Gemma

[JuliPotter]

I would love your thoughts on Gemma!

Gemma is a 2-year-old FS Mix breed pup weighting about 66#. Gemma is quite anxious so I have been slowly working on trying to do a complete exam on her. Gemma does have a history of urinary incontinence which was diagnosed before she was a year old. Recently, Gemma's mom (Jaime) reports that when Jaime's dad scratches Gemma near the base or her tail/lower spine, she will drop her rear end to the floor. As well, Gemma has been taking more breaks during their walks, often laying down and refusing to move.

Here are the results of my last 2 exams and a few pictures and a video-

On August 21, 2021, Objective- I did notice some twitching with unilateral transverse process DV pressure on the left side at L3-L5. muscles of the pelvic limbs are quite tight and tense, Gemma does seem to have good muscle development of the hamstrings, but I do feel that there is muscle atrophy of the Vastus Lateralis (of the quadriceps) on both the right and left pelvic limbs, in general, the Quadriceps seem to be smaller on the left pelvic limb, as well, the Gluteal muscles do appear to be underdeveloped. Gemma was not standing squarely when I examined her pelvis but there appears to be an obvious change in the location of the ilium. On the right side, the Ilium appears to be more caudal and more ventral. And the left side is more cranial and dorsal. The Sacrotuberous ligament on both the right and left appears to be quite tight/tense as well as the piriformis muscles. There is slight movement of the left patella that was not appreciated on the right stifle, no obvious pain noted at L-S junction. The right Iliopsoas muscle seems tight/tense, Gemma resists hip extension on both the right and left sides, I could not flex her tail, noted normal CPs in both back legs. While walking, Gemma frequently swings her tail to the right, her hips sway as she walks and there is additional motion of her lower back, the lumbar spine is slightly rounded, both of her back legs seem to be stiff, she has a shortened stride, with little extension of the hips, her stifles and hocks are straight. She does appear to internally rotate at the stifle on the left. While attempting to trot, Gemma does not seem to be able to maintain the trot. Gemma does appear to have straight/upright shoulders as well.

Performed – cranial translation as well as dorsal translation of the right SIJ, caudal translation as well as ventral translation of the left SIJ, did thigh thrust on both the right and left sides, did tail pulls.

Follow up exam on August 29, Objective- Upon exam, though Gemma did seem a bit more relaxed today, she was quite reluctant to flex and extend at the hip and stifle when I attempted to check her ROM and flexibility, I was not able to check for patellar luxation or a drawer sign. I did find that the right ilium was more caudal and ventral while the left ilium was more cranial and dorsal. The Left Iliopsoas muscle seemed more tense today but Gemma did allow me to palpate and to massage the Iliopsoas muscle. Gemma did flinch with unilateral transverse process DV pressure on the left side at L3-L5. Gemma did flinch with DV pressure along the curvature of the ribs on the right side from rib 6-13. With unilateral transverse process DV pressure of T10-13 on the left, Gemma tensed, licked her lips and she moved away. With this reaction, I completed my exam. I will attempt to evaluate the thoracic spine, the ribs along with the lumbar spine, the SIJ and the stifles at our next visit

Performed – cranial translation as well as dorsal translation of the right SIJ, caudal translation as well as ventral translation of the left SIJ, massage of Iliopsoas muscle.

I have attached links with several pictures and one video from our recent visit on August 29th. I would like to get more video of her walking, from the front and both sides, as well as her trotting but I have to do so in stages!

Gemma Walking 8/29/21 -https://1drv.ms/v/s!Apu6EXHKuDtN5iiYydaWtcWi1GS_

pictures of Gemma from 8/29/21 - https://photos.google.com/album/AF1QipO ... BYaZ3JDPAa

Thank you so much,
Juli

[lehughes]

Hey Juli,

Okay... so, my gut feeling is that the dog has hip dysplasia. I'd want you to check for pain in the deep gluteals and pectineus. Also check for Pure hip extension (if you can) and internal rotations for checking the hips.
IF you find issues here, then add hip therapies to your regimen - laser, acupuncture, acupressure, exercises such as 'lovin on the stairs', 'three leg stands, up hill walking...

Have radiographs been taken? I think it would be interesting to see the hips and lumbar spine.

I'd also focus on the SIJ 1st, then L/S... and the T/S when you get the SIJ and L/S sorted... as I believe the T/S is secondary to posture. As such, it won't fix while the other pains exist.

I couldn't see any of the pictures / videos... (My bad for taking so long to get back to you!)

Back to you!

Laurie

[JuliPotter]

Laurie, thank you so much for your input!
Gemma is so fearful when going to the vet her owner has only taken her when she has been sick (she has had a vet come to her house for wellness visits) but I will follow up with Jaime and discuss your suggestions and recommendations.
If you don't mind, I can email you the pictures and video that I have!
when I attempted to examine Gemma she was just so tense, it was difficult to do a great assessment!
Gemma is now taking Reconcile (fluoxetine) and seems to be doing well on the medication so maybe Gemma will be a little less anxious during our next exam!
Sincerely and with much appreciation,
Juli

[lehughes]

I'll put the picture here.
(I've made it a smaller file)

[lehughes]

I see back pain…
Are the hips okay?

L

[JuliPotter]

I will be seeing Gemma again next Saturday.....I will send an update soon!!
Thank you!
Juli

[lehughes]

Awesome! Keep me posted!

[JuliPotter]

an update on Gemma - We were able to get several pictures of Gemma while standing and videos of her walking.
https://photos.app.goo.gl/qFZvsgcjYM1urtZS9 (I hope the link works)

Objective- my goal today was to focus only on the lumbar spine, SIJ and hips- Gemma did flinch and this was repeatable, with unilateral transverse process DV pressure on the left and right at L1 and L2, as well, she flinched with individual side bend/rotation (pushing side of spinous process away while pulling hips in the opposite direction) of L1 and L2 on both the right and left, the paraspinals do feel tense/tight with a possible trigger point on the left side of L1. Possible atrophy of the lumbar paraspinals, Jaime mentioned that she feels that she is able to see Gemma’s spine more than before; the right wing of the Ilium appears to be more cranial as well as more ventral, the left wing of the ilium, more caudal and dorsal, I did not notice any obvious pain with palpation of the dorsal SIJ ligament, Sacrotuberous ligament or the Piriformis muscle. No pain noted with palpation of deep gluteal muscle, the gluteal muscles do appear to be atrophied/decreased muscle mass, more so on the right side. Gemma did react, moved away, licked her lips, with palpation of the Pectineus muscle on the left, I was able to extendboth hips to check pure coxofemoral extension and though Gemma did seem tense, there was no obvious indication of pain, she did not try to move away, though I do feel that it was a bit more difficult to extend at the right hip. I was not able to check internal rotation of the CF joint; I attempted to do this in standing but even though Gemma did not resist, the motion was limited. Gemma does have very well-developed hamstrings though there is decreased muscle mass of both quadriceps, L>R. Iliopsoas does feel slightly more tense on the right side but Gemma does not resist palpation of the Iliopsoas muscle.
While standing, there is a curvature of the lumbar spine, she often places the right pelvic limb forward
While walking, Gemma appears to be quite stiff in the rear with a short stride, there appears to be limited flexion and extension at the hips and it appears as if she hyperextends at the stifle on the right as she steps forward, her tail is stiff and seems to swing more to the right.
Thank you so much!
Juli

[lehughes]

Hi Juli,

Link works fine (just have to right click and select open in a new tab / window).

So two things.
1) I'd push harder in your assessment of the SIJ and piriformis muscles... especially given the asymmetry you found (so long as she was nicely symmetrical in foot placement when you assessed).
2) I'm now throwing lumbosacral disc disease into the differentials.

For item #2 - you can go back to your Advanced Spine manual and see about doing the L-S compression techniques. AND/OR just treat the L-S junction proactively and see what you get. I'd do flexion mobs, prescribe tail pull tractions and/maybe one man standing traction if the dog will allow, plus any modalities to the L-S region.
Mob the SIJ's proactively - try gapping (if she will lie on her side for you). Otherwise, I would tread the cranial and caudal asymmetries first with the glide/mobs.

Best!
Laurie

[JuliPotter]

Thank you so much, Laurie!
I will be seeing Gemma again within the next 2 weeks! I am looking forward to following up with her!
I think I may see if Jaime is willing to work on long down stays on a mat with Gemma to see if this helps Gemma to relax a bit more during our visits and maybe this will allow me to perform more mobilizations, like gapping for the SIJ as you mentioned. As well, I feel that I may be able to add more flexion to her lumbar spine while doing the individual side bend/rotations as well as isolated flexion if Gemma were lying on her side!
Thanks again and all my best to you!!
Juli