Patient Information
Patient Name: Mackenzie Murphy
Patient Age & Gender: 9.5 years, MN, 11.7kg
Species and Breed: Boston terrier
Surgical Procedure: Ventral Slot Surgery C4-5 Vertebrae
Mackenzie arrived at our clinic three months prior to the purchase of our Companion Therapy Laser unit. His post-operative plan involved:
1. Conventional medication to manage pain (fentanyl, tramadol, gabapentin) and muscle spasms (methocarbamol).
2. Physical therapy targeting proprioceptive activation (foot strikes, ‘tickle toes’) and passivemovement exercises (bicycle legs for front and hind limbs).
Mackenzie required labour-intensive care that included changing body position every 3-4 hours, manual evacuation of his bladder, stimulation for bowel movements and hand feeding.
The neurologic assessment supported the opinion that Mackenzie would eventually regain his ability to walk but could not
provide a timeline. Instituting the treatment plan described above produced very slow neurologic improvements. Two weeks
following the surgery Mackenzie was still exhibiting significant neck pain and showed little improvement in his ability to walk or
control his bladder function.
Treatment Details
The following is a chronologic description of Mackenzie’s clinical response to therapy and rehabilitation. Mackenzie’s Video Diary is referenced throughout the case:
2 days post op surgery September 2012
Evaluation: Tetraparesis
- Non ambulatory, very painful neck, raspy voice
- Patellar reflex response-exaggerated, hyperesthesia
- Deep pain reflex present in front and hind legs
Treatment: Control pain, allow Mackenzie to heal from surgery, support bladder and bowel function, nutritional support
6 weeks post op surgery October 2012
Evaluation: Moderate neck pain now controlled by gabapentin, tramadol, and Metacam
When fully supported in a sling Mackenzie could stand for a short periods, knuckling on all four paws, with flaccid core. He had slow righting reflex with front legs, planting on knuckles; back legs no righting reflex. Evidence of ‘creeping’; observed Mackenzie pushing with hind legs to get a toy that was out of his reach. Manual compression of bladder and stimulation for bowel movement still necessary
Treatment: Mackenzie visits the Canine Wellness Centre in Toronto for day of intense physical therapy
In Mackenzie’s Video Diary, See: Oct 27, 2012. In this session Mackenzie is encouraged to build his core and gait retraining is
initiated
10 weeks post op surgery November 2012
Evaluation: Unsupported Mackenzie is able to stand for 1-2 sec. He is still knuckling, core is regaining some strength.
- Mackenzie is goose step walking (varies between front and hind legs) when supported in a sling.
- Mackenzie is able to use his core to pull to a supported standing position
Treatment: Building core strength -doggy crunch exercises
Stimulate proprioceptive response by continuing with ‘tickle toes’ exercises, foot strikes on textured surfaces- gravel, grass. Passive ROM exercises, bicycle legs, front and hind legs
In Mackenzie’s Video Diary, See: November 2012. Mackenzie practices ‘sit to stand’ supported
The arrival of our Companion Therapy Laser early December
14 weeks post op surgery December 2012
3 weeks laser therapy
Evaluation: Neck is tender, voice is raspy
- Has normal ‘righting’ reflex in front and hind legs when standing supported.
- Mackenzie has the ability to run once standing and supported in a sling. He falls as soon as he stops moving.
- His core is resisting bladder compression, however he is not able to urinate on his own.
Treatment: Laser treatments started every other day for 3 weeks
- C- spine: Pain trauma protocol, muscle, power 6W, total joules 1080, time 3:45
- Front legs, nerve treatment, 2 cycles: pain trauma, nerve setting, power 5W, total joules 815/ leg, time 3:24
- Hind legs, nerve treatment, 2 cycles: Pain trauma, nerve setting, power 6W, total joules 1356/leg, time 4:43
- Physical therapy: Build core strength, balance exercises- physio peanut/ball work, air bag walking supported
In Mackenzie’s Video Diary, See: December 2012. Mackenzie running/falling
18 weeks post op surgery January 2013
7 weeks laser therapy
Evaluation: We find Mackenzie’s neurologic weaknesses to be rapidly resolving
- Jan 5- Mackenzie urinates on his own while walking supported in a sling.
- Jan 19- running unassisted, he does fall in a slightly controlled fashion when he stops
- By the end of January he is able to maintain balance in a standing position and on occasion bend his elbows and sniff the ground.
- Although his core is strengthening, he stills has balance issues due to core weakness and proprioceptive deficits
Treatment: Laser treatments once per week – same protocol as December 2012
- Add laser treatment to sacral area to stimulate bladder nerve root.
- Sacrum, nerve root: Pain Trauma, muscle, power: 6W, total joules 1080, total time 3:45
- Physical therapy: balance exercises, gait retraining water treadmill, core exercises, proprioceptive exercises
In Mackenzie’s Video Diary, See: January 2013 Mac stands and maintains balance on his own
22 weeks post op surgery February 2013
11 weeks laser therapy
Evaluation: Mackenzie’s voice is back and we discover he has a robust and hearty bark
- His neck is sensitive to stimulation however it is not painful and his fur is growing back
- He is swimming using both his front and hind legs to paddle
- He is able to go up stairs while supported in a sling
- He has bladder control however he requires assistance for bowel movements
Treatment: Laser treatments once per week protocols same as January 2013
26 weeks post op surgery March 2013
15 weeks laser therapy
Evaluation: Treating stiff muscles in shoulder/neck region as well as mid back
- Balance and core strength greatly improved
- Mackenzie continues to improve and is able to ‘walk’ slowly without falling over
- Dragging toes so boots must be worn to prevent damage to the nails
Treatment: Laser treatments every 2 weeks:
- C spine, sacrum nerve root- bladder, front and hind leg nerve protocols
- Physiotherapy: swimming, resistance waking in sling, water treadmill
- Stretches for shoulder, neck band, and latissimus dorsi
34 weeks post op surgery May 2013
23 weeks laser therapy
Evaluation: Able to do cavalettis with sling support, go up rehab stairs without sling support, do figure eights and balance exercises on balance balls with minimal assistance.
Treatment: Laser treatments maintained once every month
In Mackenzie’s Video Diary, See: May 2013. Walking unassisted
60 weeks post op surgery November 2013
11 months laser therapy
Evaluation: Today Mackenzie enjoys fetching his toys, and going for walks.
- He is able to climb up stairs assisted and can walk on slippery floors without the benefit of traction boots.
- November 8th Mackenzie had a bowel movement for the first time on his own and has continued to do so intermittently.
- He maintains the ability to urinate on his own.
Treatment: Maintain laser treatments as needed for arthritic changes in spinal column and to maintain soft tissues health, particularly the cervical spine and shoulder region
- Physical therapy: stretches for neck, shoulder and latissimus dorsi
- Cavaletti work to improve gait- lifting paws off ground while walking
- Maintain foot health. Mackenzie drags his toes, front and hind
In Mackenzie’s Video Diary, See: November 2013. Mackenzie playing outside.
Summary
Mackenzie continues to show improvement 15 months out from surgery. Prior to implementation of laser therapy as an adjunct
treatment therapy, cases like this with significant neurologic dysfunction, without voluntary control of urination and defecation
and limited improvement over time, would end up facing euthanasia.
We feel the addition of laser therapy to the treatment protocol has had a profoundly beneficial effect on neurologic recovery.
What appeared to take three months to accomplish with conventional support needed only three weeks to achieve with the
addition of laser therapy.
The success we have witnessed with Mackenzie has forged the template for all our future cases of neurologic impairment. We do
not just recommend laser therapy, we insist on it.
