Brooks Humphries

Background

Brooks, an 11 year old labrador was referred to Fitzpatrick Referrals on 3^rd July 2008 for assessment of non-specific shivering and apparent lumbar pain.

The owner had owned Brooks since puppyhood and Brooks had been an agility dog. In early 2006 the owner had noticed that, after agility sessions, on the following day Brooks was almost crawling on his pelvic limbs and was shaking considerably on both. Rest resolved this issue but when he went back to agility the clinical signs recurred. MRI scan performed in August 2006 had revealed moderate inter-vertebral disc degeneration at the lumbo-sacral junction. The agility training stopped and carprofen (Rimadyl^TM) medication was prescribed but the owner reported that it was difficult to judge whether this was making a significant difference.

Occasional shaking of the pelvic limbs was noted but then the owner felt that signs of pelvic limb discomfort had become more apparent. The owner reported that Brooks had changed his demeanour in terms of not feeling as happy as usual and when he lay down he would stretch his left pelvic limb out straight. The owner also felt that he was tentative when getting up on a chair or when being touched over the rump region. On one occasion the owner threw a ball too far and when Brooks stopped abruptly the pelvic limbs were very shaky.

Condition on presentation

On the day of his clinical examination (3^rd July 2008) with us Brooks appeared to be very uncomfortable with deep digital pressure application to the lumbo-sacral junction and also on deep digital pressure application to the sciatic outflow in the caudal recesses of the biceps femoris muscles bilaterally. Radiography and MRI scans were undertaken for the pelvic limbs and the lumbo-sacral spine on 3^rd July.

Diagnosis

Radiography of the lumbo-sacral spine revealed ventral and abaxial spondylosis at the lumbo-sacral junction and at L6-L7. MRI scan of the lumbo-sacral region revealed inter-vertebral disc degeneration at L6-L7 and at L7-S1. Sagittal imaging revealed that both discs were moderately herniated and transverse imaging revealed that the L6-L7 and L7-S1 inter-vertebral disc herniations had resulted in neuroforaminal impingement bilaterally which was likely to be clinically significant via dynamic intermittent neuropraxia.

Treatment

Rehabilitation

It was felt that this level of pathology did not warrant surgical intervention at this stage and so an intensive course of physiotherapy and hydrotherapy was initiated at our rehabilitation centre.

Physiotherapy

Brooks was assessed by our physiotherapy team and treated with joint mobilisation exercises, massage and heat wave therapy (h-wave). H-wave therapy is a form of electrical stimulation that produces a direct, localized effect on the conduction of underlying peripheral nerves. Brooks was seen weekly by the physios for a period of a month and his owner was given a set of exercises to perform at home. He was also gradually weaned off his pain relieving medication.

Brooks re-presented on 7^th August 2008 for veterinary reassessment subsequent to physiotherapy and he appeared to have improved considerably with no further episodes of shaking. Following removal of pain relieving medication there was no deterioration. Continuing physiotherapy was advised  indefinitely twice monthly and a course of hydrotherapy was instigated. NSAID medication was advised to be used on an ad hoc basis only if necessary. Our veterinary and rehabilitation teams were keen to avoid surgical intervention if at all possible.

Hydrotherapy

Hydrotherapy was instigated on a weekly basis and although Brooks was very reluctant to use his hind legs at first, he soon began to relax in the warm water. After the first few sessions he settled down and started to enjoy the pool using his legs really well and swimming strongly. He continued to come for weekly hydrotherapy sessions and was closely monitored by our physiotherapists. His owner was delighted with his progress and he has been coming for regular, weekly hydrotherapy sessions ever since. In March 2011 he was our first patient to have been for 100 hydrotherapy sessions and is an excellent example of a patient who has benefited significantly from physio and hydro therapies without the need for surgical intervention.

Current Condition

Brookes continues to do well with regular hydrotherapy. He sees our physiotherapists as required when he has an occasional set-back. This occurs from time to time but he is swiftly made more comfortable with soft tissue massage, stretching exercises and trigger point release. Once treated, we reduce his hydrotherapy for a short while but then gradually increase the exercise again. The regular hydrotherapy sessions help to keep his condition stable.