Laurie's Blogs.

What do you do when the dog owner either can't see or is dissatisfied with the improvements their dog is making?  This is a bit of a tough dilemma.  On one hand you question yourself, your diagnosis, your treatment plan, and your assessment of the dog (this is where objective outcome measures come in handy).  On the other hand, you struggle with getting the owner to see that improvements are being made or have been made and to keep them encouraged and positive.

The inspiration for this blog came from a podcast I recently listened to( http://www.themanualtherapist.com/2016/07/untold-physio-stories-s2e1-being-tough.html )  where the story being told was of a PT/Physio treating a 16 year old girl whose mother seemed to be the biggest barrier to the daughters response to treatment.  It reminded me of some of my past human patients and of one particular dog-owner client.

So the dog in question is a large breed 12 year old male dog.  He had a TPLO with complications causing some degree of residual neurological deficits in the leg.  He was also found subsequently to have a brain tumour (radiation completed) and a lumbar disc (which I think is a non-clinical finding).  And did I forget to mention the elbow arthritis?  He's been a healthy, rarely lame, strong, big boy up until the stifle surgery.  With all that's happened to this dog, I've been fairly pleased with his rehab, but I think he's hit the ceiling of his recovery.  The surgical leg is not 100% but it improved more than I ever thought it would!

The trouble comes in the fact that the owner keeps asking, "What more can be done?"  Now, I'm all for providing every opportunity for healing, but I also think that there needs to be some amount of realism as well.  What does one do to help owners see the reality of the situation and to appreciate the blessings while not having them feel as though you are giving up on their dog?

So I think the answer comes in two parts.  The first part is to actually try different things to help with healing (within reason… for example, I'd not suggest a surgery as a 'guess' that it might help).  Any conservative management regime that can do no harm would be advocated.  By doing so, you are proving that you have tried, have thought outside the box, have exhausted your ability.  Perhaps you even make a referral to another complementary healthcare provided that can offer services different than yours.  Simply put, you put in the effort!  Secondly, you have the reality conversation.  But it's not a depressing conversation, it should be a conversation about seeing the blessings.  Seeing how much function their dog does have.  Seeing how the dog still has a great quality of life.  Helping the owner to appreciate the dog they have as compared to the dog he was when he was younger (or before an injury or ailment).  It can be hard for some people to come to this point.

I am reminded of another case.  I had told the owners that their dog likely had some arthritis in his knee.  They were devastated!  "He'll always have pain!  He'll never be able to go on day-long hikes with us!  He'll always need supplements and/or medication!"  My reply was, "There are far worse things in this world than arthritis.  I have it, you likely have it, and most people will get it.  It's manageable.  It's not life threatening."  These people were not convinced until we headed back out to reception and in the waiting room was a paralyzed dog that was happy as all-get-out to come for therapy with his equally happy owners, who were heralding, "Hi Auntie Laurie, look who's here to see you!"  I made a fuss over the paralyzed dog and then returned to my arthritis dog owners and gave them a 'see what I mean' look.  They actually said, "I see what you mean now.  Thank you!"

So my challenge to you is to think about the following: Given a similar situation, how might you facilitate that change in mindset for people?  How would you get an owner to be realistic and positive all at the same time?

I welcome your replies!