Delayed healing with medical cases?

[lehughes]

is there any research to support or dispute there is delayed scarring in for dogs that have Cushings disease, Diabetes, obesity or even old age with cranial curicate ligament injuries, dogs with either with an extracap surgery or no surgery at all? It seems like more of these pups take longer to create any functional stability from the scar tissue when they have opted for conservative management.

Your thoughts?

S

[lehughes]

Hey S!

Nice to hear from you! Your question prompted a literature search, which means… I’ll likely use this information as a blog post at some point in the future.
So, I divided the search into first tendon healing + each condition. Then I had one heck of a time trying to figure out what search terms to use regarding the question at hand.
I figured muscle building, muscle something would work, and then I landed on Myopathy… which is the fundamental underlying condition / affect of these diseases / pathologies as to why or why not for muscle rebuilding after an injury / surgery etc.
Your exact question, cannot be answered in the literature, but these ‘side questions’ can (sort of)… which gives you the ‘best available evidence’ towards obtaining an answer!

The summary is:
Yes, there is evidence of delayed tendon healing &/or myopathy for Cushings, Diabetic, or Obese patients. Older patients however, have the ability to heal and/or build muscle.

I guess I could have also searched ligament healing + the conditions… however, I think the tendon one covers the principles of ‘soft tissue healing’ anyways.

Okay, so I hope these help!

Cheers,

Laurie

PS The actual research articles ARE this this week's blog!

[lehughes]

This is fascinating and correlates with my own experience.

Now, of course, I want to know how best to proceed with these cases where I know the healing may be slow. Is it just communication in letting clients know, or should I use more PEMF? Any tips or suggestions?

S

[lehughes]

Maybe all of it!

It’ll take more time. Let the owners know this. Spend longer in each phase as compared to other dogs (not time dependent but functional improvement dependent), and may this is just a point that we should reminder ourselves of, rather than making it into a ‘protocol’ for the Medically Challenged patient.

And if we know that there is less than perfect ‘healing’, then why not use modalities for longer as part of that thinking?

Or maybe we think, ‘okay, what would work for a ‘normal’ dog, will be less effective for the Medical dog, so maybe the medical dog needs more ‘directed exercise therapy’ to build quads, glutes, etc… as compared to a ‘normal’ dog that will build muscle with activities of daily living or a generic UWT protocol. To that end, one could argue that we might need to push the Medical case just a bit more and/or add in some specific strengthening in addition to a traditional rehab program. If that makes sense. Maybe it’s 5 extra minutes of a specific exercise… Less passive, more active.
I’m just throwing ideas out off the top of my head!

Oddly, I’m thinking it’s one of the other… Either they can’t heal as well, accept it, or they can’t heal as well so throw a bit more at them and work at it longer… or maybe the other way around Do more / Rehab longer and you might get to a point where you accept that your outcome won’t be as good. Which, is likely the most realistic way to look at it!

Laurie

[David Lane]

I don't know of any research, but I have always considered extracapsular repairs to be contra-indicated in cushings patients due to decreased production of fibrous tissue secondary to elevated corticosteroid levels... the same way prednisone impairs healing. Anecdotally, I did have an ex-cap case that did great for years until it developed cushings, and then the repair fell apart.

[lehughes]

That's fascinating... but it makes lots of sense!
Thanks for sharing!

L