fourleg.com

Hello
Hoping for some help with this bilateral severe HD case. Bambi is a 1yo ME Akita. Obvious issues since 6 month of age, Radiographs 4 months ago (8mth age) attached and a short video of his bouncing gait.
Bambi has seen a boarded orthopaedic surgeon and surgery (THR or FHO) have been ruled out at this stage by owner.
My findings:
• Bilateral- Luxoid hips with Pain on hip ROM, especially extension
• Severe muscle atrophy L>R. Severe muscle atropy to epaxials from T11.
• Significant discomfort in bilateral quadriceps (vastus med/ lat)
• Stifle hyperextension L 179/ R 184 (normal 160-170)
• Tarsal hyperextension L 195/ R 190 (normal 160-170)
Gait video...... https://youtu.be/VLrPLlxEroY
Bilateral severe HL lameness- both tarsi (ankle) and stifle (knee) are held in extension/ hyperextension, the L tarsi has more significant hyperextension during walk. Koyo prefers to move slightly faster allowing both HL to land together with a small bounce only. There is very limited hip and stifle ROM with walk or faster gait. Spinal kyphosis (hunched spine), pelvic tilt. Body weight is forward over the FLs- hyperextension of carpi (wrists) in stance- L>R. Elbows abduct mildly with walk.

We have pain management and home plan in place: pain medication, joint supps, PEMF, Laser, thermotherapy, non-slip flooring etc. He will hopefully start UWTM if owner consents.

I am after some ideas for starting to strengthen the dog’s HLs. He is starting from a worse place than my previous bilat FHO cases, so I will work with peanut support initially but any other ideas appreciated!!

thanks
Jane

Is it wrong to start with "Holy $?*!" And of course the owners declined surgery but expect a miracle from you! Oi!

Okay... so, we go with what CAN you try? This dog appears to be very well versed in compensations. As such, I think your traditional exercises will be out-smarted quite easily.

My thoughts:
Start with / trial the basics: Cavalettis, Figure of 8, Backing up

Try things that trick the dog into using the hips:

• I had a Bernese Mtn Dog patients a number of years ago with crappy hips that had similar (not as bad) hyperextending tarsal & stifle compensations. We tried bracing the tarsal joints into some degree of flexion and then just walking the dog around (while doing cavalettis, backing up, etc.). By taking away the compensation, it forced the dog to use the hips. He was always exhausted afterwards. (Did it 'change' things much? No... he was still a mess... but it was something that got the dog using the hips more.)

• Up hill walking or up stairs (very gradual stairs)

• Is there anywhere to get the dog swimming?

Change the goal:
These hips will remain crappy painful hips, which will impede normal use and any strengthening attempts.
So perhaps instead of banging your head against the wall - you make your therapy 100% pain management from now until the end of his life. Would the owners go for this? Regular maintenance? Add in acupuncture, dry needling, massage , myofascial release...

Oh gee Jane! What a case!



Laurie

Hi Laurie
Thanks, good ideas on use. If I can't get movement at hip then we won't progress anyhow, so unless we get more comfort then we might be forced into FHNE. And so in this case I feel like a bilat FHNE could be no worse as a place to start from. I am hoping to get into UWTM and see what movement we get then. I'll keep you posted. thanks for your feedback.
Jane

Good on both accounts - UWT and FHNE...!

Best of luck!

L