Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017016

Abstract
Suspected degenerative myelopathy in a geriatric German Shorthaired Pointer with severe ataxia and complete loss of conscious proprioception, as well as fecal and urinary incontinence. Medical acupuncture treatments improved mobility and incontinence.

History and Presentation
JS, a 13 year old neutered male German Shorthaired Pointer, presented for hind end weakness. He had been having a hard time getting up and walking and would sometimes loose his bowel in the house, which was unusual for him. Despite prior massage and laser treatments with another practitioner, his fecal incontinence, paraparesis, and ataxia continue to worsen.

Physical Examination and Clinical Assessments
JS was bright, alert, and responsive. His temperature, pulse, and respirations were within normal limits and he had a strong appetite. Upon physical examination he had marked bilateral atrophy of the quadriceps, gluteals, and hamstring muscles. Neurologic examination showed severe hind end ataxia, absent conscious proprioception with no correction of knuckling or crossing his hind legs bilaterally, hyperesthesia along the caudal lumbar spine and positive crossed extensor reflexes bilaterally in the hind. His mentation, cranial nerve function, and forelimbs were normal. No pain elicited on cervical palpation nor with tail elevation.

Medical Decision Making
Neurologic examination localized the lesion to the spinal cord in the thoracolumbar area. Due to financial constraints, advanced diagnostics and/or surgical intervention were not options for this client. Based on the progressive nature and differential diagnoses, prognosis was grave. The owner elected palliative measures in an attempt to improve quality of life and comfort during hospice care. Laser was discontinued in the event that neoplasia may be present and it had not provided improvement previously, and the only laser available was a linear beam Erchonia 600 nm more suited for cutaneous lesions. Acupuncture points were chosen to focus on improving bowel control, improve neurologic function of pelvic limbs and minimize pain. This would have been a perfect case for electroacupuncture but unfortunately an E-stim unit was not available at this time.

Differential Diagnoses
Degenerative myelopathy
Thoracolumbar intervertebral disc disease (IVDD)
Discospondylitis
Bony neoplasia
Degenerative lumbosacral stenosis (LSS)

Definitive (or Putative) Diagnosis (or Diagnoses)
Degenerative myelopathy is supported by the geriatric age of the patient, progressive nature, and insidious non-painful onset. IVDD in an older large breed dog may also have slowly progressive clinical signs. Degenerative lumbosacral stenosis is made less likely by the lack of pain with tail manipulation. Advanced diagnostics including magnetic resonance imaging (MRI), myelography, and/or cerebral spinal fluid analysis are required to elucidate the definitive diagnosis. Unfortunately these were not available due to financial constraints. Even if IVDD or LSS were determined as the existing pathology, surgical intervention was not feasible for this client.


Treatment: Medical Acupuncture and Related Techniques
First two treatments were 3 days apart, then once per week for a total of 4 sessions. Treatment frequency dictated by client’s schedule and financial abilities but frequent treatments (at least once weekly) were recommended due to the severity of neurological deficits.
Needles used: Seirin J type 0.20 mm diameter (blue), 30mm length
Points used (all with dry needling):
– GV20, 14, and BaiHui – relaxation and to assess tolerance of needling
– BL 19 – local lumbar pain
– BL 20, 21 – GI function and local lumbar pain
– BL 22, 23 – local lumbar pain
– GB 29, 30, BL 54 – “hip triad” for local muscle atrophy and sciatic nerve dysfunction
– ST 36 – systemic anti-inflammation, local pelvic limb pain
– Bafeng – pelvic limb neuropraxia
During treatment JS laid quietly and calmly and would occasionally wag his tail.

Outcomes, Discussions, and References
The owner stated JS responded fantastically to acupuncture. He was able to hold his bowel for longer periods of time and was able to ambulate better. He was able to get up the stairs more easily and seemed like a happier dog per the owner. Unfortunately due to financial constraints therapy had to be discontinued. This was a great case that taught me how acupuncture can significantly improve the quality of life for patients with severe neurologic dysfunction as well as improve the bond they have with their owners. Without acupuncture, treatment options would have been very limited for this patient.


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