Max

Max is an 8 year old male Jack Russell Terrier. He presented to the SMART Clinic on 15th November 2011 with a history of not being able to stand. His  symptoms were first noticed on the 5th October when Max was taken for a walk in the park. His owner reported that he would normally run off, but on this occasion he was struggling to walk. By the next day, Max was unable to stand and was struggling to breath whilst drinking. He had also lost his bark. It appeared that Max had develped an extremely rare condition known as polyneuropathy which affects the function of a large number of nerves in the body including those which control his larynx, trunk and limbs.

Max’s condition appeared to stabilise at this level and when he presented at the SMART Clinic his owner reported that although he still couldn’t stand or sit up, he was able to crawl on his side for a very short distance. On his initial assessment, Max struggled to remain propped up on his chest and was unable to hold his head up for more than 30 seconds. He had weak movement in his limbs when his toes were pinched but was unable to stand even with assistance as his legs would crumple underneath him. His breathing was very shallow and he had a high respiratory rate.

Max was treated with acupuncture and then was encouraged to walk in the aquatic treadmill. We used a high level of water to reduce the weight taken through his limbs, a life jacket and a member of staff to help him move his limbs in a correct pattern. Max quickly tired, so we encouraged him to walk for short periods and have long rest breaks. His owner was asked to assist with an extensive home exercise programme which consisted of exercises encouraging Max to interact with his surroundings and to practise lying and sitting with assistance.

Max started as a day patient on the 17th November, where he would be dropped off at 10 am and picked up at 3 pm. This allowed us to work with him frequently, but for short sessions due to his rapid fatigue level.  Max made steady progress and was able to stand for 5 seconds unassisted on the 1st December. We progressed his home exercises and prescribed a wobble cushion to aid his sensory input and weight bearing with each leg.

On the 8th December, 64 days after his initial symptoms, Max was able to walk for a few steps. We were delighted with his progress and could now encourage his owner to take him for very short walks initially, building up to 5 minute walks almost within a week.

By the 20th December, Max ran into the clinic and we were struggling to catch him! We are hopeful that he will return to full health after such a rapid and debilitating illness.   

Hattie

6 year old, female neutered, German Short Haired Pointer

Hattie presented to the Smart Clinic in April 2011. Her owners had noted for some months that she had not been her usual self. She had less energy than before and was sensitive when touched around her lower back. She had become grouchy when approached from behind or when touched around the lumbar region. Investigations were carried out at a veterinary hospital. X-rays had shown lumbosacral spondylosis (which is arthritic changes to the spinal column of her lower back). An MRI scan had shown a moderately severe disc protrusion into the spinal cord canal at the junction between the lumbar and the sacral vertebrae in her lower back. It was also noted that she had a healed fracture site on the left side of her pelvis. She is a rescue dog so the history surrounding this injury is unknown. The main signs observed at the Smart Clinic when we first assessed her were that she was lame on both hind limbs, particularly the left hind. She had a wide hind limb gait with little clearance from the ground of her hind feet. She had very little flexibility in her spine and her lower back was permanently arched. She had little control over individual limb placement and it was often possible to hear her hind feet scraping on the ground. On her initial examination, it was clear that ‘Hattie’s’ forelimb muscles were considerably more developed than her hind limb muscles, because she had been relying on her forelimbs so much to propel her movement forward. Muscle spasm was present in the muscles on either side of her spine in the lumbar region from the end of her ribcage to the pelvis. She was extremely unhappy about her abdominal muscles and her hamstring muscles being touched. This is a multi-faceted case, in that the signs that we were seeing in the beginning could be attributed to the arthritis and disc protrusion found with diagnostic imaging. However there have been other strands running throughout ‘Hattie’s’ rehabilitation path. Firstly, there was marked myofascial sling constriction on the inside of her hind limbs and around her lumbar region. Myofascia could be described as the cling-film which runs over the surface of all muscles. Compensatory gait patterns, trauma and poor posture can lead to constriction in areas that are designed to be mobile. In turn this can impede movement of the dog or cause discomfort. When we find myofascial constriction, soft tissue release techniques are employed to ease these patterns. At the point where a nerve leaves the spinal cord, it becomes a nerve root. ‘Hattie’ was showing nerve root pain in the earlier stages of her rehabilitation process. This may have been associated with the arthritic changes seen on the x-rays.

Before Hattie started to show signs of back pain, she had enjoyed a very active life. It was frustrating for her to have to reduce her activity levels to short 15-20 minute walks at a slow pace. Hattie was coming to the SMART Clinic weekly for the first four months of treatment. We are currently seeing her every 2-3 weeks and we hope to be able to reduce her treatment interval further in the coming months. So far her rehabilitation program has employed acupuncture, aquatic treadmill sessions, a comprehensive physiotherapy exercise program, myofascial release techniques and soft tissue work. The lameness initially seen is no longer present. Her overall gait pattern and core strength and stability have improved dramatically. She is using her hind limb and core muscles properly, taking pressure off her back and forelimbs. Much of the muscular discomfort originally noted has subsided.

Hattie is now bright and breezy and enjoying life with much more enthusiasm. She can relax in a busy room without guarding her back-end vigorously. She is going for hour long walks twice per day with jogging, hills and stints of off-lead walking thrown in. Her program continues. Hattie’s wellbeing is our main concern and this has improved greatly. A good indicator of this is the frequency at which she does ‘Dotty-dog’ which involves running around the house like a wild thing and playing with her toys.

Phoebe

Phoebe is a three year old, female entire Staffordshire bull terrier. She presented to the Smart Clinic six months ago, two days after losing function in her hind limbs. She was not able to walk. X-rays at an orthopaedic specialist had shown swelling of the spinal cord at the level of her 12^th and 13^th thoracic vertebrae but there was no obvious compression of the spinal cord. She was diagnosed with ischaemic myelopathy and a rehabilitation program was instigated at the SMART Clinic. Ischaemic myelopathy is when a small portion of material blocks the blood supply to the spinal cord. On initial presentation, Phoebe was attempting to walk. There was a small amount of voluntary movement in the left hind and enough awareness of where her foot was in space, for her to stand using the left hind for short periods of time with assistance. Conscious pain perception was present in both hind limbs. She was not able to place her hind feet correctly. If the top surface of the hind feet were placed on the ground, she was not able to move them to the correct position. In clinical terms, this can be translated as proprioceptive positioning tests being negative. Anal tone was present and conscious urination occurred during the consult. Her neck muscles were extremely tight and there was a lot of tension in the muscles running parallel to her spine in the lumbar region on the right and in the right hind. Patella reflexes were exacerbated in both hind limbs. The panniculus, skin twitch, reflex was absent behind the level of the twelfth thoracic vertebra.

A rehabilitation program was instigated. Methods used include acupuncture, aquatic treadmill work, soft tissue work and specific physiotherapy exercises to encourage hind limb strengthening, proprioceptive awareness (awareness of limb position in space) and sensory awareness. It has been found that the close association between the motor and sensory parts of the brain make sensory stimulation a valuable part of regaining limb movement. Heat packing has also been applied to relieve the muscular spasm that she was experiencing. In the initial stages, icing was used over the site of the spinal lesion. We are now six months into her program and her motor function has improved so much that she is able to walk with correct hind limb positioning during most strides.  The skin twitch reflex is now present in a much larger area (from the sixth lumbar vertebra). The muscle tension in the right side of her body and right hind has normalised and tension in her neck has subsided greatly. We continue to work on Phoebe’s fine motor control and in recruiting her core muscles and hind limb muscles appropriately. She is currently walking for 30 minutes per day and she has started doing low level obstacle courses to encourage proprioception and fine-tune individual limb placement.

Phoebe’s progress has been phenomenal. It was particularly valuable for her to start her rehabilitation program so soon after the initial diagnosis.