Discussion related to the musculoskeletal system - injuries, post-op, lameness, extremity issues (joint, muscle, tenon, fascia...), axial skeleton issues, etc., as it relates to canine rehabilitation.
Hey Laurie,
I hope you and your family are well…that includes the dogs and shower chicken!
I have a 16 y.o. GSD mix (approx 45lbs) that was attacked by another dog on Thanksgiving and had to have RR amputated due to open comminuted fractures of the tibia. They did a midfemoral procedure. He is otherwise in really good shape and health for a 16 y.o. dog both mentally and physically. The problem is he strongly resists lying in half sternal left side down. If we force him into full sternal he will settle down and relax but will fight and flip if in half sternal. I see this with almost all my amputees but it usually resolves pretty quickly and I assume it is a matter of finding a new balance point. He also ambulates with his LR in an abducted position vs an adducted like most do pretty quickly.
Objectively the stump no longer has swelling or pain on palpation. ROM of the LRL and spine is WNL and amazingly good for a dog his age, so I think he CAN assume half sternal on left hip comfortably, but yet he fights. There is no obvious pain on spinal palpation either.
So I am kinda at a loss. Does any of this sound like cases you have seen? I wonder if there is some phantom pain phenomena he is dealing with. Just at a loss.
I am well, as is the family - furry & hairless! I hope all is well with you too!
Now, as to your patient. I find it very interesting. I've not seen anything exactly like this, but I can come up with a few different thoughts.
1) Phantom limb pain was one of my thoughts as well. In which case, there is no harm with getting the owner to desensitize the stump, and do therapies for pain management on the other side and the spinal nerve roots.
2) Lots of standing practice with perturbations to help him find the mid-balance point for that rear leg. Even if just standing practice in a pool / UWT and add a current / jets. Or standing practice on a soft surface (mattress, foam).
3) The the other thing I find is that the remaining leg isn’t immediately strong enough to do a great job with getting up and down or from lying / sternal. When I get down into 1/2 sternal myself and imaging not having my uppermost leg to help change my balance points, I think it would feel very vulnerable. Hard to get that lowermost leg tucked under enough to use it to push up, and no counterbalance b/c of the missing uppermost leg to create the flip into a better sternal position from which to get up.
So, my thinking is a) bed mobility - lots of treat exercises to the sides to work on side to side movements in sternal. Sort of like what I would do to lure a dog to turn and reposition their rump so they are in the opposite 1/2 sternal position. Maybe some side crunches too. b) Strengthen that remaining leg+++. I’d do lots of 1/2 squats / sits. Work on strength, biomechanics, and control of the movement.
Those are my thoughts off the top of my head anyways! Good luck!
