Type 1 IVDD

[JuliPotter]

Laurie,
I have been working with Bindi, a 5 year old FS Dachshund, who was diagnosed with Type 1 IVDD at the T-L junction in May. The owners were not able to do surgery and elected conservative management. Bindi has improved quite a bit. Initially, she was quite painful and paraplegic with an UMN bladder but now she seems to be urinating and defecating normally and she is walking but she remains quite weak and ataxic in the rear end. CP is decrease in both the right and left rear but much more delayed on the right rear. Bindi does resist and try to pull away from me when I hold her paws, she is quite a bit stronger on the left rear. Bindi has much better muscle development in the left pelvic limb compared to the right. At home Bindi is confined to an X-pen when not supervised and the owners are working on balance, proprioception and strengthening and they do traction. When I see Bindi, I repeat an examination at each appointment and I consistently find reactivity, she tenses and moves away slightly with side glide of C6 and C7, bilaterally. Bindi also avoids any attempt to flex and extend her thoracic limbs; she does have carpal hyperextension and valgus and I do remember thinking her left GH joint may be hypermobile. Bindi does flinch with transverse pressure along the dorsal spinous process of T13 and L1, bilaterally, and the paraspinals along the caudal T-spine and L-spine, along with the quadratus lumborum, feel tight. She flinches with DV pressure along the curvature of the ribs from rib 9-13 bilaterally. SIJ – right ilium is more caudal and dorsal compared to left, Bindi is slightly reactive with palpation of the dorsal SIJ ligament on both the right and left and with palpation of the left sacrotuberous ligament.
I have been doing manual therapies and acupressure at each visit and we recently started laser therapy again (caudal C-spine and T-L junction) but I am worried that I am missing something. I am thinking that maybe we need to work more on coordination, core strength (back and abdominals) and motor control and timing. The owners recently purchased a Wiggleless back brace for support and I am hoping that the additional support to her long back may provide some stability and to help prevent further injury.
I am looking for some guidance on how to progress with Bindi! Thank you so much!
Juli

[lehughes]

Hey Juli,

Okay, let me think / type in 'real time'...

So, the primary healing has occurred at this stage, BUT via neuroplasticity, we know that more gains can be made.

I would continue with the laser (pain and stimulation of the spinal cord) - HIGH doses to penetrate to the depth you want. i.e. you can laser as much as able and you won't come close to what research says will help - in other words, you can't over do it in a clinical situation.

I think the back brace is a great idea. Please take a video with / without and share if you can!!

Instead of static exercises (balance and the like), I could do movement / walking based exercises (treadmill or just simply more walking). Walking with stimulate release of Brain Derived Neurotrophic Factor which can help with healing. And if on a treadmill, then you can also work on balance by slowly pushing from side to side, stepping over your fingers, resisting one leg and then the other. I find this to be very functional.

Keep mobilizing - the neck and the back. If there is discomfort then there are things to work on. You might want to change up WHICH mobilizations you are doing and add in some neck traction. Try the rotations for the spine. Try the rib rotation mobs as well. (PS Go back through your Advanced Spine Manual and try some different techniques!) You can likely be more aggressive in treating the SIJ as well.

I hope this helps. Good luck!

Laurie

[JuliPotter]

Laurie,
Thank you!! I will get video of Bindi without and with the back brace this week! And we will do more laser therapy and work on more walking-based exercises! I am not quite sure what you mean when you say, resisting one leg then the other…..do you mean briefly holding back/creating resistance for one back leg, then the other, as Bindi attempts to move forward?
I have not taken the Advanced course yet, though I would love to! Will you be teaching it again in the States?
I have not done rotational glides for the spine or rib rotations for Bindi has not been willing to lay on her side during our visits, but I will give it a try!
I have been doing side glides with rotation of C-spine, applying transverse pressure along the dorsal spinous process of T1 and T2 while moving the head in the opposite direction, dorsal glide at T1 and T2, owners do neck traction at home when Bindi is more relaxed. I have done rib distraction and rib springing, individual side bend /rotations as well as isolation flexion in standing of the spine and we do tail traction as well. For the right SIJ, I have done cranial translation, ventral rotation and ventral traction as well as thigh thrust.
I also want to try a vibration platform! The physical therapist has been using this for my son during his PT sessions and now I am intrigued and want to learn more! I will watch your training videos! I think I read on Four Leg that I might be able to find a mat for under $200!

Thank you so much, Laurie!! You are wonderful!
Juli

[JuliPotter]

Hello again, well it may take a bit longer to get video of Bindi walking with her back brace! According to the owner, Bindi is not very fond of the back brace so she is going to work on helping Bindi feel more comfortable with this. The owner did send me recent video of Bindi walking around outside, which I emailed to you, but the videos are blurry, so I will try to get more video.
I do have another question.....I just read your blog from 2019, Lasers and an IVDD case, and you mentioned that you rented out the Respond 2400XL (now called the 2400VS) to your client.... I wonder if this unit (or The Zeus unit from SpectraVet) might be a good idea for Bindi?! Right now we are only able to do laser once a week. The clinic I work for has a Class 4 Companion laser and I don't really like it! After watching your training videos on laser therapy, I really want a SpectraVet laser! I wonder if I can rent from them?

In your laser training video, you mentioned that you can use laser for the brain! I know you mentioned this to me before but I am wondering if laser could be used after treatment/regression of a pituitary tumor!! This is for a human, my son! He had a pituitary tumor secondary to Langerhans Cell Histiocytosis, and as a result, he has panhypopituitarism (deficient in vasopressin, cortisol, growth hormone and possibly testosterone)! This has certainly affected his quality of life! I have asked about stem cell therapy, which the doctors immediately rejected, but did not consider laser therapy! I hope you don't mind me asking about this!
Thank you so much!!
Juli

[lehughes]

Hey Juli,

So, the holding back / creating resistance is exactly as you seem to understand it. Check out Video Training 88: Treadmill and the Neurologic Dog. I do a whole pile of things in that video that could work for your little dog.

I am hoping to teach at STAAR next year. I don't know what course(s) I'll be teaching... I was thinking the Beginners Manual Therapy, because it's been so long, but I don't know yet!

Question: Did I miss something in the history? Why are you doing neck traction for the T-L Disc? I'd go with hanging traction or tail pulls to get closer to the site of injury.

But if the dog doesn't lie on her side very well, then it might not be worth it to try the rotation. It could just be a fight. However, you could do rib springing in standing to affect the disc. I guess the traction (especially hanging traction) could be the best of the options... and transverse pressures on the spinous process down closer to the site of the lesion.

Vibration platform off of Amazon could be fun to work with for sure!!!

And I saw the video you sent via email. Bindi is walking fairly well already - without the brace. Not sure that the brace will help in her scenario, as her trunkal control seems acceptable. However, if you do get a video, please send my way!

Now as for the laser rental for yourself - you'd have to reach out to the laser companies.

As for your son. I think you could be justified in trying laser at the base of the skull as a way to irradiate the blood going to the brain vs having a questionable effect (i.e. positive or negative) on the tumour itself. And I second the medical doctors rejection of Stem Cells. You can put stem cells into a body, but you can't always control what they want to become or where.

All the best!

Laurie

[JuliPotter]

Laurie, thank you so much! I will take a look at Video #88!

We have been doing neck traction because Bindi is reactive (she tenses and attempts to move away) with slide glide at C6 and C7 bilaterally. Bindi also avoids any attempt to flex and extend her thoracic limbs; she does have carpal hyperextension and valgus and I do remember thinking her left GH joint may be hypermobile, so I wonder about (I have not been able to check the shoulder abduction angle)
MS hypermobility and/or tendinopathy. I have done shoulder stretches and laser as well.

This reminds me of a question - when there are multiple issues, is it best to focus on the most pressing issue(s) first and then add to the treatment plan over time? I find that I try to treat every change I find from the start but feel that this is most likely too much, at least initially.

I am looking forward to trying the vibration platform. I am trying to figure out which one to purchase!
and with the back brace, I was thinking it might be helpful for prevention as well. I did contact the company prior to ordering and they suggested this as a benefit to the brace.

I am so excited that the STAAR conference is taking place again!! I would love to have an opportunity to take the Advanced course soon!

Thank you so much for your comments on the potential use of laser for my son! According to the MRIs, the tumor is no longer present but the panhypopituitarism is permanent. Unfortunately, this can be a common sequela to having LCH. I will do some research to see if I can find some information to present to Eli's oncologist and endocrinologist about the potential benefits of laser therapy.

With much appreciation,
Juli

[lehughes]

Well, see what you think about the brace.
There is zero research to back up that it can prevent a disc.
We don't anything like that in humans... the opposite actually. Movement is therapeutic.
I am reserving my endorsement of using the back brace preventatively unless it is proven to work for that purpose.

Best of luck with the case and hope to see you in 2023!

[JuliPotter]

Laurie, thank you so much for letting me know! Movement is therapeutic....I will remember this! So the best way to try to avoid further disc lesions is to avoid slipping and jumping/impact, to maintain a good body weight, to continue regular rehab check ups, to strengthen and to keep moving; does that sound appropriate?

Video #88 on using the treadmill with the neuro patient was great! I am looking forward to trying some of these exercises soon!

I tried to share a video of Bindi from November 1 but the link didn't work on the Forum! I will email you!

Again, thank you!
Juli

[lehughes]

The only other addition I would make to your prevention plan is "Traction".

"All small long backed dogs should be hung." I believe traction to be preventative for disc issues, and that chondrodystrophic dogs should be receiving traction on a regular basis as part of their home management/prevention program. And in fact there are rat and pig studies that come to the conclusion that traction can slow disc degeneration and maintain disc height. So the animal studies are coming out in support of what I've believed for years! Hurrah!

Cheers,

Laurie

[JuliPotter]

That is wonderful, Laurie!! Thank you so much!
Juli