The Assisi Loop Blog Expert Interview with VCA Rehab Specialist, Dr. Carrie Woodcock

Dr. Carrie Woodcock of VCA Hospitals talked with Assisi Animal Health about her use of the Assisi Loop with veterinary rehabilitation applications. In this interview, you'll learn about the many conditions that she has successfully treated as a part of a multi-modal treatment plan. She also discussed the use of the Loop post-operatively. We can't thank Dr. Woodcock enough for the time she spent with us. We hope you'll enjoy it as much as we did.Assisi Animal Health: How long have you been in veterinary medicine and how you would describe your practice?Dr. Woodcock: I've been in veterinary medicine since 1996. I have been doing physical therapy and rehab in addition to general practice since 2010. I've been doing an integrated program since that time. My current practice is the one I've been in for the last three years and it is general practice with small animals. We have also developed a physical therapy and rehab practice.Was this program developed at the VCA where you work?Yes, at the VCA. Actually it's pretty nice, because we have our small animal hospital and we're attached to a huge boarding hotel so we're able to help patients on both sides. As a result, we use the Loop in a wide variety of ways. It's been very interesting because I also work at VCA Smoketown in Lancaster and I do rehab with them one day a week. Within my rehab area, we do a low-level laser, we do electrical stim, I do VOM (Veterinary Orthopedic Manipulation), I do dry needling, as well as manual mobilization, we have underwater treadmill, therapeutic exercise--all the standards you've probably heard many times when talking to rehab people.You have a pretty comprehensive rehab facility from what it sounds like. And is that something you helped to develop? Or was that something you joined?No, this is the second practice that I've developed as far as rehab, I built a rehab program and specialty facility before I took the position at Wellington, so this is the second rehab program I've started from scratch.What got you to turn the corner on really starting to integrate the Assisi Loop into some of your multi-modal protocols?Beyond client response, patient response. The turning point for me and the coolest thing that I've seen consistently across the board is that clients will see an improvement in pain control, but it's all reflected in their pet's attitude. When you're doing physical therapy, sometimes before you see physical changes, like before the lameness goes away, before the swelling goes away, you'll see a change in demeanor. The pets just seem to feel better.I guess the thing that really pushed me over the edge from a therapeutic standpoint is when I started using the Loop on my patients that have plateaued. That's the best way to describe it. Through every other standard rehab protocol, they've done TENs, they've done electrical stim, they've done laser, some acupuncture, they've done some dry needling, they've done some therapeutic exercise, underwater treadmill, and their progress had stabilized. It's kind of plateaued and that would be the point where I would say "hey, let's just try this." I let half the clients take the Loop home and try for a week. I didn't charge them because that was my research. They would come back and consistently, across the board, tell us that they were seeing improvement. So these were cases where we were pretty happy. I just wanted to see if I could get more. So the only change in the program was the addition of the Loop. So that's about as controlled as you can get in rehab without doing controlled studies.That was a great experience for me. One of my favorites was when I have an older dog that had a TPLO done on one side by his surgeon. They did standard rehab--there are certain things that we all do. I knew she had laser, TENS, all that good stuff. And I think it was two years later, she had to have the other knee done. Then she actually came to me and I talked to the owners and said "I just want to try this, I want to try the Loop. We're going to do all the regular stuff but I'm going to add the Loop." And when she went back for her recheck, the surgeon didn't know that we had added the Loop. I wanted to eliminate the placebo effect, so it was up to me to decide on rehab. I wanted to see what someone else would see if we add this additional modality. And the surgeon said the dog was about two weeks ahead of where he expected her to be and her surgical healing was also ahead of schedule. So that was pretty cool.The other big thing for me that I think has been great is that some of my patients actually seek out their Loop. I thought was really cool. I have an old boxer who will go and get her Loop when she wants therapy. My favorite is one patient with Cauda Equina Syndrome. Cauda Equina is just hard--those lumbosacral dogs hurt and I feel like if you don't have shock wave, there's a point at which you're like "there's only so much I can do." They just seem harder to get really, really comfortable. The first week I added a Loop, they came in and said "He likes the cat now." We put the Loop on him and now he likes the cat. That's hilarious.And I thought that was great, but at that point, he relaxes, he feels better, he's comfortable. And I've also looked at it from the perspective of "what are you doing while you're Looping the dog? Are you petting the dog? Are you snuggling with the dog?" Because all of those things could feed into why dogs like the Loop, and I've seen across the board that no one is doing anything different. If it's a neck problem, they're putting the loop on the collar and going for a walk. If it's for the back, they put it on, but they are not paying extra attention to the pet. Therefore to me, that doesn't fit with the added attention that's having an effect. The effect of the Loop is what is creating that response.What are some of the other cases that really stand out for you? I know you have several that have been pretty remarkable.I had one of the worst fibrocartilaginous embolisms (FCE) that I've seen. It was a C6, C7 left-sided FCE, the dog was completely paralyzed. Within 48 hours he couldn't even lift his head. So when he came to us, which was probably a week after his injury, neurology had basically told them the dog will never walk again or they didn't expect it to. And I've talked to other neurologists who have said, you know, FCEs tend to do great, but this kid was really, really severe. We started with the Loop. We did laser in clinic but we could also send the Loop home with him, and the owners could Loop him three times a day, every day, and do additional as well as the regular therapeutic exercise. His injury was in November and he was walking by Christmas. This dog couldn't even get himself sternal. He couldn't sit, he had nothing in the middle of November. By Christmas he was walking. We still see him today just because we want to do better. I mean we're being really nit-picky when we say we want to do better because he's fully mobile. He can get on and off the bed. He had some restrictions still in his front limbs, but he goes to the beach, he can play.He was in a quad cart, literally we had him in a sling and by Christmas he was loping around. But he was a cool one. The neuro cases are very, very cool. We had a brachial plexus case. You've obviously heard a lot of cases, what kinds of things would be different for you?We hear a lot of positive reports on Wobblers, OA, post-surgical healing and wound healing but with some of the other neuro cases or dysplasia or other kind of non-typical conditions like internal inflammation? We'd love to hear more about people using the Loop for those kinds of conditions and what kind of results they're getting.Actually, we have an interesting case which is our own hospital cat, where she licked something caustic and this one's very, very fresh for us because it actually happened Saturday. I came in Sunday and we found her. So she's out and about in our hospital, in our treatment room. I came in Sunday morning--she was vomiting, depressed, painful in her abdomen, painful in her back which I actually think was referred pain, just dehydrated within three hours of finding her. She had severe oral ulcerations. We actually thought she had Calicivirus, she was so bad. We did part of her treatment protocol, because she was nauseated, she was painful in her belly, so we did use the Loop. But actually more significant for us is we used the Loop by her mouth. We had it around her neck, trying to provide some pain relief and healing, for her mouth, and just because we didn't know what we were dealing with. So she actually has been wearing her Loop several times a day and we've assured her tongue is in the treatment field. Today is Thursday, her ulcerations are healing. So we ruled out Calicivirus, but for her, it helps us to avoid having to put in an NE tube. We were actually able to syringe feed her within 24 hours of adding the Loop, which is pretty cool. So it's kind of a wound healing I guess but it's probably not necessarily something people would rush to think of. How often have you used the Loop to titrate down on certain meds?Actually, I use it fairly often. Because usually we've gotten to the point where things have plateaued, so I'm adding the Loop and then I'm starting to take things off. I've used it often in lieu of non-steroidals because I come across a lot of patients who can't tolerate them. So it's been great. Like my own dog--48 hours post MPL-he was walking. With no Rovera. I mean we literally were forgetting to give him his Rimadyl.Because he was doing wellHe was and he wasn't painful.How often were you treating?3 times a day with him.When you're talking to pet owners about using it, what is their initial response? And how do you engage them in this as a part of their treatment protocol?I use your research and brochure. One of the big selling points for me is we have plenty of people who come in that can't d