Serving the Voiceless: Expanding O&P Care for Animals

American Pet Products Association research shows that more than 60 percent of US households own a pet; and like humans, pets are vulnerable to injuries and health conditions that impair their mobility and can be addressed by O&P interventions. Given this potential number of clients, more O&P students and practitioners are considering either specializing in veterinary O&P or adding this service to their traditional practices. We asked early explorers in the field to address the challenges and rewards, complications, and considerations of serving nonhuman patients—as well as the earnings potential it offers. Joys and Perks of Animal O&P Care Some patients are cuddly, cooperative, and needy. Some resist treatment, inflict damage, and exhibit poor judgment, and hygiene. Caring for any of them requires not only good intentions, but education and experience through training and mentorship, our sources agree. Today’s successful animal O&P care practitioners are largely self-taught, and some don’t advertise or charge for their occasional services. Kevin Carroll, MS, CP, FAAOP(D), vice president of Lower Extremity Prosthetics, Hanger Clinic, enjoys after-hours opportunities to provide pro bono care to animals in need. His work in partnership with Dan Strzempka, CPO, to create a fully functional prosthetic tail for an injured dolphin named Winter inspired the 2011 movie Dolphin Tale , and his efforts on behalf of regional Florida wildlife like sandhill cranes and turtles are widely recognized. “My interest in animals goes back for a lot of years,” he says. “Not that I can provide care to all of them, but maybe to the extent that I can make recommendations for their care or help the pet owners make good decisions regarding appropriate care for their particular animal.” [caption id="attachment_249356" align="alignright" width="206"] Turtle photograph courtesy of Hanger Clinic.[/caption] He recognizes animal or veterinary O&P care as a new area of specialty and wonders how far our expertise in this area has yet to grow. “Recently I was teaching at one of the schools where some of the students are taking an interest in animal care. So much so that they’re taking prosthetic and orthotic residency, becoming a CPO, and then planning to switch over into the animal care side in the future. “Some may very well begin by managing their own private practice, seeing these animals at night or on weekends, but I always advise they hold onto their day job. As their practice grows, then they can make a decision on whether or not they want to change over to full time,” he says. Frank Snell, president and CEO, Snell Prosthetics & Orthotics, Arkansas, has guided his staff in appeals for O&P interventions for nonhuman patients, including shoes for a penguin with an ulcerated foot and an orthopedic boot for Jewell, a circus elephant retired to the care of the Little Rock Zoo. “A fungus between her toes was exacerbated by exposure to soil and fecal matter, and thus was not responding to treatment,” he explains. “They asked us to make a special walking boot to allow the applied medication to work. But elephants are very savvy, and very adroit in removing with their trunks whatever you put on them.” The additional challenge was to discover materials sturdy enough to support an elephant’s weight. It took several tries to develop a canvas boot with a walking pad made from conveyor belting surface, attached with supersized four-inch snap-locks, similar to quick-release dog collar buckles, which Jewell was unable to outwit. She ultimately responded well to the treatment and healed successfully. The local humane society also requested help creating a prosthesis for a rescued horse who had entangled his foot in barbed wire and subsequently had his foot amputated due to gangrene infection. The day the prosthesis was fitted, three TV stations showed up, and while on a cruise the next day, Snell’s family were astonished to spot the story and his interview, which had been shared nationally by the Fox network. “I got some of the nicest cards and letters from total strangers,” he says. [caption id="attachment_249357" align="alignright" width="245"] Deer photograph courtesy of Pawsthetics.[/caption] “These opportunities were rewarding in their own right. If you love animals, you get to do things to help them that would normally be out of your scope of practice and try new ideas. It’s great fun.” He encourages others who hadn’t planned to explore veterinary O&P care to accept pro bono cases that come their way. “It’s great PR. It shows that you’re willing to do something for the greater good, it’s interesting, gets you out of your comfort zone, and you’ll meet some nice people. We haven’t made a dime doing any of this, but I’d do it again in a heartbeat,” Snell says. Carroll also points to the educational value of animal O&P care in raising public awareness, recalling the children and families who continue to visit and support Winter’s aquarium, asking questions and learning why she used a prosthetic device, and Rosie, a Great Dane with a prosthetic leg who visits schools with her owner, Maja Kazazic, who is also a prosthesis user. “They’ve really turned it into a teaching experience for the kids,” Carroll says. The appeal of an injured-animal story with a happy ending is also illustrated by the Xploration Station Second Chance Pets TV series, now filming its third season. (Season 2 episodes premiere on January 6 on the Fox network nationwide.) Jim Alaimo, CPO, co-owner, My Pet’s Brace, Pennsylvania, was initially reluctant to allow his practice and his patients to be featured in a reality TV show, but viewers are fascinated by the science that enables animals that receive “a new leash on life” through custom O&P devices. “It’s really great—no controversy; it just shows what we do and how orthotic or prosthetic intervention can have a positive effect on the lives of these pets.” Blazing the Veterinary O&P Trail Alaimo traces his beginnings in the field of veterinary O&P care to the date he was severanced out when his employer—a human O&P practice—changed ownership. He and a partner circulated a survey that reached 1,000 veterinarians nationwide to determine if they would be willing to use a service providing braces for dogs and other animals. “The response was very positive, so we opened our facility in 2010, producing 86 braces that year. Over the last ten years, we’ve made more than 16,000 braces for dogs. Most of them are CCL knee braces [cranial cruciate ligament]—the equivalent of a human ACL [anterior cruciate ligament] brace. Basically, we see orthopedic issues for dogs and some cats, goats, [and] sheep; we just completed fitting an elephant in Sri Lanka. [caption id="attachment_249358" align="alignright" width="241"] Sheep photograph courtesy of My Pet’s Brace.[/caption] “Generally, dogs wear their knee braces for about nine months,” he explains, “because that’s how long it takes for that scar tissue to get strong enough that they’re not likely to reinjure it. We get excellent results, possibly because we work only with a prescription from a veterinarian. We want to make sure a vet has diagnosed that injury, and we will treat that injury. “We don’t do a lot of cats because they’re pretty finicky,” he adds. “Whenever I brace a cat, I first do something temporary, just to confirm that they will adapt to the device, then I’ll make them something permanent.” Lifelong dog owners, Alaimo and his wife appointed their dog, Strider, as chairman of the board, and still honor his memory and title on the company’s website. How many animal O&P care providers are currently operating in the US is unknown, but Ben Blecha, CPO, founder of Hero Braces, Nebraska, one of four such businesses that opened in 2004-2005, estimates that between 20 and 25 are currently marketing their services. He began training in 2005 with Robert Taylor, DVM, MS, at his state-of-the-art Alameda East Veterinary Hospital, Colorado, and its unique biomechanics lab for animals, where Blecha developed a stifle brace design. His Ace Ortho Solutions—which makes custom braces for animals—was opened as a sister company to Sky Prosthetics, his human O&P facility. (He closed Sky Prosthetics in 2014 to focus on his rebranded Hero Brace solutions for animals.) Although he left the human side of O&P to escape the tyranny of L-Codes and documentation drama, Blecha warns of a different set of problems in the veterinary O&P industry. “You’re asking owners to pay out of their pocket, and with that there’s a much higher customer service need. And because our animals can’t talk to us, we convey what we think the animal is thinking, so there’s a whole different level of projection the owner puts on their animal. Because it’s coming out of pocket there’s a different demand or thought process involved.” Although many people will spend generously on their pet’s behalf, Blecha serves those who come to Hero because they can’t afford surgery out of pocket. “A TPLO surgery is $5,000 or $6,000, and so they’re being more frugal by coming to us for a brace. So if they spend $1,000 on a brace and there’s a rub spot, which we all know happens, they aren’t as forgiving as an amputee going through the process with insurance coverage.” Although he makes free adjustments, his team also works from a distance, so additional adjustments may be required. “Some companies start to charge for adjustments, but pet owners live in a retail world where they think they can return it, like Amazon, if it doesn’t work,” he says. “But these are custom devices, so we have some hard conversations about that.” Angela Boncz, CTPO, Specialized Pet Solutions, Washington, first added animal O&P care to her human O&P care resumé 15 years ago. She began an O&P central fabrication business in 2010, also serving as a subcontractor for a business that provided animal O&P solutions, Animal OrthoCare, building an estimated thousands of devices. Her fabrication experience prompted her to establish Specialized Pet Solutions in 2019; since then, she has served over 100 of her own patients. “There’s not enough research yet into animal O&P—especially on the veterinary side of things,” she says. “Ninety percent of your patients need knee braces. That’s the most frequent complaint, but vets prefer to do surgery. So this is a struggling industry. Some larger companies do fairly well, but it’s a challenge for smaller companies to get our name out there.” Every animal brace should be custom, just as for a human, Boncz stresses. “There’s a lot of brainstorming that goes into the devices I design—a lot of Home Depot trips since you’re not getting componentry from your O&P distributors. Knee joints from Becker are not designed for animals, so the success of your brace relies on figuring out how to make it work, transitioning what you’ve learned in the human industry, and developing a parallel technique for the animal world. There’s definitely a learning curve.” She describes some unique solutions she’s developed: a carpal front-leg hyperextension brace with an added hyperextension stop—borrowed from a human AFO—and help for Winston, a dog whose elbow didn’t develop and was fixed at a 90-degree angle upward. “I had to build an extension off his elbow so that he could put weight on that front leg to unload the extra stress from the good front leg and the two back legs,” she explains. “If you’re missing one leg, you’re going to put extra weight and extra wear and tear on all of the remaining legs. “The sky’s the limit for prosthetics,” Boncz notes. “You can make whatever you like. There are many different designs out there as more and more people are getting involved, and 3D printing is building full-limb prosthetics. “If you’re considering this as a career, education is a good start. You’d want to start looking at anatomy, the same things you learned in your O&P programs.” Bobbie Adams, RVT, CCRP, MSPO, LPO, veterinary O&P strategy and development coordinator, OrthoPets, Colorado, also charted a unique career path, beginning as a registered vet tech, and working in veterinary rehabilitation for ten years. “I was thinking about O&P for animals, but there was no avenue for one to become qualified to do that, so I went to graduate school for orthotics and prosthetics for humans. While working on my Master of Science degree, I started volunteering with a nonprofit that was making 3D-printed protheses and orthoses for animals. “The veterinary side of O&P is so new that we’re still creating it,” she says, so, following her residency, she sought to break in by working in the human O&P field. When she learned from OrthoPets founder Martin Kaufman that the company was partnering with CPOs to become independent regional contractors for OrthoPets, she seized the opportunity to establish her Oklahoma-based veterinary O&P practice, Pawsthetics, and also accepted the coordinator role for OrthoPets. Adams’ first patient, last October, was a fresh challenge: a domesticated white-tailed deer who was injured and needed a device. “I’ve worked on a lot of species but never a deer.” After the diagnosing veterinarian’s referral and Adams’ initial examination, they discuss what device design would best suit the animal. She advises the pet parents about the process, casts the animal, then scans the cast and sends the file to OrthoPets, where CAD/CAM is completed. The device is then fabricated at Friddle’s Orthopedic Appliance, South Carolina. The Human/Animal Difference “Currently there isn’t a standard for care in veterinary O&P, and vets don’t get a ton of physics,” Adams points out. “They take a biomechanics course in vet school that’s geared toward the gait of the quadruped, but they don’t really learn about forces and movements and lever arms. So you either work with the veterinarian that is excited to learn something new, and glad to collaborate, or you get a skeptical veterinarian who may give it a shot, but isn’t wholeheartedly into it. “Not every company requires a prescription or a referral to get the process started; not every company uses device designs that use three-point force systems or control mechanisms. So results vary, depending on the company or the practitioner that you use.” She and OrthoPets are committed to establishing a standard of care and educational professional requirements so that outcomes are more consistent, supported by a growing body of research, “the same type of research that would be conducted in human O&P,” Adams says. “We strongly feel there’s a need for more research, and more longitudinal studies of mixed methods, and also prospective studies with qualitative data from the pet care industries and veterinarians would be very helpful. So we are always looking for people to collaborate with in terms of research.” Such studies, she believes, would add credibility by proving that devices really do what they’re designed to do, e.g., that their stifle orthosis does measurably decrease loads on all ligaments, decrease anterior translation of the tibia, and decrease internal tibial rotation. Likewise, research is progressing on OrthoPets’ Paladin device, a novel low-cost alternative approach to treating a CCL rupture in a dog, and findings should be released soon. Bottom Line Having good intentions and loving animals is not enough—but true compassion is a bare minimum requirement if you choose this business. “I would hope,” says Adams, “that the person considering a veterinary O&P care career is an animal person. Because we get people in animal O&P that aren’t necessarily animal people—and you can tell. Pet parents can tell. And because animals can’t speak, obviously you have to be a people person.” “That capacity—that calling to take care of sick or injured pets and animals and to serve nature’s wounded and helpless who have no other hope—what more could we ask for from those who already have the heart to provide O&P care?” asks Carroll. “If somebody has the passion and the will,” advises Boncz, “definitely go for it. But if you’re out for a paycheck, I wouldn’t recommend it.” Judith Philipps Otto is a freelance writer who has assisted with marketing and public relations for various clients in the O&P profession. She has been a newspaper writer and editor and has won national and international awards as a broadcast writer-producer. The Vital Veterinary-O&P Partnership Partnering with veterinarians in the same way that prosthetists and orthotists strive to partner with physicians and surgeons is essential for those involved in animal O&P, advises Kevin Carroll, MS, CP, FAAOP(D), vice president of Lower Extremity Prosthetics, Hanger Clinic, Texas. “When we talk about animal care, we have to realize that we’re not in it alone. There’s a team taking care of this animal. Pets or any animal, whether it’s a turtle or a sandhill crane or a dog, I always have the prescribing veterinarian sign off on what I do, because we’re not in veterinary medicine—we’re not in the veterinarian’s position. That’s very important for anybody who is interested in animal care; know that you’re not working in a vacuum, and you don’t want the veterinarian’s association to censure you because you’re practicing veterinary medicine.” Bobbie Adams, RVT, CCRP, MSPO, LPO, veterinary O&P strategy and development coordinator, OrthoPets, Colorado, who began her career as a registered vet tech and worked in veterinary rehabilitation for ten years, strongly agrees. “We at OrthoPets always advise that a veterinarian be involved because we value the patient-client-veterinarian relationship that exists in veterinary medicine. As a vet tech, I must operate under the indirect supervision of the veterinarian, so we get a referral from them, make sure we have a diagnosis, and make sure they’re on board. They’re on the team, right? And it’s the team that comes together to make this happen for the animal.” Jim Alaimo, CPO, co-owner, My Pet’s Brace, Pennsylvania, also works based on the vet’s prescription and advance agreement. “We work with them, we have videos, we talk them through the process. Once trained, a vet will take a cast and send it to us. We’ll make a brace and return it to the vet. But we always provide video and written instructions, and always have a conversation with the vet before we make the brace, so they understand what they need to do.” Angela Boncz, CTPO, Specialized Pet Solutions, Washington, notes that even with vets on board, fitting a brace can be a challenge, as they don’t know the mechanics of how O&P braces and components work. Since it’s so important to get the casting done exactly as it needs to be, with the animal in a natural standing position—a point which is often difficult to emphasize to vets and pet owners—Boncz notes that her team spends a lot of time on education, with website videos, a mail-order casting kit with detailed instructions, and frequent encouragement to “call us and we can walk you through it.” “It’s best to have patients in-house for casting,” she says. “The mail order tends to get sloppy; during transit, casting material can activate if it gets even a small hole in the packaging materials.” Ben Blecha, CPO, founder of Hero Braces, Nebraska, also tries to work with veterinarians whenever possible and develop relationships in advance. “Typically the vet will take the cast and send it to us, and we’ll manufacture it. Since the pandemic has forced people to adapt to using FaceTime and Zoom, it’s helped our customer service, because now people will jump on a video call with us, so in many ways we can ‘be there.’ We can’t have our hands on the animal, but technology has accelerated our customer service a lot.” “When we work with our humans,” Carroll notes, “O&P professionals don’t prescribe orthotic and prosthetic devices—the physicians do that. But we communicate with the physicians about what we think would be good for that particular individual; [it’s the] same way with the animals. I don’t see animals without having direct communication from the veterinarian. “Even casting the animal, it’s good to have a veterinarian there. In one case, the veterinarian was able to give the animal something to calm it down a little bit, not knocking it out completely for the procedure, but alleviating the animal’s stress—that’s something I’m unable to do.”

Serving the Voiceless: Expanding O&P Care for Animals

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