When talking to your dog’s veterinarian or physical therapist, a thorough history of events and observation can be an indispensable part of successful diagnosis and treatment.
Signs and symptoms can be subtle and ambiguous and elude an explanation. The more puzzle pieces you can gather, the more likely your PT or veterinarian are to be able to put together the full picture.
Cookie’s new lameness
Not every orthopedic problem screams its presence with full non-weight-bearing lameness. Your dog’s gait might not visibly change at all. Yet, they might modify how they do things, change their posture and other subtleties.
While I generally believe that an acute problem ought to have an acute cause, I do realize that sometimes a quiet issue can go undetected until something breaks the camel’s back. Is that the case with Cookie?
I am putting together a report for Cookie’s PT in preparation for an appointment on Monday. My intention is to include everything that could be relevant. There is no such thing as too much information, particularly when it might fit the overall picture.
Example report for dog PT—Cookie
Cookie is officially a senior dog now. She, however, did not get the memo. Cookie is very active and her enthusiasm often gets the best of her. Combined with our present ground conditions, it is a miracle that she managed to remain in one piece at all.
There are at least two feet of snow outside; deeper in places. It is not the nice fluffy stuff but rather layers of ice with a crystal-like mess in between. The ice isn’t hard enough to carry either my or Cookie’s weight but hard enough to grab a leg like a vice when you break through.
We have made trails all over the place for Cookie to get around safely. But the squirrels, bunnies, and a feral cat wonder every which way. And Cookie find is essential to try and pursue every trail she finds that is fresh enough. As well as she doesn’t like to eliminate on the trails—she just won’t. Which means that she’ll go struggling through the mess even if we prevented her from everything else.
The ground was this way since the beginning of the season and she was getting away with her shenanigans until now.
At dinner time a couple of days ago, after one of the exuberant outings, Cookie got up from resting favoring her front left leg heavily. She limped for a couple of paces, lifted her paw up, then limped the rest of the way. While she walked out of it, she’s been favoring the leg since every time she gets up from rest.
We didn’t find any issues with her foot, no swelling, heat or pain response. She is under rest now and getting a low dose of Deramaxx with dinner. There was no vocalization at any point; not when the injury might have happened and at no time since. Other than the first night, she remains eager to go out and do things.
We did discover what we believe is a muscle knot in her left shoulder area. It has reduced in size with massages.
Unrelated or relevant?
Two months ago, we were trying to figure out the cause of Cookie’s random yelps. There seemed to have been no rhyme or reason for them. She would stand by daddy’s chair and yelp. We examined her and didn’t discover any problem. There was no limping, no pain we could detect and she’d be fine until the next time she’d yelp again.
We investigated thoroughly. Several theories were considered and thrown out and in the end, we were non-wiser. Neither ourselves, Cookie’s veterinarian, her PT, her chiropractor, or animal communicator could put a finger on what the reason could have been. She did that a couple of days in a row and hasn’t done it since. The veterinarian suspected disc pain but given what Cookie does every day, having a disc issue she’d have to be screaming in pain. Unless it was a root signature?
I have seen root signature cause severe front leg lameness that would come and go. Except there was no lameness.
The first sign?
One new thing I noticed recently was the way Cookie has been coming down her ramp. She’d go down much slower and more gingerly than normal. Some days this has been more apparent than on others. It has been generally more pronounced toward the end of the day.
Yes, we’ve been doing some renovations and stuff has moved around. However, this change started before that. I felt it was significant but there was no way of deciphering it with the absence of other clues. Could it be some back pain?
Both her chiropractor and PT noted soreness in Cookie’s back muscles. Given what she does outside every day, I could think of several reasons why her back muscles would be sore.
With no other signs to go on and having a good explanation for painful back muscles, I accepted that as a reason.
There were no signs of lameness or slowing down; just the change in the way she was using the ramp.
A little odd thing I found suspicious
Every now and then in the last little while, I noticed something that got my attention. I filed it in my mind but wasn’t sure whether to even bring it up as it could have an innocuous explanation.
To convey this observation, I need to describe Cookie’s mouse hunting technique under the present conditions. Because of the deep snow with layers of ice throughout, the way she gets down to where the mouse would be is by breaking through it with her front legs.
It’s almost a jump but with mostly front end off the ground busting the stuff on the way down. Once she breaks through she will do a combination of digging and further pouncing.
This continues until she gets the mouse or has to go home.
There was, however, the odd time when she would pounce once, break through, and walk away. It happened only a few times but I did wonder whether she abandoned the hunt because she changed her mind or because it hurt.
A change in stance
A few days prior Cookie became visibly lame, I observed an odd stance. The top part of her front right leg seemed to have been sticking out enough to notice it didn’t look right. At first, I wondered whether there is some swelling in that area or just me being paranoid.
It wasn’t until Cookie started limping on her front left leg when I connected the dots—she was offloading from the front left a few days prior already.
Considering all the other prior signs, it would seem that what might have looked like an acute injury is an issue that’s gone on for a while—perhaps a couple of months. Was there a low-grade injury she finally aggravated to the point of lameness? Or are those two not related?
It does remind me of a similar problem with the same leg two years ago. The circumstances were identical as well and the assumption is that intentional or unintentional breaking through the mess of ice and snow is what caused it.
Normally, with front leg lameness, one ought to consider compensation. Particularly since at one point Cookie had reduced range of motion on her hind right leg. Front left is the one that would compensate.
But because the terrain is far from normal, Cookie doesn’t do a lot of normal walking which makes compensation less likely. Primary injury or issue of the sort would be my main suspect at this time. As well as the right hind leg seems to have sorted itself out since.
I figure that either a muscle injury or myofascial trigger point(s) might be the likely culprit. I am, of course, concerned about root signature or a spine-related problem. As well as there is always the dread of potential for bone cancer in a Rottweiler breed. We are awaiting the PT assessment with bated breath.
Cookie is on the third day of limited activity. The lameness has improved but it is still present. She does walk out of it fast. She is also starting to get stir-crazy already.
PS: What I missed
This just comes to show that is easier to notice when new things crop up than things seizing to happen. It wasn’t until the morning after Cookie’s PT treatment when she did a pretty nice stretch. She always stretches a lot. It didn’t occur to me that she stopped doing that until after she started again.
Things that don’t happen and should are apparently harder to notice, especially when you’re more focused on things that are.
Update from the PT appointment
Cookie is sore through the thoracic back as before. It doesn’t look like we have anything new there, I massaged and lasered the area.
Cookie’s left front, all the joints are moving well with no signs of discomfort. The tendons I suspected [supraspinatus and biceps tendon] might be involved all seem ok. I did find her to be painful in the area of the upper shoulder around the infraspinatus, rhomboid, and deltoid muscles.
I performed massage of the area, stretch, laser and ultrasound of the muscles also. (Cookie was weirded out by the new thing.)
I checked Cookie’s toes, metacarpal and carpus and they all seem happy.
See how she feels, She did let me massage fairly deep so she may be a bit sore, If that’s the case you can apply ice for the night and then discontinue.
Assissi loop can be applied over the upper back T3-T6 area as well as over the outer/upper shoulder—three 15-minute applications a day.
I also massaged her right shoulder around the edges of the scapula because its was a little tight in there.
She maybe had a subtle lameness on arrival and did not seem to be exacerbated by the massage and stretch.
I think the back is sore more related to her activities as you explained. It seems more muscular but perhaps an adjustment would help. I dine find any muscle pain into the neck as before.
I would give her a few .more days of rest and the loop and see how she is doing and then try return to activity.
Lameness Exam: What Am I Missing?