Laurie's Blogs.

Hi Laurie!

First time emailer but long time admirer!  I am a very new newbie at Rehab and don't have much in the way of people in my proximity to ask for help so thought I would reach out to you. I am an LVT at a rural small animal practice and although my wonderful vets are being super supportive of my new venture, none of them are very familiar with rehab (yet).  My equipment is all portable so no UTM, but I carry a laser.

I just met a 3 yr old terrier-mix (piranha) that had a unilateral FHO (left) performed 18 months ago (legg-calve-perthes). Prior to that he had been lame on affected limb and along with the delay in diagnosing, developed severe muscle atrophy.  Client did not seek out rehab post op.  7 months post op, he was found on the floor unable to move his hind limbs. He may have jumped off the bed or fallen. They took him to the vet who found nothing abnormal on spinal x-rays, FHO site appeared normal.  Painful lumbar spine and no proprioception to rears. Declined referral to neurologist. Steroids and cage rest allowed mobility within 24 hours.

Repeat performance but had mild conscious proprioception (cp) deficits one week ago.

I saw him yesterday and here is what  I found. 2 cm difference in thigh circumference. Mildly warm back at thoracolumbar region, circumducts left limb to move forward, left limb shorter than right limb. No pain with movements or massage, and no cp deficits. He will bite at the drop of a dime, so my hands on lasted as long as my peanut butter kong lasted.

Client not interested in orthotics, but interested in doing some exercises at home. I am working on core strengthening, proprioception exercises, hip extension, and rear limb strengthening to get some muscle back in left rear. 

My main concern; is this going to be enough for a dog with one limb shorter than the other? He uses the leg (with extra hock extension)  but it seems like with the difference, he will always be tweaking his back and cause some recurring back issues.

Any advice is appreciated!

MC

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Hi MC

Okay - so with this dog, in addition to a leg strengthening plan, I would also add in some back prevention therapy.  I'd suggest hanging traction and tail pulls to the owner.  Pretty much like they sound.  Pick up the dog, hold him against the chest (all done by the owner in this case!!) and just let his rear end dangle.  Traction in this manner for 30 seconds to a minute at a time... a few times a day.  Tail pulls... in standing, one hand grasps the tail and the other hand braces an ischial tuberosity. Pull slowly and to tolerance - you can pull quite strong usually.

As for the leg use.  It sounds like you are going to have to make the exercises easy for the owner.  And sort of 'fun' for the dog.  I would keep it simple - slow cavalettis, slow walking up hill, loving on the stairs (front legs up on stair number 2 while owner gives praise and some treats), backing up, and maybe figure of 8's following a cookie around the owners legs.  In my head, I don't see that this owner will do much... so you'll have to be realistic with your exercise prescriptions... keep them simple, and make them things that both the owner and dog will enjoy and not find too burdensome.  Oh, and maybe just walks with a bootie / sock on the 'good' leg.

Sounds like a difficult case from the perspective of a 'temperamental' patient and a somewhat non-compliant owner.  And in these cases, you have to make a psychological assessment of the whole scenario and put together a plan that works for this pair.  Maybe not the ideal... but a plan that will make the most sense (and hopefully 'get done'!)

Best of luck!

Laurie