Today we worked with our potential rehab patient(75lb 11 year old lab) to get a sense of what she is able to do, what therapy approaches may benefit her and possible short and long term goals. We still don't have a definitive diagnosis and are also in the process of ruling out some other things that may be affecting her overall strength and muscle tone.
Here's a quick (ok quick-ish) list of the major things that we need to address/rule out before we can get a clear picture of her situation and potential for improvement:
1) Long term administration of steroids (Prednisone) may be causing some of her muscle weakness and preventing her from building muscle---Solution? She is being weaned off of the steroids over the next 2 weeks. Bam!
2) She has not recently had any bloodwork done to check for Hypothyroidism which may also be affecting her body condition and causing some of her neurological issues (lessened/minimal reflex responses in her limbs)---Solution? Blood work to run tests for T4 and TSH levels which give us an indication of how well the thyroid is functioning. Bam!
3) She is displaying some symptoms that are seen in Degenerative Myelopathy which is similar to ALS or Lou Gehrig's Disease. It's a progressive illness that affects the spinal cord causing the animal to be uncoordinated in muscle movement(ataxic) and can eventually cause paralysis. This disease could potentially be responsible for our patient's significant hind end weakness and the front end weakness. Unfortunately, this is not a disease that can be treated, so fingers crossed that this is NOT the problem. Solution for ruling this one out? There is a DNA blood test that is sent out to determine whether the patient has the genetic mutation causing this disease, results will probably take about two weeks. Bam!
So, in the meantime we did a little trial run of some rehab options just to see how she did. First, we tried her in a cart. We kind of figured that she would have a hard time in the cart since she has weakness in her front end and fatigues quickly. Aaaaaaaand, we were right. She isn't a good candidate for a cart at this point but she did initiate movement in all four limbs which is a good sign. Second, to the water!! We fitted her in a life jacket which she did not appear to be a fan of but tolerated nonetheless. We hoiked her along in to the underwater treadmill and with ample support started to add the water. The idea behind the water based therapy is that the water reduces the amount of body weight that the animal has to support by about 70% so it allows weaker or injured animals to hold themselves up and be more mobile than they would be without the water helping them. Her owner told us that she liked water so we were optimistic. She did as well as could be expected. She was able to push up her hind end and hold herself up for a few moments. We then gave her a little more support and moved her gently from side to side to see if she would shift her weight from her left to right legs. She did this for a short time and then began to pull up her back legs so they were no longer holding any weight. So that coupled with some majorly assisted walking from her run to the grass outside and back was more than enough for our patient.
We gave the owner a few exercises to do with his dog to maintain muscle mass and keep her moving as much as possible. She is going to be getting three injections of anabolic steroids over the next three weeks which are sometimes used in older dogs to help build muscle mass. We will be able to reassess her capabilities in a few weeks when she is completely off of the Prednisone, has had the injections and we have gotten results back on all of the blood tests. So that's it for that kid at least for a couple of weeks. We're hoping to get some answers from the blood tests and see some improvement once she is off of the Prednisone.
As a side note, I experienced my first tornado-like weather last night and, while observing the greenish-blue lightning illuminated sky, sideways and cylindrical sheets of rain and flying debris decided that I did not want to live in tornado country for any extended period of time. Judging by my cat's response (hunkering down behind the bathroom door and nearly leaving permanent claw marks in the floor), neither does she.
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