PAW REHAB is proud to present our "Patient of the Month." Our patient of the month showcases a patient's journey through its initial or ongoing rehabilitation process. We hope to promote awareness for pet parents and the veterinary community of the benefits of rehabilitation therapy in veterinary medicine. Each patient of the month is selected by our rehabilitation therapy team. PAW REHAB will be making a donation in the patient's name to a nonprofit organization of the pet parent's choice. PAW REHAB has made contributions in the past in support of the following pet charities and will donate to one of the following if the client would like this option instead: Best Friends, Operation Blankets of Love, Pugnation and GreySave.
REHABILITATION & INTERVENTION
Initial Evaluation: July 25, 2018
Emmy Lou presented 12 weeks post-op for a consult with PAW REHAB and was evaluated by our veterinary doctor. A complete physical exam was performed including a gait evaluation, orthopedic and neurological assessment. Emmy Lou was assessed for pain, current muscle strength and muscle mass, muscular tension and joint range of motion.
At her initial evaluation, Emmy Lou weighed 10.5 lbs with a mild overweight body condition score of 6/9. She was determined to be in good health otherwise with the exception of her disability.
Emmy Lou expressed no discomfort during cervical and spinal palpation of her neck and back.
Emmy Lou had voluntary motor (the ability to move) present in her hindlimbs but was unable to fully support her weight to stand and was unable to ambulate independently (she could not walk without assistance). She had no conscious proprioception (awareness of the position of one's limbs in space) with significant paresis (limb weakness) and ataxia (an unsteady, wobbly gait). She could stand for no more than 2 seconds before sinking in the hindquarters and Emmy Lou was unable to get into a proper sit position (her hind limbs had a tendency to displace forward or she would sit to the side on one hip).
Muscle mass was assessed by measuring the circumference of her shoulders and thighs. Her forelimb musculature measured fairly evenly but the right hind limb was 2cm less than the left hind limb. There was tightness on hip and shoulder extension and a comfortable, normal range of motion in her other joints.
RECOMMENDATIONS/PLAN
An in-clinic rehabilitation program was recommended for Emmy Lou consisting of visits two to three times weekly. For Emmy Lou's initial program, we focused on healing by decreasing inflammation and increasing comfort as well as minor weight loss in order to help decrease the stress on her spine. Therapies included body work, cold laser therapy, and therapeutic exercises. In addition, she received acupuncture and B-12 aqua-puncture injections administered by our veterinary doctor twice weekly. Acupuncture is often used to help with pain relief, to stimulate the nervous system, help reduce muscle tension and increase circulation as well as to help with calming which can be helpful when pets are less active or need to be restricted post-op.
Emmy Lou was fitted for an assistive harness and aids for paw traction in order to provide secure footing to prevent slipping and to encourage more confidence with using her hindlimbs. A wheel chair fitting was also performed to ensure a proper fit. (Note: We recommend consulting with a rehabilitation specialist prior to ordering a canine cart/wheelchair in order to determine the best type and proper measurements).
The clients were provided instructions including review of basic home exercises such as passive range of motion of the limbs, stretching, and circulatory massage. Additional exercises were prescribed and implemented in-clinic based on the patient's progress and ability. As Emmy Lou was observed at home and by us at PAW REHAB, more exercises were recommended and reviewed for home.
PATIENT'S PROGRESS
Emmy Lou has just completed her first month of therapy and is "making waves" now going into her second program. She is comfortable, has less muscle tension, is noted to be standing longer and she is now able to walk and support her own weight! Her progress is noticed both at home and at the time of her therapies. Emmy Lou continues to make improvements weekly and has gained 3-4 cm of muscle mass in each hind limb! "Go Emmy Lou, Go!"
A patient's recovery may depend on the condition or type of injury, severity of injury, ability to heal and can greatly be affected by the pet owner's compliance with recommendations from the pet's health care team. Emmy Lou's owners are doing an outstanding job bringing her in for her therapies as well as ensuring they're doing all they can for her at home, and it really shows. The owners are elated to see Emmy Lou gaining strength so quickly. They have hope that she will be an independent dog once again. :)
Emmy Lou has elected for PAW REHAB to make a donation to Kitten Rescue in her name. Kitten Rescue is a non-profit organization dedicated to housing homeless cats as well as pulling cats out of the shelter before euthanasia. Kitten Rescue is largely responsible for educating the public on the importance of proper pet care and is where Emmy Lou found her family (despite not being a kitten).
DISCUSSION:
Intervertebral disc disease may be a chronic degenerative disease or sometimes an acute traumatic injury of the discs or soft tissue areas of the spine. Discs may weaken over time and can bulge/herniate or cause pain, inflammation and swelling at the spine. This may result in pain and can also lead to decreased neurological function that may cause weakness of the limbs which can be progressive. If a more rapid decline or sudden explosive disc herniation occurs, the pet may have increased difficulty walking or paralysis. If this happens and your pet is unable to rise, walk or is in severe pain, please see your veterinarian immediately as this may mean a surgical or medical emergency. Chronic disc disease may be managed by keeping your pet at a slim healthy weight and using pain medications, anti-inflammatory medication or steroidal medication, rehabilitation therapy and acupuncture.
Other diseases can mimic symptoms of disc disease such as infections, tumors or cancer or stroke type events amongst others and intervertebral disc disease vs these other causes can only be diagnosed definitively with specialized tests and advanced imaging such as MRI (Magnetic Resonance Imaging) or sometimes CT (Computed Tomography) scan. Consultation and evaluation with a veterinary neurologist can be helpful in determining the cause and best course of treatment.
This patient had been treated prior to presentation with a surgical hemilaminectomy. A hemilaminectomy is a surgical procedure performed under general anesthesia in which the affected areas of the spine and intervertebral discs are accessed. Bone of the vertebrae is removed and the herniated disc material is carefully removed as best possible in order to alleviate pressure placed upon the spine and to help decrease spinal cord swelling. This type of procedure is best performed by a board certified veterinary neurologist or surgeon. PAW REHAB believes in a collaborative approach and works with the pet's veterinary care team in order to enhance your pet's outcome. Follow-up with the surgeon, neurologist or primary care veterinarian is encouraged and we will keep them up to date on your pet's progress.
AUTHORS
Laura Kirschbaum RVT, CCRP & Joanne Bak DVM, CCRT PAW REHAB, Pacific Animal Wellness Rehabilitation Center
Sherman Oaks, CA (November 04, 2018)
Emmy Lou was assessed and is overseen at PAW REHAB by Dr. Joanne Bak, a veterinary doctor and Certified Canine Rehabilitation Therapist. Assisting with Dr. Bak's plan and performing therapies with Emmy Lou is Laura Kirschbaum, a Registered Veterinary Technician and Certified Canine Rehabilitation Practitioner.
PATIENT PROFILE
6 years, Mixed Breed (canine)
Emmy Lou
GOALS
Prior to beginning her therapy at PAW REHAB, her owners’ goals were that they would like Emmy Lou to be able to independently stand and walk on her four limbs again.
HISTORY
Emmy Lou was rescued 4 years ago and has been a family pet since then. Emmy Lou has a history of seizures and hepatic microvascular dysplasia (a congenital abnormality of the liver) which are both being medically managed. She has been healthy otherwise.
On May 12, 2018 the owners noticed Emmy Lou's reluctance to use the stairs and brought her into a veterinary emergency hospital for acute inability to walk or stand. The owners elected to move forward with the recommended diagnostic tests which included advanced imaging study using a CT Scan (Computed Tomography Scan). An intervertebral disc rupture (herniation) was diagnosed and surgical intervention took place that same day. A right sided hemilaminectomy was performed with vertebral fenestration to decompress the affected areas. Fat grafting was also performed to provide a cushion over the area of the spine where bone had been removed during the decompression. The surgeon found bulging disc material compressing the spinal cord at the intervertebral disc spaces of L1-L2 with bruising at T12-T13. Emmy Lou recovered from surgery uneventfully and was referred by her surgeon, Dr. Jason Balara of Animal Specialty Group, for rehabilitation therapy in order to enhance her recovery further.
EMMY LOU & MOM
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PAW SUCCESS STORIES
PAW REHAB is a veterinary facility dedicated to physical rehabilitation therapy for pets in a calming and relaxed environment located in Sherman Oaks, CA. If you would like more information about PAW REHAB, our staff or our services, please see our website at www.pawrehab.com.
Paw Rehab, 14942 Ventura Blvd Sherman Oaks, CA 91403 Phone: 818-847-7299 Fax: 818-860-7672