Case Study - Muscle Matters - Manual Therapies & Phototherapy helps improve Mobility and Quality of

Introduction:

My Geriatric Cairn Terrier, Libby, who has suspected Degenerative Neuropathy, with myoclonus and mild ataxia, remains active and retains good muscle mass, enabling her a good quality of life in old age.

Patient Description:

Pure bred, Female Cairn Terrier, born 05.04.2006, spayed at 3 yrs - an average weight of 7.6 kgs – Breed Show Exhibit until the age of 3 yrs – Re-homed to me and started competing at Agility from the age of five and then retired at age of eleven (after showing signs of disinterest, not injury)

Case History:

13 yrs:- 

Oct 19 - Physically becoming a little unsteady on her legs & tired after a long walk   

(approx. 2 miles). But not after bursts of exertion.

14 yrs:- 

Oct 20 – Now started to notice a lack of stamina when on walks.

Feb 21 – When resting – occasional rapid eye blinking followed by slight head bobbing.

15 yrs:- 

Apr 21 – Forelimbs – visible twitching of muscles, sometimes making her take a                

step forwards. But no decrease to activity levels.

May 21 – Twitching now visible through thorax to hindlimbs and progressively happening more  

often. At worst counted 30 episodes in one day. Only lasts approx. 5 secs.  Stops her 

from whatever she is doing i.e. drinking/eating – mobility unaffected. 

Exercise levels dropped considerably.

Very unsteady on her legs later in the day (when tired) – almost losing balance.

Vet consulted – Diagnosis – Degenerative Neuropathy or Partial Seizures.

Medication trialled for Partial Seizures. Twitching (myoclonus) reduced, but side effects from Meds. (Lethargy, slightly unresponsive) Making her less mobile than the twitches, so meds. discontinued. No increase in twitching.

Sept 21 – Had an acute episode of lameness left forelimb (no obvious reason). Normal function returned after 10 days of meds. light exercise. Peripheral vision also starting to impair, together with hearing at this stage.

Oct 21 – Started to experience anxiety type behaviour:- trembling, panicking, panting, lasting for periods of 20-30 mins – generally after resting or after eating.

Gait changes – pacing/shortened stride in walk, mild H/L nail scraping (1 in every 10-17 steps). At the end of walks her tail carriage is low.

Postural changes – kyphosis – mid to low tail carriage.

Vet consulted for signs of pain/discomfort – medication trialled – 2 wks.

Changed her routine – from where she sleeps/rests to where she eats and what she eats from.

Feb 22 - Only had the odd few days per month of showing any signs of anxiety. 

Lentil sized mass just lateral of right 4th nipple discovered – removal attempted but went into heart block – operation abandoned.

From Feb 22 – to date – No more displays of anxiety.

Veterinary monitoring ongoing for repeat medication six monthly.

Veterinary Physical Exam Summary of Findings - Between – Sept 18 to Aug 22

· Heart Murmur Grade 1 detected Sept 2018 – Now Grade 3.

· Heart rate within normal parameters and pulses good.

· Good range of motion all joints.

· Focal cloudiness approx. 2x3 mm centrally bilateral corneas and early nuclear sclerosis.

· Inguinal hernia left side (fatty tissue).

· Neurologically sound.

· Pupillary Light Reflex intact.

· Menace Response intact.

· Bilateral cataracts.

· Proprioception normal.

· Stiff Hindlimb gait.

· Hips/Stifles nothing abnormal discovered.

· Slight Ataxia.

· Kyphotic.

· PCV Bloods – Good for age.

Summary of My Initial Physical Findings – Between Feb 21 – Oct 21:-

· Slight restriction on protraction of forelimbs.

· Kyphotic.

· Tension in Cervical region.

· Sarcopenia – Thoracic & Pelvic limbs, Spinal.

· Gastrocnemius m. slightly congested.

· Mycolonus felt bilateral hindlimbs, medially - Sartorius/Quadriceps Mm. (femoral nerve?)

· Tail responsive to stimulation.

· Ataxia – (Neurologic - Abiotrophy?) affecting hindlimbs only.

· Delayed paw positioning reflex – 2-3 sec

· Slight resistance to hindlimb flexion.

Treatments:

· McTimoney - From 2015 Libby had been having regular sessions after displaying discomfort in her right hind limb & then continued due to her competing in Agility & then just for general maintenance. Her last session was in Sept 21 as she appeared to be sore afterwards.

· Pharmacologic – monthly injection.

· Nutrition

· Manual Therapy – Massage & Mobilisations – Every other day.

· Phototherapy – Photizo Vetcare – Every other day.

· Regulated exercise – One walk daily, regular access to garden.

· Gentle exercises.

· Weight management.

Conclusion:

While we know there is no single therapy out there to delay the loss of muscle and function associated with aging or disease, a multimodal approach clearly appears to be helping Libby to maintain a really good quality of life at nearly 17 years of age. Below are different areas which can be measured to help support this:-

· Retention of muscle mass – 

Measurements taken in April 2019  

o R Thigh – 7.5 cm R Thigh – 7.5 cm

o L Thigh – 7.5 cm L Thigh – 7.5 cm

o R Forearm  – 6.0 cm R Forearm – 6.0 cm

o L Forearm – 6.0 cm L Forearm – 6.0 cm

o Waist – 15.0 cm Waist – 15.0 cm

o Neck – 12.3 cm Neck – 12.3 cm

 Measurements taken in March 2023

o R Thigh – 7.5 cm R Thigh – 7.5 cm

o L Thigh – 7.5 cm L Thigh – 7.5 cm

o R Forearm  – 6.0 cm R Forearm – 6.0 cm

o L Forearm – 6.0 cm L Forearm – 6.0 cm

o Waist – 15.0 cm Waist – 15.0 cm

o Neck – 12.3 cm Neck – 12.0 cm

· Mobility levels (daily exercise) managing to sustain 50 mins to 1 hr (approx. 0.46 of a mile) comfortably.

· Exercises – Tailed specifically for a geriatric patient. 15 mins. over a wk. 

· Weight management – from 8 kgs mid-2020 to a stable 7.6 kgs from late 2020 to date.

· Hindlimb nail scrapping – 1 in every 10-17 steps noted in Oct 2021 - no decline.