E356 - 수 야노프(Dr. Sue Yanoff): 스포츠견에게 문제가 생겼을 때 대처법

Or is it possible for dogs to kind of have the equivalent of spraining an ankle? And then, you know, how do we tell? Yeah, it's not necessarily serious. And a sprain is a serious injury. A sprain is an injury to a ligament. So I think often we'll see dogs limp off for various reasons that are not serious. I was at an agility trial two weekends ago and a dog crashed into a jump and started limping on the hind leg. By the time the dog came off the arena and out of the ring, he wasn't limping anymore. And then another dog was limping towards the end of her run. The owner brought her out and she ended up having an abrasion of one of the pads. So injuries are not necessarily serious. Like we can be walking around and stub our toe and it hurts a lot. But then after a few minutes, it doesn't hurt anymore. So you're not limping anymore. Or we can like twist our ankle like to the side and it hurts a lot. But there's no serious damage to any soft tissue. So after a couple of minutes or maybe an hour or so, it doesn't hurt anymore. So yes, it is possible for a dog to injure themselves doing their sport. And it can be not necessarily serious. I would say if it doesn't get better overnight, then I would say it needs to be checked out. Thinking about that for a minute, you know, often our dogs are so good at hiding pain. And, you know, hopefully as sports antlers, we're a little bit more in tune with their dog than maybe the typical pet owner. But I guess my question is kind of twofold. I guess what are some of the more subtle signs that we need to watch out for? Something that says, you know, maybe the dog's still hurting, but they're doing a good job of hiding that pain. Or and how do we kind of present that information so that we're taken seriously at the vet and it's not maybe dismissed as an exaggeration or, you know, the dog's not limping anymore. They must be fine. You know, that kind of thing. Right. Those are good questions. I think we often see subtle changes in sports dogs that we would not notice in a pet dog. So if a dog is limping or holding a leg up, that's obvious. But some of the more common things I see, especially in agility dogs, are things like the times are a little bit slower. The dog is taking wide turns, wider than normal or knocking bars. The dog that doesn't normally knock bars is knocking bars or stuttering up to the jump and then jumping. A common thing is popping the weaves or other changes in performance. So those are usually the things that a competitor notices.

I've also seen dogs that were brought to me because during a lesson, the instructor said, you know, there's something off with that dog. And then I've seen the dog and we have found injuries. And then I've also seen a couple of dogs that were being shown in breed. And the history is when I stack the dog, he always moves one leg slightly. So I remember a corgi we had once that the only complaint was that when they stacked him for the show ring, he moved his right hind leg forward just like half an inch and consistently. And then we checked him and he ended up having a pretty severe iliopsoas muscle strain. So, you know, just because the signs are subtle doesn't mean that it's not a serious injury. So the clinical signs don't always match with the severity of the injury. And of course, we all know that our high drive performance dogs will hide their injury and not worry about it while they're running agility or doing their hunting or whatever other sport they're engaged in. And then when they get home and sleep on it and then they get up and they're stiff, then we notice that there might be a problem. But oftentimes, really, the history is a performance issue. And a general practitioner who doesn't know much about sports would look at you funny if you said, oh, my dog's doing great, but he's popping the weaves and I know something's wrong. And then a general practitioner who is not necessarily experienced or trained in doing orthopedic exams is not going to find anything wrong because either they don't know where to look or they don't know how to look. So and we'll talk about that later. But if your general practitioner recommends a treatment, which is perfectly reasonable to try and your dog doesn't get better, then we have to start looking elsewhere for a diagnosis. Do you have, you know, kind of anything that you'd recommend going into that appointment with that general practitioner vet? You know, assuming something obviously came up that made you consider it serious enough to warn a vet visit. Is there anything we can do, I guess, to kind of increase the likelihood that we do get something kind of taken seriously, that we do get maybe a diagnosis if possible? You know, is there anything we can do to kind of be our best prepared, most prepared selves to increase the likelihood of things, you know, having a positive outcome? Yeah. So probably the best thing you do is give your vet a crash course in sports. So if you do agility, you can explain to the vet that oftentimes dogs that are not lame but are having a decrease in performance have a problem.

But there's not much you can do. The vet is going to do an exam as best they can. They often will recommend conservative treatment consisting of often NSAIDs and restricted activity, which is very reasonable. If there's if it's nothing, if it's something serious, the vet is not going to miss it. If it's subtle, the vet might miss it. And that subtle problem could become serious if it's not treated properly. So in most cases, I don't have a problem treating a dog conservatively at first. But then after two or three weeks, if your dog's not getting better, then I think we have to look further. So two or three weeks seems like the key factor there. Are there any other things that maybe you'd highlight as red flags that mean we should, you know, pursue a more serious diagnosis? Well, if the dog is getting worse after you see your regular vet, then yes, you don't want to wait two or three weeks. But in general, if the dog's not getting worse and it's not a serious lameness, like if the dog's walking around with one leg held up, that's serious. So that has to be taken care of right away. So I'm fine if the vet says, I can't find anything. Let's just see how he is in a few days. That's kind of okay, I guess. It depends on how far you want to pursue things. But if it doesn't get better within a week or two or if it gets worse, then we need to look further. Okay. So let's talk about what that means when you say look further. So talk to me about how you recommend kind of what is looking for, what does looking for there look like, I guess. How can a handler, you know, push more for a diagnosis if, you know, the answers they're getting from their vet are less definitive or, you know, didn't solve the issue? Okay. So that's the key, in my opinion, is to know where to look further for a diagnosis. And I think it's very important to get a diagnosis. When the dog is first injured and you go to your general practitioner and they can't really find anything and they say, well, it's probably just a soft tissue injury. Well, I don't like to say just because some soft tissue injuries are very serious. But it is possible it's a mild sprain or a sprain is an injury to a ligament or a mild strain. A strain is an injury to the muscle. And with a week or two of treatment, it'll get better. And then you get the dog back to normal. But if it doesn't get better or the handler says, you know what, my vet can't find anything, but there's something not right with this dog. There's two places to go to look further.

And these are the American College of Vietnary Surgeons and the American College of Vietnary Sports Medicine and Rehabilitation. So you want to see either a surgical specialist and that somebody that does a lot of orthopedics. And some board certified orthopedic surgeons have a lot of experience with sports dogs. Some surgeons also are dual qualified in surgery and sports medicine. And the American College of Vietnary Sports Medicine and Rehabilitation are veterinarians that are trained in sports medicine and rehabilitation. Obviously, they don't get training in surgery, but they don't necessarily need training in surgery to do a good exam and make a diagnosis. So if your veterinarian does not have somebody that they can refer you to, if they don't know a board certified surgeon or a board certified sports medicine vet, then you can get on the website of either of those and look up a diplomat or a board certified veterinarian in your area. And that's what I do a lot for the students in my class. They I need them to get a diagnosis and I need them to see a specialist, but they don't know who to go to. So they tell me where they live. Then I get on the website and I look up specialists in their area and then I read the bio of that specialist and see what their interests are and what their experience is. And then based on that information, I can make a recommendation of who they should see. Is it always possible to get a firm diagnosis? No, which I'm laughing because my dog is a good example of that. But let me say that in the vast majority of cases, yes, you can get what we call a definitive diagnosis, which is a diagnosis that we should we're sure that's what the problem is. When we do an exam and we get shoulder pain, I can give you a list of things that it might be. But I don't know definitively which one of those is causing the pain unless I do further tests. And a lot of times it's not necessary to do further tests. If the dog gets better with a couple of weeks rest and NSAIDs, we don't need to do further tests. But if you want a definitive diagnosis, if your dog is not getting better with just standard conservative treatment, then yes, you need to go further. You need radiographs. You might need an ultrasound exam, a musculoskeletal ultrasound exam. And then and of course, it all starts with a really thorough orthopedic exam. And some some practitioners have force plate analysis. So you trot your dog over a force plate and you can tell if one leg is is not putting it. The dog's not putting as much weight on one leg as the others.

And then there are more advanced diagnostic tests like an MRI or a CT or even arthroscopy to look into the joint. But yeah, my my younger beagle hops on her right hind leg and she's been doing that since she was less than a year old. So she skips on it sometimes like you would expect a dog with a medial patella luxation to do. So I examined her and couldn't find anything. And so I brought her to a sports medicine practice and they examined her and she was taking some weight off that leg. And they did radiographs, which were normal. And they did an ultrasound exam, which found an abnormality, which we treated for about six months. And then as soon as I started getting her back to normal activity, she started skipping again. So the next step would have been to do an MRI of her lumbar spine. But I declined that because her clinical signs were so mild and they didn't bother the dog. And I was not about to do spine surgery in a dog that had such mild clinical signs. So she basically lives with skipping and it doesn't bother her and it doesn't affect her performance. It probably bothers me more than it bothers her. So, yes, she's an example of a dog that has an abnormality because it's not normal for dogs to skip, even though people often say, oh, you know, sometimes beagles skip or sometimes Jack Russell Terry is skipped. They just do it. But it's it's not normal. But we don't know why she's doing it. And we might never know why if it never gets worse. I'm not going to pursue any further diagnostics. But we did do a lot of diagnostics. So if she was getting worse, then I for sure would do an MRI. And that hopefully would give us an answer. But it might not. So fingers crossed that she won't have any problems with her skipping. Yeah. Yeah. So, yeah. But most of the time we we can get a diagnosis. Most of the time we can, but it sounds like it's worth kind of thinking through what are the treatment options, depending on what we think are the most likely causes. And maybe it doesn't make sense based on signs, symptoms. Right. I mean, you know, we could we could find something wrong and it could be mild. And it's a condition that we know can be treated with surgery. But surgery is not without risks. So you have to always weigh the risk versus a benefit. So if it's something that's not very serious and it's not bothering the dog and it's something the dog can live with. Then I would say just don't do surgery. Patella luxation is a perfect example.

If a dog has a grade one patella luxation and skips on that leg occasionally, but can do anything the owner wants to do, agility or fast cat or any other or obedience, whatever they want to do. Then I would absolutely say do not do surgery on that dog. But if the dog has a grade two or three or worse patella luxation and it's hopping more often than not and it's affecting how the dog is is doing her sport, then I would say yes. Then the risk of the benefit of surgery outweighs the risk and that dog should be considered for surgery. Gotcha. Gotcha. So in those cases where something like restricted movement is recommended, right, can you talk a little bit about what it's reasonable to ask for in terms of like medical assistance with that? So I think a lot of times vets recommend restricted activity and sometimes they don't necessarily think about how difficult that might be with a higher drive dog. I know when Huey tore his toenail out, they were like, well, keep him from doing things. And I was like, he doesn't care if he's bleeding all over the floor. Like that's not a problem for him. So I had to ask for medicine, right? I had to ask for something to help sedate him just a little bit. So can you just talk about that? Yes. And I did go through it for about six months with Quinn where the only exercise she got was walking on a leash. Now she got other mental stimulation and some basic training, low impact training, but no running, no jumping. So when I talk about restricted activity, I do not mean crate rest. So I don't, there's only two conditions where I recommend really serious crate rest where the dog is in a crate or an X-pen unless it's out for a potty walk. And that's a dog with a fractured pelvis that is not amenable to surgery or the owner can't afford surgery or a dog with severe pain or neurological deficits from disc disease. And for some reason, the dog is not having surgery. So other than the two cases, for most of the soft tissue injuries that I see, restricted activity to me means no running, no jumping, no training, no playing with other dogs, no running up and down the stairs. I tell the owner, it's okay to walk your dog slowly up the stairs at night if they sleep in your room or down the stairs in the morning if you have to. Leash walk only so they can be out on a leash for five or 10 minutes several times a day sniffing around, but no or minimal trotting, no running.

And you have to be careful when they're in the house if you're in a room that you can confine the dog to the room and you're all there and you're sitting on the couch watching TV, the dog can lay next to you. Or if you're in the kitchen working, they can be with you. But I tell people either tie the dog to your waist with a leash or plop off the room because we all know if the doorbell rings, all the dogs can be running full speed across the house to the door. Or if one dog's barking at the window at the squirrel, the dog that's supposed to be on restricted activity is going to run to the window. So you have to be careful about that. But restricted activity does not mean crate rest. Now, it is hard with high drive dogs to to minimize your activity. And I will say that I've never had a dog die from restricted activity. And I've never had an owner die from having to restrict their dog. They all manage to get through it with a lot less difficulty than they think it's going to be. There is a drug called trazodone, which is very mild sedative, which is a really nice drug because people think, I don't want my dog knocked out on drugs. But the nice thing about trazodone is when you get the right dose, it just takes the edge off. It makes the dog a little easier to handle and it makes the dog accept its restrictions a little better. And I use that with Quinn. So I do have experience with it. And it's a really good drug. And there are other drugs we can use if we need to sedate the dog more. But you shouldn't have to. I have to say the vast majority, if not all, of the dogs that the owners say, oh, it's impossible. I won't be able to do it. They do it. And the dog just gets used to it. The dog says, oh, well, I guess this is normal now. And if you can do things to work their mind, because we all know when they have to think and concentrate, it gets them tired. Same as, you know, maybe not quite the same as running in the woods, but it does help. And you just have to get through it. It has to be done. Fair enough. I know we've talked before about the value or kind of the idea of having some baseline video. But I do think it's a really good conversation to mention anytime we're talking about this stuff. So can you just talk a little bit about, you know, what folks should and could do now while their dog is presumably healthy that might be helpful should their dog be injured in the future? Well, for sure, photographs. And there's a lot more people teaching fitness classes for FENSI. And I take them all because I want to know what they're teaching and I learn from them.

And then I can say, yes, I recommend this class because the instructor is fantastic. And so far, they've all been fantastic. But they all talk about what normal posture is for a dog. So what normal standing posture, sitting posture and posture when the dog is down. So I think it's important to learn what normal posture is or what balanced posture should look like and then take a photograph of your dog. And then if you take a photograph every six months or every year and compare them, you will know if something's off. So if your dog always has a flat top line and now they have a little roach in their lumbar area, you can say, hmm, that wasn't there before. I wonder if that's a problem. Or if your dog always has a nice balanced stand with the hind legs far enough back that the metatarsis is perpendicular to the floor. And now you notice, hmm, every time I get her into a stand, she moves his leg forward just a little bit. Then, you know, that's not normal. It would not hurt to have video. And the video that I like and that I ask my students to show me is with the dog trotting at a nice steady pace. And the video is taken from the side so I could see several good strides of trotting. And the reason I like trotting is it's a symmetrical gait. So it's easier to tell if something's off. And then I'll have them trot the dog towards me so I can see the front end and then trot the dog away. So if somebody wants to do that every six months or a year, then that's a good thing to do. And even if you don't repeat it, even if you just do it now when the dog is young and healthy and fit, then if you think something's off, then at least you have a baseline to compare it to. The other thing that students are learning in some of these classes is how to stretch your dog. So I have not frequently, it's not every day, but after agility trials, I'll just stretch my dog's shoulders and flex and extend all her joints. And I'll extend her hips. And I will do a stretch that stresses the iliopsoas muscle so that I know if there's any soreness in the iliopsoas muscle or I'll palpate the iliopsoas muscle. And then I'll do neck stretches. And so I know what normal stretching is for my dogs. So if I ever go to stretch her and her right shoulder doesn't go as far forward as it normally does, and I get that finding consistently and she seems a little sore, then I'll know that there's a problem there. So those are some things that owners can do. They can also learn how to massage their dogs and palpate the muscles. My dogs always are a little bit sore in certain areas after an agility trial.

And I know that if I just massage them and let them rest, then that soreness goes away and it's just not a problem. So you can't know what's abnormal until you know what's normal. And so you have to get to know what's normal for your dog. And this also gets the dog used to be handled. So if a veterinarian has to examine the dog, it's not like it's the first time they've ever had their shoulder extended is at the vet. Yeah. So part of the reason we're talking about all this stuff is you've got a new webinar on the calendar. What's the diagnosis happening May 9th at 3 p.m. Pacific time? Do you want to share just a little more on, you know, what you'll cover in the webinar and maybe who might want to join us? Right. So, I mean, anybody can join because I think it's important for anybody to know how to get a diagnosis on their dog's injury. And I just and we'll talk about this in the webinar. But I just want to say that hind leg lameness is not a diagnosis. Hind leg lameness is a clinical finding. It doesn't tell us why the dog is lame. If you see a rehab vet and they say, oh, you know, the back is sore. That's not a diagnosis. That's a clinical finding. We don't know why the dog's back is sore. A lot of times people will go to a chiropractor if they have a problem with their dog and the chiropractor will find a rib is out or this is out or and they adjust the dog. But that's not a diagnosis. So if you go to a chiropractor and then your dog is absolutely fine and you have no more problem, that's great. But a lot of times if you go to a chiropractor, either the dog does not get better or the dog is better for a day or two and then has a problem again. So the most important thing that we'll talk about in the webinar is why it's important to get a diagnosis and what a diagnosis is. We'll talk more about the different specialists that you can see for a diagnosis. And we'll talk about the certifications that some vets get in rehab that you could use that vet as for their special training. And what's the difference between a board certified specialist and somebody with a certification? And then I have two case histories. Both are students from last year's sports medicine class and both had dogs that did not get diagnosed for over a year with the problem. And when the dog finally got diagnosed and got proper treatment, both dogs got better. So we will walk through what they did. And both dogs were treated for over a year for clinical signs that sore back or or some mesolatrophy or whatever, whatever they were being treated for.

They were being treated for something that was not what the real problem was. And that's why the dogs weren't getting better. So people will learn why it's important to get a diagnosis and how to get an accurate diagnosis. And then once you have an accurate diagnosis, then you'll have a guide to the proper treatment to get the dog better. So kind of on that note, Sue, before I let you go. So if you get a diagnosis and you're treating it following a treatment plan, you know, is it reasonable to ask at that point? Kind of, you know, how soon should we begin seeing progress or something like that? And if those kind of guidelines aren't met, is it time to maybe think it's a misdiagnosis? Is there something in there? Yes. And that's really important because what I usually when I make a diagnosis of a soft tissue injury and I can usually narrow it down to the joint. I can't necessarily make a definitive diagnosis without radiographs or an ultrasound exam or some other tests. But I always give the owner the option of treating the dog conservatively for a couple of weeks or doing further diagnostics now. And a lot of them choose to do the conservative treatment. So I would work with Lynn, who was my physical therapist, and we would do the exam together. We would make diagnosis or a tentative diagnosis. And then she would see the dog once or twice a week for physical therapy, whatever that physical therapy should be. And I would recheck the dog in three to four weeks to see if they're getting better. So how do I know if they're getting better? The owner notices less lameness. They notice the dog seems more comfortable. And on my exam, I don't get pain or I don't get as much pain as I did when I palpated the area that was affected when I first saw the dog. So when I do a recheck in three or four weeks, if the dog is showing progress, they don't have to be 100% better. But if the dog's showing progress, then we continue with that treatment. If the dog is not getting better, then I tell the owner, we need to do further diagnostics because I might not have the right diagnosis or it might be something that needs more than conservative treatment. So if I'm treating a dog for an ileusose muscle strain, most of the dogs that have a grade one strain, which is the mildest form of injury, will show improvement in three to four weeks. They're not better in three to four weeks, but they're showing improvement. So then we just keep doing what we're doing. So we do physical therapy, pain control until I get no more pain on palpation of the muscle. And then we go from rehab to conditioning.

And after conditioning, we go to return to sport. So it's a whole process over several weeks to several months, depending on the injury. If I see the dog at three or four weeks and they still have a lot of pain, then I'm suspicious that they might have a more serious injury. So maybe a grade two muscle strain, whereas there is some tearing of the muscle fibers. And sometimes those don't get better without further treatments, advanced treatments like regenerative medicine, stem cells and platelet-rich plasma and things like that. So it depends on the dog and it depends on how they're doing. It depends on how much time and money the owner has. Sometimes doing advanced diagnostics and treatment, it's very expensive. Not sometimes. It is very expensive. We're talking about thousands of dollars. So we always have to balance that with, well, should we stay the course and continue doing conservative treatment for another three or four weeks, which is not wrong. So there's no wrong or right. There's no right answer or wrong answer or better or worse. It depends on the owner. It depends on the dog. It depends on where somebody lives. If you have to drive eight hours to go to a specialist, you might be less likely to do that than if you have to drive 30 minutes to see a specialist. But the most important thing is, and I have a slide in my webinar because we'll discuss this. In my opinion, and this is not in any book, but in my opinion, based on my training experience, if a dog's not getting better in a reasonable amount of time, and reasonable can vary, but I would say three to six weeks, either we have the wrong diagnosis or we're doing the wrong treatments. And I see a lot of my students that take my sports medicine class. They're dogs and also clients I used to see in my sports medicine practice. The dogs are being treated for one thing or another for months and sometimes years. And when I see the dog and we do an exam and we do further tests, they're being treated for the wrong thing. And that's why the dog is not getting better. So it's fine to try, quote unquote, conservative treatment for almost any injury. But if they're not getting better, we have to figure out why. Excellent. All right. Any final thoughts or key points you just want to leave listeners with? The only the reason I'm doing this webinar is I see posts on the FENSI alumni Facebook page all the time about people asking questions about their dog's medical issue. And and sometimes I contribute to the thread and sometimes I don't. But a lot of times they don't have a diagnosis.

So they're asking for advice on what to do with their dog when nobody really knows what's wrong with the dog. So if nothing else from this podcast or the webinar, if people take the webinar, I want them to know. That without knowing what is wrong with your dog, you're not going to be able to treat it properly. And it's going to take much, much longer to get your dog back to competition than if you get a proper diagnosis in the first place. So, you know, the best treatment. Excellent. All right. Well, thank you so much for coming on the podcast to chat about this, Sue. It's always fun to talk to you, Melissa. Excellent. All right. And thanks to all of our listeners for tuning in. We'll be back next week. Don't miss it. If you haven't already, subscribe to our podcast in iTunes or the podcast app of your choice to have our next episode automatically downloaded to your phone as soon as it becomes available. Today's show is brought to you by the Fendi Dog Sports Academy. Special thanks to Denise Fendi for supporting this podcast. Music provided royalty free by bensound.com. The track featured here is called Body. Audio editing provided by Chris Lang. Thanks again for tuning in and happy training. Be right. Thank you.