Tuesday, November 24, 2015

Figuring out What Might Be Going on with Cookie's Legs: The Diagnosis

Most of the sinister reasons why Cookie's legs weren't working the way they should were more or less ruled out. We were awaiting the appointment with orthopedic specialist hoping that we'll get some definite answer(s).

Cookie in pursuit of a chipmunk

The specialist examined Cookie thoroughly.

She translated our description of the events as Cookie not being able to get her hind legs under her. In retrospective, that could be a good way to describe it. It is important from diagnostic point of view.

In physical examination, both iliopsoas muscles were sensitive touch and particularly to stretching Cookie's hind legs backward.

On that note, the stretching of the legs was causing Cookie enough pain to cry, yet the vet went on doing what she was doing.

I was taken aback and didn't really know what to do about it as it wasn't clear whether it was or was not necessary for the diagnosis. I stood there, screaming inside, praying it's over sooner rather than later. The vet finished just when I was going to make her stop.

Knowing now what the diagnosis is, I DO NOT feel it was necessary. Jasmine's vet diagnosed the same type of injury on Jasmine without causing any pain whatsoever.

I will not allows this to happen ever again, that's for sure.

I asked around and apparently such things happen often with orthopedic surgeons. I don't find it acceptable. Jasmine's vet is not a specialist but is able to diagnose things just by feeling the resistance and subtle signs of pain. He never made Jasmine cry no matter what he was diagnosis, except when her neck was bad and she cried even when nobody was touching her.

I feel I failed Cookie by having allowed that.

In retrospective, if we just made the trip back South to see Jasmine's vet we could have had the diagnosis without causing pain to Cookie. Next time we should probably just do that.

Besides that, the specialist did a rectal exam to feel for pain in lumbosacral spine, fortunately there was no pain there other than the obvious pain in the butt. There were no signs of any back pain, no neurologic deficits in any of Cookie's limbs and no issues with her joints. All joints checked out. Those were all good news.

The diagnoses was suspected bilateral iliopsoas injury.

She used the term suspected because I guess MRI would be needed to confirm that conclusively.

She said Cookie was going to have be on strict rest for one to three months. Whoa. Cookie is a dog who needs three hours of exercise and play daily. Because we did feel she should be taking a bit easier since the last event, we cut down to two hours and she was already bouncing off the walls at that! I expressed to the specialist than this was not going happen unless Cookie was sedated.

It didn't seem to surprise her much and she recommended a medication to use for that.

I will write about the medication later. I avoid using drugs for my dogs with all my might but I knew that without some chemical help Cookie was going to be frustrated, miserable, depressed and out of control--complete danger to herself. She needed help to remain at peace with the sudden lack of activity because the main part of her treatment was to be strict rest.

I also agreed on short-term NSAIDs until we were going to work out an integrative approach with Cookies primary vet.

The specialist agreed that it will be good to continue with Cookie's regular chiropractic treatments.

Typically, iliopsoas injuries come secondary to another orthopedic problem. In Cookie's case this would be the situation at her pelvic region.

She recommended a physiotherapy consult which we had already all planned. I was very happy to find out that by leaving our old place we didn't leave the possibility of hydrotherapy. There is a place up here, at reasonable distance, which does physical therapy and has underwater treadmill. It's about an hour and a half drive each way but that's not really that much further from how far we normally travel(ed) to any of our vets.

The diagnosis made sense to me. The needed treatment--strict rest, nearly broke my heart for Cookie.

But we gotta do what we gotta do to get her back to doing what she loves.

Cookie's primary vet was kind of surprised by the diagnosis, unfamiliar with this issue. That's not too strange, many vets are not familiar with this and it's rarely diagnosed. Rarely diagnosed, though, doesn't mean a rare condition.

The specialist is quite confident that not only the physical exam but the presentation match this diagnosis quite well.

Thinking about it armed with this knowledge it is adding up.

What the heck are iliopsoas muscles?

I've looked at tons of picture but all of them make it hard to really picture how the muscle goes.
This genius depiction by massagetherapy.com keeps the illustration very simple and awesome.

Iliopsoas muscles are also referred to as hip flexors or groin muscles. Their main function is to flex the thigh at hip joint. In other words, they work when the leg moves forward toward the body. Which would explain why with this injury Cookie would have a hard time getting her legs under her.

There isn't much good literature on this type of injury in dogs.

But Jasmine's vet is familiar with it, and through Jasmine so were we.

This injury is most typical in sporting and working dogs. But Cookie works at least as hard as an agility dog, probably harder, particularly given the terrain she runs through. Overall, it's all adding up to this diagnosis.

So that's what we're working with now.

Further reading:
Iliopsoas Muscle Injury in Dogs

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To Breathe or Not To Breathe: Cookie's Hind Legs Transiently Fail to Work (Again)
Figuring out What Might Be Going on with Cookie's Legs: The Process


Do you have a story to share?

Your story can help others, maybe even save a life!

What were the first signs you noticed? How did you dog get diagnosed? What treatment did/didn't work for you? What was your experience with your vet(s)? How did you cope with the challenges?

Email me, I'll be happy to hear from you!

2 comments

  1. Well... the good news is that it was now worse, right? Though the treatment really is heart breaking for Cookie. I hate that the vet hurt her during the exam (and I wouldn't think did the injury any good either). Another example of all vets are not the same. Can't remember if you've already seen the chiropractic vet, but hoping that makes a huge difference. At least you now know what's going on and can do something positive about it.

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    Replies
    1. Thank you, Sue, yes, at least it's not worse. Though the ortho vet said that these things CAN get quite debilitating. Hopefully we can get those muscles sorted out as quickly as possible and as completely as possible.

      The rough exam, I suspect is either because that's how it is taught or because of lack of experience with which gentle manipulation and simply getting resistance at certain point would have been enough for a diagnosis. I know with Jasmine's vet such things were enough. They should set his hands in gold.

      Yes, Cookie's been seeing chiropractor regularly (monthly) now seeing weekly trying to get on top of things.

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