​Today marks day 83 post-abdominal surgery for Rainey, which makes tomorrow the start of week 12. I skipped writing last week because it was a long weekend of agility trialing and I had other homework to attend to.  Today we will discuss how Rainey did last weekend, and a few of her exercises in the last week.  Rainey returned to the competitive agility field Saturday, March 27th, 2021 for a real trial. Our last Qualifying run at an actual show together was November 1st, 2020 at an AKC trial. Our last real trial UKI Q was December 14th, 2019. I believe we only did 1 day of trialing per trial weekend this fall, and only a few times. Which means since March 2020, Rainey has only run maybe 4 worth of agility competition.  After her surgery entering a 2-day UKI trial was a big leap.  It was a large request to ask her to run that much in 2 days – 4 runs per day.  This trial also presented another difficulty – we were competing at the Senior/Champ level in a live trial.  This is the highest and hardest level of UKI.  When the shut down started UKI Agility was the only organization that offered an at home trialing experience.  You would sign up for a trial, but it was done in the safety of your home.  You would submit video of your run and it would be judged.  Instead of earning up to 6 points per Clean or Qualifying run, you could only earn 2 points.  That equaled a lot of runs to gain a lot of titles last year.  It had proven to be excellent training opportunities for us.  However, it also meant the next time we entered a live trial we would be running all our runs at the highest, more difficult level.  Lots of backsides, tight turns, extension, collection, all the things I mentioned in the first blog post.  For some reason, this fact did not register to me until the day of the trial.  And somehow, Rainey lasted 8 runs, having the same fierceness at run 8 that she had at run 1!  I have to say, this girl is amazing!

​On Saturday, it was a wake-up call.  Rainey was lightning fast, and I was not.  I was tired from the busy week and my mental game was not strong.  We were Eliminated in all 4 runs.  What this means is in every run Rainey took an off-course obstacle.  You are not whistled off, instead you are whistled, but can finish doing what you are doing unless you are over time.  The majority of the off courses were handler error (as in my fault).  I was either too slow, or I even forgot the course.  I was also running cautiously, as I did not want her to hurt herself.  I considered Saturday a learning day.  We were learning to run together again and learning how to run in a live trial with complicated coursework. With each run, she grew happier and more confident. She wasn’t over-aroused or over-stimulated.  She was just too fast for me.  

On Sunday we returned with hopes of earning a Clean or Qualifying run, and to my pleasant surprise we brought home 3! Despite some hiccups, Rainey pulled off a Clean run in her first run, Senior Speedstakes, taking 1st place and earning 6 points.  Her next run was Champ Snooker.  Snooker is sometimes complicated to understand.  There is a course numbered 2 to 7, but before you can start that you must complete 3 of what they call red jumps, followed by an obstacle.  Once you complete this series, then you start the closing sequence.  For some reason, Snooker has always been easy for me.  I do not know if it is the ability to design my dogs own course or maybe the challenge to do so.  When you take the red jump and an obstacle, you gain game points from the obstacle you take.  These obstacles are also used in the closing, and their number in the closing corresponds to the number of points they are worth in the closing and opening, which also corresponds to their difficulty to obtain after a red jump.  The ultimate goal to get 3-7’s in the opening.  In UKI this is almost impossible because you are also on the clock and must complete everything in a very short amount of time.  For Rainey, I chose jump sequence #6 (2 jumps), jump sequence #7 (3 jumps), and then jump sequence #6 again.  Rainey ran extremely well, and I would have to say this was my favorite run of the weekend!  She earned 49 game points (maximum is 51) in 38.36 secs, earning 6 game points for her International Agility Champion Title.  This run is included at the end of the video below.

​In Champ Agility, which contains weaves and contacts, Rainey ran Clean at 3.579 yards per second, taking1st place, earning 6 points towards her IAC title.   This translates to 7.32 miles per hour!  This is extremely fast for her, especially coming off of surgery and the first time she has ran this level at a trial.  To be able to run 7.32 mph over that level on complex jumps, turns, twists, contacts, weaves, and tunnels for a 12.75-inch-tall dog is very impressive!  I know there are faster teams out there, but right now if this is our starting point for returning to sport, I think we are doing an excellent job!

​To say that I am incredibly pleased with how Rainey performed at the UKI trial is an understatement. We ran Clean in 3 of 8 runs, Eliminated in 4, and faults in 1.  Her speeds were the same or slightly faster than AKC, which it huge since these are much more technical courses. She maintained her high energy level and athleticism from run one to run 8, continuing to give it her all weekend.  Yes, there are holes in our training and I need to work on my fitness. But we have an excellent starting place, and a renewed drive to do it! Rainey did everything I asked of her at this trial, and more!  I am incredibly proud of her performance!  And most importantly, I have not noticed any negative impacts in her physical status since the trial.  The week of she only exercised Tuesday and Wednesday, with agility class Thursday.  Friday she had off.  Saturday and Sunday she trialed.  Monday she had off, and Tuesday we returned to our normal fitness schedule.  I performed spinal manipulation (animal chiropractic) yesterday just to make sure everything was ok, and it was.  She has no sore spots and no weaknesses.  We are not entered in another trial for at least a month, as we continue to work on our fitness and agility training.  But, I am very excited to see where this journey takes us!  Rainey is more fit than she has ever been!

​Twist Ups – this exercise is a progression or advanced variation of the Rocking Sit to Stand with Elevation.  It adds increased complexity with turning and footwork, increasing the muscles worked on the dog.  Aside from strengthening the rear end, this variation allows for increased lateral spinal flexion and lengthening of the back and abdominal muscles.  This attempt was again her first attempt at this.  It is ok that her feet did not fully turn straight, but ideally the dog would pivot their whole body toward the KLIMB.  The FitBone was used for her to sit on in order to gain a sideways to the KLIMB sit.  Using the yoga block may be more ideal, as it would provide less of a challenge for her.  I included a side view and rear view of her performance so you can gather how much coordination and muscle strength this exercise takes, even for a tiny dog.  This exercise should not be performed with a dog who has active ACL, hip, or spinal/back concerns, as the twisting motion is too much.  For a healthy, fit dog, this exercise will help strengthen those areas in a novel way, hoping to aid in preventing future injury.

​Lateral Hind Side Step – the goal of this exercise is to have the dog step off of the object with their hind foot.  This will aid in strengthening the core, quadriceps, hind limb adductors, and hind limb abductors, as well as improve hind end awareness.  This video demonstrates our first time attempting this.  I feel there will be different ways I try to do this, as I feel I was more pushing her than her realizing what I was asking for.  I hope that like other exercises I can shape train this, meaning she offers a behavior and I reward her.  We will see.  For now, you can understand the difficulty of this exercise.
 
Stability Obstacle Course – sometimes I like to set up random things for the dogs to perform.  In a small way it provides strengthening, but in a large way it aids in teaching body awareness and how to be careful while the dog is moving.  If you can provide novel stimuli to the dog in a controlled environment that may replicate what they could see in play or in their job their bodies are more likely to be able to respond favorably vs resulting in an injury in real life.  This exercise required core engagement and foot awareness, as well as general coordination.  Rainey did very well!
 
Angled KLIMB & FitBone Challenge – this is an example of me wondering if she could possibly do this.  It is another exercise that is focusing primarily on muscle engagement and proprioceptive abilities (body awareness).  It is also a strengthening exercise for stabilizer muscles and the abductor/adductor muscles.  This was the first time Rainey performed this exercise, and despite being apprehensive at first, she was a willing participant.  I also performed with Aurora, and since she is smaller, she had a much easier time.
 
Diagonal Leg Lift Core & Strength Assessment – Rainey is looking really good!  I hope from this video you can appreciate the muscles in her hind end.  She was groomed this week, which helps with visibility.  I also noticed when comparing previous side profile images that Rainey has definitely increased her shoulder musculature.  She is looking great!

Working the dogs 5 days a week has become part of my routine, and therefore it will continue for the long term.  Not only has Rainey benefited greatly, but so has her sister and my 10-year-old and 11-1/2-year-old standard schnauzers.  All 4 dogs are extremely athletic and living their best lives!  As much as I wanted a puppy from Rainey, this surgery pushed me to finally take back the dogs’ health and help them fulfill their athletic potentials! 
 
Being week 11 to 12 I am supposed to only have 1 blog post left.  I am not sure if I will stop at that post or continue on.  I have enjoyed writing these, although time consuming, it has help me accountable and it has helped me review and/or learn things I haven’t looked back on in a while.  I can say I hope to do at least 2 more posts, as I still wish to discuss warm-ups and cool-downs, along with Tui-na massage, which is a large part of my dog’s warm-up program, and I hope to finish the series by reviewing everything Rainey has accomplished since January.  However, I am also nearing the end of the semester for my Masters of Science in Traditional Chinese Veterinary Medicine Program.  This means I have 2 case studies to write up by next weekend.  This weekend I spent the majority of my time finishing assignments and taking my final exams (getting an A in both, yay!).  Therefore, I am not sure what I will get to for next week.  I will try my best to work on warm up/cool down information. 
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP

​Today marks day 69 post-abdominal surgery for Rainey, and tomorrow is the start of week 10.  Last week Rainey did agility Thursday and Sunday.  We did not exercise those days, or on either of the Mondays at the start and end of the week.  This allowed for a recovery period, which is important for muscle healing and regeneration, even in dogs.  They can do normal dog things, like go for a walk or play with house mates, but doing exercise day after day after day is just too much for them.  Unlike humans, a dog won’t stop.  It is up to the human to stop the dog.  A dog does not know what is in their best interest.  Ask every dog who ever went face deep into a porcupine.  They didn’t know better, therefore ended up with a face full of quills. 

Rainey did not demonstrate any extra soreness or tiredness from her extra days of agility.  The seminar we attended contained a lot of running, which she hasn’t done in a while.  She was tired Sunday evening, but by Monday she was energized again.  This coming weekend we are running in a UKI agility trial.  I will take each run and each day as they come, assessing what will be best for her.  If she appears to be enthusiastic by end of day, we will keep running.  If she is tired and over-aroused like a child who needs a nap, we won’t run.  Simple as that.

​This week’s topic is going to focus on anatomy.  Earlier this week I saw a social media post of a dog backing up stairs.  It was a larger breed dog and it was only 2 stairs, so not that bad.  What was bad was the dogs head position.  Its head was cranked up over his shoulders, as the reward placement was at a height that was convenient for the handler, not what was best for the dog.  At the same time, the dog was being asked to lift its hind end at an angle while backing up stairs.  However, from its head placement, it was shifting the majority of its weight to its hind end, which makes it much more difficult to appropriately lift the hind legs.  Not to mention the stress this head placement was putting on the dogs cervical-thoracic junction.  The handler was receiving all sorts of likes and comments on how wonderful this was.  I had to move on.  It was hard for me to watch that video without wanting to comment that this was actually harmful for the dog, for several reasons.  Backing up is a difficult task.  Backing up stairs is an extremely difficult task.  Backing up stairs with your head held high is nearly impossible and will create pain at the transition zones of the spine if continued frequently.
 
But what are transition zones of the spine?  These are areas where one type of vertebrae is changing to fit to the next type.  The sections include:  occiput to cervical, cervical to thoracic, thoracic to lumbar, and lumbar to sacral.  In dogs there are 7 cervical vertebrae, 13 thoracic, 7 lumbar, 3 sacral (which are fused to form the sacrum), and 20 caudal or coccygeal vertebrae, depending on breed and tail docking.

The occiput to cervical region is at the base of the skull, and isn’t commonly thought of as a transition zone, as its not a location where a disc can be herniated.  There are actually no intervertebral discs at C1, C2, or the coccygeal vertebrae.  An intervertebral disc is a fibrocartilaginous structure consisting of a soft center (nucleus pulposus) and surrounded by concentric layers of dense fibrous tissue (anulus fibrosus).  They are the shock absorber during physical activity.  The intervertebral disc is what we think of when we say ‘the dog herniated a disc’ aka the disc is protruding from its location between vertebral bodies and putting pressure on the spinal cord, resulting in inflammation and pain.  The disc space is what we look at on radiographs when assessing for back health, aside from spondylosis and other arthritic indicators.  When a disc becomes unhealthy or a traumatic injury occurs, the disc space narrows as the disc protrudes out of the space and into the spinal canal, resulting in inflammation, pain, and possibly neurological dysfunction.
 
The Occipital, C1, and C2 region is the location that can become very stiff when a dog is always heeling on one side of a handler (ie always looking up with their head turned to the side).  The occipital protuberance is the large bulge on the back of the head.  Most prominent in breeds such as setters.  The occipital condyle is at the lower portion of the occiput, and it articulates with the atlas to form the atlanto-occipital joint.  The main movement of this joint is flexion and extension.  The wings of the atlas are the bulges on the side of the neck closest to the head that you can feel.  Cervical vertebrae 1 (C1) is the atlas.  C2 is the axis.  The atlanto-axial joint is responsible for rotary (left and right) motion of the head.  There is a lot more going on here, but we will keep it simple.  The axis, as seen in the photo with just the cervical spine, has an elongated ridgelike dorsal spinous process and has characteristics different than other vertebrae.  

​As we move down the spine, and visible on the photo of the cervical spine is the cervical thoracic junction.  There is a lot to be said about the thoracic vertebrae.  Mostly, each thoracic vertebra has a corresponding rib and as you move down the thoracic vertebra the shape of the bones change as they transition to the lumbar spine.  At the C7-T1 junction, you will note that C7 has the highest dorsal spinous process (the bone pointing upward) of all the cervical vertebrae.  This is so it starts to match the upcoming thoracic vertebrae. However, they are not perfect fits.  This brings forth the issue with the transition zones.  Note – not to be confused with transitional vertebrae, which are congenital anomalies of deformed vertebrae.  Transition zones are weak by nature.  You cannot expect two opposing bones to fit perfectly, but the body tries very hard to make the perfect match.  Because they are not perfect and they are changing from one type to another they are weak areas in the back.  The 3 remaining zones (cervical thoracic, thoracolumbar, and lumbosacral) are the points in the back to most commonly suffer injury.  This is due to what has previously been mentioned, and the simple fact that they are weak zones.  That is just nature.  Yes, a disc can herniate at another location, but these are the 3 most common locations.

​Back to the cervical thoracic junction.  Not only is this region at risk for herniation, it is extremely protected and therefore extremely difficult to properly assess.  What puts this region at risk of injury?  The previously mentioned backing up the stairs with head held high or any activity that puts the neck in a high, hyperflexed position, especially if a concussive action (landing) is to follow.  In the simplest of ways to think about this, think of holding a grape between the left pointer finger and the right pointer finger.  There are a few positions that you can do that keep the grape (disc) stable and happy.  But if you look at the adjacent photo of C7 from behind (caudal, so looking tail to head through the spinal canal), then the lateral (side) view of the cervical and T2 photo with scapula removed, and then the side photo of the dog skeleton, you will see how sharp the angle is from C7 (marked with a 5 in the full dog photo) to T1.  Remember, the spinal cord is ABOVE the disc space.  Now, use your imagination and picture what is actually happening to the joint space and disc space of C7-T1 when you ask a dog to hike its head up while its rear is going up.  It’s not pretty and it sounds pretty painful, even without a disc herniation.  And now you can imagine how a disc herniation could happen at this location.  This is why I stress A NEUTRAL NECK!!!  A neutral neck is a neck that is in alignment with the spine while you are performing an activity.  When the dog is performing front feet on floor and back feet on a thing their head position is an elongation of their back.  It is NOT hiked up creating a sharp angle from neck to thorax.  Now you understand why.  Physics, my friends, physics.  Oh, and anatomy.  Think of how dogs move and how their bones move.  It will help you create a better exercise program for them and prevent injuries.  An injury to the C7-T1 junction is subtle.  Like I mentioned, this area is deeply hidden under lots of muscle and the scapula.  Due to the brachial plexus being in this region, a sign of a C7-T1 injury may be front limb lameness.  It may also be reluctance to lift their head.  Or it could be spasms when that region is palpated.  If this disc space ever has to be surgically relieved, I have heard it is extremely difficult to access.  I can only imagine.

​As we move down the thoracic vertebral column, you will notice that the dorsal spinous processes decrease in height slightly, but remain pointing towards the tail (caudal), giving you the sloping appearance from shoulder to back.  Once you reach T7 or 8, the spines become progressively shorter, and when at T9 or 10 they are at their shortest point.  At T11, the dorsal spinous process is nearly pointing straight up.  In a lean fit dog, you will notice a dip in their back at this point.  This is called the anticlinal region.  T12 and T13 continue to change direction of their dorsal spinous process, pointing toward the head (cranial). 
 
As we enter the lumbar vertebrae, they dorsal spinous process continue to point forward and the bodies of the lumbar vertebrae are longer than that of the thoracic vertebrae.  The lumbar vertebrae also have transverse processes projecting of their sides and pointing toward the head.  L1 has minimal transverse processes, and as the lumbar vertebrae go on, the transverse process gets larger.  The transverse processes serve as attachment sites for the epaxial muscles of the back.  The articulation (joints) of the last portion of the thoracic and lumbar vertebrae allows for flexion and extension of this section, but limits lateral motion.  This brings us to the thoracolumbar junction, which is one of the most common regions for disc herniation.  Based on the previously mentioned anatomy, you can imagine that this area is not as strong at other regions of the thoracic or lumbar spine simply due to all the boney changes in this region.  If you look at your dog, you will also note that in this region there are fewer muscles.  The C7-T1 region is well protected with muscle.  But the T13-L1 region does not have that degree of stabilization.  Therefore, if your dog is being asked to be extreme tasks, such as tight turns for a region of the spine not necessarily meant to bend laterally, abrupt landing where there may be extreme flexion at the T-L junction, or even a small dog being picked up by their mid-section, this area will become broken down much faster if it does not have the support of a strong core and strong back musculature.  Again, think physics with anatomy.  

​As we move down the back, we come to the lumbosacral region.  It is important to note that at L6-7 the spinal cord comes to an end, therefore leaving unprotected nerves in the canal.  Since there are still discs between the vertebral bones of L6-sacrum, this means when a disc herniates in this region it is applying pressure directly to nerves, not the nerves protected by the spinal cord.  This is why dysfunctions in this region are extremely painful.  The sacrum, as previously mentioned, is 3 bones fused together, and the bones is located between the ilium of the pelvis, which it articulates with.  The disc space between L7 and the sacrum is the largest space and the highest motion joint space of the spine.  As such, this location is predisposed to injury.  This is the location, along with the T-L junction, that is most at risk when a dog goes butt over head (think an uncontrolled A frame, or even a stopped A frame). 
 
This has been a fairly brief overview of the 3 major transition zones of the spinal column.  I hope it has provided you with useful information on why we do the things we do – why form is so important with exercises, and how building muscle appropriately can help keep these zones intact, aiding in a long, healthy career for your dog.  I realize this topic should have been covered sooner in this blog series, as it would have provided better understanding when I described Rainey’s exercises.  But, from reading this I hope you can understand the difficulty in organizing this information.  I’ll admit, I was dreading it.  There is so much more that can be described on these 3 transition zones – muscles attachments, articular facets and rotation, exercises to stabilize and strengthen, etc.  But my hope is you will look through the videos of Rainey’s exercises and see that I have already taught you the importance of proper form and function.  Now you understand the WHY!!!

​Squats – this an a very difficult exercise that strengthens the gluteal muscles and hip flexors, as well as the large muscle groups of the hind end.  I used the Cloud as a way to ‘roll’ Rainey into a sit, while keeping her front legs elevated.  Then she slowly and controlled, pushes herself upwards to a stand, with all feet remaining stationary.  Like I said, this is very difficult, but also very rewarding, as it is great for strengthening.
 
Rocking Sit to Stand with Elevation – the purpose of changing up the Rocking Sit to Stand is to work her muscles a little differently.  It does take away the power component, and maybe once she’s more practiced at this form she will regain a power drive from the rear.  This attempt was her first and she’s still trying to figure it out.  A couple critiques – try to maintain a straight back in the stand position.  We weren’t the best, but tried for it.  Second – to lure her into a sit I did have to have her head/neck a little too extended for my liking, noted especially after watching the video.  Therefore, a better start for this would have been have dog sit on the balance pad and stand to the FitBone.  This goes to show that videoing is very helpful.
 
Plyometric Jump Progress – everything seems to be paying off, as Rainey is now able to make the jump about 3 or 4 times her height from a sit!  She isn’t clawing her way up the Peanut, instead she is powering from her rear and landing on the top of it.  She looks good!  The set up is 1 KLIMB with the tiny legs, 1 KLIMB with no legs, and an upside down KLIMB.
 
Wobble Board/FitBone/KLIMB – I wanted to share an updated version of this exercise, paying more attention her form.  Note in this video the lure is held lower, which is making the position of her front legs and elbows less stressed.  I try to maintain a neutral neck.  I am also moving the wobble board in various directions for her to keep the stimulus novel.  She does a great job stabilizing and maintaining her form.
 
Diagonal Leg Lift Core & Strength Assessment – Rainey continues to have a strong core and excellent core engagement! If I were not adding this to blog videos, I likely would only assess this once every few weeks or once a month.  Despite having this done weekly, Rainey still does not appreciate it.  From her side profile, Rainey still looks great!  There is not much new to report.  Hopefully before the week 12 post she will get groomed, which will aid in demonstrating her fitness.

​I continue to be very happy and proud of Rainey’s improvement and progress! She continues to get better every week!  This is week 10 of Rainey’s recovery process.  That means I have 2 more weeks of blogs left.  Next week we will return to an agility trial, and I am not sure I will have time to write a large post.  It will possibly just be a summary of her trial experience back from recovery and COVID.  She has not participated in a trial since October 2020.  In the remaining two posts, I will discuss warm-ups and cool-downs, along with Tui-na massage, which is a large part of my dog’s warm-up program.
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
Millis, D., Levine, D. Canine Rehabilitation and Physical Therapy, 2nd Edition. Elsevier. 2014.
Evans, H.E., deLahunta, A. Guide to the Dissection of the Dog, 6th Edition. Saunders. 2004.
Dyce, K.M., Sack, W.O., Wensing, C.J.G. Textbook of Veterinary Anatomy, 4th Edition.  Saunders Elsevier.  2010.

​Today marks day 62 post-abdominal surgery for Rainey, making this the start of week 9.  Rainey returned to jumping 12 inches this week, and also ran in a seminar today.  In class this week, Rainey had no difficulty with 12 inches, along with running all contacts and weaves.  She also maintained no issues the following days.  Each week it seems her confidence has improved.  When started back at class some of her previous over-arousal issues showed themselves – excessive barking, grabbing at me, being very ‘sticky’ and lacking independence.  As we have progressed in our physical rehab and slowly moved her back up to 12 inches it seems her strength is fair greater than it’s been in a very long time, possibly ever, and her confidence is reaching new heights.  Rainey has always been barky when she runs.  She instructs me on whether I am too slow or simply providing her incorrect cues.  She’s very opinionated.  I suppose that’s why I picked her.  This week the structure of the post will be a little different.  I will cover the 3 exercises in the video, and then I will do a discussion about how I can tell from a functional standpoint that Rainey is much, much better than she once was.

 Jump-Crawl – this is yet another more advanced exercise demonstrating power and speed in action.  As you can see in the video, I have the bars set above 12 inches for her to jump.  The goal of this exercise is to engage the hind end and core through the crawl, then immediately power through to a jump.  When they return after the jump, the dog jumps and collects into a crawl.  Then repeats.  This exercise can only be performed when the dog has appropriate whole-body strength, especially the core and back end.  Rainey has not seen this exercise in over 2 years, and since we had been doing so much crawl work lately, she was initially confused and tried to crawl under the jump set.
 
Ramp – slow, controlled incline work is a great way to build muscle and engage important stabilizers.  This exercise also mimics the muscles needed for the incline and decline work needed for the dog walk, teeter, and A frame.  When performed in a controlled manner you can engage the muscles utilized for those pieces of equipment to a more thorough capacity.  As you can see Rainey sometimes prefers to crouch when she does things.  It can be a struggle to get her to fully stand upright, especially on the incline/decline.  Therefore, patience is needed and just like everything else, it’s a work in progress.
 
Back up Incline – this is complex and difficulty.  Rainey’s little brain may have exploded a little bit.  Therefore, I wasn’t extremely picky in what I was asking her to do.  It is very difficult to back up that height of an incline, but she managed to do it.  When I repeat this, I will make sure the KLIMB is pressed against the wall, therefore the target FitBone will not move.  However, as I have learned in the past, being close to a wall will sometimes encourage Rainey to perform a hand stand.  As funny or cute as this is, I really try to discourage it, alongside her offered attempts at a sit pretty.  The reason is so much can go wrong with those two activities/tricks.  It puts an extreme amount of pressure on the lumbosacral region of the spine.  Only dogs with extreme core and back strength should perform those.  If she offers them every once in a while, that is totally fine.  But under no circumstances do I encourage it, especially not at this stage in her recovery.

Diagonal Leg Lift Core & Strength Assessment – this week I put a traction mat on the KLIMB.  I recently ordered one, and I really like it.  The KLIMB isn’t extremely slippery, but for things like this it can be, especially when the dog has excess fur on their feet.  Rainey continues to have a strong core and excellent core engagement.  Her side profile stacked photo continues to show a nice topline and she happily and willingly self-stacks herself.  This is really important – she willingly puts herself in a stacked position.  Why this is important is it means she is free of pain in her rear end, her groin, and her back.  If she was standing with her legs camped under her or not stacking out nicely I would be concerned that she was sore.  I note Rainey standing like this naturally any time she is standing, and that is an excellent sign of her comfort.  Another sign of a sore hind end or groin is the dog bunny hops when it’s trotting or running.  Or it has a pacing gait – left front and right hind come together at a trot vs left front and left hind.  This is a sign that something is wrong and the dog should be assessed.  Therefore, 3 things for you to monitor in your dog’s recovery – is the dog stacking out willingly, does the dog bunny hop at a faster gait, and does the dog have a pacing gait (when it’s not a breed who should).

​The next portion of the attached video is of Rainey running in a seminar today.  It is snippets put together of the complete course from the 2 different sessions she had, a total of a 54 second run.  The sessions were 8 minutes and 6 minutes split between 10 dogs throughout 3 hours.  That clarification is so you recognize I was not over working her.  On that note, I was concerned that repeating the sequence on the second attempt would be too much for her, but in the end, I do not think it was.  I say this because she ran it with the same speed and intensity she ran the first attempt.  It was a very tough international handling course, and neither of use had ran that level for a while.  This was also the first time Rainey has seen a full-sized course since October.  

​What I want you to appreciate is Rainey’s speed, jump ability, and extension on the flat (flat out running).  Where I noticed her extension and overall confidence was her speed over the dog walk.  Now if you fast forward to the second video snippet on this video, you will see an AKC agility trial run from October 17th, 2020.  This was 5 months ago.  As I have stated previously, Rainey had barely received any strength and conditioning in the last year.  Watching this second video I can definitely see that.  Despite this being a Qualifying run at 4.261 yps (8.72 mph), which earned her 28 MACH points (as in 28 seconds under standard course time), Rainey’s extension while running is not that great, and neither is her jump quality.  Again, most notable over the dog walk.  Comparing the 2 videos, her DW time is 2.6 secs today (also a missed contact, oops) and 2.9 secs in October.  That may not seem like a big difference, but 0.03 seconds can be the difference in winning or losing (of course she needs to actually hit the yellow, but that’s not my point right now).  If you watch her head during these runs it may give you a better idea of what I am looking at.  In the AKC video, she is doing what I call the schnauzer bop.  She’s running like a little rocking horse, and is super cute.  This is what most mini schnauzers look like when they run. My first agility dog Pyper always looked like this.  And I’ve noticed for the last 6 months or more both Rainey and Aurora look like this more and more.  She’s fast, yes, but not as fast as she could be and definitely not as efficient either.  When we compare her running from today to the October video, there is a lot less bopping and a lot more full stride running (extension).  Then when we compare her jump form from the two videos, she is jumping more efficiently in extension than she has in a very long time.  In the snippet included I would like her take off (where she starts to jump) and landing to be a little more equal.  However, she still looks much better, and we have not started actually working on her jump form, only her muscles.  Therefore, these changes occurred naturally with her increased conditioning and athleticism. A discussion on jump style could go much further, but for now I wanted to point out the improvements in her functionality that were noted by her trainer and myself today.  This is extremely promising for her career.  Aside from being faster, if she is more efficient and carries herself better that can translate into a longer, healthy (injury free) career.

I continue to be very happy and proud of her improvement and progress! I hope that despite not including any data or literature you have learned something new from reading this.  Today provided some real-life experience on why things matter and why we recommend what we do for our sport dogs.  I still intend to expand on Tui-na massage, as well as provide a more in-depth lesson on anatomy.  I hope to keep coming up with new exercises and helpful information for you!
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP

​Today is day 55 post-abdominal surgery, which makes tomorrow the start of week 8.  This week in class Rainey jumped 10 inches, and we left behind caution and ran!  There is no bad news to report, as she ran as swift and accurate as she ever as!  Maybe the only negative is she’s extremely fast right now!  Her weaves are like she never left them!  Fast, accurate, and distance!  Her A Frame is actually slightly better than before, with her hitting the contact zone more accurately.  Overall, she hasn’t missed a step when it comes to her favorite sport!
 
This week we are going to discuss the Assisi Loop!  Assisi Loop, Clinica Bed, and the Loop Lounge are developed from the same technology targeted Pulsed Electromagnetic Field therapy to tPEMF.  Assisi products are a non-invasive, non-pharmaceutical healing device that utilizes low-level pulses of energy, reducing pain and swelling, while accelerating healing.  PEMF products have been an FDA-cleared medical device since the 1970’s, and the first knowledge about electromagnetic induction was in 1800!  It was in the 1950’s that scientists dived deeper into the technology of PEMF.  In 1970 Arthur A. Pilla, PhD developed a low-powered PEMF device that was later approved by the FDA for the healing of nonunion bone fractures, noting that PEMF signals could be adjusted to target bones and increase their healing in non-healing fractures.  In 1998 PEMF was approved for use in urinary incontinence and muscle stimulation by the FDA.  

How Assisi technology is different than the other brands available is it uses a specifically tuned microcurrent to deliver its patented tPEMF™ to damaged cells, triggering an animal’s own natural anti-inflammatory process.  The electromagnetic signal that Assisi uses is one-one-thousandth the strength of a cell phone.  This signal simulates cellular repair by enhancing the binding of calcium with calmodulin, which in turn accelerates the body’s production of nitric oxide.  Nitric oxide has several beneficial effects on wound healing, including its influence on angiogenesis, inflammation, cell proliferation, matrix deposition, and remodeling.  Therefore, the Assisi product uses microcurrents to stimulate the body to heal ITSELF by stimulating nitric oxide production.  The Assisi tPEMF™ signal is the only purposely designed PEMF product to deliver the largest effective dose of electromagnetic signal to the nitric oxide signaling pathway.    
 
In general, the benefits of tPEMF™ are plenty, and include increased blood flow to tissue site, enhanced muscle function, increased bone healing, blood oxygenation, decreased inflammation and pain, and accelerated recovery post-surgery or injury.  Assisi products can be used for nearly any injury or recovery.  In my practice, the most common injury I use them for is neck injuries.  They are extremely easy to apply, as you can just place the Loop through the dog’s neck.  They wear it like a necklace while their 15-minute treatment takes place, and then it automatically shuts off.  Post-op ACL surgeries are also a fabulous use for Loops.  Not only will they speed bone healing, but they will help with the soft tissue repair and healing as well.

​The treatment schedule for a Loop depends on the injury, but typically it is recommended to apply the product every 2.5 to 3 hours for the first week.  This will allow the body time to respond and recover, as well as the battery on the Loop to recharge.  As the injury becomes less severe, the frequency of treatments can become less.  Typically, after week 1 or 2, frequency can be decreased to 2-3 times per day.  Once the patient is in maintenance mode and no longer in acute pain, treatments can be once daily or 2-3 times per week.  For best results, it’s ideal to maintain once daily for chronic issues.  If your pet has multiple areas of pain or discomfort, you can either use two Loops or a Loop Lounge, which is their bed.  A few years when I had my standard schnauzer Stone, despite being an old man, I could not, for the life of me, get him to lay still for 15 minutes on my Assisi Clinica Bed.  Instead, I used two Loops – one around his neck and one around his pelvis.  Another fact about the Loop – the PEMF is emitted 10 inches on either side of the device.  It cones out, like a football, therefore it is not a 10-inch square rectangle, but instead a cylinder type appearance.  This worked great for Stone, and for Rainey it encompasses almost her entire body!  Each Loop costs $299 and lasts for 150 uses.  This breaks down to $1.99 per use, or $9.95 per day for acute injuries when you are applying every 3 hours during waking hours.  Honestly, there is not much that you can get for that cost and that efficacy.  Other common uses for a Loop are laminitis in horses, wound repair, urinary incontinence, soft tissue strain, abdominal surgery, oral surgery (unlike laser a Loop is safe around the eyes), certain cancers, etc.  Honestly, the list goes on.  Aside from its plentiful uses, the other reason I love the Loop is it is something owners can do at home.  Not only does it give owners some control over their pet’s care, but they can see the changes and benefits directly.

As we progress in our agility training, I continue to keep things interesting in the exercise training.  This week was very hectic for me, and I wanted to badly to skip a day.  Life gets busy and things get placed on the back burner.  But I knew I had this blog to write, and I knew I had to post a photo of our exercise board.  If there were multiple days missed, I would have been very disappointed in myself.  Plus, I owe it to Rainey and the other dogs to keep them in shape if I want to continue asking so much out of them physically, ie agility and scent work.  In my earlier blog posts, I laid out the physical demands of our chosen sports.  My dogs did not choose these sports, but they do love to do them.  Would they be happy terrorizing our cats as a full-time job?  Yes, I’m pretty sure they would.  But our cats wouldn’t be happy.  So, agility and scent work it is!  If I want them to have a long, healthy career I need to do my best at keeping them healthy and in shape to perform.  Someday, when I’m not rushing to write this blog at 7 pm I will go into an anatomy review and discuss how important muscles and their attachments to bones are.  It is so important!  Maybe week 12, or 13….For now, take my word for it that to keep your dog performing longer you MUST keep them in peak physical condition with a combination of proper diet, exercise, and supplements.
 
This week’s exercises revisited the old, tweaked them some, challenged Rainey some, and expanded onto some new things!

​Down to Stand on a Decline – to keep things interesting I decided to add a small 4-inch incline using the FitPaws balance board and a KLIMB.  The incline wasn’t extreme, but I am sure she noticed a difference!  Using an incline/decline will engage muscles slightly differently and possibly engage ones that are typically not used for this exercise.  This decline wasn’t so severe that she was fighting for grip on her rear end, but it was enough for her to notice.
 
Sit to Stand to Sit on a Decline – repeat about what I said above, with the addition that since she was going to a full sit to down the decline was a bit more noticeable for her.  However, she rocked it like the champ she is!
 
Sprint to a Tug – this week on social media I saw some friends performing exercises with their puppies, and I thought to myself ‘why can’t we revisit puppy things and make it fun for fitness?’  So, we did!  Please take note that the tug is NOT up.  I repeat – DO NOT TUG YOUR DOG UP! You always want to tug the dog with a neutral neck in alignment with their spine.  Combining the sprint and tug exercise gets two bangs for one buck.  You are practicing speed and stopping, with a rapid change to tugging, which allows for rapid muscle engagement changes.  Teaching muscles and joints to do new things under control is the best way to prevent injury!  If they have seen it before they may be prepared for it when it happens unexpectedly on the course.
 
Lateral Side Steps on Overinflated Twin Disc – as you can see from watching this, it requires a large amount of core strength to stabilize on the disc while walking left to right with her front feet on the ground.  Make sure to keep the dogs back as straight and neck neutral as possible.  Slow and controlled movements will result in optimal muscle engagement!

​Digging – this was an accidently trick/exercise.  I was continuing to work on shake when we hit a wall.  I was using the pod for her to foot target to when she started scratching at it.  Then I thought well, why not teach digging!  Digging is truly a full body exercise!  If you watch the video, once she gets going with both feet her shoulders are engaged and working hard, her core is working to stabilize her back and body, and her rear end is in engaged holding her still.  The thing you cannot easily appreciate is how well digging works to strengthen the flexor and extensor tendons of the front limbs!  What are those, you ask!  Those are tendons that allow their tiny legs and digits to remain upright.  They work against each other to maintain proper balance and structure.  Keeping these strong and flexible, but not overworked, is important for maintain the proper motion and function of the limbs (back legs have them too, and they are worked during things like tug when they dig their feet into the ground).  Also, think of an agility dog (or any dog that runs and turns quickly).  Their toes literally grip into the ground as they turn.  This comment can totally take me down the rabbit hole of dew claws.  Research has proven in recent years that dogs actually use their dewclaws to in turning.  They are not just there to be an annoyance factor.  They serve a purpose, and it’d be best if they were left attached to puppies.  Digging can turn out to be a great exercise in a controlled environment!
 
Peanut Roll & Jump – I finally found a use for the Cloud!  I use it for a read end strengthening and power exercise for my minis.  It’s the perfect size for them.  The idea of this exercise is similar to what you saw in the pyramid exercise or elevated stands – weight is shifted to the rear and the head is slowly turned side to side to shift weight from left rear to right rear, giving small engagements to different core muscles.  Then the dog faces center and from a stand still launches over the object.  If a dog was too weak to perform this exercise, they would likely need to take 1 to 2 steps on top of the Cloud as they pass over.  As you can see in the video, Rainey barely touches the Cloud as she passes over.
 
Back Up Over Cavaletti – what you are seeing here is the very beginnings of an exercise for Rainey.  Her antics are almost comical as she tries to back up, hitting the cone.  The point of this exercise is to teach further foot awareness on all limbs, as well as work the joints at different heights/flexion/extension while backing up.  This provides a new/novel stimulus for the dog.  Again, introducing something new in a controlled environment in hopes that when they see something similar in rear life their body can respond appropriately.

As I wrap up this week’s post, I want to take a minute to point out Rainey’s progress.  The photo listed here is a chest comparison from today to 3 weeks ago on 2-14-2021.  I hope you can appreciate how much muscle Rainey has put on in just 3 weeks’ time, simply due to a focused, targeted strength training program!  Her chest is not as hallow and her neck and shoulders are slightly thicker.  Her side profile is also greatly improved in the accompanying photo showing today from 6 weeks prior, which was 2 weeks post-op.  Look how much you can accomplish with your dog if you take just 10 minutes a day 4-5 days per week!  It is so worth it to see these changes!
 
Rainey continues to build power, speed, and strength!  This week she will move back up to her regular jump height of 12 inches, and in a few weeks, we return to the competition ring.  I couldn’t be happier with her progress! I hope anyone reading this has learned a little along the way.   I intend to expand on Tui-na massage and a more in-depth lesson on anatomy and why things matter or why we recommend what we do for our sport dogs. We have 5 more blog posts, as I promised a 12-week series.  Hopefully I can keep coming up with new exercises and helpful information for you!
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
https://assisianimalhealth.com/technology/

​Today is day 48 post-abdominal surgery.  Tomorrow marks 7 weeks.  It’s hard to believe it has been that long.  In agility class Rainey moved up to 8 inches.  I started her at 4 inches on her first class back, and moved up 2 inches every week, adding a contact obstacle weekly.  This week I added the A frame and weave poles back in.  The previous weeks class showed that Rainey was gaining control of her body, and she could be trusted in the weave poles and on the A frame.  That may sound odd to those of you reading this, but let me explain.  Rainey has no sense of self preservation.  It was 2 years ago this month during an AKC agility trial she hit the weaves so hard she LITERALLY hit the weaves.  On her exit her shoulder took out the last pole.  It reminded me of a cartoon when a character hits a pole, and they bounce on it before falling off, except she bounced on it, and kept right on going!  It was pretty horrifying to watch in slow motion later that day.  Thankfully, Rainey did not have any lasting effects.  She had strong shoulders and lots of TLC afterwards that nothing ever showed itself for an injury.  As for the A frame, at its apex it stands 5 feet 6 or 8 inches tall.  When fierce schnauzer hits the bottom, she doesn’t always run it like the hill she’s supposed to.  Sometimes she flies over the apex so fast you would think her pelvis would dislocate!  Then the landing and running off is more like an abrupt thump thump on the ground and off she goes!  The ideal A frame entrance and exit would appear like the dog never left the ground, like she’s running up and down a hill with smooth congruity.  Yeah, Rainey doesn’t do the A frame like that.  Sometimes she leaps off halfway down.  Sometimes she hits her front feet so hard on the incline I have to stop and make sure she’s not actually hurt.  She never is.  But if I don’t watch out for her, who will?  

​When I took her to the side of the room that had the A frame, I walked her up and down it, as if to say ‘hey, remember this thing, please don’t kill yourself’.  It was tire jump to A frame, and she ran it beautifully!  We did an additional pass over it, but didn’t want to overdo it.  Next were the weave poles.  For those reading that do not know canine agility, the dog must enter on a specific side of the pole, and then literally weave between them for a count of 12 poles.  This requires all sorts of strength, especially shoulder and rear end strength, but it also requires coordination and knowing where your feet are.  When Rainey entered her steps were off.  She’s typically a bouncer – keeps front feet together and bounces left to right to left as she weaves through the poles.  But she was slightly walking them, until she got to pole 8 and her muscle memory kicked in.  We repeated them once more and she performed them perfectly and at a distance!  It had been 7 weeks since she had seen the weaves and A frame, but her muscle memory was still present, she knew her job, and she was able to perform without injury.  

​We took Friday off from fitness because I wanted to monitor Rainey for any signs of discomfort from the added obstacles in class Thursday night.  Thankfully, there were none.  That is a very important reminder – you must ALWAYS be assessing and reassessing your dog.  Honestly, this goes for normal activity and when your dog is recovering or returning to sport.  As your dog’s advocate and handler, you should know their normal and be able to recognize when something is off.  Whether their pep isn’t as high or their gait is off.  It is up to you to stand up for them and say no we cannot do this activity today.
 
Next week Rainey will move up to 10 inches for a jump height.  I will add more speed to my running and be less of a helicopter handler for her.  Then the week after, 8-1/2 weeks post-surgery, she will return to full jump height.  I will watch her closely for mistakes and weaknesses.  We will reassess our plan based on her performance.  Then my hope is at nearly 11 weeks post-op, 3 weeks after jumping full height, she will compete in a UKI Agility Trial.  She will then be reassessed for weakness, pain, or discomfort, and I will adjust accordingly.  If things go as planned, she will be considered to be released to normal lifestyle.  I will keep up her conditioning at least 4 days per week as I continue to improve on her muscle and power.  Seeing the light at the end of the tunnel is a great thing.  Rainey has exceeded my expectations in her return to function.  Alongside her is her sister and her 2 standard schnauzer house mates.  As I have been working Rainey, I have also been working them.  Aurora, her sister, also competes in agility, and through the last 7 weeks I have seen Aurora’s speed and confidence improve as her strength improves.  I am excited to see where this takes us!

​Everyone can see how far Rainey has come in the last 7 weeks.  She is stronger, she is more powerful, and she is faster.  As we continue our recovery journey, which will soon turn to a fitness journey, I continue to work on perfecting her exercises, looking for the square sit or down, looking for the pop up and down, seeing if she can hold her form when challenged on different equipment.  And through it all, she continues to take these escalations and ask me what else do I have for her?!  This week I did just that.  We worked on some techniques, but then I threw in things to complicate matter to see if she could physically and mentally handle them.  We also worked a lot on shaping behaviors.  Rainey is becoming very good at a front feet on floor pivot, but still trying to understand shaping a front feet on disc pivot.  We also spent time shaping a paw shake.  Hopefully we can develop this into an adorable trick and fitness exercise in the near future!

Sit to Down to Sit – a few weeks ago I introduced this exercise to readers.  In the previous video Rainey was doing a walk to down and a walk to sit.  You will see in todays video, as her core strength has improved, she is able to pop into a down and does very minimal walking to a sit.  She keeps her back end solidly planted on the ground.
 
Lateral Side Step – again, this exercise was introduced a few weeks ago, but I wanted to illustrate Rainey’s improved strength in completing it.  She keeps her back feet very solidly planted, and is now able to step off with both front feet lateral and back on with OUT moving her back feet and keeping her back straight!  I can only imagine the amount of core strength and engagement this takes!
 
Cavaletti Figure 8 – we took Figure-8’s and cavaletti’s another step further today by combining them, making an exercise for spinal flexion and body awareness.  Once Rainey had the hang of the low bars, I increased complexity by angling the bars.  My other dogs are able to perform cavaletti’s and Figure-8’s without a treat in their face.  Rainey, on the other hand, has not mastered that yet.
 
Rocking Sit to Stand on Wobble Board – this made this exercise a literal rocking sit to stand!  This exercise on the flat focuses on developing power from the rear.  When you add this level of complexity, it makes it more about stabilization with a little bit of power.  The reason it is good to mix things up is because you do not want the muscles to get use to a specific way of doing things.  If you have ever weight lifted or ran, you know that after a while your body reaches a plateau where it is in a steady state and cannot get any further benefit from that work out.  The same things can happen in dog.  You don’t want to keep doing the same exercise week after week without any variation.  You need to master it, yes, but once you do, go back to the original once a week or so, and make variations of it the other days.  By performing this variant, it prepares Rainey’s body for the unexpected.  If you have ever watched a dog run agility, especially a dog who lacks self-preservation, you know some pretty crazy things can happen.  They can fall off the dogwalk or A frame, they can lose traction turning, they can decide to turn the other way quickly which twists the lower limbs, etc.  So, it is good for their receptors to learn to react in a calm controlled environment when stimulated differently.  Maybe when they do something silly on the field or in the yard it won’t hurt them so badly or at all.
 
Back Up to a FitBone Up a Ramp – this week I decide to increase the complexity of Rainey’s back up even more.  I had her back up a very minimal incline to place her feet on her FitBone.  She did great!  It was a learning curve for her, but overall, she figured it out.  To critique this exercise, I would not want her to hyperextend her back and elbows like she did.  We only performed a few repetitions; therefore, I am not overly concerned, but I wasn’t aware it was so severe until I watched the video.  Ideally, I wouldn’t want to see that level of extension in an exercise.  A stretch post-exercise, yes, but not during one.  To remedy this, I would place my reward further forward
 
Diagonal Leg Lift and Core Assessment – next is assessing Rainey’s strength and core.  When lifting her right hind and left front, Rainey waivered slightly.  I’m fairly certain this was due to her wanting to lick my hand and a little slipping on the Klimb.  The left hind and right front lift she did not waiver at all.  Both lifts, her core was extremely strong and engaged.  Looking at Rainey from a stacked side profile she is looking good!  Not to mention, she is getting fabulous at self-stacking for photos!  Next week I will give an update about her shoulder muscle building and compare photos since it will have been a few weeks.  As a reminder, what you see today is the result of what you did 2 weeks ago!

As I continue to increase the complexity of Rainey’s exercises, she continues to build strength and power.  I still intend to expand on the Assisi Loop, Tui-na massage, and a more in-depth lesson on anatomy and why things matter or why we recommend what we do for our sport dogs.  But for toward, this is short and I am proud of myself for actually doing it!  It has been a long week, filled with lots of downs, but hopefully this coming week is better!
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
References:
Millis, D., Levine, D. Canine Rehabilitation and Physical Therapy, 2nd Edition. Elsevier. 2014.

​Today is day 41 since Rainey’s abdominal surgery.  Today is all the day she was supposed to delivery the puppies.  It’s a bittersweet day for me.  On one hand, I am incredibly grateful that she is here and doing so amazingly well, but on the other hand I try not to think about the coulda, woulda, shoulda beens.  Life is complicated enough without dwelling on those daydreams.  Regardless, the loss of a massive dream that I spent a lot of energy, finances, and time on needs to be mourned.  Today I told myself will be the last day I dwell on it.  After that, onward, my friend!
 
This week I continued to add complexity to Rainey’s exercises, and I decided to start grouping her exercises into a more rationale breakdown.  Instead of randomly picking exercises to do, I looked at my list, and I picked exercises for specific body parts on specific days.  Tuesday and Sunday were primarily for her rear end and core; Wednesday was proprioception and shoulders; Thursday was agility class; Friday whole body; Saturday shoulders and core; and Sunday basically whole body, but heavy on rear end.  Having body part days helps keep me from over working a certain body part.  Having the chart on the whiteboard helps me from performing the same exercise too many days in a row.  Below I will go through the new exercises Rainey had this week, as well as their importance for her.

Now I want to discuss Rainey’s diet.  There are a lot of ways to formulate a diet.  There are wrong ways, right ways, and just to get by ways.  The major myth in formulating a homemade or raw diet is that they are completely balanced without a vitamin/mineral supplement.  This is not true.  Even if you are feeding an 80/10/10 raw diet, you rotate all the things all the time, or your dog is eating exactly what you’re eating daily, it still needs some form of vitamin/mineral supplementation.  How I learned to formulate diets for pets was from Chi University.  We were taught to pick ingredients using TCVM principles, and break ingredients into percentages correlating to ounces.  I will not get into the nitty gritty ways of balancing a diet, but I will say I use BalanceIT and their supplements when I formulate diets for pets.  It is a complex process, and if you would like to feed your dog a whole food or raw diet, I would highly suggest contacting someone with experience doing such.  There are all sorts of individuals who formulate diets for pets, the most ideal being a board-certified nutritionist.  Actually, what is the most ideal is a board-certified nutritionist who also uses ingredients based on TCVM principles.  There are websites that offer homemade diet formulation, and they are typically ran by human nutritionists who have training in animal nutrition.  Today we are going to focus on the TCVM way to formulate a diet and what ingredients Rainey is eating and why.  I will not focus on how much of things, as I do not want someone going rouge formulating a diet for their pet.

​Rainey is a hot dog.  When you touch her, she is warm, when you work her, she is spirited.  She just runs hot.  Therefore, based on the knowledge you have gained over the last few weeks you should know that Rainey needs Cooling foods.  I also like to have in my healthy sport dogs diet a nice base of Blood Tonics to keep their tendons/ligaments moist to prevent injury, ingredients to nourish Qi so they do not become deficient from their exercise/work schedule, and ingredients to prevent Phlegm.  Phlegm is what happens when body fluids slow down.  It is the side effect of Spleen, Lung, Triple Heater, and Kidney Disharmony, resulting in accumulation of Body Fluids. In general, a healthy, non-processed diet, active lifestyle, and balanced body will prevent Phlegm accumulation.

Phlegm is a thick, damp, turbid material.  In TCVM there are two types of Phlegm – Substantial and Non-substantial Phlegm.  Substantial Phlegm can be described as ‘thick, sticky, condensed’ or as ‘the Phlegm having form’.  This is what we think of with sputum, mucous, and greasy, lipid, or caseous material.  It is also focal masses or tumors, which can be benign or malignant.  Pathogens can be associated with substantial Phlegm as well – Heat, Cold, Damp, and/or Spleen Qi Deficiency.  However, it is most often caused by Excessive Heat or Excess Damp.  When Phlegm is caused by Heat (Heat Phlegm) the Heat from the body cooks the Body Fluids, resulting in them accumulating and congealing, forming tumors.  Damp Phlegm (Phlegm resulting from Dampness) is caused from the accumulation of large amounts of sticky, Damp Body Fluids.  Damp Phlegm and Heat Phlegm are the two most common forms of Phlegm accumulation seen in veterinary medicine.
 
Non-substantial Phlegm is something you cannot touch.  It is considered something that causes a strange disease, and a the saying goes “Where there is something strange, there must be Phlegm”.  Phlegm of this form may be diffuse, disseminated cryptic, or within the Channels.  It can obstruct Channels, preventing the free flow of Qi, and resulting in mania or depression (‘Phlegm misting the Mind’ by blocking the Heart) or seizures (stagnation in the Liver Channel leading to Internal Wind). 
 
Diseases due to Phlegm are various, but include Retention of Phlegm in the Lung, leading to cough and asthma; Obstructed Phlegm in the Channels, leading to subcutaneous masses or suppurative inflammation of the deep tissues; or Phlegm affecting the Heart, resulting in Shen or mental disorders, loss of consciousness, or even coma.

​You can see why ingredients that treat Phlegm and keep Body Fluids happy and flowing would be important – to prevent cancer.  If you’re too cold, your Body Fluids slow down and accumulate with the Dampness, forming tumors.  If you’re too hot, your Body Fluids burn up and congeal forming tumors.  Therefore, you must be just right.  There is so much to consider when ‘Balancing’ an animal.  So many reasons for a diet ingredient or an acupuncture point or an herbal medicine formulation.  When an already sick animal presents, with a laundry list of maladies the most important must be chosen.  But – the most important for whom?  The owner?  The doctor?  In my practice, I try to pick what I feel is the most life threatening to the pet, while also paying close attention to what may be affecting the quality of life of the owner.  As you can imagine, attempting to undue years of Excess Heat, Excess Cold, Damp Accumulation, Phlegm Production, etc is a lofty goal.  But it can be done.  It just takes time.  As I tell my clients whose pet has multiple health concerns, it is like pealing back the layer of an onion.  We will address one thing first, but as we balance that section of your pet a new issue you did not know existed may show itself.  The process of balancing an individual is not easy and it takes times and patience from everyone involved.  This why even if you THINK your pet is healthy, it would be best to get them assessed early in their lifetime, and ideally 3-4 times a year.  As the seasons change, so does out balance.  Some are more stable than others, and may only need re-assessment 1-2 times a year. However, the longer a patient goes without fixing a benign problem, the likelihood increases that it becomes a unfavorable problem.  How does a practitioner find these problems if they do not exist in the physical state?  By assessing everything we have previously discussed – tongue, pulse, preferences, specific acupoints, and temperature of the patient.  There is so much that can be found in these simple things that can aid a skilled TCVM practitioner in catching illness early.

Now that we have seemingly gone off topic, what is in Rainey’s current diet?  The answer is, a variety of things.  I have also previously discussed Rainey’s supplements, noting that she receives medicinal mushrooms, probiotics, omega 3’s, and BalanceIT Canine multivitamin/mineral supplement.  All of my dogs receive a variety of antioxidant, free radical scavengers to try to keep them as healthy as possible, but as I have previously stated, sometimes you can’t beat genetics.  To keep Rainey the healthiest she can be, the following is what she is currently on, describing the ingredients TCVM energetics and why it was chosen:
*Beef - Sweet, Neutral -Tonify Blood, Qi,  and Yin; moisten dryness; strengthen bones and sinews; relieve pain; limb weakness; fatigue;
*Turkey – Sweet, Neutral to Cool – Tonify Qi and Yin; soften the hardness; indicated for Kidney/Liver Yin Deficiency;
*Cod - Sweet, Cold - Tonify Blood and Yin, clear Heat; general Yin Deficiency; promote digestion, Stagnation, Vitamin D source;
*Chicken Egg, whole - Sweet, Neutral - Tonify Blood, Qi, Jing, and Yin, calm Shen; clear Heat;
*Sweet Potato - Sweet, neutral - Tonify Blood, Yang, and Qi, Blood Stagnation, resolve Toxins, low glycemic index, rich in Vitamin A
*Kidney Bean - Sweet, Neutral – Tonify Blood, Yin, Jing and Qi; Blood Stasis; clear Heat; benefit the Kidney;
*Black Bean - Sweet, Neutral - Tonify Blood, Jing, and Yin; relieve pain; brighten eyes;
*Brown Rice – Sweet, Cool – Clear Heat; weakness; tonify Blood, Qi, and Yin; quench thirst;
*Millet – Sweet, Salty – Relieve thirst; tonify Yin; clear Heat; resolve Toxins; it actually has anti-fungal properties that aid in treating Candida albicans overgrowth;
*Quinoa - Sweet, Sour, Neutral - Tonify Qi, and Yin; strengthen whole body;
*Spinach - Sweet, Cool - Moisten Dryness, Soothe Liver, Clear Liver Heat; nourishes Blood; strengthens all organs
*Celery - Pungent, Sweet, Cool - Send down middle Qi; clear Heat; agitation due to Liver Heat; calm Stomach Fire;
*Rainbow carrot - Sweet, Neutral - Tonify Liver Blood, Soothe Liver Qi, resolve toxins; moisten dryness; benefit the eyes
*Turnip - Pungent, Sweet, Neutral – Drain Damp; transform Phlegm; engender Body Fluids; Blood Stagnation; tonify Blood, Qi, and Yin; circulate Blood; assist in dry mouth; aid in thirst; resolve toxins; clear Heat;
*Beet - Sweet, Neutral - Tonify Blood; moisten intestines; clear Heat; detoxify; cool Blood; irritability; calm Shen;
*Red Cabbage – Sweet, Pungent, Neutral – moisten intestines; mental depression; circulate Qi; clear Heat;
*Daikon Radish – Pungent, Sweet, Cool – transform Phlegm; moisten Lungs.
​

​Rainey continues to make excellent progress in her healing.  If I was inpatient, I’m fairly certain she would like to return to competing at full height, but that’s not on my agenda.  I want Rainey to return stronger than when she left.  Like I said last week, I have slacked in the last year with maintaining my dogs’ fitness.  Rainey has a natural musculature physique, and the absence didn’t hit her as hard as her sister.  But it was still noticeable.  In previous years Rainey has had significant musculature definition.  She always was mistaken for a boy (insert facepalm emoji).  Whereas Aurora as a very feminine physique.  This goes back to our discussion on being a Yin or Yang animal, and correlates some with their excess hot or cold needs.  Anyway, in 2019 I had all the dogs in peak physical performance.  I had started out by exercising them 4-5 days a week, with 1-2 rest days and 1 agility day.  They got to the status I wanted, and I backed off to 1-2 times a week, and honestly, sometimes less.  Given that they were in phenomenal shape, they were able to maintain this peak physical fitness while competing frequently and minimal fitness exercises.  Until the pandemic hit.  Looking at my videos of them, it’s really crazy to think 2020 was just a wash for us.  It’s like the year that didn’t happen.  Or maybe an extended vacation where we all just ate way too much and exercised way too little, the girls and I combined.  Now I find myself 5 weeks into an intense fitness routine with the dogs, and I am getting bored.  Yeah, that’s right…I’m bored with our routine.  Do you see that list?  There are 22 exercises on that list!  22!!!  And I am bored.  I circulate through each and every one of them throughout the 6 days we do fitness.  I am finding that they are no longer a challenge to the dogs.  Last week I introduced you to the Pyramid.  It’s one of my most favorite exercises.  When I restarted fitness with the dogs, the standards couldn’t jump from yellow peanut to blue peanut.  They’d either fall or just thrust themselves over the top, landing on their belly.  The minis were alright.  Now, the standards are Mexican jumping beans, springing from yellow peanut to the blue like it ain’t no thing!  And I am running out of ideas on how to challenge them!  Ok, that’s not 100% true.  I am running out of whiteboard space to write my ideas.  But – here’s the deal – in human and canine (or equine) fitness once an exercise becomes easy, we make it more complex.  We can take a boring, use to be difficult static stand on the flat or FitBone and perform it on varying sized yoga blocks or a really unstable piece of equipment.  We can do those down to stands on a peanut or a low-level ramp.  We can increase the height of the thing we back up to.  We can add resistance bands.  We can do a lot with our foundation exercises!  Imagination and physics are your friend!  This week I’ll cover some new exercises and some modifications to old exercises.  Rainey is getting strong, and I need to keep things fresh and new for her, or she will plateau.  And no one likes to plateau!

​Crawls – or like I would call this, as to not be confusing, crouching.  When most think of crawls, we think of extending the back feet behind the dog in order to push themselves forward.  This is how I described this exercise previously, and even within the last 2 months, to owners.  However, a much more muscle efficient exercise is having the dog crouch and walk lower.  It puts the muscles in a contracted formation, working them a little differently, while forcing the back and core to engage to maintain stability.  The idea would be to perform them slowly as to work the muscles to the max capacity. 
 
Cavaletti – this week I added a lot of complexity to the cavaletti.  The primary formation I use for caveletti’s, and what most people likely think when they think cavaletti, are bars spaced as far out as the dog is tall in order to produce a lovely even, flowing gait, while increasing proprioception and balance.  This week’s version of cavaletti involved balance equipment and the bars were spaced around 14 inches or more apart, enough to get the FitBone’s in between (also, do you know understand why I have so many FitBones?).  The objective of this exercise was to get her to slow down and think about her balance and where she was placing her feet.  It took her proprioceptive reflexes to the next level, as well as combined stability work for her joint mechanoreceptors as she navigated the rough terrain.  What you cannot see from the video is every other FitBone had a different inflation level.  There were 2 FitBones that were extremely over inflated and rocked.  With this exercise I was not concerned with gait patterning, therefore her slight hopping was fine.
 
Static Stand on an Unsteady Thing – next up was Rainey performing a static stand on an even more unsteady object.  Up to this point she had performed this on 2 over inflated mini FitBones.  Due to their nature, the FitBones rocked cranial-caudal (forward backward).  The object this week is a Flexiness Twindisc that is over inflated, therefore it rocks all directions.  I made sure Rainey was standing relatively square, not tucking her hind legs underneath her, and then asked for a variety of motions.  It was definitely more difficult for her than the FitBones!  Goal achieved!

​Plyometric Jumps – one of my favorite exercises to do with a very fit dog are plyometric jumps.  The purpose of this exercise is to get the dog sitting as close to an object as possible, and then have them jump straight up unto said object without pulling themselves with their front legs.  It is all about teaching power from the rear end push off.  You can see how the Rock Back Sit to Stand has set her up for success for this exercise.  In 2019, Rainey was able to sit on a stabilized wobble board and jump nearly as high as my chest from a sit.  That video snippet is included after current videos.  Today we didn’t go quite as excessive. From the video, you can see I used a hand touch to get her close to the table, and then sat her squarely in front of it.  Then I lured her to jump onto the table. I started with a single Klimb, and with continued repetitions, added 2 Klimbs on top of the initial Klimb.  When the 3 Klimbs were stacked on each other I did add the wobble board as a ramp for her to get down.  You will also see she completed a crouch crawl on her way back to starting position.  I did this to try to limit the impact of her front legs jumping off of the 3 Klimbs.  It’s important to note what repetitions and sets are.  Repetitions are the number of times you repeat the exercise in a row, and sets are the number of repetitions you do.  For example, I typically perform 5 repetitions of an exercise in a row, release dog, and repeat 1-2 more sets of 5 repetitions.   Again, monitoring for fatigue and loss of control that would indicate the dog has exhausted those muscle sets and that exercise is no longer useful at this exact minute, and a break is needed.
 
Back Up to a FitBone – this is Rainey’s original back up to a thing exercise.  When she started her recovery process, I used a low object (the FitPaws ramp) for her to back up to.  Now that her core and back strength are significantly improved, as well as her increased body awareness, I can increase the complexity for her by raising the height of the object and increasing the distance to the object.  I want you to appreciate in the video that when she gets into position, her back is straight, her neck is neutral, and no part of her body is hyperextended or flexed.  Teaching the dog to do this is as simple as choosing the correct reward location and being fast with your reward placement.  I don’t always lure my fitness exercises.  I really enjoy shape training my dogs.  This week I actually started shape training their front feet on disc and back feet on disc pivots.  So far, it’s looking good!
 
Static Stand on Yoga Blocks – this is an exercise I have been working on for about a year with the dogs.  It’s extremely difficult to perform and requires a tremendous amount of coordination and core strength.  I have 4 yoga blocks, all different heights.  The dog stands with each foot on a different block, and you perform slow varying head motions, sometimes tapping on hips/shoulders, to allow dog to engage their joint and muscle stabilizers differently.  The height difference is a great challenge – the dog must reach with one front leg, but the other front leg is crouched (I feel like this is my word of the week) slightly.  The same in the back, but no leg is on the same height block.  It is a difficult exercise, and I do not recommend you try it unless your dog is cleared of all joint and muscle injuries.  As you can see in the majority of the videos, when I perform exercises with my dogs, I am CONSTANTLY checking in on them.  I am feeling the muscles I want or think should be engaged, I am feeling their back to make sure it is straight, and I am constantly checking their stability.  Frequently assessment DURING the 10-30 second exercise is KEY to performing it accurately and injury free!

​Wobble Board FitBone – this we saw last week, I believe.  It is truly on of my favorite exercises simply due to its complexity and full body work out.  It is an excellent shoulder stabilization exercises, but it also requires significant core engagement.  This week I worked on Rainey’s form.  Her front legs were more under her, with less hyperextended carpi (front wrist).  She was able to hold stabilization better and longer.
 
Figure 8’s – a simple, yet complex exercise.  Figure 8’s not only engage the spine for lateral flexion, but it helps train the joints for lateral motion and increased stabilization on turns.  Throughout this exercise, I varied between slow and fast walk and increased/decreased the distance between cones.  The variation in complexity allowed for her to respond and react.  If we correlate this to agility, it is the foundation steps to training her muscles and joints to stabilize for sharp turns after jumps. 
 
Peanut Balance Walking – ok, I’ll admit, I think this exercise is adorable and kind of reminds of a monkey.  My ultimate goal here is to have the dog be able to engage their core so well that they can stabilize and walk the peanut without me guiding it.  This exercise helps with body awareness, core strength, back end limb strength, and back strength.  Important to note, you want the dog to keep a straight spine with a neutral neck.  If I was able, I would be reaching down to feel her core and back legs to make sure she is properly engaging.  Due to it’s complexity, this exercise is kept extremely brief and only repeated once.
 
There you have it – Rainey’s newest exercises for the week.  She is coming along nicely!  This past week she jumped 6 inches in class and was able to perform the dogwalk (thankfully without falling off).  She is running fast and happy!  Her overarousal and clinginess was already declining.  Hopefully with more exposure she will continue to return to a level headed agility speed demon!

​The last section of the video demonstrates Rainey’s diagonal leg lifts.  The largest issue I have with performing these on her is she constantly wants to lick my face or hand, therefore making her look weaker than she is, as she wobbles to chase my hand or face.  Despite this, I am happy to report that her stability and core strength and engagement is extremely strong!  When we look at her free stack, her back is flat, her back legs are extended in a normal stacked position, her front legs appropriately underneath her, and with her new haircut, you can appreciate how tiny and tight her waist is becoming. 
 
This week I will continue to increase the complexity of Rainey’s exercises, while building her strength and making her as agile as possible.  She is such a willing and able partner that this process continues to be a joy!  I still intend to expand on the Assisi Loop, Tui-na massage, and a more in-depth lesson on anatomy and why things matter or why we recommend what we do for our sport dogs. 
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
References:
Xie, H., Preast, V.  Xie’s Chinese Veterinary Herbology, 1st Edition. Wiley-Blackwell, 2010.
Fowler, M,. Xie, H. Integrative and Traditional Chinese Veterinary Medicine Food Therapy Small Animal and Equine, 1st Edition. Chi University Press. 2020.
Millis, D., Levine, D. Canine Rehabilitation and Physical Therapy, 2nd Edition. Elsevier. 2014.

​Today marks day 34 post-operative abdominal surgery for Rainey, making tomorrow week 5!  She continues to do great, and returned to agility class this week, where she only jumped (speed bump) 4 inches and did tunnels.  No contacts or weaves.  She was fast, happy and full of energy!  My goal with taking her to class was to see where she was at.  It will be a few more weeks before she’s allowed on contacts and the weave poles.  Rainey has no self-preservation skills, and right now with her excitement level and state of body awareness that is a very dangerous thing.  Plus, I’d like a little more healing on her linea and back/core strength before she jumps full height, bends her body (weaves), and runs up/down high, sometimes narrow things (dogwalk, teeter, and A frame).

​This week Rainey was groomed.  For her, that is a combination of rolling her coat and hand stripping it, along with clippers and scissoring for certain areas.  In this week’s video you will notice the change in her appearance mid-week.  She appears slightly thin coated.  What’s nice about the hair cut is you can now fully see her muscles.  I know my focus on her recovery has been about her core and back, but this week I started to notice that I need to strengthen her shoulders and front end.  My noticing this was not due to anything she did, but rather with her hair cut I was able to better assess her overall musculature.  I will be honest, 2020 was not kind to me in regards to having time for my dogs, myself, or my family.  It was a very busy year work wise, and this year is looking the same.  Because of this, and the cancellation of all major events, I severely slacked on the dogs conditioning and fitness.  They returned to agility class weekly around late June, and had only a few one-day trials in the fall.  Running in agility class is not an appropriate fitness regime.  In the last year, we became weekend warriors, except our weekend was Thursday nights.  I was so busy with work and moving, that without goals in my mind, keeping my dogs fit wasn’t a forethought.  And it really needed to be.  Aside from Rainey, I have her littermate Aurora, 12.5-year-old rescue female standard schnauzer Jade, and 10-year-old rescue standard schnauzer Sterling.  Each of these dogs have their own needs fitness wise, and each has to have a plan tailored to their abilities and needs.  And sometimes, it seems daunting to work with all 4 dogs.  However, it only takes about 30 minutes a day to do all of their fitness, which includes each dog and the set up/tear down time.  Each of the dogs have suffered from not working on their fitness in the last year.  Aurora, who was spayed December 2019, use to have a very strong core, but now it is weak.  After her spay, I did a slow 8 weeks rebuild with her.  But then the world shut down, and so did my ambition.  Fast forward to today, and her physical weakness is illustrated in her dislike for jumping 12 inches.  She chooses to run around the jumps.  But at 8 inches, she is all willing!  I assessed Aurora the other day, and sure enough her core is weaker than it ever has been.  This is most likely due to the lack of keeping up with her fitness after her spay.  She went in strong, and rebuilt strong, but then it slowly faded as she didn’t receive more than 10 targeted fitness sessions from February 2020 to January 2021.  Since I have been determined to not let Rainey’s body become weak, the other dogs have all benefited.  In just 3 weeks, I am noticing that Aurora is more musculature and leaner than she has been in previous months.  Jade’s hind end muscles (the first things to go in older dogs) are looking larger and more fulfilled.  Sterling is gaining the ability to jump on furniture more easily, working on his hind end strength.  All it takes is a small amount of time each day to achieve this.  I know it’s daunting, but just 5 to 10 minutes a day 3-5 days a week will benefit your dog so much!  If I can find the time, so can you!  I mean, I do have to get up at 4:30 am during the week, but it’s worth it!

​Rainey’s incision continues to heal very well.  The sutures under the skin are getting softer by the day, but the cranial aspect (closest to her belly button) is slightly irritated.  This is the location that all the closure knots are located, therefore the largest quantity of suture.  Rainey’s core is rock hard when she is challenged by way of diagonal leg lifts.  She will waver slightly on the right hind, but overall, she is looking fabulous!  Aside from the other modalities and treatments discussed, I attribute the healing of Rainey’s incision to laser therapy.  Laser therapy, also known as Low Level Light Therapy, Cold Laser, Soft Laser, Laser Phototherapy, and more recently photobiomodulation, is, per the National Center for Biotechnology Information defined as “a form of light therapy that utilizes non-ionizing forms of light sources, including lasers, LEDs, and broadband light, in the visible and infrared spectrum.  It is a nonthermal process involving endogenous chromophores eliciting photophysical (ie linear and nonlinear) and photchemical events at various biological scales.  This process results in beneficial therapeutic outcomes including, but not limited to, the alleviation of pain or inflammation, immunomodulation, and promotion of wound healing and tissue regeneration.”  

Laser therapy provides painless and non-invasive safe treatment with controlled amounts of laser light to modulate natural biological processes in order to produce beneficial clinical effects.  The positive effects of laser therapy include pain relief; resolving chronic and acute inflammation; reducing edema; healing and regenerating nerve tissue; promoting wound healing and tissue repair; and modulating an immune response.  Laser therapy should not warm tissues more than 1-2oC and it is not considered a thermal modality.  There are different levels of laser therapy machines, but the most commonly used range from 3b to Class IV.  Laser therapy works on 4 levels.  At the primary level, laser therapy is dependent on the actual interaction between light and tissue.  These include the absorption of photons by photoreceptive molecules (chromophores) at the sub-cellular level.  These interactions cause a photochemical and photophysical reaction that leads to a cascade of biological processes.  On the secondary level, there is modulation of ATP (the molecule that carries energy within cells) production, which is dose dependent, as well as Nitric Oxide release and formation of Reactive Oxygen Species (ROS).  On the tertiary level, the products of the secondary mechanisms then produce effects including gene transcription, inter-cellular signaling, and vasodilation.  Finally, on a quaternary level, the vasodilation increases cellular perfusion, which allows improved oxygenation and an influx of macrophages, neutrophils, and lymphocytes to affected areas that are undergoing repair and/or infection.  It also brings blood supply or re-vascularization and proliferation of cells that aid in healing.  Improved profusion or blood supply will also facilitate the removal of inflammatory cells, fluids, and debris (lymphatic drainage) more efficiently.  All in all, laser therapy improves wound healing, reduces inflammation, promotes cellular reproduction, stimulates nerve regeneration, and provides pain relief. 

​The treatment protocol for laser therapy is variable depending on the injury and chronicity.  In Rainey’s case, she has been lasered every 3 days since surgery to aid in increasing the rate of healing.  I am also experimenting with whether laser therapy will increase the rate of suture dissolution.  According the manufacturer, the suture used will take approximately 200 days to dissolve.  I would like it gone closer to 16 weeks, which is 112 days.  There is no data on whether laser therapy will increase the rate at which sutures dissolve, but based on the softness of Rainey’s sutures, it seems to be helping.  Even if it doesn’t help dissolve them faster, performing laser therapy every 3 days for 16 weeks will provide a much healthier, stronger linea alba, especially in combination with the use of the Assisi Loop and Tendon/Ligament Formula herbal medicine.

​As I stated above, Rainey has been showing remarkable progress in her fitness.  This week I decided to push her past her comfort level and try new to use exercises.  I continued to expand on her quantity of repetitions and exercises, while watching her for fatigue.  I also increased the complexity of some of her exercises, whether with adding stability equipment or higher angles for reaching.  While making these changes, I continued to closely monitor her form.  If her form suffered, whether with increased complexity or increased repetitions, I did not push her further.  I stopped.  This illustrates that she is tired and it has been enough.  If you push a dog through this you will cause injury.  In rehab the saying is ‘Quality over Quantity’.  It is extremely important for handlers/owners to understand that.  

​​With that in mind, lets look at the video….the first segment is a down to stand but on a peanut.  A peanut should be fully inflated and firm.  This exercise was made more difficult due to the shape of the object she was on and the fact that is it unstable.  What I noticed during this video is Rainey’s back feet turn out a little more than I’d like.  When in a proper down to stand position or stacked stance or square down the back feet should be pointed forward. Seeing this, I know I need to work on her form on the flat (aka ground) before moving to stability equipment.

​The next exercise in the video is a pyramid structure made with Klimbs, FitPaws Disc, FitPaws Peanuts, and a Bosu ball.  The goal of this exercise is hind end and front-end awareness and strengthening.  We start by ascending the pyramid.  The goal is for Rainey to maintain a straight back with her weight loading her hind legs.  You will notice that I feel her core and her back legs while she is in this position, and I vary the location of the lure (cookie) to engage these body parts.  Then you see her jump from the disc to the peanut.  Note that she is PUSHING from her rear.  She is not pulling herself with her front limbs.  I am happy to see this appears effortless for her!  We repeat the previous exercise, but this time she is more stretched out, elongating her back.  Also, Rainey is beyond enthusiastic for cookies, which can make the precision of fitness training difficult at times.  Then again, she jumps effortlessly from the yellow peanut to the blue peanut, which is a greater distance than the previous jump.  I am happy with this.  The next part of the exercise is to illustrate control on the decline.  She now has to move her way downward, while maintaining her hind legs on the peanut above her.  This would be very difficult without adequate core and back strength.  Think tail over teakettle.  She also needs the appropriate strength in for forelimbs to stabilize herself on the peanut below her.  The goal of movement for this exercise is also maintaining a straight back and neutral spine.  Ideally, Rainey’s head should be lower and nose pointed more towards the floor.  Then she moves lower to the Bosu with forelimbs and peanut with hindlimbs.  Again, I really would like a more neutral neck in alignment with the rest of the spine.  That is handler error, not dog.  

​Tuesday was all about pushing boundaries with Rainey and seeing how much we have left to make up for.  The next exercise shows a Klimb at an angle, with the FitBone resting on the angled legs and a small wobble board in front.  This again asks for a straight back, stacked hind legs, and front legs under the dog.  This is an exercise that focuses on the shoulder stabilization musculature and it is incredibility difficult.  My critiques of our positioning are head too high and forelimbs to far forward.  In reality, I should have placed something under the wobble board to stabilize it to allow for better form. 
 
Wobble board balance work was next.  This is a full body work out, challenging the body’s stabilization mechanisms.  We kept things simple by luring from corner to corner and circles on the board.  As you can see from the video, Rainey was lacking confidence on it and chose to crouch.  Although this was not the sought behavior, it was still beneficial in its own right. It engaged the musculature in a different manner, challenging the joints differently, and providing a novel input.  

​Tug as an exercise – yes, that’s a thing.  Watch the video of Rainey tugging.  What muscle groups do you think she is using/engaging?  Pretty much her whole body.  Throughout our tug session, I would reach and feel her core and back legs.  What you will also notice is what she is standing on.  You have likely noticed these mats throughout the last few weeks.  They are Flexiness Sensimats.  I have 3 different mats with different textures to them.  I randomize which one I use each day.  Their purpose to provide a novel stimulus increases proprioceptive responses from the paw to the brain.  I also like to use them for keeping the dogs straight and square.  They also provide a non-slippery surface, because sadly my flooring can be slippery.  Originally, I purchased them to aid in novel stimulation for the puppies, that weren’t born.  The other thing to observe from this video segment is neck position.  I try my best to keep Rainey’s neck in alignment with her spine.  This is extremely important for longevity of neck health.  

​The next exercise was a rock back sit to stand.  As I discussed previously, we do not want our dogs pulling themselves up, instead we want them to use their hind end. This exercise if done incorrectly, will teach your dog to pull with their front.  The goal of this exercise is for the dog to propel themselves forward with their back end, strengthening their gluteal muscles and quadriceps.  To return to a set, the dog must engage their core and to pop back down.  What we don’t want is the dog walking themselves forward and backward with their front feet.  The back feet should stay stationary during this exercise.  Ultimately, the dog will be pushing themselves forward and returning to the sit with power and speed.  This was literally the first time in her life Rainey performed this exercise, and I think we did well.  Reward position will play into the dogs’ motion, so be careful where your hands are.  Also, as with the down to stand, make sure the back feet are pointing forward.

​I continued to challenge Rainey this week by working on her precision and slow movements.  The next segment in the video shows a mini obstacle course set up with a wobble plank, Klimb, and FitPaws Disc, as well as a Sensimat on the plank.  The goal of this exercise was similar to the pyramid set up, but with different heights.  The goals of the decline and incline on the plank were to try to go slowly and work on her precision and push off (incline).  Rainey does everything at mach speed, hence all the luring vs offering in her fitness exercises!
 
There were a few more exercises thrown in there, but if I share them all today, I won’t have anything left for next week!  We are up to 19 exercises, with different variants able to be performed with many of them. The goal of her fitness is to challenge her, but only when she is ready.  At the end of today, I checked her strength with diagonal leg lifts.  It’s honestly hard to determine if she has weakness in her right hind or if she simple is too over excited for snacks!  But her strength when her left front and right hind are lifted is definitely rock solid, as is her core strength!  The last image in the video is a stacked photo of Rainey.  Again, getting her to stand still is a difficult task!  But she’s looking great!

Over the next week we will continue to build her strength and dexterity, regaining her balance and eventually speed.  We will go to class this week, at 4 inches and only jumps and tunnels.  I am very pleased with her progress, and am exited to get her back to full height!  She is a fun little dog who challenges me in every way, but I wouldn’t have it any different!  This week was again kept short, as I somehow ran out of time.  I hope to write about her diet next week, and continue to expand on any new exercises we perform.  I still intend to expand on the Assisi Loop, Tui-na massage, and a more in-depth lesson on anatomy and why things matter or why we recommend what we do for our sport dogs. 
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
Millis, D., Levine, D. Canine Rehabilitation and Physical Therapy, 2nd Edition. Elsevier. 2014.
Evans, H.E., deLahunta, A. Guide to the Dissection of the Dog, 6th Edition. Saunders. 2004.
Jenkins, P.  Spectrvet Therapeutic Lasers.  2017

​We are almost at 1-month post-operative abdominal surgery for Rainey!  If we are counting by the weeks, we will be at week 4 tomorrow.  To keep things specific, we are at day 27 post-op.  Rainey has been doing very, very well!  Her spirits are high and she seemingly has her physical status back.  This week we played scent work, and she excelled!  I attribute Rainey’s seemingly speedy recover to the multi-modal approach to her health, or a whole health approach to her care.  This has included her diet, physical fitness, appropriate supplements, appropriate herbal medicines, and her mental stimulation.  I have worked hard to engage her and make her feel important and included.  Her life was thrown upside down the weekend she got sick, and in one day she went from pregnancy hormones to no hormones.  Throughout my entire career I have heard that you should not spay a bitch when she is cycling or during pregnancy, as the affects on her mental state could be devastating.  But, did anyone have any data to support this?  Or even antidotal data?  Or was this just hearsay?  I will not lie; I was terrified Rainey would be locked in a constant state of pregnancy or false pregnancy brain, unable to function and too emotionally sensitive to rebound.  I was determined to keep her mentally stimulated throughout this process so that she would not become depressed and her mental acuity would suffer.  Whether it be my process of inclusion or the fact that trapping a bitch in a state of pregnancy brain isn’t really a thing, Rainey is exceeding expectations!

Whenever a patient has a surgery that involves cutting of a tendon or ligament or a sport dog with a strain, the herbal formulation I reach for is Tendon/Ligament Formula by Jing Tang Herbal.  Its Chinese name is Zhuang Jin Jian Fang and it is a modified Bu Gan Qiang Jin San.  Tendon/Ligament Formula nourishes Liver Yin and Blood, as well as strengthens tendons and ligaments.  For centuries, Chinese herbal medicines have been used to treat martial arts injuries.  These herbals can also be used to strengthen tendons and ligaments, which is the reason I recommend once a year an active performance dog go on Tendon/Ligament Formula.  The micro abrasions to the tendon and ligaments can be nourished, and potentially prevent major injury.  In TCVM, by supplying and nourishing the tendon and ligaments with Blood and Yin, the Liver dominates and controls them.  When there is weakness or poor growth of tendons and ligaments, there is usually Liver Yin/Blood Deficiency.  Therefore, the key to treating tendon and ligaments injuries is to nourish Liver Yin and Liver Blood.  In horses, there is ultrasonic evidence of complete healing of a tendon injury after just 3 months of administration of Tendon/Ligament Formula.  You may be asking yourself ‘if this formulation is so amazing, why hasn’t it made it’s way to mainstream medicine?’  That is an excellent question!  The answer is because mainstream medicine wants evidence-based medicine, and evidence-based medicine involves studies.  The purpose of Chi Universities Master in TCVM Program is aid in providing this evidence-based medicine in hopes of bringing the benefits of TCVM to Western Medicine, making it a more accepted practice for our patients.
 
The ingredients and actions of Tendon/Ligament Formula are as follows:
*White mulberry – Soothes limbs
*Epimedium – Nourishes Kidney Yang and Yin
*Dang Quai (Angelica Sinensis) – Nourishes Blood
*Chinese Peony – Nourishes Blood and Yin; soothes Liver Yang
*Cyathula – Strengthens the Kidney and benefits the knees
*Sichuan Lovage – Moves Blood, resolves Stagnation
*Lycium – Nourishes Liver Yin and Blood
*Cinnamomum Aromaticum – Activates the Channels and Limbs
*Asiatic Dogwood – Nourishes Liver Yin
*Rehmannia (Shu Di Huang) – Nourishes Blood and Yin
*Psoralea – Nourishes Kidney Yang and Yin
*Eleutherococcus Sessiliflorus – Strengthens ligaments and tendons

This week I am running low on mental power, and would like to expand on Rainey’s diet, but I am going to wait until I have more time and brain power.  Therefore – onto her fitness!
 
This week I confused myself by over thinking, was she on week 3 or week 4?  I couldn’t decide, so I called it week 3 to 4.  This week Rainey had 3 full rest days – Monday, Wednesday, and Sunday.  Despite these appearing to be perfectly placed, they are actually the consequence of my schedule.  This week we increased our intensity, and I wanted to see what Rainey could give me, strength wise.

​At the start of the week Rainey was assessed with diagonal leg lift to see if she could balance better than last week.  The answer was yes, but unfortunately a valid video was not obtained.  Once it was determined that Rainey was engaging and utilizing her core better, I decided to push her a little harder.  Instead of doing 2-4 exercises per day, we did 4-5 different exercises per day.  We started the week working on down to stands, pivots, static stands on mini FitBones, and sprints.  At this time, Rainey continued to rise equally in her down to stands, showing significant improvement from just a week ago.  I decided to start focusing this week on her shoulders and rear legs, as it had now been a solid 3 weeks since these areas were specifically engaged in fitness exercises.  If Rainey is to perform sharp turns, weave poles, and contact bottoms she must have a strong front and hind end to support her core and back.  A pivot is typically seen as an obedience move.  I see you it as an opportunity to work on forelimb and hindlimb adduction and abduction, as well as emphasizing foot awareness.  Initially, I have the dog place front paws on a disc, and pivot all the way left, then all the way right.  This works the back legs.  Ideally, the dogs’ neck is kept in a neutral position with their spine, which is straight.  Their rear legs are in a stacked type position, and they are not arching their back.  The key here is the dogs’ neck is not up looking at you.  That can be harmful to their cervical-thoracic junction (I see another subject to be discussed – transitional spinal zones). The dog will move around the disc with each hind foot moving independently.  No hopping.  A dog that hops indicates a dog that is either weak or has a groin injury.  No hopping.  Next, release the dog and reset with their front feet on the floor, and their back feet in a stacked position on the disc.  Neck is in a neutral position with the spine.  Now ask the dog to pivot all the way to the left, then all the way to the right.  Again, legs should not be hopping.  In an ideal world, the front legs will actually cross each other as they move sideways around the disc.  In both of these exercises, the feet on the disc DO pivot.  They do not shuffle.

​Next, we worked more on our static stands.  In the video, you will see static stands from 2-3-2021.  The FitBones used were over inflated.  When a FitPaws piece of equipment is OVER inflated it increases its difficulty, as it is more easily rolled.  One important piece to note is that if your dog stands on a piece of fitness equipment and shakes uncontrollably STOP, just stop.  They are not fit enough for that piece of equipment!  This maybe they truly are not fit or they are guarding a stabilizing muscle.  Regardless, get them off of it.  If they shake, but within 2-3 seconds stabilize and stop shaking, they have engaged the needed muscles for stabilization.  Keep the session short and sweet, as to not over work them. 
 
Next, we worked on sprints.  Nothing crazy, my room is only 24 feet (or so) long.  I placed Rainey in a sit stay, lead out across the room, and called her to me.  In this space she couldn’t get up a tremendous amount of speed, but she gets fast.  I was actually assessing her push off from the stay, making sure she’s still pushing from her rear vs pulling from her front.  I did not want her compensating for a weak core by not using her back legs. How would this happen?  In dogs, a primary muscle for hip flexion, or bringing the hind leg forward, is the iliopsoas muscle.  This muscle complex starts at around T10-12, follows the underside of the lumbar vertebrae, until it gets to the pelvis, where it splits and attaches to the lesser trochanter of the femur.  The secondary function of this muscle is core and back strength and stabilization.  Therefore, it can be assumed that if the core is not engaging, the iliopsoas is likely not performing to its full potential, and then the dog will not be properly flexing and extending its back legs, as they may be hunching their back and guarding their back/abdomen.  This results in a shortening of the iliopsoas, which results in increased flexion and decreased extension of the hind leg, resulting in a choppy gait. Then after a while, as the dog continues to hunch its back, its core weakens, it stops engaging their core, the dog decreases their hip extension and push off, and with time the dog starts dragging itself forward with their front vs pushing from their rear. Assessing early on if the dogs normal running function is abnormal is important at catching something early before it has a chance to progress.

​We continued to work on shoulder exercises by performing a lateral side step with an elevation.  You will notice watching the video that I used a different pair of mini FitBones.  This pair is not over inflated.  This makes them more stable and decreases their difficulty.  For this exercise I did not want to insert another complicated factor, as the technique is already complicated.  The goal of this exercise is to keep hind feet still while walking laterally (to the side) with front feet, stepping off the FitBone, and back on.  This is difficult and likely more complex than she should be doing right now, but again I wanted to see where we were at.  This exercise engages the core as a stabilizer, allowing the dog to step down and back up, while utilizing the abductor/adductors of the forelimb.  This is definitely not an exercise for a lower physical fitness athletic with weak forelimb stabilizer muscles.  Rainey did very well, and maybe became overly excited.

Side steps on the flat are next in the video.  The important element with this exercise is trying to keep the head in neutral position (difficult with small dogs).  Next, the goal is for the dog to actually cross their front feet and their back feet as the step sideways.  In the video, Rainey is almost shuffling sideways, with some points she will actually crisscross her legs.  She was very excited, and we had not performed these in a long time.  Another project to work on!  Again, this exercise focuses on hind limb and forelimb abduction/adduction, but in order to stay straight sideways, the dog must stabilize their core.

​This week we returned to the land treadmill!  The focus was a slow 2 minute warm up, followed by 3 minutes at a faster pace, with the goal being improving her cardiovascular fitness.  With the weather currently being below 0 in Minnesota, we are not able to do this outside.  However, Rainey thoroughly enjoys her treadmill!  As the weeks progress I hope to work up to more HIIT training at 90 to 120 second intervals, which will aid in training her cardiovascular fitness for agility.
 
This week Rainey was able to return to something that resembled agility and training – wraps!  I went down this path for three reasons – 1. To assist her mental stimulation and joy for training, 2. To assess her ability to control herself at speed, and 3.  Continue improving her spine flexibility.  I would say I am happy with her progress.
 
The last technical exercise of the week was a ‘Sit to down to sit’.  This exercise requires a stronger core, and the ultimate goal is for the dog to ‘pop’ to a sit and ‘pop’ to a down.  This means no walking with their feet.  Initially, Rainey wanted her cookie, and did a half-effort down to sit.  You will see that I correct her by luring her head to a higher seated position.  This looks like I was trying for a sit pretty, and I can assure you I was not.  Then after that first attempt, Rainey performs the sequence with better effort.  She is still walking her feet slightly for the down to sit, but overall, her performance is pretty good!
 
This week we complicated our cavelletti’s by placing the bars at apposing angles.  This further challenged Rainey’s proprioceptive input (the ability and speed at which her eyes communicated with her limbs and her brain telling them what to do when and where).  As you can see in the video Rainey struggled a little bit to this challenge, which as with everything she does, was at speed.  I wanted to continue the lovely patterned gait, but with increased complexity.  Having a quick reaction time is important in the jobs Rainey performs (agility). 
 
Lastly, Rainey finished the week out with scent work practice, at which she excelled!

And there we have it – all of Rainey’s exercises for the week plus some anatomical reasons why I chose these exercises.  This week, I increased complexity and started to push Rainey past her comfort zone.  She continued to exceed my expectations, especially as her willingness and love to train returns.  It will be soon that Rainey returns to class at low jumps, as we continue to rebuild her core and overall strength.  Next week I hope to write about her diet and expand on any new exercises we perform, and in the future, I do plan to expand on laser therapy, the Assisi Loop, and Tui-na massage.  I also discovered that I would like to go more in-depth on anatomy and why things matter or why we recommend what we do for our sport dogs. 
 
The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
Xie, H., Preast, V.  Xie’s Chinese Veterinary Herbology, 1st Edition. Wiley-Blackwell, 2010.
Millis, D., Levine, D. Canine Rehabilitation and Physical Therapy, 2nd Edition. Elsevier. 2014.
Evans, H.E., deLahunta, A. Guide to the Dissection of the Dog, 6th Edition. Saunders. 2004.
 

​Today marks day 20 post-operative abdominal surgery for Rainey.  From day 14 to today she has been allowed free range of the house, which has helped add some muscle back to her back.  On day 15, we started some basic fitness training with her.  Below you will find videos of her work-outs this week.  She had 3 exercise/rehab days and 1 day for scent work practice.  She thoroughly enjoyed getting out of the house and showing us how awesome she is!  This week we will review Rainey’s first week post-operatively in regards to her diet and herbals.  Rainey was placed on meloxicam (a non-steroidal anti-inflammatory) and Clavamox (an antibiotic) post-op, but other modalities were added to help her rejuvenate what was lost.  I will provide a brief description of these.  I feel the best way to break this down is to involve headings and possibly lists.  Then I will discuss Rainey’s rehab and how to assess your dog and things to look for.  Going forward, this series will be heavy on fitness and tracking Rainey’s progress, with additions on each modality that has been used, despite it not being used at that moment!  Ready or not, here we go!

​As I said in my last post, Rainey was extremely Qi and Blood Deficient.  When I typically touch Rainey, she is hot and her tongue is dark pink to red with her pulses being thin and fast.  But on this night, her pulses were deep and weak and her tongue was pale pink and dry, and she was cold to the touch.  She also needed to be hand fed.  From a Western standpoint, we know this is normal post-op behavior, especially after such a massive infection.  The idea is to wait it out and within a few days, the dog will rebound.  I wanted her to rebound faster.  That night I performed acupuncture using 5 simple points, leaving the needles in place for 15 minutes.  Below is a list of the points and the reason they were chosen:
ST36 - Master Point for the GI, generalized weakness, general Qi tonic, nausea, vomiting, stomach pain,
LI11 - Mother tonification point for Deficiency patterns, immunodeficiency, fever, abdominal pain
LI4 - Fever, immunodeficiency, general pain syndromes
GB20 - General pain
LIV3 - Support the Liver, abnormal heat cycles, general pain conditions

I also injected the Conception Vessel channel with B12.  This is called aquapuncture.  This channel happens to run along the ventral midline, where the incision is.  I injected B12 on each end of the incision, with the thought that this will help heal the broken line that is the Conception Vessel.
 
Rainey rested overnight, and by morning her tongue was darker pink and her pulses were wiry and weakest in the Liver and Spleen positions, which made sense for her condition.  The Spleen position was weak because she was tired and weak and lacking nutrients.  The Liver position was weak because she had Qi Stagnation and pain.  

Rainey is typically fed a cooling diet, but as you can imagine this wouldn’t be a good idea right now.  A cooling diet means a diet where the ingredients are energetically cooling.  In TCVM/TCM it is believed that all food have an energetic property.  In order to understand this, I provide the analogy that in a room of 3 people with the temperature set at 68 degrees Fahrenheit there will be one person who is cold, one person who is warm, and one person who is just right.  That is their energetics.  The next step is understanding that all food has these properties.  The analogy I use for this is on the 4th of July the weather is hot, and the last thing you would likely do is eat a bowl of spicy chili.  Instead, you crave a cool, soothing salad.  That is because the salad will cool your warm body, and the chili would add more heat to your already hot body.  Does that make sense?   If we take this a step further, every ingredient of every meal has its own energetic properties.  This was something that was determined many, many, many years ago by the Ancient Chinese, and it has stood the test of time.  For Rainey, now being cold, feeding a cooling diet would only make her colder.  Therefore, she was switched to a diet that was meant to warm her and it was filled with Qi tonics.  I did not rush out and make Rainey a new diet.  I go above and beyond for my dogs, but not that day.  That day I simply fed her what her sisters eat.  How handy!  Below will describe the ingredients used for Rainey's Food Therapy, their TCVM energetics, and why this ingredients was used:
*Beef - Sweet, Neutral -Tonify Blood, Qi, strengthen bones and sinews, pain, limb weakness
*Chicken - Sweet, Warm - Tonify Blood, Jing, and Qi, fatigue, weakness, Blood Stagnation
*Lamb - Sweet, Hot - Tonify Qi and Yang, dispel cold, remove Stagnation to relieve pain, cachexia,
*Cod - Sweet, Cold - Tonify Blood and Yin, promote digestion, Stagnation, Vitamin D source
*Venison - Salty, Sweet, Hot - Cold limbs, lumbar pain, tonify Blood and Qi, strengthen sinews
*Shrimp - Sweet, Salty, Warm- Tonify Yang, Blood Stagnation, inappetence
*Chicken Egg, whole - Sweet, Neutral - Tonify Blood, Qi, Jing, and Yin, calm Shen
*Sweet Potato - Sweet, neutral - Tonify Blood, Yang, and Qi, Blood Stagnation resolve Toxins
*Kidney Bean - Sweet, Neutral - Tonify Jing and Qi, Wei Syndrome, Blood Stasis
*Black Bean - Sweet, Neutral - Tonify Blood, Jing, relieve pain
*White rice - Sweet, neutral - Inappetence, weakness, anorexia, thirst, depression, irritability
*Quinoa - Sweet, Sour, Neutral - Tonify Qi, Yang, and Yin, strengthen whole body
*Spinach - Sweet, Cool - Moisten Dryness, Soothe Liver, Clear Liver Heat
*Celery - Pungent, Sweet, Cool - Send down middle Qi, agitation due to Liver Heat
*Rainbow carrot - Sweet, Neutral - Tonify Liver Blood, Soothe Liver Qi, resolve toxins
*Parsnip - Pungent, Sweet, Warm - Stagnation, hemorrhage
*Turnip - Pungent, Sweet, Neutral - Promote appetite
*Beet - Sweet, Neutral - Tonify Blood, detoxify, cool Blood, anemia

The final step in helping Rainey heal as fast as possible was adding herbals to support her.  Rainey was started on 3 formulations during the first week – Rehmannia 14, Wei Qi Booster, and Tendon-Ligament Formula.  Since Tendon-Ligament Formula will play a part in this story for the next few months, we will save that one for later.  Right now, we will discuss the first 2 formulations.  Rainey only stayed on Rehmannia 14 for the first 7 days.  This formulation nourishes Yin and tonifies Qi and Yang.  After she was no longer Qi Deficient, Rainey was switched to Yi Guan Jian, a formulation for nourishing Liver Yin.  This will also be discussed at a later date.

The ingredients and actions of Rehmannia 14 are listed below:
*Poria - Clears Damp, strengthens the Spleen
*Astragalus - Tonifies Qi
*Ophiopogon - Moistens and nourishes Heart and Lung Yin
*Rehmannia - Nourishes Yin and Jing
*Schisandra - Consolidates and nourishes Lung Yin
*Cassia - Warms Kidney Yang
*Asiatic Dogwood - Nourishes Liver Yin
*Chinese Peony - Nourishes Liver Yin and Blood
*Phellodendron - Clears Heat and nourishes Yin
*Tree Peony - Cools Blood, clears Heat, breaks Stagnation
*Chinese Yam - Tonifies Qi and Jing
*Anemarrhena - Clears heat, promotes body fluid and Yin
*Sichuan Aconite - Warms and tonifies Kidney Yang

Wei Qi Booster was used to tonify Qi and Blood, as well as boost the immune system to protect against infection by boosting Wei Qi.  Rainey just went through a tremendous ordeal, and she needed as much support as possible.  The ingredients and actions of Wei Qi Booster are listed below:
*Codonopsis - Tonifies Qi and boosts Wei Qi
*Astragalus - Tonifies Qi in the whole body and Wei Qi
*Angelica Dong Quai - Tonifies Blood
*Hedyotis - Resolve Heat, release Toxins
*Scutellaria Barbata - Resolve Heat, release Toxins
*Scrophularia - Cools Blood, nourishes Yin
*Tangerine - Moves Qi
*Lindera - Moves Qi, clears Stagnation

Aside from the above-mentioned herbals and diet, Rainey was continued on the following supplements:  CAS Options Medicinal Mushrooms, Welactin Omega 3, Dasuquin Advanced, Vitamin E, Proviable-forte probiotic/prebiotic, VetriScience CardioStrength, and BalanceIT.
 
At 24 to 36 hours post-op, Rainey remained quiet, but was eating on her own and was aware of her surroundings. It was another low-key day for her.  I stayed by her side the majority of this day, only leaving for a couple hours to see some clients.  She had not defecated yet, but was urinating well.  She received another simple 5-needle acupuncture treatment, focusing on her immune system, but added support for her Liver and Gallbladder.  The following points were used for another 15-minute acupuncture session:
GB34 - Influential point for tendon and ligaments, weakness, general pain relief
LI11 - Mother tonification point for Deficiency patterns, immunodeficiency, fever, abdominal pain
LI4 - Fever, immunodeficiency, general pain syndromes
GV14 - Clear Heat, immunodeficiency
LIV13 - Mast point of Viscera, abdominal pain, agitation and anger, generalized pain

By 48 hours post-op, my Rainey was beginning to return.  She was weak, but she was walking.  Her ears perked up at the sound of food, and a bark could be heard every once in a while.  The greatest gift was that evening when I returned from seeing clients all day, Rainey barked for me to visit her in her pen!  She was starting to feel better!  Rainey received her 3rd round of daily 5-needle acupuncture.  This treatment continued to focus on her immune system, and Liver, but added support for her Kidney and Spleen.  The following points were used for another 15-minute acupuncture session:
BL20 - Bask-shu association point for the Spleen, Spleen deficiency, pancreatic and digestive disorders
BL22 - Back-shu association point for the Triple Heater, abdominal pain
BL23 - Back-shu association point for Kidney, Kidney Qi Deficiency
LI11 - Mother tonification point for Deficiency patterns, immunodeficiency, fever, abdominal pain
LIV13 - Mast point of Viscera, abdominal pain, agitation and anger, generalized pain

​By day 3 post-op, Rainey was Rainey.  She told us she was going to be ok by jumping out of her x-pen and running to the door to be outside with the rest of the dogs!  This was when Rainey was down graded from a spacious x-pen to a full crate to prevent her from running amuck through the house when we were not watching.  Despite feeling her best, Rainey needed to be confined until at least day 10 to prevent a seroma (fluid under the skin) and to prevent her sutures from coming loose.  Up until day 7 post-op is the highest risk for sutures to fail, but it is ideal for animals to remain confined until day 10 to 14.  For Rainey, we chose day 14.  Between day 7 and 10, Rainey was allowed to wander the house, but not allowed to do stairs or jump on furniture, and she was confined when we were gone or not directly supervising her.  From days 10 to 14, Rainey was allowed to use the stairs and have free reign of the house while we were home, including jumping on furniture, but was confined while we were gone.  Day 14 and forward, Rainey had no further restrictions and was returned to the house pet lifestyle, but still nothing crazy for a while to come.
 
During the first 14 days post-surgically, there are a few important things to watch for.  We are all aware that your pet should be eating and drinking, but also know you must monitor for signs of urination and defecation, as well as vomiting.  It’s not uncommon for a pet to have some coughing after anesthesia from irritation of the endotracheal tube, but they should not have excessive coughing.  If your pet is exhibiting any signs that stray from their normal, please contact your veterinarian immediately.  Another sign to watch for is suture dehiscence or stitches failing.  This may be noted as the obvious opening in the skin incision or less obvious a bulge under the skin.  A bulge under the skin may also indicate a seroma.  A seroma can occur when the normal serous fluid gets caught in a space between the skin and muscle.  This typically occurs when the pet has too much activity during the first 7 days.  However, a bulge under the skin may indicate something more severe, such as the suture of the linea alba (remember blog post 1 of this series) have failed and there may be abdominal fat or even worse, intestines, coming through the incision.  This is a medical emergency, and your pet should be seen as soon as possible.

​Day 15 was the first day I tested Rainey’s core strength and her ability to engage her core.  Prior to Rainey’s surgery she had one of the strongest cores I have seen in dog.  I would love to give myself the credit for this, but it’s actually partially due to how she urinates.  Yep…you read that right.  Ever since I can remember Rainey urinates by crab walking.  She will squat, lift her rear legs, and balance on her front legs, as she swivels her back end left to right, while walking forward.  For real.  She does this.  Every time.  The saddest moment of her recovery was when she tried to do this post-op for the first time, and it hurt, real bad.  Just 9 days before her surgery, which she was potentially 10 days day pregnant/post-breeding, I was trying to teach Rainey a kick back stand.  This is where the front feet stay planted, while the back feet reach back into a standing stacked position.  Instead of doing this, Rainey took it a few steps further, and provided me with a hand stand, climbing up the wall with her back feet.  It was hilarious!  But it was also a demonstration of her athletic ability and core strength.

​On Day 15, January 26th, 2021, I made a chart on the white board in my dog room with a list of exercises and the day of the week.  I would mark off what we did which day in order to better track her progression and not to double up on things two times in a row.  The first thing I did was evaluate Rainey in a normal stacked position.  In this position I can determine her comfort and look for any abnormalities.  What I noticed is Rainey’s back was kyphotic or arched at about lumbar vertebrae 3 (L3) to L5.  This was not too unexpected, given it was likely a guarding position she had developed over the last two weeks to protect her sore belly/incision.  That evening I did assess Rainey using spinal manipulation aka animal chiropractic, and provided the necessary adjustments.  The next thing I did was evaluate if she was engaging her core and what her core strength was.  A dog can have a strong core, but not be engaging in it, whether due to pain or weakness locally or distantly in the body.  How I do this is through diagonal leg lifts.  When I lifted Rainey’s right front and left hind she quivered on her right hind leg.  When I lifted her right hind and left front, she again quivered.  During this attempt, her back remained arched and when I felt her core it was mildly strong.  This told me that she was not engaging her core to support her back and her hind legs.  This may have been a pain response or a muscle loss issue or both.  At this time, it is important to note that throughout the surgery to 14 days post-op I noted a tremendous amount of muscle loss over Rainey’s back or topline.  It wasn’t unexpected, but it was shocking.  It is stated that a dog can decondition in as little as 14 days of restriction.  Add to that restriction a major illness and surgery, and the catabolism of her muscle expediated.  Rainey also had no fat to lose during this adventure, which did not help her retain her muscle mass.

​Next in my foundation assessment of Rainey’s core and overall fitness level was evaluation her functionally while she completed her down to stand.  The premise of a down to stand is to teach the dog to push off the rear and the front equally, rising the rear at the same speed as the front, while all 4 feet remain stationary, and then immediately repeating the exercise.  This will aid in balancing the dog, strengthen their core, and in turn strengthening their back.  It is also an excellent exercise for learning to power off the rear from a down.  Prior to this surgery you can imagine Rainey had a very nice stationary down to stand.  As expected, Rainey now was not engaging her core, her rear end appeared weak, and she was fatiguing quickly.  As you can see in the attached video, even from push off 1, Rainey was pulling her rear up with her front end, and by attempt 3 she was fatigued.  As heartbreaking as it was to recognize these changes in my once strong girl, it was a very important step for establishing a baseline.  I needed to know what I was dealing with in order to know when she was ready for the next thing.  Therefore, these 3 things will serve as my markers of her progression.  I urge any owner whose dog is experiencing the same type of surgical intervention to use these 3 factors to gauge your dog’s progression, and to keep video and photo evidence for comparison.  

​Rainey received a rest day on Wednesday, and Thursday we performed cavelletti’s, static stands, and side steps.  Cavelletti’s are performed to enhance foot placement and reaction time, also referred to as proprioception.  There are several different variants of cavelletti’s, but for this purpose I space them out as far as the dog is tall at the withers, and I look for a nice gait pattern of two feet landing in center at the same time.  Evaluating your dog through cavallettii’s will allow you to look for any lameness or compensatory changes they may have, catching them early.  Rainey’s cavalletti performance from January 31st, 2021 is included in the video below, with an extra slow-mo version.  Static stands are a simple, yet great exercise for dogs.  When done on the flat (aka ground), it begins the process of core engagement, balance, and proprioception.  When the dog is able to stand still for at least 10 seconds, you can add tapping on their hips and shoulders.  This will increase their ability to properly balance, as well as core engagement.  For Rainey, this exercise was too simple on the flat, therefore we performed on mini FitBones.  In the attached video, you can see I also add small amounts of head turns, forward motion, and backward motion to increase her complexity.  The last exercise that day Rainey performed was side stepping.  Side stepping works the muscles of the inner and outer thigh and shoulders, as well as some core movement.  The goal is to have the front feet cross and the back feet cross as the dog moves laterally left and then right.  Side stepping is another great exercise for balance and proprioception.  It can be made more completed later on in the healing process.

​On Saturday, Rainey was finally able to leave the house to do something – she had a private nose work lesson!  It was outdoors, and we managed to prevent her from doing anything too strenuous.  Rainey had a blast and it was an excellent mental exercise for her!  On this day I happened to catch Rainey free stacking on the work-out bench, and took a photo.  After 2 days of targeted fitness and 5 days of allowing her to free range in the house her back was already straighter!
 
Sunday, we returned for another day of fitness, completing down to stands, cavelletti’s, static stands, and backups.  Rainey now had much better form and function for her down to stands and did not fatigue!  Yay!  We’re making progress!  We finished our exercises with a backup.  Typically, Rainey would backup to a higher object, life a full size FitBone, but today I just wanted her to target to something, so I used the ramp.  Backing up is an excellent exercise for core strength, as well as proprioception.  An ideal backup involves the dog separating both their back legs for individual steps.  If the dog hops backwards we likely have an issue and should be evaluated.  To my surprise, Rainey had no issues backing up.

That brings our first 3 weeks to a close.  Throughout this time frame I have watched my powerful, spirited dog turn into a wounded animal, and then return to her powerful state, demanding she be put to work.  I can definitely see why, at this stage, owners feel it would be ok to return to sport with their dog.  But just because the dog wants to doesn’t mean it should.  The same could be said if the dog wanted to eat a bowl of grapes – that’s not really the smartest idea and they do not know that.  It’s up to you, the owner and handler, to make the right choices for your sport dog.  If you want your dog to have a long, healthy career take things slow.  Seek the appropriate help.  And don’t let the dog bribe you into allowing them to do something too soon!  I know Rainey thinks she is ready, but she is most definitely not!  I am certain we could trial next weekend, but would she hold up 6 months down the road?  Unlikely.  It is up to you to make the best decisions for your pet, after all, they are counting on you!  Rainey is not where she once was, quite yet.  I can feel she lacks muscle over her topline, despite engaging her core better.  She is stronger than she was a week ago, yes.  However, her linea is still healing.  To promote its healing, she continues to get laser therapy every 3 days.  I can still feel the suture under her skin, but they are getting softer.  Her spirits are high, and she wonders why she can’t do agility.

We covered a lot of ground today, but I felt I needed to paly catch up.  Next week, I will expand on her current diet and current herbals, as well as provide assessments for her progress.  In the future we will expand on laser therapy, the Assisi Loop, and Tui-na massage.  The road to recovery is long, and sometimes there are setbacks, but the time it takes to get there will always be worth it!
 
Take care and may the Qi flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
Xie, H., Preast, V.  Xie’s Chinese Veterinary Herbology, 1st Edition. Wiley-Blackwell, 2010.
Fowler, M,. Xie, H. Integrative and Traditional Chinese Veterinary Medicine Food Therapy Small Animal and Equine, 1st Edition. Chi University Press. 2020.
Millis, D., Levine, D. Canine Rehabilitation and Physical Therapy, 2nd Edition. Elsevier. 2014.

We are now at Day 13 post-operative abdominal surgery for Rainey.  Life remains very boring for her as she continues to allow her incision to heal, and heal it has.  Therefore, this week I will be very heavy on the theory of TCVM, in hopes for you to gain an understanding of how TCVM works.  I realize this can sound a little crazy, but bear with me.  And if you have a Western trained medicine brain, try to think of it as learning medicine in a different language.  It can be a little dry and a little confusing.  I will try to provide info that is pertinent, but we may get over our heads.

Sunday afternoon was when I noticed her abdomen was painful, but no fever. She ate kibble if I hand fed her, but she wouldn’t touch her homemade diet. Monday morning, she wouldn’t get out of bed. I immediately took her into her reproduction veterinarian, who verified my worst fear - a uterine infection that would require an emergency spay to save her life. There was no hesitation in my mind that spaying her was the correct option. Rainey was placed on IV fluids, and surgery was performed later in the morning. Surgery was successful and Rainey was discharged to go home that evening. When I picked Rainey up that evening, she was tired and painful, and I could tell her body had been through a lot. When we got home, she did urinate, but wanted to spend the rest of the night being held. She ate if I hand fed her. Rainey was suffering a significant Qi and Blood Deficiency. The infection and the surgery had drained the literal life out of her.  My usual ‘hot’ dog was incredibly cold and lethargic.  

​In TCVM, Qi is your life force. Where there is Qi, there is life, and where there is no Qi, there is death.  A living being is born with Yuan Qi or Source Qi, which originates from Prenatal Jing.  Prenatal Jing is the foundation of life, and it is the lifeforce you accumulate from your parents.  Think your DNA, RNA, etc.  Then there are seven other forms of Qi – Zong Qi, Gu Qi, Ying Qi, Wei Qi, Zang-Fu Qi, Jing Luo Qi, and Zheng Qi.  For the purposes of this blog, I will only expand upon two forms of Qi – Gu Qi and Ying Qi.  Gu Qi is the nutrients that you absorb through your diet, and it replenishes your Yuan Qi, as well as provides the building blocks for all the other forms of Qi.  Gu Qi also provides your body with Postnatal Jing, which aids in keeping you healthy while building your defenses or immune system to prevent illness.   Have you ever heard the term ‘burning the candle at both ends’?  This refers to a person working so hard that they are literally burning up both their predetermined Prenatal Jing and their accumulated Postnatal Jing.  They will tire easily, and eventually burn out if they are not taking the proper steps to keep themselves balanced and healthy.  As you can imagine, a proper diet is one of the best ways to keep yourself healthy.

​In TCVM, Blood contains and circulates Ying Qi through the vessel of the body.  Ying Qi or Nutrient Qi is derived from, you guessed it, Gu Qi – what you eat.  It makes sense, from a Western standpoint, that what you eat promotes healthy blood circulation and improves your overall health.  The function of Blood in TCVM is to nourish and moisten, as well as carry Qi.  Nourish and moisten makes sense, if you consider how blood travels through your body, but let’s take it one step further.  In TCVM, we have meridians or channels.  I feel this is common knowledge.  But what may not be common knowledge is that each of the channels is associated with an internal organ.  Now, I do not want to go down this rabbit hole, as I could provide hours of reading for you about each Zang-Fu organ and how they corelate and relate.  Therefore, for the topic of discussion we will stick with identifying the Liver and the Heart.  But wait (do you feel like you’re on a made for TV infomercial yet?) we need to break into the 5 Element Theory and Yin-Yang BEFORE we can talk about the Liver and the Heart.  I will try my best to keep this as simple and concise as possible.  As most of my clients and friends are aware, I have a tendency to be long winded and go off on tangents.  We will revisit Blood in a moment…..

The 5 Element Theory and Yin-Yang – in TCVM I assume most of you are familiar with Yin and Yang.  You cannot have Yin without Yang, and vice versa.  One is light (Yang), while one is dark (Yin).  One is hot (Yang), one is cold (Yin).  One is feminine (Yin), one is masculine (Yang).  When you combine the two, you are whole.  But sometimes one dominates (Excess) or one is weak (Deficiency).  The five basic principles of Yin-Yang are:

1.  Everything in the universe has two opposite aspects – day (Yang) vs night (Yin);
2.  Any division of Yin-Yang can further be divided into Yin and Yang aspects – a sunny day (Yang) vs a rainy day (Yin tendencies);
3. Yin and Yang control each other – on a cold (Yin) day you may turn the heat (Yang) on (adding Yang to Yin to rid the cold);
4. They mutually create each other – for the scientific minded, during gluconeogenesis, the body uses energy (Yang) as it creates glycogen (Yin, nutrients); this can also go the opposite direction where normal physiological balance is destroyed (Excess or Deficiency)
5. They may transform into each other in certain circumstances – when Extreme Heat (fever from an infection – Yang Excess) consumes and damages the Yang Qi the persistent fever will produce Cold (Yin) signs, leading to a Qi Deficiency.  This can leave a patient weak, with a decreased ability for the body to function for normal activities.  It can be generalized or specific to an organ.

​The Five Element Theory was born when the ancient Chinese observed the world, and became fascinated by the seasonal changes. As everything in the universe can be divided into separate Yin and Yang categories (there is a long list of this if you want to search it), the ancient Chinese also divided the seasonal changes into five forces – Wood, Fire, Earth, Metal, and Water.  Taking this a few steps further, the theory of Five Elements was born and everything in the universe can fit into five categories.  Various items such as seasons, directions, climates, colors, tastes, and body parts were grouped together under a common element, with a Yin and a Yang organ accompanying them.  This later became the foundation for TCVM.  When used appropriately, the Five Element Theory can describe the complex relationship between the body’s internal organs, as well as the body’s relationship with the natural world.  Combine Five Element Theory with Yin-Yang theory, and a practitioner can produce a clinical diagnosis and treatment plan individualized for the patient.

They love to be held and petted,  but on their terms.  As such, sometimes it is difficult to work on a Fire animal.  They may accept it, or they may absolutely refuse.  As a Fire animal, Rainey LOVES to work or perform.  Working is her joy.  But she can get frustrated, and when she does, she lets me know by barking, but she is relatively harmless.  Rainey must be the center of the party.  If another dog is getting attention, she will literally push them out of the way.  She is a difficult dog not to love!  Wood is the Mother of Fire, and Fire is the Child of Wood, when discussing the Five Element Theory (it goes in a circle – Wood – Fire – Earth – Metal – Water – back to Wood).  Wood organs are the Liver and Gall Bladder.  In TCVM, the Liver nourishes tendons and ligaments and maintains smooth flow of Qi.  When the Fire element is weak, whether from illness or overwork, it drains from its Mother, and when left unchecked, the Mother (Liver) can become Deficient.  We can see drying of body fluids (Blood), and in the case of tendons or ligaments, they may become dry and brittle, resulting in tears or fraying.  This can be seen in overworked sport dogs.  The majority of sport dogs are Fire or Wood constitutions.  Aside from mental issues (whether overarousal, anxiety, or irritability), we see a lot of tendon and ligament injuries in these dogs.  Yes, it is the nature of the game, but WHY a PARTICULAR dog over another?  What was different about Dog A from Dog B – same breed, same attitude, same training, but different diet, different body work, different supplements, different feedback loop on the Five Element Cycle.  TCVM can explain it.  A balanced dog, one who receives the proper nutrition, supplements, herbals, etc will be less likely to suffer an injury.  However, if the injury was a true accident, TCVM can help bring this acute Excess back into balance.  This may raise a question – then why did Rainey, the dog of a TCVM veterinarian, develop a life-threatening uterine infection?  Were you not taking the precautions to keep her as balanced as possible to prevent such a thing?  The answer is yes and no.  During pregnancy you want to preserve Blood, you do not want to move Blood.  As you can imagine moving Blood would sound a lot like a miscarriage.  Therefore, a lot of things need to be stopped during pregnancy that would otherwise prevent bad things from happening.  And sometimes, no matter how hard you try, fate, and sometimes genetics, have other plans.  The best you can do is the best you can do in the moment.  

Do not worry – from a rehab standpoint you are still not missing a thing.  Rainey is still on restriction from ​running, jumping, playing, and stairs.  She remains in her kennel when we are gone.  Her sutures were removed at day 11 post-op.  She continues to receive laser therapy for cellular healing and regeneration every 3 days, but the use of the Assisi Loop to stimulate cellular healing as been discontinued.  I fear I do not have enough space throughout this series to dive further into those modalities, but I also know some weeks will run short, and we may revisit them then.  For now, I will let you go with the promise that next week we will discuss how nutrition plays a roll in recovery, how herbals can stimulate healing and recovery, what role acupuncture and Tui-Na play, and how on week 3 post-abdominal surgery we will begin to return to function and what signs you should look for that your dog is not ready!

Take care and may the Qi (now that you know what that is) flow freely for you!
Dr. Shantel Julius, DVM, CCRP, CVA, fCoAC, CVSMT, CVFT, CVTP, CVCH, CTCVMP
 
References:
Xie, H., Preast, V.  Traditional Chinese Veterinary Medicine Fundamental Principles.  Chi Institute Press.  Reddick, FL.  2016.