By John C. Cargill, MA, MBA, MS
Source: Dog World, March 1991, page 18, 19, 85, 87, 88
If you breed enough litters, you eventually may experience raising a “swimmer”. What is a swimmer? It is a puppy that, for one reason or another, fails to crawl normally and instead moves with a swimming motion not unlike the breast stroke. The legs are splayed and are unable to support the trunk 1-4. A review of the literature is not every productive. Little has been written, and little is understood about the condition. What I intend to do in this article is to share a slightly different perspective on the treatment and the retraining of swimmer puppies.
Before continuing, note that in the literature swimmers generally recover on their own5,6; however, Lorenz writes that in severe cases euthanasia should be considered7. Experience and conversations with breeders of various breeds suggest that many swimmers are put down for humane reasons. Few of the remaining swimmers ever make it as show dogs because of poor movement as adults. Swimmer puppies can become “dorsoventrally flattened, which is a permanent disfigurement.”8
Infrequently, an entire litter may be affected; however, more commonly, only one, two or three pups become swimmers. Earl writes, “These pups are usually seen in litters of only one or two pups.”9 They are generally a littler larger and less energetic than their littermates10 and Kelly suggests that swimmer puppy syndrome incidence is highest in obese puppies11. Not until the puppies start moving around, usually at one to 1-1/2 weeks of age, can the difference be detected. Earl reports that the condition may be “noted in one to two days after birth and becomes progressively worse.”12 My experience was that I was unable to diagnose the condition until 1-1/2 weeks after birth.
Swimmers are generally large puppies which move less than their littermates and are noticed as being awkward in their early attempts at crawling. They seem unable to get their feet underneath them. The old breeder’s tale is that puppies become swimmers if they fail to achieve traction on a slick surface, such as newspaper. This is supported to some extent in the literature, which cautions against whelping boxes with slick floors13. My experience with swimmers involved using indoor-outdoor carpet cut to fit a four- by six-foot whelping box.
Instead of crawling with a "pacing" or "trotting" movement, the swimmer puppy seems to put his front legs out to the side, much as a human would when stretching in the morning. Rather than a front-to-rear crawling movement, the puppy moves his front and rear legs as if he were attempting to swim. At first observation little difference can be seen physically between a swimmer and the rest of his litter.
The literature reveals no known genetic link14-16; however, it is reported that certain breeds of dogs, specifically the English Bulldog, Basset Hound and Scottish Terrier, are especially predisposed to this syndromel7. It is unknown whether the condition is related to genetics, a viral or bacterial infection of the dam during gestation, some dietary deficiency or improper husbandry. Undocumented theories abound and range from "altered neuromuscular synapse function, improper or delayed myelination of peripheral nerves, slow muscular development
and ventral horn dysfunction (neuronapathy)"18 to strictly environmental considerations.
As normal littermates grow and become more active, the swimmer spends more time sleeping. He sleeps on his chest rather than on his side. The consequence of this resting position is that the chest becomes flattened severely and a fold develops in the rib cage on each side. As the puppy grows heavier, the chest becomes flatter and it becomes more difficult for the puppy to get his feet underneath him. He can still "swim" to momma for feeding, but otherwise his mobility is greatly reduced.
It may be that this dorsoventral flattening of the chest is more pronounced in the larger and heavier breeds; it can become quite marked. Any knowledgeable dog person, upon picking up such a puppy and expecting a normal puppy shape, is shocked by the feel of the flattened and sometimes even concave chest. Often, the flattening does not progress to this point, and this is why the literature contains examples and statements to the effect that swimmers usually recover completely and suffer no ill effects. On the other hand, "failure of the trunk to be supported by the appendicular skeleton results in dorsoventral compression of the thorax, abdomen and pelvis. This compression causes malpositioning of the limbs in a lateral manner. . . . Joint deformities commonly develop because of the altered limb angulation."19
In a recent litter of four Akitas, two were swimmers. This was my first experience with swimmers, but it was easy to tell that something was wrong. By two weeks of age, the two biggest puppies were becoming flat as pancakes. They were beginning to look like bulbous fat toads. I have no doubt that they would have been deformed had corrective action not been taken.
The literature suggests "hobbling" the puppies by tying the opposing legs close enough together to keep them under the puppy20,21. "Hobbling reduces the permanent dorsoventral flattening, but probably has no effect on the speed of functional improvement of the limbs."22 In checking with various veterinarians and breeders, they too, had read of this course of treatment, but had little or no success with it. As one veterinarian friend said, this method only seems to make for crying puppies. If the chest is already flattened, it may not be possible to hobble the legs under the chest. I learned of an AKC champion that was previously a swimmer, whereas many other swimmers have had to be put down.
It quickly became obvious that I was not going to receive much help from medical or veterinary literature, from veterinarians or from other breeders. I had two puppies out of four in a "super pedigree" litter that were becoming more and more deformed every day. I could not wait in hopes the condition would correct itself.
I explored several approaches. The first was to make it impossible for the two puppies to lie on their chests. There was an easy and effective solution to be found: I took a 500 Vari-Kennel, covered the bottom of it with soft blankets and rolled three towels into cylindrical forms. I placed these forms in the middle and along the inside edges of the crate and then draped them with another towel. This created ridges and valleys into which I could place the two puppies on their backs and sides. They were unable to turn over and their own weight served to provide gentle pressure to their sides with the effect that they were compressed, with a corresponding lift to the chest. This seemed to work.
The other solution I tried and then abandoned was to place the puppy in a sling. This upset the puppy even when the feet could hang down and touch the ground. Possibly in a case of minimal flattening this would be effective, but I had two "super squashed" puppies to work with and I abandoned this method. After two days in the Vari-Kennel, there was a noticeable rounding of the rib cage and an outward rounding of the chest on both puppies. Something good was working. Yet, when placed on a flat surface, the two puppies automatically put their legs out to the side and attempted to swim.
I consulted a neurosurgeon friend who happens to be a dog person. Apparently, there are humans born without various reflexes or with incomplete reflexes. Cases abound where babies are born without sucking, body-righting, labyrinthine, lip, plantar, Pavlov's, scratching or vomiting reflexes. Could it be that these puppies lacked the genetic imprinting or coding to crawl and instead reverted to an earlier evolutionary time when swimming was the method of locomotion? At the risk of offending those in dogdom who do not believe in evolution or genetics (i.e., selective breeding), this seemed to be a plausible definition of the problem.
A preliminary on-line search of the literature provided a number of conditions, such as various myopathies, which seemed to meet many of the conditions observed. In congenital myopathy, "a typical infant has hypotonia [diminution or loss of muscle tonicity, in which case the muscles may he stretched beyond their normal limits] and delayed motor milestones."23
In congenital fiber-type disproportion, "Clinical factors include hypotonia, weakness, delayed milestones. skeletal deformities. . . . Prognosis is generally good with most patients showing improvement with age although some residual motor impairment commonly persists.”24
In cerebral palsy, “Spastic diplegial [referring to spasticity in paired limbs] is the commonest form (accounting for 50 percent of cerebral palsy) and generally the mildest…The stiff, awkward movements of the legs, maintained in an extended, abducted posture, does not usually attract attention until several weeks or months after birth (human infant)…It is not uncommon to observe a delay in all normal developmental sequences, especially those which depend upon the motor system.”25
These were all distinct possibilities based upon clinical signs; however, the veterinary literature specifically indicates that neuromuscular abnormalities cannot be found upon necropsy, which would be the case in the event of the various myopathies.
The neurosurgeon had no answers for how to train the puppies to crawl instead of swim, but suggested that I might consult with someone who worked with stroke patients. I consulted with a physical therapist whose specialty was nerve regeneration in hands and working with stroke patients. She suggested that techniques for retraining stroke patients might be effective. The first problem was to get the weight off the puppy's chest to prevent further flattening. The second problem was to put subtle pressure on the puppy's sides to round the rib cage to its normal shape. The third problem was to train the puppy to crawl instead of swim. Seeing these grotesque, flattened, bullfrog-shape puppies, this seemed like an impossible task.
The puppies were now 2-1/2 weeks old and here is what she prescribed: Keep the puppies sleeping on their backs (i,e., most of the day and most of the night). Reduce their weight by not letting them feed as much with momma. Determine from the other puppies the “gait" they use crawling and walking. By this time the two normal puppies were just beginning to stagger around. As instructed, I knelt behind a normal puppy with my forearms on the ground and learned the movement of the front feet as they moved. Then I tried the same thing with the swimmers, except that the movement had to be forced.
The physical therapist insisted that was most important to re-create each gait the normal puppies exhibited, but in practice this was easier said than done. Rather, what happened was a military left-right-left sort of gait, as if someone were calling cadence. Something quite amazing happened: The next day, both swimmer puppies, after several training episodes, tried to walk instead of crawl. I recognize that this is anecdotal evidence, that I lack a control group and a treatment group to validate cause and effect scientifically26. Nonetheless, the puppies abandoned their attempts to swim. It is well established in various animals and in the human infant that various stimuli must occur within a specific period for a response, instinct or reflex to be evoked.
Commonly cited are the various studies where “releaser” activities are required during a critical period, if the response is to follow the animal throughout its life. Well documented is the resultant sexual dysfunction in primates and several species of birds when deprived of adequate parental contact while newborn27. Also well documented are puppies’ bladder and anal responses to stimulation by the mother. In addition to “releaser” activities/stimuli, there may also be “repressor” activities/stimuli.
“The nervous system is plastic at birth and the human brain rich in the possibilities of connection. There are critical periods when particular types of connections are especially readily made if the stimulation is adequate. The sensory-motor responses of the newborn are highly dependent upon external conditions and the level of CNS [central nervous system] stimulation at any one time."28 Further, it is known that "There are critical 'catch up' periods, also wherein a deficit must be normalized if subsequent development is to follow a standard curve. This is certainly apparent in low- birth-weight infants, where there is a critica1 period during which, if the child's weight is brought back into normal range, subsequent weight gain will proceed normally."29
Similarly, it is reported in a study of amblyopic children [who have dullness of vision without any apparent change in the eyes] that "the critical period of stereopsis [stereo/binocular vision) may be at or before three years of age and the sensitive period may last until 12 years of age."30 Obviously, there are no hard and fast rules here. It does seem, however, that if a puppy does not learn to crawl fairly quickly, it will become deformed to the extent that it will never walk normally.
No good story is without its setbacks, and this one is no different. The next morning after the physical therapy sessions, the puppies were swimming again. More physical therapy and "walk training" followed, and by the afternoon, both puppies again were making clumsy attempts at walking while assisted. The use of a sling under the puppies' bellies made it possible to see the difference in their movements, especially when compared with the response of the normal puppies when they were in the sling. During the next week, I spent a couple of hours each day training the puppies to walk.
By the end of their sixth week of life, both puppies were walking, running around and acting like silly Akita puppies, as if nothing had happened. I took the puppies in to my veterinarian. He had seen the puppies shortly after birth and at three weeks. He was amazed, but because of the flattening of the chest he still was able to tell which puppies had been swimmers. At 10 weeks of age, he was unable to tell. Another veterinarian (who had not been on the case) was unable to determine which in the eight-week-old litter had been swimmers.
One normal puppy bitch from the litter was placed in a show home. One normal puppy dog was sent to Manitoba, Canada, to be used in weight pulling and hunting. One swimmer puppy dog was placed in a show home at 10 weeks, and I kept the other swimmer puppy to show in California. Videotapes of the movement of the swimmers reveal them to be sound animals at 15 weeks of age. There is no indication from their movements now that they were ever swimmers. The puppy I kept is approaching five months of age
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Original Doc: therapy for swimmer_pups.doc
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