PAW REHAB is proud to present our "Patient of the Month." Our patient of the month showcases a patient's journey through its initial or ongoing rehabilitation process. We hope to promote awareness for pet parents and the veterinary community of the benefits of rehabilitation therapy in veterinary medicine. Each patient of the month is selected by our rehabilitation therapy team. PAW REHAB will be making a donation in the patient's name to a nonprofit organization of the pet parent's choice. PAW REHAB has made contributions in the past in support of the following pet charities and will donate to one of the following if the client would like this option instead: Best Friends, Operation Blankets of Love, Pugnation, GreySave and others.
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PAW SUCCESS STORIES
PATIENT PROFILE
Female, Spayed, Golden Retriever, Age: 12 Years
SYMPTOMS/REASON FOR VISITS
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Chronic forelimb and hind limb lameness
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Chronic management of arthritis
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Post cruciate ligament rupture (post-op TPLO surgery right 2017, left 2014)
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Post limb sparing procedure for osteosarcoma (Dec 2017)
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DIAGNOSIS
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Suspect Partial Cranial Cruciate Ligament Rupture at right knee
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Lumbar/Lumbo-sacral pain (low back)- suspect lumbo-sacral stenosis
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Discomfort multiple joints (stifles, hips, elbows, shoulders) suspect due to degenerative joint disease/arthritis
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Lymphosarcoma- in remission, treated with chemotherapy- maintenance protocol
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Osteosarcoma
BEI BEI
HISTORY
Bei Bei was a rescued dog obtained from Taiwan back in February 2010. Two days after arriving, she was spotted by Robert at a SCGRR (Southern California Golden Retreiver Rescue) rescue event at a local pet shop in Studio City where he instantly fell in love with her. He immediately contacted the rescue and told them he wanted her. Bei Bei is a very loving, happy and enthusiastic dog. She also loves hanging out on the pool steps. Her motto in the early days was definitely "why walk when you can run".
Bei Bei has a history of Hip Dysplasia. Additionally, years ago, Bei Bei had TPLO surgery at her left hindlimb for a common knee injury, Cranial Cruciate Ligament Rupture. A tear of the cranial cruciate ligament causes instability at the knee joint, inflammation and lameness. This may have been caused by further injury to a weakened ligament, trauma or degenerative changes at the ligament.
Bei Bei was diagnosed with Lymphosarcoma back in 2015 and she quickly went into remission after being treated with chemotherapy. Lymphosarcoma is a cancer of the lymphatic system. It may affect one or more peripheral lymph nodes or it may be present within the gastrointestinal system.
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Just prior to Bei Bei's arrival at PAW REHAB, she and her pet parent had experienced the loss of longtime companion and patient of PAW REHAB, Rudy, a 13 year old Chocalate Labrador. Her new companion, Marty, a young Australian Shepherd attended her initial visits to "hold her paw". It wasn't before long, that Bei Bei made herself at home and over the course of her visits, she is so content she doesn't want to leave (see middle pic above ;) She even came in for visits when she was taking a break from her rehab program when restricted due to her mulitple surgical procedures.
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EVALUATION
Bei Bei presented for a consult with PAW REHAB in April of 2017 and was evaluated by our veterinary doctor. A complete physical exam was performed including a gait evaluation, orthopedic and neurological assessment. Bei Bei was assessed for pain, current muscle strength and muscle mass, muscular tension and joint range of motion.
When Bei Bei presented to PAW REHAB, hindlimb weakness and a right forelimb and right hindlimb lameness were present. She had areas of discomfort and stiffness at her knees, hips, elbows and shoulders suspected due to degenerative joint disease/arthritis. Partial Cranial Cruciate rupture was suspected at the right knee.
Additionally, she had discomfort at her low back at the lumbar spine and lumbosacral areas suspected to be due to spondylosis and lumbo-sacral stenosis (nerve root impingement at the spine/pelvis) which could also account for her hindlimb weakness.
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GOALS
Client goals or expectations: To improve Bei Bei's comfort.
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Our additional goals post-evaluation to help achieve this:
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Enhance mobility
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Manage pain
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Decrease inflammation, promote healing
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Manage osteoarthritis, promote joint health
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Immune system support
REHABILITATION & RECOMMENDATIONS
An in-clinic rehabilitation program was recommended with a frequency of initial visits twice weekly. For Bei Bei's initial program, we focused on healing by decreasing inflammation and increasing comfort. Her rehabilitation plan included the use of massage, passive range of motion exercises and therapetic exercises. Acupuncture and injections for joint health administered by our veterinary doctor were also recommended to help with pain relief, reduce muscle tension, increase circulation, and to help enhance her immune system. Home exercises and recommended activity was reveiwed.
PATIENT'S PROGRESS
After her initial two months of rehabilitation therapy and acupuncture, Bei Bei was showing improvements in joint comfort, less muscle tension and improved weight bearing of the affected limbs. There was milder low back discomfort at her lumbosacral area.
By the end of June, Bei Bei's cruciate ligament further weakened and she needed TPLO surgery. The surgery went well with no complications. The surgeon was pleased at her recheck a couple of months later and rehabilitation therapy resumed. Bei Bei's next Rehab Program was tailored to decrease inflammation, promote more weight-bearing and strengthening of the limb. We recommended modifying Bei Bei's activities to encourage gait retraining while limiting flare-ups of inflammation at the post-op joint.
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Novemenber 2017:
Bei Bei is reported to be doing well. She is comfortable at all joints as well as her spine and has more muscle mass on her hind limbs.
Walks were next increased to 20-30 mins over the next months. She is a healthy weight.
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Bei Bei with her dad, Robert
December 2017:
The client reports Bei Bei to have an increase in her right forelimb lameness which continues to get worse over a matter of two weeks and has not responded to an anti-inflammatory medication prescribed. Dr. Conrad present for Bei Bei's rehab session, noticed a lump/swelling of the bone on the front of Bei Bei's right wrist which was confirmed to not have been present just a few weeks prior. The client was informed to have radiographs taken ASAP and made aware that there is a possibility of osteosarcoma, a type of cancer that affects bone and which can spread to local lymph nodes and the lungs. Radiographs were imperative as fast as possible to help confirm a diagnosis and decide on a treatment plan. The diagnosis was confirmed and Bei Bei's owner was faced with the options of amputation vs a limb sparing procedure and additional chemotherapy.
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April 2018:
Bei Bei presents for post-op recovery for a right forelimb radius bone graft procedure for treatment of osteosarcoma. This type of surgery causes the carpal joint to become immobile due to carpal bone arthrodesis performed in order to secure the new bone graft. Additional strain may be placed on the elbow and shoulder. Mild hindlimb weakness was present as well as decreased strides at both hips.
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Rehabilitation therapy and acupuncture continue to be performed over the next year for comfort. She additionally was treated by her oncologist with a trial vaccine for osteocarcoma. She still stays active with walks and it is difficult to keep her out of the pool.
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December 2018:
A year after her bone cancer diagnosis and now four years in remission from lymphosarcoma, Bei Bei is maintaining well and comfortable. She now has partial blindness due to glaucoma in her left eye. Due to her sight she seems to be having a little more difficulty getting around, mostly in the dark.
A continued rehabilitation treatment plan was recommended as previous for comfort and continued management of her arthritis, alternating rehab sessions and acupuncture every two weeks. The client continues to follow-up with her oncologist as directed.
March of 2019: Bei Bei is doing well despite developing an infection at her limb spare implant site and side effects from the antibiotics necessary to treat it. The swelling from her bone infection has subsided significantly and she seems to have perked up quite a bit, is in better spirits and is moving better. This June, her infection at the site is being challenged yet again but it is not holding back Bei Bei's mobility, weight bearing or spirit.
Over two years after her initial evaluation and at the age of 12, we are so amazed with Bei Bei's bounce back attitude and achievements. We are all so proud of her as well as her dad, Robert, her sitter Kathrin and her health care team including her PAW REHAB family and her team of doctors which include her general practitioner, an oncologist, surgeons, a dermatologist and a holisitic veterinarian. We are so happy to call Bei Bei not only our “Patient of the Month” but our PAW REHAB “Lifetime Achievement Recipient”! Bei Bei and her dad have chosen for our honorary donation, the SCGRR. Bei Bei continues to fight the good fight and she fights better than any girl we know! Congrats Bei Bei! With love, your PAW REHAB FAMILY
AUTHORS
Joanne Bak DVM, CCRT, Emmerine Gonzales, Certified Veterinary Assistant
Pacific Animal Wellness Rehabilitation Center
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Bei Bei was assessed and is overseen at PAW REHAB by Dr. Joanne Bak (pictured top middle), a veterinary doctor and Certified Canine Rehabilitation Therapist. Assisting with Dr. Bak's rehabilitation plan and performing therapies with Bei Bei are Emmerine AKA EV (pictured to the right), April, Laura and Nancy, our team of veterinary assistants and technicians who are trained and experienced in veterinary technology and canine and feline rehabilitation therapy. Providing extra hugs and TLC are our client liaisons, Keva, Michelle and Jenny (pictured top right).
EV with Bei Bei
PAW REHAB is a veterinary facility dedicated to physical rehabilitation therapy for pets in a calming and relaxed environment located in Sherman Oaks, CA. If you would like more information about PAW REHAB, our staff or our services, please see our website at www.pawrehab.com.
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Paw Rehab, 14942 Ventura Blvd Sherman Oaks, CA 91403 Phone: 818-847-7299 Fax: 818-860-7672