Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4379
Jamie, a 14 yr old MN Greyhound mix, has chronic arthritis in the hindlimbs and often has adverse GI signs with many oral medications. The client first called me because Jamie could not move at all. Jamie showed neurologic deficits in his hindlimbs in addition to arthritic changes in his knees and hips. I initially performed acupuncture points along the neck, back, and shoulder. In the following weekly sessions, I treated hips and knees while I introduced the electroacupuncture on BL points. After 34 weekly sessions, his neurologic deficits improved and he is able to ambulate enough to get up and use the bathroom on his own. At the time of this report, we continue to treat his suspected T3 L3 lesion as well as his arthritis. We may have reached a plateau in his clinical signs, but his overall quality of life has improved from the first visit.
History and Presentation:
Jamie is a 14 yr MN 80 lb Greyhound mix who presented to my housecall service on June 12th, 2017 for being suddenly unable to get up without any known trauma and vomiting. The owner reported that the patient often develops vomiting and diarrhea on many oral medications. Jamie had seen a veterinarian for arthritis for his knees and hips about a month ago. NSAIDs were prescribed, but Jamie was not able to tolerate those medications. Jamie had an eyelid mass removal a few years ago and has no other pertinent medical history.
Physical Examination and Clinical Assessments:
Jamie was sternally recumbent on his bed and his hind quarters was wet with urine. He was bright and alert with normal vital signs and healthy, pink gums. Thoracic auscultation was unremarkable. Both of his stifles were thickened and he resisted coxofemoral extension bilaterally. He was unable to get up on his own. With a towel supporting his caudal half, he was able to stand with assistance. His gait was ataxic and showed bilateral general proprioceptive deficits in his hind legs. Patellar reflexes were normal to increased. His anal tone was normal. No back or neck pain was noted. The remainder of his neurologic exam was within normal limits. Taut bands were noted on the myofascial exam around the lateral neck and shoulder areas.
Medical Decision Making:
My first priority was to target the acute neurologic deficit (T3L3 lesion) and use BL points along the spinal cord. I also used neck and shoulder points to relieve the taut band, which was mostly likely caused by the patient tendency to overuse neck and forelimb muscles to compensate for the hindlimb paresis. As the neurologic deficits improved, I wanted to help with Jamie’s chronic arthritis in his hips and knees.
Fibrocartilaginous Emboli (FCE) vs IVDD vs trauma vs neoplasia Jamie showed upper motor neuron neurologic deficits, but did not reveal obvious signs of pain and there was no history of trauma. The lesion was localized to be T3L3 based on neurologic deficits in the hindlimbs only. Osteoarthritis of knees and hips Thickened stifles were noted on exam in addition to a decreased range of motion of the coxofemoral joints.
Definitive (or Putative) Diagnosis (or Diagnoses):
FCE: Acute neurologic deficit improved significantly in two weeks and Jamie has seemed consistently nonpainful.
Osteoarthritis of knees and hips: see above.
On the first day, I chose BL 1223 points to stimulate and treat the suspected T3L3 lesion. I used BL10, GV14, SI 9, 11, 12 to release the tension on the neck and shoulder area. I chose coated 25mm, dry needling. No electroacupuncture was utilized since this was the first time the patient was treated with acupuncture. The following treatments were performed every 57 days with a total of four treatments so far, however, treatment is ongoing. Electroacupucture was started in the second session with the wires connected between BL 12 and 23 [mixed mode (2/100 Hz, 1.5v)]. The patient has tolerated 30mm uncoated (Hwato) needles. The same neck and shoulder points were treated. Hip points (GB 29, 30, BL 54) and stifle points ST 34, 36 were added.
Outcomes, Discussions, and References:
The neurologic deficits were significantly improved by two sessions, five days apart. Jamie was able to get up on his own and use the bathroom without any support. No other medications were offered because the patient often cannot tolerate them. I believe the BL points along his spinal cords did contribute to these results. He still suffers from chronic arthritis and we plan on continuing with acupuncture for this reason.