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Little Dude relaxes while he enjoys his medical acupuncture treatment.
Case Report by Hannah Baker, DVM, CVMA. August 2023.
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Abstract: Little Dude is a 4-month-old French bulldog that presented for severe hind limb weakness and ataxia. He was examined and treated with acupuncture & laser over several weeks, with marked improvement in strength and stability after treatments.
History: Little Dude is a 4-month-old male intact French Bulldog that first presented on April 14th, 2023 after being taken in by a local rescue organization. At the first presentation his current foster explained that she had recently obtained him from a breeder who stated that he was unable to use his hind legs from birth. She suspected that he was a “swimmer puppy” and was unable to sell him, so he was given to the rescue. A previous veterinarian tentatively diagnosed him with degenerative myelopathy and gave a guarded prognosis. Dude is here today for a second opinion and to discuss a possible integrative medicine treatment plan. Dude is up to date on vaccinations, was recently dewormed with pyrantel pamoate, and was given Simparica Trio for parasite prevention.
Physical Exam & Clinical Assessment: On physical examination Dude is bright, alert, and responsive. He can ambulate by using his forelimbs to pull himself until he can get his hindlimbs under him enough to stand and walk.
Eyes, ears, nose, mouth: Eyes appear normal with no conjunctivitis, discharge, or opacities. Retina appears normal. Ear canals are clean and clear with a small amount of wax bilaterally. Nares is slightly small due to brachycephaly, otherwise appears normal. Moderate underbite with malocclusion.
Heart: Normal rate and rhythm. Heart rate 80 bpm
Lungs: Auscultate clear with no crackles or wheezes. Respiratory rate 20 bpm
Abdomen: Soft and non-painful on palpation, with no mass effects palpated. The urinary bladder is moderately full but soft on palpation.
Skin & coat: Skin and coat appear healthy, with no alopecia or inflammation. Some fascial restriction over the back from mid-thorax to mid-lumbar regions.
Musculoskeletal/myofascial: There are taut bands around the forelimbs bilaterally, worst around the scapula and lateral neck. Iliopsoas is tight. Ventral deviation of the spine is palpable around cranial thoracic vertebrae (T2-T4). There is significant muscle atrophy of both hindlimbs, with the flexor muscles (biceps, semimembranosus, and semitendinosus) flaccid, and extensors (quadriceps) with more tone. There are bilateral medial luxating patellas.
Neurologic: Dude is ataxic and weak during exam, with delayed conscious proprioception in both forelimbs and absent conscious proprioception in both hindlimbs. There is a delayed but present withdrawal reflex in all four limbs and a positive crossed extensor reflex bilaterally.
Imaging: There is severe hemivertebrae involving all thoracic vertebrae, but it is most prominent between T6 and T8. Cardiac silhouette is normal shape and size and lungs appear normal. Abdomen appears normal, with stomach, liver, spleen, urinary bladder, small intestine and colon all normal size, shape, and opacity. Left hindlimb patella appears luxated on ventrodorsal view, but this may be artifact from poor positioning (patient was resistant to extension of hindlimbs for radiographs).
Problem List
- Hindlimb weakness and ataxia
- Neurologic abnormalities including crossed extensors, delayed/absent CPs, delayed withdrawal reflexes
- Thoracic hemivertebrae
- Medial luxating patellas
- Fascial restriction on dorsum
- Taut bands around forelimbs
- Dental malocclusion
Differential diagnoses:
Hindlimb weakness & ataxia leading to poor ambulation
- Vascular: thromboembolism, anemia
- Infectious/inflammatory: Rickettsial disease, meningitis/encephalitis, distemper
- Neoplastic: Central or peripheral nerve tumor, other tumor causing compression of spinal cord
- Degenerative: Degenerative myelopathy, hip dysplasia
- Iatrogenic/intoxication: Toxin ingestion including marijuana, ethylene glycol
- Congenital: Congenital malformation affecting spinal cord or brain
- Autoimmune: Myasthenia gravis
- Traumatic: Traumatic injury during birth or neonatal period affecting spine
- Endocrine/metabolic: Hypoglycemia, hypoadrenocorticism, hypothyroidism
- Myofascial: Myositis, Muscle weakness & atrophy leading to inability to ambulate
Neurologic abnormalities
- Vascular: thromboembolism
- Infectious/inflammatory: Rickettsial disease, meningitis/encephalitis, distemper, diskospondylitis
- Neoplastic: Central or peripheral nerve tumor, other tumor causing compression of spinal cord
- Degenerative: Degenerative myelopathy
- Iatrogenic/intoxication: Toxin ingestion including marijuana
- Congenital: Congenital malformation affecting spinal cord or brain
- Autoimmune: Degenerative myelopathy, myasthenia gravis
- Traumatic: Traumatic injury during birth or neonatal period affecting spine or peripheral nerves
- Endocrine/metabolic: Hypoadrenocorticism, hypothyroidism
- Myofascial: Myositis, Muscle weakness
Definitive diagnoses: Dude has visible compression of the thoracic spinal cord on radiographs, which is believed to be the underlying cause of his neurologic changes and his weakness, and ataxia which contributes to his inability to ambulate normally. It is possible that he has other lesions in his spinal cord, or other central nervous system problems that aren’t visible on radiograph.
Medical decision making: Medical treatment was chosen based on myofascial examination, neurologic examination, and presenting complaint of inability to ambulate effectively at home. To try to address the owner’s concerns, treatment was focused on regaining function of the hindlimbs.
Acupuncture & related techniques: Dry needling was used at the initial appointment, using 0.16 mm x 30 mm long Seirin needles. A combination of dry needling, electroacupuncture, and laser was used during continued treatments. Needles used were a combination of Seirin 0.16 mm by 15 or 30mm, Seirin 0.2 mm by 30 mm, and Carbo 0.2 mm by 30 mm needles (for trigger points).
Initial treatment: During the first acupuncture treatment Dude was treated somewhat conservatively to gauge his tolerance and response to needling. Serein 0.16 mm by 30 mm length needles were used (0.15mm length would have been preferred but were unavailable at the time of the first visit). Points used: GV 14, Bai Hui, BL 10, BL 14, BL 25, BL 27, ST 36 (all bilaterally).
Follow-up treatments: Treatment varied slightly at each treatment, but electroacupuncture was used for each treatment after the initial treatment. Baxie & Bafeng points were added at the second visit. The Ito e-stim was set to 4 Hz and set to 2-2.5 power, and was attached between BL 25 to ST 36, BL 54 to ST 40, or BL 10 to BL 25 depending on the treatment day and exam findings. Therapeutic laser was added at the fourth appointment, using the Respond Systems Luminex laser. The laser was set to 500 mW and 6 J using the Profile 808 probe. He was treated over the dorsal spine and along the caudal aspects of both hindlimbs. Trigger points were palpated in each exam along Dude’s shoulders and neck and were treated with dry needling as needed.
Dude’s foster continues treatments at home by using massage, exercises outside, and controlled water walking. She focuses her massage on his hindlimbs and tries to stimulate the nerves in his hind paws and toes with massage at least once every day. She is attempting to build muscle by taking him on walks, going up and down hills, and encouraging him to go up and down stairs (with assistance from her as needed). Water walking is implemented by placing him in water just deep enough to give him some buoyancy, roughly chest deep on him. He is supported by a harness and encouraged to walk for 5-10 minutes 2-3 times a week.
Discussion: Dude’s foster was very pleased with the improvement that she saw after his acupuncture and laser treatments. She stated that she could see a visible improvement in his comfort, movement, and activity level, which waned about 10 days after his treatment. About 3 treatments in there was a span of a few weeks in which his foster was unable to bring him in, and Dude lost most of the improvements that we had made. His exam on the following appointment was very similar to his initial exam, emphasizing his need for continued, regular treatments. Because of what was seen with Dude, this case solidified the need for regularly scheduled treatments in patients like Dude, to keep improving and avoid losing ground.
Dude’s foster has had trouble with scheduling recently, which means that we haven’t been able to treat him as regularly as we would like to. This is reflected in his condition and ability to ambulate. Despite our best efforts his ataxia seems to be worsening over time. This may be because of longer time spans between appointments, or it may be related to his growth, which may be causing changes in his spine and worsened spinal cord compression.
Dude’s foster is currently raising funds to have him evaluated by neurology at Nashville Veterinary Specialists later this summer, which will provide more information on his diagnosis and guide future treatments. In the meantime, we will continue to try to see him for acupuncture and laser roughly every 2 weeks.
References
- Liu, Ching Ming, et al. “Acupuncture Combined with Chinese Herbs for the Treatment of Hemivertebral French Bulldogs With Emergent Paraparesis.” Journal of Traditional and Complementary Medicine. Vol 6, no. 4. 2016, pp 409-412.
- Ryann, R, et al. “Prevalence of Thoracic Vertebral Malformations in French Bulldogs, Pugs and English Bulldogs with and without associated Neurological Deficits.” The Veterinary Journal, vol 221, 2017, pp. 25-29.