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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. He was neutered at 6 months old and spent the next 6 years working as police tracking dog. He retired at age 7 due to developing arthritis. Toby presented to the veterinarian due to worsening lameness of left front leg, veterinary exam found a firm swelling on his distal radius, radiographs were taken and showed bony proliferation and lysis of the radius, while fine needle aspirate confirmed osteosarcoma diagnosis. Toby’s owners elected to proceed with leg amputation and palliative care Client details: Lucy Smith is a 34-year-old police canine handler, with a well-developed understanding of canine health and wellbeing, alongside a moderate literacy and scientific understanding. Matthew Smith, 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. 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. 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 & Thermotherapy Demonstration Stretches Demonstration Passive Range of Motion Demonstration Hydrotherapy Demonstration Functional Activities Demonstration As Toby’s owners, you will be responsible for a majority of his physiotherapy during recovery from front limb amputation. Ideally two people should be present during physiotherapy – one to hold and distract the animal, and one to perform the physiotherapy manoeuvre. It is vital that the person holding the dog is aware of animal behavioural signs that a stressed or painful animal may show, for example wide eyes, lip licking, resisting, or growling, in order to recognise when a certain physiotherapy exercise may be too much for the patient and a rest is needed to prevent escalation. It an animal is showing repeated signs of pain during a particular exercise, the exercise intensity should be decreased (through decreased time or repetitions), and your veterinarian or physiotherapist should be contacted to ensure maximum patient welfare. If the patient is only mildly anxious or stressed, distractions such as treats, or toys can be added into the routine to provide a positive diversion from the physiotherapy. Only the physiotherapy techniques listed below that have been shown to you should be attempted at home, per the written guidelines. Hydrotherapy and other advanced physiotherapy manoeuvres should only be done by a qualified professional, as incorrect technique may cause harm to the animal and yourself. Physiotherapy is considered a potentially hazardous manual task under safe work Australia, as it can feature repetitive movement or forces, and awkward postures, therefore it is imperative to be mindful of your own health and wellbeing during this process. During stretches and range of motion exercises it may be beneficial to have the dog in a laying position to allow you to sit comfortably while performing these manoeuvres, making sure not to hunch your back or strain your muscles. As you are only moving within the dogs comfortable range you should only need to use minimal force on the limb or joint to complete the technique. If you start to feel muscle fatigue or pain while performing these exercises, please discontinue and seek professional help if pain continues. When walking your dog with a sling, you may be carrying up to 30% of their body weight as they learn to balance on three legs, which for Toby at 33kg is approximately a 10kg weight. It would be beneficial to walk Toby with two people, one to hold the sling and one to hold the lead, so that you can swap to prevent muscle fatigue. If Toby needs to be lifted up, for example into a vehicle, where possible entice him to get up himself via a ramp or use multiple people and mobility aids such as slings or blankets to distribute the weight load and minimise adverse forces. Toby should continue to improve throughout his surgical recovery. If at any point you notice redness, swelling, discharge, or have any other concerns about the surgical site please contact your veterinary surgeon. If you feel Toby is not improving as much as he should with learning a three-legged gait or has gone backwards in any of his physiotherapy exercises, please contact the veterinary surgeon or a qualified animal physiotherapist. Thank you for listening