Understanding and Treating Nerve Pain After Amputation for Dogs: Tripawd Talk Radio #124

Welcome to Tripawd Talk Radio #124, a conversation all about helping your Tripawd feel less nerve pain after amputation surgery.

Nerve Pain After a Cat or Dog’s Amputation Surgery is Common, and Treatable.

Have you ever noticed your cat or dog’s muscles twitching near the incision site during amputation surgery recovery? Or, have they ever jumped up with a sudden yelp, weeks after their leg was removed? These scary behaviors are common signs of nerve pain, and phantom limb pain.

Gabapentin and other pain medications are often prescribed to address nerve pain in new Tripawds. But what exactly is “Nerve Pain”? And how can something called “Sensory Re-education” help it go away?

Learn How to Reduce Nerve Pain After Amputation or Injury with Sensory Re-education

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Meet the Expert, Ilaria Borghese, MS, MA, OT, founder of TheraPaw and VitalVet

Ilaria Borghese is the founder of TheraPaw, a maker of dog mobility braces and supports. She is also the founder of Vital Vet, an amazing educational resource for all special needs pets. As longtime fans, we are so excited to have her on the show today.

Play our Tripawd Talk audio file above, watch the video below, or read the transcript in full to understand the difference between General Pain and Nerve pain in animals. Ilaria shares her expertise about phantom pain and muscle memory. And, she explains how the VitalVet Desensitization Protocol can help rewire the brain after limb amputation, without additional medication.

Ilaria walks us through “Sensory Re-education” with simple, practical steps you can take to aide in your pet’s amputation recovery, and nerve pain management, such as:

• Remapping the brain with different types of fabric to stimulate the senses
• Easing pain and getting stronger with Transcutaneous Electrical Nerve Stimulation (TENS), Pulsed electromagnetic field (PEMF), and weight bearing exercises

Watch Nerve Pain Management for Tripawds Interview on YouTube

Transcript: Tripawd Talk Radio Episode #124

Understanding and Treating Nerve Pain After Amputation for Dogs with Ilaria Borghese

Tripawds Jim: [00:00:51] Hello. It’s Jim and Rene from Tripawds again. Back with Tripawd Talk Radio, Episode Number 124.

Ilaria Borghese is the creator of the therapy orthopedic dog boot and founder of Vital Vet, an amazing resource for all special needs pets, and we’re excited to have her on the show. Today, Ilaria talks with Rene to help us understand the difference between general pain and nerve pain. We discuss phantom pain and muscle memory, and she explains how the desensitization protocol can help rewire the brain after limb amputation without additional medication.

Ilaria walks us through sensory re-education with simple, practical steps you can take to aid in your pet’s amputation, recovery and nerve pain management.

Check the show notes for links to more helpful information, and be sure to take your own notes as we learn what you can do at home to help relieve pain for your dog or cat. Ilaria, thanks so much for joining us today.

Ilaria Borghese: [00:02:19] Oh, thank you so much for being here. I’m actually I’m thrilled and very honored. Very well.

Tripawds Rene: [00:02:24] We are too. Ilaria, this is Rene, and I have been wanting to meet you for a long time because our community has been really familiar with your work ever since therapy and now vital vet and all of the work that you do to help special needs animals. Please. For those who are unfamiliar with your background, can you give us a snapshot of what you have been doing in the animal community?

Ilaria Borghese: [00:02:50] Sure. I actually started out as an occupational therapist working with predominantly with children, but I had a lot of dogs. And as an occupational therapist, what what we’re trained to do is we we actually help people accomplish their daily tasks. So whereas physical therapists help people get from point A to point B, be it with crutches or wheelchairs or a walker, occupational therapists actually help people accomplish the task once they get there. So it’s bathing, dressing, feeding themselves, toileting, the whole nine yards. Occupational therapists are very well versed in assistive devices, adaptive equipment making braces, that type of thing.

My animals started to get injured because they were crazy greyhounds off the track and we had a great time in the back yard. But, you know, there were a few injuries that that they sustained. I wasn’t really thrilled with what was available for them back then. So I started bringing some things home from my practice, and I started to formulate some things for them.

I started to make thermoplastic splints for them whenever they had a sprain or a fracture. Instead of having to cast them, I could I could have them splinted so that I could do some range of motion or some massage for them.

Ilaria Borghese: [00:04:18] I had several greyhounds that had foot problems. So I developed the therapy boot, which was the first product that I developed. And so once I started developing these products for my dogs, then, you know, the door, the floodgates opened and people started asking me for similar products.

I started manufacturing those products. And then the next thing that happened was that people were asking me for things that were either already on the market or things that I did not have developed yet. “Hey, you know, my, my dog had his limb partially amputated. Can you make me a prosthetic?” No, I can’t, but I know several companies that can, and here they are.

I was always referring people out to all of these different companies, and many of them were small. They had started out in a practice like I had, and they had developed a product or a couple of products for their own pets. And that grew into a little niche market that they had.

But all of these companies were spread out all over the globe. Basically, I knew them. I knew a lot of them because I’d gone to conferences and I’d met with them and I knew from my dealings in working with animals with special needs, how many companies were out there. And I was wanting to get a resource to have all of these companies put under one umbrella.

Ilaria Borghese: [00:05:45] And that’s where Vital Vet came in. So vital vet is basically all rehab assistive fitness products for animals with special needs. Whether it be weight loss and weight management to senior pets that are having issues with like mobility or, dogs with injuries like amputations. Everything’s under one umbrella. All of those websites are there. Not just our products, it’s everybody’s products.

It also helps veterinarians as well, because let’s say a dog is looking for a prosthetic. You know, a pet parent is is is looking for a prosthetic for their pet. There are several prosthetics companies out there. And so the veterinarians can look through all of those prosthetics companies. All the companies that make prostheses for dogs, and then they can review all of their choices with the pet parents. They can get together and make the best choice for them and for the animal. So yeah, I love that.

Tripawds Rene: [00:06:57] I love that about Vital Vet. It’s interesting how so many people have come from the human space into the veterinary space, and that’s what’s driven all this innovation since we started Tripawds. And I think therapy has been around a long time. When did you start?

Ilaria Borghese: [00:07:17] So TheraPaw started in 2001, with the dog boot. And as a matter of fact, I dealt with my own amputations. They were toe amputations, my greyhounds had several of them had corns in their toes. The way it was dealt with back then was to amputate the toe. Well, you amputate the toe, you get rid of the corn, but then a corn or a callus develops on the other weight bearing toe.

And then there was a point where I didn’t know any better. I had one dog who had the three toes on his back foot amputated. He only had one weight bearing toe, which was his outer toe, which was the smallest toe that he had. And his whole foot was a mess and he just couldn’t utilize it. I mean, it was it was not functional. I ended up making him not only at that time, I already had a therapy boot, but I ended up making him a big, thick sheepskin slipper for indoor use because he couldn’t even use his foot inside. He couldn’t even weight there just with his little toe.

So therapy has been around for quite some time, and it was that first product that I had made for my dogs with toe amputations that were only comfortable on the carpet or grass. And at that time, I was actually living in New York City.

Ilaria Borghese: [00:08:43] The TheraPaw (boot) is really heavily padded and thick at the bottom. Then this neurologist, who is a local neurologist, said, ‘Oh, I’d like to order some boots for my practice.” And I said, ‘Why are you ordering the TheraPaw boots? And he said, “For our dogs with sciatic nerve injury that are dragging their back legs.” And I said. ‘But, you know, TheraPaw protection is at the bottom. And these dogs are dragging, so they’re abrading the top of their foot.” And he said, “Aha! I have the answer.”

I flipped the therapy boot upside down, so the tough part is on the top of the foot. And I have this whole vision of this dog dragging its leg with the boot on. And yes, it’s protecting the foot, but it was totally not functional. My occupational therapy mind went crazy and said, ‘That’s not functional at all! We have to fix this problem.’ With that boot came the DorsiFlex assist, which is basically elastic straps that help to pull the foot up and position the foot properly, so that a dog with sciatic nerve injury can actually have assistance in placing their foot. And then it went from there.

Tripawds Rene: [00:10:11] One of the articles that you wrote caught my eye because it’s talking about nerve pain. People get their dog’s leg amputated, and we pet parents don’t realize these are nerves that get severed, and these are nerves that are angry. They don’t know what to do with themselves! Let’s talk about what amputation does to the nerves and how it may or may not affect animals after amputation surgery.

Ilaria Borghese: [00:11:32] Sure. It all goes back to the brain and how the brain projects what what the image of the body is on the brain because the brain doesn’t really see what the body is.

The brain actually develops a picture of the body based on sensation, based on feeling. And a perfect example of that is when a baby’s born, baby’s crying. Their whole sensory system has gone awry. They they’re just born.

And what what do people do? They swaddle the baby. They they put a nice, you know, blanket over it and swaddle it. And, and what that does is that allows a lot of sensation throughout the entire body. And that helps to calm the nervous system and calm the brain down and say, ‘Oh, okay, my body is in this tight little space right here. It’s not all over the place, and it helps to calm the nerves that way too.’

So it helps the brain to formulate a picture of where the body is in space, and that helps to calm the nerves and helps to decrease pain. So as the child or the puppy grows up, they know where their body is in space because of all of the impact that the body is receiving when the body is moving through space. When a limb is amputated, the brain has no idea that that limb is gone.

Ilaria Borghese: [00:13:07] None whatsoever, because the brain has a mental map of what that body looks like in the brain, and it has no idea that the limb is amputated. So the brain has to relearn where that body starts and ends. Now it ends a little bit differently.

And so what happens is the brain is saying, ‘Right forelimb, move! Well what do you mean you can’t move? You don’t have a right forelimb?’ And the brain has no concept of that at all. The brain is trying to move the right forelimb. The right forelimb isn’t moving because it’s absent, and the brain sort of goes on a short circuit. And that actually can manifest itself as pain.

The brain is actually in pain because it doesn’t know where its body is in space because it’s gone. That is a part of the equation. The other part of the equation, of course, is also at the surgical site. The nerves are damaged, the nerves are severed. And that causes a lot of discomfort and pain as well. With amputation, the brain’s body picture is distorted.

Ilaria Borghese: [00:14:32] It no longer matches what the brain thinks the body looks like. And so what we try to do with desensitization and a sensory reorganization type of protocol is to try to reteach the brain where the body is now, so the body no longer has this ‘limb brain,’ to understand that ‘I don’t have this limb anymore. And this is where my body ends.’

Tripawds Rene: [00:15:05] This is so fascinating to me because in all of our years of doing Tripawds, this is something that hasn’t been discussed with veterinarians that we’ve talked to, or rehab therapists. But it’s such a major part of the recovery, this de-sensitization process.

Normally we think that Gabapentin will take care of this. Boom. We go home with it. It’s supposed to help. But why does it not always work? And what can we do to help it work?

Ilaria Borghese: [00:16:01] So let’s go back a little bit. When the amputation first occurs, the brain hasn’t caught up with the fact that the limb is no longer there. And so it starts to send out signals and the signals are going nowhere. That manifests itself as pain.

Sometimes it depends. Dogs react differently sometimes. Dogs kind of recover as the wound starts to recover. And because the wound is being managed, you’re getting a lot of sensation in that area where the wound is being managed, it’s being cleaned, it’s being re-bandaged. All of that is sensation into that amputated portion.

And that is helping the brain sort of re-formulate the picture of what the body looks like. But sometimes it takes longer. And so that’s where Gabapentin comes in. And as we all know, sometimes medications work on some dogs, and not others. And sometimes it’s kind of hit or miss. So you try it and see if it helps. But with a desensitization protocol there are no medications that are involved. And it can only help. It can’t it can’t hurt.

Ilaria Borghese: [00:17:26] It helps the process along. And it also helps to maybe reduce the sensation, reduce the time that the animal spends in pain, and also helps with healing. Because the more sensory input you can get into that area that’s that’s been damaged, the faster the brain recovers. And when the brain recovers, the body recovers faster too.

Tripawds Rene: [00:17:52] What I really love about this, this process that you’ll describe today is that it’s not it’s not woo-woo. Forgive me, I know Reiki can be really wonderful, but I think that in a case like this, when an animal is in a lot of pain, Reiki may not always be the answer. You know, therapies like that hands on healing, that sort of thing.

It can only, like you said, it can help, it can’t hurt. But I’d like to do something more effective. And when I hear about a dog that’s screaming out in pain, or we get this a lot where a cat will start walking backwards suddenly like they’re trying to get away from their missing leg. Generally this kind of thing happens shortly after they come home, but sometimes it happens weeks, even a couple of months later, where an animal will start jumping up all of a sudden, like they just got an electric shock.

From my conversations with human amputees, phantom pain is pretty much identical in in non-human animals as it is in human animals. Is phantom pain always nerve pain? Is nerve pain always phantom pain? Or are there different types?

Ilaria Borghese: [00:19:04] It’s sort of a sort of a general broad category because it does present it in different ways. So when you’re looking at signs of pain in general, pain can manifest as anxiety or nervousness. It can manifest as fear. It can manifest in changes in behavior, like the animal doesn’t want to eat or the animal you know is whining or crying. But when you’re looking at nerve pain specifically, and when you’re talking about nerve pain so that that actually looks a little different, you’ll have excessive licking at the site of the injury or gnawing at the at the level of the injury. You’ll have overreaction to stimuli or touch.

When you’re talking about that cat jumping up like it was an electric shock, a lot of that overreaction is just one tiny little thing that can that can feel like pins and needles. Now, you and I understand, let’s say if we sit down for a long time with our legs in a certain position, we we get up and we get all that pins and needles sensation, and you and I can make sense of that. It doesn’t make sense to an animal at all. So a lot of those pins and needles can be very distressful for an animal.

Ilaria Borghese: [00:20:21] And not only that, because the brain hasn’t figured out that the limb isn’t there yet, they’re trying to utilize it. It can be quite scary to see an animal trying to trying to figure out how to use its body. And it just can’t figure that out just yet. And it’s it’s a painful thing.

When the brain is trying to think about utilizing a limb that’s not there and it can’t do it, that often manifests as pain, the brain will register that as pain because it’s unable to move that part of the body. So when you’re talking about phantom limb pain, it’s sort of this general category that can manifest itself as like a slight overreaction to stimuli, to all of a sudden an animal thinking that it’s that its limb is they aren’t trying to utilize it and going crashing nosediving into the ground. It’s this whole thing about the body again, not realizing that the limb is there and that manifests itself from, you know, it’s got a whole spectrum of of how it can manifest depending on where the pet is in their state of, in their level of recovery.

Tripawds Rene: [00:21:32] Is a muscle twitch the same as pain?

Ilaria Borghese: [00:22:08] It can certainly be muscle twitches, or a hallmark of pain. So when you’re, you know, you’re using your fingers and you’re going down the spinal spinal column and you’ll see the back muscles kind of twitch, that’s areas of of tightness or tenderness in an animal. When you see muscle twitching, it can be pain. And it can also be residual nerves firing, trying to get a muscle to work that’s no longer there.

Tripawds Rene: [00:22:38] Had I known about your sensory re-education process, I would have done that to (our Wyatt) long ago. Can you tell us more about that process? And what we can do from the time that we bring our our dog or cat home from the vet, until later in life?

Ilaria Borghese: [00:23:19] Sure. With muscles, it’s not just their end range. They have they have a beginning and an end. So when you see (Wyatt), even though he had a mid femoral amputation, that muscle still had connection at at the humeral level. So that’s where that twitching is coming in. And that the he’s probably still trying to utilize that limb to some degree, or there’s some residual memory of how that limb used to be. It’s sort of like, you know, muscle memory, like they talk about with sports. It’s just a habit where that muscle always wanted to move because that’s what he used to use to use that leg.

Tripawds Rene: [00:24:05] Yeah. We see that a lot with dogs who have a back leg amputation. When they try to do what we call ‘air scratching.’ They’ll take the missing leg and start to try to scratch their ears. It’s like the saddest thing in the world. We always had a back scratcher handy for Wyatt.

Ilaria Borghese: [00:24:30] So let’s say you have a dog with a nerve injury, that’s not an amputee. The dog, let’s say, is dragging its leg and abrading its foot. The pet parent might bring him in to the vet. The vet will say, ‘Well, you know, it takes a while for nerves to regenerate. Let’s go ahead and bandage the leg to protect the leg and then we’ll see if we get regeneration. Wait a month or two and then we’ll see where we’re at.’

But what happens when you bandage the leg is yes, you’re protecting that limb, but you’re also covering it so it doesn’t get any sensation whatsoever. And the way you actually help nerve to regenerate is to flood the system with sensory input. To get sensation into that limb, into that, that place where the nerves have been injured because the nerves are saying ‘I’m injured! I’m not quite sure how to react to to the environment.’ You’re just wanting to bandage the leg and it’s not getting any information.

Ilaria Borghese: [00:26:02] So what you want to do is you want to add sensation, add stimuli to that limb. To allow the nerves to get the information that they need in order to heal. So when a limb gets amputated, you’re going to have that area that may be hypersensitive and that may have sort of odd type of sensations to it.

What you want to do is flood that area with sensation. You want to say, ‘Hey, brain, this is where my body ends in space. And so therefore I’m going to make sure that you understand what that feels like.’ You want to basically flood the system with as much information as possible.

What happens when we walk around during the day, we get all kinds of environmental stimuli. We’ll put on some nice soft slippers. We get something harder, we take off our shoes and walk on the sand. We get something cold, like the cold water. We get something hot, like when we go into the bathtub. So our system is always getting flooded with all kinds of sensations. You know, it’s something rough, like the sand. And something soft, like our our socks or our slippers.

Ilaria Borghese: [00:27:28] That’s the same type of thing that you want to do to that stump area. You want to flood it with sensation. But because it’s hypersensitive, you have to be really careful about how you proceed.

You want to go from the mildest, softest, lightest things and the lightest touch to something that’s a little bit more rougher and longer duration and more sensory input.

You never want it to be painful and you never want your dog to be anxious about it. You never want your dog to be painful.

This is not that type of reaction where you’re sort of forcing a stimuli on the dog. You actually want it to be a nice, easy transition from one stimuli to another, and also from different temperatures, different materials, different sensations like vibration.

When we look at the protocol that we developed for the article, we’ll go from the lightest, which could be like introducing a piece of chenille or a piece of fleece on that stump area and petting them lightly with it.

What I always recommend is before you go to that stump area, you do the same with the other leg, the non missing leg. Right? And even though it’s not missing, and even though you can’t get into that whole stump area, let’s say it’s their front limb.

Ilaria Borghese: [00:28:54] Rub their shoulder, rub their shoulder with the chenille first, okay. And then go over to that stump area shoulder and then rub their that shoulder with the chenille so that both sides start to feel the same.

Then you progress to something that’s a little bit more abrasive. Then you’ll go to something like a terrycloth, which has a little few little nubs on it, and you don’t want to do anything too drastic. You want to move from something like chenille or a fleece to a terrycloth. You might go then step up. If the dog’s okay with that, you might even step up to something like a burlap.

But this is this is done through a period of time. Phase one, which would be our first phase where we get started, we are going to start with the chenille, something that’s really soft. So take a piece of chenille, rub their non amputated portion of their leg with it and then go to the amputated side the same place and then rub the chenille on that side.

Make sure that they’re comfortable with both weight and just do it for a few seconds. Nothing too nothing too harsh, nothing that the animal’s not comfortable with. Just do it a few seconds.

Ilaria Borghese: [00:30:13] Remember, your pet is always with you, so you don’t have to force the therapy on them right away. You know, just start for a little bit, and then if they move away or if they look uncomfortable, come back to it maybe five minutes later, 15 minutes later, half an hour later. There’s no pressure.

This is not you know, you have to do it right away and they have to get this treatment, you know, five times a day, five times a day for 15 minutes at a time or it’s not going to work. Just take it easy with your dog. This should all be a very comfortable process.

The next thing that you would probably want to do is you would probably want to use some kind of a brush. So you go from a chenille and the brush I would actually use maybe like a cotton wand. That’s that’s as abrasive as I would get.

Go from something that’s really soft like chenille, to maybe a cotton wand rub their unaffected non-amputated side first. Then go back to the amputated side with the cotton wand. And then I would use my hands. Rub, a nice, light touch. Rub their unaffected side first and then rub their affected side pressure. You don’t want to do anything that’s like tickling because that’s always a noxious thing, you know? You don’t want to do a light tickle or uncomfortable stimuli, no matter where you do it.

Ilaria Borghese: [00:31:37] You just want some light pressure on, let’s say, the shoulder area of the limb that’s not amputated. And then go to the amputated side and do the same pressure on that side. And then that that would be all for phase one. And I would probably do that for a couple of times a day.

If you apply all of those stimuli all at once, it’s going to take you a minute and a half at the most. Right? I would do that maybe five times a day. You’re going to be petting your dog anyway. You might as well make it functional, right? So if you’re going to go and sit down and pet your dog and tell him he’s okay, why don’t you grab a piece of chenille and start doing some of that protocol?

Maybe you can even associate it with some treats, and something that’s positive. Once the dog is comfortable with phase one, then you can easily move on to phase two. And so then you go from the chenille. Then it would be a fleece.

Ilaria Borghese: [00:32:39] And fleece is actually more abrasive than chenille. So chenille is nice, you know, soft, fluffy and fleece is a little bit more abrasive. You go over to like a bristle brush, a very soft toothbrush. So you went from the brush, the cotton wand, to a bristle brush, which is a soft toothbrush, and then you brush that area lightly again using their unaffected side first, and then go over to the affected side with the light toothbrush and use that for a little bit. Next one. Go with your hands again. So now you’re using your hands again. And now the pressure is going to be a little bit more intense unaffected side first.

Then go back to their affected side a little bit more pressure than you did for the phase one a little bit longer, even if the dog can tolerate it. If you can, if you can lengthen the amount of time that you can touch that affected area, go ahead and do that. And then you start to introduce temperatures. So you want to take maybe your fleece and you want to dip it in a little bit of cool water and then put it on to on their unaffected side and then on their affected side and get the temperature thing going in there.

Ilaria Borghese: [00:33:58] If they’re okay with that, then do the hot, warm water, do fleece with warm water and do that as well. That’s a phase two. Again, it shouldn’t take you more than five minutes at the most. I would do that 3 to 5 times a day.

As many times as you’re petting your dog, get, you know, make it a functional activity and start introducing these materials. And then you can move on to phase three, which is a little bit more. It’s not aggressive, but the materials are a little bit more abrasive.

You’re starting with a Terry cloth as your as your material with a brush you’re going to use. Maybe not a soft brush, maybe you’re going to use something that’s a little bit more, has a little bit more oomph to it, like a little bit of a bristle brush brush with the with your hands instead of a gentle compression, which is what you were doing, you’re going to start tapping. So then you’re going to take your fingers and start doing some tapping. And tapping is the next step after the compression.

So you were doing the compression for phase two. Now for phase three you’re you’re going to start to do a little bit of tapping with your fingers. And then you can also start to introduce a little bit of vibration. So there’s a totally new sensation.

Ilaria Borghese: [00:35:18] If you take maybe one of those little they have little mini vibration tools. You can start using that again. Turn it on first. Make sure that you’re comfortable that your dog’s comfortable with the noise okay. Make sure that they’re not scared of the noise first. I do all this with the Dremel too. Just turn on the Dremel and leave it there while they’re eating, you know, so that they get used to the sound. And so the sound is not scary for them.

Then I’ll take the tool and start doing just a little bit. With the mini-massager, I’ll start with the non-affected side and just touch them with it so that they know what, what it feels like on the normal side. And then I’ll start on the amputated side as long as they’re comfortable with the normal side. So then I’ll introduce that.

And then with the temperature I’ll start with cold water. And you can even move up to an ice cube if the dog tolerates it. And then warm or hotter water. Okay. Now dog’s body temperatures are higher than humans, so they can tolerate a little bit more heat than humans can. That’s the way I progress.

And then phase four, which is really the last phase, the material I would use would be something like a burlap instead of the chenille or the fleece. And then , as far as a brush would be concerned, I’d use one of those like a bristle brush or comb.

Ilaria Borghese: [00:36:52] I’d use a comb that you would usually use on short haired dogs to brush them. There’s also those great friction gloves, gardener’s gloves. The rubber ones, because they pull a little at the skin. And that’s a really intense type of, of sensation that’s really good. You’re adding some tension to the skin of the amputation of the wound site and that as long as they’re healed, that’s a really good type of sensation for them to get.

It really helps to define the area where the amputation is. And it helps to clarify that in the brain, which is what you’re looking to do. All of those stimuli are telling the brain, ‘Hey, wake up! My body ends here. There’s no longer a limb, this is where it ends.’ And then the brain starts to relax, calm down, and the pain is reduced.

So that’s the whole point. If the brain interprets a missing limb and trying to move the a missing limb and interprets that as pain because it can’t do it, then the whole point of a desensitization program is to tell the brain that the body now ends here and it can calm down.

Tripawds Rene: [00:38:18] When would you start doing this protocol? Would it be the day they come home from surgery? Would it be after the stitches come out? At what point can somebody begin?

Ilaria Borghese: [00:39:19] I would probably allow the dog to heal somewhat. If the surgical site looks good, there isn’t any infection, there’s no redness, there’s nothing like that. And it’s starting to heal. I would probably start on week two after surgery.

Jjust give them a little bit of time to heal. I wouldn’t go directly on the incision site. I would go around it. Leave the incision site alone. You can certainly use the chenille to go all around the incision site. That’s fine. I wouldn’t use vibration. I think the warm and the cold water cloths are fine. But I would probably stay away from the vibration, and probably anything that tugs on the skin, like the comb and the friction massage glove. At least until the stitches come out. That’s a very fragile area. But you can certainly introduce soft materials. And the sooner you start, the better. The brain just needs as much information as possible.

Ilaria Borghese: [00:41:18] I try to flood that environment as much as I possibly can without hurting the site of the injury. So just be careful about that. Just try to flood it as much as possible.If you can get away with doing it six, seven times a day for a couple of minutes at a time, it’s it’s only going to help with the outcome.

Even if you start them on Gaba, maybe you can even reduce the amount of Gaba that you give them a lot faster and get them off the Gabapentin sooner, too.

Tripawds Rene: [00:42:43] I was just going to ask you how this would interact with anything like Gabapentin or Amantadine, another one they come home with. This is so helpful! This is really good information to have when your pet comes home from surgery. And we are just so grateful that you were here today to explain it. Thank you so much.

Ilaria Borghese: [00:43:17] Was a real pleasure of mine. , and,I was just thinking about one more thing real quick. You know, any time that we have a cut or a sting, what happens if we get a cut on our arm, if or if we get a burn on our arm or if we get a sting, we don’t just leave it. What do we do? We hold it. We try to like, you know, massage it. Any kind of input to help re-educate the brain and feed it a different type of stimulation so that it doesn’t feel that pain all the time.

So sensory input into an injured area or into that surgery site is so important to help re-educate the brain as to where the body ends. There’s only a certain number of pain fibers that go up to the brain. Try to flood them with different types of information that will also help to reduce the pain.

Tripawds Rene: [00:44:23] This is a good kind of flooding. Usually we hear about it being a bad thing, but this is a good a good flooding for our pets! We will hopefully have you back someday. Thanks a bunch.

Ilaria Borghese: [00:44:35] Thanks so much, both of you.

Tripawds Jim: [00:44:38] Wow. I hope you were taking notes. It’s not often we hear such detailed, practical tips you can try at home to help ease your pet’s pain. Really, just while you’re petting them anyway. So check the show notes for links to the resources we mentioned and let. Let us know about your experience coping with phantom pain for your dog or cat by posting in the forums, or starting a free blog at Tripawd.com.

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RESOURCES:

Vital Vet Article: Nerve Pain After Injury or Amputation

Therapaw Mobility Support for Dogs

VitalVet Special Needs Pets Resources

All Tripawds Articles About Phantom Pain in Dog and Cat Amputees

All Tripawds Articles about Pain Management

You may also be interested in Farabloc:

Episode #70: Effects of EMF on Pain in People and Animal Amputees

Farabloc EMF Shield for Amputees

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