Written by a Medical Acupuncture for Veterinarians curse graduate. Signed release obtained from client/author. 4383
Abstract: A 14 year old Golden Retriever (neutered male) was assessed and treated for a 16 month history of idiopathic bilateral laryngeal paralysis. This had been previous diagnosed by the regular veterinarian but surgical treatment was not performed. Acupoints treated were ST 9, GB 21 (Estim), CV 22, CV 23 (Estim), Bai Hui, ST 36 and GV 20. Patient was refractory to treatment so additional points not selected. Three treatments performed. Owner reported mild but notable increase in exercise tolerance, especially in warm summer weather.
History and Presentation:
Cody, a 14 year old neutered male Golden Retriever was diagnosed via endoscopy with idiopathic laryngeal paralysis 16 months ago. Initial complaint was exercise intolerance and moderate to severe respiratory stridor. At the time of diagnosis surgical intervention was discussed but declined due to financial constraints. Cody receives Meloxicam (1.1 mg/kg daily by mouth) for coxofemoral osteoarthritis.
Physical Examination and Clinical Assessments:
Cody is bright and alert and in good body condition. Cody has difficulty getting up and down due to bilateral hip arthritis, and in motion shows bilateral hind limb stiffness that improves with exercise. There is a mild right front lameness and the left hind is more clinically lame than the right hind. Heart rate and temperature are within normal limits. Respiratory rate is elevated with notable stridor both at rest and in motion. Stridor worsened with stress/physical palpation.
Musculoskeletal restrictions include the following
- Reduced range of motion in both carpi
- Right elbow joint is thickened; triceps atrophy with palpable trigger points throughout the triceps musculature
- Latissiumus dorsi over developed bilaterally; more so on the left side
- Intercostal muscles painful and reactive to light palpation in most rib spaces bilaterally
- Pectoral muscles are reactive and painful to palpation
- Reduced range of motion through the right cervical facet joints; C5 -6 is painful on motion palpation
- Ventral neck musculature thickened and reactive to palpation
- Laryngeal area diffusely thickened
- Muscle spasms noted through the expaxial muscles at the thoracolumbar junction
- Oblique and abdominal muscles overdeveloped and hypertonic
- Kyphotic lumbar spine with restricted range of motion L1 – L7
- Reduced range of motion and discomfort noted through both coxofemoral joints
- biceps femoris, gluteal and hamstring atrophy noted on the left hind; corresponding right hind musculature is hypertonic with multiple trigger points throughout
Medical Decision Making: Goals of acupuncture treatment were primarily to address the laryngeal paralysis, and secondarily to address the musculoskeletal discomfort.
Differential Diagnoses: Laryngeal paralysis, Coxofemoral osteoarthritis, Carpal osteoarthritis, Right elbow osteoarthritis, Vertebral spondylosis affecting multiple segments, Facet joint arthritis affecting multiple segments, Compensatory muscular spasm due to respiratory issues
Definitive (or Putative) Diagnosis (or Diagnoses): Bilateral laryngeal paralysis, Bilateral coxofemoral osteoarthritis
ST10 – GB 21 (Estim between), CV 22 – 23 (Estim between; Piercing technique used to secure needle placement); Bai Hui, ST 36, GV 20; 3 weekly treatments performed
Outcomes, Discussions, and References: Cody was not overly tolerant of the acupuncture treatments so minimal needles were placed; the primary focus was on the laryngeal points as opposed to the musculoskeletal points. Unfortunately Cody acutely developed renal and gastrointestinal issues before the fourth treatment was performed. A follow up video was not able to be obtained, however the owner reported a mild but notable increase in Cody’s exercise tolerance. Every day they walk to the park bench and have a rest before returning home, and have done this routine for the past 16 months. There was no difference after the first treatment, however after the second treatment Cody was eagerly walking past the bench without even attempting to stop. After the third treatment he was able to make the return trip home in less time. There did not appear to be any notable change in the degree of stridor noted, however his willingness to walk was improved.