Case Study: HBC, Multiple Fractures and TraumaJune 16, 2022
Background: Initial Presentation and Immediate Care
Nika is an 11-year-old spayed female Australian Shepherd mix who presented to Dr. Richard Kohler in October 2021. Nika was not “new” to Massachusetts Veterinary Referral Hospital but had been seen in 2012 by the Surgery and the Physical Rehabilitation department after she ran across the street to see a friend and was unfortunately hit by a car. From this incident, she ended up with multiple pelvic fractures, as well as, fractures in various long bones of both ankles and ruptured ligaments in her stifles. Pelvic trauma to her inguinal region caused muscular tears, and more importantly, lifesaving surgery that had to be performed to repair a diaphragmatic hernia.
Thankfully after weeks of rehabilitation therapy, she was walking but not without a very abnormal gait. She continued to recover to the point of self-ambulation. Her outstanding owners and the rehab team of Mass Vet nursed her along to adequate and comfortable mobility, but her hind limbs never resumed normal configuration, nor did they regain full function.
In the fall appointment with Dr. Kohler almost a decade later, it became apparent that Nika’s old injuries had taken their toll. Many ill healed joints in her hocks, stifles, and pelvis were now disrupted by arthritis and the torn muscles had fibrosed to the point of ankylosing (crippling) conformation, no natural movement. Nika’s owners had to lift her to get her moving and she could not sustain more than 4-5 feet of motion. They would give her rides around the neighborhood in a wagon which she enjoyed, but of course, they hoped for more. Dr. Kohler did not believe surgery was an option given that so many joints were involved in her non-mobility, but that didn’t stop him from suggesting she seek help from the Pain Management team who works closely alongside the surgeons.
acupoint injections and medications
Our first job was to make Nika more comfortable. This was done through a combination of acupoint injections and medications to help reduce muscle inflammation, tightness, fibrosis, and nerve pinching because of the mal healing of long ago.
Next, Nika was fitted for a mobility cart. We utilized a cart from Walkin’ Pets by HandicappedPets.com in nearby NH. Given that she had the potential to heal, the goal was to make the cart comfortable so there was no skin and rubbing issues. Also, our goal was to allow Nika to get a small workout from the vehicle when she used it, therein helping her to improve for the long run. Nika was hesitant in the new device at first, but with her wonderful owner’s encouragement & positivity and all her neighbors help (as it turns out, she’s a celebrity at home), she has done fantastic in utilizing the cart “part-time”. It has been a great plane of function and assistance that allows her to return to a great life.
Many neurologically and musculoskeletally challenged small animal patients who get to the point of using a mobility cart hardly ever reach “the sweet spot”, namely, a functioning quality existence wherein they learn to use the cart for difficult times but can ambulate without it well. Even better, the lucky ones improve because of the cart. This requires three essential components:
- A great family (Nika’s moms and neighborhood)
- A great dog (If asked, everyone will say that she is exceptional and exceptionally lucky!)
- A cart that allows adaptation and modification as life, dog, environment, disease process changes. (Nika should be the poster “dog” for the company, she does so well in their vehicle!)
According to her owners, Nika now has quite the charismatic existence; visiting many houses close by & getting biscuits, bringing her happiness and cart through the neighborhood. She does so despite her chronically disfigured and ill healed back end, thanks to her family’s commitment (financial and emotional, and it’s been a long haul!), the mobility cart, and new chronic medication regimen.
Being an adopted mutt (part Boxer part Australian shepherd), Nika’s her lower jaw abuts beyond the upper jaw by an inch or two giving her a chronic “smile”. However, it’s her wiggling, tail wagging, “always pushing against you for love” silliness that attracts so many technicians, assistants, and concierge to her when she comes to visit. Nowadays, her tires run over our toes (thankfully she’s not too heavy!). Nika knows her way around Mass Vet from the front to the back, seeking “treats” from her “old friends” offices, many of whom remember her from her initial accident so long ago. Nika’s moms are pleased with her progress and have waited through the pandemic to again be able to enter the hospital in her cart, trail down the hallways to meet and greet.