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Soft Tissue Injury In A Dog

by Dr. Krisi Erwin - May 11, 2018 View Case Report

Hello,

I have seen twice now a 4 month old Great Dane puppy (first time on 4/30 and second time today 5/11). Around 4/23 she was being rambunctious running into her crate and slid and then fell on her side. She was lame on the RRL. At the rDVM, she was painful on full stifle extension and they did radiographs. They did get a radiology consultation on them and all was normal with her bones and growth plates. They prescribed Tramadol for pain and the mom was giving Arnica and Traumeel and then crate resting the dog.

On my exam, she was very hyper and exuberant. I had a hard time really seeing her tongue but it seemed like a normal pink color. Her pulses seemed full and normal to me. I did not get active points on the initial visit but thought she was uncomfortable on palpation around BL 18-22 today. She has been growing and her rear end stands higher than her front and I think that is putting stress on the TL region in general in addition to maybe shifting her weight a bit forward due to the injury. I felt there was some “clicking” on flexion and extension of the right stifle on the first visit and still today but less so. I get no laxity in the joint, no drawer, no cranial tibial thrust. No effusion in the stifle. No pain on medial or lateral rotation of the stifle in any degree of flexion. Mild discomfort around the SI region. No visible lameness as p is moving around the exam room. Outside, she moves well- o reports no true lameness just some weakness in the rear. She is leash walking the dog, doing sitting to standing and other strength training exercises, and started swimming her yesterday in the river near by. No worsening after exercise.

This dog will be a show and breeding dog. I am nervous treating a puppy this young in terms of messing up anything re: her growth plates or causing trouble. We have avoided laser therapy- just dry needles x 10 minutes the first time and 15 minutes today (with lots of treats and PB)- I've treated Bai Hui, SI points, BL 40 (R), 60 (R), GB 34 (R), ST 36 (R), and Xi Yian (R). Today I also did BL 23 and GV 3 as well to help cover for some of the discomfort in the paraspinals- I couldn't any more needles to stay in due to movement.

Mom asked re: the homeopathic- I didn't know if the Ruta Graveolens would be appropriate for her and I am also unsure re: western or Chinese herbal formulas in a young puppy? I would appreciate some help and am happy to give any additional information if needed. Thanks!

Sincerely,
Krisi

by naturevet

May 18, 2018

Hi Krisi,

I admire your work-up here. You're very thorough. Did you happen to notice which specific points changed the pulse to something more moderate and less strong? I'm wondering about GB 34 in particular.

Also, I'm just curious how you will monitor progress here. It sounds like the dog is no longer lame. If that is the case, and you're just being pro-active, then your physical therapies may suffice.

Regarding Ruta, no problem to use it. The homeopathic version (which I assume is what you are referring to) does not pose any risks.

If there is a growth plate injury, one approach I have used in young growing Great Dane pups successfully (with mild radius curvus) is the western herb Boneset (Eupatorium perfoliatum). It has the strongest anti-inflammatory effect within the bone of any herb I have ever come across, and in the above-noted animal, was sufficient to reverse the deformity. I gave 1 ml of the tincture twice daily, and within three months, the problem was resolved. There are no known adverse effects, although other Eupatorium plants can contain pyrrolizidine alkaloids which can be hepatotoxic in large doses or with sustained use. So limiting treatments to small doses (such as the above) for just a month or two is prudent. Again, though, I've never seen a problem even after decades of use, so a little prophylactic use here would seem to be fine.

Otherwise, the deeper strong toned pulse makes me think of a Shao Yang disharmony, which is the main cause of SI joint irritation. Kan's Benefit Hips and Knees, a version of Minor Bupleurum, addresses that well.

Hopefully this helps you out. Let us know what happens

Steve

by Dr. Krisi Erwin

May 19, 2018

Hello! Thanks so much for your reply. I saw River again on Wednesday pm. I felt that her right stifle was pretty normal- no more of the "clicking", comfortable on palpation/flexion/extension. More evenly weight distributed between the left and right side although her left side of the pelvis/hip does sit higher than the right. I had our rehab technician take a feel and we felt that there was most pain in the SI region. She is also developing more compensatory (I feel) pain in the TL region. I did not feel that GB 34 was turgid or painful at all although she is very wiggly and I am still learning. I'll be honest, I forgot about assessing the pulse after needling as I was mostly focused on trying to keep her still. She is sweet but doing her therapies is a bit wild!! Most of the trigger points that I felt were at the TL. She is growing such that her pelvis is higher than her shoulders and I expect that is putting strain on her back. Her owner feels that this is an awkward growth phase she has seen with many of her Great Danes (she is a breeder). On questioning the owner further about River's fall, she slipped with all 4 feet going to the same side and landed pretty hard on the right side. Kasey (our rehab tech) did some gentle joint mobilizations and traction to try and help her to feel better. She was more lame after with a more apparent weight shift to the left rear and a bit more off balance in the rear end when she turns quickly. Before Kasey did her palpation, I did needle her- focusing predominantly on points along her back but I did also do BL 40 and 60. We also did some cautious laser therapy over her right gluteals (avoiding any bones where we may accidentally affect growth plates). We spoke with the owner today and the dog seems uncomfortable and she will give a few doses of Rimadyl just through the weekend and will report back on Monday. We also recommended some ice therapy over the right SI just to try and help with inflammation and gave her the names of some folks in the vicinity that do chiropractic. I feel like we have made some progress in just the 3 visits that I have seen her and any notable trauma to the right leg itself is resolving. Now just have to tidy up the SI region. We see her again at the end of this next week.

I do have Benefits the Hips and Knees in stock. I would have to order Boneset by itself as I only have it in combination with Hoxsey. I would assume that the homeopathic Ruta is not necessarily indicated at this time since it isn't a problem in her knees?

I'm not sure if this elucidates anything further, but I really appreciate any additional thoughts and advice.

Sincerely,
Krisi

by naturevet

May 19, 2018

Hi Krisi,

My main additional suggestion would be for you to make sure there are no spinal fixations. They may not have all worked themselves out with Kasey's manipulation, can be a significant source of pain, and would be expected with a fall in which the spine torqued as all four feet swung out to the same side. They are also common in SI issues, at least at L7 and the sacrum if nowhere else, but possibly also at the T-L junction given the sensitivity you're seeing. Hopefully there is someone in your area, even a chiropractor for people, who can palpate the dog and gently correct any problems, perhaps with an Activator.

Steve

by Dr. Krisi Erwin

May 22, 2018

Thanks again! I will try the Benefits the Hips and Knees as well as the physical stuff if that sounds good? I really appreciate your help and hope that this is a good place to ask questions like this. Have a good day!

Sincerely,
Krisi

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