Re: 12yo Tripod lab with severe OA

[Guest guest]

Is the dog having GI upset or does he have elevated numbers

on his chem. panel? If not, why stop NSAIDS? I think you are right on base that

pain control is your first priority, so stopping NSAIDS would be contradictory to

that goal. Adjust doses and/or add acupuncture, physical agents or more drugs; don't take away one of the best ones.

Once pain is managed to the best of your abilities therapeutic

exercise may help increase mobility and decrease some pain as well. I would

start with getting a harness that fits well; I find that Ruffware Webmaster

harnesses work great, even for forelimb amputees and they also give some hind limb

support due to their length. With a harness, you can practice transitional movements

and build strength in getting up and down. If the patient is unable to get up

and down with ease, then he will not feel like doing much else. If this is too

much for the patient, bend exercises or luring nose to tail in repetition can

mimic many of the same actions as transitional movements. I hope this is a good start for yall.

PS, have him eat with the harness on, that will stop the

resistance. Also, all transitional exercises should be performed using positive reinforcement

IMO. Lure reward techniques work fast and yield very good results.

You can find exercise videos on my youtube channel in my sig.

Good luck, Robby J Porter IIICertified Canine Rehabilitation PractitionerLouisiana Veterinary Referral CenterAnimal Rehabilitation CenterMandeville, LA70448Main Hospital: ext. 208lavrc.comtwitter.com/LAVRCfacebook.com/LAVRCyoutube.com/user/LAVRCfacebook.com/louisianaCOP*********************************************************************************************************This document, and any attached information is proprietary, privileged and confidential property of the Louisiana Veterinary Referral Center (LAVRC) under applicable law and is intended exclusively for

business use by all LAVRC employees and intended recipients with a legitimate LAVRC business need. The reproduction, dissemination, distribution and/or disclosure by unintended recipients is unauthorized, strictly prohibited and may be unlawful (Privileged and confidential pursuant to La. R.S. 13:3715.3).If you have received this transmission in error, please immediately reply to the sender and delete this information from your system. To: VetRehab Sent: Monday, August 13, 2012 6:52 PM Subject: 12yo Tripod lab with severe OA

Hello all,

I just met a lovely geriatric labrador today who I would love to be able to help. He is 12 yrs old and is missing his RF leg after being hit by a car 7yrs ago. The current owner adopted him a year after this event and doesn't know much about his history previous to that.

Over the past few years he has become less and less mobile due to arthritis in the remaining elbow and wrist and now only walks about 20ft from his bed to the door and back. Today on exam he had significant muscle wasting of the remaining leg, and is painful to palpation and manipulation of the metacarpals and carpus. His elbow is very thick and he has only about 50 degrees of motion in the elbow (loss of both flexion and extension). He also has significant muscle wasting of the hind end though he has minimal arthritis in the hips or knees. He is currently on Tramadol, Glucosamine and Rimadyl and is still in a lot of pain per owner (crying, panting, very reactive to any motion)

While obviously I would love to work on rebuilding strength and coordination in this dog, I think the primary goal needs to be pain control. I spoke with the owner about stopping NSAIDS since this is a very chronic process, and trying other pain med options (Gabapentin, Amantidine, Acupuncture, etc) and I also spoke to her about considering a cart or orthotic to help support the remaining front leg. She has tried a harness in the past but the one she has doesn't fit the dog well and slides around due to the missing leg. The dog also runs away from the harness/vest and resists having it put on. She is not interested in acupuncture or a cart but is willing to consider the other options if I do all the "legwork" for her.

I showed her ROM, moist heat, and massage today but the dog is really too weak and painful for much else at this point. What do you think about how to proceed with this dog? Do you think a brace would be helpful? Any experience with pain control in dogs like this? Any other suggestions?

Thanks so much,

Joni Barsky DVM (CCRT pending)

[Guest guest]

What doses of Tramadol and Rimadyl was the dog on? Maybe another NSAID would be

more effective if Rimadyl has been used for years.

It seems the dog is resistant to a harness because of the pain anticipated with

trying to put it on? A help 'Em up harness may be effective for both the rear

and forelimbs. Sizing could be difficult because of the muscle atrophy so the

dog probably wears a medium. See if there are any distributors in your area that

actually have the product so the dog can try different sizes on (I find many

dogs wear a smaller size in the rear and larger in front).

Side bending exercises on a piece of foam can also be a good workout for the

" down " dog until they can bilateral better. Depending on standing duration time,

try weightshifting as well to activate muscle contractions. All done to

tolerance of course and shouldn't be painful. If should be fun!

If the dog is good at holding things with the front foot, a Kong filled with

peanut butter can be a fun activity (or the food frozen into one) and you might

get some active rom of the neck or gripping of the king with a foot.

-

L Hagler BS RVT CCRP CVPP CBW

Certified Canine Rehabilitation Practitioner

Certified Veterinary Pain Practitioner

Small Animal Osteoarthritis Case Manager

Canine Body Worker

www.goldengaitcanine.com

www.ivapm.org

Sent from my iPhone

[Guest guest]

Joni,I have had several similar cases recently where we have incorporated a cart as an assisting device in the management of the patient. I will attach a video link of one such case.Therapy considerations1. Management of chronic pain and any other medical conditions.- NSAIDS- Amantadine - 2-5mg/kg qd- Gabapentin 5-10mg/kg q8-12h and titrate upwards if needed- Amitriptyline - 0.25-0.5mg/kg q12h- Adequan Injections - twice weekly for 4 weeks then q2-4weeks- Intraarticular cortisone - Elbow - Vetalog 6mg, Carpus - 3mg. I recommend d/c NSAIDs for 5 days before and after IA injections- Tramadol on bad days - 5-10mg/kg q4-6h, d/c amitriptyline on those days.- Physical medicine modalities2. Rehab therapy following improved management of chronic pain and any other medical conditionsThe video is a 11yr. patient born without a left thoracic limb, multi joint OA, right elbow the most painful. She became acutely effected by a possible spinal cord injury of unknown cause leading to a pelvic limb parapareis. In addition to multi-joint pain and considerable myofascial pain she was also painful in lumbosacral spine. Treatment included using some of the above medications, IA injections of several joints, epidural injection with DepoMedrol, dry needling of trigger points (several sessions), and rehab. The cart enabled an improved level of ambulation which aided in improvement in musculoskeletal strength and cardiovascular fitness. Just last week the owners recognized declining function and examination revealed a return of LS pain. I repeated the epidural injection.https://vimeo.com/47592037Rick Wall, DVMThe Woodlands, TX

[Guest guest]

Hi Joni,I love your idea of introducing Amantadine, especially since this is chronic pain.  Gabapentin is also a good idea, but be very careful combining Tramadol and Gabapentin in a geriatric dog.  In my experience, it can often have a synergistic effect on sedative side effects.  I would also caution against stopping the NSAID.  Successful therapy for advanced arthritis should always include an anti-inflammatory, since the disease is primarily inflammatory.  Instead of stopping the Rimadyl, try a different NSAID- my favorite is Metacam, but you can try a few to see which the dog responds best to.  Most people recommend a few days washout between changing the NSAIDs.

My other recommendation would be to introduce a quality omega 3 fatty acid.  Try to reach 100 mg/kg.  At higher doses, omega 3's have a wonderful anti-inflammatory effect in the joints.

Try Dasuquin, instead of just Glucosamine.  The ASU (avocado soybean unsuponifiables) is perhaps more effective for treating arthritis than glucosamine (especially if glucosamine is used alone).

You can also try judicious use of acetaminophen (be sure the dog has no liver issues and monitor blood work routinely).Another thought is SAM-e, which has also been described to help arthritis.

Beyond the pharmacologic approach, you should also try lasering these joints, along with your manual therapies.If the owner can afford it, they could also purchase a PEMF bed, which can help the pet's overall comfort.

If the dog will tolerate it, swimming or hydrotub therapy would be wonderful.And last but not least, be sure to palpate this dog carefully for trigger points.  I find that a lot of my geriatric patients with chronic mobility disorders experience a great deal of muscle pain secondary to compensatory gait patterns.  If you release the trigger points, along with acupuncture therapy, you will be amazed with the immediate improvement.

Good luck!-- Leilani Alvarez DVM, CVA, CCRT, CVCHMCertified in Veterinary Acupuncture, Physical Rehabilitation and Chinese Herbal Medicine

DirectorRehabilitation and Fitness ServiceThe Animal Medical Center510 E. 62nd StreetNew York, NY 10065p: f:

 

Hello all,

I just met a lovely geriatric labrador today who I would love to be able to help. He is 12 yrs old and is missing his RF leg after being hit by a car 7yrs ago. The current owner adopted him a year after this event and doesn't know much about his history previous to that.

Over the past few years he has become less and less mobile due to arthritis in the remaining elbow and wrist and now only walks about 20ft from his bed to the door and back. Today on exam he had significant muscle wasting of the remaining leg, and is painful to palpation and manipulation of the metacarpals and carpus. His elbow is very thick and he has only about 50 degrees of motion in the elbow (loss of both flexion and extension). He also has significant muscle wasting of the hind end though he has minimal arthritis in the hips or knees. He is currently on Tramadol, Glucosamine and Rimadyl and is still in a lot of pain per owner (crying, panting, very reactive to any motion)

While obviously I would love to work on rebuilding strength and coordination in this dog, I think the primary goal needs to be pain control. I spoke with the owner about stopping NSAIDS since this is a very chronic process, and trying other pain med options (Gabapentin, Amantidine, Acupuncture, etc) and I also spoke to her about considering a cart or orthotic to help support the remaining front leg. She has tried a harness in the past but the one she has doesn't fit the dog well and slides around due to the missing leg. The dog also runs away from the harness/vest and resists having it put on. She is not interested in acupuncture or a cart but is willing to consider the other options if I do all the " legwork " for her.

I showed her ROM, moist heat, and massage today but the dog is really too weak and painful for much else at this point. What do you think about how to proceed with this dog? Do you think a brace would be helpful? Any experience with pain control in dogs like this? Any other suggestions?

Thanks so much,

Joni Barsky DVM (CCRT pending)