Laurie's Blogs.

Laurie, I have a quick question. I had a client with very overweight Lab that blew out his ACL on his LEFT leg.  I told her I would not do surgery until the dog lost weight. He was in rehab with me for two months and lost a bit of weight.  Anyhow, he did become sound and I told the owner this was not a permanent fix and he had to lose more weight. He started off at 140 pounds.  Anyhow, they didn't listen to me and found a veterinarian to do the TPLO surgery.  The owner came into my clinic Saturday begging me to take her dog back as he hasn't used his RIGHT leg since surgery. I reviewed the records and all injections were given in the left leg (surgery leg).  I did brief exam after they picked him up from the other clinic.  Surgery was performed on a Wednesday and they kept him in hospital until Saturday.  He was highly sedated so I determined that a good neuro exam wasn’t going to happen.  I totally redid all meds he was on and sent him home until Monday. I can tell you, he knuckles his RIGHT leg, has deep pain on medial phalange but other three have no deep pain. I am assuming nerve damage from being down with surgery and excessive weight.  He went into surgery at 135 lbs and he needs to be 100 lbs or less.  She is bringing him back in tomorrow but was wondering if you had ever dealt with this.  I have dealt with this on large animals but never post-op on a canine.  Thank you so much for any advice.  I love your website and it is so helpful.

J

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Hey J, 

Very strange case…  I have questions firstly... did they do an epidural?  Could be that they punctured in a bit too far &/or set off an inflammatory reaction near the cauda equina / lumbar nerve roots.  Medial toe can have some sensory input from a branch off the femoral nerve... the outside toes are sciatic components... so this makes more sense from a lower motor neuron (LMN) perspective...

I'm not sure that simply being down and the excess weight caused this (i.e. as a direct cause & effect).  I'd also throw FCE into the differentials too. 

And just as an aside, we've had a number of dogs not need surgery during a conservative trial or weight loss pre-surgery, as they were doing so well after a round of rehab.  We’ve had few dogs in particular now (one side surgery, the other side not) that their vets can't tell which is which. 

At this next appointment, I guess you just have to go with a fresh neuro exam.  Look at protecting the foot (Therapaw dorsiflex assist for normal foot placement - or rig something up with theraband or ace bandages in the mean time).   

I've not had exactly this scenario before - I've seen myelogram gone wrong.  I've seen surgical-'oops hit a nerve' cases.  I've seen dogs walk in neuro and offered cruciate surgery... who, after the surgery, walk out still neuro!!!  I've seen same sided issues with lower motor neuron signs following an extracapsular technique (same vet did the surgery on two different dogs... something fishy there!!!).  I've seen terrible auto-immune / allergic suture reactions following a tibial tubercle transposition surgery that ended up with LMN issue.  But not overweight dog - neuro issues following surgery.

Let me know what you find on Monday!

Laurie

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Laurie, Thank you for your response. So my patient, off all sedation medications has what I believe to be peroneal nerve damage from the leg being tied up during surgery!  He has no sensory one lateral metatarsal area, tarsal area and lateral phalanges.  He has normal Gastroc reflex and cranial tibial reflex - okay as normal as could be he was trying to get up and wiggly the whole time.  Gluteal good, patellar reflex good. I ordered dorsi flex for him and starting rehab Monday.  A few neuro vets laughed at me saying this was impossible but I think I'm right. Anyhow, gonna start I bit of acupuncture alternating with laser Monday, Wednesday, Friday. Gonna start his overweight body in water treadmill and rehab like post acl surgery with a lot of rehab on nerve. Any other suggestions would be great.  Oh, no epidural was given and all injections of medications were given in surgery leg.  Of course, he is using surgery leg too much.  Thank you again.

J

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Hey J!

Great info!  And I agree with you.  I never thought about the tying up!!  That could certainly make sense!

With all of the reflexes intact... everything should come along nicely.

I'd also laser over, near, along the nerve for stimulation.

Sounds to me like your plan has everything covered! – I think you'll do fine with this one!

Laurie