Hoping for help with this case.
Daisy is a 5 month old Maremma with Neospora.
She has responded to the medication required but now has issues.
She has fibrotic shortening of most of her muscles. Hind legs are worse.
She is reasonably pain free and functional (can walk and sit and get from sit to stand and stand to sit) except for her ability to get from lateral recumbency to sternal recumbency.
This from an online text: "rigid contracture of the muscles of the affected limb. This arthrogryposis is a result of the scar formation in the muscles from lower motor neuron damage and myositis
In some pups, joint deformation and genu recurvatum may develop.
Gross lesions include multifocal streaks of necrosis, fibrosis, and mineralization of striated muscles, especially the diaphragm."
So I am trying to sort out the getting from lateral recumbency to sternal recumbency. She is growing and those long giraffe hind legs with fibrosis are restricting this positioning.
I have a few ideas which I have just started
1. Place her in sternal recumbency and wobble to try and get some active stretching happening
2. Shockwave the shit out of her hind leg muscles -especially quads, hammies gastroc and adductors (abduction is also reduced) to try and reduce scar tissue
Also have seen other practitioners using therapeutic ultrasound then placing in an air splint for half hour afterwards. This would be the opposite of what I need for getting the dog into sternal recumbency but figure there will be some feedback happening where if I improve extension then I will get improvement in flexion. Don't have therapeutic ultrasound but may get one asap. I've tried a human arm air splint but it was the wrong size. Do you have any sources for canine air splints?
Thanks for any advice
Steve
Dog with Neospora
Re: Dog with Neospora
Hey Steve,
So, this sounds like a complicated one! I've treated 2 neospora cases in the past... but neither of them had rigid contractures!
So, I would break this up problem list, and then goals...
Problems:
Fibrotic shortening of muscles / ROM issues
Mobility issues (lateral to sternal in particular)
Crappy diagnosis that could result in a worsening of issues
Goals
Maintain / Improve ROM
Retrain mobility
Be ready to deal with whatever 'shit' happens next!
Ideas
Hold in prolonged positions (sit and sternal) for flexion. Slow rewards with cookies in those positions. So, maybe do them elevated (i.e. sits on cinderblocks or a raised stool, lying on a plank)
Standing practice and pinch / poke / stimulate the quads. Try the same on the gastrocs and/or glutes.
When standing, push down on the rump to try and stimulate reflexive extension of the gastrocs, quads, glutes.
Questions for you...
I can't really 'see' in my end what she is doing in lateral recumbency. Are the hind legs in rigid extension?
IF so, then perhaps use 'key points' of control (i.e. flex the toes and/or stick a thumb into the web space between the main tarsal pad and the toe pads to initiate a flexor withdrawal response to get some flexion in the rear legs.
I don't think I'd rush out to buy the Ultrasound, and I guess I'd not go hog-wild with the shockwave unless you started to see some evidence of the fibrosis. AND/OR give it a try on one muscle group and see how it goes.
What else do you have at your disposal? E-Stim? Laser?
What do the muscles feel like? Do they feel fibrotic? Would massage help? How do the muscles feel to stretch?
Can you upload a picture?
All in all, I'd aim for more active than passive as my first choice of treatments.
To answer your questions, I don't think there are doggy air splints. We bought a set of children-sized air splints to try... but have only ever used them on a handful of dogs.
Okay - back to you!
Cheers,
Laurie
So, this sounds like a complicated one! I've treated 2 neospora cases in the past... but neither of them had rigid contractures!
So, I would break this up problem list, and then goals...
Problems:
Fibrotic shortening of muscles / ROM issues
Mobility issues (lateral to sternal in particular)
Crappy diagnosis that could result in a worsening of issues
Goals
Maintain / Improve ROM
Retrain mobility
Be ready to deal with whatever 'shit' happens next!
Ideas
Hold in prolonged positions (sit and sternal) for flexion. Slow rewards with cookies in those positions. So, maybe do them elevated (i.e. sits on cinderblocks or a raised stool, lying on a plank)
Standing practice and pinch / poke / stimulate the quads. Try the same on the gastrocs and/or glutes.
When standing, push down on the rump to try and stimulate reflexive extension of the gastrocs, quads, glutes.
Questions for you...
I can't really 'see' in my end what she is doing in lateral recumbency. Are the hind legs in rigid extension?
IF so, then perhaps use 'key points' of control (i.e. flex the toes and/or stick a thumb into the web space between the main tarsal pad and the toe pads to initiate a flexor withdrawal response to get some flexion in the rear legs.
I don't think I'd rush out to buy the Ultrasound, and I guess I'd not go hog-wild with the shockwave unless you started to see some evidence of the fibrosis. AND/OR give it a try on one muscle group and see how it goes.
What else do you have at your disposal? E-Stim? Laser?
What do the muscles feel like? Do they feel fibrotic? Would massage help? How do the muscles feel to stretch?
Can you upload a picture?
All in all, I'd aim for more active than passive as my first choice of treatments.
To answer your questions, I don't think there are doggy air splints. We bought a set of children-sized air splints to try... but have only ever used them on a handful of dogs.
Okay - back to you!
Cheers,
Laurie
LAURIE EDGE-HUGHES
Re: Dog with Neospora
Hi
Thanks for your suggestions
Yes - the muscles feel fibrotic. The legs aren't really stuck in rigid extension like a spasticity. Extensors are tight as well - her walking isn't great but is functional.
She can get some flexion of the hind legs but the limiting factor seems to be the max flexion and slight abduction of the hip she needs to get her legs from the lateral recumbency to sternal recumbency.
She can get from sternal to sit, sit to stand and can ambulate ok.
The owner thinks my shockwave barrage seemed to help for a few days and then wore off so I'll persist with that for now- my thinking with this is that maybe some of fibrosis may be reduced and we will get a kickstart to replace it with normal muscle again.
The muscles feel like active stretching might help but massage is likely a waste of time.
Owner has sent me through a video - I'll figure out how to get it on here. It's not really showing all that I want.
Thanks
Steve
Thanks for your suggestions
Yes - the muscles feel fibrotic. The legs aren't really stuck in rigid extension like a spasticity. Extensors are tight as well - her walking isn't great but is functional.
She can get some flexion of the hind legs but the limiting factor seems to be the max flexion and slight abduction of the hip she needs to get her legs from the lateral recumbency to sternal recumbency.
She can get from sternal to sit, sit to stand and can ambulate ok.
The owner thinks my shockwave barrage seemed to help for a few days and then wore off so I'll persist with that for now- my thinking with this is that maybe some of fibrosis may be reduced and we will get a kickstart to replace it with normal muscle again.
The muscles feel like active stretching might help but massage is likely a waste of time.
Owner has sent me through a video - I'll figure out how to get it on here. It's not really showing all that I want.
Thanks
Steve
Re: Dog with Neospora
Hmmm...
So, some additional ideas:
Maybe some dry needling into the fibrotic muscle (i.e. using acupuncture needles). I just had it done on my Traps and it was magical! I've done it a little bit on dogs... but I'm thinking it has more applications that I'm currently using it for!
Maybe after needling or shockwaving, you do long prolonged holds of the stretches (more like a myofascial hold - i.e. 5 minutes)... and show the owners how to do the same.
If you do go with some splints, then maybe just create something cheap and cheerful (half cast or PVC pipe... (i.e. the sort of thing I would create for a calf on the ranch!)
Now, as for video - if you can upload to YouTube, then you can put a link in here!
Back to you!!
Lauire
So, some additional ideas:
Maybe some dry needling into the fibrotic muscle (i.e. using acupuncture needles). I just had it done on my Traps and it was magical! I've done it a little bit on dogs... but I'm thinking it has more applications that I'm currently using it for!
Maybe after needling or shockwaving, you do long prolonged holds of the stretches (more like a myofascial hold - i.e. 5 minutes)... and show the owners how to do the same.
If you do go with some splints, then maybe just create something cheap and cheerful (half cast or PVC pipe... (i.e. the sort of thing I would create for a calf on the ranch!)
Now, as for video - if you can upload to YouTube, then you can put a link in here!
Back to you!!
Lauire
LAURIE EDGE-HUGHES
Re: Dog with Neospora
She finally walks at about 1 min 40s in this video
https://www.youtube.com/watch?v=FwNROrd0UWU
This is her trying to get out of lateral recumbency
https://www.youtube.com/shorts/MXbDOwRuT4k
Not great for what I wanted to show you but you can see the fibrosis in the walk in the first video
Thanks
https://www.youtube.com/watch?v=FwNROrd0UWU
This is her trying to get out of lateral recumbency
https://www.youtube.com/shorts/MXbDOwRuT4k
Not great for what I wanted to show you but you can see the fibrosis in the walk in the first video
Thanks
Re: Dog with Neospora
You have likely seen this book
https://www.amazon.com.au/Clinicians-Gu ... B08CPLDBRD
https://www.amazon.com.au/Clinicians-Gu ... B08CPLDBRD
Re: Dog with Neospora
These videos help for sure!
Okay, so when she finally walks, I can see the hips and stifles being held in flexed positions.
My next question is Can she straighten the stifles and What is her passive hip extension like?
She can actually get into a sit, so she has the ROM to fully flex, but not the power to get there or get out of it very well. So, what I see with this task, is the need to practice, practice, practice (easy at first, then fully normal later on).
So,
1 > Sit to stands onto / from a block, step, stool, or knee/lap.
2 > Sit to stands with someone guiding the movement from behind (i.e. guiding her to go down into a proper sit (or sit onto a stool/step/etc), and then reposition the legs so that they are tucked in properly to get a good stand.
3 > Front feet up on a step or stool to actively stretch hip flexors and attempt to gain full stifle extension (i.e. reach up for a treat with front feet elevated).
4 > Oh, for the lateral recumbency to sternal to lying, this also just looks like more practice is needed to relearn the skill. Owners should be shown how to tuck the dog's legs under itself to be most successful at next transitioning to a sit. Practice, practice, practice.
I don't know that any sort of 'passive therapies' (ie splints OR shockwave/MTrPt releases / myofascial holds) will make as much impact as practiced movements. BUT, the owners need to learn HOW to do that with their dog (how to guide the limbs, how to put the limbs in the best start position, how to break down and exercise into achievable bits.) Which then means that you need to look at the same and figure out how to coach them.
Does that help? Thoughts?
Cheers,
Laurie
Okay, so when she finally walks, I can see the hips and stifles being held in flexed positions.
My next question is Can she straighten the stifles and What is her passive hip extension like?
She can actually get into a sit, so she has the ROM to fully flex, but not the power to get there or get out of it very well. So, what I see with this task, is the need to practice, practice, practice (easy at first, then fully normal later on).
So,
1 > Sit to stands onto / from a block, step, stool, or knee/lap.
2 > Sit to stands with someone guiding the movement from behind (i.e. guiding her to go down into a proper sit (or sit onto a stool/step/etc), and then reposition the legs so that they are tucked in properly to get a good stand.
3 > Front feet up on a step or stool to actively stretch hip flexors and attempt to gain full stifle extension (i.e. reach up for a treat with front feet elevated).
4 > Oh, for the lateral recumbency to sternal to lying, this also just looks like more practice is needed to relearn the skill. Owners should be shown how to tuck the dog's legs under itself to be most successful at next transitioning to a sit. Practice, practice, practice.
I don't know that any sort of 'passive therapies' (ie splints OR shockwave/MTrPt releases / myofascial holds) will make as much impact as practiced movements. BUT, the owners need to learn HOW to do that with their dog (how to guide the limbs, how to put the limbs in the best start position, how to break down and exercise into achievable bits.) Which then means that you need to look at the same and figure out how to coach them.
Does that help? Thoughts?
Cheers,
Laurie
LAURIE EDGE-HUGHES