Knee Arthritis|Knock Knees|Virtual Knee Surgery

Patients with knee pain now comprise of at least 30 percent of Orthopaedic practice in urban population. The clinical presentation varies from subtle knee pain arising after activity to severe incapacitating pain which limits the activity of an individual to household.

Osteoarthritis Knee usually affects men and women in their fifties or sixties. It has a genetic predisposition, but more important factors are excessive weight, lack of exercise, sedentary lifestyle, previous trauma. The importance of weight reduction and regular activity can not be over-emphasized. Most patients offer pain as the limiting factor in their willingness to comply with the physiotherapy and exercise regimen.

Osteoarthritis develops due to progressive loss in the cartilage layer of the articular surface, mediated by chemical markers like Interleukins; and by lack of glycoproteins in the synovial fluid. Gradually, the two articular surfaces come in contact with each other, and the pathology migrates from a chemical to purely mechanical one.

Radiographs serve an important role in diagnosis. Loss of joint space and formation of osteophytes makes for an easy diagnosis.

The treatments offered for Osteoarthritis knee vary from- Physiotherapy/ Analgesics/ Bracing - to Arthroscopy- to Knee Replacement.

Early Osteoarthritis knee wherein the joint space is still preserved, and there is minimal osteophyte formation; can be successfully managed with painkillers and Supplementation of Inflammtory marker inhibitors. The role of Glycosaminoglycans is debatable.

In patients who present with moderate to severe pain, there is limited role of Arthroscopic joint lavage; wherein the joint is entered via two small 1 cm incisions, and the interior is visualized with a camera. this offers a short term relief, but provides a good alternative for patients who are medically unfit to undergo major operations.

Patients with severe arthritis, are usually offered Joint Replacement as a definitive solution. The most important factor in the success of a knee replacement is good patient selection. A patient with good compliance for physiotherapy and having a knee pain which is substantially limiting his quality of life is a good candidate for surgery.

The availability of technology has made knee replacement one of the commonly performed surgeries in Orthopaedic practice. The options include a Unicondylar knee Replacement or a Total Knee Replacement. The former is advocated for patients with a single compartment involvement, and those with mild deformities. Total knee Replacement is offered for a bi- or tri- compartmental arthritis.

The technical options among the various types of Knee replacement implants include- (a) Cruciate Substituting, (b) Cruciate retaining. The former involve resection of the Anterior Cruciate ligament and substitution by an inbuilt mechanism in the implant design. The latter involves retention of the Anterior Cruciate ligament. Rotating platform designs are also popular these days.

The important judgment regarding the various types depends on the status of knee deformity, and the functional status of ligaments.

Total Knee replacement is one of the commonly performed surgeries today. The note of caution need to be exercised both on the part of the patient and the treating surgeon to restrain the influence of market forces in making the correct judgment. Total knee replacement offers significant improvement in the patient's status, provided the selection criteria are strictly adhered to. A few complications that need special mention include- Deep vein thrombosis, Pulmonary Embolism, Infection, Implant Loosening.

If you suffer from joint pain and stiffness, you may be inclined to wear a brace to help stabilize the joint. Joints damaged by age or overuse may become weakened and stiff during everyday activities. A supportive brace may help alleviate this pain and stiffness throughout your busy day. Whether it's inflammation from an injury or arthritis, braces can offer patients a reprieve from the pain and stiffness.

What Are They?

A supportive brace is just as it sounds. It is a contraption that you wrap around the weakened joint which lends support and aid to the joint. There are many types of braces for such pain, such as a knee brace, ankle brace and the like. Generally the brace will have a type of restriction which keeps the joint in perfect alignment and can ease the pain associated with overused joints. For example, a knee brace can lend support to a weakened knee joint, realign the joint so that it is in proper alignment with the hip and back, and help ease the pain of misalignment.

If you have an injury to a joint, bracing it can help speed up the process of healing, by keep the joint in proper alignment. Braces with strong support are frequently utilized by individuals who have experienced some trauma to a joint, like overuse or sprains. For this, supportive braces can strengthen the muscles and ligaments associated with the injured joint by essentially acting as a second muscle group, keeping the injured muscles from experiencing additional trauma.

For those who suffer from arthritis, supportive braces can increase motility of the damaged joint and in some case, relieve the pain associated with the condition. Often arthritic braces act as an insulator, applying heat to the afflicted joint to reduce pain by keeping it warm. Neoprene sleeve are a common type of arthritic supportive braces. The neoprene sleeve can insulate and thereby help alleviate joint pain from arthritis.

Should I Just Go Get One?

As with any medical condition, it is always advisable to seek medical treatment for any injury or disorder. If you have joint pain, you may have a more serious arthritic condition which may require surgery. Minor injuries do not always require a supportive brace and in fact supportive braces can do more harm than good if worn inappropriately. This is why it is important to consult a physician before wearing a supportive brace. Only a physician can affirm whether a supportive brace is the right choice for you.

1. Djembe Size

Sometimes, people looking for their first djembe will buy the smallest, most inexpensive drum they can find and expect to become a professional player in no time. Please do not make this mistake! Smaller djembes are fantastic for children, but as an adult player you should opt for a djembe with at least a 9"-10" playing surface diameter and a 19"-20" height. Your hands need room to learn all the different striking techniques and trying to play a djembe that is significantly too small will work against you. For many players, the most comfortable djembe playing position, is seated in a chair, with feet planted on the floor and the djembe lifted slightly off the ground while anchored between feet and knees. In this position, the drum will ideally rise about 2-3 inches above your knees (if much lower, your knees will be obstacles while striking and if much higher, your arms will be raised uncomfortably high while striking). A djembe with a 24" height and a 11"-12" playing surface is most commonly recommended for adult players.

2. Djembe Drum Materials and Construction

Traditional djembes are made from a single piece of wood (ie mahogany, lenke, etc) and range from Intermediate/Jammer to Professional level (Please note these categorizations refer to djembe construction quality rather than player skill level) and come in a variety of sizes. Most wooden djembes are rope-tuned and commonly have goat skin heads. Many players like wooden djembes for their warm, rich tones in addition to their traditional hand-carved look.

Djembes can also be constructed of synthetic materials, such as Fiberglass djembes. Fiberglass djembes often have a more amplified, resonating tone with deeper bass. As a result, many players prefer these while performing so the djembe can be heard among other instruments. Players also like fiberglass djembes for their extreme durability and light-weight. These qualities make for an ideal traveler's djembe.

With that said, you should select the djembe best suited for your preferences and lifestyle. If you're a person who like a lot of bass or may be traveling frequently with your djembe, you may want to consider a fiberglass djembe. If you like warm, full tones and a traditional hand-carved look, you should consider a wooden djembe.

3. Environmentally Friendly Djembe

It's very important to consider the wood source of your djembe. Is the wood used to make the djembe "Lacey Act" compliant? Purchasing items made from illegal wood is extremely harmful to the ecosystems of the world at large, and provides much more detriment to Mother Nature than the rhythms you play on drums carved from it will ever benefit you as a player.

Whichever company you buy from, please make sure the wood used is Lacey Act compliant, sustainably harvested. Never buy from a company that can't back this up. If a drum sounds too cheap, it probably is. Particularly on eBay you will see knock-off carvings of drums that appear similar to legitimate products, but are made from illegally harvested wood. Not only are these drums inferior in quality, they're also leaving behind an ecological footprint that is unsustainable.

4. Djembe Head

Most wooden djembes have goat skin heads. Jammer style wooden djembes have treated goat skin heads, and professional wooden djembes have untreated goat skin heads, providing for better tonal range and increased bass.

Many fiberglass drums also have goat skin heads, but more often than not, they will come equipped with a synthetic head. If you decide to select a synthetic-headed djembe, keep in mind that not all synthetic heads are created equal! Some synthetic heads consist of a harder plastic, resulting in a very tinny sounding drum. Other synthetic heads have a more realistic, malleable feel.

Fiberglass Drums made by the brand, "Freedom Drums," have FiberSkin synthetic heads, which look and feel very similar to goat skin, but maintain their tune much longer, which brings us to the next point...

5. Djembe Tuning

There are two types of tuning systems; Key-Tuned Djembes and Rope-Tuned Djembes. Key-tuned djembes are typically synthetic and include a tuning wrench which enables you to tighten the lugs around the djembe head and in turn make the skin stretch tighter over the head. Key-Tuned djembes are slightly more convenient for the beginner, however you will sacrifice a slight amount of sound quality, as a rope-tuning system holds the skin in place a little tighter.

Tuning a rope-tuned djembe involves a process called the "Mali Weave" which is the process of weaving the extra tuning rope around the djembe head in a diamond pattern, thus creating tighter tension on the skin. The Mali Weave is actually much easier than it looks, and something you should eventually learn as a player. There are many helpful resources and djembe tuning videos across the internet that demonstrate how to tune a rope-tuned djembe drum. If you're willing to learn this relatively simple process, you will find owning a rope-tuned djembe drum quite rewarding. With regards to tuning frequency, this is largely dependent on the conditions in which you store your djembe and your sound preferences. If you would like your djembe to maintain its tune longer, it's best to keep it indoors and in a case. If you prefer a tighter sound, you'll probably find that you want to tune it more often.

6. Djembe Tuning Rope

This is a very important factor to consider if you've decided to select a rope-tuned djembe. Just like djembe heads, not all djembe tuning rope is created equal. Low quality rope on a djembe can truly make an otherwise excellent drum sound sub par. When selecting a rope-tuned djembe, make sure that the rope used is internally braided and non-stretch. This allows the tuning to stay in place. If the rope used is stretchy and more similar to twine, all the work you put into tuning it will be for naught, and you will find yourself with a drum that sounds forever out-of-tune. Ideally, the rope will be made from nylon or polyester material, will be between 4 and 5 mm in width, and will not twist or spiral.

7. Djembe Cost

As mentioned earlier, it's important not to select the smallest, cheapest djembe you can find and expect a great-performing instrument. With that said, however, it is still possible to get a high-quality djembe without breaking your budget.

For players not so concerned with aesthetic imperfections such as minor dents, scratches, small areas filled in with wood glue, slight skin discoloration, etc, there are additional opportunities to save big without sacrificing performance or sound quality. The beginner player will often find that their instrument may become slightly scuffed during the playing process anyway, so it can benefit you to receive or ask about discounts on blemished djembes.

A few years ago there was an article written in Men's Health Magazine titled "Everything You Know About Muscle Is Wrong." by Christopher McDougall

The article talks in detail about what scientists have discovered as being the secret to healing long time sports injuries, improving posture, and building a stronger, faster more athletic body is actually hidden within you.

What essentially they are talking about is the patterns that develop in the connective tissue of the body. Just think of the ruts in an old dirt road that no matter how you try to drive your tires still end up in the ruts...

Connective tissue also know as fascia surrounds our muscles, organs and bones. This connective tissue or fascia is what needs to begin to change in order for knee therapy to be permanent and long lasting. So back to the comparison of the ruts in the dirt road, if the ruts are not smoothed out you are always going to fall back into the old patterns in your body.

So what does this article have to do with your knee pain and how does it tie into your knee therapy?

Well I'm glad you asked!

The patterns your body takes on as a result of a long time period of stress, trauma or injury are functional patterns for the stress, trauma, or injury however these same patterns become dysfunctional when they continue to present problems for your body resulting in chronic knee pain.

The key is to begin doing your knee therapy exercises slowly and with conscious awareness. The more awareness you bring to the table the more your mind is able to connect with that part of your body, namely your knees and begins to re-pattern the dysfunctional tension patterns in your body reducing the pressure going to your knees.

One drawback on the article is it only covers how to actively re-pattern these dysfunctional tension patterns through modalities of body work like Rolfing and Feldenkrais. At the end of the article they also talk about how doing this yourself can take a very long time...

This is partially true however there is a much easier and much quicker form of knee therapy I refer to as "passive stretching" that I cover in my Virtual Knee Pain Clinic. This approach works with the tension in the nervous system that builds up as a result of the body tensing up to protect itself. By teaching our body to understand what comfort is you avoid the entire tension mechanism and allow your body to "reset" itself.

When your nervous system is reset...It is much easier to go in and do the slow controlled knee therapy exercises that hold longer with better faster results...

Aromatherapy

To help reduce inflammation, try drinking ginger-castor oil tea daily at bedtime.

Chiropractic

Although chiropractic cannot do a lot to turn back the clock, it can prevent progression of the disease. Specific chiro practic adjustment (SCA) can help patients with rheumatoid arthritis by increasing joint flexibility, decreasing swelling in the joint areas and joint capsules, and decreasing fluid accumulation that results from arthritic changes. For example, if the patient's hands are affected, care includes SCA of the affected joints, moist heat application, and hot water soaks with Epsom salts to promote mobility. In some cases, care may include paraffin (hot wax) baths.

Herbal Therapy

Rheumatoid arthritis and osteoarthritis have many similarities, including herbal remedies. However, there are some subtle variations. For rheumatoid arthritis, take a combination tincture of meadowsweet, willow bark, black cohosh, prickly ash, celery seed, nettle' wild yam, and valerian to help temper arthritis symptoms. To make the blend, mix equal amounts of the tinctures; take 1 teaspoonful of the mixture 3 times daily. The blend is safe and can be taken for a period of time. (See also "Osteoarthritis" entry.)

Herbal products are available in health food stores and in some pharmacies and supermarkets. Follow package for specific directions.

Traditional Chinese Medicine

Acupuncture To treat rheumatoid arthritis, which commonly affects the wrists, knees, shoulders, ankles, and elbows-acupuncturists may focus on the heart, kidney, back of head, and internal secretion points. They may also target any points that are associated with the afflicted joint.

To help quell arthritis-related foot pain, the practitioner may manipulate Liver 2, Kidney 3, Bladder 60, Liver 3, Stomach 44, and several points on the ear. Arthritic ankle pain is often treated by inserting needles into Stomach 41, Bladder 60, Gallbladder 40, and additional auricular points.

AcupressureFor rheumatism-related ankle pain, a practitioner will probably target two points: Large Intestine 4 (in the webbing of the hand between the thumb and forefinger) and Bladder 60 (in the depression behind the outside ankle bone). Several points on the foot and on the ankle itself also may be targeted.

Elbow pain may be relieved by massaging LI 11 (toward the outside of the elbow); knee pain will be helped by manipulating several points on and around the knee itself; shoulder pain is best helped by performing acupressure on several points, including Large Intestine 15 and Gallbladder 21; while wrist pain is alleviated by applying pressure to several acupoints on the wrist. In addition, ear acupuncture may be used to help further relieve the symptoms of rheumatoid arthritis.

Generalized joint pain may be relieved by pressing the two Gallbladder 20 points on the back of the neck.

Chinese Herbal TherapyThere are many Chinese herbal arthritis formulas available at health food stores or by mail order, such as Angelica and Loranthes Combination for lower back and knee pain; Xiao Huo Luo Dan for stiff joints; Feng Shih Hsiao Thng Wan for finger, shoulder, knee, and hip pain associated with rheumatism; and Tian Ma Wan for general rheumatic pain.

Men are something of a puzzle to most women. If you've ever been attracted to a certain fellow you know that trying to determine what appeals to him isn't easy. All men have their own set of standards when it comes to the women they are attracted to. There are some seduction tips for women that do work with the majority of men. If you really want him to feel hopelessly in love with you, you need to employ a few effective techniques that will knock him off his feet.

Scent has everything to do with grabbing and keeping a man's attention. Most of us do put some thought into the fragrance we wear, but you should also consider where on your body you're applying it. One of the most effective seduction tips for women is to apply your favorite fragrance to a few pulse points on your body that men naturally find appealing. You likely already apply a small amount to your wrists, and behind your ears. Other spots include behind your knees and inside your elbows and ankles. Ensure that you wear the same fragrance each time you see the man you are interested in. You want him to create a strong association between the appeal of the scent and you.

One of the most obvious seduction tips for women is one that most women never employ. You have to be super confident if you want to seduce a man. Even if you don't feel completely confident you need to give the impression you are. This includes being proud of who you are, what you do for a living, and how you look. Never make excuses for your shortcomings. Instead embrace them. Men love this in a woman. They find it irresistible.

Orthopedic surgery is the branch of medicine that deals with the study of injuries to the skeletal system. The study includes the various parts of skeletal system like muscles, bones, joints, tendons, nerves and ligaments. Musculoskeletal ailments are the second most common reason for people to seek medical help.

Orthopedic surgeons a great many procedures to fix broken bones and ligaments, surgically remove tumors and work on the functional ability of joints, including perform reconstructive surgery on joints.

Failure of Orthopedic Surgery Procedures

One of the most common reasons for orthopedic surgery procedures to fail is that the tissues being repaired do not hold up against the strain of rebuilding and healing. Examples of these failed procedures include the instances of rebuilding ligaments, non-healing of fractures, recurrent arthritis and recurrence of pain after surgery to heal causes of chronic pain.

One of the other causes of the failure of orthopedic surgery is infections after surgery. Infection is, of course, a common cause of surgical failure after any sort of surgery, but these are more critical in the case of orthopedic surgery. This is because orthopedic procedures commonly involve the use of foreign bodies and metal implements. If these implants are infected, the body's immune system cannot deal with the organisms affecting the implants because these are foreign to the body. If infection sets in after the surgery, the results on the body can be quite disastrous.

The only way to prevent infections during and after surgery is to maintain an antibiotic cover during and after surgery. Signs of infection building up in the body after an orthopedic procedure are a recurrent redness around the site of incision, together with a discharge from the site of the wound.

Another reason that causes the failure of orthopedic surgery procedures is the forming of blood clots. These blood clots occur when the patient has been laid up and stagnant for a long period of time or because of some inflammatory substance or chemical produced at the wound site. Orthopedic surgeries involve an extra risk of blood clots because the nature of the procedures itself makes for reduced movement and increased stagnation. Blood clots that are formed in a limb can be catastrophic if they travel up to the lungs, causing blood flow to cease.

While orthopedic procedures are usually quite safe to undergo, in some cases, complications can show up because of subsidiary reasons, like infections or the formation of blood clots. These can be reduced or eliminated by following a correct and adequate antibiotic protocol and trying to be physically active as soon as possible after the surgery.

There are plenty of orthopedic surgery procedures like knee or joint replacement surgery that can make a significant difference to the quality of life that a patient enjoys. Going in for orthopedic surgeries is not something that can be needlessly risky and can be easily carried on smoothly if some precautions are taken.

There are many studies to show that acupuncture can be used effectively in orthopedics cases and for pain management. As students of acupuncture and Oriental medicine, we are eventually faced with a dilemma in our training. Some schools of thought state that "De Qi," or the arrival of qi at the acupuncture point must be obtained in order to have a therapeutic effect. Systems such as Traditional Chinese Medicine-style of acupuncture posit that it is essential and others such as Kiiko Matsumoto's style of Japanese acupuncture claim that it is not necessary. How can there be so much difference in opinion and whose school of thought can be believed?

The concept of "De Qi" is taught in acupuncture schools throughout California. In his book The Art of Acupuncture Techniques (a book on the list of required texts for the California Acupuncture Licensing Exam), Robert Johns discusses "De Qi" as follows, "Needling response (de qi) is typified by increased feeling of tightness or heaviness around the needle. It is described as a fish hooked on a line, jumping up and down, floating and deep. The patient's response to the arrival of qi may be light or very slow in coming. When the qi comes late or takes a long time to arrive, it indicates that the patient is weak and that overall response to treatment will be slow.

The strong patient experiences a quick arrival of qi. When the qi comes quickly the therapeutic results also are quick. Slow arrival of qi or a weak response can also indicate incorrect depth of needling or wrong placement of the needle. The importance of the arrival of qi cannot be overstated: in order to apply the desired technique there must first be arrival of qi, or needling response."1 It is generally accepted that the action of a given acupuncture point is assured only when needling is accompanied by "De Qi."

I recently came across a study that caused my eyebrows to rise a bit. It is regarding whether or not "De Qi" is necessary in treatment response to acupuncture in pain treatments.2 I am specializing in the treatment of chronic pain conditions and am concerned for the comfort of my patients so I became very interested to read this study. The aforementioned study comes out of the University of Southampton School of Health Sciences, Southampton, UK. The object of this study was to assess the importance of the strength of "De Qi" on the outcome of acupuncture treatments for patients with osteoarthritis of the knee and hip. The interventions used in this study included real acupuncture, Streitberger needle and mock electrical stimulation on 140 patients.

The relevant outcomes were pain reduction (they used a visual analog scale to assess) and the Park needling sensation questionnaire. The results showed that a) there was no significant correlation between the strength of "De Qi" and improvement of pain and b) that there was no significant difference in pain relief from those who felt "De Qi" and those who did not. The study concludes, "These data suggest that the presence and intensity of de qi has no effect on the pain relief obtained for patients with OA [osteoarthritis]. This result may have implications for both acupuncture treatment and for future trial methodology."

This eye-opening experience has caused me to focus more on my patient's comfort level than that of obtaining "De Qi" to ensure therapeutic effect with acupuncture treatment.

It sounds like something out of medieval times. Using leeches to treat every disease and condition known to man. But as it turns out leeches are actually very powerful for treating a wide variety of ailments including knee osteoarthritis.

Knee osteoarthritis is a degenerative joint disease that results in the breakdown of the cartilage between the joints in the knees. This leads to pain, loss of range of motion and bone damage. There appears to be several origins of knee osteoarthritis including joint deformity, repeated injury, or excess weight. There is no cure for osteoarthritis so the focus is on treatments for the pain and reduction of continued damage to the joint.

And this is where leeches come in. Leeches secrete morphine, a potent pain killer. Leeches also secrete an anticoagulant which improves blood flow to the area where the leeches are applied and an anti-inflammatory. Since inflammation is responsible for the symptoms of osteoarthritis, researchers believe that leeches might relieve pain in patients with osteoarthritis.

The U.S. Food and Drug Administration (FDA) classify leeches as medical devices and has approved them for microsurgery. The FDA is also involved in the regulation of the transport and sale of leeches. In Germany there has been an estimated 70,000 treatments a year over the last few years with four to five used for each treatment. Most of these treatments have been aimed at pain reduction in knee osteoarthritis.

Several studies have been conducted regarding the use of leeches for treating knee osteoarthritis.

One study, reported in the Annals of the Rheumatic Diseases, focused on 16 patients with an average age 68. These patients had experienced persistent knee pain for more than six months. None had suffered any knee injuries and all had x-ray evidence of osteoarthritis. These patients were already treating their knee osteoarthritis with physical therapy, relaxation, diet and exercise.

In this study, part of the group was provided traditional treatment and the rest were treated with leeches. Four leeches were applied to the knee for 80 minutes. Pain levels were measured three days before and 28 day after the treatment. The results were rapid. Treatment with leeches resulted in pain relief after three days and continued through the 28 day test period. The patients who received traditional treatment did not experience relief. There were no side effects noted from the leeches and the patients reported that the initial leech bite was mildly painful.

A larger study was conducted involving 51 patients age 40 and above with knee osteoarthritis with high pain. Four to six leeches were applied to the affected knee and were allowed to remain until they detached themselves, which took about 70 minutes. Then the patients rested the knee for 12 hours. Researchers then measured the patients' pain, stiffness and range of motion after 3, 7, 28, and 91 days.

The results were similar to the smaller study. The patients receiving leech therapy reported less pain, less stiffness, better function, and fewer total osteoarthritis symptoms through the full 91 days that the researchers followed them.

These studies give hope for alternative treatments of knee osteoarthritis for reducing pain and increasing mobility. In order to properly validate these studies additional research needs to be conducted over a longer period of time. But it appears that leeches do provide relief to knee osteoarthritis sufferers.

Thousands of dogs fly every year. If they could talk; the majority of them would get down on their knees to beg their owners never to force them to repeat the experience.

Unless your dog is small enough to be crated and tucked under your seat, where you have complete control, he or she will be flying in the cargo hold. This is an extremely traumatic experience for many dogs. Some stress out so much, they don't survive it. Others, have such a negative association, it at times causes serious behavioral problems, mainly abandonment issues.

Suggestions to prepare your dog for their flight are:

1. ACCLIMATE YOUR DOG TO THEIR CRATE: If your dog is not crate trained, several weeks before the trip, purchase a crate to allow them to get accustom to it. Place small treats and toys inside, feed them in it, and allow them to sleep in it. They must associate the crate with good things. Leave the door open.

2. MOTION: Once your dog is comfortable with being in the crate, close the crate door while they are in it. If the crate is small, pick it up with the dog inside and carry it around. If it is too large to lift, gently slide it around. Reassure your dog that everything is 'OK'. Repeat this as often as needed. This will help reduce some of the stress of what they will encounter at the airport.

3. MOTION: To prepare your dog for some of the motion they will experience, take them for rides in the car, while they are crated. Start with short car rides; gradually increase the length of time.

4. NOISE: To desensitize your dog to some of the unfamiliar noises they will be experiencing, make a tape of airplane engine sounds and severe weather. Begin playing them softly, and slowly as your dog adjusts, increase the volume, until your dog no longer pays attention to it. Airport and airplane noises can be deafening, and extremely disturbing to many dogs.

5. SEDATION: If you sense your dog is too frighten by the above, or if they suffer from motion sickness, speak to your veterinarian about a mild sedative. You will just need enough to take the edge off, not knock them out completely! For some dogs, a motion sickness medication is just enough to take care of both problems.

6. IDENTIFICATION: If your dog is not micro chipped, now is the time to do it! Also make you have updated ID tags on your dog, with emergency contact address and phone numbers...including one with the address and phone number of your destination. Place the same information in a non-detachable, waterproof manner on their crate. Remember to remove the vacation destination location on the return trip home. You want only your address and phone number.

7. IMMUNIZATION: Be sure your dog is current on all their required inoculations. Carry those papers with you in your hand luggage. This way you will have their health certificate should the airline require it.

8. LEASH: Carry your dog's leash in your hand luggage. Should there be an extended delay, an overnight delay, or your dog escapes from the crate, you will be glad you have it handy.

9. WITHHOLD FOOD and WATER: Food should be withheld for 6 hours prior to your flight. Water should be with held for 2 hours. Make sure the empty water bottle is attached to the crate, should there be a delay. You may need to inform the airline staff that your dog is in cargo, and will need to be hydrated.

10. NATURE CALL: Prior to crating your dog, allow them enough time to relieve him or her self. Do not rush them! Upon arrival to your final destination, you may find you dog soiled in the crate...be sensitive to what they have just gone through. Consider how many times YOU used a rest room during this flight.

11. DISTRACTIONS: Place one or two of your dog's favorite toys, and blanket in the crate. Also by placing an item of yours, such as a T-shirt you have worn; the scent may give your dog a needed sense of security.

12. NON-STOP FLIGHT: Whenever possible, book a non-stop flight. Trying to make connecting flights is one of the leading causes of dogs being misplaced, put on the wrong plane, or left sitting in the baggage area.

13. TIME OF DAY PREFERRED: Cargo holds are not heated or cooled while the plane is on the ground. To avoid hypothermia or heat exhaustion; in the summer try to fly early in the morning, or in the evening. Remember, most thunderstorms occur in the afternoons, sometimes causing a delay for several hours. In the winter, try to book your flight during daylight hours.

14. INFORM THE FLIGHT CREW: The pilots are usually informed if there is an animal in the cargo hold. However, they have a lot on their minds. Ask a flight attendant to remind the captain, so they can monitor the temperature and air pressure gauges for the cargo hold.

15. AIRPORT DEPARTURE: Arrive at the airport with time to spare. Your dog does not need to sense any more stress than they are already experiencing.

16. AIRPORT DESTINATION: Get your dog BEFORE you get your luggage. Ask if there is a designated area where they are allowed to relieve themselves. Give your dog a small drink...they are most likely dehydrated. Don't let them over do it though...remember their stomach is empty. Give them a special treat. They are hungry, and they earned it! The security and relief your dog will sense simply seeing you, will help them from feeling abandoned. Your luggage can always be replaced.

17. FINAL DESTINATION: Your dog has just had an experience you would not wish for yourself. When you arrive at your final destination, allow them enough time to calm down and adjust to their new location. Remember, they have to repeat this horrendous experience on the return trip home.

Bottom Line: Whenever possible, try to make arrangements for your dog to stay home. Traveling on an airplane is not a pleasant event. Either board them in a reputable boarding facility, where they can make new friends...some even have pet-cams where you can watch on a computer, what your dog is doing all day. Or, find a reliable pet sitter. Your dog will be happiest in his or her own home, on their regular schedule, and you will have the added benefit of having someone watch your home for you.