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Rehabilitation for Peroneous Tertius Rupture

May 17, 2018

Rehabilitation for Peroneus Tertius Rupture  (Solange Mikail)

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Mikail, S; Stancov, L.Y.; Lopes, A.

Espaco Equus- Brazil

INTRODUCTION

A 17-years Old Lusitano horse was evaluated at Espaco Equus Rehabilitation Center after a nine months history of rest due to a rupture of the Peroneus tertius in the left hind limb. Ultrasound examination at  arrival showed an enlargement of the Peroneus tertius near its origin, with hypoechoic areas and diffuse edges. A biomechanical evaluation was performed with an app (Hudi Thecnique) for smart phones, developed for measure angles during exercise. The angle of the left tarsus in maximal flexion was 140 degrees.

OBJECTIVE

The goal was to reeestablish the ability to flex the left tarsus.

MATERIAL AND METHODS

Two treatments were implemented: Therapeutic Laser (Respond Systems Luminex®) 20 J/cm2 to address the healing of the lesion and a program of exercises with progressive intensity to address the flexion of the tarsus and strengthening of the limb. The exercises consisted in stimulation of the tarsal flexion, using different techniques during one month: whip, handwalking, ridden exercise, tactile stimulation of the pastern. walking over poles, cavalettis and kinesiology taping (VetkinTape®) during exercise.

RESULTS AND DISCUSSION

After 30 days, the ultrasound examination showed the Peroneus tertius with normal size and echogencity and also with well defined edges. The biomechanical evaluation showed that the maximum flexion angle of the hock at walk improved from 140 degrees to 57 degrees. According to the literature (Koenig, 2005), the lesion of the Peroneus tertius takes several months to heal, and when is near its origin, it carries a poor prognosis. Despite the poor prognosis for the lesion site, this case had an excellent outcome in a short time.

 

 

 

CONCLUSION

This rehabilitation protocol resulted in an excellent outcome in a short time (one month), considering the previous longtime of rest without evolution (nine months). It also highlights the value of adding a program of therapeutic exercises during the healing of this type of injury.

 

REHABILITATION PROTOCOL

 

 

 

 

REFERENCES

KOENIG J, CRUZ A, GENOVESE. R, etal. Rupture Peroneus tertius tendon in 27 horses. The Can vet Journal p. 503-506 Jun 2005

CLAYTON HM; KAISER LA, STUBBS NC. Hindlimb flexion responses to different types of tactile devices. Am J Vet Res 72: 1489-1495. Jan 2011

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Combating White Line Disease

May 2, 2018

Every farrier or horse owner is unfortunately familiar with white line disease.   Contributing factors vary widely from nutritional and mechanical to environmental, but whatever the imbalance, the microbes which are always present in some form in the hoof, proliferate out of balance leading to what we know as white line disease.

The white line in a horse’s hoof is present only when barefoot which is why a good farrier is usually the first to identify the disease.  A healthy white line is solid from heel to heel and is “waxy” white in color. An unhealthy white line will be black and striated (see associated image).  White line disease, presents as a separation of the wall and the sole as fungus and bacteria eat away at the layers of the hoof wall.  White line disease is a generic name for this insidious condition also called wall thrush, seedy toe and hollow foot.  The true issue is not in the white line but in the deepest portion known as the non-pigmented stratum medium.  White line disease caused by an active anaerobic bacterium mostly present in the toe and quarters of the hoof.

White line disease is treated by debriding the area, exposing the fungus and bacteria to air when oxygen is its worst enemy.  There are several commercial, topical ointments that have shown great success in addition to debridement.

One Respond Systems’ customer, Karen Gould from California, found herself with a case of white line disease on her hands that went undiagnosed by a previous farrier. She credits her current farrier, the diligent Nathan Zacharias from the San Diego County area of California, with successfully treating the disease. This is their treatment timeline and technique.  And just like many cases of white line, there were some treatments that lent to greater success than others.

The more information that is out there about treatment options and cases, once reviewed and analyzed, can help lead to faster recovery for others faced with the same situation down the line.

As always, consult with your veterinarian for proper diagnosis, treatment recommendations and medications before commencing any therapy program.

Timeline and Treatment:

– At the end of March 2018, Karen found out her horse had white line disease that went up about two inches from the toe.

– Cleaned thrush out and commenced peroxide twice a day into the separation until foaming stopped. Horse continued to be lame

– Lots of heat in foot.

– Started laser treatment with 2400XL Respond Systems laser using the Ultra-Wide, Super-Pulse Head. 20 min per treatment, twice a day.

– Commenced daily Empson salt soaks to address the continued heat in the hoof and draw out the infection

– Applies fungicide into separation area

– Continuing to laser twice a day to coronary band as well to stimulate new growth. Either on F6 or F3 if the area is super sensitive and hot.

– Farrier packed it with fungicides, copper sulfate, then hawthorn hoof packing, dental impression material (DIM) and pad.

– Pocket of separation had DECREASED from a week prior. Both the vet and the farrier seemed surprised at the positive progress

– Swelling is gone. No heat in hoof and horse moving soundly and willingly.

– Still lasering 5x per week including the coronary band.

Laser therapy was one part of a full treatment program to combat white line. In this specific case, as in all cases where bacteria, virus or fungi are present, laser therapy cannot kill the offending culprit. A multi-faceted approach using topicals, pharmaceuticals and natural remedies is required to conquer the disease-causing agent. Laser therapy comes into play by helping to reduce the inflammation and accelerate healing through a cascade of biochemical pathways that enable the body to fight back faster and reduce complications that lead to more severe lameness.  Laser therapy can help the other agents involved in the treatment plan work faster and more effectively. The continued use of laser therapy after the condition has cleared up stimulates new, healthy growth of the hoof.

Jazzy- Meriden Humane Society

December 7, 2017

Before and After 5.13.17

Before and After 5.23.17

June 9, 2017

 

 

 

 

 

 

 

 

 

At 9-years of age, Jazzy had been bred repeatedly, spent most of her life in a basement and probably had never seen a veterinarian. She was rescued by the Meriden Humane Society in Connecticut in May 2017.

When rescued, Jazzy had a gaping wound on the side of her head. Chronic ear infections and allergies had resulted in an abscess that ruptured leaving a large, open wound as depicted in the images dated 5/6/2017.  Jazzy was given antibiotics from the veterinarian to help fight the infection.

On 5/10/2017, Jazzy commenced laser therapy treatments using the following protocol:

– Use one layer of Saran wrap over the open wound when treating to prevent the spread of any bacteria
– 2 joules per spot for the open wound
– 4 beeps per spot for the ears and the tissue surrounding the open wound

Repeat daily. 

Within 1-week, the wound had decreased in inflammation and size (photo dated 5/13/17)

Within 2-weeks, the wound was almost closed (photo dated 5/23/17)

By 5 weeks, the wound was fully closed and fur was growing back (photo dated 6/9/2017)

By July 11, 2017, Jazzy had found her new forever home!

Jazzy at her new forever home!

 

 

 

 

 

 

 

 

 

 

Laser & PEMF / Suspensory Ligament

January 18, 2016

Presentment: 10-year old dressage horse with desmitis at the origin of Suspensory Ligament.

Treatment: Treatment 3x week with laser for 8 weeks (24 total treatments), Luminex Ultra 5W probe (808nm), dosage was 6 joules/cm.sq for first 4 weeks, 8 joules/cm.sq. for last 2 weeks.

This horse was also treated 3x weekly (24 total treatments) with Maxi Pulse PEMF legging for 30 minutes each treatment. PEMF therapy continues twice weekly for conditioning and maintenance.

Results: Horse was evaluated by thermography, and again 25 days later. Note how the inflammation pointed at the arrow is gone. Horse returned to competition (show jumping), and owners reported no recurrence of the condition as of December 2015.

case_2_img_1 case_2_img_2


Dr. Solange Mikail, DVM
Sao Paolo, BR
September 2015

PEMF / Equine Bone Cyst

January 18, 2016

Case Study Courtesy of Dr. Heitor Scholl, DVM, Sao Paolo, BR. (July, 2015)

Presentment: 3 year old mare with a bone cyst on the medial femoral epicondyle. Mild to moderate pain, cyst appeared 2 months prior, was large and was non-responsive to traditional treatment. Owner’s daughter unable to ride her favorite horse.

Treatment: Respond Maxi-Pulse legging was applied for 60 minutes a day, 5 times a week.

Results: After 9 weeks, the cyst had greatly reduced in size and pain was reduced such that horse could be ridden normally.

cyst_1 cyst_2 cyst_3
Bone Cyst After 60 Days                                     Bone Cyst First Day After Surgery                      PEMF Wrap During Treatment

 

Dr. Heitor Scholl, DVM
Sao Paolo, BR
July 2015

Use of Respond 2400XL Laser to Treat Head Wound on Screech Owl

December 10, 2015

June 12, 2008, juvenile male screech owl found hyperthermic, nearly drowned in a pond. Scalp lacerated, maggot infested, left eye closed and maggot infested, right hock edematous. June 13 exam by DVM found lacerations on scalp believed due to predator attack. Scalp from eyes to caudal portion of skull removed due to injury and infestation. Viability of site was questionable. Left globe intact, no blood, infestation cleaned and treated for conjunctivitis. Oral Baytril, topical Ciprofloxin, and Flurbiprofen given; diluted Chlorahexidine applied to wound. Photo taken June 16, 2008, three days post surgery.

  • Photo taken 6/16/08, 3 days post surgery

  • Photo taken 6/18/08 (two laser treatments)

  • Photo taken 10/10/08

Rehabilitation and Therapy Protocol-Initial
Due to concern that tissue would become necrotic, low level laser therapy was initiated. Dosage of 1 J/cm2 was delivered (F1) with 2400XL laser, 500mW probe, total treatment six to eight joules, once daily. Treatments 6/13, 6/14, 6/20, 6/21/2008 (four treatments). June 20, 2008 DVM rechecked patient, tissue on dorsum dry and healthy, no necrosis, left eye resolved.

Rehabilitation and Therapy Protocol-Extended
Consensus among Doctors regarding total wound closure and feather follicle regrowth was mixed. Additional low level laser treatments were ordered to close the wound and stimulate follicle re-growth. Over next two months, additional therapy administered on four occasions, 7/5 and 7/6/2008 and 9/11 and 9/12/2008 using above protocol. In September, the owl’s minor moult revealed pinfeathers in lacerated area and on eyelids.

Follow-up assessment
Due to re-growth of feathers, decision to overwinter the patient and allow full moult in 2009 to increase survival potential. The Respond Laser worked very well to expedite healing of the scalp laceration, but also appeared to stimulate feather re-growth in area with severe damage to follicles. The owl did not become stressed because of the speed of the laser treatments.

 

Photos and Case Study courtesy  
of Orchard Park Veterinary Medical Center
Contact DM Testa , LVT, CCRP

Layla

December 9, 2015

Layla had been a long term (>1 year) patient of the dermatology service for the autoimmune skin disease Pemphigus Foliaceous, of which the hallmarks are marked pain and swelling due to blistering, vesiculation, and secondary infections of the skin. Layla was on a combination of several immunosuppressive medications and chronic antibiotics but had never been in remission since her disease was diagnosed one year prior. Newly diagnosed high blood pressure and incredible liver enzyme elevations (ALP >5000) had lead to discussions about euthanasia due to decreasing quality of life. The owner felt Layla did not seem comfortable or interested in her normal activities (eating, playing) as her illness progressed. Her skin lesions had begun on her face (predominantly nasal planum) and ears and had progressed to body-wide. The UTVMC Dermatology service said this was the most resistant case of P.F. they had ever seen.

Images 1-3. Spring 2012. Layla is pictured at the heart of her flourishing disease, with ulcerated and blistering lesions across her body and face. Note the abdominal silhouette secondary to liver enlargement from the hepatopathy induced by the suite of immunosuppressive medications being used in attempt to control her disease. Her ALP liver enzyme value approached 45x the upper end of normal when these images were taken.

Layla became a patient of the Integrative Medicine Service in Spring, 2012. The owner was largely considering euthanasia, but wanted to consider all options prior to that decision. A variety of options were discussed, and after meeting the service and Layla’s owner decided to put Layla on a homemade balanced diet and liver-protective supplements. Biweekly sessions were begun using 670 nm module on the Respond Systems Luminex Ultra laser.

The first 6 sessions consisted of 6 J/cm2, CW, on lesions of the body and face. When working around the face, protective eyewear appropriate for the laser wavelength were placed on Layla; during the treatment on regions other than the face, a black cloth was held lightly over Layla’s eyes to shield them.

After the first two sessions, Layla’s owner noted improved comfort when walking due to decreased foot swelling as well as decreased pruritis and scratching. It was noted that the blisters present healed faster after laser therapy, and secondary infections were largely eliminated (based on observation and skin cytology).

After the first month of biweekly sessions, Layla began coming in once weekly for laser therapy. A repeat of bloodwork showed her liver enzymes had decreased by 50%, and her palpable hepatomegaly was visibly decreasing.

Images 4-6. June, 2012 (three months after initiating laser therapy). Note marked decrease in blistering lesion occurrence on the body and face. Few lesions persist,…..

slow wean off of some of her immunosuppressive medications was begun, and a repeated decrease in her systolic/diastolic blood pressure allowed weaning off of her anti-hypertensive medication. Monthly laser sessions have been initiated at the three month period and Layla will continue to be monitored and her progress updated.

 This Luminex Ultra 670 nm red laser has lead to an increase in skin lesion healing, and an increase in comfort to the patient with no side effects as were observed with her other modalities of therapy. The Dermatology service is amazed that Layla is approaching remission while being able to decrease her immunosuppressive medications.

Laser Specifications:
Power Density : 500mW/cm2
Beam Area: 1 cm2
Energy: 6 Joules
Energy Density: J J/cm2
Treatment Time: 12 seconds
Laser Output Power: .5W

 

Case study of Respond 2400XL laser system treating injured lamb

December 3, 2015

I used the 2400XL laser today to treat this 3 month old lamb who was attacked by a dog. She has had laterally flexed neck with muscle spasm (torticollis) and bite wounds for 5 days. I treated her with the laser and manual therapy – she was then able to position her neck in a neutral position and she fell comfortably asleep. I used the HPLP (500mW probe) at F4, 2J/cm2 on 6 points on each side of her cervical spine for a total of 12 points. I stayed on the dorsal and lateral aspects of her cervical spine. I also did some lymphatic drainage massage, reciprocal muscle inhibition techniques and passive positioning. The photos I sent were taken after the first 20-30 minutes. The one with her on the fleece was at 45 minutes.

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Many of my treatments are with inpatients for just one or two days and then the animals are discharged to home. I was pleased to see immediate results today with the lamb, as did the faculty and students.

Jackie Woelz, DPT, MS
Physical Therapist
Veterinary Medical Teaching Hospital
University of California, Davis