Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4388
Abstract: Acute onset of severe pain and neurologic deficits associated with lumbosacral stenosis and cauda equina syndrome in a dog. Patient did not initially respond to medical/pharmaceutical therapy including NSAID treatment, but has returned to near normal mobility and comfort following medical acupuncture and therapeutic laser treatment.
History and Presentation: Patient is a 12 year old SF Airedale cross weighing 43 pounds. She has been remarkably healthy, only presenting for routine wellness exams, dental cleanings and vaccines annually. Senior blood screening performed before her dental in January 2017 revealed slight renal azotemia, at which time the patient was started on Prescription k/d diet.
Patient presented on 7/27/2017 to my associate for pain and non-weight bearing (NWB) lameness right hind. There was no injury or incident leading up to this visit. Radiographs were taken which revealed lumbosacral spondylosis. She started the dog on grapiprant (Galliprant) at 1.5 mg/kg once daily and performed a therapeutic laser (using the Arthritis pre-set on Companion Therapy Laser machine).
Physical Examination and Clinical Assessments: The patient returned 8/8/2017 with more severe pain, weakness in the left hind as well as continued NWB lameness in the right hind. Exam on this date revealed severe pain (subjective) and reluctance to relax/extend the right hind leg. She could support herself on her left leg to some extent, but it was very weak and her tendency was to fall to the left. It was difficult to assess conscious proprioception (CP) at this time, as she would not extend her right leg to the ground. The CP was estimated to be slightly decreased on the left, but this was also difficult to assess, as I was supporting most of her body weight. There was normal range of motion in all joints of the right hind leg. She didn’t seem particularly painful to manipulation or palpation. There was normal withdrawal reflex, no crossed extensor reflex and the patellar reflex was estimated to be slightly decreased, although nearly normal.
L-S spondylosis resulting in potential nerve root impingement
Tumor/Mass – spinal cord or bone (Osteosarcoma)
Spinal cord compression from mass or arthritis
Cauda Equina Syndrome
Cranial cruciate injury
This list was compiled from the exam findings and initial radiograph findings. Cruciate injury was less likely, but included until further radiographs could be assessed.
Definitive (or Putative) Diagnosis (or Diagnoses): The patient was referred for a CT scan, which led to the definitive diagnosis. Results were L-S spinal canal stenosis, Cauda equina and nerve root compression due to degenerative IVDD and osteoarthritis
Medical Decision Making: Once the definitive diagnosis was reached, I increased the Galliprant dosage to one 60 mg tablet once daily, which is slightly higher than the label dose, but within the dosing “table” that is provided by the manufacturer. I also started the dog on gabapentin at 5 mg/kg BID. She continues on both of these medications to this day.
My goal with acupuncture treatment was to decrease pain and improve her neurologic function, particularly of the right hind leg. Via particular acupuncture points, I would be stimulating nerve endings and cause release of neurotransmitters, which will have a central effect on the dorsal horn of the spinal cord. At the cellular level, stimulation of fibroblasts will increase blood flow, release growth factors which aid in healing, and increase metabolic activity overall which will speed healing of affected tissues. Treatment of trigger points and tight bands within the muscles will result in connective tissue stretch and nuclear remodeling. I started with one treatment weekly, as this was the most frequent the owner could get the dog in along with therapeutic laser treatments and the medical/pharmaceutical therapy noted above.
Acupuncture Treatments: Once weekly treatments started within 4 days of CT scan which provided the definitive diagnosis. The clients were traveling internationally, so I had to wait until the pet sitter could bring the dog in. I used dry needling and electroacupuncture, along with therapeutic laser. For electroacupuncture, I used a Pantheon unit set on mixed frequency with 2 leads (4 points) treated with each session. I have indicated points I used E-stim on, although I didn’t use all points at each treatment.
These are the points I used and rationale:
GV 14 – for associated neck and back pain (compensatory) and improved immunologic function
Bai Hui – for lumbosacral pain, pelvic limb pain and neurologic dysfunction *E-stim
Right hip triad (BL54, GB29,30) – for sciatic nerve pain, hip pain and pelvic limb dysfunction *E-stim
ST36 – for parasympathetic support (right side only)
BL40 – for pelvic limp pain/paresis, low back support (right side only)
BL23 – for lumbar and pelvic pain (bilateral) *E-stim
BL25 – lumbosacral pain, digestive support (bilateral) *E-stim
BL27 – sacral parasympathetic support, sacroiliac support (bilateral) *E-stim
BL28 – sacroiliac support, pelvic limp pain/paresis (bilateral) *E-stim
Trigger points and tight bands along lumbar spine and bilateral hind limbs – mostly lateral and caudal thigh
Outcomes, Discussions, and References: At the time of the first treatment, the patient was still quite unstable on the right hind and minimal weight bearing. The medical/pharmaceutical therapy (gabapentin and Galliprant) had been quite helpful, but she still had fairly significant dysfunction.
I believe acupuncture and laser helped significantly in this case. The owner is also convinced and wishes to continue treatment every week to 10 days indefinitely. I noted improved coordination, particularly of the right hind leg. She never did knuckle specifically, but she is placing her foot normally now. She is able to rise comfortably from lying down, has no trouble with stairs and is able to jump onto furniture and into vehicles as needed (she had not been able to perform any of these tasks prior to treatment).
Acupuncture for Veterinary Neurologic Conditions
65th Convention of the Canadian Veterinary Medical Association, 2013
Allen M. Schoen, MS, DVM, PhD (Hon.)
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