PAW REHAB is proud to present one of our "PAW SUCCESS STORIES" which 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 is selected by our rehabilitation therapy team or nominated by a pet parent! 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 prior contributions in support of the following pet charities and will donate to one of the following if the client would like this option instead: Operation Blankets of Love, Pugnation, GreySave, The Gentle Barn and others.
PATIENT PROFILE
Male, Neutered, Domestic Short Hair Age: 2.5 Years
HISTORY
On the morning of May 19, 2019, the owners heard Riley crying and trying to get into his litter box. Riley has been known to chase flying insects and will jump up to try to get them. He was still trying to jump and climb at home but would limp on his right hind limb.
Riley was initially assessed at VCA Animal Specialty Group. Diagnostic tests included: In clinic blood tests and radiographs. The radiographs determined Riley had a right proximal capital femoral physeal fracture of his right hip and surgery was performed the following day.
Riley recovered from surgery and anesthesia uneventfully and presented for rehabilitation therapy 10 days post-op in order to further enhance his recovery.
GOALS
Prior to beginning his therapy at PAW REHAB, his owner's goals were to maintain comfort, increase muscle mass and prevent further muscle atrophy of the right hindlimb. They also wanted Riley to be able to jump onto high surfaces again and to return to normal function for a young feline. Our additional goals for Riley included reducing muscle tension and improving range of motion of his hip.
REHABILITATION & RECOMMENDATIONS
An in-clinic rehabilitation program was recommended for Riley consisting of visits three times weekly. For Riley's program, we initially focused on healing by decreasing inflammation and increasing comfort and later progressed his rehabilitation for strengthening and gait re-training. Therapies included body work including passive and active stretches, cold laser therapy, and low impact therapeutic exercises to encourage weight bearing on the affected limb.
The clients were provided instructions including review of basic home exercises such as passive range of motion of the limbs, stretching, and circulatory massage. Additional exercises were prescribed and implemented in-clinic based on the patient's progress and ability. He even started therapy in the underwater treadmill to further improve his range of motion and hindlimb strengthening. As Riley was observed at home and by us at PAW REHAB, more exercises were recommended and reviewed for home.
EVALUATION
Riley presented 10 days post op for a consult with PAW REHAB and was evaluated by our veterinary doctor, Dr. Bak. A complete physical exam was performed including a gait evaluation, orthopedic and neurological assessment. Riley was assessed for pain, current muscle strength and muscle mass, muscular tension and joint range of motion.
At his initial evaluation, Riley weighed 15.6 lbs with an overweight body condition score of 6-6.5/9. He was determined to be in good health otherwise with the exception of his disability. Riley had mild reactivity at his lumbosacral spine (low back) during palpation. He was tense upon right hip extension. Riley gaited with a right hindlimb weight bearing lameness.
Muscle mass was assessed by measuring the circumference of his shoulders and thighs. His forelimb musculature measured evenly. There was a mild decrease of muscle mass on his right hindlimb (surgical leg) compared to his left hindlimb. There was tightness on his right hip extension but he was comfortable with normal ranges of motion in his other joints.
MORE ABOUT THE CONDITION:
FHO (FEMORAL HEAD OSTECTOMY) or FHNE (FEMORAL HEAD and NECK EXCISION) is the surgical removal of the head and neck of the femur bone or removal of the ball portion of the hip joint. This is done to eliminate bone on bone contact at the joint for pain relief. This may be done for dogs or cats that have severe arthritis, hip dysplasia, fractures of the femoral head or neck or Legg Calve Perthes Disease (avascular necrosis of the femoral head). Dependding on the condition or injury, alternatives to FHO may include THR (Total Hip Replacement), TPO (Triple Pelvic Ostectomy for hip dysplasia if a candidate), stem cell therapy, conservative management with pain medication, anti-inflammatory medication, joint supplements, acupuncture and rehabilitation therapies for pain management.
Once the femoral head is removed, the surrounding muscles and scar tissue help to support the area and creates a false joint.
Smaller patients typically have a better outcome due to less stress and force at the false joint but it can improve the quality of life for large dogs as well. Some degree of lameness may still be present. The dynamics and function of the hip have changed and the limb will most likely be slightly shorter than the opposite limb.
Pets should be encouraged to use the limb soon post-op in a controlled manner. Typically toe-touching is expected in about 10-14 days and partial weight bearing by about three weeks. It can take up to six months for complete healing and function.
Common complications may include decreased range of motion, muscle atrophy, infection, regrowth of unwanted proliferative bone which may cause bone on bone contact, lack of adequate scar tissue or muscle support within the false joint which may also result in bone on bone contact and pain.
Post-op rehabilitation therapy with the guidance of a veterinary rehabilitation therapist may help reduce the complications and can help enhance and speed recovery. Rehabilitation therapy can also be helpful for gait retraining and to remind the pet to use the affected limb.
SYMPTOMS/REASON FOR VISIT
Right hindlimb lameness
FHO Post-Op Recovery
FHO (Femoral head ostectomy) surgery performed May 20, 2019
DIAGNOSIS
Hip fracture (growth plate of the femur)
Right proximal capital femoral physeal fracture
RILEY
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PAW SUCCESS STORIES
AUTHORS
Joanne Bak DVM, CCRT and Nancy Lee RVT CCRP
Pacific Animal Wellness Rehabilitation Center
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.
Paw Rehab, 14942 Ventura Blvd Sherman Oaks, CA 91403 Phone: 818-847-7299 Fax: 818-860-7672
THANKS PAW REHAB!!!
PATIENT'S PROGRESS
Riley had been making waves in his recovery within his first month of therapy. He was found to be comfortable, had less muscle tension and his lameness was noted to have improved. Riley continued to make improvements weekly with his in-clinic exercises and underwater treadmill sessions.
Over the course of an additional four months of in-clinic rehabilitation and home exercises, his weight bearing on the affected limb continued to improve and he is now able to walk with a normal gait! Active range of motion at the hip has improved and his weight bearing on the affected limb while standing has more than doubled since his initial presentation. He has gained 1 to 1 1/2 cm of muscle mass in his surgical hind limb! His muscle mass improved on the other three limbs as well. "Way to go Riley!"
At the time of his evaluation in October of 2019, Riley was weight-bearing on the affected right hind limb well and had a comfortable and functional range of motion. Hip extension has significantly improved since his initial visit. Muscle mass was improving and becoming more symmetrical. Riley has since graduated from his rehabilitation program and is reported to be doing well with his normal activities at home. He has a new young kitten playmate that is keeping him active.
A patient's recovery can greatly be affected by the pet owner's compliance with recommendations from the pet's health care team and in the case of a feline, dependent on our cat patient's cooperation and willingness to perform for us and tolerate handling. Some cats may or may not be candidates for water therapy depending on certain requirements and a cat's attitude towards water, so most commonly, exercises are performed on land. Riley was such a good patient for both and apparently thinks he is a dog thanks to growing up with a big handsome German Shepherd named Noah (also a prior PAW REHAB patient :) Riley's owners did an outstanding job bringing him in for his therapies as well as following our exercise plan for him at home, and it really showed. The owners are elated to see Riley's progress.
Riley was assessed and is overseen at PAW REHAB by Dr. Joanne Bak, a veterinary doctor and Certified Canine Rehabilitation Therapist. Assisting with Dr. Bak's plan and performing therapies with Riley is Nancy Lee, a Registered Veterinary Technician and Certified Canine Rehabilitation Practitioner trained and experienced in canine and feline rehabilitation therapy.
