Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10S2017026

Abstract:
Max is a 6 year old neutered male Dachshund who presented in September of 2017 for weakness that progressed to complete paralysis of the hind limbs with an inability to express his bladder or control his stool. Owners declined a neurologist referral, surgeon evaluation, and elected medical treatment. Due to his lack of ability to eliminate on his own, concern for his quality of life, and owner’s significant financial constraints, euthanasia was considered. Ownerswere offered to be a case study for the MAV acupuncture course. Over the course of his treatment, Max began to regain sensation, expression of bladder, ability to hold himself up, and increased mobility. Max had the support of a cart during the time he was unable to walk.
Electroacupuncture will be continued as Max regains mobility.

History and Presentation:
Max presented on 9/18/17 for weakness in the rear limbs that progressed to rear limb paralysis with negative deep pain, positive withdrawal reflex, and UMN bladder signs. Radiographs were taken and showed narrowing of disc spaces at T10-T12. Max was initially started on carprofen, gabapentin, and polyglycan while he was still mobile. He was switched from NSAIDs to steroids at the time of progression from paresis to paralysis. Antacids and
gastroprotectants were utilized during transition from NSAIDs to steroids. A urinary catheter was placed to continually express bladder as manual expression was difficult and not well tolerated. Antibiotics, cranberry supplements, and prazosin were used early on while urinary dysfunction and cystitis were a concern. Diet was switched to canned prescription GI diet (Royal Canin).

Physical Examination and Clinical Assessments:
Heart Rate: 120 ppm, strong, synchronous femoral pulses
Respiratory Rate: 72 – panting, eupneic
Temperature: 100.2 F
Weight: 27 #
Body Condition Score: 6/9
EENT/Oral – Mild lenticular sclerosis, scleral pigment, no oral calculus or significant gingivitis (recent dentistry)
CVR – Normal sinus rhythm, euhydrated, lung fields clear
GI/GU – Tense on abdominal palpation, full bladder and colon present. Bladder difficult to express manually. Urine concentrated with strong odor on expression. Moderate amount firm stool palpable and moderately easily expressed with stimulation.
MSI – Integument intact, hindlimb paralysis, taut myofascial bands neck and shoulders. Muscle atrophy rear limbs bilaterally
PLN – No peripheral lymphadenopathy.
Behavior – Slightly anxious for exam, taking food rewards readily.
Neurologic Exam: Cranial nerves intact Cervical range of motion -within normal limits Weight bearing, reflexes, ROM within normal limits – forelimbs
bilaterally Hindlimb paralysis, conscious proprioceptive deficits bilaterally Hindlimb withdrawal and deep pain present bilaterally Crossed extensor reflex present Hindlimb hyper reflexia Panniculus reflex present caudal thoracic dorsum, absent lumbar dorsum Anal tone present, but weak Full bladder – difficult to express Flaccid tail

Medical Decision Making:
Based on the likelihood of caudal thoracic spinal cord injury, acupuncture and electronic stimulation were chosen with the goal of parasympathetic neuromodulation, local and peripheral nerve stimulation, and pain control based on assessment of function and discomfort at time of each individual treatment. Acupuncture points were chosen along the spine (Hua to ja ji) from mid-thoracic spine caudal. GV 14, GV 20, GV T 1/3, Bai Hui, Ba Feng, Ki 1, Bl 10, Bl 25, Bl 28, Bl 40, Bl 54, GB 30, GB 31, St 36. Electronic stimulation

Differential Diagnoses:
IVDD, FCE, Spinal cord trauma, other neuropathy

Definitive Diagnosis:
IVDD

Acupuncture Treatments:
Weekly acupuncture using Vinco 0.22 x 25mm uncoated needles and dense disperse electronic stimulation with Electronic Acupunctoscope WQ-6F started 10/5/18 and continued through 11/21/17. Treatments became more spread out (every 2-3 weeks over the holiday season) starting in late November to early January of 2018. Monthly treatments have continued.

Outcomes, Discussions, References:
Conscious proprioception, mobility, and muscle strength consistently improved over the course of treatment. Two and a half weeks in, Max was able to urinate on his own when positioned appropriately and supported during micturition. Max was able to stand when positioned without support for short periods of time four weeks into therapy. Walking with minimal to no support and mild to moderate ataxia (variable with pace) was achieved within six to eight weeks. At ten weeks, Max was able to ambulate almost normally with minimal effort. Five months out, Max is doing amazing and his parents are ecstatic that they were able to get their dog back, especially when his condition was so severe at presentation. Initially devastated that they would not be able to manage a dog with the inability to eliminate, Max’s people then became resigned to being comfortable with a dog in a cart for the rest of his life as long as he could be happy. There are few words to explain the emotion associated with having Max happy and running, and not have to settle for less

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