Fracture, amputation, FHOs & can't walk

[lehughes]

Hi, Laurie!
I have a new rehab case I wanted to run by you.  I've also attached video.
 
Daysie is a 2 year FS Golden Retriever.  She was hit by a car in September.  Both hips were dislocated and closed reduction did not work.  The owner said that her right front leg was broken beyond repair; the referral said the elbow was dislocated, I think.  Doesn't matter now...  They were told that she has an ACL tear on the right.  There may be a partial. 
 
In October, the right front leg was amputated.
 
In November, the right FHO was done.
 
In early January, the left FHO was done. 
 
No rehab was ever done.  She has not walked or even stood since the accident.  She will sit up occasionally if she has something to lean on. 
 
She is bilateral iliopsoas pain and greatly restricted extension of both "hips", R>L.
 
She will stand over a peanut and bear weight on her left legs.  I have to place the right continuously.  It is difficult to motivate her to do even cookie stretches over the peanut.  She just tries to throw herself on the floor. 
 
In a Walkabout, she just picks up her hind legs and lets them carry her. 
 
The owner was trying not to give her an NSAID but we have recommended increasing her pain management as she starts rehab. 
 
Daysie has become accustomed to this way of life and does not care to stand or exercise!  She will just throw herself down and go belly up!
 
I'm going to call the RDVM for the post op rads to be sure that there isn't a surgical issue with the right FHO.  It may just be that this has gone on too long. 
 
Any thoughts on how else to motivate her to at least try? 
 
Thanks for your help.
 
Janine

VIDEO LINK: https://youtu.be/os6kYEKNVtk

-----
Hi Janine,

So this looks to be a heart breaking case - with a 'shame on the vet' that did this to this dog without any rehab!!
So, I'd recommend a wheelchair to get this dog started.  We've had a couple of other cases of surgeries gone wrong, amputees, or bilateral surgeries that we've not been able to get going and a wheelchair did the trick.
We've got about a dozen wheelchairs that we can rent out or sell, which makes it easier to convince the owners.

I would agree about checking for a bone spur on the FHOs - just to make sure.  And pain management - great idea.  But I don't think you'll get her walking if you can't make it her idea to some extent... and forcing her upright might do that.

All the best!

Laurie

[tania]

i tried to access the video, but it says it is private..i would love to see this video
Tania

[lehughes]

Darg! YouTube is not my main video source... I think I fixed it.
Sorry about that!
Laurie

[Kay Webb]

I couldnt view the video either but Im guessing she must be incredibly weak. You dont mention if any hydrotherapy has been tried but I can imagine it may be helpful as a step towards walking.

[lehughes]

I made the video public now, but the link doesn't seem to work - cut and paste it into the browser bar. Essentially, the dog is dragging itself around... can't get up at all!

[Douglas]

I had a similar case (without amputation involved): within 4 months the dog had surgery on both stifles for ACL; then had right FHO - no rehab. Dog did not walk for 8 months prior to seeing me.

My patient suffered greatly from Central Sensitization.

I hospitalized for 72 hours running CRI of Lidocaine/Ketamine/Hydromorphone at the same time started acupuncture, EAP, laser, E-stim and neuroproprioception exercises - this patient HATED the underwater treadmill so that modality was out. She also suffered from severe Myofascial Trigger Points - which I treated via intra-muscular dry needling. She stayed with us for a week and by the end of the week she was able to walk about 15 feet.

Please be sure to address your patient's pain level. Pain management in this case is extremely important, if they are not comfortable they will not do well during any type of physical modality to increase neuroproprioception or strength.

Douglas Stramel, DVM
Certified Veterinary Pain Practitioner
Certified Veterinary Medical Acupuncturist

[Christie Carlo]

I agree. Maladaptive pain is a big issue in many rehab patients, esp. when the issue has been going on for any length of time. I use a lot of Gabapentin and have also used a CRI before. The other part you need to check is for left over femoral neck from the FHO surgery. I just saw a patient last week that had an FHO done 4 months previously as has not used the leg since. She cried when I tried to place her leg in a normal standing position. Sedated x-rays showed there was significant femoral neck left from the surgery so now she has to go back to surgery and then get rehab which was never done in the first place. I feel so bad for all of these pets and their owners. What a shame!

[lehughes]

Remember this dog? Here's the update...
Hi, Laurie.
It doesn't seem like we did much... Lots of sitting practice and pushups, standing practice. She had no idea how to be a tripod. Standing over a peanut, especially with weight shifting and rolling it forward to encourage her to reach and catch her balance with the front leg. She did her cookie stretches and played tug over the peanut also. We did some of her hind leg range of motion exercises in the warm treadmill water. They never did use a wheelchair. They tried once, she hated it, and they didn't try again. We did not participate in that activity!
I would still love to see radiographs because I'm still concerned about the way the case was handled in general. I feel there may be a little quackery involved when we hear some of the things the owners say. Supposedly one of the femurs has made a "socket" much higher than the other but the RDVM said it was okay. They have not sent the rads to us. I'm going to offer to do them here at no charge just so we know what kind of other limitations we may have. Daysie can stand to urinate but still lies down to defecate. Supposedly, there was an ACL repair on the right at the time of the FHO but the records are minimal and hard to read. I'll send copies of the rads when we get them.
Thanks for your help.
Janine

VIDEO LINK:
https://youtu.be/EQpSwpzYowE

[backontrackvetrehab]

I have a couple patients that do the same thing you described with the walkabout or wheelchair - they just lift up the hind legs and let themselves be carried/supported! Most of these patients are DM dogs, not sure if that's significant. Besides counseling owners to keep the hips low when supporting them, and doing lots of work on weight shifting, standing over peanuts, striking and limb compressions and gait patterning in the treadmill, I'm not sure what else to suggest. Any ideas?

Joni

[lehughes]

Hey Joni,

At my clinic, we've recently been 'playing with' adding weights to the wheelchairs to change where the animal feels the cart and how the cart 'rides'.
We've also played with using theraband to help with the forward movement of the limb.
And 'yes', I do think that the DM dogs can be difficult to get going / using properly. And I think it's far more the loss of volitional control... when they start going down hill... they can spiral quite quickly!

Laurie