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b) Add Bu Yang Huan Wu for Qi or Yang Deficiency (rear weakness, pale and wet tongue, and deep/weak pulse). Better tolerated than Double P II, so can use instead of Double P II if animal is prone to diarrhea.
c) Add Di Gu Pi San for Yin Deficiency (cool-seeking, or rear weakness, red/dry tongue, and fast/thin pulse).
d) Add Hindquarter Formula for Qi and Yin Deficiency (cool-seeking, rear weakness, red or pale tongue, and fast/weak pulse).
e) Add Stasis Breaker if a tumor or mass is present in the spinal cord
f) Add Jie Gu San for fractures of the vertebra.
Physical Rehabilitation for General Practitioners
In conservative cases of acute and recurrent thoracolumbar disk disease, it is important to perform minimal intervention and avoid motions that might
risk further herniation of disk material for one month or longer. Patients with cervical or thoracolumbar disk disease are more likely to have proprioceptive and motor deficits, requiring greater attention to balancing and strengthening activities.
A. General exercise:
a) Gentle massage of musculature in the cervical, forelimb, paraspinal, and hindlimb for 10-20 minutes to warm up the muscles or to relieve muscle tensions, BID- TID
b) PROM with bicycling movements all joints of affected limbs, 10-15 reps, BID-TID
B. Proprioception and balancing training:
c) Assisted Standing with abdominal support (e.g. sling, physioball beneath abdomen, standing in water level to the greater trochanter) as needed on a stable, high- traction surface; gradually decreasing support as the patient was able to stand better
d) Weight Shift (weight bearing, balance): Stand behind the dog with the hands placed on either side of the pelvis to support the dog for rear limb weight shift (place on the chest for front limb weight shift). With the limbs
in a square standing position, the dog is gently pushed in one direction, and then the other in a slow, rhythmic fashion. Gently push 10-15 times, BID-TID. Make sure this is done on a surface with good traction with the four legs underneath the dog in a normal standing position
e) Challenged Standing (improves weight bearing, balance/proprioception): Have the dog stand on any irregular surface such as couch cushions, foam, trampoline, etc. While standing, can provide gentle
pushing to challenge balance, but not too much to lose balance. Repeat 5-10 times during each session, BID-TID.
f) Figure Eights (balance, spinal ROM, weight shifting): Walk the dog on an outline of the number ‘eight’ on the ground. Start with SLOW speed and BIG Eights. Watch the weight-shifting and weight-bearing carefully. Repeat 5-10 times during each session, BID-TID.
g) Weave Poles (core strengthening/range of motion): Place the cones or bottles close enough together that the dog has to bend its spine sufficiently during the exercise. This distance is typically slightly less than the body length of the dog. Lead the dog carefully through the cones so that the head, neck, and body flex as the poles are negotiated. Repeat 5-10 times during each session, BID-TID.
h) Obstacle Course (balance/proprioception): Place various objects in a hallway or in a line and slowly walk the dog over the obstacles on a short leash. Obstacles can be pillows, cushions, rolled towels, PVC pipes, broom handles, air mattresses, steps, dog beds, etc. Repeat 5-10 times during each session, BID-TID.
C. Strengthening (typically 4 or more weeks postoperatively):
i) Sit to Stand (rear leg strength/ROM): Using a treat or other cue, the dog is placed in a square sitting position. She is then allowed to push up to a standing position. Be certain that the dog sits and stands squarely and symmetrically. Placing an affected leg against a wall
or having the dog sit in a corner helps to encourage symmetrical sitting and standing. Repeat this motion 5-10 times during each session, BID-TID. Give only as much support as needed to help encourage the dog to use its muscles
j) Stair Climbing (ROM/strengthen legs/core): Begin with wide, low stairs; avoid open stairs. Gradually increase number and steepness of stairs. Initially, walk dog upstairs 5 steps , and downstairs 5 steps. Repeat 3-5 times, SID-BID. Gradually increase the steps up to 10 each time.
k) Cryotherapy at lesion site as needed for 20 min after exercise
* Caution: Choose only 2-4 exercises per session. Other exercises may be performed as part of a home exercise program. Doing all exercises may result in lameness and pain early in the program
Outcome Measurement
Using a 0-5 grading scale to evaluate clinical neurological signs of IVDD (Table 1), it can be a valuable tool to help choose the mode of treatment, determine the prognosis, and assess the success of treatment. 9 For the most optimum recovery, it is best to use TCVM with decompressive surgery for cases with grades 4 and
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