Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017038

Abstract:

Luna was a Dachshund that presented for acute hind limb paralysis. Eight acupuncture treatments were preformed along with traditional medications over the course of about 2 months. At the end of the treatments she was ambulatory and walking again. Her owners and myself were very happy with the results.

History & Presentation:
Luna is a 13 year old, spayed female, Longhair Dachshund. She first presented to me in January 2015 for acute paralysis. She was referred to the University where a MRI was preformed and she was diagnosed with IVDD between segments C2 and C3. A ventral slot surgery was preformed and she made a full recovery.

Luna’s owner is diabetic and has relied on her dogs to alert her when her blood sugar is low. While she is not technically a service dog, she is very valuable and loved by her owners. Luna is one of the dogs that I thought about when I considered taking an acupuncture course. When I first saw her in 2015, I felt like there was more I could do for her but I didn’t know how.

In November 2017 Luna presented to me for hind limb paralysis. She walked up a few stairs the night before and now she was unable to stand.

Physical Exam & Clinical Assessment:

11-13-17: Dog was bright, alert and responsive. She has a grade 3/5 heart murmur, lungs sound are clear. Her teeth have severe tartar. She was not clinically dehydrated; she is overweight at 18.8#.
Neuro exam: Luna was weak and unable to stand on her hind limbs. She had conscious proprioception (CP) and normal muscle strength in her front legs. Both hind limbs had no CP, no muscle strength or conscious movement. There was deep pain present in both hind limbs.
Patellar reflex in was hyper reflexive. Anal tone and tail tone was decreased.
Myofascial palpation showed decreased muscle tone in back legs. There was muscle sensitivity over T11 to L5 region.
No blood work or imaging was preformed. Luna is not currently receiving any medication.

Medical Decision Making:

11-13-17: At this time, the owner was not interested in a referral for surgery for Luna. She had been thru that before and didn’t know how Luna would handle another surgery. So we decided to hospitalize her for a few days to start aggressive treatment. She received intravenous dexamethasone for 3 days and then switched to oral prednisone. She also received 3 acupuncture (AP) treatments the first week and then we started to space out the treatments, first weekly then up to 2-3 weeks apart.

The acupuncture treatments were focused on stimulating her central and peripheral nervous system and to reduce inflammation and pain in Luna’s thoraco-lumbar area. Electro acupuncture (EA), at both high and low frequency, was used along the BL line on her back to stimulate the thoracolumbar spinal nerves and aid in pain control.

ST36 was used to provide overall parasympathetic stimulation and stimulate the fibular nerve. BL40, as the masterpoint for lower back, was used to stimulate the tibial nerve. KI1 and Bafeng points also stimulated the tibial and digital nerves.

Other AP points, such as GV 14, GV 20, and BaiHui were used to stimulate the parasympathetic nervous system and promote relaxation and calming.

Active traction was preformed by me and my technician at the clinic. Chiropractic adjustments and vertebral subluxations were address as needed. No adjustments were applied to the thoracolumbar area at any point during the treatment, Luna’s neck was also manipulated with caution because of her previous surgery.
The owner was instructed on how to perform passive traction at home and also how gentle massage would be beneficial. We also discussed water therapy in her bathtub with a towel for support so Luna could start standing on her own again.

Differential Diagnosis:

IVDD of spinal cord segments T11 to L3
Trauma or injury to back legs and pelvis
Trauma to spinal cord and vertebrae
Neoplasia in vertebrae
Caudal cervical IVDD

Definitive Diagnosis:

A presumptive diagnosis of IVDD of spinal cord segments T11 to L3 was made. Considering Luna’s breed and her history of IVDD in other spinal cord segments, I felt confident that we were dealing with another episode of IVDD. Her physical and neurologic exam also supported this.

Acupuncture Treatments:

Luna received a total of 8 acupuncture treatments on the following days:
11-13-17
11-15-17
11-20-17
11-27-17
12-4-17
12-11-17
12-27-17
1-8-18
Details and points on first 3 treatments:

First Treatment on 11-13-17:
For this first treatment I was fairly conservative, I stuck to what was ‘safe’. Luna was one of my first AP patients.
AP points included: GV14, GV20, BaiHui
BL18, BL20, BL21, BL23
ST36, BL40, KI1.
Red Serins 0.16mm diameter, both short 15mm and long 30mm, were used. All points were bilateral unless on midline.

Second Treatment on 11-15-17:
For this treatment I added electro acupuncture (EA) over the BL line. High frequency EA was applied from BL18 to BL23 for 10 minutes with Hwato 0.20 x 25mm needles using an Ito unit.
AP points included: GV14, GV20, BaiHui
BL18, BL20, BL21, BL23, BL35
ST36, BL40, KI1, Bafeng points.
Red Serins 0.16mm diameter, both short 15mm and long 30mm, were used. All points were bilateral unless on midline.
At this time, Luna was given her last dexamethasone injection and sent home on oral prednisone, gabapentin, and tramadol. We also switched Luna’s diet to a prescription diet dog food to facilitate weight loss.

Third Treatment on 11-20-17:
High frequency EA was applied from BL18 to BL23 for 10 minutes with Hwato 0.20 x 25mm needles using an Ito unit.
AP points included: GV14, GV20, BaiHui
BL18, BL20, BL21, BL23
ST36, BL40, KI1, Bafeng points.
Red Serins 0.16mm diameter, both short 15mm and long 30mm, were used. All points were bilateral unless on midline.
At the time of this treatment, Luna was getting noticeably stronger. She was not able to stand by herself but she reacted to placement of Bafeng points, especially on the right hind leg. Kari was encouraged by the improvement in just a week and we continued to treat her as an outpatient for the next few weeks.

Outcomes & Discussion:
After each treatment, Luna improved. Highlights of the other treatments follow.

11-27-18: At the time of this treatment the CP in her back legs was improving, she was still slow on the left hind but much better on the right hind leg. She was still not able to stand but she was getting stronger. At this point I started using a combination of high and low frequency EA using my Ito unit. I would just do high frequency for about 5 minutes then switch to low frequency.

12-11-18: Luna’s strength continued to improve. She was shifting her weight in her back legs. AP points in her neck were used to relieve muscle tension and tight bands.

12-27-18: Luna was now able to stand on her own. Kari reported she was even better at home than she was at the clinic.

1-8-18: This was the last AP treatment Luna received. She was functional and ambulatory at this point. She still had a little way to go but Kari was very happy with overall results.

Of course there is no way to know for sure, but I feel that Luna recovered faster and began walking sooner with AP treatments than if we had only prescribed rest and medications.
After reviewing this case, there are a few things I would do differently. During her initial treatments, I should have been more aggressive with EA in other areas other than just along her back. Also I seemed to get focused on her bladder line and her back legs. More care should have been taken to address myofascial restrictions in other parts of her body.


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