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Expert Interview with VCA Rehab Specialist, Dr. Carrie Woodcock

Sep 15, 2016

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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.

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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.

post-loop backpain.JPGI 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 well

He 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 do advanced diagnostic workups, so we may or may not know if there is cancer in the painful area. There's a lot of comfort in knowing that if I give you a Loop and you use it and there is cancer, it's not per se contraindicated. Whereas a laser is. So it's opened up a lot of options for me, as far as having things to offer people where we don't know for sure what's going on. How do you know when you can't afford an MRI? You know, it's a little scary to say "I'm going to take my chances on laser." So that's been great.

Usually my approach with clients is, "I believe in this, I've had fantastic results." I've always told them, when I first started using it that I was cautiously optimistic but it had to prove itself to me. So my approach is that we have a standard rental fee and we rent the Loop to clients for a week to let them see for themselves. That has been the most effective, and I know people have gone back and forth, I've seen people on the rehab groups list ask "What do we do? How do we know they'll come back?" You don't. You just kind of have to know your clients and you have to hope that people will honor the trust you put in them by letting them have a $270 piece of equipment for $55.

Woodcock Loop in use.JPGYou mean that they may not bring it back?

Exactly. I don't worry about the number of times that they use it because my whole approach on this is, "if these people believe in it, they're going to come back and they're going to buy another one."

How often do you see that happen?

I would say 9 times out of ten.

I know you’re a multi-model vet, but are there times you use it as the sole treatment?

Actually yeah. Honestly, the most common for me where it's a sole treatment is medical management of cruciates. Because a lot of the guys who cannot afford surgery cannot afford rehab. So when I get those cases, I absolutely prescribe a Loop. Hands down, because PEMF can increase tensile strength of ligaments. If I have to pick one thing--something like a ligament injury, a shoulder injury, absolutely hands down its the Loop. If I've got a tear, even if I can't rebuild that ligament or that tendon, because its avascular, the Loop increases the tensile strength of a ligament by 25%.  Theoretically, I might be able to counteract that instability. And those guys have done great. Anytime I'm looking at a shoulder and I think it's a bicep tendon injury, I'll use it.  I'll send a Loop home, even if they can't do anything else.

Have you had any clients that have come back and said, "you know what, Dr. Woodcock, this just didn't do it for me?"

The only ones I would say I've had are probably in the same category as degenerative myelopathy. I've got a couple of those post-op hemi-laminectomies where the dogs just aren't going to come back, no matter what you do. It's worked great for my radicular neuropathies.  I had one neck where the Loop didn't fix it but a higher dose of Gabapentin did. There was nothing on MRI and ortho couldn't find anything. So I have to suspect that we were just in the wrong area. It was a very hard-to-handle dog, so that's not a great example because maybe if we had put the Loop on the back and that's where the pain was coming from, we would have fixed it.  I'm very excited because bringing in the VOM allows for a much more objective way to look for subluxation.  Having this technique to help me isolate and then add the Loop on top of that based on that more objective evaluation, that is going to be huge. 

You mentioned using the Loop post-op. Would you tell me more about that?

If I were still at the specialty practice, that would be a no brainer.   We’ve actually had in the last 2-4 weeks 4-6 immediate post-op cases. Dogs have gone to surgery elsewhere and then they come to us to medical board. We manage them post op, because it's summer, clients want to go on vacation, so they are scheduling surgery and boarding right around vacation. All of the medical boarders get Loops three times a day. I had a post-op pelvic case after the animal was hit by a car. It was an ischial repair on one side or ilial fracture on one side, tibial fracture on the same side, FHO on the other side, and that dog got Looped three times a day. I've had multiple MPLs, I've had TPLOs, and it's been wonderful because I'll have them for a week usually post op. After a week they're consistently weight bearing. And my dog was a poster child, I was like "this is insane." I mean it was nuts. And he hasn't batted an eye since then. And he wasn't TTT (tibial tuberosity transposition)--he was a wedge resection. To have negligible lameness by 48 hours is kind of crazy.  Woodcock's dog post mpl surgery.JPG

Yeah, it's pretty awesome, for the dog and for you. 
I don't understand why anyone wouldn't use the Loop post-op. What we do is we integrate it in the cost of our medical boarding. So they pay an extra fee, but it includes being Looped three times a day and it's something we can do easily. It also helps with the edema reduction--the bruising is literally gone. The last one I had, he was just bruised top to bottom, so we were all looking at him going, "Oh, this looks awful!" By the time he left a week later, it was gone and he was consistently weight bearing. Hemi-laminectomies--there's no reason why you wouldn't do it.  It just makes no sense to me not to do it. Those to me are no-brainers, medical management of cruciates, it's great, any neuro, it's been awesome. I feel like it shortens my treatment time by 25%. 

Well that's pretty significant. 
 I don't have any measure but it definitely moves their progress well in advance. My post-op knees are ridiculous, the ones that are Looped, they come back to me for physical therapy, and I'm kind of going, "what am I supposed to do with you now?" You know, they look great. So you almost put me out of a job in some respect, but what I care about is that these guys heal! That is all, that's all that matters. And most importantly, there are very few clients who can't do this for their pets. And it's less expensive than Rovera plus bloodwork and it's safer. You're actually healing--you're treating the process not just the symptoms. In this day and age where everybody's watching their money and everyone wants to do something, this is something that almost every client can do for their pet no matter what they're treating.

That's great. 
I have an old pug that was brought to me as the last resort before euthanasia; her quality of life was so compromised I truly was the last resort.  We were doing everything possible, and then I get my Loops in. This guy Loops the dog--I swear from head to tail.  Everywhere!  Now we're 15 months from initial presentation, and she's walking over to the neighbors to get snacks.

One of the things it's done for me is helped with my mission that my patients will not die of orthopedic disease. They're going to die of something else. 

Dr. Carrie Woodcock, DVM MS CCRP is a 1996 graduate of the University of Illinois, College of Veterinary Medicine. She currently lives in West Grove, PA with her husband, 3 children, 4 cats, 2 dogs, guinea pig, hamster, and bearded dragon. She is a certified rehabilitation practitioner and will soon be certified in chronic pain management. She is currently pursuing certification in Veterinary Orthopedic Manipulation.  Her passion is improving quality of life for our fur children through improved mobility and excellent pain management. She is excited to offer a wide variety of Rehabilitation services here at VCA Wellington Animal Hospital and is eager to get your friends comfortable and mobile!

 



Category: Expert Interviews

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