Thank you Bruce, and thank you everyone for coming and listening to me wrap it on tonight about inter intervertebral disc disease, and this is a really Quite a topic that there's a lot of information about, so we'll just move through what, so this is a little bit about my background so you can have a look at my ugly mug and my, my dog Nalu. But what we're gonna be talking about is what is intervertebral disc disease, because a lot of people have misconceptions about what it is. We're actually not going to be talking about how to diagnose this tonight because it, I have 50 minutes with you and this is actually a 2.5 hour presentation that I have actually coming up over the next couple of months to my students.

And as we go through, I'll talk about how you can get access to that because we're actually gonna do a part two to this webinar series, where I talk about, it's a whole webinar just on physical examination and how to do that, but I'm actually giving that in 2 weeks to my students at Veterinary Teaching Academy.com, so, We'll give you a link and send out a link that if you want to come and join that free webinar series, we will get that link to you as well. Or you can wait till next month or in a month or two's time, and we can organise a schedule to do part two.

But I only had 50 minutes, and Anthony wanted me to talk more about the rehab side, not the, how to do the physical examination, but we'll talk a bit about that as we go through. But there's a whole component to this webinar that isn't here that, I would like to get to you if you need it in the short term, we'll get you that link. But if not, then you can wait.

We'll be doing that part in part two of this webinar series, for your membership there at, The webinar be. We're also gonna be talking about signs and symptoms of intervertebral disc disease. We're gonna talk about, just briefly what treatment options are available, but that goes with the next webinar, we're gonna talk about all the different surgical procedures and what they entail.

And then we're gonna talk about what therapeutic modalities are there to help patients with intervertebral disc disease and what's worse. And then I'm just gonna give you a quick example of, and it's gonna be really quick, of what exercises you could do over a 12 week period for patients suffering indivertible disc disease, and then we'll follow up with questions and hopefully that will be within the hour time frame. We have a lot to get through, so I hope you have your pens and paper ready, and let's go.

So I thought I'd step back and let's talk a little bit about anatomy and what actually body structures are involved with this disease. So we all know the spinal cord anatomy, there are 4 sections to the spinal cord, the thoracic, the cervical, sorry, cervical, thoracic, lumbar, and the sacral regions. And one, the spinal cord is one of the most important organ systems that we find in the body.

If damaged the cells do not regenerate in the spinal cord, we know nerve cells don't regenerate, and damaged cells are replaced with scar tissue or some type of fibrous tissue that do not transmit any signal fibres. So any type of injury that we sustain to the spinal cord can be permitted if we don't get onto it and address it quickly enough. The spinal cord is divided into 26 invertible segments, and so these are segments of bone that protect the spinal cord, and the invertible segments are designed, and they're really awesome, this made structures that are.

Allow the spinal cord to be protected but allows the spine to be to move as well. And the intervertebral disc component of the spinal cord are a rubbery cushion-like material that allows a little bit of cushion between those bony segments. So with one of the intervertebral disc disease, and so the intervertebral disc is situated between each of the intervertebral vertebral bony segments of the spine.

Their function is to connect the two bony vertebrae together and they act as like a shock absorber that allows movement in the spine so it can go up and down and sideways. So this is where the movement and, Really, I think nuts and bolts of what the spine can do actually comes down to these little rubbery invertible discs. There are two zones that make up the intervertebral discs, the annulu fibrosis zone or the outer zone, and the nucleus propulsus is the inner zone.

So I like to think of it like a jam doughnut or a jelly doughnut, depending where I'm in the United States, and no one knows what jam is, they call it jelly, and for you over in the UK, think of it like a jam doughnut, you have that crust around it of pastry, and inside you have that nice jam filling. And so the annuous fibrosis, the outer crust to that jam or jelly donor, is the outer tough fibrous layers that surround that jelly centre. And for some reason it's thinner at the top, and we'll talk about why that is in evolution, a problem for our patients.

And it functions to create stability between the two vertebrate bony sections and allows flexibility in the spine. The nucleus propulsis is the inner jam area, and it's a soft, spongy material that acts as a shock absorber and helps equalises forces that are placed on the spine and allows movement of nutrients and fluids to pass between the indivertebrate bones and also the indivertebral disc. So as we age, We see degeneration of the outer fibrous parts of the disc.

So we have hardening of the inner spongy material due to dehydration, so we lose water of that material. And the dehydrated disc no longer acts as a good shock absorber, becomes harder and harder rubbery, and once the dehydration sets in, we sometimes see mineralization of that area, so it crystallises and becomes a little hard of it. And we'll talk about which breeds are more, Prone to this type of disease.

So as the outer fibrous layer degenerates, the harder inner layer is actually pushed up under pressure and can escape through the hard outer layer. And this displaced inner material then can place pressure on the spinal cord. So if you look at the my diagram on the right-hand side, you can see that little red fingerpo that's supposed to represent the escaping disc or that hard material coming in and putting pressure on the yellow spinal cord.

Degenerative disc disease is a chronic degenerative of the outer part of the disc that leads to a sudden disc rupture that causes a disc herniation. We hear like slipped disc, pinched nerve, all these different terminologies to represent this slipping out of the disc, so the propeller shoots out and now puts pressure on the spinal cord. And this herniation or slipped disc is usually associated with a traumatic event.

So when we talk about rupture of the invertebral disc, this leads to two types of damage to the spinal cord. So we'll have a compression and a concussive force that puts pressure or force on the spinal cord. And the extent of the damage in nerve cell loss can be determined by the amount of force.

We'll talk about this in future slides, but the amount of force, is it slow or is it fast like a bullet? The degree of force applied to the spinal cord and the length of time that that force is applied to that spinal cord. It's got more force, it's cutting off the nerve signals, but also blood supply and nutrients in the spinal cords, and we now start to keep necrosis of the nerves that are downstream from wherever that blockage is.

Biomechanically in a vertebral disc consists of protoglycans, glycoproteins, and both the collaginous and non-collaginous proteins. In the immature dog, the composition of the nucleus for pulses is usually higher with protoglycans and glycoproteins, while the annulu fibrosis has a higher collagen content. And we'll see as the pet ages, how these ratios change.

So we see degeneration of the invertible dis occurs with ageing, and the results is a significant change in the biochemical structure of the nucleus pulses. So the proteoglycan content decreases, we get more collagen content increases in the nucleus pulses as we age until it becomes harder and stiffer. The direct relation there is a direct relationship that exists between the proprioglycans and the interstitial fluid content of the nutri nucleus pulses.

So as they age, that fluid dehydrates and the proprio glycans get harder. And then more collagen content is laid down. So with the loss of institial fluid, the content alters the gel-like consistency of the nuclear propulsive and decreases its ability to become a good shock absorber, and to distribute forces evenly over the invertible disc structure.

So now we get pockets of nice disc and hard disc, and now we get forces that are not evenly distributed and that creates a perfect storm to now push and propel that. Neutral pulses up into the spinal cord. The project lycan and interstitial fluid content also decreases with age, and the analous fibrosis inhibiting its ability to act as a shock absorber.

So as everything dries out, we no longer get that nice shock absorber material. So that's all we're saying, everything dries out in the outer layer, the inner layer, and then we talk about the worst thing is that inner layer then starts to crystallise. So here's an example of, once again, my fantastic diagram on the right-hand side.

So when a disc rupture, it can crush the spinal cord and all the peripheral nerves that are in that area. So we think that this is either a slow force going in, or it can be a bullet that shoots in and causes, spinal shock syndrome to the spinal cord and spinal bruising. But either way, we're damaging the nerves in the area that we have the slipped disc.

So most common clinical signs, we see positive or negative pain, positive or negative loss of limb function. Positive or negative, loss of peripheral and deep pain stimulus. And we also see positive or negative neurological deficits.

So we can have a whole combination of all this, and we go through and talk about the difference between cervical and thoraccolumbar region slipped discs. They all have a combination of all these different signs to actually give a diagnostic picture of where that lesion is. So in a vertebral disc disease clinical signs, the most common form of degeneration we see happens over time.

So it's a chronic degenerative process, and it's a slow process. And the most common clinical signs are intermittent pain, with reluctance to move, it lasts a few days and then it resolves. And so, and that's a chronic, with acute, there is some type of traumatic event that happens, and this is a sudden, quick, Impact or some event, and then we can see clinical signs within an hour after that event, so it can be really quick.

Relative minor spinal cord damage due to chronic degeneration can lead to loss of coordination. And what I call it the drunken sailor, we've all seen the movies that sailors stumbling down, and we've all seen neurological dogs. They kind of sway and stumble in the back end, they cross their legs.

I call it the drunken sailor walk and we see this. Damage that's more significant to the spinal cord from acute trauma caused by a violent concussive force. So, I say that bullet acknowledge it shoots out, bruises, causes spinal shock, and this can lead to an inability to walk or move the legs voluntarily, so they become paralysed.

If it's in the cervical area, they can become quadriplegic straight away, and the raccolumbar area, they can just be called become, paralysed in the hind limbs only. So severe damage from long-term compression forces can lead to an entire loss of pain sensation, but this will gradually happen over time. This, and so if this happens, this is a surgical emergency and can have a poor prognosis for recovery depending on the duration of pain, loss of perception.

So if we lose peripheral pain sensation, we'll talk about this engrading is one thing, but if we lose peripheral pain and deep pain sensation, that's a surgical emergency and they need to get the surgery within 24 hours for, And he talked of satisfactory resolution. So here's really interesting that 65% of disc ruptures occurred in the thoracolumbar region of the back. And 18% of all the others happened in the cervical spine region.

So that's really interesting to think about most of your injuries when you're looking at animals coming into your practise, 65% of them are gonna be in the Tarraco lumbo region. So breeds most commonly affected, so we have chondrodystrophic breeds, so these are our dwarf breeds, and here's just a list of the most common of these breeds that we see coming in. The big one we're gonna talk about is the dash hound as we go through this presentation.

So, we see with these chondrodystrophic breeds, dehydration of the big disc begins about 2 months of age and between 2 months and 2 years of age. But what's really interesting at 1 year of age, 75% to 100% of all the intervertebral discs in the body are now starting to undergo some type of degeneration. Degeneration of the propulsis is followed by mineralization material being laid down, so we only see mineralization material being laid down in our chondrodystrophic breeds, and in in in.

Sorry, a bit of a slip. Invertebral disc disease clinical science is seen usually about 3 to 5 years of age. So this is a young dog disease when we're talking about chondrodystrophic breeds, and it happens in multiple joints, not just one joint.

And we'll talk about that tip later on. So with the condo dystrophic breeds, we have Dashan as our number one, and they represent between 45 to 70% of all the cases you're gonna see with this. If a dashan walks into your surgery and it's overweight and it's knuckling, you know that this guy's got some type of indivertical disc disease and they make up between, as I said, 45 to 70% of all cases you're gonna see.

In these dogs, the average, as I said, clinical stage is 3 to 6 years of age, although X-rays can show cal calcifications in each of the indivertible discs at about 2 years of age. So let's talk about non-chondrodystrophic breeds, and the most common breeds we see that are affected with indivertible disc disease are our German shepherds, our Labrador retrievers, and our Dobermans. And I've also put here on the slide working dogs, and we'll talk about working dogs later on just because they put their spines in such different, Range of motions, they have the ability to have acute blunt force trauma, and this can then make them more susceptible to some type of acute indivertebral disc, lesion or slipped disc.

So with a non-cho dystrophic breeds, we see a slow ageing process. This is an old dog breed, old dog disease. So I want you to think we see the onset about 8 to 10 years of age usually.

And it's rarely accompanied by mineralization of the nucleus propulsive. So this is a, just a general ageing disease, not a mineralization disease we see from a chondri dystrophic breeds that we talked about. They'll get mineralization of that nucleus propulses.

These guys just have ageing disease. So here's another study that showed Labrador retrievers and German shepherds were most common, and once again 5 to 12 years of age was the common window that we see this disease. So just think for non-chondrodystrophic breeds, it's an old dog disease, for chondrodystrophic dogs, it's a young dog disease.

So gender study, I just put this as study here, but it didn't show that there was any significance between males and females, which you want to know anymore. Here's the reference for that study, but we have a lot to go through, so I'm just gonna push on. So this was a really interesting study that I want to spend a few little bit of time working through.

So the highest incidence of indivertible disc disease, 73% of them in dogs between 3 to 6 years of age, and these are, are chondrodystrophic breed dogs. Other dogs over the age of 7 made up 21% of reported cases, and these are non-chondrodystrophic dogs. But the table on the right is a summary of all the cases that came in over a retrospective study of a 5.5 year period, and we see that Dashhound at 308 cases and the next closest one was the Boodle at 67 cases, gives you an idea of just the overwhelming, how can we say case load that you will see with dash hounds compared to every other breed when it comes to individual disc disease.

So in vertebral disc disease is the most common neurological problem that we're gonna see in our profession. Chondro dystrophic breeds are more affected, and the dashian once again, said 45 to 75% of the cases you're going to see. And also seen many other dogs, including working and sporting dogs, just because of what they do, your police dogs, your military dogs, your agility dogs, your fly ball dogs, your, duck diving dogs, all those sports put additional strains on the back, cervical and thoracolumbar region compared to what I call the backyard heroes, the weekend warriors that aren't out there training, and usually they're training as a young puppy, and that sets up their diseases later on in life because they're starting training too young.

So, we'll talk more about that later on this webinar, but also on next, next webinar, So tips, so this is a really good tips that I tell people. So you have a dog that comes in with clinic sudden clinical signs of trauma or without trauma, comes in. Greater likelihood of a high risk condo dystrophic breed, and you really, you got a 90% chance that it's gonna be a disc involved injury or a vertebral disc disease if it is a chondrodysplastic breed and has no signs of trauma.

This is some tips when you see these patients in the waiting room, you and you, I know I look at them and I go, OK, what's going on? In your mind, that little red light should start to go off saying OK, this is potentially a disc issue. So let's talk about diagnosis, and I only have one slide because I have a whole, as I said, another presentation on diagnosis.

The diagnosis of invertible disc disease is based on the medical history, physical examination, neurological examination, and radiographic examination. We're gonna talk, I've got a whole hour just talking. On this.

So, as we'll go to see veterinary Teaching academy.com, and, but we're gonna put a link. You go there, to sign up to the free email list, and you'll get access to in 2 weeks' time, that webinar for free for 36 hours, just dealing with this.

If you can't wait for the next month or two when we can organise the schedule. So grading, a lot of people have confusion about grading because it can be done either way. So it's a 5 point system, but I've seen it done in both ways.

So I like to grade from 0 is normal, all the way to 5. But other people, grade 5 is normal, and all the way through to 0 because 0 means they have zero function. And so, whichever way you work, work out your own grading system.

But this is how I classify in my grading system. So grade zero is a normal dog. Grade 1 is slight to mild cervical or thoraccolumbar pain.

We have a bit of paresis, a little bit of muscle weakness, and slight decrease in proprioception, but they're still able to walk. They're ambulatory, and you might not notice any neuro neurological deficits when they're walking. With grade 2, we now have mild cervical or cervical to tracal lumbar pain.

Prosis were a little bit more marked muscle muscle weakness with mild decrease in proprioception. We can now actually see they have some form of neurological deficits when they're walking. Class or grade 3 is now severe pain.

They, they're screaming. Paralysis with absence proprioception, they're able to stand, but they're knuckling, they're falling over or they're not able to stand. It's in that little bit of a grey area, but now we're, we've lost, they still have deep pain, but we've lost peripheral sensation.

Grade 4, this is where it's starting to get really serious. We see severe pain, we see paralysis, and they're not able to stand, they're not able to move, can be, they can be quadriplegic or just in the high limbs. We have decreased or no bladder control, so now these guys are incontinent, and we have decreased, peripheral pain, but they still can have deep pain, present.

Now if we get to grade 5, and this is everything in grade 4, but now we've lost the pain, proprioception, there's severe paralysis, the urinally and fecally incontinent, and these guys are a surgical emergency and need to go to surgery within 24 hours. So this is how I grade my patients when they come in. And we'll talk about in treatment, what the treatment outcomes are for those different grading systems.

So now let's talk about history and clinical signs when a patient comes in the door. So these are history questions that I like to ask any patient I think has any type of neurological problem. So what is the duration of the problem?

What is the rapid onset, is it acute versus chronic? The status of the problem, is it, was it aggressive or is it static or is it unimproved? History, any history of trauma, any history of prehistory of spinal problems, any previous therapy or responses to therapy for spinal problems, and any alteration in bloody sorry, bladder or bowel function.

So with acute cervical indivertebral disc disease, so we sometimes can see trauma, but mainly not. We see severe painful episodes of unknown cause, and then there's sudden severe neurological deficits of paralysis and quadriplegia. With an acute thoracolumbar in the vertebral disc disease, there is a history of trauma.

So the owners will say they were climbing the stairs, they were jumping onto the furniture, they were jumping into the car, out of the car, they were standing on the hind limbs, they screamed, they vocalised, and they clapped to the floor. So there will be a history of trauma for acute thoracollubar disease, usually. So for chronic cervical invertible disease, we usually see once again trauma can be or can't be.

We see a severe painful episode of unknown causes once again and a sudden neurological so we show with cervical injuries just because it's under the neck and it's such a mobile area. These guys. Go really quickly.

We might see chronic pain, they might be sore to the touch. We might see they're reluctant to move, but we don't really see the chronic deficits that we do with the thoracolumbar region. So usually think cervical areas, they're usually sudden onset, they can be of a chronic nature, but they go really quickly.

With our chronic thoracolumbar area in the vertebral disc disease, we have a history of trauma, sometimes, sometimes not, but there's a history of severe pain. And this severe pain is kind of intermittent and can resolve after a few days. They'll be reluctant to get up, they'll be reluctant to move, they'll vocalise and then it goes away with a little bit of non-steroidal anti-inflammatories or just rest.

They can be protective of that area when you go to touch and go near that recolumbar region, and they can have aggressive behaviour if you go to touch them for some reason they might growl at you, but they're protecting themselves, and these are common things that I hear from owners. Working sporting dogs, I always love these owners because they have a better idea of what's going on with their pet because these dogs are finely tuned to athletes. So they might respond with then signs of slight to mild pain.

Clinical signs can be slight to mild paralysis, like the dog might just knuckle a bit, might slip a little bit on wet grass. But they start to have slower competition times. They start to lack the ability to extend while they jump.

And so they'll be knocking down bars in agility, for example. They'll start to slip on turns. They'll not be able to complete the weave poles and they'll shoot out.

Usually around the 3rd or 4th weave pole. They'll start to fall off equipment, and then they'll have pain in the back resolved that that will resolve after rest. So let's look at signs and syndromes.

I know we're going fast, but we have a lot to go through, and hopefully you're keeping up. So clinical history, the signs seen in any animal with invertible disc protrusion, extrusion or rupture may vary with location. The onset of the problem suddenly versus is a sudden versus slow or gradual onset of the problem, and the severity of the spinal cord compression or concussion can mask what type of disease it is, which will be a slow push on those nerves and just slow degeneration over time, or can be fast like a bullet, and you see within an hour clinical signs.

Sometimes the nucleus of pulses explodes into the spinal cord canal and hits the spinal cord with a lot of force and this concussion history that can cause spinal shock syndrome. More often though, the nucleus proposis slowly pushes its way into the spinal canal, causing pressure on the spinal cord, and this is a compression in industry, compression injury, a slow injury. The longer the duration of the compression, the more severe the cranial signs due to inflammation and the reduction of blood blood flow and and to the spinal cord, so we now get a damning and we start to lose nerves, the peripheral nerves first.

Because we know nerves are very, metabolic active, and they need high blood flow and oxygen supply, so we start to lose the peripheral nerves first. And that's why this, these are surgical emergencies and need to be treated within the 1st 24 hours for some, satisfactory resolution. Common clinical history, once again, neck or back pain, not wanting to eat, reluctance to move, vocalising when moving or being picked up.

There's a big, especially, you know, little dogs, dachshunds and things like that, and shaking when standing. So they like to shake, muscle tremors, weakness, those types of signs. Other clinical history, so witness and wobbling when walking, neurological knuckling, or incorrect poor placement when walking, dragging the hind leg is or para paralysing the hind limb is a real, Giveaway and loss of bowel or bladder functions they can have incontinence and that's a big giveaway that we've got nerve entrapment.

Invertible disc disease presents with different degrees of pain, however, when nerve damage starts to develop and progresses, it's followed by a predictable pattern. So here's the pat pattern that, what I've always used, and I haven't found any, how can you say, any time that this pattern hasn't fulfilled itself. So I start off with a back or neck pain, and usually they have a reluctance to walk, reluctant to get up, they vocalise, and they have pain.

Then it progresses to, as I said, the drunken sailor walk, they become wog wobbly, they become a taxi. They cross their hind limbs, they drag their hind limb knuckles, and they cross themselves as they're stepping. And the disease then progresses to loss of hind limb motor function.

So this is usually at the same time, bilaterally, and, but it can be unilateral to start with, depending how that disc is pressing on the spinal nerve. So don't get caught out by that one. And the pet can lose the ability to urinate or void its bladder completely.

And then the final stage is, Pain proprioception has lost a deep pain, we've seen as a sign of severe spinal cord injury, and this is a guarded poor prognosis with surgery, but a really poor prognosis without surgery. So this is a great 5. It's either they're clearing the clinical signs, severe pain or intermittent periods of pain.

So this is for the cervical region, walking with the head down, being neck guarded, so they're just protecting that cervical area. And we see muscle fasciulations or muscle spasms when I'm patting or doing my physical examination of that area, and you learn all about that and and how I do my pain evaluation in the next webinar. Other sides you have decreased activity due to pain and you have increased paralysis, it can be of all four limbs or it can just be of the hind limbs only.

Other signs, so with cervical invertible disc protrusions is most commonly in the, as I said, the chondrodysplastic breeds, so Labradors, German shepherds, and non-chondrodystrophic breeds, sorry, dystrophic breeds affected, We then, sorry, let's start the slide again. So, cervical with chondrogous strastic breeds is most common. With our non-chondroous tragic breeds, we have a syndrome called wobblers, and this affects, German shepherds, Labradors, and the Dobermans, and we have a high incidence of indivertible disc protrusions in these guys.

So clinical signs for Tarraco number region lesions we have paralysis, positive or negative, depending how long the, lesion is pressing on the spinal, we have pain positive or negative. They usually walk with a roach back and they have weak or wobbly drunken legs. Neurological deficits are noticed, and then they have a knuckling or incorrect pare placements.

And this is really important when we talk about diagnostic workout with a machine like the gate, right, or walking in sand over water, you'll see in a wet car park, you'll see them dragging their feet and not doing correct pare placements, when you're doing, gait analysis. Neurological deficits assessed by examination are influenced by the size of the lesion and its severity, so, here's a tip, consider there's always more than one lesion, especially in a, Condodystrophic breeds, you have all, you can have, as you fix one disc, you have to go to surgery, the discs on either side will go. So think of these guys as a continual evolution of a disease, especially in our little chondrodystrophic dash hounds, you will never, I say you'll never cure them, it's just a continual management of the additional discs that you haven't treated early on.

So it is one think of many. Urinary urine and bladder function and anal tone may also be altered with these thoracic lumbar region lesions. So when I see damage to the lung to the bladder, I think of low, lower motor neuron disease, if it's a flaccid bladder and it's easy to express.

If the bladder is hard to express, I think of upper motor neurons. So you can still express it, but there's tension to that bladder. I'm now thinking of upper motor neuron disease.

In either case, we have incontinence with indivertebral disc disease, but that's just the way that you can start to pinpoint where the diagnosis will be. And if they have a flaccid anal tone, then I know that's lower motor neuron damage. So, severe spinal cord damage can progress to intramedullary haemorrhage, and this is a life-threatening disease.

We'll talk about this more in the next presentation, things to watch out for for that, but this is a really important thing to watch, and this is almost always fatal. Patients exhibiting, You know I can always, there's a tongue, tongue twister for me, so Hemato Molina have an anxious appearance and dilated pupils and clinically they manifest, Century paralysis with depressed hind limb reflexes. And if you see a dog come in with dilated pupils, perilous neurological signs of the back leg, start thinking of intermodality, haemorrhage.

That's why we don't give aspirin as a non-steroidal anti-inflammation because that can cause haemorrhage in the intramodal, and that now is a life-threatening condition and this has a grave prognosis. So the presence or absence of sensory functional deep pain in the hind limbs is the most important prognostic sign when I'm doing my neurological evaluation. And so if there's sensory paralysis loss and no deep pain over 24 hours without surgery, this is a really poor prognosis.

So then think, let's think about where the most common signs or sites we see for lesions in the thoracic lumbar region. So this is anywhere from T1 to T12, but here's some little tips. 71% of incidences are T11 to T12 to L2 to L3.

So just that little block of, Indivertebral discs is where we see 73% of the lesions, occurring, and that's because we think of the rib cage as a box, and the most amount of movement of force has been placed, once you've got a box that's stable, when you leave the box, the spinal cord now becomes, movable, and at those junction points is where we see the most, cheer forces put on and the most incidences of invertible disc disease. The treatment options. So medical and surgical treatment options seek to alleviate pain, speed recovery, And reverse any neurological deficits, improve patient comfort and quality of life.

So medical management, neck pain and muscle spasms associated with cervical indivertebral disc protrusions are often a mediated to conservemenable to conservative therapies, a cage rest, anti-inflammatories, and muscle relaxants. Patients exhibiting neurological deficits like ataxia, paresis, paralysis often have large amounts of extruded disc material, crystallised material within their spinal canal and are less responsive to medical management and are more responsive to surgical outcomes or surgical management. A high incidence of reoccurrence exists because we talked about all the discs that are involved, and those patients that respond to medical management initially may require surgery at a later date or multiple surgeries to relieve multiple discs on an ongoing process.

The objective of medical management of cervical indivertebral disc disease is to allow the spinal cord nerve root inflammation to subside and the dorsal annulus to heal. So we have a multi-modal approach, we'll talk more about this, so it's good pain control, weight control, diet, physical rehabilitation, daily exercise and nutraceuticals. And this makes up the most important part of how we treat medically these patients.

So with conservative treatment stage one, we use a multimodal approach and we'll talk about that in the next webinar, but anti-inflammatory drugs, no aspirin can be used, we want to use drugs that relieve the inflammation. Pain relievers, Muscle relaxers, no non-muscle relaxants. I only use muscle relax relaxers for 1 to 2 weeks.

2 weeks max, usually 7 days, because I don't want all the other muscles to start using muscle strength and muscle, bulk. And I see that people put them on to 456 weeks. And we now see muscle loss, and they actually do worse than just we want the quick muscle relaxants.

Exercise restrictions and rehabilitation modality so we'll talk about it a little bit. Stage 2 and 3, multimodal approach again, anti-infla inflammatory drugs, no aspirin, pain relievers, muscle relievers once again for a week to 2 weeks maximum, exercise restriction, rehabilitation modalities, and if the status changes, so this is the big thing, you need to constant look watch these guys, if they do not improve after 7 days, or clinical signs worsen day to day, they get upgraded to a grade 4 patient in my book. Grade 4, we need really aggressive multimodal approach now, anti-inflammatory drugs, pain relievers, muscle relaxants, exercise restriction, aggressive rehabilitation modalities.

They should have surgery, but surgery is not an emergency and some clients can't afford it. Or some patients aren't good surgical candidates. We'll talk about how we deal with those.

Some dogs will cover on their own, and if the status does not change in within 4 days or clinically gets worse, straight away, acutely, they now go to stage 5 and they are a surgical emergency. Surgical emergency, best outcomes if we perform surgery within the 1st 24 hours of onset of clinical signs. So surgery So the goal of surgery is to release the pressure on the spinal cord caused by the slipped disc material.

Multiple surgical procedures and approaches exist and depends on the surgery, the veteran surgeon and the location of disc of what they do. And it's the choice of what procedure is in the in the hands of the veterinary surgeon, really for their experience and their expertise and what they're comfortable with, and that's all I'm talking about surgical procedures in today's webinar, and I said we're gonna talk more about that in the next. Not swelling up.

So study, there was a retrospective study that mentioned that improvement rate of ambitation of invertible disc compression surgery was 89% for deep pain present animals and only 50% of animals with absence of deep pain, emphasising the importance of deep pain posts for post-surgical recoveries. Another important factor, the study showed that neurological, Paraplegic animals, so 42% of these animals that could not am actually walk later on, we call it spinal walking. So they have no deep pain sensation, but 2 to 4 months after surgery, these guys will start to walk on their own, and they will walk and called spinal walking.

The spine takes. Control of the walking, it's not the mind anymore, it's down the grey matter, the dorsal horn takes control, and these guys can in about 40 50%, 42% of the patients, especially with electroacupuncture, we'll talk about that later, can get up and walk later on with no deep pain sensation. Recovery outcomes, really important this owner support is critical, that's the number one thing, many owners don't know what will happen to their pet, and you need to have frank and honest discussions with them.

Offer help and support, but don't promise them more than you can reasonably be certain of, so be, pessimistic in outcomes and give them realistic goals. So here's some rates for, recovery with or without surgery for each of those stages. I'll let you go back and have a look at that as we're running out of time.

But you can see, surgery is the really, I won't say the gold standard, but you get the best outcomes, but we can manage our stage 1s and stage 2s, real and stage 3 is really well with medical management. Neurological functional recovery and pain relief is not immediately post-surgery, can take days to weeks to months to get improvement, depending on the severity of the underlying disease and damage to the spinal cord. So outcomes with stage one, with no neurological deficits we have and well-controlled pain, patients have a really good chance of recovering just from medical management.

Stage two, These patients have more severe clinical signs with slight to moderate neurological deficits and moderate pain, and they have a fair to good chance of recovery with just medical management. Stage 3, it's they're fair recovery with medical management. Now we're starting to slip into the realm of these guys do really well with they're now becoming more surgical candidates if they can tolerate surgery.

Stage 4, these guys do really well with surgery and medical management, and stage 5, these guys need me, surgical management straight away, and they have a fair to good prognosis with surgical management if we can get them within the 1st 24 hours, but as I said, it's a fair prognosis. So outcomes Sorry, my cat just jumped up on my computer and I have to be able to see the screen. So outcomes, invertebral disc disease is not a fatal disease, unless the animal develops into medullary haemorrhage.

And recovery times for stage 5 patients with loss and sensation, can be 2 to 4 months. So you've got to tell all your clients that this is a long-term disease and recovery is long-term. OK, hospitalisation, in hospital, usually 4 to 7 days.

We have to wait or we usually wait till they bow and you, you, urinary control comes back but not essential. But I don't like to exceed 7 days because the complication rates increase. Motivation decreases in the patient.

I see after 7 days being stuck in the crate, harder to start rehabilitation and you have poorer outcomes if they're in hospital greater than 7 days. Patients, Must remain clean. This is a big thing.

We can't let them to soil themselves because they develop ulceration. They, if they're seeing their faeces, urine scalding, and cages should be placed with padding and clean because they have, they can't turn themselves, so we need to give these guys plenty of cushioning when they're in hospitals. Factors that affect recovery, what was the amount of damage to the spinal cord before decompressing surgery?

Was the surgery done in time to prevent permanent damage to the spinal cord or scar tissue formation? Are there any other complications? When can physical therapy start is the big one?

Can physical therapy be done at home, and what's the patient's parents' attitude to, Physical therapy at home and rehabilitative therapy. So let's talk about home recovery quickly. So, urination defecation, the big thing that we see.

So most dogs that reach this point will also lose control of their bladders and are at risk for chronic urinary tract infections and urine scaling. So we need to teach the clients how to express the bladder, and this needs to be done 3 to 4 times a day. If they can't express, we need to put a permanent catheter placement in, they can then express themselves with syringe, we put diapers or urinary pads down.

Skin integrity, skin abrasions and breakdowns will occur in most dogs, so we need to educate the owners on prevention, so using booties, avoiding con concrete and asphalt as possible, staying on appropriate surfaces like grass or concrete, and educate owners on quick treatment, so we need to get on top of abrasions and not allow abrasions to become infected. So bedding, really has to be a soft, absorbable urinary pad type of betting. So here's the comfort care assist we use in the hospital, and that's that memory foam that it will help and prevents these guys developing bed sores and wounds because they can't turn themselves because they don't have the motor function at that time.

Confinement, cage rests for 2 to 4 weeks, so they need to be in a cage or some confinement room where they can't run or jump or get into things. Harness and assistive devices, this will make your life a lot easier and their life easier. So here's some examples of a walkabout sling or a help them up harness.

Harnesses instead of having collars around their neck, so we now leave them with a shoulder harness or a halty collar harness, so we don't, especially if they're cervical, animals, we don't want to have them being pulled by their neck anymore. Wheelchair devices if they're neurologic and don't get back, so Eddie's wheel is a hard, chair for great for bigger dogs, you look them up with little dogs, and Dog on wheels has a neuroprene sling that we use for my degenerative allopathy, Dog, and that allowed you to carry her around as a sling as well, but there are two examples of wheelchairs. This is just an example of different booties to protect their paws.

So rough wear and Poor's boots. And so let's talk about remodalities. And so really want to look at laser class 4 class 3B, therapeutic ultrasound, neuromuscular electrical stimulation, underwater treadmill, or sorry, transcutaneous electrical stimulation, pulse electromagnetic field therapy, cryotherapy, manual therapy, acupuncture chiropractic, regenerative medicine, therapeutic exercise, and swimming.

So with laser, laser's real important, broken down into class 3B and class 4. Now class 4 is a more powerful, that's, and it uses multiple heads coination. I don't really like this with my, unless you're using an appropriate head because you can burn, these guys surgically because we've opened up the spinal cord and you can actually burn and irritate that area.

So I like class 3B because that uses infrared, and here's an example of class 3 pads and light pads, so it works in the infrared red blue light spectrum. This is something you can go back and look at, so I don't have time, but this is what the different lights do, the blue light, the red light, and the infrared light for healing and what levels of the tissue that they work at. So cold laser therapy, it increases wound and tissue healing time, increases speed, quality, and tensile strength of tissue repair, decreases musculoskeletal pain and inflammation, relieves stiffness and pain in the joints and muscles, assists muscles and nerve regeneration, and decreases edoema.

Therapy ultrasound is really important for these guys because not only the surgical site, but for all their other limbs because it helps, accelerate wound healing, decreases pain and muscle spasms via muscle relaxation, increases range of motion in limb and joint contractures. So if we're not using those limbs, they start to contract, increases local blood circulation, increases soft tissue mobility, and accelerates fracture healing. And so it helps breakdown tendon calcification, prevents scar tissue formation, and prevents soft tissue adhesions.

Electrical stimulation, great for joint pain, inflammation, neuropathic pain and joint difffusion, but not over the spinal area. Neuromuscular electrical stimulation, this is what I really like to help, because it helps treat and prevent muscle atrophy on the affected limbs, assists in strengthening and re-educating individual muscles or muscle groups, and accelerates wound healing and reduces muscle spasms in these legs that have no neurological function. They start to stiffen up and helps relax these limbs.

Relieves pain and edoema, maintains and increases range of motion and improves the proper muscle firing sequences that we see with our neurological patients. Hydrotherapy, fantastic for these guys, so works many muscle groups simultaneously, decreases post-surgical injury recovery time, and minimises post-exercise muscle soreness, provides resistance throughout range of motion, provides a closed change. Hydrokinetic exercise permits longer than normal training periods, the water buoyancy reduces gravity, diminishing concussive forces on those spinal segments, and reduces stress on the joint and allows early intervention and quicker recovery times.

The warm water assists with pain reduction, helps allow geriatric patients exercise more effectively, and decreases the risk of overheating, but also we can change the water height as the animal adapts and gets better with walking under its own weight and reduces the gaits affected and we, and, and helps with the, Patients with neurological deficits can get in there and actually walk for them and help refire and relearn those axons and neurons to how to walk, especially for the spinal walking dogs that don't have deep pain. This is really instrumental in them developing the ability to walk again. Deepwater swimming only in a registered, Facility after all the surgical site is, sealed, and you have the go-ahead from the veterinarian because it's a thrashing motion, and if they're not using their hind limbs, it really is, and I prefer to do underwater treadmill over swimming, but I put this slide in because other people swear by swimming, so I just put in, but only with a registered, rehab trained swimming professional.

Pulse electromagnetic field therapy, new technology, incredible technology that's coming to market, decreases swelling and inflammation associated with soft tissue trauma and surgical wounds, accelerates bone healing times in relation to bone fractures, relieves pain associated with osteoarthritis, improves recovery. Times associated with degenerative joint disease and alleviates tendon and ligament damage, healing and recovery times. So, accelerates.

Great for osteoarthritis, great for degenerative joints, as I said, but also helps with intervertebral disc disease and neuron and nerve regeneration. And so here's two examples of two different products on the market, the Ili back actually has a brace you can stick it on, and the CC loop is more of a loop you hold over the area. Acupuncture acupuncture, one of my go to everything with invertible disc disease guess electroacupuncture.

Based on the premises of chi, that there is some blockage or disruption in q causing this neurologic disease. So the benefits for patients with orthopaedic problems and also neurologic problems, and there's a great thing for geriatric patients, and those patients don't tolerate anti-inflammatory or pain medications. So here's a, I'll just leave the slide to go back to look at this study, because we don't have time to go through it at all, but it showed that dogs with 3 to 4 grade dysfunction, the group 10 out of 10 of those had significantly higher outcomes than the placebo group, when it came to using electroacupuncture.

Conclusion, electroacupuncture combined with standard Western medicine was effective in reducing short-term to recover ambulatation and deep pain perception. Then compared with those that just had a Western medicine treatment outcome alone, and here's some studies to go and have a look at. Cryotherapy, we want to do cold therapy to increase blood circulation to the area, help detoxicate those bruised tissues, increase tissue repair and recovery times after sporting activities, but also surgery, and helps reduce swelling, inflammation, pain associated with soft tissue injuries.

Manual therapy is really important, includes strengthening massage, joint manipulation and sensory motor exercise, helps manage pain, elicit circulation and influence the inflammatory response, but the passive range of motion exercise increases the availability of nutrients in the joint and stretches the existing muscles and helps keep existing muscle mass there. Therapeutic exercise, here's just a list of all the different pieces of equipment you can use. And each animal has to go home with a home care package.

So, and then therapeutic exercise, we talk about this weight shifting exercise. We want to get the proper reception-based exercises, knowing where their pores are in space, and we want strengthening exercises as well to help build up that muscle, and those muscle bellies that have the atrophied from no use or neurological dysfunction. So the benefits for that, we have cardiovacular fitness, muscle strengthening flexibility, and increases their wellness but also helps them deal with chronic diseases like osteoarthritis and invertebral disc, the other disc later on in life as we know this is a progressive disease that they're gonna deal with over life.

So which modalities when? I know you're all asking this and we're getting to the end of the webinar. So laser, I like class 3B laser.

Therapeutic ultrasound, love it for all the limbs and other joints, but not over the surgical side. Transcutaneous nerve stimulation to help build muscle and prevent atrophy, love it. Underwater treadmill for these guys is really important if you can do it.

Pulseed electromagnetic field therapy is just coming to the market, but this is a game changer for nerve injury and helping with surgical recovery times. Cryotherapy is really important. Thermotherapy, heat therapy, I don't really like around that surgical site to start with, can be used on the extremity limbs, but I don't like doing thermotherapy, but a few people swear by it.

Manual therapy, very important. Shockwave didn't talk about it, but it should be nowhere near as indivertible discs at this time. Acupuncture, chiropractic, really important by go tos, therapeutic exercise.

And swimming, yes or no depending what your stance is, and if you have a therapeutic trained rehab professional in the pool with a patient at all times. So here's a little example of what I do week one. I use in my 4 week in clinic process, and I know we're right on time, so I've got a few more slides and then we'll get to a few questions.

Laser cryotherapy, electrical stimulation, electrical acupuncture straight away. I get these guys in 2 to 3 times, I really hit them hard with electroacupuncture and laser and pulsed electromagnetic field therapy. And so here then, with underwater treadmill, I use a 5 minute protocol, and that's what it's there for.

Week 2, here I'm now using joint manipulation, stretching techniques, massage, modalities, once again, my laser cryotherapy, electroacupuncture, electrical stimulation, and the pulsar electromagnetic field therapy. Now I'm starting to do is I can stand. And wildable boards side to side, exercises, and proprioception exercise, and then getting them underwater treadmill for 2 to 5 minutes.

So you gotta remember, underwater treadmill, 1 minute is the equivalent of 4 minutes walking on that, so these guys can tyre and fatigue really quickly. Week 3, you can see I'm changing is the amount of time that they're in the underwater. Treadmill and adding cavallettis to my therapeutic exercises.

Week 4, I'm now doing them about 10 minutes to 15 minutes, the underwater treadmill, and everything else is pretty much the same, but now I'm doing re-evaluation that we'll talk about in next month's webinar. Nutraceuticals, we're gonna talk about next month's webinar, but these are my nutraceuticals, and I'll give you a whole 12 week nutraceutical and pharmaceutical plan, but these are my go to nutraceuticals, the Daoqui, Duolactin, Relactin, Canniva for muscle building, oral hyaluronic acid, L carnitine, core 10 for muscle building. Ligape for joint regeneration, adequine injection, because it helps, change the oil on these old joints.

But also, I'm actually looking and reading all the research paper on two new nutraceuticals coming to the market soon, that will help build muscle and really exciting, but we'll talk more about those in next month's webinar because I'm running out of time. 12 week home programme, now I can't go through this, I've just given you, The 12 week programme, the speed recovery of the affected limb, decrease pain and swelling post-surgery, enhanced tissue healing time, facilitates the restoration of normal range of motion, further prevents muscle atrophy, and limits the recurrence of compensary problems. We'll talk about that in next month's webinar.

And so I've just given here some rules, these guys that'll be supported all the time. We want to minimise no running or Jumping onto anything, they want crate, rest, and gated off areas, confinement, is really important. We've talked about that in previous slides.

And so, exercise rules are, no running or jumping, no free running through the house, leash walks only with shoulder harnesses, 3 times a day, and quality over quantity, and the owners need to understand the risk. One slip, one fall, one jump. We can undo all the good work that we've done.

So now these, you can go back, I've given you just example exercises for week 1, week 2, week 3, week 4, and so you can go back and look at these modalities, then what to do week 5 to 8 and then 9 to 12. So prevention, we talk about the multimodal approach is really important, prevention in these breeds that predisposed to invertible dis disease, I'm sorry I'm going really fast. We want to lower their weight.

It's really important that these guys, weight is the big thing and we need to keep them in a 4.5 out of 9 body condition score. Well there was a study that showed approximately 35% of older dogs in the United States were young dogs and middle aged dogs, up to 50%, are morbidly overweight, and this excessive weight puts excessive force on the joint.

There was a study done at the University of Tennessee that showed that one extra, 1 pound of weight puts an additional 4 pounds of excess load on the joints if we think of the dog as and I've seen some accounts there. 10 pounds overweight, can you think of 10 pounds it's like a tick, it's a sausage, that's putting an additional 40 pounds of force on those indivertible discs, and no wonder they have indivertebral disc disease. So prevention we talked about walking with different harnesses, bringing in steps and ramps to help make it easier so they can get up on the bed in the couch on into the car.

Pre, we'll talk about in next month's changing their quality of light and diet. So keep muscle core strength is really important for you guys. Here's Tova on the right-hand side, my wife's Belgian melano, there's glue.

And when Tova got degenerative myelopathy, we could no longer take her to the beach to run, do things. You have to change your activities and change their lifestyle so they don't injure themselves or hurt themselves or redevelop another indivertible disc disease at another location. So thank you very much.

Here we are at the end. Bruce is coming on, how much have I got over? 05 minutes over, so I apologise for going so fast I get so much information.

I can hear Bruce laughing there in the background, but I encourage you if you want to come and watch the webinar on, how to do the physical examination, we talk in more depths. Come to veterinary Teaching Academy.com, just join our mailing list, it's free, and we just.

Send out, emails once a month about our up and coming free monthly webinars where I just deal with, rehab-related injuries. And it's called, Canine Rehab Teaching Academy is our branch of veterinary teaching academy just for canine rehabilitation. And at the end of this month, I'll be talking about, really, this is part two of the two-part webinar series.

I'll be talking about more the part one and how to do all your workup, your neurological and your, pain workup, and your diagnostics and talking about surgery. Or you can wait. For the next month or in whenever we can talk to the guys, webinar vet about when we can time up to do the second part to this webinar series.

But I thank you for listening to me, because I know your time is important, and I've gone over, but I hope that you've got some good information. I'm sure Bruce has some questions for me now. John, that was a real whistle stop tour, and I'm sure everybody joins me in saying that we can't wait for the, the other part, part one, which will be part 2.

Yeah, really, really interesting. Couple of questions that have come through. Gordon wants to know, these elderly old German shepherd dogs that get the sort of Code quina syndrome, how well do they do with electroacupuncture without surgery?

These guys do really well and you really need to look at them in a grading system. And it comes back to the grading what grade they are. And most of them that I see that come through are probably grade 2.

They're, they're starting to, they're painful. They're starting to show neurological and knuckling. When you do your neurologic exam, they're not, they're not placing really quickly, but they still can place, or they're starting to collapse more on one side, I notice, than both sides, but then it can compress or progress to both sides.

Just let me get a. And so, drink of water. So, collect your acupuncture is my go to.

Anything that I see that comes in with any type of neurological deficits, I instantly electroacupuncture. Now being in the United States, I'm not a licenced veterinarian in the United States, I laugh, I can work everywhere else in the world, but the United States, but I then outsource them to, acupuncturists in clinic, that then puts needles into them. But that's my go to.

Laser is probably my laser and acupuncture my two go to's for these guys, because the laser. It really helps with, inflammation and just that area. And now I'm pulling in electromagnetic field therapy as well.

And I have a couple of units that I use. I was involved in the CC loop study, and that technology is really exciting and really good, but, and that's coming to, that's now come to market, and it's quite cheap. Where the unit that I was using for the study was about $1000.

Now you can buy these loops for about 30 to $100. 2 questions with that, John. One is what happens if the patients don't tolerate acupuncture.

And the second part of that was, why, why are you not keen on class 4 lasers? Oh, I love Class 4. Class 4 is my laser of choice and what I've been trained on.

And in our clinic, we had 4 Class 4 lasers, and I got a class 3B laser because, it works well on skin infections, and it had a different surgical and post-surgical, so every animal that came out, we we had, in Colorado, we had an outbreak of MRSA, and some of the dogs were going swimming in pools and, and coming back, and, we had Mercer, so I bought the Class 3B laser for treating Mercer for the blue light. And then it works really well with the heating, the pads, because you can do a lot of area. And, but I love the Class 4.

I'm just very conscious about the Class 4 post-surgically along the back. If you don't use the big ball diffuser head, if people are using the collimated, non-diffusing head because you can heat up those invertible spaces, and we had one dog come in, and it had decompressive surgery and, They came in because they said every time the dog has laser. 5 minutes after the laser, the dog is in excruciating pain, and it goes neurological for about 3 days, and we can't work out what's going on, this is the client, they brought it to us, and we felt the back and went, oh, there's something going on here, and we took a radiograph and they had, Secured or cemented the invertible disc or the vertebrae together and used screws that went down and the screws were potentially very close to the spinal cord cavity.

And when we were lasering, we were heating up those lumps of concrete, and it was heating up the screws that were going down, and we're pretty much cauterising the peripheral nerves to the spinal column. And that's where we went, wow, we have to be really careful with our Class 4, especially when we don't know the history of these patients. If there are surgical patients, we now know what's in there.

We can laser, but we then put a a, how can I say, a hospital note out, that we have to be. Really careful with the Class 4 laser that we just use to fuse heads, not collinated heads for the penetration of that light. So I love a Class 4 laser.

They are my go to. I both do, it's like having different shoes for different things. You have Wellington's, wellies or gumboots to go out and play in the rain, or do your large animal work, and then you have your slippers for running around the hospital.

Same thing. It's a different piece of equipment that does different And things. But I, so I apologise if I'm, I sounded like I didn't like Class 4.

I'm just very careful when I'm telling people about Class 4 laser, especially post-surgicals we've opened that spinal column, especially when we've done hemectomies and things like that. They don't have the protection of bone over those nerves. And I just get very scared.

Like when we do regenerative medicine, stem cells, I don't use Class 4s over those joints just because We don't want a potential do anything thermically to those stem cells in that area and treat them back the same. Excellent. John, one last quick question for us, is quality of diet important in preventing IVD and or recovery of it?

Well, I just put there because we're now seeing, especially in the United States, Davis University just put out a study showing that grain-free diets are actually causing cardio, megaley in golden retrievers and large breed dogs because they're deficient in taurine and arginine from these boutique, food companies like Blue Buffalo, for example. And so I just put it there, they're now looking at, are we seeing that now we have these boutique diets and we don't have, great long-term history of what, duck or kangaroo or these exotic proteins and that when they're cooked, how those proteins go across in food. And so these guys, we want to keep them in a condition score of about 4.5 to 5 on the, I like the 1 to 9, body condition score, and to do that, I like to see a high, a, a good quality protein source, so you have to feed less to give them the new.

They need to keep them in a lean body condition score. I know that, and so I just say that because I know some manufacturers, they have to feed volumes, to get to that, and then, and some of the cheaper foods out there, some of the canned foods, some of the rubbish foods that we see. Allow the dogs more carbohydrates and more sugars, and they put on weight.

So my, that's my big comment to that is we need to keep these guys lean and mean, instead of fat. And I find I can do that better with my clients, putting them on a good, good quality diet from a reputable food manufacturer. Doesn't need you up your home cooked diet, but we just need to monitor these guys to make sure that they don't put on weight for the excess.

Force that puts onto those additional invertible discs that we know with chondrodystrophic breeds are all affected, and so it's more for my little dash hounds, things like that. I like to keep them really skinny and lean. Excellent.

John, thank you very much. We nearly didn't make it tonight, but we got through it and we didn't go too far over. So well done to everybody.

And so thank you everybody, hopefully you can come join me or come join me in when we we'll do part one for you guys, but, Anthony asked that I try and hit more the rehabilitative side of things and then come back and do the physical. And, therapy and the physical, my, my approach to how I treat these clients when they walk indoors. So if I had 2 hours, you would have got the whole presentation or good, all good.

We'll get Dawn to to line that up and and sort it all out for us. So John, thank you for your time tonight. Dawn, my controller in the background.

Thank you for getting everything running tonight. And folks, thanks for being with us. Sorry that we've run over, but it really was worth it.

And look forward to seeing you on the next members webinar. Good night everybody.