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Case Study: Grady – a Labrador Retriever with an Elbow Brace for Arthritis

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Grady, an 11 year-old, 74-pound, Labrador Retriever with severe arthritis of the right elbow.

Case of Interest: Over 80% of our business is providing stifle braces for Cranial Cruciate Ligament injuries. However, we also fabricate carpal, hock and elbow braces for multiple etiologies.

Grady was diagnosed with severe arthritis in his right elbow. His owners were medically managing his condition for approximately 5 years when they decided to pursue an elbow brace for additional stabilization.

Diagnostic History: In October 2017 Grady presented to our clinic for a brace for his right elbow for severe arthritis. The brace aids in protecting the joint as well as giving the elbow stability and support. An evaluation of his condition and lifestyle were evaluated and it was determined that he would benefit from an elbow brace.

A cast was made of Grady’s elbow from the styloids of the radius and ulna to as high into the axilla as possible. This cast was then used to create a custom-made brace for Grady. This brace was made with a closed-cell foam interior, a hard-medical grade plastic exterior and specialized veterinary urethane joints at the elbow.  Range of motion straps allowed 10-15° of motion at the joint. The brace was fit and adjustments were made as necessary.

Grady was given a restricted exercise regiment, which included eliminating running and ball/dog playing.  Stairs were limited to 1 to 4 steps and if more than 4 steps were required, then some help would be needed. Leashed walks were encouraged, starting with 3 times a day for around 5 to 10 minutes each.  As he became accustomed to the brace, his walks increased and he was given more freedom.

Follow-Ups: Grady was seen approximately 1 month, 3 ½ months, and 6 ½ months after delivery. At each of the follow-up appointments his condition was evaluated and straps were replaced as necessary. He was able to go out for walks and was off most of his pain meds. Unfortunately, he had a recurrence of soft tissue sarcoma in his good elbow in August 2018 which is being managed.  With the help of the brace, Grady is getting along well and he enjoyed playing in the snow this winter.

Case Study: Teddy Bear – a Samoyed with a Rear Prosthesis

By: Amy Rosenthal, My Pet’s Brace Practitioner

The Patient: Teddy Bear, a 45-pound Samoyed with a missing left rear paw

Case of Interest: When a portion of a limb is missing, the dog compensates in one of two ways, either they put their weight down using the stump as a weight-bearing surface or they hold the limb up and off-load their weight onto the other three legs. Both responses put abnormal stresses and strains on the remaining limbs which could cause joint, ligament, tendon, or spinal issues. Putting weight down on the end of the remaining limb can cause sores, cuts, and scraps which have the potential for infection and pain to the dog.

A prosthetic device takes the place of the missing portion of the limb, allowing the body to be held in a more natural position. There are different levels of prosthetics available depending on how much residual limb is remaining. For our design, a minimum of 1.5-2 inches of residual limb is needed below the carpus and hock. This is needed to allow for enough suspension of the device and because dogs cannot manipulate a jointed prosthetic device.

Teddy Bear was rescued from a puppy mill while he was a small puppy. His mother chewed off his left rear paw and the tip of his tail. He healed from this traumatic injury and was taken in by his current owners who are avid hikers with three older Samoyeds. They were referred to My Pet’s Brace by their veterinarian for a prothesis to protect his residual limb and to correct the height difference between the rear legs. He was evaluated at our facility when he was 9 months old, but the casting was postponed three months to ensure he was fully grown and would therefore not out-grow the prosthetic device.

Diagnostic History: He returned in January of 2017 for a casting of the residual limb, which was used to create a positive mold of his stump. A prosthesis was created, the outside is a shell made of hard medical grade plastic and a rubberized sole. The inside is a flexible sleeve which is in direct contact with the remaining limb. The flexible sleeve slides in/out of the outer shell. This allows for the prosthesis to be slipped on and off in case the prosthesis becomes trapped while outside, but allows for ample suspension so it does not come off during play or running.

Teddy Bear returned approximately 2 weeks post-casting for the fitting of the prosthesis and adjustments were made to the inner sleeve and outer shell to relieve any excess pressure and reduce the chance for rubbing and sores. Teddy Bear’s owners were instructed to allow him to wear it for 30 minutes the first day and increase by 30 minutes each day until he wears it for a total of 6 – 8 hours. He was given no restrictions with regards to play and exercise, but was encouraged to go out for walks a few times a day for around 10-15 minutes.

Follow-Ups: Teddy Bear returned several times over the course of the next two years. At each of these appointments the condition of his skin and his activity level were assessed and the prosthesis was adjusted accordingly. An adjustment that was made several times was the replacement of the sole of the prosthesis. This is done for ground-contacting orthotics and prosthetics, as the sole wears out from use it can be easily replaced at our facility to allow for ample traction.

Teddy Bear is an active dog and he wears his prosthesis every day, for most of the day.  It allows him to keep up with his pack on walks and hikes and enables him to lead a happier life.

Rehabilitation Therapy and Braces

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

Often clients ask if therapy would be beneficial in conjunction with a brace.  While it is not absolutely necessary, many dogs benefit greatly from combining physical therapy with the application of their custom brace. The next question then becomes what type of therapy? While that question is best answered by a discussion with your veterinarian or rehabilitation therapist, let me touch on various therapies available.

Physical therapy is a series of specific exercises performed under the guidance of a trained therapist. These exercises are designed to improve muscle strength and flexibility, reduce pain and encourage healing. Traditionally when we think of physical therapy we think of a series of exercises performed on a hard or matted surface utilizing balls, weights, balance, etc.

Hydrotherapy refers to exercises performed in water. The water provides buoyancy and enables the dog to exercise without the stress on joints and muscles that is experienced when exercising on harder surfaces. The therapy is beneficial for a variety of issues including arthritis, joint pain, cruciate ligament ruptures, as well as neurological disorders such as degenerative myelopathy or spinal strokes.

Depending on the type of hydrotherapy, the session may include an underwater treadmill, a whirlpool or a dog pool. Underwater treadmills are often used for patients with joint problems, such as cruciate ligament issues, carpal injuries or Achilles tendon injuries. The dog enters a plastic or glass chamber that fills with water once the door is closed. The amount of water used is dependent upon the type of injury. The dog walks on a treadmill and the water creates the resistance. The combination of treadmill and water resistance works together to strengthen muscles and joints in a low-impact environment.

Laser therapy, also known as cold laser, red therapy, or low-level laser, is used to treat a variety of conditions including muscle, ligament, and tendon injuries, post-surgical and soft tissue injuries, acute pain, and chronic conditions. It uses a deep-penetrating, non-heat producing light to create a number of chemical reactions knows as photobiostimulation. This process stimulates injured cells to heal at a faster rate and helps to reduce pain through the release of endorphins. It is non-invasive, non-surgical and involves no drugs.  Each treatment session may range from 3 – 15 minutes in length with the length and number of treatments dependent upon the type of injury being treated. The treatment is non-invasive and most dogs find it very relaxing.

The number of rehabilitation therapy sessions and the length of each treatment needed are dependent upon the type of injury being treated. The cost of the sessions would need to be discussed with your veterinarian or physical therapist. If you have pet insurance, be sure to check with your insurance company as these sessions may be covered under your pet insurance.

Keep in mind that while we all want the very best for our dogs, ease of accessibility and affordability has a great influence on what avenues of therapy clients are able to pursue. If your capabilities prevent you from getting professional therapy, remember that those frequent daily walks that we suggest during the healing process of ACL injuries are a form of therapy and will go a long way to strengthen your dog’s leg.

Sources:
https://www.petmd.com/dog/care/laser-therapy-dogs
https://www.dogster.com/lifestyle/dog-health-hydrotherapy-how-it-works
https://www.whole-dog-journal.com/issues/14_12/features/Canine-Hydrotherapy_20409-1.html
http://www.thedrakecenter.com/services/dogs/laser-therapy-for-dogs
https://fidoseofreality.com/the-reality-of-cold-laser-treatment-for-dogs/