Hi all,
Yesterday I took my puppy (BC X, 8kg , 10m) to get an opinion as I was concerned she never sits straight. She tends to tilt her pelvis under, abduct her knees, straighten hocks. She can sit straight when she is cued, but never does on her own. Sometimes she will sit with one knee tucked under like a post cruciate dog. (I have her sister, and she always sits straight, however other sister will do similar to this pup).
Ortalani negative at 14w. No lux patellas. No limping or offweighting. Nice angles, little long in lumbar spine.
So ortho specialist examined her, said she is sore in her pectineus and iliacus. To do this he lifted her back legs off the ground, extended her pelvis/tilted it forward, and palpated hard. She cried. He wants to do an MRI to check her muscles..
I then took her to Chiro last night for 2nd opinion. He checked her muscles in standing and said they felt fine. He feels she is just hypermobile/loose and not very strong yet, and that is why she isn't sitting straight. Feels we just need to practice straight sits, drops to sits and she will be fine. Said SIJ back etc fine.
My rehab vet (not good with my own dogs), who hasn't examined her as she lives interstate, said probably her glutes aren't working properly.
I know you are guessing without hands on her but what do you think? My feeling is Chiro is correct .. (or maybe wishful thinking lol)
Thanks!!
P.S either of you want to move to Perth.. ?!
Two differing opinions for puppy
-
David Lane
- Posts: 164
- Joined: Mon Oct 24, 2016 10:51 pm
Re: Two differing opinions for puppy
Although I can't comment on this space specifically about the correct course of action (because I haven't seen the patient), in general I apply the algorithm when considering any diagnostic test:
what are the severity of the symptoms?
how likely is the test to change the treatment plan?
how invasive/expensive is the test?
what will the test potentially reveal?
In this case, we have a subtle clinical sign, and conflicting evidence whether pain even exists. In contrast, to perform and MRI, we are talking about a fair financial outlay and a general anesthetic. What is the specialist hoping to find via MRI? A macroscopic muscle tear? IVDD? If he is looking at primary muscle tearing, why not ultrasound instead? If there is macroscopic tearing, what will he recommend as treatment, and could one proceed directly to treatment based on symptoms (assuming that pain can be consistently isolated to a specific location)?
If the empirical treatment options were invasive (eg surgery), then absolutely get a firm diagnosis first if possible, but therapeutic exercise is relatively benign, and again for such a subtle symptom, why not give it a try for a month and see if clinical improvement happens?
what are the severity of the symptoms?
how likely is the test to change the treatment plan?
how invasive/expensive is the test?
what will the test potentially reveal?
In this case, we have a subtle clinical sign, and conflicting evidence whether pain even exists. In contrast, to perform and MRI, we are talking about a fair financial outlay and a general anesthetic. What is the specialist hoping to find via MRI? A macroscopic muscle tear? IVDD? If he is looking at primary muscle tearing, why not ultrasound instead? If there is macroscopic tearing, what will he recommend as treatment, and could one proceed directly to treatment based on symptoms (assuming that pain can be consistently isolated to a specific location)?
If the empirical treatment options were invasive (eg surgery), then absolutely get a firm diagnosis first if possible, but therapeutic exercise is relatively benign, and again for such a subtle symptom, why not give it a try for a month and see if clinical improvement happens?
David Lane DVM
ACVSMR, CVA, CVSMT, CCRP
ACVSMR, CVA, CVSMT, CCRP
Re: Two differing opinions for puppy
David's response sounds very intelligent and well thought out. And its entirely correct as well.
My initial instinct was that if I had to weigh in on the two assessments, I'd bank with the chiro. The testing procedure described by the ortho doesn't sound very specific, and indeed, I think could yield pain with any dog (if it's what I am envisioning). The recommendation - MRI to check muscles - seems like overkill. And after those thoughts went through my head, then I was at the same place as David.
Why MRI? What are the possible differentials? What would be the goal afterwards? And finally, why not try strengthening first and see where that gets you?
Less eloquent... but I think we end up thinking along the same lines!
Cheers,
Laurie
My initial instinct was that if I had to weigh in on the two assessments, I'd bank with the chiro. The testing procedure described by the ortho doesn't sound very specific, and indeed, I think could yield pain with any dog (if it's what I am envisioning). The recommendation - MRI to check muscles - seems like overkill. And after those thoughts went through my head, then I was at the same place as David.
Why MRI? What are the possible differentials? What would be the goal afterwards? And finally, why not try strengthening first and see where that gets you?
Less eloquent... but I think we end up thinking along the same lines!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Two differing opinions for puppy
Thank you both. I agree it sounds like overkill , just find it very hard to have perspective with my own dogs. We will practice straight sitting and correct her when she sits sloppily.
I also placed her psoas and pectineus on stretch, and palpated, and didn't get any reaction.
I also placed her psoas and pectineus on stretch, and palpated, and didn't get any reaction.
Re: Two differing opinions for puppy
Perfect.
Many years ago, my own dog came up lame. And whenever I tested things on her she cried with everything. So I took her to my vet to evaluate her. He poked prodded and stretched and pronounced that it was her biceps tendon. I thanked him, paid the bill and said, "I'll take it from here."
I went home and my husband asked "What did the vet say?" I said, "Biceps tendon." And, knowing me well enough, he asked, "And what you you think?" I said, "His finger was on supraspinatus."
So I treated her supraspinatus and she got better! But I had to pay for that consult for both me and my dog to be objective! So, it was worth every penny!
And the moral of the story is, carry on with your plan and what makes sense to you now in your head!
Best of luck!
Laurie
Many years ago, my own dog came up lame. And whenever I tested things on her she cried with everything. So I took her to my vet to evaluate her. He poked prodded and stretched and pronounced that it was her biceps tendon. I thanked him, paid the bill and said, "I'll take it from here."
I went home and my husband asked "What did the vet say?" I said, "Biceps tendon." And, knowing me well enough, he asked, "And what you you think?" I said, "His finger was on supraspinatus."
So I treated her supraspinatus and she got better! But I had to pay for that consult for both me and my dog to be objective! So, it was worth every penny!
And the moral of the story is, carry on with your plan and what makes sense to you now in your head!
Best of luck!
Laurie
LAURIE EDGE-HUGHES
Re: Two differing opinions for puppy
Thought I'd give an update here for anyone reading and interested.
Nothing wrong with dog, she sits straight most of the time now, and has muscled up nicely. Total pocket rocket in agility, too!
Nothing wrong with dog, she sits straight most of the time now, and has muscled up nicely. Total pocket rocket in agility, too!