Hello, it's Anthony Chadwick from the webinarett welcoming you to another one of our podcasts with Vet Chat, and I'm thrilled to have John Waterhouse, who's a very good friend on the line. We're gonna be talking about all things rehab. John.

Tell us a little bit about where you've come from. You, you are, a bit of a mongrel really, aren't you? You've travelled around from Australia, working in America now, just, just, let the listeners know a little bit about, your background.

I would have to say that's probably one of the greatest compliments you've paid me, Anthony, over the years is I'm a mongrel. But yes, I started off, I'm Australian and I I'm an Australian licenced veterinarian, but, 11 years ago, came out to the United States to undertake a fellowship in pain management, rehabilitative medicine for 1 year to take it all back to Australia. Well, things never go as planned and 1 year turns into 2 years, turns into 3 years.

Went to the University of Tennessee and undertook my canine rehab certification training with my wife, Doctor Celia Waterhouse, and then we came back and built a bricks and mortar rehabilitation facility for 6 orthopaedic surgeons in Colorado. Springs because before vet, you could call this part of Mongrel. I have a construction degree and so I got to put both the vet new degree, the rehab or certification and the, the construction degree together to build a facility and once we had built that, Celia, my wife, who really is the brains of the partnership, said, well, why don't we take all that incredible information we've learned over the last 5 years and put that online and train vets around the world with what we have learned, and that's where we launched the Veterinary Teaching Academy, and so that was back in 2015.

And since then, every month we do a webinar on rehabilitation through the canine Rehab Teaching Academy for veterinarians to train them in the area of rehabilitation for certain orthopaedic and non or soft tissue diseases. So we've been doing that now, well, wow, 7 years and have over 70 webinars in the can in that membership designed for veterinarians. So that's pretty much what we do is we produce training, a lot like you, and to try and educate our profession on this great field called rehabilitation.

That's fantastic, John, and I think actually I started Webinarett under the tutelage of Stephen Essa and I think actually Stephen introduced us to each other and I would say, For those of you who don't know John, and obviously this is a podcast, and Celia, Celia is not only the brains, she's also the looks as well, but, but John, you've got a great personality, haven't you? What did they say? I have a face for radio.

Yeah, I, I'm, I'm the same. I'm the same, no, he's actually, he's a good looking man. You're, you're missing out and in fact this is one of the benefits of.

The webinars, because I presume the one we've just done with you a couple of weeks ago, you actually showed your face on the webinar or do we just see your slides, John? No, I, I started new technology, actually we were laughing about trying to set this up. Technology and myself aren't great.

So it took me about 3 weeks of hard work to perfect how to record video at the same time as PowerPoint at the same time as audio and I've now perfected it, so yes, you were the test case of. Of recording video live while I did the presentation because I get quite animated when I present on a topic that I believe and love in. And so I find that gives another dimension so people can see me getting excited, but also see me working with models and things in my hands to help describe what I'm talking about on the slides.

No, that's brilliant and I just advise people to look up if, if you want to on the site. It is, looking at the, the treatment of osteoarthritis, either surgical or non-surgical. And John's a great speaker.

I know you piled a lot of content in there, and as you said, the benefits of webinars is you can stop it, start it again, go backwards, go forwards. I, I remember, I think it was at one of our virtual congresses, one of the first ones. When you came on, I think it was also with a colleague.

And this was a whole new area for me as I'm sure it is for a lot of vets. Where that whole idea of the sort of physio side as well comes into it, where, you know, just because a a a dog has damaged, for example, a cruciate ligament, we're a bit obsessed in the UK with them repairing that surgically, but sometimes, actually rehab will be enough, particularly for smaller dogs, maybe talk a little bit about how you pick where, A dog needs surgery and where, you know, rehab will be sufficient to bring it back into full use. Well, as now we've got technology, I call it surgical and non-surgical options for cranial cruciate ligament, we can now brace them, and bracing with custom orthopaedic bracing really has progressed massively over the last decade.

There was a great study done by the, vet school just up the road from us here in Colorado CSU, and they did an MRI of a stifle joint in a brace, and they put it under load, and they showed that the bracing, a custom orthotic brace, stopped about 97% of the sheer force of the tibial thrust. And so now we actually have a really great documented modality or model that we can use to stabilise that stifle joint, but that's all we're doing with sur surgery is small dogs. We're doing the tight rope or the fishing line technique or whatever you call it in which country, and that's just stabilising that forward thrust while the scar tissue forms around the stifle joint.

And so what the brace does is that it usually takes 2 weeks to order, comes off a plaster, they make a plaster cast, they send that cast off to a company like Ortho Petts down the road in Denver, and they make a mould and they actually build the custom brace around that mould. And so it's custom for that patient's stifle leg anatomy, and it prevents forward thrust, so they're 95% active or functional once they get the brace on two weeks later. The COVID is they've got to wear that brace for 6 to 9 months to allow the scar tissue formation to evolve.

With surgery, we know they go straight into surgery, TPLO we cut the bone, they then are post-surgical, I treat them like a a fracture repair, they're out of action for 6 months. So at 2 years down the track, studies have compared surgical and non-surgical options. They are the same amount of osteoarthritis, degenerative joint disease for either process, so it, As now as technologies come along we can see that either one works, but some dogs are not great candidates for surgery.

They may be old, they may be overweight, they may have pre-existing medical conditions or they've been hit by a car, they've got fractures elsewhere, they can't go to surgery, or they may have owners that don't believe in surgery at any cost. We now have great alternatives that we can offer them. And that was a real light bulb moment for me because, obviously I was a dermatologist and and didn't do a lot of orthopaedic surgery, but I've done some earlier on in my career and I think, There can be an obsession sometimes with, with healing things through surgery, whereas if you could avoid a piece of surgery.

It probably is always to the better, isn't it, not to put a dog through a, a general anaesthetic if there can be. You know, there can be an alternative to that. Just interested again with the cranial crucid repair.

Obviously if you've got the cast on, are you able to do rehab on that joint or does that sort of stop movement of the joint as well? So when I said that a cast, we do a fibreglass cast of it and then we cut the cast off. And then they get a hinge joint, so it's hinged in the stifle, it just can't go forward and forward thrust.

So they can walk, run, they can do everything that they could have done pre-injuries, about 95%. We say don't let them go running and jumping off things and doing that, but they're pretty much functional. They've got it, but when we're doing rehab, we do it all with the brace on, except for certain exercises like passive range of motion.

Massage, icing or heat therapy, we take the brace off, but the brace is on all the time that you're in supervision of the dog. The braces on, that's the cave because the dogs can destroy that within a few minutes and it's $1000 worth of hardware that gets munched very quickly. So when the dogs are never left unsupervised without the brace.

So overnight you take the braces off, yes, yes, and you confine them to a laundry or a small room so they can't go running around you keep them confined to an area, because we know, Over the last, how old, 40,000 years or more, millions of years, dogs have blown their cranial cruciate ligaments. As long as they could eat food for the nine months, get food, the scar tissue formation happens and they're up and running. It's about getting food and they will heal.

Naturally in the wild or we look at street dogs around the world, you can see they're limping because they've, Potentially torn and cranial crucial ligament, but it will heal to be some function. With bracing, we can get them back to in the 90% range of function after we take the brace off 9 months later. And I suppose bracing is part of it, but then it's obviously all of the all of the exercises, all of the physio type exercises you have to do, it's making sure you know how to do them, it's doing them properly.

We almost need, John, something like a Jane Fonda workout for dogs, which would show how those exercises were done. So maybe that's something that you should think of doing, John, for example. Amazing that you bring that up because we're just launching.

That programme we've been in development now or testing it for 9 months, and it came about because of this little pestic bug or bacteria or virus called COVID. And as COVID came out, my students or vet students around the world, other governments came in and took their respirators out, and some clinics lost their anaesthetic machines because they went to human hospitals. And so my students are saying, or the vets say, What can we do, we can't do surgeries, so I can't see clients, can we somehow give clients access to your veterinary teaching training?

And I said well why don't I do one better? And so we've taken the educational portion of the canine rehab Teaching Academy. I then went and recorded all the videos, wrote all the exercises, and created 12 week rehabilitation programmes for the top 20 most common orthopaedic diseases.

We now have 10 top 10 up. We beta or beta tested depending which country you're in, over the last 9 months, and so that was launched about, 34 months ago, canine rehab on demand, and that program's designed for the public to be able to do rehabilitation at home, but also for the veterinarians who were members of my teaching academy, but actually now we're opening it up to all veterinarians, to be able to profit share and give back to them, so we have a 40% affiliate fee for our members when they refer the programme we give back. They're able to give something to Mrs.

Smith who can't get in to see them now because we're so busy. They get a degenerative myelopathy or a hip dysplasia programme. Mrs.

Smith, do these exercises at home till we can see Scruffy in 2 months' time. Mrs. Smith's happy.

Scruffy gets some treatment, and the veterinarian makes some affiliate commission. So in that, everyone wins and now we're training the industry, but more importantly training the public on the benefits of rehabilitation. Fantastic, John, and obviously what we can do at the end of the podcast is just put the various links on, so if people want to contact you afterwards, they can, they can do that.

So, John, obviously we're talking about cruise ships there and, and again we mentioned in the webinar and I'm, I'm loving it at the moment, I'm just looking out in my garden, I've just had two wood pigeons climbing in. We obviously can't do . Physio for their osteoarthritis, but perhaps talk to us a little bit about the, the webinar you did, the surgery versus rehab for those osteoarthritis cases, where do you see, Cos osteoarthritis is obviously such a common condition, is this something that your .

Seeing a lot of areas where rehab can take the place of having to do surgical repair, I suppose things like. Hip replacement or or actually taking a femoral head out. Is there a, is there a rehab opportunity there instead of doing surgery that you could use rehab to, to prevent surgery?

And if so, maybe talk a little bit about that. So we know that certain breeds, and I don't think if you've seen the site, we actually have a hip replacement and a femoral head osteotomy post-surgical programme, 12 week programme as well in the 10 programmes we have, but, Anything with, we'll call it degenerative joint disease because osteoarthritis is the clinical term of the disease, but really it's the degeneration of the cartilage of that joint that causes degenerative joint disease that end up is what we call osteoarthritis. And degenerative joint disease is a multi-factorial disease.

So there's 5 to 10 different factors that affect from puppyhood if their joints, Develop correctly, if we're spraying or neutering them pediatrically, their joints will actually grow long, the bones will grow longer so their joints don't fit, correct nutrition, overweight, underweight, we know we get OCD lesions, in the shoulder joint or elbow joint in large breed dogs when they're growing if they're overfed, . We look at overuse exercise, under use exercise, all these environmental factors, genetic factors, all come in that bubble of what we call degenerative joint disease. So if we can bring in plans, if we can understand what exercise physiology, nutrition physio or nutrition, pharmaceutical, nutraceutical, surgical options, all of these come together in what I call the multimodal approach that we use to treat our patients to try and limit the chances of them getting degenerative joint disease later in life, because we know some breeds will have hip dysplasia like their ball and socket.

Doesn't even talk to each other. Other dogs may have a traumatic injury when they're young, fracture hit by cars. We know that though or they're confirmationally bulldogs, things the great British bulldog.

It is a confirmational nightmare and . When you talk about mongrels for me, it's like, you mean we know that that guy is going to have a hard life later on. So if we can bring in strategies early on, multimodal approach, rehabilitation, physical therapy, we can slow down the progression of degenerative joint disease and hopefully give them the best quality of life for the longest time before we need to go more drastic surgery, pharmaceuticals and that, to give them a good quality of life later on.

And I think this multimodal approach is so important, we've done it for a long time in anaesthetics, we tend not to just, you know, use gas to induce an anaesthetic, we use an injectable thirst, and I always use that as an example. Within dermatology where obviously. You know, you wouldn't just use one drug, you'd be using shampoos, you'd be using flea treatments, you'd be using a food trial.

All of these things to help control and make the animal more comfortable. So it's, it's a more holistic approach because it's looking at the whole animal rather than just saying surgery is going to be the answer or rehab is gonna be the answer. So no, that's really .

That that's really powerful. Do you do much rehab, interesting question, and I suspect, a bit more trying to do in cats. Cats are a little bit more trying, but we know that 90% of cats over the age of 9 will have osteoarthritis in one or multiple joints.

Some people say it's the most common disease in cats, don't they? But again, because cats don't want to show their disease, it's actually difficult to spot it, but they in fact do have it. I'm gonna throw you a question.

Go on, this is putting you on the spot, drum roll. What percentage of cats do you think are diagnosed with osteoarthritis? Probably 10 to 20% maximum.

Oh, closer with the 10, about 5%. A study just came out, and, so they're the they're the little warriors because we don't walk them every day. We don't play in the park, we don't throw the ball.

The cat's a sedentary. My 19 year old cat usually sits here on my desk and I'm doing rehab and different tech modalities with her. But they are very stoic.

And so we don't see and pick up those changes like we do with dogs. And so, rehab is actually very good, but it's also very hard because we the the joke is when you wrap your cat up, there's always that fifth leg that gets you, the 5th paw. They don't like doing the exercises as much as dogs do.

So we need to think more changing environment, we need to think nutrition, we need to think supplements, nutraceuticals, and pharmaceuticals, things that we can do. Without touching them more so than what we do with our dogs, we can do all the sit to stands, things like that, we can play ball with a cat and a laser pointer, but they're a lot harder to deal with when it comes to rehabilitation, and actually next year is my feline year and I'm going to create. Programmes for felines because there's nothing out there.

And take what I've done for the osteoarthritis hip and elbow dysplasia programmes and transfer that over to cats and then try and build and work out how to do a 12-week rehab programme with cats and what exercise you can do, because you might see 2% of the patients that come in the door for rehabilitation are cats. And so, knowledge of what to do with cats is also very limited. I think it's really interesting.

I was adopted by a cat during the pandemic, John, myself and Rachel, . And basically we, we in the end found out who the owner was, but he just kept on coming back to our house and I think it was quieter, they didn't have dogs, they didn't have kids, he didn't have kids grabbing him. So I think he saw it as a retirement home for himself.

He's about 15. You can tell when he walks that he probably is a tiny bit stiff, but actually he's still able to jump on top of the the roof on our sort of outbuilding. You know, get onto the top of fences, jump off the, the window to come back into the house.

So they, they obviously cope, but at the same time, it, it is, as you say, a really misunderstood area because I remember one of our first ever webinars, Duncan Laces gave it and he said, you know, of all of the conditions of cats, which is the most common, is it skin, is it kidney, is it dental? No, in fact, you know, it's osteoarthritis because the majority of them, this cat is 15 buddy, he almost certainly will have osteoarthritis, won't he? Yes.

And there are, but that's also the trick. So I'm at the moment in a 6 month trial of, PEMF technology, electromagnetic field therapy. And I have my great German shepherd, he's now 9, and he's got medial shoulder syndrome, not instability.

But we went and radiographed his shoulders and elbows, two weeks ago, and he has slight mineralization in his tendons. In his shoulder. So he doesn't have laxity, but he has inflammation.

And so I'm using this, pimp bed, but dogs, it's very hard to keep them on the bed for treatment. Cats are different. So we have the cat bed set up on my desk.

I have another little pimp pad underneath there, and every time I sit here, I'd lean over, press the button, she gets a 15 minute treatment, lean over, press the button, she gets a 15 minute treatment. She has improved about 5 years. She's gained 5, the time capsule's been turned back 5 years, she's now going up and down the stairs, going outside, playing in the garden, jumping on butterflies and that, chasing things in the backyard on the grass.

Things that she hasn't done for 5 years, she's now able to do. And so, but that's very passive. All I do is reach over and press a button on the machine and she gets a treatment dose of electromagnetic field therapy.

Same thing we mix into a food, right, there's a product called myos, and that builds muscle. And there are other things that we're doing that are very subtle that the cat doesn't know we're doing but are having changes in their quality of life and that. Dogs are different.

When you see you tell your dog to lie on the mat, they think they're in trouble, you know what I mean, it's, and you're never in the room when they're lying on the mat to run up and press the button. So that's made it, I, you have to box them in with chairs to give them treatments. So, I'm learning that dogs are harder to give treatment to in some areas where cats, And feline's actually quite easy if we're doing it subtly and what's subliminarily, they don't know what's going on, you just sit there and you just treat them and that's the way you've got to treat them without treating them.

It's been fascinating, obviously following your journey over the last, probably 5 or 6 years and seeing, you know, these new treatments like the electromagnetic treatments as well. It's, it's obviously just a young discipline that is just continuing to grow. Obviously even in the UK we're seeing it with the help of yourself on the webinars, so just want to, to thank you for all the, the hard work you're putting in this, in this field, John.

Well, it's fun and it's making a difference and that's where the canine rehab on the demand, we're actually pivoting next week and we're allowing veterinarians then to prescribe just the 12 week programmes after surgery. Because most small vet clinics bring in outside orthopaedic surgeons to do the surgeries. The surgeon throws his last stitch, takes his gloves off, and now the patient's the responsibility of the vet hospital.

And so a lot of the vet hospitals that were testing or my programme said, can we just give the 12 week programmes because that would be a great adjunct to surgery, to be able to send the animal home. So we're trying to, technology, we, we were laughing, getting all our microphones and that working and poor Charlie was pulling her hair out, but we're trying to work out a programme, billing programme where vets can collect the money upfront in their till. At time of discharge, or at least say Mrs.

Smith, here's a programme that we think would help Scruffy after surgery, go to, here's a link and it's your affiliate link and then they can purchase the programme off outside of the clinic and at least get going, and so we're looking at that and these are early days as people are asking for changes we're, Trying to make the changes, but I think that will be a big one because now vets have the opportunity, they don't have to learn that new discipline, but they can prescribe rehabilitation at home for their patients and the clients are ecstatic, the patient gets the treatment and everything we do is to make the vet the hero of the story. COVID has, has been a terrible thing, but. Within that there's always silver linings and blessings, and I think one of them is practises and people, general public are becoming more and more digitally transformed.

They're seeing the advantage of things like this, obviously, the stuff that we do as well, but also bringing that digital transformation into how to book appointments and the vets. All of these things are, are coming and I think it's, you know, it's a great thing to see. So John, I wish you all the best with the the new programme.

Obviously we will put all the links on. If anybody's listening and wants to know more, obviously get in touch with John and yeah, we'll, we'll hopefully speak again soon. I.

I remember just to finish off spending a very nice few days with you when I came to your house in Colorado and immediately you took me up the mountain to Breckenridge and . I was struggling for the next two days with what I thought was chest pain but was actually just oxygen sickness wasn't it? So I finally caved and started taking oxygen and felt a lot better, but it's it's great to see you again and hopefully with things opening up, it won't be too long before as much as we love the virtual, we can get to meet face to face again.

Very true, and thank you also for, yeah, having me on, and I love doing webinars because it's about training. It's about getting the education out. As we said at the beginning, my webinars that you, I talk really quickly and I cram a lot into those webinars because there's so much exciting stuff out there that's coming out that can change how we treat our clients.

But also change how our staff interact, train the staff, giving them new technologies and new learning so they can get enthused and because one of the other big problems is staff retention. And by bringing in new disciplines to the hospital, giving them new things that they can learn about, we find that we're keeping our staff longer, their staff are happier, the clients are happier, and everyone wins. That's brilliant, thank you so much for your time.

I give my love to Celia and hopefully we'll speak again soon. Love too, bye bye. Take care, bye bye.