Remote Consultations: How does it work?

Covid-19 has thrown a lot of different challenges at all sorts of businesses and we were no exception!  It forced us to think about different ways to try and support our owners and their dogs when we were not able to see them in clinic.  As a result, we developed a new service of remote consultations via phone or Zoom. With physiotherapy and hydrotherapy being very much a “hands-on” treatment this may seem like a bit of a non-starter.  However, we have found that we can build up a really good picture of how a dog is doing with their clinical notes, veterinary referral, some video footage provided by their owner and good old chat about how their dog manages day to day.  Having completed a number of these over the past few weeks, we are thrilled to say that we have had some great feedback and positive changes in the dogs in response to our advice regarding home adjustments, appropriate exercise regimes and home physio exercises we have recommended.

So how does it work?  Once we have the dog’s referral and clinical notes from their vet, we provide instructions on what sort of video footage would be helpful to see in advance of the consultation.  From these videos we can assess the dog’s ability to load their limbs and potentially how they compensate for areas that are uncomfortable or restricted.  We can do a visual assessment of muscle mass and development to start identifying areas that may be weak or other areas that may be overdeveloped.  We evaluate all the footage prior to having the consultation so we have started to build a picture of how the dog is managing in terms of comfort and mobility.

On the call or Zoom consultation, we will ask questions about the dog’s daily routine and discuss anything their owners notice they struggle with.  In combination with the vet’s clinical notes, we can also answer questions about the dog’s diagnosis and discuss basic nutrition and body condition.

Once we have gathered all this information, we can start to make suggestions for things that can be done to help improve the dog’s comfort and mobility. This can include small changes in the home environment, to make it as mobility friendly as possible. There may be activities which would be better avoided, and we can make suggestions for alternatives that are potentially less demanding on the musculoskeletal system. We can provide support and advice on exercise levels, and how to recognise signs of fatigue or discomfort.

Finally, if appropriate, we will make suggestions of physio exercises that can be completed at home.  These are basic exercises that can be safely recommended having done this level of assessment but can be very effective to start improving things like limb loading patterns, muscle recruitment and posture.  They often involve minimal equipment or items readily available in the home.

Further to all this, we provide resources based on the information and feedback we have discussed.  This may include more information about the dog’s condition, support groups, useful websites or blogs and, if we have recommended getting hold of any other equipment, where you can source these.

We are working on rebuilding the number of appointments we can offer per day whilst still maintaining social distancing and necessary sanitisation protocols.  Having not been able to book any new clients since lockdown in March we currently have a bit of a waiting list for appointments in clinic.  However, we hope that by providing remote consultations we will be able to support some of those clients that we are not able to book in clinic straight away and get their dogs started on the road to improved mobility and comfort.

If you have any queries about our remote consultation service, please do get in touch by phone or email and we will be very happy to talk through the options available.

Consent Based Rehab – how does this apply to dogs?

At Bach Canine Rehab, we aim to put canine comfort and welfare at the forefront of all our interactions with our canine patients. Canine comfort and welfare are the reasons we became therapists in the first place and are what inspires and motivates us on a daily basis.

But what does this actually mean, “putting canine comfort and welfare at the forefront”? What does this actually translate to, when a dog arrives in our clinic? Is it not just fancy “marketing talk”? No! As we will explain….

To start with, we aim to treat all dogs we see “holistically”. Ahh… another buzz word!! Again, what does this actually mean?

The online dictionary definition defines holistic as “characterised by the treatment of the whole person, taking into account mental and social factors, rather than just the symptoms of a disease” (Lexico.com, accessed 13-03-20).

We interpret this to mean treating the whole dog, not just the diagnosis on the referral form we receive from the vets. The dog may have other musculoskeletal problems, compensatory issues or movement patterns relating to the diagnosis, or there may be factors which have made them more susceptible to the presenting diagnosis in the first place, which need to be addressed if the issue is to be managed or improved effectively.

However holistic also refers to mental and social factors, not just the musculoskeletal system. And what does this mean, in relation to the dog?

In dogs, and in fact in most mammals, pain, behaviour and movement patterns are inextricably linked. How do you walk and interact when you have a headache, or when you feel low, or angry? Is it different to how you walk and interact when you are excited, or happy, or pain-free? Our dogs are the same. We know that by addressing a dog’s pain levels, we can have an influence on their behaviour and demeanour (see our blog on the inspirational Pluto, for a case study on this, link here). However, this also means that, as the way we interact with our dogs can affect their behaviour, it can in turn have an effect on their pain and movement levels.

So…what does this mean in practice? For us, it is a question of consent.

Consent in canine rehabilitation throws up a few questions. Is it even possible to “gain consent” when treating a dog? Does “gaining consent” make a difference to treatment? What does “canine consent” look like? Why do we want to gain consent?

Let’s start with that last question. When a dog is stressed (possibly due to being in an unfamiliar environment, meeting and being handled by new people, seeing and being in contact with new and unfamiliar objects…..hmmm sounds familiar…) what we know as the fight or flight response is activated, and sets off a cascade of hormone release in the body. The physical effects of this are increased heart rate and blood pressure, quicker respiration, tense musculature and a heightened sensory system, as well as quite an unhappy dog and one which may feel the need to react to defend him/herself. As well as the obvious risks to everyone involved (including the dog!) and the ethical considerations of treating an animal in a distressed state, there are also negative implications for the treatment techniques. As therapists, we can’t assess musculature in a tense state effectively and it is not going to respond well to any release techniques. Some of the hormones released during fight or flight (namely cortisol) reduce protein synthesis and prevent tissue growth, which is not productive in the rehab process.

Another hormone released, called corticotropin-releasing hormone, or CRH, limits the ability of the brain to collect and store memories, meaning a dog in fight or flight is not in a receptive state for learning and absorbing information. The proprioceptive system of the dog is also not activated effectively when stressed (– see our other blog here on why this we are obsessed with proprioception and why it is so important in the rehab process!).

So if we are trying to retrain gait patterns, teach specific conditioning exercises, improve proprioception (and we are always trying to improve proprioception!) or even introduce a dog to new equipment, we are not going to be getting very far if they are stressed.

Ok. So how do we try to ensure we are “gaining consent” for treatment, and what does “canine consent” even look like?

We define this as the dog being a willing and often active participant in the rehab process. They may need assistance, and this may be physical, depending on their mobility levels but they are willing to go into the treatment room, to approach the equipment and to go into the pool or treadmill. Consent is particularly pertinent for hydro – a dog swimming against their will is in pure survival mode, which is why we try to take our time introducing each patient to the hydro scenario, even if it means a slow start to rehab. In some cases, we may not do hydrotherapy at all, if the dog finds the whole experience just too stressful. We have other techniques we can use instead!

We also take note of subtle body language and behavioural signs that can give us clues as to how comfortable a dog is with a particular situation – for instance, lip licking and yawning can be a dog’s way of saying “this is a bit too much for me right now”, so in response we might slow things down, or try a different approach. Each dog has different levels of tolerance, and just like people, some shout loudly if uncomfortable, but some might just whisper, so we need to be watching for these signs all the time. We also use food rewards (a lot!), as promoting “rest and digest” is the antidote to “fight and flight”. Kongs, lick mats and healthy treats such as carrots and cucumber are always welcome at the clinic!

Working at each dog’s pace (not at a pace defined by our treatment aims), reading body language and behavioural signals and paying attention to them, and breaking treatment techniques down into manageable chunks are all ways we can ensure that the dogs in our care are treated fairly and with respect.

Consent doesn’t just have to be in a rehab setting! Are there any activities you do at home that you could “gain consent” for? It might change your relationship with your dog!