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Care of the Down Dog: Part Three: Case Examples

Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, American College of Veterinary Sports Medicine and Rehabilitation

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Standing Exercises - Staged
Assisted Standing Maximal Assistance Active Assisted Standby Assisted
Strengthen the patient Support 75- 100% <75% support from us Now has strength and motor to support on own

Aid in proprioception Cannot independently stand Maintain standing longer Can work against gravity

Improve circulation and respiration Team effort Some independence Still ataxic or weak

A chance to eliminate Place feet appropriately Carts/hoists Right by their side

Mental well- being Start with 10-15 reps, Up over a peanut, Always adjust for
(upright, engaged 2-3x a day, increase to other inflatable tolerance throughout
in environment) 5 minutes per session

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Express Yourself! (ok, they need help)
Bladder
- Avoid Catheters
– Infection, trauma, progress?
- BE PATIENT/ATTENTIVE
- GENTLE bladder expression
- Start it, let them finish
- Meds? Phenoxybenzamine, Bethanecol? – “last” resort
- 4-6x a day

Bowel
- Baby wipes?
- Thermometer – Roto- Rooter
- Digital emptying
- Go walk!
- Lactulose PO/Enema
- Gastrocolic reflex
- Bath/Underwater treadmill

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WALK
- Cart, hoist, Help Em Up Harness
- Underwater Treadmill?
- Land treadmill?
- Start with 2-3 minutes, really slow, place their feet.
- Build it up slowly – every week add 20%

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Rinse, Lather, Repeat
- Mix up the routine every 1-2 weeks.
- Apply TENS during breaks/naps
- Food/Praise Motivate?
- Eventually add in more TherEx (see other presentation)

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These are a marathon
- Update owner (DVM) every day, 2-4 days
- Reset goals and decide on next steps q 1-2 wks
- Be patient
- Since 2007 (personal)
- Large breed cervical cases
– 95% walked out on their own in 1-3 months
– Of those only one didn’t make it out to 1 year
- All breeds acute T3/L3
– all but two were alive at 6 months, 85% were independently ambulatory

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How about referral?
- A case that you don’t feel comfortable with
- A case that is regressing
- Cranky owner
- Cranky patient
- Needs modalities you don’t have access to

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How do I go about referring?
- Check out websites: IAVRPT.org, VSMR.org,
- Local specialty hospital
- Local Veterinary school
- Call or email me. Case consults, referrals, videos on YouTube or email.

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Cage
- 10 year old MN Rhodesian Cross.
- Hx: TTA in each knee in last 2 years, elbow DJD
- Early in 2015 – Splenectomy, two IVDD surgeries (T3-L3)
- Presented two weeks after 2nd surgery. No motor in hind legs

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Medications
- Cephalexin 1000mg TID
- Meloxicam 3.75mg PO SID
- Amantadine 200mg PO SID
- Adequan – 2x a week for 4, then once a week, then q 2-4 weeks
- Gabapentin 400mg TID
- Dasuquin Advanced, Omega-3

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Paralyzed?

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His protocol
- Needed bladder/bowel expression for first month
- TENS, LASER, manual therapy, ther ex, hoist, cart
- Found out he liked to play soccer

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Adjunct Treatment
- Electroacupuncture – daily for one week, then every other day for 2 weeks, then taper further
- Daily – ROM – 3-4x a day, massage 1-2x daily, change recumbency q 4-6 hours.

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Cage - outcome
- Did well at home for about 4 months, then regressed
- Herniated another disk
- Humanely euthanized

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And then there’s Dixie
- 2009: Shot in neck C4/5 fractured
- 2 weeks at Cornell post-op. Intense rehab
- Owner driving to/from Ticonderoga (3.5 hrs one way)
- Transferred to me at 2 weeks. Non- ambulatory tetraparesis

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Her protocol
- Metacam, Lyrica, Fluoxetine, methocarbamol
- Acupuncture 2x week
- TENS, heat, massage, ROM, Hoyer lift, Help ‘Em Up harness, underwater treadmill, land treadmill, begging, pleading.....

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Dixie continued
- Lived with us 24/7 for 3 months.
- Back to Cornell at 8 weeks for follow up CT
– fractures healed
- Got a little more aggressive
- Tried “partial custody"

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And on and on....
- Fair motor (physical)
- No motor (mental/emotional)
- Weaned off Lyrica

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After that
- Made dramatic improvement
- Was home full time within a month
- Outpatient rehab for 3 more months
- Immiticide treatment that fall
- Maintenance care for a year
- Managed her lifelong

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Summary
- Be patient, be thorough
- Small steps lead to walking
- Mix up routine, know your patient
- YOU can do a lot!

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References
- Millis, Levine, “Canine Rehabilitation & Physical Therapy” – 2nd Edition, Saunders Pub
- TotoFit.com
- HelpEmUp.com
- EddiesWheels.com
- UTCanineRehab.com

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Thank You
- Matt Brunke, DVM, CCRP, CVPP, CVA Diplomate, ACVSMR
DrMattBrunke@gmail.com
DrBrunke.wordpress.com