Long term pain management and rehab for 16 week old puppy

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Edit postDelete postReport this postReply with quoteLong term pain management

for 16 week old puppy

by GoldenGaitK9 » Fri Feb 24, 2012 8:54 am

Hi All,

I really need help with this case making long term recommendations for her

chronic pain management from the orthopedics/rehab/chronic pain gurus. I have

ideas, but would love to collaborate more!

History: Female Labrador retriever (intact), currently 16 weeks old.

Routine vaccinations. Severe malocclusion at 6 weeks of age requiring removal of

deciduous lower canine teeth to help in mandible alignment. Odd conformation

noted at 8 weeks of age. Radiographs revealed very abnormal growth plate

development at multiple joints. Range of motion in the left elbow flexion

moderately reduced (bony end feel/block) with mild pain at end range, shoulder

extension mildly decreased (soft end feel). All other joints normal range of

motion. Joint tap results: CYTOLOGICAL INTERPRETATION Mild to moderate

hemodilution with mild increase in neutrophils (considered consistent with their

introduction by the blood in the specimen); no organisms or inclusions found and

consultation from

UCD VMTH concluded likely physitis from a previous septic event (pup had no

previous indication of a such event however) with a congenital problem less

likely because the proximal joints were more affected. The puppy was placed on

Clavamox for 2 weeks and recheck rads @ 4 weeks.

During that time, LLLT twice weekly was started for inflammation and neural

block. Palpation of the puppy persistently showed pain at the LS region and with

full available end range extension of the left elbow and shoulders. The pup was

not placed on pain meds despite findings and reports from the foster home that

she was not doing small bits of stairs anymore. The pup also started daily rehab

therapy at home (step over's, dynadisc body transitions/stand-to-sit/play

bow/turning/joint approximations).

Recheck radiographs at 16 weeks of age: significant deterioration of the joints.

There is concern for avascualr necrosis of the femoral heads bilaterally (left

worse than right), very unusual left elbow congruity, shoulder

arthritis/remodeling was worse, etc. Rimadyl and Tramadol were started BID and

the next day the foster home reported she was much more interactive and wanting

to use stairs. Clavamox was resumed again for 30 days based on recommendations

from orthopedic surgeon.

MY Questions!!!

When should we spay her? Over 10 months of age?

How long would we expect her to stay on a particular NSAID? Re-eval pain scores

periodically?

When would other medications like Amantadine/Gabapentin start in a case like

this?Others?

Long term strategies I would suggest are:

Stem Cell Therapy - start when?

Acupuncture

NSAIDs

Tramadol

Adequan (when should this start?)

EPA rich diet

Physical rehab medicine (UWTM to start next week,we had to wait on 16week

vaccines)

Neutraceuticals

LLLT

My goals are to stabilize the proximal articualr surfaces and maintain range of

motion/muscling through rehab, but that can only do so much. Her long term

quality of life is a huge concern for our practice, especially as she gets

bigger. This case is difficult because of how unusual it is and people are

looking to me to help with long term reccomendations for her care.

I have cross-posted this on the IVAPM listserv as well.

-

Hagler BS, RVT, CCRP, CBW, CVPP-candidate