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ZOE_Recheck

Recheck

PATIENT PROFILE

Female, Spayed, Yellow Labrador Retriever, Age: 6 Years

HISTORY

Zoe presented for her rehabilitation consultation due to an acute sudden spinal cord injury that occurred one month prior while she was playing in the yard. This left Zoe paralyzed in the hind limbs with absent pain sensation in both hind limbs and her tail.

Directly after her initial injury, Zoe was evaluated by her primary care veterinarian where radiographs showed narrowing intervertebral disc space at an area of her thoracic spine. She was subsequently referred by her veterinarian that same day to a veterinary specialty center, ACCESS, for a neurology consultation. There, Zoe had been evaluated by a board certified neurologist, Dr. Malte Schwartz, who performed advanced imaging using MRI. Zoe was diagnosed with an acute concussive non-compressive disc also called a Type III or "explosive disc" at the lower thoracic spine (T12-T13 vertebral spaces). This happens when the soft inner portion of the spinal disc ruptures out causing trauma and bruising of the spinal cord which can often times cause neurological dysfunction.

GOALS

-Being able to stand, walk again, enhance mobility

-manage pain, promote healing

-decrease swelling

-walk independently with fecal continence

-weight loss

REHABILITATION & RECOMMENDATIONS

An in-clinic rehabilitation program was recommended with a frequency of visits 3 to 5 days per week. For Zoe's initial program, we focused on healing by decreasing inflammation and increasing comfort as well as weight loss. Zoe’s rehabilitation plan included the use of cold laser therapy, pulsed electromagnetic therapy, massage, passive range of motion exercises and assisting with her daily functions such as standing and walking using a support harness as well as a land treadmill. Zoe was not a candidate for water therapy initially due to her significant fecal incontinence. As this improved, water therapy was added to her regime. Acupuncture and aqua-puncture injections administered by our veterinary doctor were also recommended to help with pain relief, to stimulate the nervous system, reduce muscle tension, increase circulation, and to help with calming which can be helpful when pets are less active or need to be restricted post-injury.

Home instruction, including nursing care, and therapeutic exercises, were also provided and reviewed with the client. Zoe was fitted for an assistive harness and booties to aid with traction to provide secure footing to prevent slipping and to encourage more confidence with using her hind limbs.

EVALUATION

Zoe presented one month post-injury 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. Zoe was assessed for pain, current muscle strength and muscle mass, muscular tension and joint range of motion.

When Zoe presented to PAW REHAB, she was unable to walk due to significant weakness of her hind limbs with the right limb weaker than the left. Zoe needed full assist to rise and to walk using the help of a sling. Once placed into standing she was only able to hold partial weight of her hindquarters and would slowly sink down. She had very minimal movement of her limbs but she had been shown to have regained feeling or pain sensation in her hind limbs. Zoe was not able to correct her hind paw when knuckled over. She had areas of mild discomfort along her spine.

Additional exam findings: She had tightness and mild discomfort at both shoulders and elbows due to significant chronic forward weight shifting. She had some mild instability and discomfort of both knees which was suspected to either be due to significant muscle atrophy or chronic weakness of her knee ligaments. She also had mild discomfort at her hips. She was also overweight which provided an additional challenge to her rehabilitation process. She had been in good health prior to the injury other than a food allergy.

Zoe was given a fair to good prognosis for regaining the ability to walk but her prognosis for regaining fecal continence was guarded.

MORE ABOUT THE CONDITION:

This patient’s spinal injury was diagnosed via MRI and determined to be due to an "Explosive Disc".

Acute concussive non-compressive disc or “explosive disc” is a low volume, high velocity traumatic herniation of usually normal spinal disc material which causes a significant bruising of the spinal cord with minimal to no spinal cord compression. It occurs usually during vigorous exercise (such as running, jumping, playing). Symptoms reported include vocalization, such as a yelp, scream, or cry as if in pain followed by a sudden inability to walk or loss of use of the limbs.

Explosive disc is usually treated conservatively with supportive care (management of the recumbent animal, nursing care), rest, time and physiotherapy also known as physical rehabilitation therapy. If you think your pet is experiencing symptoms of intervertebral disc injury, please see your primary veterinarian or nearest animal emergency center promptly if your pet appears painful or is suddenly unable to walk. Once your pet is evaluated and a diagnosis is made, your veterinarian may determine if surgery and or physiotherapy is appropriate for your pet.

PATIENT'S PROGRESS

Only a few weeks after beginning her rehabilitation program, Zoe was showing improvements in comfort, less muscle tension and regained the ability to stand and walk! Zoe continues to make improvements weekly including walking with no to minimal assistance, she is able to perform a proper sit and the client also reported that Zoe may be responding to the additional acupuncture points we used to try to help the incontinence. We are so proud of Zoe!

Over the next several months, Zoe’s rehabilitation program was advanced to additional therapeutic exercises to further enhance her strength, balance and coordination. She has been independently walking and playing with a playmate and romping around in the snow!

One year after her initial evaluation, Zoe’s pet parents continue to do a fantastic job with their homework and care of Zoe. We couldn’t be prouder of them, Zoe and our PAW REHAB team. We are so happy to call Zoe not only our “Patient of the Month” but our “Patient of the Year”! Zoe and her pet parents have chosen for our donation Little Angels Service Dogs.

SYMPTOMS/REASON FOR VISIT

Acute inability to walk. Recovery from spinal cord concussion/explosive disc (non- surgical disc)

DIAGNOSIS

Hind limb paraplegia/paraparesis (significant weakness of hind limbs, non-ambulatory) due to acute non-compressive concussive spinal disc extrusion at T12-T13 vertebral spaces

Summary of Findings/Problems:
Non-ambulatory paraplegia with voluntary motor
Back discomfort
Discomfort at multiple joints
Fecal incontinence (loss of bowel control)
Overweight

ZOE

AUTHORS

Joanne Bak DVM, CCRT, April Mathison, Nancy Lee RVT CCRP
Pacific Animal Wellness Rehabilitation Center

Zoe 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 rehabilitation plan and performing therapies with Zoe is April Mathison (pictured to the right), a Certified Veterinary Assistant and graduate of veterinary technology college who is trained and experienced in veterinary technology, canine and feline rehabilitation therapy.

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

info@pawrehab.com www.pawrehab.com