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VET3VPT - Assessment 3B: Canine Front Limb Amputation By Daniel Moffatt Signalment: Toby is an 8-year-old, male neutered purebred German shepherd. Social & Clinical history: Toby was bred by the Australian police to be part of the police dog squad. He was neutered and went through specialised training from a young age in order to help track down missing people, eventually started his career at 1 year old. Toby spent 6 years working as a police dog, tracking people through long distances and tough terrains, until he retired at the age of 7 due to arthritis and was adopted by his handler. Toby presented to the veterinarian due to worsening lameness in his left front leg over the last month, that the owner’s had thought were due to the advancement of previous arthritic changes. On veterinary exam, Toby was found to be in fairly good health, with good body condition and muscle preservation for an older dog, however a firm swelling was identified on the distal radius of his left front leg. Radiographs were taken of his leg which showed a bony proliferation and lysis of the radius, while secondary chest radiographs did not show any obvious changes. A fine needle aspirate was then taken from the mass to confirm the suspected diagnosis, which showed immature mesenchymal cells with osteoid properties. Due to these results Toby was diagnosed with canine osteosarcoma. After discussing various treatment options, his owners opted to amputate the affected limb in order to prevent cancer spread and relieve his immediate pain, then to manage him on palliative care medications ongoing. Client details: Lucy Smith is a 34-year-old police canine handler, who has worked with the dog squad for 10 years. Therefore, she has a well-developed understanding of canine health and wellbeing, alongside a moderate literacy and scientific understanding. Matthew Smith, her partner, is a 32-year-old primary school teacher with limited dog experience, however, has high literacy and scientific understanding Toby’s physiotherapy plan primarily consists of Cryotherapy, Thermotherapy, Stretches, Passive Range of Motion, Hydrotherapy, and Functional Activities. First 24 hours post-surgery. Cryotherapy around the wound can be used immediately post operation to help reduce pain and swelling. This should be applied for 10 minutes, 4 to 6 times a day for one week or longer as needed. A few hours post-surgery the patient should be encouraged to stand and take slow walks with the help of a sling to provide balance and support as they re-establish a new gait pattern 48 hours post-surgery. Thermotherapy can be used to reduce compensatory muscle soreness in the back and other limbs. Heated wheat packs are ideal as they are light and conform to the shape of the body. This can be applied for 10 minutes, three times a day, ideally before performing motion exercises. Cryotherapy and Thermotherapy can be applied at the surgical site, alternating each 10 minutes over a 60-minute period, three times per day to assist with swelling reduction. Stretches can be used to retain muscle length in the remaining limbs. Stretches can be performed with the patient lying laterally or in standing, however standing stretches will need to be sling supported. The muscle should be stretched until resistance is felt, then at this point the stretch should be held for 15 seconds, then rested, and repeated three times, twice a day. Passive range of motion exercises can be used to maintain muscle strength and flexibility in the remaining limbs. Movements should only be done in a pain-free range, with repetitions of 10 to 20, three times a day for the first two weeks 2 weeks post-surgery. Controlled exercise through a slowly increasing walking regime, by increasing walking time while decreasing sling support, to help build muscle strength in the remaining limbs. Stretches should continue with 15 seconds stretching at the point of resistance, then rest, then repeated three times, twice a day. Passive range of motion exercises should continue in the pain free-range, with increasing repetitions of 15 to 30, three times a day over the next two weeks. Balance and proprioception exercises can begin, with sling-supported walking on uneven or unsteady terrain and walking over cavaletti poles to develop stability. Once the surgical wound has healed, the patient may start hydrotherapy, ideally with an underwater treadmill which utilize buoyancy, viscosity, and hydrostatic pressure to improve stamina, muscle strength, range of motion, and re-establish gait. The patient will initially benefit from a heightened water level around the stifle, slow treadmill speed, and short 2 to 5-minute sessions, 1 to 3 times a week. Sling support may be beneficial to provide reassurance and reduce energy demand 4 weeks post-surgery. Begin functional activities such as stairs and obstacles to work on balance and proprioception, starting with street curbs, small stairs & small obstacles. Continue stretches at the point of resistance for 15 seconds, then rest, then repeat three times, twice a day. Continue Passive range of motion exercises in the pain free-range, once again increasing repetitions of 30 to 45, three times a day for the next two weeks. Continue to improve stamina through increasing walk length and introducing different terrains whilst decreasing sling support. Continue hydrotherapy sessions 1 to 3 times a week, increasing session length to 5 to 10 minutes, increasing treadmill speed to improve stride length, and reducing water level to the hock to increase weight baring and develop muscle strength. 6 weeks post-surgery and ongoing plan. Continue hydrotherapy sessions once a week ongoing, with appropriate difficulty regarding water level and session length compared to patient’s ongoing status, in order to promote continued muscle strength, stamina and range of motion. Keep a consistent walking schedule regarding length and terrain difficulty, adjusting for the animals ongoing status, to maintain cardiovascular fitness, balance, and proprioception. Cryotherapy aka “cold therapy” involves applying a cold stimulus to an area to minimise inflammation and thus associated pain and swelling post injury or surgery. This method works by causing constriction of the nearby blood vessels, which reduces swelling, local tissue damage, and oedema. Administer this technique using a sealed zip-lock bag of ice chippings, wrapped in a damp towel, and apply directly to the inflamed site for 10 to 20 minutes every 4 to 6 hours as needed. Caution should be taken in dogs with low body temperature or altered skin sensation, and the ice stimulus should never be placed directly onto the skin. Thermotherapy aka “heat therapy” involves applying a warm stimulus to an area to promote healing, and reduce associated pain, stiffness, and muscle spasms. This method works by causing dilation of the nearby blood vessels, which allows for increased blood flow and cellular healing activities. Administer this technique using a warmed wheat bag or similar, wrapped in a dry towel, and apply directly to the inflamed site for 10 to 20 minutes every 4 to 6 hours. This method should only be used after 72 hours post-surgery once the initial inflammation has settled, and caution should be used in dogs with high body temperature, infection, burns, or altered skin sensation. Stretches are performed to maintain or increase muscle length in patients that have undergone surgery or are recumbent, as muscle shortening quickly occurs with disuse. Stretching the muscles involve applying a pushing force at the base of the muscle or limb until resistance is felt, at this point the stretch should be held for 15 seconds, then the muscle should be rested, and the process repeated three times, twice daily. Caution must be taken to not push the muscle past its comfortable stretching range. Passive Range of Motion (PROM) involves manually extending and flexing the joints of the limbs in order to maintain or increase joint range of motion, and to prevent joint inflammation and stiffness. This technique is performed by pushing the individual joints or whole limb together and then pushing them back apart within the animal’s pain-free range, with initial repetitions of 10 to 20, three times a day, increasing repetitions over the 4-week recovery period. Caution should be taken to not overextend the joints by staying in the comfortable range, and never pulling on or tightly gripping a limb or joints. Hydrotherapy must always be supervised by a qualified hydrotherapist or veterinary worker. This technique utilizes an underwater treadmill to provide buoyancy, viscosity, and hydrostatic pressure in order to enhance stamina, muscle strength, range of motion, and re-establish a three-legged gait. The patient will initially benefit from a heightened water level around the stifle, slow treadmill speed, and short 2 to 5-minute sessions, 1 to 3 times a week. As time progresses the difficulty can be increased through increasing treadmill speed, lowering water level, and having longer sessions. Sling support may be beneficial to provide reassurance and reduce energy demand. Caution should be taken in animals with open surgical wounds, systemic compromise, gastrointestinal upset, uncontrolled seizures, and recent chemotherapy patients.