Canine paralysis often comes unexpectedly and suddenly, leaving an owner overwhelmed and uncertain, coupled with a dog that is now completely dependent on the owner for every need. It is important for us as therapists to have an understanding of the challenges that will be faced by an owner, their dog and ourselves. This will allow us to be prepared, anticipating difficulties and challenges, so that setbacks can be prevented or dealt with as swiftly and effectively as possible.
We spoke to Marti Drum in The Veterinary Rehabilitation Podcast on this subject, and she has given some fantastic insights into these challenges, and how they can be dealt with.
The Challenges Faced by an Owner:
Bringing home a paralyzed dog for the first time can be a lot like bringing home your first baby. The experience can be overwhelming for an owner, laden with uncertainty and the fear of doing something wrong. But unlike raising a baby, taking care of a paralyzed dog becomes easier as time passes; a routine develops, and owner and dog learn to work together.
Let’s look at some of the challenges an owner of a paralyzed dog will face, and how to make them easier.
Bladder and Bowel Management
Many dogs with paralysis have little or no bladder control and will need to be manually expressed in the initial phase after injury or surgery. An owner will need to learn how to effectively do this routinely throughout the day, in order to reduce the risks of a urinary tract infection. Even in the event of excellent expression, the risk of infection is still high, and urine should be regularly tested to ensure that the dog remains infection free. Females tend to be at a higher risk, and should be monitored closely.
Medication to support bladder management
Taking advantage of medication during the first few weeks can help to relax the sphincter, making expressing easier, and can also help to strengthen the bladder and decrease the risk of infection. Medication will reduce the amount of stress the owner and dog experience during the initial phase, which will make management easier and more effective. The referring veterinarian should be consulted in each individual case.
Weak and leaky bladders
Occasionally dogs will have a very weak or leaky bladder, posing a very real challenge to hygiene and maintenance of a healthy skin and environment. This condition can improve over time with a regular and stringent routine of expression. There are those, however, that continue to be a challenge. To make the management of a leaky bladder easier, it is best to confine the dog to an area with a soft and washable surface, so that cleaning can be achieved more easily. If a leaky bladder continues to be a problem, doggy diapers can be used. These will pose their own challenges however, as urine will be trapped against the skin, causing skin irritation and breakdown over time. Diapers should be used as a last resort and need to be changed regularly.
Lack of bowel control can be just as frustrating a problem, especially if the faeces have a low tone or become diarrhea. The bowels can also be expressed manually to develop an evacuation routine, if necessary.
Dealing with diarrhea can be very challenging as it will cause skin breakdown and irritation very quickly. It can, however, be dealt with and is not a permanent state of affairs; be sure to get advice from the referring veterinarian on medical treatment, assess the diet and keep the skin as clean and dry as possible.
Skin care and hygiene are essential and a continuous challenge. The skin needs to be kept clean and dry. The less mobile a dog is, the more difficult this can be as urine gets trapped against the warm skin. A regular cleaning routine may consist of regular baths with a hypoallergenic shampoo that will protect the skin’s pH, or wiping the body down with a saline solution. Baby wipes can cause skin irritation and reactivity in some dogs and should be avoided or used very sparingly.
Pressure sores can develop easily on any bony prominences that make contact with the ground, especially when the dog is unable to shift weight or change position. An orthopedic bed coupled with regular passive exercises (where you move your dog’s limbs) should prevent these from developing. Ideally a paralyzed dog will not be left alone for more than two to three hours before being taken outside where gentle, passive range-of-motion exercises are performed. This will prevent the development of stiffness, boredom and pressure sores.
Dragging sores can develop very quickly and are very difficult to resolve, as the dog will continuously be putting pressure on the same areas. Ideally a paralyzed dog will be given very little opportunity to drag itself, and movement will be assisted with a sling or harness during short breaks outside, or a cart or wheelchair for longer or more interactive periods. The reason for this is both to prevent the dog from developing secondary sores due to dragging, as well as to reduce the pressure placed on the forequarter and back by maintaining a straight alignment of the spine during walking. If dragging cannot be avoided, a drag bag can be used to protect the legs from injury.
Skin health and integrity can also be supported and supplemented through the diet.
Nutritional imbalances can occur very easily in the initial phases of paralysis, and a correct diet and body condition score can be vital aspects in the healing and recovery process. The veterinarian should be consulted regarding the best possible diet for each dog, as there may be concurrent illnesses such as kidney disease that will need to be treated with a specific diet. Supplementation can also assist the body in the healing process, reduce stress and provide the building blocks for muscle development. Each dog should be assessed according to their needs, and their diet adjusted accordingly.
Creating a suitable home environment will improve the experience for both dog and owner, and make life much easier. Initially after injury or surgery, a paralyzed dog should be confined to a small area or room, potentially a crate or play pen close to where the owner spends most of their time. This area should have a soft sleeping area; there should be no possibility of the dog developing pressure or dragging sores in this area. Remember to provide easy access to water. Some stimulation in the form of chew toys or a kong will also be helpful. Feeding bowls should be raised so that the dog can easily eat from a sitting position – paralyzed dogs should not eat from a lying position as they have an increased risk of developing aspiration pneumonia. A heat lamp or heat pads can be a great addition to this area as temperature regulation can be affected in a paralyzed dog.
All stairs and changes in levels in the house should be blocked off, and non-slip soft surfaces should be available throughout the areas where the dog is able to move freely.
The Challenges Faced by the Dog:
Most dogs will adjust very well to paralysis, seeming to take things in their stride with ease. The dogs that seem to struggle the most with the adjustment are those that are naturally independent and active. A good adjustment period to give dogs is two weeks.
Once a dog becomes paralyzed, all training, socialization and mental stimulation have a tendency to stop. It is important to continue to stimulate the dog in as many ways as possible – provide chewing toys while in the crate, play brain teaser games, spend time outside playing and doing exercises, and continue training your dog while doing the exercises to keep them engaged. Clicker training can be a great stimulation in this time and will provide a new facet to the relationship between owner and dog. The more engaged your dog is while doing gait retraining, the better motor patterns can be recreated and relearned.
Active and Independent Dogs
Very independent dogs can really struggle with a sudden dependency on their owner. This can be eased and facilitated by acclimatizing them to assistive walking devices such as a cart as soon as possible, to allow them time to be independently mobile during the day. Never leave your dog strapped into a cart when he is alone – the cart may tip over or the wheels jam on some item of furniture, leaving your dog in a precarious position. Carts should never be used without supervision. Playing games and engaging in training can help to deplete energy levels without massive physical exertion, and providing plenty of toys and opportunities for safe play will assist in reducing the dog’s stress levels.
Signs of separation anxiety in dogs can escalate when they become paralyzed, as they become more dependent on their owner for their needs. This can be a challenging situation and should be treated as proactively and preventatively as possible. It is important that owners maintain the ability to live their own lives to the fullest, while remaining sensitive to the dog’s increased need for human company.
The Challenges Faced by the Therapist:
Treating patients with paralysis can be one of the most overwhelming and rewarding fields to work in. Neurological disease will rarely follow a predictable pattern, and the outcome of treatments will remain unknown.
Along with the mental challenge that neurological patients pose, we will often form an emotional attachment to the patient and owner as treatments stretch over months and occasionally years. It can be difficult to remain emotionally unattached to the outcome of the treatment.
A good way to retain perspective is to regularly have an honest and candid conversation with the owner about the quality of life experienced by the dog. Discuss and reassess how the dog is responding to food, outings and play time, and look at how changes and improvements can be made to further increase the quality of life experienced. Be positive but always realistic about the goals that you and the owner would like to achieve, and objectively measure the progressions and improvements made over time. Equip the owner as far as possible for every possible outcome. Owning a paralyzed dog in the long term is not for everyone, but it can be done and is a great blessing in the lives of many owners.
There are times when we are forced to advise owners to consider euthanasia, and there are other times when owners will make that decision long before we are ready. Both situations are difficult to deal with.
In the first scenario we must remain objective, considering the quality of life and most likely suffering of a patient we have grown to care deeply about, as well as the needs of the owner. They will often struggle with feelings of guilt and it is our responsibility to reassure and support them in that situation. In the second scenario we will often only find out about the decision after the fact, leaving us battling feelings of grief and loss, and occasionally anger or even judgement.
It is important that we learn how to manage and process our feelings, and learn how to offer comfort and counsel, as well as to receive it.
Despite the challenges faced by all the parties involved, owning and being a part of the treatment of a paralyzed dog can be a phenomenally rewarding experience. These incredible dogs often turn out to be the very best of teachers, partners and friends on our own life journey; savour every moment with them.
The Challenges of the Paralysed Dog, with Dr Marti Drum
Degenerative Myelopathy & your role as the Clinician, with Debbie Torraca
Challenging Cases for Brachial Plexus Injuries, with Marti Drum
Physiotherapy for Fibrocartilaginous Embolism, with Helen Nicholson
The Neurological Dog, with Marinette Teeling
Neurodynamic Mobilisation in Animal Physical Therapy, with Sabine Hárrer