Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4385
Abstract: Babui is a 9 year old French Bulldog who began limping acutely in April of 2016. Since then, he has had mild to moderate ataxia with varying neurologic deficits. He had been seen by a general veterinary practitioner (GP) and a board certified veterinary surgeon before his consult for acupuncture and laser treatment. Babui is being treated twice weekly with laser and acupuncture. Since starting treatment, Babui is overall more comfortable and making small strides toward normal function.
History and Presentation: Babui is a 9 year old, male neutered, French Bulldog who presented for a consultation for laser therapy and acupuncture for a previously diagnosed myelopathy, abnormal ambulation, and neurologic deficits. The patient initially presented for acute lameness in April of 2016 to his GP. The initial physical revealed decreased conscious proprioception (CP) in both rear limbs and mild to moderate ataxia. The GP started the patient on Carprofen at the anti-inflammatory dose and referred him to a veterinary surgeon. The surgeon confirmed the initial physical and neurologic findings and diagnosed the patient with a T3-L3 myelopathy. Since the ataxia was mild to moderate at this time, the surgeon recommended rest and continued Carprofen. The ataxia and neurologic deficits had not resolved or progressed at the time of his annual physical in June of 2016. The patient’s new GP referred him for acupuncture consultation. Yearly total organ function bloodwork has consistently been within normal limits. No radiographs had been taken prior to consultation.
Physical Examination and Clinical Assessments: On examination, the patient was moderately ataxic with rear legs swinging outward when ambulating. His CP’s were within normal limits in the forelimbs and slow in the rear with the right being worse than the left. The rest of the neurologic exam was unremarkable. Initial myofascial exam findings revealed overall strain patterns especially over the triceps, trapezius, and latissimus dorsi. The triceps and biceps femoris both had tight ropey bands and trigger points. Radiographs showed moderate to severe osteoarthritis and hip dysplasia as well as mild spondylosis.
Medical Decision Making: Based on the physical, specifically the neurologic and myofascial exam findings, an initial twice weekly acupuncture and laser protocol was started for 4 weeks. The treatment plan includes neuromodulation of the peripheral nervous system and myofascial manipulation through dry needling and laser. The objective is to relieve strain patterns, reduce trigger points, and increase overall analgesia for improved ambulation, proprioception, and comfort.
Differential Diagnoses: Based on history and presenting examination, differential diagnoses included arthritis, osteoarthritis, spondylosis, myelitis, neoplasia, and intervertebral disk disease (IVDD).
Definitive (or Putative) Diagnosis (or Diagnoses): Definitive diagnosis of hip dysplasia, spondylosis and osteoarthritis were confirmed on radiographs.
Acupuncture Treatments: The patient’s current treatment plan includes laser and dry needling twice weekly with re-evaluation at the end of 4 weeks. The points chosen were Governor Vessel (GV) 20 for help with agitation; Small Intestine (SI) 11 and 12 for myofascial strain due to weight distribution compensation; Bladder (BL) 13, 14, 15, 20, 21, 22 for local pain and peripheral spinal nerve neuromodulation; Bai Hui for sacroiliac dysfunction and pelvic pain; BL 54, Gallbladder (GB) 29 and 30 for sciatic and gluteal nerve neuromodulation to relieve pain and aid in nerve dysfunction or entrapment; Stomach (ST) 36 and GV 14 for overall immunologic stimulation; BL 40 for pelvic pain and paresis; and Bafeng for neuropraxia. Based on the myofascial exam, acupuncture is performed for 10 to 15 minutes over the areas that most need to be addressed. Laser is then used over the other points that are not being needled. Carprofen is being continued at home on an as needed basis.
Outcomes, Discussions, and References: Since starting acupuncture and laser treatment, the patient’s myofascial and neurologic exams have improved. Myofascial manipulation from the modalities has reduced the majority of the initial strain patterns and improved overall analgesia. Neuromodulation of the peripheral nervous system has garnered improved proprioception; however, ambulation is still abnormal at this time. I believe the addition of electrical acupuncture could continue to improve proprioception and ambulation based on articles provided for this class and others such as “Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits” that was published in the Journal of the American Veterinary Medical Association June 2010. These articles provided consistent supporting information that electroacupuncture could be very effective for improved ambulation and other neurologic deficits.