E68: Sue Yanoff - "Sports Medicine"

SUMMARY:

Sue Yanoff graduated from Cornell University College of Veterinary Medicine in Ithaca, N.Y, in 1980.

After three years in private practice, she joined the U.S. Army Veterinary Corps. While on active duty, she completed a 3-year residency in small-animal surgery at Texas A&M University and became board certified by the American College of Veterinary Surgeons.

She retired from the Army in 2004, after almost 21 years on active duty. After working for a year on a horse farm in Idaho, she returned to Ithaca to join the staff at the Colonial Veterinary Hospital as their second surgeon. She then retired from there in December 2009 — her on-call schedule was interfering with those dog show weekends!

The following month, she started working for Shelter Outreach Services, a high-quality, high-volume spay-neuter organization. About the same time, Sue joined her colleague, a physical therapist and licensed veterinary technician, to start a canine sports medicine practice at the Animal Performance and Therapy Center, in Genoa, N.Y. The practice is limited to performance dogs. That means that's basically all she does these days, performance dogs, so she knows her stuff.

She also teaches a class on Canine Sports Medicine for Performance Dog Handlers here at FDSA.

Next Episode:

To be released 6/29/2018, featuring Julie Symons, talking introducing handler scent discrimination.

TRANSCRIPTION:

Melissa Breau: This is Melissa Breau, and you're listening to the Fenzi Dog Sports Podcast brought to you by the Fenzi Dog Sports Academy, an online school dedicated to providing high-quality instruction for competitive dog sports using only the most current and progressive training methods.

Today we'll be talking to Sue Yanoff.

Sue graduated from Cornell University College of Veterinary Medicine in Ithaca, N.Y, in 1980.

After three years in private practice, she joined the U.S. Army Veterinary Corps. While on active duty, she completed a 3-year residency in small-animal surgery at Texas A&M University and became board certified by the American College of Veterinary Surgeons.

She retired from the Army in 2004, after almost 21 years on active duty. After working for a year on a horse farm in Idaho, she returned to Ithaca to join the staff at the Colonial Veterinary Hospital as their second surgeon. She then retired from there in December 2009 — her on-call schedule was interfering with those dog show weekends!

The following month, she started working for Shelter Outreach Services, a high-quality, high-volume spay-neuter organization. About the same time, Sue joined her colleague, a physical therapist and licensed veterinary technician, to start a canine sports medicine practice at the Animal Performance and Therapy Center, in Genoa, N.Y. The practice is limited to performance dogs. That means that's basically all she does these days, performance dogs, so she knows her stuff.

She also teaches a class on Canine Sports Medicine for Performance Dog Handlers here at FDSA.

Hi Sue, welcome back to the podcast!

Sue Yanoff: Hi Melissa, it's good to be back.

Melissa Breau: I'm excited to chat. To start us out and refresh our memories a little bit, can you share a bit about the dogs that you have at home now?

Sue Yanoff: Yes. I have two Beagles. The older Beagle is almost 13, and she's retired from everything except hiking and having fun. She's a breed champion, she has her UD, her Rally Excellent MX MXJ and TD.

My younger Beagle, Ivy, is 6. Most people know her from FDSA classes. She's also a breed champion. She has her MACH. She recently finished her CDX and we're working on Utility. She has her Rally Novice and a TD.

Melissa Breau: That's a lot of titles there, lady. Congrats.

Sue Yanoff: Thank you.

Melissa Breau: So we went back and forth a bit before this call on topics to talk about today, and I want to start out by just talking about some of the basics. What is the difference between a sports specialist and a regular vet?

Sue Yanoff: In veterinary medicine, in order to call yourself a specialist, you have to meet certain requirements, and that includes completing a residency in whatever area you're a specialist in, passing a very long and difficult certifying examination, and being board-certified by the specialty board that oversees your specialty. So if you're a specialist in internal medicine, it's the American College of Veterinary and Internal Medicine. If you're a specialist in surgery, it's the American College of Veterinary surgeons. So to call yourself a specialist, you have to be certified, board certified, by one of these specialty organizations. Now, a lot of people can be very good at something and not have gone through all the requirements of being able to call themselves a specialist. But a sports specialist basically is somebody that has extra training and experience in that particular area. Regular veterinarians might be very good at sports medicine, but they can't call themselves a specialist. But, in general, regular veterinarians are general practitioners and they have to be good at everything, so it's very hard to be good at everything and specialize in any one area. I used to be a general practitioner, I have a lot of respect for general practitioners, I couldn't do what they do, but that's the difference between a regular vet, a general practitioner, and a specialist.

Melissa Breau: One of the things I've heard you talk about a little bit before is this idea of a good sports medicine exam. What's really involved in that? What does that look like?

Sue Yanoff: A good sports medicine exam, like any good exam, starts with a patient's history. It's very important to get a good history because a lot of times we don't have a history that a dog is lame. We have a history that the dog's performance is deteriorating. Their times are little slower, they might be knocking bars or popping weaves. Sometimes they might be a little reluctant to jump into the car. So it all starts with a good history, which takes time.

And then a sports medicine exam involves examining the whole dog and not just one leg. When I was an orthopedic surgeon, I often would just examine the leg that the dog was lame on. We knew which leg was a problem, I'd examine that leg, say, "Here's the problem, here's what we need to do," and that was the extent of the exam. With a sports medicine exam, I examine the whole dog — the neck, the back, all four legs, even if I know which leg the dog is lame in, which oftentimes we don't know which leg the dog is lame in, so I examine the entire dog.

As an orthopedic surgeon, I would mostly concentrate on bones and joints. For a sports medicine exam, it's really important to look at the muscles and tendons and ligaments, which often are injured.

So it's just a different way of doing the exam. It's much more complete, it takes more time, and to do a good sports medicine exam I think you need more than a 20-minute office visit, which is often difficult for general practitioners to do.

Melissa Breau: A lot of the time, people have a dog that comes up lame or has an ongoing issue and they aren't really sure what the cause is. We talked a little about regular vets, they might even take their dog to that regular vet, and the vet does what they normally do, they get an "all clear," but they're still seeing signs of pain. I guess what stood out to me from your last answer was this idea that maybe it's a little more subtle when we're talking about a performance dog. Handlers may notice the more subtle signs of pain. What should they do in that kind of situation? How can they find out what's actually going on?

Sue Yanoff: There's two ways to handle that. Oftentimes the regular vet doesn't find anything because, it's as you say, it's very subtle, or they're actually not looking in the right place.

And oftentimes dogs will get better with what I call "the standard conservative treatment," which involves restricted activity, no running, no jumping, no playing with other dogs, no training, leash walks only. When I say "restricted activity," I usually mean a lot more restriction than most people think.

And then put them on some type of pain medicine, anti-inflammatory medicine. I like to use NSAIDs; non-steroidal anti-inflammatory drugs are a good first start. Oftentimes with a minor injury, if you treat them with restricted activity and NSAIDs, they will often get better, so there's nothing wrong with handling the situation that way. But if they're still seeing signs of pain after doing that, then they really need to seek out a specialist to find out what's going on.

When I say "a specialist," I usually mean somebody who is either a board-certified surgeon that does a lot of orthopedics, or a board-certified sports medicine vet — and we'll talk about what that means later — or somebody that has some advanced certification and training in sports medicine and rehab. We would like to hope that one of those specialists can do a good exam and try to pinpoint what the problem is, because, as you know, you've also heard me say, we need a diagnosis.

Again, there's nothing wrong with treating generically for a minor injury, and a lot of dogs will get better if you do that. But if they don't, we really need to have a better idea of what's going on, what's the diagnosis, what are we treating, and are we treating it appropriately.

Melissa Breau: What if the dog is given a diagnosis and a treatment plan, and the treatment plan just doesn't seem to be doing the trick? The dog doesn't seem to be getting any better.

Sue Yanoff: In that case, if the diagnosis is not correct, which happens — it even happens to me, and I could give you an example of a case that I sent for referral a few weeks ago — or the treatment plan is not appropriate … I find what's more common is the clients that I see, if they have been to another vet, or even another specialist, they have not been given a diagnosis. I often will ask a client, "What did your vet say is wrong?" and they say, "Well, they didn't really say." So that's a problem right there. If they're given a diagnosis, that's great. Oftentimes my clients aren't even given a diagnosis. And if the treatment plan doesn't seem to be helping, either we're not treating them appropriately, or — and this happens much more commonly with pet owners — they're not following instructions. So if I ask you to rest the dog and restrict them, and you're not really doing that, then the problem might not get better.

Melissa Breau: Do most dogs recover from sports-related injuries? What does that kind of "recovery" usually look like? You just talked a little bit about what you mean when you say "rest a dog." Do you usually recommend rehab of some sort? Can you talk a little bit about how all that works?

Sue Yanoff: Sure. That's a good question, several good questions. In my practice, yes, most dogs recover from sports-related injuries. Now, there are some things, like if it's a chronic degenerative disease like arthritis or lumbosacral disease, then the dog is not ever going to recover fully. We can only manage the symptoms. But for muscle and tendon injuries, and even for fractures and some things like torn cranial cruciate ligaments, yes, dogs absolutely can recover from sports-related injuries.

In our practice there's three phases of recovery. The first is rest and restricted activity. We need to allow the injury to get better. We need to allow the injury to heal. During this phase of healing, we basically don't do anything more than have the owners do short leash walks a couple of times a day. So there's minimum stretching and minimum p.t. and not a lot of strengthening activities.

And then we will recheck the dog, and if the owner thinks the dog is doing better, and we don't find as much pain as we felt on the first exam, then we will go to the second phase of treatment, which is rehab. This is where you put in your stretching and your strengthening exercises and your increased activity to build up the dog's endurance again, and that progresses as the dog progresses, and that's tailored to each dog.

I should say, during the initial stage of treatment we will do modalities like ultrasound, if necessary, or more commonly laser or massage and mobilization and things like that.

So the first phase is treatment, which is basically restricted activity, the second phase is conditioning, where we start to increase the dog's activity with the goal to get them back to normal activity, and then the third stage is what we call retraining, and this is where we give the owner a program to get the dog back to competition in their sport of choice. That can take anywhere from three to twelve weeks, depending on what the injury is and how long the dog has been restricted and other things like that.

Melissa Breau: For that three to twelve weeks, you're just talking about that last phase, right? Might take three to twelve weeks for training.

Sue Yanoff: Yes. The last phase might take three to twelve weeks. So if you have a dog with an injury like medial shoulder syndrome, the post-operative recovery period is twelve weeks, and then probably another eight to ten to twelve weeks of conditioning and rehab to get them back to normal activity, and then another ten to twelve weeks of retraining to get them back to competition. That is one of the injuries that takes a long time to get back to competition, but certainly it's possible.

A lot of the dogs that we treat, when they get back to competition, they're better than they ever have been because they are in excellent condition, they're very well trained, the owner knows a lot about warming up and cooling down, and a lot of them go back to very long, successful careers.

Melissa Breau: That's awesome. I want to shift gears a little bit. I know that I've heard you say on numerous occasions that pain in general is undertreated in dogs. Why do you think that is? Why does that happen?

Sue Yanoff: I think it's because dogs can't whine and complain like people can. And a lot of dogs don't show strong, overt signs of pain. There are ways they can tell us subtly, but a lot of people don't know what these signs are and don't really think that they're causing pain.

I've had a lot of clients say, when they bring the dog to me, "Well, I don't think he's in pain," and I can tell you right off that if your dog is limping, 99.9 percent of the time it's because of pain. It interests me that people know that their dog is limping but don't think they're in pain, because I can tell you from experience with me, when I bang my knee or stub a toe, I limp because it hurts, and when it doesn't hurt anymore, then I stop limping. So if the dog's limping, it's because of pain.

But oftentimes the dogs that I see are not limping, but there are other, more subtle signs, and we often find pain when I examine the dog. I'll move a joint in a certain way and the dog will react, or I'll push on a certain place on the spine and the dog will react, and the reaction can be anything from something very subtle, like if they're panting, they stop panting, or they'll lick their lips, or they'll look back at me. Occasionally I'll have a dog that will yelp or whine or try to bite me, which is great, because then I know for sure that they're in pain.

Melissa Breau: There aren't many people who would follow "try to bite me" with "which is great."

Sue Yanoff: Yeah, right. Usually, I can get out of the way fast enough, because I haven't been bitten yet doing a sports medicine exam. I can't say that for any other type of exam.

But we miss signs of pain, and then it's not treated because, again, people think, Well, she's not in that much pain, so she'll be OK. What I was taught in vet school — and I graduated 38 years ago — is, this was common back then, is, "We don't want to treat the pain, because if we treat the pain, the dog will be too active." There's even veterinarians and people that believe that today: Let's not treat the pain because we don't want them to be too active.

But we know that's not true. Anybody that has a high-drive sports dog, or even a dog that wants to chase a ball or chase a squirrel, they're going to do it whether they have pain or not, and then worry about the pain later.

That's why I think that pain is undertreated in dogs. It's either not recognized, or people don't think it's that important.

Melissa Breau: What's your approach? How can you tell if pain is the problem, and then what do you usually do about it?

Sue Yanoff: My approach is, if the dog is coming to see me, whether they're limping or it's a performance issue, it is very likely due to pain, and it's likely due to pain because of an injury.

As I said, there are a few things that will make a dog limp that's not due to pain. but that really has nothing to do with sports medicine. So limping is an obvious sign of pain, crying and whining, obviously, or shifting the weight off the leg, or stiff when they're getting up. Those are pretty obvious things that people can observe in their dog at home.

But then there are some less-obvious signs that people might not notice, like if your dog normally stretches a lot when they get up in the morning, and they're not stretching as much as they used to, that could be a sign of pain. You know how when your dog shakes the water off of them they shake their whole body? Well, some dogs will shake half their body, and that might be a sign that the body part they're not shaking is painful. They might come out of their crate a little slower, they might be reluctant to go up and down stairs, they might not want to play as much with the other dogs, they might be more grumpy with the other dogs, they might have a slight personality change.

In my webinar Chronic Pain, I listed nineteen signs of pain in dogs, and there's probably more, so I think sometimes handlers need to listen to their dogs. Certainly performance issues can be a sign of pain, and we've discussed this before. A lot of people will blame a dog's reluctance to jump, or going around a jump, or not listening, to being naughty and they try to fix it with training, but it could be that the dog is painful and that's why they don't want to do that thing.

Melissa Breau: I know if I over-exert myself, I tend to get a little bit sore, and I've certainly seen my own dogs, if we do something a little over the top one day, they might be a little less …

Sue Yanoff: Active.

Melissa Breau: Yes, or sore, the next day. So I'd assume it's the same for dogs. If a dog is just a bit sore, or seems a bit sore the day after a trial, at what point do you start to worry that it might be something more serious than just that?

Sue Yanoff: I think it's something that has to go on for a while. All of us have had dogs who were out hiking, or after a trial, and they're favoring a leg, or they'll step on something and yelp and hold their leg up and then they're fine, and the next day they're fine, and that's OK with me. Or if they're a little bit stiff and sore the day after trial, especially if they're a little bit older, especially if it's a four-day trial, then I would just rest the dog, give them a day off, and if they're fine after that, then I wouldn't worry. But if they continue to show problems, if the soreness continues, as we talked about, or if performance deteriorates, or if it comes and goes, so you rest them for a day or two and then they're fine, and then you go back to normal activity, and then in another week or so, or a month or so, the same thing happens, and then you rest them for a few days and then they're fine, at that point either they're not getting better, or if it comes and goes, that's when you should maybe look further.

Melissa Breau: You recently gave a whole webinar where you talked about pain management, and you talked quite a bit about some of the drug options that are out there. What do you wish more handlers knew when it came to pain meds? Could you share one or two things that come to mind?

Sue Yanoff: I know a lot of people are reluctant to give their dogs pain meds, and I think those are mostly people that have high pain thresholds and so they don't take pain meds themselves until it's really, really bad.

I have a very low pain threshold. I'm a wimp, so if I have pain or soreness, I'm taking drugs. And I assume that all dogs are like me, that they're pain wimps and they need meds. Now there are some dogs that we all know, Labs and Border Collies come to mind, that they can have a lot of pain and still will do their thing because they're so driven. But just because they will doesn't mean they should, and just because they seem to tolerate the pain well doesn't mean they should.

So I think what I would like the handlers to know is just because you wouldn't take pain meds for certain pain doesn't mean that it's OK to not give your dog pain meds, because I think we need to address their pain, since they can't tell us how bad it is.

The other thing I want people to know are there are more drugs out there than NSAIDs. NSAIDs, I think, are really good drugs, but some people are scared because they can have serious side effects — not often, but they can. But I want them to know that NSAIDs for most dogs are great, that there are several different NSAIDs available, so if one NSAID doesn't help your dog, or your dog has an adverse reaction to one NSAID, there are other options.

One thing we talked about in the webinar that if people didn't take it might not know: there's a new NSAID available for dogs called Galliprant, which has a lot fewer side effects than the NSAIDs that we have been using.

Melissa Breau: If somebody has been listening to all this, or they have a dog that's injured at some point and they think the dog might benefit from seeing a sports specialist, what's the best way to go about actually finding one and then getting an appointment?

Sue Yanoff: There's three different types of veterinarians that you might want to see, if you need somebody with more training and experience than your general practitioner.

The first is a board-certified surgeon. This is a veterinarian that has been certified by the American College of Veterinary Surgeons, who has the training required to meet those certification requirements. Surgeons are trained in orthopedic, neurological, and soft-tissue surgery. Once they finish their residency and go into practice, they might specialize in a particular area like orthopedics or neuro, but we're trained in all three. So if you want to find a board-certified surgeon who has a special interest in orthopedics or sports medicine, then you can find somebody like that. You can get on the website of the American College of Veterinary Surgeons and find a specialist.

I would recommend that you find a specialist who specifically states that they have an interest in sports medicine and has several years experience, because the more we practice, the better we get, because, to tell you the truth, I've learned the most from the diagnoses that I've missed and referred for a second opinion and go, Oh, I didn't know that was a problem. Now I know.

The second type of specialist is a board-certified sports medicine vet. This is a veterinarian that has been certified by the American College of Veterinary Sports Medicine and Rehabilitation, and again, my recommendation is to look for somebody that has several years experience in the specialty. And for the sports medicine specialty I kind of like it if you find a veterinarian who actually does some sports with their dogs, because I think you get a whole different perspective on sports medicine when you actually do some of these sports.

The third type of veterinarian, who can't really be called a specialist but has some extra training in sports medicine rehab, is a veterinarian who has a certification called CCRT, which stands for Certified Canine Rehabilitation Therapist. This is somebody that has some extra training through online classes, through three weeks of in-person classes, and while the training is not as extensive as a board-certified specialist, at least they have some advanced training.

The point I want to make is just because somebody is a specialist doesn't mean that they're good at what they do. You would think that they would be pretty good, but not always, and just because somebody is not a specialist doesn't mean that they're not good. So if you have no place to start, those are good places to start. I like for you to get recommendations from somebody who has seen the sports medicine vet, whose dog has been treated successfully, and start there. But if you don't have a recommendation from somebody, then I think looking at the websites of American College of Veterinary Surgeons or American College of Veterinary Sports Medicine and Rehab, or finding a veterinarian with a CCRT certification is a good place to start.

Melissa Breau: Excellent. I've got one more question here for you, Sue. I've replaced the three questions at the end of every interview with a new question for repeat guests, so as a final question I want to get back to dog training. What's a lesson you've learned or been reminded of recently when it comes to training?

Sue Yanoff: I like this question a lot because I have probably ten answers for that. But having just come back from the FDSA camp, I think the lesson that came to mind first and I think is very important and that is foundation. That's getting back to the foundations. Whether you're having trouble with something or whether you just want to have an easy training session with your dog, get back to the foundations.

Melissa Breau: Excellent. Thank you so much for coming back on the podcast, Sue!

Sue Yanoff: Thanks, Melissa. It was fun, as always.

Melissa Breau: And thank you to all of our listeners for tuning in!

We'll be back next week with Nancy Tucker to talk about behavior change and why it can be so hard.

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CREDITS:

Today's show is brought to you by the Fenzi Dog Sports Academy. Special thanks to Denise Fenzi for supporting this podcast. Music provided royalty-free by BenSound.com; the track featured here is called "Buddy." Audio editing provided by Chris Lang.