Pre And Post Canine Surgical Recovery Aided By Deep Oscillation Therapy
A huge thanks to owners, Robyn Alston and Simon Frances for sharing their story of devotion and determination in the rehabilitation of Twiggy The Lurcher with PhysioPod UK Ltd. Full story with videos at https://www.linkedin.com/pulse/pre-post-canine-surgical-recovery-aided-deep-therapy-mary-fickling/
"We rescued Twiggy, our Lurcher, in March 2016 aged approximately 4/5 months old. She had been kept in a rabbit hutch for the first twelve weeks of her life, during the cold Winter months before being placed in five homes in less than a five week period via "free to a good home" ads. She then ended up in the pound, was placed with an emergency foster, rescued and then came home to us, all in just one week. As you can imagine, she was highly stressed and mixed up and came with plenty of baggage.
Six months passed by and with the help of behaviourists, Twiggy was making good progress, then one day, by accident, a workman let her out of the gate and she was hit by a transit van outside the house. Twiggy was rushed to our local vets, where he thought she had perhaps gotten off lightly with a broken toe with the way she stood to be examined, not showing any signs any fuss. But then before our eyes, bruising began to appear in her inner thighs, this concerned him and he decided to keep her there for X-rays.
A little later we received a phone call and the news was not good. Twiggy had sustained a right acetabular fracture and pelvic fractures. Basically, her femur had smashed straight through the hip socket, blowing it out and into the pelvis causing fractures there too. We were told she needed to get to Davies Veterinary Hospital urgently and that was probably one of the worst forty minute drives of our lives. Twiggy was stretchered out of the vets and we were instructed to keep her completely still on the journey; this was a big ask, as she hated the car and was a very stressy traveller, without the added problem of her being in shock and in pain. I got in the boot with her and basically had to pin her down for the whole drive. My face was very close to hers and I remember thinking please don't bite me. She didn't, thank goodness!
When we got to Davies, Twiggy was whisked off in one direction and us in the other. We sat with the surgeon who explained how serious her injuries were and we were given the surgical options:
- We could leave her without a hip socket and allow scar tissue to make a new one for her, this can be very successful with smaller dogs but Twiggy was tall.
- Amputation - I wasn't opposed to this option as I have seen many sighthounds and lurchers living full and happy lives with three limbs. However, Twiggy was pretty wild, fast and very young, and we were slightly concerned about her damaging the remaining hind leg and then having no options.
- Which we opted for, the most tricky option, a complete reconstruction of the afffected areas.
The third option was explained as one of the most complicated orthopaedic surgeries and that aftercare would be quite extensive. Before proceeding, we opted to have some MRI scans done, as her injuries were consistent with internal bleeding. We wanted to see if this was going on before putting her through the operation, luckily, there was no bleeding internally. The MRI scans are below:
It was a Friday and surgery was scheduled for early the following Monday, allowing Twiggy time to become more stable. We had left the vet hospital feeling shocked and numb ourselves, and we changed our minds on our options probably a hundred times over that weekend.
Surgery was actually delayed until the Monday afternoon, as we were still so unsure that we had to have lengthy conversations with the surgeon on Monday morning. I think what swung it for us in the end, was the surgeon saying that despite being so horrifically injured, Twiggy was very determined to get up and walk and get going again and not licking her wounds, like normal dogs would; she was incredibly stoic throughout.
That evening, we got a call to say Twiggy was out of theatre and that the reconstruction had gone really well and she was settled in her kennel. We were so desperate to see her, but were advised to stay away, as she was fragile and getting excited could damage all the work that had just been done.
My husband decided to take gifts over for the surgeon and nurses the next morning and he called me quite beside himself saying: "I've just seen her"! - as he was leaving the car park, he saw a nurse taking her out to the garden and she had suddenly stopped in her tracks and cocked her ear up to the side listening. She had heard his car engine and knew he was there. He said it was so hard to just keep on driving and not jump out to see her. He told me that, apart from being shaved, bruised and swollen with a pretty long scar, she was looking great considering and powering on with such determination. That's my girl.
Getting Twiggy Home..
We collected her towards the end of the week and it wasn't really the amazing greeting we were expecting. She actually looked quite annoyed about it all, pretty dishevelled and not too impressed about the physio session/instruction we had to go through before leaving. Nor was she too happy about the huge cone on her head. She had been on methadone and was probably suffering some degree of withdrawal too.
Simon and I took six weeks off work between us to care for her at home, as it was too risky to have her prancing around stressing in the back of the car on the way to and from work with me every day. We had said from the beginning, that she wouldn't cope with cage rest for the period, so the vet said she could be in one large room or two small rooms. No stair climbing and short five minute toilet breaks and 'always' on a lead.
Luckily, we had a large carpeted sitting room and we laid rugs on the path through the house and into the garden, so she wouldn't slip. Her separation anxiety rocketed and it was difficult to leave her, even if to just to take a quick shower. So whoever was at home, had to tie in all tasks, including walking our other young lurcher, around the other one leaving.
We passed the time with Twiggy doing physio, massage, grooming her and as she picked up in herself, brain games and training tricks and of course, plenty of cuddles. One of the hardest things was how upset she got when Dingo was taken out for a walk; it must have been like torture for her.
We were to return to the hospital at six weeks, but we felt quite out of our depth and asked the hospital to recommend a physio that we could have come to the house to help us and they recommended Nadia Kopec --Nadia was an absolute rock and Twiggy loved her from the moment she met her. The time passed more quickly than we thought it would and we were back at the hospital for the six weekly check.
We had thought Twiggy would be discharged from the surgeon and be over to the physio's for a few weeks of hydro and normal life would resume. Sadly that wasn't to be. We had a chat with him in his consulting room and he said he would like to go outside and watch Twiggy walk. I remember Simon walking her up and down and noticing straight away the look on the surgeon's face. Something was wrong..... very wrong. She was still quite lame, but to be honest after such a big trauma, I thought that was probably normal, but he felt she should be much less lame by now and said he needed to do X-rays.
We waited while they did this and then met again in his office. The vet delivered the news that the metal implant which had been screwed in to form a hip socket, had failed, a screw had broken and another buckled and there was malunion of the bones. We were so upset to hear this, as we had been so careful.
Twiggy would now need a total hip replacement, but not for six months, as we needed to rebuild the wasted muscles to hold in the new hip and allow time for a callous to form around the bones. We were to start hydrotherapy at the hospital weekly and do a lot of physio with her at home and to be in touch if anything seemed wrong between then and April, when the next operation was scheduled which would be carried out by the lead hip surgeon.
None of the restrictions at home were going to be lifted until after the next operation (bar her being able to come to work now and little lead walks starting at five mins per day and building up by five minutes a week). So we bought an airbed, as sleeping on the sofa was starting to take its toll (we ended up getting through about three airbeds as Twiggy and Dingo loved biting into them after we had pumped them up).
A very regimented routine followed, getting up at the crack of dawn to walk the dogs, one with Twiggy on her short walks and the other taking Dingo, then doing her physio, then off to work, an hour of physio at lunchtime and then another hour in the evening.
Nadia visited regularly giving us more things to add in to rebuild her muscles and we did the weekly trips for hydro. However in December, we had to stop the hydro, as Twiggy was completely non-compliant and had also had to go in for more X-rays due to a swelling that had appeared on the hip. This turned out to be a seroma and they thought maybe being caused by the tension wires and that possibly hydro was aggravating this and causing her pain.
Introducing Deep Oscillation Therapy to the protocol
I spoke to my friend Rebecka Blenntoft following the six week appointment and she kindly suggested we borrow her Deep Oscillation machine (which she uses in human and equine manual lymphatic drainage with excellent results). It provides electrostatic massage to a clinically proven depth of 8cm and can be used over implanted pins and plates. There are studies backing up its effectiveness too.
Rebecka felt Deep Oscillation would help work on the scar tissue, to get it in as good a condition as possible for the next operation. She brought it over to us and instructed us on its easy use. Twiggy took to it straight away, she would quickly trot over to her bed whenever we got it out and always lie on her left side giving us access to the right leg.
We now had another thing to add to the regime; we were tired and run down, but weren't going to miss any chances of getting her in as good condition as possible for her new hip. Twiggy loved Deep Oscillation and it was another slot in the day to keep her still and calm!
I imagine the sensation of the gentle vibrating impulses were lovely on her leg and that it gave her a degree of pain relief too. Fast forward six months to April 2017, and at the check up, the new surgeon was happy with the condition we had got her into and after another set of X-rays, confirmed her booking for surgery.
We felt terrible dropping Twiggy off there again wondering what memories it held for her, but we knew we had no choice and we would all have to grin and bear it. It was the end of the month and the Bank Holiday weekend. Surgery took place on the Friday morning and this time I went to work, rather than staying at home pacing about. They said she was going down at 7.00 am and we should hear around noon.
At 2.30 pm, the vets rang to say all had gone well and Twiggy had a very small, new hip, which was tightly fitted with the majority of the metalwork gone. They called again in the evening to say she was sitting in her kennel, eating chicken with her pills in and had an epidural to keep her comfy for the night. They would call me late morning on Saturday with an update.
Saturday morning came and went with no news, so at 2 pm I rang and spoke to a receptionist who said she would put me through to her kennel nurse, but after holding it was the receptionist I spoke to again, who told me that the duty vet would like to speak to me but had a couple of emergencies and would call me as soon as she could.
The waiting is awful when you get the feeling something isn't right. She called back later and said that they'd found Twiggy in her kennel in the morning having removed all of her stitches, so she had had to be rushed off for a clean out and stapling. She was also a little concerned that Twiggy was showing reluctance to weight bear on the affected leg, but was quite vague about it. The same news about the weight bearing followed on Sunday and also that her paw was knuckling over. As soon as I heard this, I thought 'nerve damage' and this was confirmed by the surgeon.
She'd been X-rayed after taking her stitches out and again on the Tuesday morning and the hip was where it should be, so the vet felt that the sciatic nerve had been stretched during the op causing her the pain and knuckling over, we could collect Twiggy later in the week.
Seeing her come out of the kennels that time was probably the hardest moment throughout it all; she was dragging the leg along and once again had had a lot of drugs and had been given a mild tranquilizer to keep her calm on the journey home.
Twiggy was pleased to be home though, and did come round much quicker than she did from the first operation and jumped up the next morning as if to say 'I'm ready for my walk now'! This time round we had removed all the sofa's from the sitting room and made a den out of it with a mattress from a spare bed and loads of cushions and throws. I was terrified of luxation of the hip, although it being in there so tightly we stood a chance of it not happening. We ended up sleeping downstairs with her for months, as the restrictions as before, went on for a very long time. Again, we took six weeks off work between us and worked closely with Nadia and the physio's at the hospital and the surgeon.
The surgeon wanted her back at two weeks post op to see what was happening with the nerve, he felt it should resolve itself in 2-4 weeks. When we went back he was worried, as she had adapted her movement to hike up the hip to get around and he felt the muscles were going to become fibrotic, which would be a disaster, so we were to start hydro the next morning and return for it twice weekly.
We decided there and then, that because Twiggy's problems were going to go on for a while and we needed to avoid her muscles becoming fibrotic that we should invest in our own Deep Oscillation unit. We contacted Julie and Mary at PhysioPod and they were so helpful and delivered it promptly.
Twiggy's Rehabilitation Protocol:
After an iffy start, Twiggy did really well with the hydro the second time around and we did three hours of rehab daily, morning noon and night again and it included a vast range of physio exercises, massage, deep oscillation, kinesio taping, muscle stimulation, hot and cold therapy and proprioceptive techniques, along with her two weekly hydro sessions and building up her walks again.
The nerve damage was hard to put right, but we taught her a command 'foot' whenever she stood with her foot knuckling over which meant 'flip your foot back', which she got and then we literally crawled behind her in the garden - one of us walking her slowly on the lead and the other placing her foot the right way as she stepped. We taught her the command 'step' which meant to place her foot properly in walking and she soon got it and after a while of this eventually started placing all paws firmly on the ground with each step.
We continued our rehabilitation routine until the 30th December 2017, when she was eventually discharged from Davies. Twiggy now legs it around like a greyhound and I think only a very trained eye would spot something had happened to that leg, so it really was worth all the hard work and we were so lucky to have an amazing team of vets and physio's behind us spurring us on when times were tough.
A Special Thank You..
We are so grateful to Rebecka Blenntoft for suggesting Deep Oscillation to us and loaning us her machine. We do believe that without Deep Oscillation, we may have had a much bigger struggle to get Twiggy where she is today.
Deep Oscillation in Humans
As well as treating Twiggy, I treated Nadia, the physio with Deep Oscillation after she had broken her wrist. She felt it helped hugely (see below).
I have used it on my own knees, I had Osteochondritis dissecans (OCD) as a child which is a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. I had it in both knees as a child which didn’t resolve into adulthood and although I had physio, osteopathy etc I didn’t rest the knees at all and then as an adult I made them worse by running a marathon and a half-marathon and then doing Snowdon and Ben Nevis. The machine helps with the swelling I get in them and also the pain so I have experienced first hand the relief it provides. It has helped us both with injuries and the aches and pains of our friends and family too.
Twiggy's recovery was so inspiring to me with regards to how something so serious can get so much better, that I have returned to doing massage and reflexology in my own home practice with Deep Oscillation providing some very positive outcomes.
Thank you again to Mary and Julie, the great ladies at PhysioPod for their continued support.
To read more of Deep Oscillation in equine and canine please click here
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