E451: 수 야노프(Sue Yanoff, DVM) - 정확한 스포츠 수의학 진단 받기

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But if you notice it every day or you notice that they're maybe favoring one leg a little bit longer than normal, then that's something that probably should be addressed. And as always, the sooner the better. Yeah. I know this is a big topic, but, you know, why is it when we see these types of things that it's so important to get a really accurate diagnosis for what's going on as part of the critical care and, you know, caring for our performance dogs? Yeah, this is so important. And we could talk for an hour just about this topic because I see posts on Facebook all the time where people are having their dogs treated, but we don't really know what the diagnosis is. So the importance of an accurate diagnosis is that it leads us to the correct treatment for that particular problem. And it also will help us formulate a prognosis. In other words, is this something that will get better? And once we treat and rehabilitate the dog, they're good to go for the rest of their life? Or is this something that's going to affect them for the rest of their life? So if we have a correct diagnosis, you do the correct treatment, then we have the potential for a better outcome. Now, there are a lot of times when I'll have a lameness and I can localize it to which leg it is and even which joint it is. But without further diagnostics, I can't tell you exactly what the problem is. And I have no problem treating that dog with a standard, you know, week or two of NSAIDs and restricted activity. That's fine. I don't have a problem treating dogs without a definitive diagnosis, as long as I can localize it to the specific joint and have a tentative diagnosis. But if after two or three weeks, the dog is not getting better, or if the dog gets better, and then as soon as we start increasing activity, they become lame again, that's when we have to do further diagnostics. And I've had students in my sports medicine class whose dogs have been in rehab for weeks and sometimes even months, and they're not getting better. And when I ask the student, well, what are we treating? What are we doing rehab for? They can't answer me because we don't have an accurate diagnosis. And limping is not a diagnosis. We need to know the cause of the limping. Or back pain is not a diagnosis. That's just a clinical sign. We need to know the cause of the back pain. And that's why I preach in my class, or anytime anybody will listen, what's the diagnosis? We have to have a diagnosis unless it's something relatively easy that, as I said, will get better with a couple of weeks of rest and some anti-inflammatory drugs.

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Can you talk a little bit about kind of the importance of advocating for your dog versus, you know, trusting the vet who presumably has professional experience? You know, how do you push back if a vet's like, there's nothing really wrong here. But, you know, as the handler, you're like, I'm seeing some signs that make me think otherwise. You know, is it ever just impossible to get that diagnosis? Yes, it is impossible that the diagnosis sometimes, and I'll give you an example. But to answer the first part of the question, if you go to see a general practitioner, they are very good about knowing a little bit about everything, but they don't specialize in any one thing. So while I could take 30 to 40 minutes to do a sports medicine exam and examine all four legs, they have maybe 20 minutes to get a history, do a quick exam, and not find anything. And I have the training experience to do really detailed exams on each of the legs, whereas they don't have that training and experience. So I often find things wrong with dogs that the general practitioner said that they can't find anything wrong. And that doesn't mean that they're bad people or bad vets. It's just that they don't have the training to look more in more detail at what might be wrong. So if your vet can't find anything wrong, they are likely to do the generic treatment of rest and NSAIDs, and that's fine. But if you if they say there's nothing wrong, and you know, your dog and you know, there is something wrong, you have options. You can ask for a referral to a sports medicine vet or a board certified orthopedic surgeon. Or you don't necessarily need a referral to see a specialist. You can look up specialists in your area and make an appointment to see them without your general practitioner. There are two specialty colleges, the American College of Veterinary Surgeons and the American College of Veterinary Rehabilitation and Sports Medicine or Veterinary Sports Medicine and Rehabilitation. And you can get on those websites and look up specialists in your area. And a lot of people have to drive far. I drive six hours to go see a sports medicine specialist, even though Cornell University is 15 minutes from my house, because I want to go to somebody that only does sports medicine for performance dogs. And the one that's closest to my house that I think is very good is six hours away. So you don't have to take your general veterinarian's word that there's nothing wrong with your dog, but your options are now to go see a specialist. And if you're not happy with what the specialist tells you, and you still think there's something

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wrong, then you can get a third opinion and go to another specialist. And I have had students in my class who, after we go over their dog's case, I refer them to a second or sometimes a third specialist. So it's fine, but you have to keep going until you find somebody that can tell you what's wrong with your dog. Now, are there cases where you cannot make a diagnosis? Yes, it's very rare. But I have a dog sitting right next to me on the couch who is one of those dogs. When she was probably eight or nine months old and I started doing some basic jump grits with her, I was a little concerned about some of what I was seeing. She also would hop on her right hind leg occasionally when we would go hiking. It never affect her performance in the show ring. I was showing her in confirmation, but it's not normal for a dog to hop. Usually it indicates patella luxation. That's the most common thing that will make a dog hop, but she did not have patella luxation. So she was worked up with a full sports medicine exam, x-rays, ultrasound. We thought she might have something called piriformis syndrome, which causes some pain of the sciatic nerve, which will make the dog hop. And we treated her for several months for that. And I treated her for months, probably five or six months with restricted activity, NSAIDs, ultrasound treatments. And while she was on restricted activity and getting treated, she did not hop. But as soon as I started increasing her activity, then she started hopping again. But I also noticed that as I got her more fit, she hopped less. So the next step for her was to do an MRI of her spine to see if we could figure out what was causing the hopping. But I also knew that whatever the MRI showed, I wasn't going to do anything about it because the clinical signs were not severe enough for me to risk doing surgery or some other invasive procedure. So I decided not to do an MRI. So she never got a diagnosis. She still does hop occasionally, although right now she's very fit. And I don't notice it very often. So that's a case where we don't have a diagnosis. It happens, but usually we can figure out what's causing the clinical signs. Can you talk about the difference between the exam imaging and the functional assessment and kind of why each of those matters or kind of what role each of those might play in trying to get a diagnosis? Yes. A clinical exam is basically just examining all the systems of the dog, heart, lungs, eyes, ears, nose, throat, abdomen.

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And for when I do a musculoskeletal exam, I do a very cursory check of all those systems and I concentrate on the bones, joints, tendons, ligaments, and muscles. And that's the start. Okay. I would say for me, 95% of the time, I can localize a problem to a specific limb and or a specific joint or the back or the neck or something like that. With imaging, if we need to look further to try to get more information, then we have things like radiographs, which are x-rays, musculoskeletal ultrasound, which is a really good tool for evaluating soft tissue, and then CT scans or MRIs. Functional assessments, that's more of a human term. In people, a functional assessment is basically evaluating the person's ability to perform their daily activities. In dogs, we don't really do functional assessments. I guess the equivalent in dogs is I do a gait exam. So I watch the dog move at a walk, trot, and a run. Sometimes doing the evaluation, we'll ask the owner to send the dog over some jumps or even to do some weaves. But another way I can do a functional assessment is if the owner has video of agility runs or fly ball runs or the dog working or even the dog just going for a walk. And the owner says, see, that's what I'm talking about. And then I see the hop or I see the lameness or I see the hesitation before the jumps. And that helps me evaluate the dog's functional activities. I can hear her fussing at you there in the background. Do you hear that? She's just sharing her thoughts on all this. That's Ivy, and it's getting close to dinner time. She's letting me know. So sorry about that. In case you weren't watching the clock. How do you decide which diagnostic tools to use first when a performance dog is presenting with something that's kind of vague or like an early stage symptom? Yeah, that depends on what we think the problem is. And I have to emphasize, I can't emphasize this enough. Same with getting an accurate diagnosis. The most important thing is a good examination. History is very important. I spend a lot of time on history. But it's really important that you go to somebody who has very good skills at doing a clinical exam, doing a musculoskeletal exam. Because then I can get, based on the history, also on the breed and the age and all that, but based on the history and my exam, I can often, mostly, most of the time, narrow it down to which leg is the problem. Because oftentimes, the owner doesn't come with a history of he's limping on his left front leg. They come with a history of there's something not right. His gait is a little off. He's knocking bars. He's popping weaves.

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His fly ball times are slower. There's something wrong and we don't know what it is. So often, I don't even know which leg is affected. So I have to do a very good exam to try to figure out not only which leg is affected, but which part of that leg. Is it the toe? Toe injuries are very common. And it's not so easy to evaluate toes because a lot of dogs don't like to have their feet handled. Is it the shoulder? Is it the elbow? Is it the bone? Is it the joint? Is it a muscle or a tendon? So once you narrow down an area and once you have what we call a differential diagnosis list, so a list of what the possible diagnoses could be, then we can decide what diagnostic tools we need. Do we need to take x-rays? Should we look at x-rays to see if there's any bone involvement? Do we need to look for somebody who can do a good musculoskeletal ultrasound exam because we think that this is a muscle problem or a tendon problem? Jumping right to an MRI or a CT, I think, is overkill because those require general anesthesia. Do I need to do blood work? Do I think maybe this dog could have a tick-borne disease and we should do a tick titer? Do I think, and this is not common, but I have seen it, does a dog have a heart problem, a heart arrhythmia that is causing it to have less energy? Does a dog have a heart arrhythmia that can affect its performance? So the diagnostic tools are based on what the history and the physical exam tells me. And sometimes we have to do all those things, but we should do them sequentially and not just do everything at once. So obviously, while we all wish money was never a factor in these types of things, the reality is it probably factors in for a lot of people a lot of the time. So how do you kind of decide how to pursue appropriate diagnostics without simply doing all the things, right? Like just all at once to figure out what's going on? Yeah, well, that's similar to the answer to the last question is if you think the dog might have hip dysplasia, you don't want to jump right to an MRI. Or another thing I've seen in my class is they go to a general practitioner and the dog is lame, but they can't figure out why. So they jump right to an MRI. And while that may not be wrong, that's a very expensive step to go to. So again, it depends on what your physical exam shows. Might you have to do everything? Yes. But should you do everything all at once? No, you should do it sequentially and then use the information you get from this diagnostic test to inform what you want to do next. On the other hand, there are some examples where jumping to an MRI is the right thing to do.

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And my older beagle, Ivy, is a perfect example. Well, last year, several months ago, she woke up and was ataxic. That means that she didn't have good balance. And she also had a head tilt. And that is obviously not normal, but she's an older dog. So the first thing I thought of is she might have a brain tumor. And so to rule out a brain tumor, we need to do an MRI of her head. So to do x-rays or to do other tests probably is not going to get me the answer I need because basically I want to rule out a brain tumor. And so she had an MRI two days later. And she does not have a brain tumor. She has what we call old dog vestibular disease, which a lot of people are probably familiar with. And it causes vestibular ataxia and a head tilt. So I wanted to rule out a specific thing right away. And that led me to an MRI. I could have done a bunch of other diagnostics, but I still would have had to do an MRI to rule out a brain tumor. So we jumped right to that. And yes, it's all very expensive. Some diagnostics and treatments are thousands of dollars. So either save money or get pet insurance. And then you don't have to worry about how much it's going to cost. When a dog, you know, adjusts to pain, so, you know, in a chronic issue situation or whatever, and they're adjusting to avoid pain, you know, why does that matter long term? And can that compensatory, you know, them compensating for that kind of mask our original problem? Like, how do we dig deeper when we think there's something like that going on? So to answer the second part first, usually compensatory clinical signs do not mask the original problem. That might be the first thing you notice, the compensatory problem. But if you do a good physical exam and you do correct diagnostics, you're likely to pick up the initial problem. And if the dog compensates long enough, or a person for that matter, but the dog compensates long enough, they could do pretty serious damage to the joint, muscle, tendon, back, whatever is causing the compensatory pain. So we want to evaluate both. And again, I mean, Quinn is my younger beagle is a good example. Lucky for me, she's an example of all the bad things that can happen to your dogs. But I think anybody who attended the FENSI camp this past year, anybody who knows about Quinn knows that she had a iliopsoas muscle problem. She had no clinical signs other than she refused to weave at trials. And I examined her and found pain in her right iliopsoas muscle. And after the generic three weeks of restricted activity, then said she was not any better.

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So I made an appointment to have an ultrasound for muscle done. And the practice that does the ultrasound requires x-rays of the hind legs. So I x-rayed her hind legs and she has mild hip dysplasia. We don't really know if it's hip dysplasia because her hips were normal when she was a year old, but she has degenerative changes in both hips. So now the question is, is the iliopsoas muscle problem a primary muscle pull or is compensatory because she's favoring her hips? And while I never noticed any clinical signs in everyday life, we don't know what came first. Did she, were the hips absolutely not bothering her? And she pulled her iliopsoas muscle and then I dug a little deeper and found the hip problem. Or is the iliopsoas muscle pain secondary to her compensating for some hip pain? And I don't know. And we probably will never answer that question. But it's like, which came first, the chicken or the egg? So I now have two problems that I had to deal with and treat in which we've done. And happy to say Quinn is back to full unrestricted activity. She won't do agility again. I retired her from agility because I don't want to deal with, you know, retraining her and getting her back up to weaving normally and then having her have a problem again. So I'm perfectly happy for her to do obedience and tracking and hiking with me. We're done with agility. But that is a good example of compensatory versus initial problem. And sometimes we don't know which the initial one is. But we still have to. But I don't think, you know, thinking back to my experience, I don't think I've ever seen a dog with compensatory problem mask the initial injury. All right. So part of the reason we're talking about this is because you have your class on this stuff coming up in the April term. Do you want to talk a little more about the class and maybe who might want to sign up? Yes. Anybody can sign up. If you own a dog, you can sign up. And basically, the goal of the class is to give people enough information that they can be advocates for their dogs. And it's like going back to one of your earlier questions. How can you advocate for your dog? Well, one good way to do that is to have knowledge. Knowledge is power. And I've had lots of students that say the most important part of this class is now my dog has a problem. I have a lot more knowledge that I can use to then help me make decisions. So the class has a lot of information in it. And but you don't have to be a veterinary student or even a scientist. I present it in a way that lay people can understand what's going on.

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I teach about all the bones and joints and all the different things that can go wrong with those joints and that leg. And we just talk a lot of things related to sports medicine. We talk about regenerative medicine, which is becoming more and more common. We talk about other things that can mimic sports injuries or lamenesses. We talk about warming up and cooling down and how to potentially prevent or minimize the chance of getting an injury. So there's a lot of information. But I think the most valuable part, which I've learned over the years of teaching this class, I think the most valuable part of the class is for the bronze students to watch me work through problems with the gold students. So most of the gold students have dogs who have injuries, who have had performance problems, who can't get a diagnosis, who have been rehabbing their dogs for weeks or months and and they don't get better. And then I go over their medical records. I go over their x-rays. And all of this, of course, is posted in the gold forums. And then we talk about step by step by step what to do, what we might do, what we should do, what we can do, what the next step is. And the bronze students, there are no silver students in this class. It's just gold or bronze. And the bronze students, if they pick one or two or more gold students to follow along, I think that's where the value comes from, because you can see exactly how I recommend what to do and why. And that's a good way to learn what to do if your dog has a problem in the future. Any final thoughts or maybe key points that you want to leave folks with? Well, the key point, as always, is get an accurate diagnosis. If nobody can figure out what your dog has, again, there are a few cases where we cannot figure out what the problem is. And then you have to decide if your dog gets better, then that's fine. You'll never know. If your dog doesn't get better and continues to have pain or problems in performance or functional problems, then you have to decide how much you want to do with your dog. It's sad to have to never let them have full activity, but it's also sad to have a dog that's in pain all the time. So get a diagnosis. And there are specialists out there, some of which are really, really good, some of which may not be as good as others. So you just have to be an advocate for your dog and try to get a diagnosis. Awesome. Well, thank you so much for coming on the podcast, Stu. Thank you, Melissa. And thanks to all of our listeners for tuning in. We'll be back next week. Don't miss it.

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If you haven't already, subscribe to our podcast in iTunes or the podcast app of your choice to have our next episode automatically downloaded to your phone as soon as it becomes available. Today's show is brought to you by the Fenzie Dog Sports Academy. Special thanks to Denise Fenzie for supporting this podcast. Music provided royalty-free by Bensound.com The track featured here is called Buddy. Audio editing provided by Chris Lang. Thanks again for tuning in and happy training. Annie Annie