SIJ issues

[lehughes]

Well that is frustrating.
I was hoping to see / find one of my colleagues from my days in Aus doing my Master Degree.
These folks should be good. I think someone just needs to sit back and feel for 'different' things.
arghhh!
Laurie

[Kriszty]

Are none of them in Perth then?
I am taking her back to see Leigh on Thursday. See if she can find anything else going on.
Thanks
Kriszty

[Kriszty]

OK Leigh thinks she has adversal neural tension of the obturator nerve, LH. Her muscles and SIJ feel fine but she has some crepitus in her lumbar spine LHS.
She has asked me to ice her lumbar spine and do a neural glide consisting of (hanging off couch): extend the hip, internally rotate the knee, adduct leg then bring leg cranially to about 100 degrees (just past hamstring stretch) and bounce for 30secs x 4 twice daily. She has advised me to stop strengthening the adductor as this is contraindicated.
I have watched the 1st of your neural tension vids and will watch the other 2 asap.
I would assume that laser of the paraspinal muscles would be helpful. Since I dont have a laser at work I would have to buy one for individual use.. would something like the 'B-cure' laser be any good or do I really need to buy the 15K + ones? She also wants acupuncture to the lumbar spine which I will have to get done.
Thanks
Kriszty

[lehughes]

Well it's worth a try! Why not give it a whirl...
Leigh had her hands on your dog, so go with that.

In regards to the stretch, I'm not sure what to say. Without a manual assessment, I am just guessing on my end!

So, make a go of it, and let me (us) know how it turns out.

All the best!

Laurie

[Kriszty]

UPDATE:
Rosi had an MRI today (since we finally have one for MSK issues in Perth).
She has a mild disc protrusion at L-S on the LHS. No signs of nerve impingement (apparently, not sure I believe that). So that explains all her clinical signs. I now very much doubt she had an 'adductor tear'.
So my plan is:
Increase pain relief by adding in amantadine and paracetamol and try gabapentin again (I had her on pregabalin but that seems to have caused neurological signs so will have to watch that). NSAIDs when I can stop using low dose preds for her skin.
Considering trying DMSO roll-on (the surgeon didnt want to inject steroid today, not sure why)
Traction twice daily- tail pulls, figure of 8s, pulling her pelvis whilst holding on to her thorax and stabilise L7 and traction sacrum caudally.
Working out how to use my e-stim for pain relief (bought it through CRI and have not used it once!)

Question:
Should I get shockwave done again? She had 4 treatments approx 5-6months ago
Anything else you would suggest?
I am relieved to finally (after 3 years) get an answer, although I am not sure if she is going to be able to continue doing agility, guess I will see how she goes.

Thanks again
Kriszty

[lehughes]

I think L-S disc disease is more common than noted - especially in agility dogs and especially in certain breeds (border collies being one of those).

I also think you'll be able to manage it better now that you have a location to focus on. (And the adductor strain always had an eyebrow raise from me!)

My L-S plan usually consists of tractions (daily), in clinic I like laser, acupuncture, shockwave, and mobilizations, manual therapies.
Always keep an eye on that SIJ. When it's not moving well, it affects the L-S significantly.

Work on plank-type exercises for abdominal strength and support, and to get the dog learning to stretch out again.

Given that the MRI didn't show any NR impingement, there's a good chance you can reverse it.

As for the drug cocktail... I'd go that route. If she is sooo painful as to need all of them, then why was it so hard to diagnose? My point being, it sounds to me that there is a presumption of pain based on the imaging (which is JUST a MILD disc protrusion), not on the dog itself. I'd try therapy before drugs, especially in this case!

Cheers,

Laurie

[Kriszty]

Thank you, again, Laurie for your input. Sorry to be a pain, esp when you are so busy!
When you say 'keep an eye on the SIJ' to ensure it is moving well , what exactly are you looking for ? I have watched your vid and read the article, and I do the general mobes you advise (which she enjoys). Is that what you mean, or something in addition?
She does have signs of degeneration on the LHS on the MRI.
The orthopod also was not excited by the results.
Thanks !
Kriszty

[lehughes]

yep... just keep an eye out for an SIJ dysfunction.

[David Lane]

A couple of thoughts:

1) Although the disc protrusion is considered mild, the volume of protrustion or extrusion is not directly correlated with severity of clinical signs (the same way degree of radiographic OA findings do not correlate with patient function). Having said that, most cases with this sort of presentation can be resolved non-surgically. I'm with LEH in that I would love to get my hands on this dog...

2) As an alternative to the Rx cocktail above, consider epidural depomedrol... as 1st described in VCOT 2009. I don't do all 3 automatically, but start with 1 and see how it goes from there:


Lumbosacral degenerative stenosis
in the dog
The results of epidural infiltration with
methylprednisolone acetate: a retrospective study
L. Janssens; Y. Beosier; R. Daems
Anubis Veterinary Clinic for Companion Animals, Aartselaar-Antwerp, Belgium
Keywords
Lumbosacral disc protrusion, dorsal laminectomy,
epidural infiltration, methylprednisolone
acetate, dog
Summary
Thirty-eight dogs with Hansen type II lumbosacral
disc protrusion were treated with
epidural infiltration of methylprednisolone
acetate between the seventh lumbar vertebra
and the sacrum. Epidural infiltration was
carried out under C-arm fluoroscopic guidance
at standardised intervals for the first
three treatments and later on demand.
Retrospective evaluation by owner questionnaire
found that 79% of the animals were
considered to have improved, and 53% were
totally cured. Epidural infiltration with
methylprednisolone acetate has a clinical
outcome comparable to decompressive surgery
and can be safely used as a less invasive
alternative.

[lehughes]

Agreed!
It would be worth trying an injection to see what changes / improves. So as much as a diagnositic as a treatment.
Great suggestion David!

Laurie