Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017039

Abstract: Stage 2 Hypocalcemia in an aged fresh milk cow. The cow was found down within an hour after calving and was weak in hind end with mild knuckling of hindlimb fetlocks (right side more effected than left). The cow was unable to stand despite IV treatment and would stand in front end but not the hind end when lifted. After 3 days of repeated lifting and daily acupuncture treatments, the cow was able to stand on her own and ended up being put back into the milking herd within a week of calving.

History and Presentation: #792 is a 4th lactation cow. During her previous lactation she was treated for Stage 1 hypocalcemia with IV calcium and recovered uneventfully. Her 2nd lactation she was prophylactically treated with oral calcium. She presented being down within an hour after calving.

Physical Examination and Clinical Assessments: Down in lateral recumbency. Eyes bright. Mild tachycardia with skipped beats. No ruminations noted. Manure normal. Deep pain positive on both hindlimbs. Placenta not discharged. Calf alive and attempting to stand. Diagnosed with Stage 2 Hypocalcemia with mild-moderate calving paralysis.

Medical Decision Making: Was IV’d with 2L Hypertonic Saline, 500mL Calcium 23%, 15cc Banamine. Cow was alert, and persuaded to try to stand 15minutes after IV. Was able to get up in front end, but mildly knuckled over in hind fetlocks and still weak in the hind. #792 was brought out of the barnyard to the grass and was lifted. Able to stand in the front end but still needed support in backend.

For acupuncture decision making: Wanted to stabilize circulatory system so chose generalized points of GV 14 and Bai Hui. Wanted to address obturator nerve and hindlimb neuritis and inflammation from calving and being down and addressed those with the hip triad and local points across her hip joints. Appetite was diminished so wanted to address local inner bladder points for rumen and GI health.

Differential Diagnoses:
Hindlimb weakness: calving paralysis, spinal cord lymphoma, hypocalcemia, hypophosphatemia

Definitive (or Putative) Diagnosis (or Diagnoses): Stage 2 Hypocalcemia with mild-moderate calving paralysis

Acupuncture Treatments:
DAY 1 PM: GV 14, Bai Hui with brown 30mm Seirin and hip triad bilaterally with purple 30mm Seirin. Performed while laying down
DAY 2 PM: GV 14, Bai Hui with brown 30mm Seirin and hip triad, BL 18, 43, 43-01, and ST 36 with purple 30mm Seirin. Local points around hips from being swollen from being lifted with purple 30mm Seirin, Acupuncture performed while lifted.
DAY 3 AM: GV 14, Bai Hui with brown 30mm Seirin and hip triad, BL 18-21, 43, 43-01 with purple 30mm Seirin. Local points around hips from being swollen from being lifted with purple 30mm Seirin, Acupuncture performed while laying down.

Outcomes, Discussions, and References:
DAY 1: Was IV’d as previously described. Was lifted and cow showed no stability in the hind end. Was lifted again before acupuncture treatment in PM. Appetite improved after acupuncture treatment. Was left down with feed and water overnight.
DAY 2: Showed marks in the ground as attempted to stand overnight. Was lifted. Up in front, but weak in hind-end but was able to partially bear weight (improvement from previous day). Within 10 minutes of her acupuncture treatment, she started to bear more weight in her hind-end and was able to release the hip lift and she stood on her own. She took a few steps and maintained standing. Within half an hour after treatment, she laid back down. Appetite was minimal throughout the day and most marked after acupuncture treatment. Still unable to stand on her own. Owners maintained oral calcium every 12 hours along with another 15cc Banamine.
DAY 3: Was found in lateral recumbency in AM. Didn’t attempt to stand in front end when lifted. Administered IV calcium and dexamethasone and allowed cow to remain laying down. Was lifted again throughout the day and still generalized weakness. Came back in PM and appetite had increased and could get halfway up when attempting to stand. Performed acupuncture with her laying down. An hour after acupuncture she was able to stand on her own but still wobbly. Appetite maintained consistency.
DAY 4 AM: Cow stood on her own and maintained ability to stand and lay down on own. No longer lifted. Kept on soft ground to ensure full recovery.
DAY 7: Cow was brought into the milking barn and fully recovered.


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