Written by a CuraCore Veterinary Medical Acupuncture course graduate. Signed release obtained from client/author. 4D2018058
Abstract
Bull calf #21 presented for being unable to stand, after being previously diagnosed and treated pneumonia. His pneumonia was improving, but he had become weak and was unable to stand. He received several acupuncture treatments and an electroacupuncture treatment over the course of a 10 days. His condition continued to improve during that time and after being down for 5 days he stood up on his own. At the time of the last treatment he appeared to have recovered completely and had no difficulty standing or moving around.
History & Presentation
Holstein bull calf #21 had been diagnosed and treated for pneumonia. Before his illness he was an apparently healthy calf with no issues noted by the owner. His treatment plan for pneumonia included two doses of antibiotics and pain medication. After this treatment his condition had improved, but he had labored breathing, nasal discharge and was unable to stand up. At the time of my first examination he had been unable to stand for one day. He was 2 months old at presentation.
Physical Examination & Clinical Assessments
Upon examination heart rate was within normal limits. Respiration rate was increased, and crackles were heard bilaterally on auscultation of the lungs. There was mucoid nasal discharge present bilaterally and his coat was dull. His temperature was normal, and appetite was decreased, but he would still take food when it was offered to him. The owner said this was an improvement, prior to the antibiotics he was not eating. He was not able to stand. Myofascial exam revealed tender, mildly reactive areas at BL10, BL 13, BL 23, and moderate tension in the left lumbar area. I was not able to palpate heat, enlarged joints or fluid in the limbs.
At the follow up exam the calf was able to stand. Heart rate, respiration rate and temperature were all normal. Auscultation of the lungs was the same as the first exam. On myofascial examination he was mildly reactive in right lumbar area, and strongly reactive on palpation of the left lumbar area, as well as ST 36. When gently palpating BL27-28 and ST 36 on the left side, the standing calf would buckle the left leg and almost fall. There were also tight bands in the muscles of the neck bilaterally. The calf was able to stand and move on his own but was stiff in the neck and rear, especially on the left side.
The last exam of the calf revealed normal heart and respiration rate, normal temperature, and lung sounds had improved. He was ambulating normally and had a healthy appetite. Myofascial palpation revealed tight bands in the muscles of the neck and sensitivity to palpation in the mid-thoracic region.
Differential Diagnoses
Initial possible diagnoses: Vascular – endocarditis, Infectious – pelvic limb joint infection, Neoplastic – lymphoma, Degenerative – degenerative joint disease, Iatrogenic/intoxication –mycotoxin, Congenital – limb deformity, Autoimmune – hemolytic anemia, Traumatic – soft tissue trauma to the pelvic limbs or hips, Endocrine/metabolic – metabolic acidosis, Myofascial – muscle weakness due to pneumonia
Definitive Diagnosis
Muscle weakness due to pneumonia (complication of pneumonia) and/or trauma to lumbar or pelvic limbs
The calf had harsh lung sounds at presentation and was responding to the treatment. Pneumonia can lead to decreased appetite and dehydration, both of which could lead to a weak animal that is unable to stand. Muscle and nerve damage could also occur from lying down for extended periods of time or from an unknown trauma. No traumatic injuries were seen on exam or noted by the owner when taking history on the case, but I still felt it could have led to his inability to stand.
Vascular issues were low on my list because of normal heart rate and sounds. Pelvic limb joints (and thoracic) all palpated normally with no signs of heat or fluid making joint infection less likely. Although neoplastic and degenerative issues are possible this calf was very young, making these less likely possibilities leading to his weakness. Congenital issues would most likely have been noted in the first few weeks of life and physical and myofascial exam ruled out any limb deformities. Hemolytic anemia is rare in calves. Metabolic acidosis could cause weakness and failure of the calf to stand but would have been much more likely with a case of scours and in a calf that was not eating and drinking for a longer period of time.
Medical Decision Making
When deciding on acupuncture points to treat my goals were to provide neuromodulation, analgesia and immunomodulation. I wanted to reduce pain while stimulating the nerves and tissues that were possible causing weakness and leading to the calf’s inability to stand. I also wanted to help him relax and stimulate his immune system to help fight off infection. It was important to get him standing on his own as soon as possible to minimize any muscle tissue and nerve damage. Keeping him comfortable and reducing stress would also help him continue to eat and drink. Stimulation of the central nervous system, peripheral nerves, autonomic nervous system, providing relief for areas that were tender on palpation and supporting lung function were all part of the medical decisions of the acupuncture treatments. I also wanted to utilize electroacupuncture in the pelvic limb to provide pain control and reduce any inflammation that might be present.
Medical Acupuncture and Related Techniques
Seirin J size .20 30mm needles were used for all dry needle and electroacupuncture treatments.
During the first treatment he was lying down sternal, with his left side most easily accessible. GV 20, GV 14, Bai Hui, were used to stimulate the central nervous system, help relieve anxiety and provide neuromodulation to the spinal cord. BL 10 (bilateral), BL 13 (bilateral), LU 1 (left side), BL 14 & BL 15 (left side), BL 23 (bilateral), BL 27 (left) BL 28 (bilateral), and BL 31 (left) were all dry needled to stimulate the peripheral nervous system. These peripheral points stimulate S1 & S2 sacral nerves, femoral nerve and sciatic nerve. Points BL13 and LU1 were used to support lung function. BL10 and BL23 were dry needled because he was reactive there on myofascial palpation. ST 36 (left) was chosen to stimulate the autonomic nervous system. Electroacupuncture was done at GB31 to ST36 with Ito unit. Low-frequency treatment of 2HZ for 5 minutes followed by high-frequency treatment of 100HZ for 5 minutes.
2nd treatment:
GV14, GB21 (left) was added as a relaxation and peripheral point, BL 13 (bilateral), LU 1 (left) BL 23 (bilateral), Bai Hui, BL 28 (bilateral), GB 31 (left), ST36 (right), and massage of tender cervical trigger points. No electroacupuncture was done because calf was standing and moving around.
3rd treatment
GV14, GB21 (bilateral), BL 13 (bilateral), LU1 (left), Bai Hui, BL 27 (bilateral), BL 28 (bilateral), GB 31 (left), massage of tender cervical trigger points. I was not able to use ST36 during this treatment because he was too rambunctious, and I didn’t want to get kicked.
Outcomes, Discussion and References
Before the first acupuncture treatment the calf was weak and unable to stand, four days after his first treatment he was standing on his own. His appetite and strength continued to improve between the first, second and third treatments. At the time of the second treatment his pneumonia had begun to resolve, and lung sounds had improved. Although he could get up and stand unassisted at the time of his second treatment, he still was weak and stiff in the pelvic limbs and preferred to lay down. At the third treatment he was up and moving and had minimal reactive areas in the pelvic limbs and lumbar area, compared to the first two treatments. After the third treatment he appeared to move around easily, curious about what was going on and had the “spunky” calf attitude again.
The antibiotics that this calf received were vital to his improvement and recovery from the previously diagnosed pneumonia. With the additional use of acupuncture, electroacupuncture, and massage we were able to minimize the amount of pain medication that was needed and provide a faster recovery. I am unable to say if the acupuncture was what helped him regain his strength and stand again or if he would have stood without, but both the owner and I were happy with the outcome. No adverse events were noted.
I learned the value of treating a down animal quickly and was happy to have more options then just antibiotics and pain medication for this calf. In farm animals and production type situations there is not as many options for treatment. Rehabilitation is usually not an option and when working with larger animals it is imperative that they stand as soon as possible to avoid muscle and nerve damage. Acupuncture gives any down production animal another option and it does not require using any off-label drugs, provides analgesia, and reduces inflammation.