A Case of the Week: Cassidy’s brachial plexus and radial nerve damage

November 24, 2012 by · 3 Comments 

cassidy brachial plexus radial nerve damageCassidy, a year old Australian Shepherd, was picked up by animal control and brought to the Humane Society of Jackson County, IN in late August. She had an injured left front leg that was swollen and dangling at the time. 3 veterinarians said it was nerve damage and only time would tell if the leg would regain use. Cassidy has brachial plexus and radial nerve damage sometimes called brachial plexus avulsion and is a common injury in dogs that are hit by cars.

In October she came to see me for treatment of the dangling leg since it was not seeming to be improving and in fact she was getting sores on the top of her foot. Her vet was considering amputation. Examining her it was obvious that she had suffered a severe injury to her brachial plexus and radial nerve and could not extend her leg as her triceps muscles and her digital extensor muscles were limp. She had also developed a common complication of this injury in that the opposing muscles the biceps and the carpal flexor muscles were contracted, since they have no opposing force to stretch them back out.

Most general practice veterinarians will give an anti-inflammatory (many times corticosteroid) and give the nerve time to heal and in many cases it does. If the brachial plexus or the radial nerve has been completely severed the dog will never regain use of its leg – the extensor muscles will remain flaccid and the flexor muscles will remain contracted. In cases in which the dog appears to not gain any movement back in the leg for an extend time such as in Cassidy’s case, most vets assume that the nerve is then severed and usually opt to amputate the limb; however some of these cases the brachial plexus/radial nerve just doesn’t heal with out stimulation. Neuromodulation is necessary to stimulate the nerve to regain function. It is sort of like you don’t use it so you lose it concept. Canine rehabilitation with neuro rehab is the treatment of choice for these dogs. The only problem, without trying to do electrodiagnostic testing, is that we will not know if it will work without doing the rehab and we have to try for 4-6 weeks without improvement to determine if it will not work.

In a case like Cassidy’s we have two goals – increase brachial plexus and radial nerve function and reduce flexor muscle contraction.

Therapies to reduce flexor muscle contraction –

  • Laser Therapy
  • Ultrasound Therapy
  • Manual Manipulation and Stretching
Therapies to increase brachial plexus and radial nerve function –
  • Acupuncture
  • Chiropractic
  • Laser Therapy
  • Electrostimulation
  • Manual Therapy and exercises to coax her to extend

Cassidy’s first visit we did laser therapy and chiropractic. Electrical acupuncture the next week. The third week we saw no improvement so we started electrical stimulation and laser therapy weekly along with exercises to entice her to extend her leg. The very next week we noticed movement in her triceps muscles! Some progress which meant that the brachial plexus was intact and eventually she would heal she just needed some stimulation.

There still was no movement even with electrical stimulation to the extensor muscles that controlled her carpus (wrist). What is very interesting is that if the nerve does not function electrical stimulation will not contract the muscle no matter how high of an electrical current you place into the muscle. If the nerve doesn’t work, the muscle does not work period. However repeated electrical stimulation will entice the nerve to function. I was a little discouraged that we had movement in the triceps but not the digital extensors I was starting to fear that the damage to the radial nerve was too great and we were not going to get that function back.

The very next week Cassidy came in still the same and although she was really extending her elbow. Although weak she was extending it during play, but the wrist remained contracted and unable to extend. We could straighten the wrist out about 80% of normal manually but there was no movement in the extensors, that is until we placed the electrical stimulator on her. We have movement with electrical stimulation to her toes! Way to go Cassidy!

We are going to continue electrical stimulation and exercises to entice her to extend her limb for the next few weeks. Hopefully in the next month or two she will be back to normal. Her brachial plexus and her radial nerve damage will be repaired and she will have normal function an start rebuilding the muscle she lost from the last 6 months.

Traditional Chinese Veterinary Medicine: TCVM a different approach to disease

November 14, 2012 by · 3 Comments 

Traditional Chinese Veterinary Medicine (TCVM) is a medical system that has been used in China for thousands of years. In the US it has been used to treat animals since the 1970′s. Today acupuncture (one part of TCVM) has shown to be an effective treatment for many diseases both acute and chronic and really has shown to be very effective in treating pain and neurologic conditions thus making it a main stream treatment. TCVM includes using acupuncture, Chinese herbs, Tui Na (Chinese massage) and food therapy to treat the body to promote the body to heal itself.

Veterinarians can learn acupuncture and other TCVM modalities at one of the veterinary schools that offer programs –  Colorado State University, Tufts University or the University of Florida; or they can take a certification course offered by IVAS or the Chi Institute. The Chi Institute offers the most comprehensive programs for TCVM including all of the modalities and advanced courses up to and including a Masters Degree in TCVM offered in conjunction with South China Agricultural University. For this reason I choose the Chi Institute for my certification. I have considered pursuing the Master Degree program.

TCVM has changed considerably since its inception in China back when it was primarily used to treat horses and farm animals. Today it is used for those animals and also dogs, cats, and birds. Much has been learned about acupuncture and TCVM through the study and treatments of these companion animals. Here in the US TCVM is used many times, as it is in my practice, in conjunction with other treatments such as chiropractic, western herbs, nutritional supplementation and rehabilitation therapies (laser, electrical stimulation, and exercise). It is exciting to be part of a medical field that although has been around for 3000-4000 years is changing and expanding due to scientific advances and research and more owners being accepting of the treatments. I look forward to many years of treating my patients with TCVM.

The basic premise of TCVM is rebalancing the body to allow it to heal itself. A diseased body becomes out of balance. In TCVM some of the cause of disease is because the body is out of balance and in other cases the body becomes out of balance by an external force, such as a traumatic accident. In either case TCVM can be used hand in hand with western allopathic medicine to help the body recover from disease or trauma. They come from the disease from opposite aspects and can meet in the middle due to a common cause – to heal the patient. Western medicine is great at treating acute problems TCVM is great at treating chronic problems that western medicine has difficulty in curing. TCVM has little to no side effects. Western medicine is far superior in diagnosing due to the technological advances. An integrative approach works wonderfully for the patient because you can get the best of both worlds with superior diagnostics and treatment that has less side effects. Treatment that can approach a disease from both aspects that of treating the disease and that of helping the body heal.

One of my first cases in using TCVM was Bear – Canine Case of the Week: Bear and Cervical IVDD I hope I have many more successful cases such as Bear. He is still a patient and is doing well.

Lepto Vaccine: Should I or Shouldn’t I

November 8, 2012 by · Leave a Comment 

I am asked quite often if a dog owner should be giving a Leptospirosis vaccine to their dog. In typical non-committal the owner makes the final decisions about their dog fashion I usually answer – “it depends”.

lepto raccoonTo be honest I am on the fence about it. In Illinois and in Indiana, which is where I live, it is endemic. Meaning it is all over the place here. There are estimates of 50% of the raccoon population carry the disease. Lepto is transmissible to humans and you can get it from your infected dog. Your dog can die from the disease or it can cause permanent kidney disease in dogs and humans. For those reasons it is important to vaccinate. In fact most veterinarians stop right there when describing lepto in order to convince you how necessary it is for your dog to receive the vaccine. It can be a scary disease.

So why would I be on the fence about such a horrific disease? Well, Lepto is a bacteria (spirochete) so the vaccine is not as long lasting as vaccine that protect against viruses, and it has to be given every year. In the past, the vaccine produced some significant side effects, the vaccine is cleaner now which has reduced some of the side effects, but it seems that some dogs are still experiencing them. Lepto has numerous strains more than 20, the vaccine protects only against 4 (the most common ones), so even if your dog is vaccinated it still can contract lepto, become sick and possibly transmit it to you or your children. 

So if you have a healthy dog and you have wildlife in your backyard or you have a dog that does spend time out in the woods, ponds, or areas that are known to have a lot of wildlife then the Lepto vaccination would be appropriate. However, if your dog has allergies or other immune system issues then you need to consider that giving an annual vaccine is not the best for the health of your dog. Also one thing to know is that lepto is not a death sentence. It is a bacterial infection and if caught early can be treated successfully with no long term effects. It has to be caught, tested for, and treated. There in lies the problem. Many owners are slow to bring the dog to the vet and many vets do not think of lepto first when the dog comes in lethargic with signs of a urinary tract infection, because it usually isn’t. Most of the time symptoms like that  is a simple bacterial infection not a kidney destroying life threatening zoonotic (that means humans can catch it) disease. The main difference is usually lethargy, if the dog is acting sick and has a urinary tract infection it is important to test for Lepto especially in endemic areas.

If you have more questions then ask away in the comment section below.

Here are a couple of articles with other opinions – 

Epidemic Canine Obesity: Killing Them With Kindness

November 6, 2012 by · 2 Comments 

Fat dog ObesityEveryday I see it, the pudgy dog whose owner just loves them to death literally. There is an epidemic in this country with obesity and that includes our dogs. Obesity in dogs, as in humans, leads to several health problems such as diabetes, respiratory issues, skin conditions and most important from my perspective on canine movement is osteoarthritis. Yes, osteoarthritis can be caused by canine obesity. Your dog being overweight puts more stress, strain, and ultimately more inflammation on joints and leads to destruction of the cartilage. So these owners with the little pudgy dogs that can’t help themselves and just have to feed that cute little face are killing them with their kindness.

What is very interesting is owner’s perception of their dog being overweight versus what we as veterinarians perceive as overweight. It is a sensitive subject for owners that their dog is fat. A British study published last year shows “Although a high proportion of owners claimed to have discussed the dog’s weight with their veterinarian, some discrepancies were apparent between owner perception of animal weight and the veterinarian’s evaluation of body condition score. Owner disagreement was significantly greater for the veterinarian-defined overweight dogs (P=0·005). Owners often provide personal narratives to account for their dog’s weight status.” The study concluded that verbal communication should not be the only information given to an owner of an overweight dog.

There have been several other studies recently in regards to the prevention and/or the decrease in progression of arthritis in dogs that were fed restricted calorie diets. A diet of only 25% reduction in calories has shown to decrease the incidence of arthritis in elbows, hips, and shoulders of dogs and it was noted in one study that it increased the average age of the dogs by almost 2 years!

Talk to your vet, talk to a canine nutritionist about how to feed your dog appropriately. Realize that the dog food companies are trying to sell you food and that the amounts on the bag that they recommend feeding are only estimates and of course they are on the high side for most dogs because the more your dog eats the more food you will buy. If your dog is already overweight do not treat him like a human and feed a diet high in fiber that will just produce gas. I know that those of you that have tried the store bought “diet” foods have experienced the problem with high fiber diets and your dog really is the one to blame for clearing a room. The first order of business is to talk to your vet, have an exam and possibly some blood tests to be sure your dog does not have an underlying condition causing him to be overweight; however in my experience it usually is the amount and quality of food being fed.

The best steps to take (after the visit to the vet) for the overweight dog is to go to a diet that is species appropriate which means for your dog a carnivorous or meat based diet with no grain. Similar to people some dogs have a problem with grain and especially gluten and no not celiac disease but rather grains being pro-inflammatory, meaning it promotes inflammation. Increased inflammation in the body can lead to weight gain, similar to people that have a puffy appearance. It makes it very difficult to lose weight. It is best to feed your dog a meat based, grain free diet and count the calories. Use the following formula for an estimate of what your dog requires for calories per day Calories = 132 x (body weight in kilograms) X 0.75

For example the daily energy requirements of a 20 lb dog –

Convert pounds to kilograms ( 1 lbs = 0.454 kg)
20 lbs x 0.454 = 9.08 kg

Determine the metabolic body weight (kg0.75)
9.08 x .75 = 6.81

Multiply metabolic body weight by 132 (for the average dog)
6.81 x 132 = 898.92 or 900 kcal per day

So a 20 lb dog needs only 900 kcal per day total. To do a reducing diet you need to reduce the calories by 25% which is 75% of the total 900 X .75 = 675 kcal per day.

You can calculate an estimate of calories of the food you are feeding by using University of California-Davis School of Veterinary Medicine formula of 3.5 kcal per gram of protein and carbohydrates and 8.5 kcal per gram of fat. Just use the percentages found on the side of the bag and weigh a cup of the food to determine how many calories are in each cup. You will find some interesting results and that maybe, just maybe, you have been overfeeding your dog.

Remember a thin dog is a healthy dog and a long lived dog, one that is not as likely to have arthritis or other diseases. So the next time you go to give that begging fat face a treat just because he wants it; realize he doesn’t know what you know – he doesn’t know you are killing him :-)

Another great article with even more specifics – Pet Food Calorie Mis-Information

A dog food calculator – Dog Food Calculator