Do you ever reach a point where you feel you can't do anymore with a canine??
I'm struggling with this case-
SO:
WInston is maybe 3yo. Adopted from Mexico. Dachshund/spaniel mix
Myelopathy T13-L3. CP deficits (R >L) HL
History of pelvic fx. R ilium 11/20/2019 unknown repair in Mexico.
I've seen him since February 2021 and have not been able to elicit many changes.
(After Winston was adopted in 11/2019 he started to knuckle L side 4 months 2020.)
Gait: Permanently knuckling R HL and actually has hard callus in place. I am able to attain full ROM in his paw however he does not like it!!!! L HL sporadically knuckling- see more when fatigues.
O's bought on their own a "toe up" brace (rear No Knuckling Training Sock) - was not successful- Would not put weight down. My observation appeared painful the way he bit at it.
I spoke with Ilaria who recommended trial hard type splint- so trialled rear Walkin Splint (hard splint)- still could not tolerate toes being straightened- even a little bit and would continue to lift leg up.
I trialled DFA as well but could not get his paw into the boot.
His pelvic alignment is a mess- due to hardware can't be corrected.
Continent of bowel. Sporadically incontinent of urine primarily at night.
Thoughts? I know this is scattered I just don't feel like I can do much else here??
HC
Can't do any more?
Re: Can't do any more?
Hey H.,
Now as for your patient - yes, there are dogs that can’t / don’t get better… and that’s okay.
I figure you need to chat with owners about realistic expectations at this point and you can still help them by coming up with adaptive devices to improve the ‘what is’.
Does he need a cart for longer walks?
A special bootie to protect his foot?
Periodic therapies for his spine and/or myofascial restrictions, and or laser on sacral nerve roots for bowel and bladder?
Just in reading the history - perhaps there was a combination of UMNL - T13 - L3 myelopathy and LMNL from the Pelvic fracture. So, perhaps the combo is making it difficult to correct the foot issue… but since the urinary incontinence is sporadic, maybe there are still some LMNL issues that you can still work with - L7S1 and or try gapping the SIJ… just to see how it goes. (However, it’s a crap shoot at this point).
I have one client right now that I have told, ’she’s not going to walk again’. It’s been 1.5+ years now. We’ve fitted her with a cart… but he keeps wanting to try. I look at it as I’ve done what I can do. I’ve been honest. If he wants to continue with UWT, I guess he can. Why should I stop him from booking in? Maybe it’s an outing. A change of scenery. Psychosocial rehab… but, I can’t make her better!
So, that’s all I’ve got. You can’t win them all… but you can help the owner know how to cope, guide them on adaptive devices, and periodically help with secondary issue.
Best of luck!
Laurie
Now as for your patient - yes, there are dogs that can’t / don’t get better… and that’s okay.
I figure you need to chat with owners about realistic expectations at this point and you can still help them by coming up with adaptive devices to improve the ‘what is’.
Does he need a cart for longer walks?
A special bootie to protect his foot?
Periodic therapies for his spine and/or myofascial restrictions, and or laser on sacral nerve roots for bowel and bladder?
Just in reading the history - perhaps there was a combination of UMNL - T13 - L3 myelopathy and LMNL from the Pelvic fracture. So, perhaps the combo is making it difficult to correct the foot issue… but since the urinary incontinence is sporadic, maybe there are still some LMNL issues that you can still work with - L7S1 and or try gapping the SIJ… just to see how it goes. (However, it’s a crap shoot at this point).
I have one client right now that I have told, ’she’s not going to walk again’. It’s been 1.5+ years now. We’ve fitted her with a cart… but he keeps wanting to try. I look at it as I’ve done what I can do. I’ve been honest. If he wants to continue with UWT, I guess he can. Why should I stop him from booking in? Maybe it’s an outing. A change of scenery. Psychosocial rehab… but, I can’t make her better!
So, that’s all I’ve got. You can’t win them all… but you can help the owner know how to cope, guide them on adaptive devices, and periodically help with secondary issue.
Best of luck!
Laurie
LAURIE EDGE-HUGHES