’ is formed, mainly by scar tissue formation, which doesn’t have full range of movement which the original hip joint would have, but often dogs are pain free and functional. A permanent slight limp will usually remain, partially due to a minor shortening of the affected limb.

If you think, or know, that your dog is affected by Hip Dysplasia, do ask PeRiHab for advice in helping your dog have the best possible quality of life with this debilitating condition.

FOCUS ON FORCES

DOG HARNESSES

Posted on 23 February, 2022

Nowadays, there are many different types and brands of dog harnesses available, made from various kinds of material, and in all sorts of shapes, sizes and colours. In general, we really like harnesses for dogs, but there are certain things we should all take into consideration, when choosing the right ones.

The reason we like harnesses is that they’re great for lots of situations: in general, they give good control over our four-legged friends, without putting unnecessary pressure on their heads and necks. This is especially important in small dogs (like Yorkshire terriers for instance) who may suffer from ‘tracheal collapse’ (put a lead and collar on these little guys and if they pull, they might pass out!). They are also good for dogs who like to pull (harnesses, apparently, change the dog’s centre of gravity and make them feel more confident, more relaxed and actually less likely to pull). It is vitally important for dogs who have had neck surgery, for instance for IVDD (‘slipped disc’). We like them for brachycephalic (‘short-nosed’) dogs, such as Pugs and Frenchies, who are at risk of eyeball prolapse. They also often have narrowed tracheas, making it even more important not to put any pressure on them. Finally, harnesses are great for dogs who are at risk of increased intra-ocular pressure (pressure inside the eye balls).

However, a dilemma may be what exact type of harness we should get for our dog. There are many different harnesses on the market, but it is critical that we use a ‘non-restrictive harness’ when exercising dogs, and by non-restrictive we mean one that leaves the entire front leg free to move. The front leg of a dog is attached to the body purely by muscles, and when the dog moves, the front leg moves forward with some glide over the body wall too (the faster that they are moving, the more glide is occurring). A non-restrictive harness allows for plenty of control over the dog, whilst still leaving the front legs free to move over their entire range of movement. This is particularly important for sporting and other working dogs.

A good, non-restrictive harness is one that fits perfectly, snugly (you should just be able to place two fingers underneath the harness on all sides) and doesn’t cause any friction or excessive pressure. Some harnesses are fleece lined and therefore very comfortable. Some harnesses have D-rings at the front of the harness, for an additional attachment of a (second) lead. This may give more directional control, in some circumstances. Harnesses with only one D-ring to attach a lead onto, placed over the middle of the back of the dog, give poor control.

A ‘restrictive harness’, on the other hand, restricts the movement of the front limb, often by sitting over the shoulder joint, usually in the form of a straight band of the harness crossing in front of the dog. Sometimes there is also a strap positioned right under the axilla (‘armpit’) of both front legs. This type of harness is problematic because it restricts the ability of the dog to move its front leg forward and after a while the dog alters its gait to restrict movement of the limb forward even when not wearing the harness - this is bad for any dog, but especially for performance dogs. It also presses on the front of the shoulder joint, where the ‘biceps tendon’ runs, and there is some debate as to whether the increased pressure in this area may be acting as a factor in biceps tendon problems, such as bicipital tendinopathy, a soft tissue injury we commonly see in sporting dogs. In addition, some restrictive harnesses have a strap across the back that presses on the back of the dog’s shoulder blade, also preventing the free movement of the front leg.

There is also some research demonstrating that using a restrictive harness reduces the dog’s stride length (or the forward step of your dog), and reduces the foot pressure by the dog. Interestingly, if the dog is pulling a weight, then the step length increases if they are wearing a restrictive harness. This may increase pressure onto the shoulder joints! The effect of a harness on a dog’s mobility is greater, the greater the contact surface of the harness on the dog, and the more often the dog wears the harness.

Unfortunately, restrictive harnesses are often heavily marketed and promoted for training and ‘all day wear’, and often win awards in popular dog magazines for ‘best harness’ or ‘best new product’, which isn’t helpful for the consumer or the dogs wearing them! Another problem is that a lot of the working dog harnesses are restrictive.

If you are going to use a harness for your dog, then please make sure that it is non-restrictive. Harnesses can be brilliant - as long as you get the right one and one that fits your dog properly!

FOCUS ON FELINES

Posted on 16 February, 2022

Today we’re talking about ‘felines’, or cats, to me and you. Yes, we are called ‘PeRiHab - Mobile Canine Rehabilitation’, but cats are just as important as dogs are and cats can suffer, generally, from the same or similar conditions as dogs do. As vets in general practice, we have been treating cats and dogs in more or less equal numbers for many years. As rehabilitation therapists, we mainly deal with dogs, but we are very happy to see and treat cats as well! Cats can be a real challenge, but they can also be very satisfying to treat.

One of the most common conditions we see in cats is arthritis, or osteo-arthritis (OA), a joint condition which can affect all animals, including humans of course. But many people seem to think that cats don’t suffer from OA, probably mostly due to the fact, that cats don’t show pain very well and have a very different lifestyle than dogs. In this article we describe osteo-arthritis in cats and the specifics of this condition, especially as compared to the same condition in dogs and humans.

Causes of OA in cats are very similar to those in other species: congenital and developmental bone and joint conditions, joint injury, joint surgery, old age wear and tear, genetic conditions. Obesity makes the symptoms of OA more obvious.

Symptoms, most of which are, in fact, behavioural:

• Stiffness, especially after resting

• Limping - often difficult to appreciate in cats

• Reluctance, or hesitance, to jump up or down

• Difficulty going up or down stairs

• Difficulty using the litter tray

• Difficulty navigating the cat flap

• Irritability / grumpiness – unwilling to be petted – sometimes mis-interpreted as aggression

• Reduced activity in general – sometimes hard to tell in cats!

• Difficulty grooming, leading to an unkempt appearance

• Overgrown claws

• Hiding away – unwilling to make contact, interact or play

OA is mostly diagnosed on the basis of a combination of the symptoms, as seen by the owner, a thorough clinical examination and further investigations, in the forms of radiography (the taking of ‘x-rays’) and possibly advanced imaging techniques, such as CT, MRI and arthroscopy. The veterinary surgeon examining a cat with OA may find things like swollen and painful joints, reduced range-of-motion of joints, muscle wastage, crepitus (grating sensation when moving a joint) and, often, a reluctance to be examined. In some cases, vets will diagnose OA in cats, when owners are unaware of the condition, mostly because cats are really good at ‘hiding pain’, and showing only behavioural signs, rather than outright lameness, as often is the case in dogs. Alternatively, owners may feel that the cat is simply ‘slowing down’ with age, whereas, in fact, the cat is suffering from OA.

Treatment options for cats with OA are very similar to those in dogs and are plentiful! They include pain relief medications (many different types and groups of drugs, although less than in dogs), joint modification drugs, weight and exercise control, nutritional management, dietary supplements, environmental adaptations, monoclonal antibody treatment, stem cell treatment, platelet rich plasma treatment, acupuncture, intra-articular injections, surgery, Western herbal medicine, and, of course, rehabilitation! Various rehabilitation techniques are suitable for cats, as they are for dogs, such as soft tissue massage, electric therapies (such as TENS/NMES), joint mobilisations, laser therapy, ultrasound therapy, thermotherapy and hydrotherapy.

There are many things you can do, at home, that make life much easier for cats with OA:

• Provide a soft, warm, comfortable bed, preferably in a warm place

• Buy or make ramps and ladders to help cats get to higher places they like to spend time

• Supply a litter box with low edges, and ideally on the same floor as the food and water is positioned (but not next to it!)

• Help your cat with grooming, using soft brushes or a zoom groom

• Clip your cat’s claws regularly

• Make sure your cat doesn’t gain weight, or help them to lose weight

Obviously, apart from osteo-arthritis, there are many different conditions in cats, for which rehabilitation is suitable, in fact, often advisable or even essential! These include orthopaedic conditions such as hip dysplasia and patella luxation; neurological conditions such as ataxia and intervertebral disc disease; trauma cases such as fractures and nerve avulsions; metabolic conditions such as diabetes mellitus; muscle disorders such as contractions.

If you think your cat may benefit from treatment for osteo-arthritis, or from any kind of rehabilitation technique, please do not hesitate to contact us at PeRiHab!

FOCUS ON FEET

DEW CLAWS – SHOULD THEY STAY OR SHOULD THEY GO?

Posted on 9 February, 2022

Dew claws are the small ‘thumb-like’ structures on the feet of dogs, either on the front or the rear feet, just above the other four toes, but below the carpus (wrist) or tarsus (hock) joint. Most dogs have dew claws only on the front feet, naturally, but some dogs also have them on their rear feet. These breeds include St. Bernard, Pyrenean Mountain Dog, Briard, Anatolian Shepherd Dog and the Catalan Sheepdog. Most breeds will have Kennel Club breed standards which dictate whether they should have front or rear dew claws, and how many. This is because some dogs have ‘double dew claws’, either at the front or the rear, where instead of a single small toe/claw there is a double one. Often one or even both are loosely attached to the rest of the leg only, sometimes only hanging on a piece of skin. Officially, having extra toes is a condition called ‘polydactyly’, literally meaning ‘many digits or toes’.

It is generally accepted that front dew claws, at least those that are firmly attached to the rest of the foot, have a real purpose for the dog. They are attached in a similar way to the way our thumbs are attached, with bones and joints, and therefore make up part of the carpal joint, or wrist joint. They also have several tendons attached to them, which, in turn, have muscles attached to them. Their function is to minimise rotation, or torque, of the front leg, especially when turning. This is even more important at high speed, when dogs are running, jumping and turning, for instance in agility or other dog sports. From slow motion video footage and sports photographs, it can be easily seen that the dew claws are in contact with the ground during these activities, and their nails can dig in to the ground for extra ‘hold’.

Dew claws are also important as a tool to hold on to things, like chews, bones, toys etc. Just watch your dog, next time you give them a chew, and see how they use their ‘thumbs’ to hold on! On top of that, they can be useful for dogs when they climb out of holes and ditches, sandpits, rivers and so on.

It is often said that dew claws are prone to injury, especially when running through undergrowth and for working dogs. They can indeed suffer damage, tears, rips and even fractures, but, actually, this is fairly rare in general veterinary practice! Even if it does happen, it can easily be treated by your vet. Dew claws that are unattached, very loose or very large, are more prone to injury though. The length of the claw which is attached to the dew claw also plays a role, as the longer the nail, the higher the chance of damage. Therefore, it is of utmost importance to keep the nail (as well as all of the others of course) short at all times.

Often, dogs have their dew claws removed, mostly at a very young age, for instance in the first few days after birth. This is often done by breeders themselves, although it might also be done at the vets. Often, no form of anaesthetic or pain relief is used at all during this procedure. It can lead, especially if not done correctly, to pain, infections, dew claw remnants being present or ugly scars, but the most important thing to consider is this: it is now known that dogs who have their dew claws removed, are at a very much higher chance to develop osteo-arthritis in their carpal joints, in the long run. This is due to the lack of stabilisation against rotation of the wrist joint, as stated above, leading to laxity and excess movement of the bones of the carpus joint. Osteo-arthritis is a painful condition, which can severely affect a dog’s quality of life.

So, should we remove dew claws or not? We, at PeRiHab, believe that, in general, front dew claws should be preserved, for the reasons stated above. However, very loose or floppy dew claws, those that have no bony connection to the rest of the foot, and rear dew claws, may be removed, in most cases. We feel that this should only be done by a veterinary surgeon, and with the use of anaesthetics and appropriate pain relief, to prevent any unnecessary suffering. We believe that dew claws should not be removed for cosmetic purposes only, or to fit the breed standard. We also believe that it is important to keep all claws clipped short and this is even more important for the dew claws.

If your dog has any issues with their dew claws, or suffers from an injury, please always get your vet’s advice on how to treat this. Often it is possible to treat it successfully.

The finishing touch

Posted on 31 January, 2022

Today we will ‘touch upon’ an important technique which we can all use, on a daily basis, easily, quickly and for free, to help our four-legged friends! Not only that, it also helps us at the same time! How amazing is that?

We’re talking about touch! And there are many recognised techniques available, in fact, there are too many to mention, let alone go into detail about them. You may know some of these, others may be new to you. There is stroking, massage, TTouch, myotherapy, acupressure, reflexology, stretching, shiatsu, watsu and many more…They all work in different ways and not all are suitable for ‘home use’. In fact, some must only be performed by trained professionals, especially for treatment of any injury!

Famously, Betty White once said: “You can always tell about somebody by the way they put their hands on an animal”, and we, at PeRiHab, believe this is true indeed! And the best thing is that this will benefit our dogs, and cats, and other animals too, in so many ways. Science has proven that touching / stroking / massaging a pet will lower blood pressure and release Oxytocin, a ‘happy hormone’, and this is true for us as well as the pet we’re touching!

Touch, and gentle massage, can help your pet:

• To reduce anxiety or depression

• To decrease pain perception

• To increase cognition

• To improve sleep patterns

• To downregulate the nervous system

• To improve emotions

• To enhance focus, memory and brain function

• To regulate appetite control

For canine athletes, touch and gentle massage may help:

• To increase joint range of movement

• To decrease muscle tension and spasms

• To prevent injury

• To assist with warm up and cool down regimes

For us, as pet owners, it will help:

• To communicate with your pet

• To get to know your pet’s body

• To discover any changes, such as lumps and bumps

• To create a better bond with your pet

• To relax both your pet as well as yourself

• To achieve tactile enrichment

Touch will lead to a happier, healthier and more relaxed pet! So why not?

Let sleeping dogs lie!

Posted on 26 January, 2022

We all know, or at least we should know, how important sufficient sleep is for us all, in order to refresh, to recharge and to rejuvenate. People who don’t get enough sleep are often grumpy, impatient, inefficient, forgetful or even physically ill due to a sub-optimally functioning immune system. Is the same true for our dogs, you may ask?

In general, dogs have a great life: Most dogs sleep all night, and then snooze or nap through the day as well, in between short bursts of activity and exercise. We often feel a little jealous, don’t we? But is this normal? And why is it so different from us humans?

Dogs are, of course, by nature predators and carnivores, and, as such, have a very different lifestyle and bodily functions than herbivores or omnivores, like humans. They often eat very quickly (you never know when the next meal is coming along, right?) and spend a long time digesting their food, and regaining enough energy to hunt again (even if this ‘hunt’ is simply running into the kitchen!)

The amount that dogs sleep, varies according to their breed, activity levels, health status, diet and environment, but age is the greatest factor. Puppies can easily sleep for more than 12 hours per day, perhaps even up to 18 hours, with quite a few hours of these during the daytime. Adult dogs sleep about 10-12 hours a day, on average, but most of these hours are at night time. Older dogs, however, sleep more hours again, and more during the day too!

Dogs that don’t get enough ‘shut-eye’, often display similar symptoms as humans do, like irritability and other behavioural disturbances and they have even been proven to be worse at performing learned tasks and behaviours. Beware that some dogs may have difficulty getting to sleep because they have physical problems, such as pain, for instance due to osteo-arthritis or other conditions. Dogs that sleep excessive hours, however, could be suffering from certain physical conditions, such as hypo-thyroidism, heart disease, obesity or diabetes.

Do dogs dream? Well, we have all seen dogs twitching or even ‘running after prey’ whilst sleeping, barking, or growling, and we believe that dogs can indeed dream. Studies have shown that dogs do indeed have REM sleep, but nowhere as much as people do. During the daytime especially, dogs often sleep less deeply than at night-time, with minimal disruptions waking them up very quickly.

What sleeping position is best? Well, just like humans, dogs also have their favourite sleeping positions, be that on their back, curled up, all stretched out or different. Each dog will develop his or her favourite place and position, and of course this may change over time too.

How do we make sure our dogs sleep well, and for enough hours? We, at PeRiHab, think there are several ways in which we can help them:

1. Try having a routine with your dog’s sleeping hours, perhaps including putting him or her inside a locked crate, to help relax.

2. Don’t let the dog sleep with you on the bed. This can disrupt both the dog’s sleep, as well as yours!

3. Make sure your dog has a soft, supportive and comfortable bed, especially if they are old or arthritic.

4. Make sure that their sleeping area is quiet and preferably dark too. Keep the children away from the dog whilst he or she is sleeping.

5. As in humans, having sufficient exercise during the day may help sleep better at night too!

6. You may choose to reduce noise levels in the evening, and close the curtains, to reduce any distractions, to help your dog to fall sleep.

7. Try using special night-time treats, for instance those containing Chamomile, Valerian, Passionflower or other herbs, to help them sleep better.

‘Move to improve’ - But what about puppies?

Posted on 19 January, 2022

‘Move to Improve’ is PeRiHab’s motto, and for good reason: for most dogs (as well as for people!), and in most situations, this is true. Especially during rehabilitation, ‘moving’ is, generally, good. Moving bodies, moving joints, moving muscles, tendons and ligaments all helps to (re-)build strength and endurance, helps to improve balance and coordination, helps to increase flexibility, if done in a sensible way and under expert guidance. But ‘moving’ also helps, in healthy dogs, to improve the general body condition, to control weight, to aid normal development during the development and growth phase, and to keep ageing bodies ‘young’!

In our working life, as both vets and rehabilitation therapists, we are often asked about the correct type and level of exercise for dogs, and, in particular, for puppies. And, as in many cases, there is no simple answer to this question. It depends on many factors, like genetics, age, sex, hormonal status, size, bodyweight, breed specific disease predispositions, environmental differences and more. However, many people rigidly hold on to certain ‘guidelines’, even if those guidelines do not have any scientific basis at all. This article sets out some basic guidelines for exercise levels in growing puppies, which we, at PeRiHab, believe to be simple, easy to follow and correct.

Many breeders, dog owners, trainers and other canine specialists have, over the years, advised that puppies should not be exercised much, or even at all, before their growth plates, the sensitive areas in the long bones from which they grow in length, have closed. These growth plates are certainly important, because if they are damaged in any way, it will cause growth disturbances and deformities, such as shortened limbs, bent limbs and joint problems, leading to early onset osteo-arthritis. In most dogs the growth plates close just before, or just after they are about one year of age, earlier in smaller breeds (say 6-10 months) and later in larger breeds (say 12-16 months), generally. Some people have also tried to establish guidelines for puppy exercise levels, for instance the much-repeated, but not scientifically proven, advice of 5 minutes per month of age of the puppy, for the total amount of exercise per day. So, let’s look at both points and see if we can come to some scientifically correct guidelines for you and your puppy!

Most canids (the group to which dogs belong) in the wild, like wolves, wild dogs, coyotes, foxes etc., do not limit their puppies from running around, do they? They walk, they trot, they run, they jump, they tumble and they play to their hearts’ content. And they do just fine! Of course, their genetics might not predispose them to OCD, Hip Dysplasia or Developmental Elbow Disease, like in certain dog breeds, but the exercise in itself in hardly damaging.

In humans too, there is no evidence at all, that regular and reasonable amounts of exercise do any damage to the skeletal development of young people. After all, loads of children play, run, do all sorts of sports, way before they are ‘fully grown’, or their growth plates have closed, and, again, they do just fine! Heavy weightlifting and other severely concussive exercises are not advised for children, but otherwise they are free to exercise as much as they want.

There are, of course, many orthopaedic conditions, which are common in puppies and young dogs, such as Osteochondrosis Dissecans, Hip Dysplasia, Developmental Elbow Disease, Panosteitis, Metaphyseal Osteopathy, Short Radius Syndrome and many more. Most of these conditions, however, are mainly based on genetic factors, whilst other factors may also be important in their etiology, such as being overweight, overfeeding and perhaps excessive and high-impact exercise. Normal, regular, reasonable amounts of exercise are never a factor in these conditions.

Lots of studies have been done, over the years, to study the effect of various types and amounts of exercise on the chances of developing different types of orthopaedic conditions. For instance, climbing stairs in very young puppies, being overweight, and being fed ad-lib (limitless) all caused an increased incidence of Hip Dysplasia. Chances of developing OCD was increased if puppies did lots of repeated and high-impact exercise, such as running after sticks and balls. We also know that being overweight is one of the most important risk factors for dogs to develop osteo-arthritis. Other studies have proven that even very prolonged regular and reasonable exercise, such as mild to moderate amounts of running per day, for many months, does no damage at all to joints, bones, cartilage or other orthopaedic structures. In fact, it often causes thicker and stronger cartilage in the joints, as well as bigger and stronger bones and muscles! Only if dogs were subjected to insane amounts of running, say a double marathon distance, daily, for many months, did they start to show negative effects. In much older dogs, higher amounts of exercise may contribute to the further development of osteoarthritis, but these dogs often already have damaged joints to start with.

So, what does PeRiHab advise regarding exercise in puppies?

1. As a healthy starting point, it is important to point out that getting a puppy from breeding lines, known to be free from hereditary conditions, such as Hip Dysplasia, Developmental Elbow Disease and others, is of utmost importance.

2. We, at PeRiHab, believe that normal, regular exercise is an excellent way to help puppies to develop in a normal and healthy way. Walking, running and playing all help with building their strength, their balance and coordination, their flexibility and, later on, their endurance. Puppies should be allowed to play with their friends, to go for short or long country walks, to sniff the outside air, to socialise with other dogs, and with people and other animals too. Moreover, exercises are also good for their mental stimulation. Make sure though, that your puppy is fully vaccinated before taking it outside, especially in public areas, for the first time!

3. We believe that high impact exercise, such as jumping in and out of the car, running up and down stairs, ball chasing (especially using the often seen ‘chucker’!) and extremely rough play, should all be discouraged, especially in their first year. In particular, specific sports training, as for agility and other canine sports, should wait until they are fully grown, although the basics can be taught from an earlier age.

4. We believe that it is sensible to try and keep your puppies on non-slippery flooring, as much as possible, such as carpet, rugs etc, rather than wooden flooring and tiles. This will help to avoid slipping and sliding and possible subsequent injuries.

5. We believe that keeping your dog slim and fit, at all times, and never to overfeed and cause your puppy to be overweight, is of utmost important too!

6. We believe that strength training should wait till at least 6 months of age, and endurance training till at least 12-14 months of age.

7. We believe that exercise is not only good for the puppies themselves, but also for their owners, so we should all aim to get and stay fit together.

If you would like more specific advice about your individual puppy, and his or her exercise levels, please do not hesitate to contact us on hello@perihab.com

Natural healing

Posted on 12 January, 2022

As part of our January Wellness Campaign, we are very excited to present our new product - PeRiBalm!

Following our recent post about ‘Winter advice’, we feel it is time to introduce our own 100% natural and organic PeRiBalm – a protective and nourishing balm for your dog’s paws!

Handmade by our own PeRiHab vet Rimante, with dogs’ paws in mind, this protective balm has been formulated using only 100% natural and sustainable ingredients. It is a powerful organic remedy which is absorbed slowly and creates natural protection against damage caused by rough surfaces, salts, frost, mud and sand.

Does your dog love adventure, no matter the weather? Perhaps, winter is his or her favourite time of the year? Winter adventures cause lots of challenges for your dog’s feet: frost can be simply too cold for comfort, snow and ice can cause irritation or even minor injuries. One of the biggest problems (especially in cities) during frosty weather is salts, often with chemicals, being spread on the roads. It can not only be irritating and painful for your dog’s paws and skin, but it can even cause wounds or burns. PeRiBalm would be an ideal remedy to protect your dog’s paws against these harsh conditions and irritants.

We would also advise using PeRiBalm for dogs who regularly work in the field, or on rough terrain, like mountain rescue dogs, border patrol dogs etc. Even most sporting dogs would benefit from PeRiBalm, especially those dogs who regularly damage their pads, for instance, on the textured surfaces of agility ‘dog walks’, ‘see-saws’ and ‘A-frames’.

Many of the paw balms or waxes on the market are made from synthetic ingredients which sometimes can cause more harm than good, especially if your dog would lick it. Also, some other natural paw balms are very often made with oils only, rather than a combination of oils and waxes, that get absorbed quickly and only soften the skin for a short time. The main thing to remember is that the skin of the dog's feet must be smooth but firm, as well as elastic and forgiving to remain undamaged by different surfaces and various conditions! In order to achieve this, we have a slowly absorbing protective wax that allows the skin to breathe and forms a protective layer. Of course, the natural oils do play a very important role in restoring the skin of the paws which is irritated and damaged. PeRiBalm is also perfect for pets with cracked paw pads, elbow callouses or even dry cracked noses, often seen in older dogs.

And the best part of it all… PeRiBalm can be customised to your wishes and your dog’s individual needs! Suitable for dogs of all ages and breeds. And, on top of that, all PeRiBalm formulas are lick-safe!

How to use PeRiBalm:

Warm the balm gently with your hands, then place some onto your fingers and massage a thin layer on your dog’s paws and in between the toes, before going outside. Due to its slow absorption, it even lasts during longer walks!

PeRiBalm may also be used for healing and regeneration purposes, especially if the skin of the paws has lesions or is very sensitive. In this case, apply a thin layer on washed and dried paws and let it dry.

If you would like to know more about PeRiBalm, or order a pot for your dog, please contact us at hello@perihab.com

Winter advice for you and your pet

Posted on 05 January, 2022

As winter has now properly set in, we, at PeRiHab, think that it’s important to take several things into consideration, to help keep your dog safe and healthy throughout this colder time.

The following are our ‘Top Ten Tips’: 

1. Keep your dog warm: We make sure that we dress up warmly when going out in the cold, so why not your dog? They may have a ‘coat’ themselves, but some dogs are definitely negatively affected by colder weather. There are many different coats on the market, to keep your dog warm and comfortable, there will be one to suit your dog for sure. This may be a fleece coat, or a waterproof coat, or something else, perhaps including cover for their legs. Make sure that, whatever you use, it fits well, snugly, but not too tight (make sure you can always get 2 flat fingers underneath it).

2. Keep your dog’s feet happy: After a walk in the snow, clear all snow or ice from their feet, including in between their toes and stuck to hair. Also, if the local authorities have spread salt or grit, make sure you wash your dogs’ feet thoroughly after a walk, as some salts and grit can cause skin burns and irritation. Some dogs benefit from wearing special boots, especially when walking in the snow or over rough terrain. Many different brands are available. You may choose to use a special dog paw balm, designed to protect and nourish your dogs’ paws’ sensitive pads. PeRiHab produces its own dog paw balm, called PeRiBalm, made of all natural and organic ingredients!

3. Make your dog visible: During the winter, days are short and we often walk them in dusk or even dark conditions. Make sure your dog is seen, by you and others, by making them wear a high vis jacket, or a flashing tag on their collar for instance. Alternatively, some dog coats have reflective strips incorporated in them, which also helps.

4. Make sure they can be identified: All dogs must, by law, have a microchip implanted. Make sure the details on the database are correct and up to date. But they should also always wear a collar and identification tag, by law.

5. Keep them active: Even if we don’t necessarily walk them quite as far, or as frequently, as during warmer months, make sure they get their activity, needed to keep them from mischief. This may mean that you do some extra play indoors, or play games, or do obedience exercises, on top of the outside walks.

6. Don’t overfeed your dog: As they may have less outdoor exercise than during warmer months, you may have to adjust their food intake, to prevent them gaining weight over the winter months. This is especially important for older dogs, or dogs with osteo-arthritis for instance, as they are more likely to suffer from being overweight, or find it harder to lose the weight again once the warmer months come along.

7. Snow and Ice: Apart from the above-mentioned potential paw issues, snow and ice carry other risks for dogs too! As much fun as it is for us, dogs may find snow and ice uncomfortable, or even scary, to walk or run on. Slipping and sliding, or subsequent falling, can cause muscle and other soft tissue injuries, or even broken legs. Beware also of frozen ponds, as the sharp ice can cause injuries, apart from the obvious risk of drowning if the ice is over deep water.

8. A comfy bed: Make sure that when your dog comes home, that there is a soft, warm and comfy bed waiting for them. Again, this is especially important for older or arthritic dogs.

9. Medication: If your dog seems especially stiff, or slow, during the winter time, please do ask your vet for advice, as they may need medication to keep them from being in pain. Remember, there are many more ways them medication, to keep your dog from being in pain. At PeRiHab, we have access to many different ways to help your dog, such as acupuncture, laser treatment and much more.

10. Dangers: Remember that some products we often use during the winter time, can carry significant risks for dogs (and other pets too of course!). The most common poisoning we see in the wintertime is the one caused by the ingestion of anti-freeze, as it’s commonly used and actually very attractive for dogs, as it’s sweet tasting! It can cause severe poisoning, often leading to death, especially if not treated immediately.  

PeRiHab hopes that with these 10 simple tips, we can all try and keep our dogs safe and healthy during the colder winter months. If you need any help with anything mentioned above, please do not hesitate to contact us.

Welcome to PeRiHab!

Posted on December 07, 2021

Welcome to our first PeRiHab ‘blog’!

We are very excited to invite you to join us on our adventurous journey. Let us explain what we aim to establish on this page of our website.

We are going to regularly write informative and educational articles, which, hopefully, will explain some of the things we do, the treatments we can give, the positive changes we can make to your pet and much more. This may be a case study, a story about a particular patient we have seen, or just an explanation of some common conditions we encounter. It may be a follow-up on a case we have treated in the past, or it may be seasonal advice, to keep your pet free from common problems and injuries.

We hope that, together with you, we can build a community, looking to improve the health and wellbeing of both you and your pets, with positivity, enthusiasm and mutual respect. We welcome any comments, reviews and suggestions which would help to make this page better all of the time. If there is a particular subject you would like us to discuss, please do not hesitate to get in touch!

Thank you for joining the PeRiHab family!

Pete and Rimante, and Spikey, of course.