fourleg.com

Hi Laurie,

First, thank you so much for your website. It’s been instrumental in helping me improve my rehab as well as inspiring me to learn and do more!

I have two cases I could use your advice on:

First case it an 8 year old 45 pound dog that had left cruciate tightrope repair 1 ½ years ago, and did phenomenal (one of those cases that makes you feel all warm and fuzzy). Then true to form, he tore the right acl 6 months ago. He also has arthritis in his right elbow and reduced ROM on both wrists (noted on initial exam). The right rear was a little slower on the healing but has done reasonably well. He actually walks and trots pretty freely with the main gait abnormality being his left forelimb toed in with a lateral swing. He also recently had a tender left iliopsoas, which has improved with therapy. SI and piriformis are nonpainful and he’s got great ROM in his rear limbs. My main concern is muscle loss on rear limbs and core muscle support that needs to improve to better support his body. Other than that I feel he is doing as well as can be expected. The owner’s main concern is that while he is back to trotting and extended walks, he doesn’t want to run and his gait at a canter is off. He also says that he intermittently won’t use the left rear to step up when doing stairs although I haven’t been able to catch that during sessions.

So long story short, I’m having difficulty convincing the owner that with two arthritic knees and carpal joint and elbow issues, he really shouldn’t be running and he’s not going to be like he was prior to the first acl. I’ve offered referral so that he can get force plate gait analysis, an MRI or diagnostic ultrasound to confirm the issues. Barring that, I feel that continuing laser on the affected joints and diet supplements plus progressing in strengthening exercises and controlled exercise is what will be most helpful. However, I’d love it if you have any other suggestions.
I’d also like some help with exercise suggestion. Currently we do cavalettis, backups, loving on the stairs, very limited snoopies every other day, and he does about 20 minutes walk/trot daily. We don’t have any good inclines except outside and this year has not been kind for outdoor activity here. (rain rain rain—richmond has turned back into a swamp). I’ve started introducing stepups but it takes two people to do it. And he cheats sit/stands so it takes two people to get him to do it correctly. He can’t do stairs as an exercise due to aggravating his front limbs (the owner will not force the dog to slow down on the way down the stairs). The dog also is very resistant to wearing leg weights and gets really nervous with certain equipment. The owner does not really push him in training such as allowing the owner to hold the legs longer for snoopies and the dog a very grabby with food rewards. Plus the owner is by himself, so he can really only accomplish exercises the dog will easily do. He’s a dedicated and caring owner and the dog is very sweet but training the exercises has been a challenge! Any thoughts on better ways to train the exercises when by himself or other exercises that might be easier?


The next case is heartbreaking. It’s a five year old 70 pound front limb amputee that had left cruciate surgery one year ago. Had extracapsular repair and had an extremely difficult time with recovery but we did manage to get him mobile---although not perfectly, he still holds the left rear out the side a little and the knee is huge with scar tissue. Fast forward a year and, yep, other cruciate blown. He can’t stand up without extreme amount of help, and the owner physically just can’t do it. She really wasn’t able to most of the rehab exercises after the last surgery and we had to go out to her house two times a week for several months until financially she had to stop. She’s still financially strapped, so I doubt that TPLO is in the dog’s future and even rehab may be limited. We had a frank discussion about how difficult the last recovery was, and that this one could be potentially more difficult, and long term concerns that we have a three legged dog with three bad legs (front limb naturally has arthritis now). We’ve gone over the options of different surgeries and even discussed knee braces and carts. I read your article about braces, and I also know how I feel—if she’s going to spend $1000 on a brace, then why not just proceed with surgery or put it to rehab. However, she had someone on a tripod website say that a brace is better than surgery for tripods. Supposedly was told by a rehab therapist at CSU that surgery is so bad on tripods that they hated even recommending it. Maybe I’m wrong, but I don’t believe it. I think they misunderstood what the doctor was telling them. However, in this scenario, do you think that the brace might be helpful at all, for either limb in giving the dog support enough to get mobile?
I feel like given the owner’s physical limitations and the dog’s physical limitations, the prognosis without surgery is very poor, and even with surgery things will be very challenging and may not go well. But I admit this is my first time dealing with an amputee with two cruciate injuries, so I’m hoping I’m wrong about the doom and gloom. Any advice you can offer is greatly appreciated.

Lastly I have a question regarding digital thermography. What is your opinion on the usefulness in rehab?

Thank you so much for your help!

SW

Hello S.!

Thank you for your kind words. I'm glad you find the site useful!

So, with Case 1: I am thinking that you need to create some kind of an obstacle course for this dog, that the owner can do in the house (i.e. walking over household objects in a basement hallway, hopping onto the couch, and then down a plank of wood with a throw rug stapled to it, crawling under the table, bed, coffee table - depending on height of the dog - weaving around a line of kitchen chairs, burst activity from a sit - i.e. retrieve a toy or piece of kibble down the hallway or other carpeted area. Think of it more as ‘fun’ exercise or training tricks in this case. Ohh, figure 8s through the legs if able. Even sit to stands on the couch or bed or other uneven surface. By the sounds of it, slow and controlled might not be easy to get or for the owner to be able to do… so find out what the dog is allowed to do at home, and capitalize on it.
Don’t worry about expensive diagnostic tests… what matters is function. And, as you are realizing, you need to customize and have different plans & goals for each owner-dog pair.

Case 2: I have really softened my thoughts about the braces. We actually do plenty of casting for them at my clinic… and I think you’re right, this sounds like a good case for one. But it will be tough going. This might actually be a case for one of the neoprene versions… I know! I know! Not what you thought I’d say. Me neither, until I typed it! I’m thinking that the actual getting up and down will be difficult for this dog, so perhaps just a neoprene sleeve type brace - A-Trac / Wound Wear might do the trick. We’ve actually had good success with them in the past (before we knew better… but research say that a simple neoprene sleeve helps with proprioceptions and overall joint stiffness… so it’s worth something!) I would worry about the dog’s ability to get up with something more rigid… And surgery scares me for the same reason. It is a heart breaking case!

IR Thermography… is a topic I plan to cover in the new year. I may have it’s place… but from what we found in using it during our Sporting Dog Assessment day was that our Hands found More and interpreted the IR findings. It was interesting because the therapists (doing the hands on assessment) were blinded to the IR Thermography findings. Bottom line, the hands found more.


Cheers,

Laurie