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Good Morning Laurie,

I have a patient that I have been seeing for the last few years. We first saw Lowell for a right TPLO which he had a great recovery. Since then I have been seeing him twice a week for underwater treadmill to keep him in good condition. About a year ago he was diagnosed with a heart base tumor with two mets to his lungs. Radiation was done and he is seeing an oncologist for the mets.

Two months ago he seemed painful on palpation of both his Iliopsoas muscles which I started laser therapy on which he was not responding to so I switch him up to ultrasound therapy with very little improvements. After a recheck with the surgeon a CT was done on January 11th. Lowell does have OA in his right elbow which I laser as well.

My questions is, Lowell now has spinal issues in his cranial thoracic region and I was hoping you could give me some tips on how to rehab him. Can I do traction to help? I am using the Artemis laser on him with massage and trigger point therapy and Lowell is currently on Tramadol, Gabapentin, and Prednisone (he had very low platelet count due to chemo (Palladia) he was on for the mets).

I know there is a lot of history on this guy but I really just need some guideness on a good rehabilitation protocol. If you can give me any suggestions I would appreciate it.

Sincerely,

Carrie S

Hey Carrie,

Interesting case… and there is a lot of ‘grey area’ and things to discuss with the owners in regards to the case.

In my head, a dog of this age and with this diagnosis, I would treat for pain management and quality of life.
As such I WOULD use laser over his thorax / thoracic spine. The depth of penetration from there would not be able to get to the site of the mets or heart tumour.
Of course, to cover your ass, you should likely discuss this with the owners. - Quality of pain free life.

You can absolutely do traction. Any kind of massage and trigger point work.
I’d add manual therapy - mobilizations to the spine (even if just some gentle chest lifts to flex the thoracic spine.
Tail pulls to traction the lumbar spine.
cookies at the hip for ROM in the T/S and L/S.

When you have pain in both iliopsoas muscles, the root of the problem is likely the spine or postural. So treat the spine instead of the iliopsoas.

Think pain management. Anything you can do is great. Management. Not resolution or reversal.

Best of luck!

Laurie