ACPAT: The Beginning

ACPAT: THE BEGINING

Mary Bromiley FCSP HPC Chartered Physiotherapist

Forgive the somewhat personal note running through this article but ACPAT was formed as the direct result of personal experience. My father had qualified in Edinburgh, first as a Veterinary Surgeon then as a Doctor of Medicine, and practiced both professions simultaneously through his working life, so a career in the medical field was an obvious choice. Realising my scholastic achievements were unlikely to enable me to be accepted at either Medical or Vet school, I settled on Physiotherapy.

Shortly after qualifying at St. Thomas’s, I married and followed my doctor husband to Malaya where he had been sent to work as the first TB specialist to the Brigade of Ghurkas. I was offered, and accepted, a job in the local Leper settlement. Plenty of interesting functional rehabilitation required – try two legless football teams and injury time being called when a leg was lost needing reattachment – a great learning curve. Our respective jobs did not make socialisation easy: ‘and what does your husband do dear?’, senior army wife, ‘he is a TB specialist’, step backward (I might be contaminated), ‘what are you doing to keep yourself amused?’, ‘I work at the Leper Colony’, departure of said wife. We were not sociably acceptable!

Light relief needed, I turned to the local Turf Club and discovered I could buy injured racehorses for their slaughter value. I acquired some broken animals. I still vividly remember the day when a vet whom I was badgering, turned and said ‘you seem able to mend humans, why can’t you mend horses?’ Why not indeed?

Anatomy, not quite as simple as the human model – relearn. No verbal communication, no chance of asking ‘where is the pain?’ To palpation skills, add speedy reflex withdrawal of examiner – animals let you know very rapidly when you hurt them. I adopted the principles of the examination procedure taught me by James Cyriax, a fanatic about observation; he considered you were a waste of space if you were not spot on, anatomically. ‘Watch the patient move; that tells you a lot’. ‘Know your muscles, their nerve supply and function’. ‘NEVER FORGET YOUR ANATOMY’. When I had, I hoped, identified the primary problem causing loss of performance or a clinical lameness, I incorporated massage, stretching and muscle strengthening. To my surprise, and to the astonishment of the Race Course Vets, not only did horses recover from muscle associated problems but actually raced again, many even winning.

On my return to England, no one seemed particularly interested in physiotherapy for animals despite my enthusiasm. Every-day life took over; work, children, ponies, dogs; animals variously came and went within the family. I treated any injuries using exactly the same principles, in so far as was possible, as I would for my human patients. Isolation of a single muscle group impossible, surely the antagonistic groups must be affected as well? Try weight on the limb in question.

Veterinary establishments usually had skeletons lying around – sometimes, in the case of cats and dogs, hanging on the walls in the waiting areas. Thus, while I was not treating many animals, but finding comparative anatomy fascinating, I continued to read, look, learn and dissect. It was always possible to visit the local Hunt Kennels and work on fallen stock.

I was shaken from lethargy into action when a patient I was treating announced she was attending a weekend course and would be, by the end of the weekend, an Animal Physiotherapist. I was irritated and telephoned the CSP. They, too, were concerned – a Physiotherapist should be Chartered, trained – it was not a weekend job, even if she was only going to treat animals. They promised to investigate. No internet then, no ability to type in a name and learn intimate details!

Following my telephone call, enquiry by Penelope Robinson working from CSP head office, revealed that a number of animal therapists were around. Few held any recognised qualification other than Charles Strong, Ros Boisseau and Penelope Richmond Watson, all three Chartered Physiotherapists.

Penelope approached the RVC and a working party was formed. Charles Strong seemed to be the only one of the trio recognised by a few Vets as being competent to work with animals – this, as a direct result of Royal Command. His rooms in Harley Street were not far from mine and I made an appointment to see him. He pointed out he had been Knighted for his efforts. This, he informed me, had not amused the CSP. ‘No’, he would not help form a group; ‘yes’, he would teach me all he could, but hands off his Royals!

I spent many informative hours watching him wield his Transeva, a very primitive form of muscle stimulator but designed with a much reduced skin sensation when compared to that delivered by the conventional Faradic machine. The machine, although large and cumbersome, was then a great breakthrough. I had recently attempted stimulating gluteal atrophy in a horse due to compete at Badminton using conventional Faradism, and had watched in horror as the patient departed his stable at the first current surge, towing the groom; luckily, the owner, ever unmoved, remarked ‘I always suspected he had a hidden turn of speed’.

Negotiations with the RVC continued slowly over a three year period. At last, Chartered Physiotherapists given the all clear but with imposed limits; Veterinary permission to be obtained in every case, no direct referrals, not to diagnose, report back to the referring vet in every case.

A small group formed and spawned the specific interest group ACPAT. I had the honour of becoming the first Chair person. I really do not know how much help I was at the time as I was busy building Downs House. This purchase, a 30-box yard with paddocks and, at the time, use of Lambourn Valley Gallop, was the result of, as usual, chatting to a patient, a charming member of the Upper House. I was discussing possible ways forward for ACPAT. ‘Mend a horse and jockey, put them together and win a decent race’ was his advice, ‘then you had better do the same in the three day event and show jumping worlds.’ As an afterthought, ‘know anything about coursing?’ ‘yes’ ‘go for it, Waterloo Cup I should think’. Sounded a good idea but where should I do this? Lambourn was the Valley of the Horse, Downs House was on the market.

After considerable family consultation, I borrowed a huge sum, calculating I could work four days a week in London to keep the bank happy and spend the other three at Downs House, leaving my luckless elder daughter to run the outfit in my absence. I converted a room to use as a human clinic in the house, built a straight swimming pool after consultation with Ray Hutchinson MRCVS (an Australian vet who was pro swimming), found a small inclined treadmill, put in an arena, a solarium, a Claydon six horse walker, and built four sand boxes large enough for turn out and safe rolling.

Bob Street riding Numismatist won a big race at York. Six months later, Mark Phillips conveniently hurt his Achilles tendon and his horse just before riding for Great Britain. Paul Nunn brought a very broken show jumper, I was fairly certain we could not get it right, said so and investigation proved this to be the case, rupture of the ventral ligament T14-L1, but at least we were honest. A dog bred by Michael Forsyth Forrest, living in Lambourn, won the Waterloo Cup. Within a year, work was beginning to fill the boxes. Over time, dogs arrived and I was requested to see a variety of animals ranging from domestic to exotic.

I was very short of cash – the horse world are not good payers. Hilary Clayton had organised the first Equine Sports Medicine Conference, location Calgary. I needed to go, I must learn more. I do not bet, a £50 premium bond win was tempting . . . Easy Come Easy Go, a horse of Jenny Pitman’s, romped in at 25 to 1. Fare and conference paid for, there was also enough left for my daughter to go to Portugal to learn the classical method of long reining.

As the years passed and those of us working with animals proved the idea was viable, ACPAT membership grew, the committee implemented various training routes. There was a time when, to be brutally honest, I regretted ever having suggested forming ACPAT. I felt people who came to ‘shadow’ seemed just to be looking for escape from the NHS. The underpinning knowledge of many, regarding animal disciplines, was, to the say the least, sketchy; illustrated by one, who, after examining a greyhound announced ‘it’s totally one sided, if I balance it up it will get better’. ‘Have you ever been to greyhound track, watched a race, and seen them train?’ ‘No, why?’ ‘They always run anti-clockwise, this dog has a torn monkey muscle. ‘What’s that?’ Ideas come and go and will continue to do so, but the wheel cannot be reinvented, conformation is conformation. You may be able to improve posture but should you? In the long run, common sense should prevail.

The RVC Course is without parallel, a world best, how fortunate students are today. I have had to learn by trial and error; those of you who read this distribute know, if you are honest, there are no short cuts. It is a long hard slog and possible failure, rather than success, lurks endlessly. So what constitutes success?

I have been privileged to lecture to, and work under, some outstanding veterinarians in many countries, and to meet a huge variety of animals, each presenting with its own unique problem. There are no receipt books, every case varies.

I consider, to be successful, the therapist should know the discipline of their patient in depth. In Los Angeles, working with trotters, I felt I had to sit on a race cart to observe the action. No one had told me the harder you pulled the reins the faster you went! I think I probably broke the course record but between moments of extreme terror, I learned a lot. I have worked with the huskies at -400 when it became obvious their shoulder injuries were secondary to the effects of the unyielding pressure of nylon at those temperatures – seal skin harnesses caused no problems. You should be able to converse with owner, trainer, stable lad, lass, head lad, kennel hand, farrier, farmer, zoo keeper, in their language, know what they require. Be honest, never be afraid to say you have been wrong; try standing alongside the open ditch at Newbury to see your NH horse jump, watch your agility dog compete, before you say your patient is ‘cured’!

Congratulations to those of you who have taken the plunge and, in the main, exchanged the human model for the animal. Never forget your anatomy, never hang up your L plates. What is so exciting is there is always something new to learn. I mean, did you know the slime of the warty black slug, Arion Arter, reduces/ cures Sarcoids?

Mary Bromiley FCSP June 2010 Exmoor and the Smokey Mountains, NC, USA