Laurie's Blogs.

As veterinary medicine expands and becomes more complex, the general practice veterinarian is pulled in too many directions, and is understandably fragmented in their ability to be up to date on all aspects of health and techniques for the species in which they choose to specialize.  This is not a negative blog post.  Instead, this is a post the recognizes a need for generalists, specialists, and even ‘outsiders’ like myself in the animal health care arena.

This past week I had another interesting case that was  presented to me that highlighted the physical therapist’s ability to localize a lesion and provide treatment options.  Localizing pain is the first step to identifying a problem.  It leads to testing further, interpreting  findings, and then proceeding with the appropriate treatment.  The case also highlighted the importance of options for animals as well – not just surgery or euthanasia… but maybe ‘rehab’!

So the case in question is a Basset Hound with IVDD and no motor control.  Her regular vet diagnosed her as having IVDD, and did a radiograph that revealed 9 calcified discs.  The owner wasn’t wanting to do surgery, but was told that if the dog deteriorated and wasn’t able to use the legs to then go to the emergency / specialist clinic.  This occurred the following day.  The owner saw the emerge vet and was quoted for a neuro consult and surgery, which simply wasn’t an option.  She was offered an MRI, but if not doing surgery, she questioned what would be the point.  She then followed up with her vet for a potential euthanasia appointment, where she was presented with a third option – rehab.  Not specifically “rehab” (as in treatment), but a rehab assessment.  She was told that if she came to us, we would give her an honest opinion about whether rehab would work for her dog or not.  

(I’m pretty proud of that referral – that the referring vet has found us (our therapists in general)  to be honest and capable of making that assessment.  Proud clinic owner moment.)

So, I read through all of the notes from the two clinics and nowhere was a full neuro examination conducted.  Nobody had attempted to localize the lesion.   With a full neuro evaluation, looking at reflexes, understanding neuro anatomy, and my trusty ‘physio fingers’, I put the lesion to be at L2-3.   That’s the first part of figuring out what to treat. With a neuro case, you need to address the root of the problem AND the functional deficits.  You need to do both.  She has deep pain.  Loss of bowel and bladder.  Loss of volitional motor control of the rear legs.  Upper motor neuron reflexes.  An intact tail wag.  Mild to moderate pain at L2 and L3.  BUT, I was able to get her propped into a standing position and with facilitating quads, I could get her to stand.  That’s hopeful, I’d say!

Next, it came to the questions of what to do, and will my dog walk again?  Do I do rehab or put her down?  We discussed the research from the Cambridge IVDD study group (researching conservative management) and the Joachim et al 2010 study (acupuncture vs surgery for IVDD).  She’s a grade 4 IVDD case, but there is enough hope in what I saw during the assessment, that I said, “Let’s give it 3 weeks to see if there is enough improvement to continue.  You don’t need to make this decision today.”    Happily at the end of the appointment, she was trying to stand!

She has a long way to go, but if there is an upward trajectory in her function in 3 weeks, then there’s hope she’ll walk again.  

Lessons to be learned:  

1)  The Rehab Assessment should be offered as an option

2)  Localization of a lesion is important for treating the root of the problem

3)  A trial of therapy (with an extensive home program) can help determine the likelihood for success.  Neuro cases are hard to predict on ‘day one’, but you get a good idea in a couple of treatments as to whether there will be a good chance (or not) for recovery.

On that note, have a great week folks!