Thursday, July 18, 2013

Wrist Management

As you know, Seven has some problems with an arthritic carpal joint.  Both wrists have limited flexibility, but the left one can only bend about 90 degrees.

Having flexible carpal joints is not crucial to performance because they do not flex it this much when they run and jump.  But it tells you that there is arthritis and scar tissue effecting the joint which can cause pain and thus affect performance.

I am not sure what caused Seven's arthritis as she only raced 21 times and nothing on her race record suggests that she was injured.  She could have been injured in training or on the farm.  She also might be genetically prone to developing arthritis.  It has only been this last year that Seven has been having problems so it might simply be the wear and tear from training, racing, agility, and life in general that has caused these arthritic changes over time.

So in the last year, Seven has had episodes of being acutely lame for about 5 minutes once or twice a week.  Sometimes it happens when she is playing with Maddie and makes a sudden changes in direction.  Sometimes it happens if I give her a late cue in agility and she does a surprise, hard left turn.  It seems to be similar to a twisted ankle that hurts for a few minutes, but you then walk out of it.  Many times she can return to what she is doing within a few minutes.  I honestly have never seen anything like it.  The rehab vet and I have surmised that it is probably a little bit of scar tissue being torn when she torques the joint.

With the help of an orthopedic specialist and a veterinary rehab specialist, I believe we have developed a good system of wrist management to minimize problems and maintain Seven.  Here is what I do:

I have mostly eliminated playing fetch and free running as exercise for Seven.  I allow her to wrestle with Maddie in our small potty yard or in the house, but I carefully supervise and step in if necessary.  Although Seven finds it quite boring, we are doing a lot more 3 to 5 mile hikes with lots of hills.  We also do lots of work on the balance discs and the peanut (core strengthening).  And thankfully, agility seems to be the best way to allow Seven to run and play, but in a controlled manner.

Another way I allow Seven to run in a controlled way, is to leave her in a stand stay on a stretch of land with good footing.  I run to the other end and then call her to me.  When she reaches me, I have her circle around behind me... to the right, or course.  We repeat this several times, back and forth. 

Next, I believe that the most important thing I do is joint rotation, flexion, and traction.  Doing so helps to warm up the joint and to loosen the scar tissue and adhesions that make it so stiff.  I rotate the wrist as if I was pedaling a bike with my hands.  Traction is pulling the joint surface apart.  The carpal joint has little joint fluid so pulling the joint helps to open it up and pull fluid in.  Then a little compression, but not much since she compresses the joint every time she puts weight on it.  Here is a video of the routine and we do it many, many times a day.
I do put a good amount of pressure on the the joint, but I never force it or cause her pain.

I also have Seven on Adequan.  The hubby and I do the injections on the first of each month.  Adequan helps to restore synovial fluid, inhibit destructive enzymes, stimulate cartilage repair, and reverse degenerative joint disease (yep, I Googled, copied, and pasted that).

We also tried a platelet rich plasma injection directly into the joint.  The idea is that when an injury occurs, platelets concentrate at the site to aid healing.  So the orthopedic specialist simply pulled platelets from Seven's blood and injected them into the problem joint.  At first I thought it was not working.  There was a 3 week period where we had a lameness episode about once a week, so it appeared to me that we were falling back into the same routine.  But then suddenly they stopped again. So in the 50 days prior to the PRP injection, Seven had 8 episodes of lameness.  In the 50 days after, she has had 3.  Yes, I am Type A. When I spoke to the orthopedic vet, he said that the PRP injection starts to peak at 6 weeks so that coincided with the 3 week period we had issues and then they stopped.  So maybe it is working.  If it does continue to help, it will likely be repeated about every 6 months.  

Seven is also on Springtime joint supplements and a ton of fish oil.  I do not hear a lot about fish oil, but it provides omega-3 fatty acids that help to reduce inflammation.  There are some good studies on the benefits of fish oil for arthritis that my vet finds far more compelling than glucosamine.  It is worth researching if you want to try it.  The dose is quite high so you need to make sure it agrees with your dog.

Lastly, I apply a little Zheng Gu Shui Analgesic Liniment and DMSO to Seven's problem wrist on most days. It came highly recommended by many racing and coursing greyhound enthusiasts from all over the world.

That is about it for Seven's Wrist Management.