Hi Laurie!
I am a small animal veterinarian recently certified in rehab through CRI. One of my own dogs was diagnosed with MSI in November last year. I live in Ohio but took her to see Sherman Canapp at VOSM in Maryland where she had an ultrasound, arthroscopy, radiofrequency, and stem cell. I am still having issues with her and feel I need to talk to someone experienced.
Do you offer paid phone consultation by any chance?
Kindest Regards,
LS
Consult on an MSI case
Re: Consult on an MSI case
I just do them from the goodness of my heart.
Can you send video or any other info?
Are you a member of FourLeg? Have you watched my MSI series or seen my MSI handout?
Laurie
Can you send video or any other info?
Are you a member of FourLeg? Have you watched my MSI series or seen my MSI handout?
Laurie
LAURIE EDGE-HUGHES
Re: Consult on an MSI case
You are amazing! I’m overjoyed that you even responded. Thank you.
I am not a member but I am enjoying the open house. I do receive your emails but I guess I was going to join when I was actually in a position to practice rehab....though that seems lame now because I could be learning anyway.
I’m currently in a small animal practice that was bought by a corporate entity. It’s not the right fit for what I want to do...so my plan is to start my own rehab facility which is greatly in need in my area.
I did watch the MSI video series last night and you definitely gave me some things to think about and practice. I can truly see the value in being a member of your site!
Olive is a 6 year old, FS, Boxer/Am Staf Mix. She is not an agility dog (in fact she hated it!), but we do live on a small 5 acre farm with horses, chickens, and other pit bulls. Dogs have access to all 5 acres and they go balls to the wall all the time....which is likely how she sustained this injury.
I first observed a subtle lameness of the left forelimb in February 2016. Yes, that’s 2 years ago. At first it appeared intermittent. Radiographs suggested biceps tendonopathy but exam did not. I used NSAIDs, gabapentin, acupuncture, and Assisi Loop. I had never heard of MSI until I took the classes at CRI. I didn’t know...and I didn’t know what I didn’t know.
In November of last year I took her to see the Canapps because there’s no one in my area with such expertise. Exam findings suggested MSI...pain on extension and abduction, atrophy of the Spinatus brothers, abduction angle was 50 degrees and 40 degrees in her good (right) leg. An ultrasound was done which was inconclusive. Arthroscopy was performed confirming a Grade 2 MSI. Moderate inflammation, fraying, and disruption of the subscapularis was noted. Mild fraying of the medial labrum and the medial glenohumeral ligament was noted. A mild to moderate craniomedial laxity was noted. Grade I-III cartilage defects were noted along the caudal humeral head. RF performed to all areas of inflammation and fraying.
He also wanted to scope her left elbow and noted a focal grade I cartilage lesion along the medial coranoid process. Mild to moderate synovitis.
Stem cell and PRP was performed on the shoulder and elbow.
She was placed in a Dog Leggs hobble vest which she wore for 12 weeks. She was crated and taken out by leash only until recently.
There was a detailed protocol which I followed. Performing all exercises twice daily.
Four weeks ago I took her to a surgeon who’s also certified as a CCRP. He basically stated my expectations should’ve never been 100% based upon the duration of clinical signs, yet Sherman never lead me to believe anything other than complete recovery. The surgeon suggested fish oil, galliprant, and Adequan and to just let her be a dog. And I thought...”so this is it?” I paid $7300 and have spent the last 7 months trying to rehab her only to have a dog who’s equally as lame as pre surgery? (Sorry...rant!). I’m sick about this. She’s only 6. I’m thinking I still have a lot of dog here and I don’t want her to be broken.
Three weeks ago I took her to surgery because she had a draining tract from her arthroscopy. Contrast did not show it going to the joint however. So what else can go wrong? She seems recovered from that but lameness persists (as seen in the video which I’ll send separately). Sometimes you can see a circumduction of the forelimb.
I just can’t make the 6+ hour trip back to Maryland for a recheck. I have called and spoken with the resident and texted Sherman but they want to see her to do an ultrasound (?).
One point....when she stretches her front end in the form of a play bow the left foreleg is always pulled back caudally relative to the right side. This was like this even pre-surgery. I have mentioned it to both surgeons and the resident but it hasn’t been addressed. In my mind it represents a restriction of some sort, doesn’t it?
Sometimes the lameness is subtle, sometimes it’s undetectable, and sometimes she’s dead ass lame on it. After recumbency or after a lot of activity...it doesn’t matter. Sometimes an NSAID seems to help sometimes not.
Today, I tried some of the manual therapies you had in your video. I had been trying to do caudal glides in my very green hands prior to this. Extension angle is 170 degrees but there’s a bit of muscle guarding. She definitely didn’t like stretching of the Teres Major but it improved as I worked on it.
I just don’t know where to go with this. I owe you with a membership sign up!
Thank you!
L.
https://youtu.be/cwHCqr0xMKs
I am not a member but I am enjoying the open house. I do receive your emails but I guess I was going to join when I was actually in a position to practice rehab....though that seems lame now because I could be learning anyway.
I’m currently in a small animal practice that was bought by a corporate entity. It’s not the right fit for what I want to do...so my plan is to start my own rehab facility which is greatly in need in my area.
I did watch the MSI video series last night and you definitely gave me some things to think about and practice. I can truly see the value in being a member of your site!
Olive is a 6 year old, FS, Boxer/Am Staf Mix. She is not an agility dog (in fact she hated it!), but we do live on a small 5 acre farm with horses, chickens, and other pit bulls. Dogs have access to all 5 acres and they go balls to the wall all the time....which is likely how she sustained this injury.
I first observed a subtle lameness of the left forelimb in February 2016. Yes, that’s 2 years ago. At first it appeared intermittent. Radiographs suggested biceps tendonopathy but exam did not. I used NSAIDs, gabapentin, acupuncture, and Assisi Loop. I had never heard of MSI until I took the classes at CRI. I didn’t know...and I didn’t know what I didn’t know.
In November of last year I took her to see the Canapps because there’s no one in my area with such expertise. Exam findings suggested MSI...pain on extension and abduction, atrophy of the Spinatus brothers, abduction angle was 50 degrees and 40 degrees in her good (right) leg. An ultrasound was done which was inconclusive. Arthroscopy was performed confirming a Grade 2 MSI. Moderate inflammation, fraying, and disruption of the subscapularis was noted. Mild fraying of the medial labrum and the medial glenohumeral ligament was noted. A mild to moderate craniomedial laxity was noted. Grade I-III cartilage defects were noted along the caudal humeral head. RF performed to all areas of inflammation and fraying.
He also wanted to scope her left elbow and noted a focal grade I cartilage lesion along the medial coranoid process. Mild to moderate synovitis.
Stem cell and PRP was performed on the shoulder and elbow.
She was placed in a Dog Leggs hobble vest which she wore for 12 weeks. She was crated and taken out by leash only until recently.
There was a detailed protocol which I followed. Performing all exercises twice daily.
Four weeks ago I took her to a surgeon who’s also certified as a CCRP. He basically stated my expectations should’ve never been 100% based upon the duration of clinical signs, yet Sherman never lead me to believe anything other than complete recovery. The surgeon suggested fish oil, galliprant, and Adequan and to just let her be a dog. And I thought...”so this is it?” I paid $7300 and have spent the last 7 months trying to rehab her only to have a dog who’s equally as lame as pre surgery? (Sorry...rant!). I’m sick about this. She’s only 6. I’m thinking I still have a lot of dog here and I don’t want her to be broken.
Three weeks ago I took her to surgery because she had a draining tract from her arthroscopy. Contrast did not show it going to the joint however. So what else can go wrong? She seems recovered from that but lameness persists (as seen in the video which I’ll send separately). Sometimes you can see a circumduction of the forelimb.
I just can’t make the 6+ hour trip back to Maryland for a recheck. I have called and spoken with the resident and texted Sherman but they want to see her to do an ultrasound (?).
One point....when she stretches her front end in the form of a play bow the left foreleg is always pulled back caudally relative to the right side. This was like this even pre-surgery. I have mentioned it to both surgeons and the resident but it hasn’t been addressed. In my mind it represents a restriction of some sort, doesn’t it?
Sometimes the lameness is subtle, sometimes it’s undetectable, and sometimes she’s dead ass lame on it. After recumbency or after a lot of activity...it doesn’t matter. Sometimes an NSAID seems to help sometimes not.
Today, I tried some of the manual therapies you had in your video. I had been trying to do caudal glides in my very green hands prior to this. Extension angle is 170 degrees but there’s a bit of muscle guarding. She definitely didn’t like stretching of the Teres Major but it improved as I worked on it.
I just don’t know where to go with this. I owe you with a membership sign up!
Thank you!
L.
https://youtu.be/cwHCqr0xMKs
Re: Consult on an MSI case
Hey L.,
Sorry for the tardy reply. Things just seem to get busier and busier!!
Anyhoo. So I think there is room for improvement for sure. Your girl doesn’t have the full reach she should, which is likely causing the majority of the lameness you are seeing.
I’d follow the protocol - the mobs to get full caudal glide of the humeral head, but most importantly the exercises. (Oh, and stretch out the scapular muscles and TMaj as you have been.)
My favourite exercise in this case would be the rear feet up on a stool or step and get her to take a treat from under her chest / near her elbows. Push gently back on her withers to encourage her to extend her shoulders more.
With the mobs and this exercise, my hope would be that you can get passive and active shoulder extension.
I also like backwards on a treadmill.
When the slow stuff is going well… then try trot poles spaced out far enough that she has to reach to trot over them well.
I like shoulders! They usually do very well!!! I think you need to work on the soft tissue restrictions (joint capsule / ligaments / muscles) and the ‘brain’ that thinks she still needs to protect that leg and has ‘remembered’ that lameness is how she moves!
Elbows on the other hand… uck!!! Let’s just treat this like a shoulder issue!
Be sure to have some kind of joint supplement on board for the elbow at least.
Okay… best of luck! From my perspective, this is a great case!!!
Cheers,
Laurie
Sorry for the tardy reply. Things just seem to get busier and busier!!
Anyhoo. So I think there is room for improvement for sure. Your girl doesn’t have the full reach she should, which is likely causing the majority of the lameness you are seeing.
I’d follow the protocol - the mobs to get full caudal glide of the humeral head, but most importantly the exercises. (Oh, and stretch out the scapular muscles and TMaj as you have been.)
My favourite exercise in this case would be the rear feet up on a stool or step and get her to take a treat from under her chest / near her elbows. Push gently back on her withers to encourage her to extend her shoulders more.
With the mobs and this exercise, my hope would be that you can get passive and active shoulder extension.
I also like backwards on a treadmill.
When the slow stuff is going well… then try trot poles spaced out far enough that she has to reach to trot over them well.
I like shoulders! They usually do very well!!! I think you need to work on the soft tissue restrictions (joint capsule / ligaments / muscles) and the ‘brain’ that thinks she still needs to protect that leg and has ‘remembered’ that lameness is how she moves!
Elbows on the other hand… uck!!! Let’s just treat this like a shoulder issue!
Be sure to have some kind of joint supplement on board for the elbow at least.
Okay… best of luck! From my perspective, this is a great case!!!
Cheers,
Laurie
LAURIE EDGE-HUGHES