Strange swelling case

[lehughes]

Hello Laurie,

I've got another confusing one for you! I would love your input for this little girl.....

Hello all,

Neala, a 4 YO FS Pitbull mix, presents for evaluation of R hindlimb lameness.

Neala was diagnosed with a partial R CLL tear and hip dysplasia earlier this year.
Neala received her vaccinations around April 8 2018- while she was being placed into the car later that day, she fell onto her right side. The owner relates that she then developed severe bruising that extended from the lateral aspect of the leg to the inner, medial aspect of the leg onto the abdomen (see picture 1).

Recheck with rDVM demonstrated concern for IMHA (hct of 25% with regenerative anemia and positive Coombs test). Her SNAP 4Dx was negative at that time. The rDVM noted severe bruising (despite normal platelets) and that the leg was deep pain negative. Recheck lateral abdominal X-rays wereWNL- no V/D view was taken at that time.

On presentation to me, the dog has pain sensation in the R HL, absent gastrocnemius reflex, decreased to absent patellar reflex, and ambulates on the dorsum of the R HL paw. The muscles along the lateral and medial aspect of the right hindlimb are rock-hard- I have not palpated muscles like this (see video and pictures 2-4). The dog is painful on hip extension. Owner had stopped giving gabapentin as she felt it made the dog too drowsy.

The owner has financial constraints. I consulted with an Internal Medicine specialist who recommends CT/MRI, muscle biopsy, Doxycycline, and chest xrays. She is smelling cancer. She is concerned that the IMHA is paraneoplastic.

The rDVM would like PT and acupuncture for the dog to avoid atrophy. My current treatment plan involves warm compressing frequently, weekly acupuncture for pain relief, PROM, and hydrotherapy. I do not think therapeutic land exercises are in this dog's best interest at the moment and am wondering if hydrotherapy (hydrostatic pressure and warm water combined with cookie stretches and PROM in the tank) might get us farther until we get the muscle biopsy back.
I do not think Laser therapy is an option until we have more diagnostics.

Please find her video, pictures,and X-rays attached.

https://youtu.be/MFwmTyyDNvQ

Thank you,
Jessie, DVM, CCRT, CVA

[lehughes]

Hi Jessie,

Sorry for my slow reply!

What a lot of swelling!!!!
So, in my head it seems to sound like a ‘compartment syndrome’ kind of a thing. Where there is swelling (or bleeding in this case) within a fascial sheath / enclosed compartment, which can compress a nerve - or blood vessels. There seems to be controversy as to whether physical therapy helps… but I think it couldn’t hurt in this case.
I’d massage upwards, you could use modalities and/or acupuncture, instead of warm compress, I’d to hot/cold alternating (i.e. 30 seconds to 1 minute of each, beginning and ending on cold, in order to pump the swelling / bruising away. PROM would be fine, as would any kind of AROM (i.e. toe tickles / pinches to get a flexor withdrawal), and /or joint compressions to the stifle and tarsus to get joint extension. Also weight shifting onto the leg. Sounds like you are on the right track anyways! And your thoughts about water are warranted…but maybe more ‘standing in the water' than much walking… or just very slow walking and lots of standing breaks.
I’d still consider laser as a healing tool. Check out the blog: https://www.fourleg.com/Search-Results?t=b&id=343
No, it’s not clear cut… but I think the value out weighs the ‘what if’. My 2 cents.

Best of luck with the poor pooch!

(And I’ll post it onto the FourLeg Forum to see if others have ideas as well.)

Cheers,

Laurie

[lehughes]

Hello Laurie,
THank you for your reply. This dog most likely had SQ hemangiosarcoma - within 1 week, the dog had stopped eating, and had no energy. Additionally, her gastrocnemius tendon of the unaffected leg had almost torn. Very sad case.
Thank you for helping me.
Warmly,
Jessie

[lehughes]

Hey Jessie,

Very sad indeed.
But thank you for the update!

Laurie