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Case Study: Schatze – A Non-Surgical Patient with an Achilles Tendon Rupture

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Schatze, a 50-pound, 12-year-old Catahoula with a mid-body Achilles Tendon rupture.

Case of Interest: Schatze was a non-surgical candidate in need of support for her left hock due to an Achilles Tendon rupture.  She was initially seen at our clinic in December of 2017 and returns for regular check-ups almost two years later.  Most of our in-house patients visit our clinic three or four times over the course of a year.  In Schatze’s case, we’ve been able to watch her mature over seven appointments and look forward to providing her with care for years to come.

Diagnostic History: Schatze ruptured her left Achilles tendon while jumping into a car on December 5, 2017. She was seen shortly afterwards by an orthopedic veterinarian and was diagnosed with a mid-body calcaneal tendon rupture. She was not a surgical candidate due to being on prednisone for a low platelet abnormality. A wait-and-see approach was followed but she showed no signs of improvement even after stopping the medication. 

It was determined that she would benefit from a custom-made hock brace. The goal of the brace was to reduce any further damage to the calcaneal tendon or the digital flexor tendon, as well as to protect the skin from excessive pressure while walking in a plantigrade stance.

Schatze presented to our clinic on December 29, 2017, limping on her left hind leg. She was collapsing in her hock and in a plantigrade stance. She was contracting her digits on her left hind leg, indicating the superficial digital flexor tendon was still intact.

A cast was made of Schatze’s hind left leg from the distal ends of the nails up to the stifle.  From the cast, a jointed hock brace providing zero degrees of flexion at the joint was fabricated.  The degree of flexion was controlled by range of motion straps affixed to the back outer shell of the brace.  As healing occurred and strength returned, the range of motion straps could be lengthened to allow for greater flexion at the joint.

Less than a week after her casting, she returned for her delivery appointment. At this appointment, the fit of the brace was assessed and appropriate adjustments were performed. Once the brace was donned, Schatze walked with an exaggerated step and consistently put her foot down with more force than necessary.  Her walk normalized as she became accustomed to the brace.

Schatze’s owner was instructed on the proper care of the brace and that Schatze was to wear the brace during her waking hours, but not at night. No exercise restrictions were given, but it was recommended that she begin with 2-3 walks a day for around 10-15 minutes each to allow her to become familiar with the brace as well as to build up the muscle that atrophied during the months she favored the leg.

Follow- Ups: Schatze returned for follow-up appointments approximately 3 weeks, 3 months, 6 months, 1 year and 1.5 years from delivery. At each appointment the condition of Schatze’s skin and the overall leg were assessed. Appropriate adjustments and general maintenance were made to the brace such as replacing the sole of the brace.

Her walk continued to improve at each appointment as she became comfortable and confident in the brace. She was able to run and play in the brace. Schatze received a favorable report from her orthopedic vet when she followed up with them after receipt of the brace. Schatze continues to use the brace for her daily activities and is a happy and active girl.

What Happens During An Evaluation Appointment At My Pet’s Brace?

By: Terry Lackmeyer, My Pet’s Brace Customer Service Representative

Frequently, owners express concern about the evaluation appointment for their dog’s leg brace. Many fear that we aLeg Casting During Evaluation Appointmentre going to manipulate the dog’s leg and cause pain, or that they will not be able to remain with their pet. Neither of those thoughts are true. So, let me explain what happens during the evaluation appointment.

The first thing needed for the appointment is a written diagnosis from your vet or rehab professional telling us about your dog’s injury. Since we are not veterinarians, we need to know the exact diagnosis so that we can be sure we are making the correct leg brace for your dog’s injury.

Next, you and your dog will be taken into an exam room where you will meet with the clinician. After taking time to review the information from your vet and meeting you and your dog, the clinician will ask several questions regarding your dog’s living arrangements, time spent inside vs outside, activity level, and any other pets in the household. The clinician will discuss your dog’s injury and observe your dog walking up and down the hallway several times. The clinician may feel your dog’s leg to check for any swelling or discomfort. We may bend your dog’s leg, in a normal flexing motion, to listen for any type of clicking or popping sounds. This will not hurt the dog. If the dog shows any type of discomfort with this flexion, the clinician will stop.

Once the clinician has gathered all the information, we will explain what is going on in your dog’s leg and how and why the brace will help. You will have ample opportunity to ask any questions you may have. Sometimes, the clinician has the unfortunate task of telling the client that the brace is not the correct solution for the dog’s injury. Rest assured that if we do not feel a brace is appropriate for your pet, we will be honest and let you know that. If that occurs, there is no charge for the evaluation appointment.

After explaining your dog’s injury and how and why the brace will help and making sure you want to move forward with the brace, the clinician will make a cast of your dog’s leg. You will be with your dog the entire time, helping to keep them calm. Someone will support your dog under their belly, so they are comfortable while the clinician does the casting. The casting process takes less than 5 minutes and is completely painless and non-invasive for the dog. The toughest thing your dog will need to do is stand there, with support of course. After casting, the clinician will take measurements of your dog’s leg. If your dog is getting a hock or carpal brace, the clinician will make a tracing of your dog’s paw.

Once the cast is complete and the owner has no further questions, payment will be handled at the front desk. All braces must be paid in full before the brace goes into production.  We accept all credit cards, cash, check and Care Credit.

Our goal during the evaluation, or any of our appointments, is to provide a warm, friendly atmosphere for both the dog and owner. We want to answer all your questions and alleviate any concerns you may have regarding the brace and your dog.

Roses are Red, Violets are Blue, What Color Brace Shall I Do?

By: Terry Lackmeyer, My Pet’s Brace Customer Service Representative

While getting a leg brace for your dog is very serious, believe it or not, it does have a lighter side – choosing a brace color. For some people it is very easy, for others it requires much thought and sometimes, a family pow-pow. The good part is, we have 35 different colors and patterns from which to choose.

Some people prefer that no one notices the brace and want it to blend as nearly as possible with the dog’s coat. For those people, a solid color closely matching the dog’s coat color works well. You even can take it a step further and choose one of our patterns that looks like dog hair (but without the shedding).

Other folks feel that since the dog must wear a brace, making it fun is the way to go. For those people we have every solid color to fit the ROY G BIV mnemonic code plus white, black, brown, silver and tan.  Our most popular brace color is hot pink.

For those adventurous folks, we have various patterns that can be fused to the brace to really spice up the appearance. The hunter in the family may want the camouflage pattern; the kids, the shark or graffiti design. The star gazer may look to the cosmos or starry nights pattern; the sophisticate may lean toward the carbon fiber design; while the fashion conscience may opt for the cheetah or zebra print. Finally, for those that like abstracts the yellow/orange or blue swirl may be the way to go.

Regardless of the color or pattern chosen, rest assured that the brace will be durable and easy to maintain. Water will never harm the color or patterns and all braces are completely waterproof and easy to clean with anti-bacterial soap and water. Dog braces can even be worn in the pool or during hydrotherapy with no ill effects.

As we like to remind owners, braces work the same no matter what color or pattern is chosen. The important point is that while we enjoy providing fun color choices, our first and foremost goal is to make the most comfortable, effective, and functional brace to help your dog with their orthopedic condition and to help them to live happier lives.

When Are X-Rays Needed To Make A Dog Brace?

By: Terry Lackmeyer, My Pet’s Brace Customer Service Representative

When a dog incurs an injury, sometimes x-rays are taken to get the “inside” scoop on exactly what’s going on with that injury.  Does that mean that we need to see x-rays to make a leg brace for your dog? Well, it depends on the injury.

If your dog has a Cranial Cruciate Ligament (CCL/ACL) injury, the injured ligament will not show up on x-rays. However, your vet may take X-rays of the knee because they want to rule out other possibilities. They may be looking to see if your dog has arthritis, a tumor or cancer. Once they see that there is nothing else lurking in your dog’s knee and they have gotten a positive result on what is called a “drawer test” on your dog’s leg, they can feel comfortable diagnosing your dog with a CCL injury.

Braces can often be used to help dogs that suffer from arthritis. These can be stifle, carpal, hock, or elbow braces since arthritis can occur in any joint. In that case, we would want to see X-rays to determine the location of the arthritis and if a brace would be an appropriate solution.

Carpal, hock, and elbow braces for dogs can be used for a variety of issues – everything from hyperextension to elbow dysplasia and many conditions in between. If we feel X-rays are needed, we will request that x-rays be provided to us before or at the time of the initial consultation.

Many times, owners contact us because their dog has been diagnosed with osteosarcoma, a type of bone cancer than often leads to spontaneous fractures. Then x-rays are very important to determine the exact location and involvement of the cancer. Frequently, we can provide a brace which is created with a front and back piece so the brace acts like a splint to help prevent or prolong the possibility of a fracture yet can be easily removed to care for the leg.

Rest assured, if we feel x-rays are required, we will request that they be provided so that we can be sure to make the best and most appropriate brace for your dog’s injury.

 

To Shave Or Not To Shave (The Dog’s Leg)

By: Terry Lackmeyer, My Pet’s Brace Customer Service Representative

Owners frequently ask us if their dog’s leg needs to be shaved for the casting process or to wear a brace/prosthesis. The good news is that no, you do not, and there are several good reasons for that.

The first reason is that we are in favor of anything that reduces stress for the dog. For many dogs, shaving the leg is stressful and upsetting and if there is any way we can avoid stressing our patients, we will. The skin on the leg can also get irritated from shaving and we don’t want to do anything that causes more irritation to an already injured leg.

The second reason is that we have learned how to work with hairy dogs, and the hair does not get in the way. When casting a dog’s leg, the leg is first covered with a stockinette (a thin sock-like material). This compresses the hair on the leg. For those hairier dogs, such as Golden Retrievers or Newfoundlands, as much of the hair as possible is gathered inside the stockinette. This helps the casting process by keeping most of the excess hair out of the way as the cast is taken. The fiberglass tape is wrapped snuggly around the leg, thereby compressing the hair even more, helping to ensure a good cast is taken and, subsequently, a well-fitting brace is made.

Finally, when the dog is wearing the brace that extra hair under the brace acts as a nice protective cover. This helps to reduce possible irritation as the hair provides additional cushioning.

Sometimes owners will comment that all that extra hair gets caught in the Velcro straps and makes putting the brace on more difficult. In that case, owners may choose to use scissors to trim away some of the excess hair. That’s perfectly fine and will not affect the fit of the brace.

Our ultimate goal is to make the casting and bracing process as pleasant and stress free as possible for not only the patient, but also the owner. If an owner wishes to trim excess hair to make putting the brace on easier, that’s fine, but from our point-of-view the dog’s hair is a benefit and shaving the leg is not needed.

Case Study: Bella with Nerve Damage and Rotation of the Hock

By: Amy Rosenthal, My Pet’s Brace Practitioner


The Patient:
Bella, a 90-pound 7 year-old Anatolian Shepard/ Afghan mix with nerve damage resulting in internal rotation at the stifle and hock with subluxation at the hock.

Case of Interest: Custom bracing enables us to design and fabricate devices made specifically to meet the needs of each individual pet.  After fitting Bella’s first hock brace, there continued to be significant laxity and internal rotation at the stifle. A second hock brace was created with a special upper cuff around her thigh to prevent the unwanted rotation.

Diagnostic History: In September of 2010, Bella had been hit by a car which caused severe injuries. Bella underwent several surgeries to repair the broken bones, but unfortunately she had also sustained nerve damage. This nerve damage resulted in a subluxation of the right hock and severe knuckling on the right rear leg. After years of knuckling, sores and calluses had developed on the top of her toes as well as an abnormal walking gait and stance.

In September of 2017, she was referred to My Pet’s Brace by her veterinarian for a brace to aid in returning Bella to a more normalized conformation.

Treatment and Plan: Bella presented with severe laxity in the hock and stifle. This caused subluxation of the hock resulting in weight-bearing on the dorsal aspect of Bella’s right rear paw and severe varus at the hock. It was determined that a right rear hock brace would be fabricated to allow for weight bearing to return to the proper surface of the paw. An accurate cast was taken of the leg from the most distal aspect of the paw to the stifle. A week later Bella returned to be fitted with her brace.

Bella was given no restrictions and could continue her daily habits, however, the brace was to be slowly introduced to her by having her wear it one hour the initial day and increasing one hour each day until she had it on from morning until night, only taking it off if she was sleeping or if she was crated or kenneled.

Follow-Ups: Bella was re-evaluated at three weeks. At this three-week check-up it was determined that the brace controlled the subluxation and laxity in the hock, but did not account for internal rotation at the stifle which had become more apparent as the hock’s movement was restricted.

Another cast was taken with more flexion to control the internal rotation. A second brace was created. This brace combined a typical hock brace with an additional cuff around the thigh to control the unwanted rotation. This brace was fit approximately one week later. It was immediately apparent that she was walking with a normalized gate with little to no rotation at the stifle or hock. Bella was seen approximately three weeks and eight month post-delivery. Bella continues to improve, muscle mass has increased and the sores have healed.

My Pet’s Brace has made many leg braces for “rescue dogs”–we wanted to find out more about our pet welfare communities and how they work

image source: filmmovement.com

In our business of crafting custom leg braces and prosthetics for dogs and other animals, we see quite a few dogs whose owners or foster families located them through rescue organizations (check out James, Rosie and Gabe on our Dog Stories page). We admire these folks and the work of rescue groups to save pets from otherwise lonely, stress-filled or abusive lives. We wanted to find out more about rescue organizations, what they do, and their place in the network of pet-related cruelty-prevention, shelter, and other such groups.

We weren’t able to find concrete, widely held definitions of shelters vs. rescue groups, but our research involving quite a few website resources led to this general understanding of the process:

Shelters are usually the first stop for animals that have been abandoned or whose owners can no longer care for them. They are often funded by local governments with limited budgets (though not always–there are also small local shelters that are privately run), so that services provided are necessarily basic. Shelters typically house animals onsite, but also utilize foster homes when possible.

From there, rescue organizations adopt pets from shelters and attempt to find permanent homes for them. Rescue groups, like shelters, are run by caring animal advocates who go to great lengths to ensure pets have happy lives. There are breed-specific rescues for most dog breeds, as well as all-breed groups. Widespread networks of volunteers create and maintain the rescue groups, doing their best to match up pets with their “forever homes.”

Rescue organizations are usually funded by donations and are able to provide training and in depth medical care and focus on getting to know the animals, the better to help each prospective adopter find the best match for their family. Sometimes placement means moving pets across long distances, with volunteers setting up chains of transportation across many miles. And it’s not just road transport–one of our clients recently told us about Pilots N Paws, whose volunteer pilots reduce the time and stress caused by long trips, by flying pets from shelters to rescue groups, and from there to their new families.

The ASPCA estimates that approximately 5 million to 7 million companion animals enter animal shelters nationwide every year, and approximately 3 million to 4 million are euthanized. The good news, from an article in Veterinary Practice News, is that in a survey comparing March 2012 to March 2011, euthanasia of cats and dogs at North American shelters declined by 19% and 12% percent respectively. And “live release” outcomes increased 5% for cats and 11% for dogs during that same period (live release includes adoptions and returns to owner).

Here’s a disturbing reality we weren’t aware of: the ASPCA warns that animal hoarders can pose as legitimate rescue organizations. Shelters looking to foster animals, as well as pet owners looking to place animals with shelters or rescue organizations, need to use caution. Animal hoarders often seem very sincere in their love for animals and can have websites which appear legitimate. The ASPCA website lists these signs which could indicate a shelter or rescue group involves a hoarder:

  • The group is unwilling to let visitors see the location where animals are kept.
  • The group will not disclose the number of animals in its care.
  • Little effort is made to adopt animals out.
  • More animals are continually taken in, despite the poor condition of existing animals.
  • Legitimate shelters and rescue organizations are viewed as the enemy.
  • Animals may be received at a remote location (parking lot, street corner, etc.) rather than at the group’s facilities.

Resources
Below is a sampling of national, and some local, organizations supporting pet rescue–there are many more out there.  Along with links, we’re showing a quote directly from the “about us” section of each organization’s website.

Humane Society: “The Humane Society of the United States is the nation’s largest and most effective animal protection organization, backed by 11 million Americans. We help animals by advocating for better laws to protect animals; conducting campaigns to reform industries; providing animal rescue and emergency response; investigating cases of animal cruelty; and caring for animals through our sanctuaries and wildlife rehabilitation centers, emergency shelters and clinics.”

ASPCA: “Founded in 1866, the American Society for the Prevention of Cruelty to Animals was the first humane organization in the Western Hemisphere. Our mission, as stated by founder Henry Bergh, is “to provide effective means for the prevention of cruelty to animals throughout the United States.” The ASPCA works to rescue animals from abuse, pass humane laws and share resources with shelters nationwide.”

American Humane Assn: “Since 1877 the historic American Humane Association has been at the forefront of every major advancement in protecting children, pets and farm animals from abuse and neglect. Today we’re also leading the way in understanding human-animal interaction and its role in society.”

Petfinder: “Petfinder is an online, searchable database of animals who need homes. It is also a directory of more than 13,000 animal shelters and adoption organizations across the U.S., Canada and Mexico.”

AnRAA: “Animal Rescue Association of the Americas is the advocacy association for the animal rescue community. We believe in the power of a unified voice. Our mission is to mobilize our members’ combined strengths and resources in order to rescue thousands more animals, reduce intolerable rates of euthanasia, promote a rescue code of ethics and elevate the entire animal rescue field.”

Pilots N Paws: “Pilots N Paws is an online volunteer organization where general aviation pilots can connect with rescue volunteers to transport animals in need to safe havens. The mission of Pilots N Paws is to provide a user-friendly website communication venue between those that rescue, shelter, and foster animals and pilots and plane owners willing to assist with the transportation of these animals.”

Greyhound adoption: “The National Greyhound Adoption Program was founded in Philadelphia, PA in 1989. Our main goals are to help find loving, adoptive homes for former racing greyhounds; to provide superior knowledge and support for greyhound adopters and other adoption groups; to educate the public and spread awareness about the plight of the greyhound; to provide specialized medical care specifically geared towards the greyhound.”

Lab rescue: “Wild Heir Labrador Rescue is a 501(c)(3) non profit animal rescue organization benefiting unwanted Labrador Retrievers.”

Wikipedia’s page on animal rescue groups

The Animal Rescue League of Western PA: “Mission: To provide temporary shelter, food, medical attention, and comfort to all abandoned, neglected and injured animals brought to us by the community; to restore lost animals to their owners or seek new homes for them, and educate the public about humane care of animals with a goal of reducing overpopulation.”

Dog obesity a risk to pet health; stress to bones and ligaments can necessitate a leg brace

image source: petprescription.co.uk

An article on PetEducation.com notes that approximately 25% of overweight dogs develop serious joint complications. Also, the extra stress on joints caused by excess weight can lead to damage to some ligaments, including the anterior cruciate ligament which is susceptible to tears or strains. At My Pet’s Brace, the prescriptions we get from veterinarians often list excess weight as a contributor to the injury that necessitates the brace. Veterinarians also tell us that the extra weight slows down the healing process in the joints. We are always careful to consider the animal’s weight when designing a brace.

Pet obesity is a serious and growing problem. Over 50% of dogs and cats were classified as overweight or obese in a recent veterinary survey conducted by the Association of Pet Obesity Prevention. APOP’s 5th annual survey finds that an increasing number of pet owners aren’t even aware their pet is overweight. A vet quoted in the study warns that preventing obesity is much easier than treating it.

Some of the side effects of obesity:

  • Osteoarthritis
  • Damage to joints, bones and ligaments
  • Type 2 diabetes
  • High blood pressure
  • Breathing problems and heat intolerance
  • Kidney disease
  • Shortened life expectancy
  • Reproductive problems

Wondering how to tell if your dog or cat is overweight? APOP’s “Pet Weight Check” page has a guide for determining if your pet is overweight–here are the symptoms (check their website for “pet condition scoring charts” with visuals):

  • Difficult to feel ribs under fat
  • Sagging stomach – you can grab a handful of fat
  • Broad, flat back
  • No waist

We also found a more in-depth and technical discussion about determining “body condition scores” for dogs–see link below.

Sources:

Association for Pet Obesity Prevention

Health Risks in Overweight or Obese Dogs, Doctors Foster and Smith, Holly Nash, DVM, MS

Body Condition Score Techniques for Dogs, Sherry Lynn Sanderson, DVM, PhD, Diplomate ACVIM & ACVN, University of Georgia

Achilles tendon injury in Doberman case study

Duchess is a nine year old rescued Doberman who has an Achilles tendon injury that was repaired previously. The injury caused shortening of the tendons in her paw which resulted in contractures and some knuckling of the paw. The pet owner is a senior veterinary technician at an animal hospital and is very familiar with dogs and bracing. She is very active and regularly takes Duchess on long runs, hiking, swimming and other outdoor activities.

Duchess presented with a Hock brace that she had been wearing for six months which was provided by another orthotic company. Because the brace was very heavy and in disrepair it had caused abrasions which resulted in scars on the front and back of her hind leg.

After evaluation it was agreed that a lighter weight, yet durable Hock brace would be a good alternative in order to eliminate the problems with skin breakdown and allow a very energetic dog to stay very active.

An impression cast from just below the stifle to the paw of Duchess’s hind leg was made. The impression was filled with plaster in order to obtain a positive model of her leg. The model was rectified and special care was taken to provide relief for those troublesome areas on the front of her leg and around the Achilles tendon. Medical grade polypropylene was then vacuum-formed over the positive model which provided a lightweight but strong superstructure for the brace. After the brace was trimmed to provide protection for the paw, straps were added in order to secure the brace on her leg.

Fitting of the brace went well and Duchess was a little hesitant at first since the brace was new and different. At the follow-up visit one week later Duchess presented with some pinching at the top of the brace which was relieved. At the two week follow-up visit, Duchess and the owner were very pleased with the outcome. They even went on a three mile run with no problems. The owner pointed out that when she takes the Hock brace off, Duchess’s paw is now in much better alignment and she can bear full weight on that paw. The end result is that Duchess is more comfortable, she can continue to stay active and the owner is completely satisfied with the outcome.