Laurie's Blogs.

Hi Laurie-

Here is that weird neuro case that I was telling you about- was wondering if you have any ideas of how we could help this boy out with rehab.  I am starting acupuncture and laser tx on this kid this week.

Dobi is a 7 year old castrated Pug- has been to a couple of neurologists to see if anything could be done- both of them said that surgery could be tried but were not sure if it would help or nor- so it was referred to our clinic for acupuncture.

The dog is able to walk and support himself- but both rear legs cross over when he walks.  He is able to walk without tripping himself.  However, when one pushes him into a sitting position- or if he falls down onto his rear end- both back legs go into super hyperextension and freeze- like he is trying to put his rear toes into his ear canals.  At this point- he can not lift his rear end up from sitting to standing- like he is frozen into this position.  But if you lift him up- the legs unfreeze and go back to "normal."  The neuro on the forelegs is normal.

What the neuro specialists said was the following:

The spinal cord appears atrophied at T 11-12

The disk in this area looks normal- maybe some annular bulge

Normal epidural space

The facets at t 11-12 appear smaller than normal

Possible spinal cord instability

We tried this kid initially on gabapentin and and herbal formula- San Ren Tang.  Dog did a lot better- the rear legs did not go into the frozen hyperextension- but as soon as the gabapentin was stopped or decreased- he went back to his old ways.

So---- any ideas of how I could approach this kid with rehab?  I (and I'm sure both the dog and owner!!) would appreciate it.

Thanks!!

CC

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Okay C,

So... was this sudden onset or slow progression?  Did you find the article I was talking about in the FourLeg News (Vol 2, Issue 2) with the neurologic pugs?  I've attached it here:

Fisher SC, Shores A, Simpson ST.  Constrictive myelopathy secondary to hypoplasia or aplasia of the thoracolumbar caudal articular processes in Pugs: 11 cases (1993 – 2009).  J Am Vet Med Assoc 242(2): 223 – 229, 2013.

Purpose:  To report the presence of thoracolumbar caudal articular process (facet joint) malformations with secondary constrictive fibrosis of the spinal cord in Pugs.

Subjects:  11 pugs with neurologic dysfunctions (secondary to constrictive fibrosis because of the facet joint malformations) and 5 Pugs with no neurologic dysfunction.

Method:  Medical records were reviewed for all Pugs that were managed medically or surgically for facet dysplasia or aplasia..

Results:  Most common finding was paraparesis with ataxia or paraplegia  without pain on palpation along the spine. Median age of the dogs was 7.7 years.  4 of the 11 dogs had urinary or fecal incontinence.  8 of the 11 underwent surgical exploration, but all (that survived surgery) continued to have neurological deficits 

Conclusion:  Presence of aplastic of hypolastic facets in the thoracolumbar region did not always produce neurologic signs.  However fibrous constrictive myelopathy should be considered in Pugs with pelvic limb neurologic signs.

So... I would continue with the meds / TCM remedies as they have been helpful... and I think that acupuncture is also a good idea (add needles into the GV meridian at the interspaces of T10-11, T11 - 12, T12-13 and each bladder meridian adjacent to these same points as well... this from an anatomical standpoint - not TCM.

Beyond that, you would want to do neuro rehab with lots of repetition... my favourite is walking walking walking on a land treadmill where YOU can place the feet firmly, stimulate a flexor withdrawal, resist active movement, utilize stretch reflexes, stimulate the abdominals, etc... while the dog is doing a functional activity.  You COULD work on sit to standing practice... but my gut is telling me that is is a bit futile without a bit of symptom regression.  

And to that end... I would suggest treatment to the site of the lesion.  Based on what the neuro specialist thought and what the paper above would suggest:

• I would work to increase circulation to the site of the presumed lesion - acupuncture, laser, pulsed electromagnetic field, or ultrasound.
• I would add manual therapies both for increasing circulation to the area as well as having an impact on the soft tissues / connective tissues in the area - specific traction, transverse pressures (side bends) with the segments in flexion, or isolated flexion techniques.  Ohhh, I would also do spinal rotations (either rotating from above - using the front legs as your lever, or from the back end - using your rear legs as the rotary lever...) There is a video on the website (Video Training 28: new Manual Technique for IVDD).
• I would utilize techniques that might enhance dural mobility - tail pulls, full flexion of the spine (perhaps passively in side lying - always within tolerance) with the hind legs extended straight and towards the front legs... and if you are co-ordinated enough and the dog is compliant, add a tail pull at the same time!
• If you or someone you know also does craniosacral therapy, then craniosacral dural glides could also be warranted.
• You could add hanging traction as another mechanism for stretching out the spine (and perhaps the dura).

I hope this helps... it is how I would start to approach this case anyways!

Best of luck!

Cheers,

Laurie