Painful Presentation: 

limping for months despite taking rimadyl/carprofen

won't go up the stairs sometimes

hard to jump on the couch and into the car

grumpy with people and other dogs

sitting weird and with his back against a wall!

What you need to know about shoulder arthritis in dogs:
> Osteoarthritis is a term that describes a process of degeneration and chronic inflammation that happens after a joint has been injured or if a joint does not have the right mechanics (it's crooked).
> Dogs don't all get arthritis in the same joints (neither to people) - why? The answer: physics.
> When we find shoulder arthritis it is often a reaction to instability or asymmetry of the muscles around the joint and after a lot of exercise.
> This means to approach shoulder arthritis in a smart way, we have to also address how those soft tissues are functioning and healing.
> Stiff muscles create asymmetry and pain that progresses arthritis.
> People who have shoulder issues often have an MRI and arthroscopy to evaluate which structures are damaged, dogs can too!
> Sometimes we settle for an xray and an ultrasound to reduce costs, but it is important that we do both to address both the joint and the tendons. as causes of pain - if we only address part of the problem, we can not expect good results.
> We can address the muscle stiffness and pain with physical treatments that no pill will ever be able to fix!

Setting Expectations: 
>> The best treatment plan for best possible outcome will include: pain management, joint lubrication, control of inflammation, restoration of muscle and tendon flexibility, and then specific exercises to restore symmetry and strength to the joint + the body.
> Full recovery takes 3-6 months of active if rehab protocols are followed, and it can take up to a year or more to have enough fiber strength in the shoulder tendons to go back to sport without immediate re-injury.
>> These dogs will need long-term regular rehab fitness exercises for stability (it is critical that these patients are NOT running, jumping, or playing ball during their recovery.

The Best Recovery Combines the Best Medical Strategy: 
> Pain relief with medications that transition into long term supplements
> A Diagnostic day with xrays, ultrasound, and treatments for myofascial pain and joint lubrication + stem cell therapy for healing factors
> Rehabilitation Therapy with hands on massage, stretch, and joint care before each set of custom designed exercises
>> Maintenance: these dogs will do best with regular intervention to prevent pain from creeping back up, often I treat them with shockwave and joint injections +/- stem cells every 6-12 months.

Diagnoses:
> Shoulder, spine, and hip arthritis
> Tendonitis of the shoulders
> Bad attitude secondary to maladaptive pain! 

Inflammation around the biceps tendon + OA

ultrasound helps us to understand the real underlying issues preventing tendon healing

radiographs help us make the best decision about which treatments we should use and how much maintence it will require

Bone spurs suggest wear and cartilage loss within the joint

Apache was 8 years-old when I met him and a sweet and salty kinda guy.  He loved to play and loved attention but when he's hurting, he can be quick to defend himself with his teeth.

He went through my special exam process with lots of video and leading him into certain positions to see where his pain was coming from and then we started his pain managment process and scheduled his procedure day.

We knew that he was sore in both his front legs and in his back legs based on how he was moving and sitting.  (See more images for funky posture in the posture gallery.)

For his procedure day:
1,  We studied his painful areas with xray and ultrasound and found shoulder arthritis and longstanding inflammation in the rotator cuff muscles and biceps sheath on both sides.  He also had a very painful back with muscles that have been tied down and stiff for a long time.
2.  We treated the arthritis with joint lubrication, the tendons with shockwave, and his back with shockwave.

With in two weeks we had him much more comfortable, much less grumpy, and he was able to go up and down the stairs.

We were then able to focus on other causes of pain driving his whole pain system: 
1.  He was overweight
2.  He had environmental and food allergies
3.  He had frequent GI upset

We will check him for arthritic pain and advance his allergy-friendly supplements as needed every 6 months!

He is likely to benefit from shockwave of his back and shoulders + joint lubrication from time to time.

Today: he can play, run the house, is down 10lbs and not itchy which means he is WAY LESS GRUMPY, and livin' his best life.

Arthritis is a progressive and degenerative problem that we will have to keep at bay.

What do you think of this posture?
 
Can you see him put less weight into his right front leg? 

Excellent! 
See more dogs who tell us where through weird sit posture in the Posture Gallery. 

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01.

Apache's Therapy Goals: 

alleviate pain from arthritis and tendonitis 

Help him to limp less and be strong enough to climb stairs and to jump into the car

RESTORE HER BODY SYMMETRY AND STRENGTH TO PREVENT INJURY

to let him play with his dog brother

One year of fun (so far) and counting!

We did it!

> Progress exercises to peanut and balance work with jumping for ultimate core and spine strength
> Regular (3d week +) strength and fitness exercises at home with regular fitness workouts at the clinic monthly
> Many dogs see me monthly for acupuncture and chiropractic to keep the pain cascade from amping up and for a check up.
> Most dogs do need and will benefit from shockwave for the compensatory muscle soreness and to reduce overall fricition in the shoulders, back and hips on a 3-6 month interval.   We will see how it goes.
> Dog with very mild arthritis may benefit from a platelet rich plasma injection instead of Synamid.  We will discuss your particular dogs needs.

phase 5: regular pain prevention in the clinic and home exercise

> Exercises start to include stairs, circles, step ups, circles and things to prepare for jumping.
> We do a slow intro to trot in the treadmill, then on land, and gradually work up to running and playing!
> We transition off of pain meds and onto anti-inflammatory supplements (see the bottom of my Resource Hub page

phase 4: working up to sport and strength with symmetry to prevent re-injury - day 90-120

> Weekly therapeutic exercise at the clinic and home exercise 3 days per week to work on balance and stability
> Massage, stretching, and water therapy in the clinic in some sessions to work on flexibility and comfort of her spine and knees
> Exercise restriction from running or jumping to prevent negative progress

phase 3: rehabiliation exercise and rebuilding symmetry - day 60-90

>. Radiographs: shoulders, spine, hips, stifles (both) for big picture assessment
> Ultrasound to evaluate tendon tears and guide our treatment to specific areas of damage
> In some cases, arthroscopic surgery is required to fully evaluate the damage in the shoulder
> A Joint injection with a lubricant that also improves shock absorption within the joint called Synamid
> Shockwave therapy to reduce myofacial pain (pain from muscle spasm), treat patellar tendonitis, and stimulate cartilage healing (more info on my You Tube video)

phase 2: joint lubrication and myofascial care - day 30-60

> Medications to control the inflammation from arthritis (more info at the bottom of the Resource Hub Page)
> Medications to reduce maladaptive pain
> Home Laser therapy rental for two weeks - 15 min daily treatment

phase 1: Pain Management - day 1 to 30 days

Like details? 

Here is the big picture recovery plan.

"Api found us through rescue and we are so grateful to have him feeling good for what must be the first time in his life.  We love him so much."

client name

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Here is what Apache's Mom says: 

DR. MARIES HEALTHY DOGS provides INFORMATION AND TRAINING TO RECOGNIZE PAINFUL CONDITIONS IN DOGS AND RECOVER THEM TO THEIR BEST ACTIVE LIFE.

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