Laurie's Blogs.

Hi Laurie,

I am new to rehab-just a few months, so don't have a lot of experience under my belt.  I've been a practicing small animal vet for 16 years, started acupuncture 4 years ago, and acquired my CCRT at the end of last year.

I am rehabbing a dog for our shelter.  Things were going fantastically until today…Tuti is a 6 year old spayed female American staffordshire terrier that was found by the road HBC.  She was initially paralyzed in the hind end, I think just for a few days.  Deep pain positive, no urinary or fecal incontinence.  One later rad was taken-presumptive T12-T13 disc herniation.  She was isolated/confined, placed on a decreasing dose of prednisone.  When we started seeing her she could walk, run, pull, but was definitely weak and ataxic in the hind end.  LH is weaker than RH and is somewhat restricted on iliopsoas stretch.  No cranial drawer.  

We started with very simple exercises-sit-stands, cavaletti poles evenly spaced, perturbations of the hind end, 3 legged stands, wobble board, underwater treadmill, acupuncture and laser.  We saw her 3 times/week for the first 3 weeks, then twice a week for the past 2 weeks. She was noticeably stronger at each session, and to the untrained eye, you would not even know there was something wrong.  She still favors the LH.  She is up to 30 mins in the treadmill, donut side stepping to both sides, snoopies (diagonal leg stands), weave polls, donut with balance disc under hind feet, and 3 legged stands.  Last week we introduced the red peanut ball, we had her front feet on the ball walking forward with stabilization from us.  No problems. 

Today she appeared normal.  After doing weaves and sit-stands and donut exercises I though she looked a little weak in hind end but thought maybe I had tweaked something.  We then did the red peanut ball exercise (bad choice in retrospect) and she was noticeably ataxic in the hind end afterwards.  There was also a noticeable significant crepitus in her caudal thoracic spine!!!  We stopped exercises.   No CP deficits all 4 limbs.

I performed laser and acupuncture, advised the shelter that she should be alone, confined, and on NSAIDs or prednisone and recommended additional radiographs.  

She also had several scabs on her face and we are wondering if the giant pit bull she's been housed with was a little too rough with her.  

My rule outs are T12-T13 additional disc extrusion, IVDD at another site, or an undiagnosed fracture.  

I was wondering what your thoughts were on rule-outs.  Of course, I'm also worried that I caused this regression by putting too much extension on her spine.  I'm confused about how much is enough when they have an IVDD without surgery.  What is helping and what is detrimental?  

Thanks Laurie!

S.M.

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Hi S,

So, as for this case...  my thoughts on differential diagnoses would be:

- exacerbation of IVDD as you bring forth - or

- instability at the T-L region... or anywhere in the L/S for that matter, or caudal C/S too should be ruled out.

It is not likely that any of your exercises that set this off...but as you bring forth, if she is rough housing, being bullied, or amorously attended to by another dog who may have jumped on her back, then that could certainly flare things up!  In which case, if you started doing exercises with extra extension... these exercises may have allowed a bit more compressed the spinal cord (nothing permanent... so no big worries...just a point of helping to understand the pathoanatomical rationale for the problems... and then you stop doing them - for the time being).

While rads would be interesting... if they didn't show a fracture before, you're okay to go without for now (unless there is further deterioration).  She's walking - so surgery is unnecessary.

(PS  Check out the first two 2013 FourLeg newsletters - lots of relevant neuro info in them).  Might as well save the shelter a penny... and it's not going to change what you do.

So your plan is sound.  Keep her from playing / being bullied, NSAIDS, laser, acupuncture.  All brilliant.  You can go back to some simple balance exercises on stable land.  I'm okay with cavaletti's etc... When she seems to have improved a bit, THEN you could reintroduce the exercises in some degree of extension - start low and work up.

You're on track!  Keep up the good work!

Laurie