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Written by a Medical Acupuncture for Veterinarians course graduate.  Author’s name available upon request.  Signed release obtained from client/author/4963.

Abstract:

A 6-year-old neutered male Domestic Short Hair (DSH) cat presented to a veterinary clinic following acute spinal trauma and hind limb paralysis. Treatment for the diagnosed narrowing of the disk space between lumbar vertebrae L4 & L5 began with medical management but lack of improvement resulted in the cat being taken to surgery where a hemi-laminectomy was performed. Post-surgery, cage rest with range of motion (ROM) exercises were prescribed. At 2 weeks, the cat was uninterested in moving around in his cage and was unresponsive to deep palpation of his pelvic limbs and tail. He was also unable to urinate on his own and constipation was an issue. The owners considered euthanasia but as a last resort, “alternative therapies” were explored. After 3 weeks of using acupuncture, laser, tPEMF (targeted pulsatile electromagnetic frequency therapy) and massage/rehabilitation modalities, the cat progressed to being interested in his environment, has skin sensation and withdrawal responses in his tail and hind legs, and is just starting to bear weight if supported. He is also able to urinate and defecate on his own. By adding medically based acupuncture treatments to a typical rehabilitation protocol, treatment efficiency may have been increased; therefore, shortening recovery time.

History/Presentation:

A healthy 6yo M/N DSH cat tipped a bookcase over on himself which resulted in paralysis of his hind legs and tail. Radiographs taken at a veterinary clinic showed narrowing of the disk space between lumbar vertebrae L4 & L5. The cat was placed on prednisolone for the spinal cord trauma. Diazepam, metoclopramide and bladder expression were used to assist with urination. After a week with no improvement, he was taken to surgery were a hemi-laminectomy was performed. Significant bruising of the spinal cord was noted at that time. Strict cage rest was employed and simple twice daily ROM exercises were prescribed. At one week post-surgery, the cat still had no response to deep palpation of the hind limbs and tail and the owners expressed concern with his depression so euthanasia was discussed. With encouragement of a friend, “alternative therapies” were sought out. A house call was made to evaluate the cat. He was lifted from his cage and had to be cleaned due to urine leakage. Diazepam and metoclopramide were discontinued. Pain was scored at a level of 2 out of 4 on the Colorado State University Acute Pain Scale. His hind legs were cold to the touch with no response to moderate pressure applied to his toes. Legs and tail were flaccid and muscle atrophy of the hind limbs were already evident. Intense knotting was palpated in the paravertebral muscles reaching from the lower thoracic area and extending to the pelvis.

Medical Decision Making and Case Treatment:

In the face of pending euthanasia, the goal of treatment was to decrease the cat’s pain, allow him to regain control of his urinary and fecal output and see improvement in the use of his hind legs. Points were chosen to positively influence the cat’s spinal cord damage, stimulate his peripheral nerves and balance out his autonomic system. Addressing his primary and secondary myofascial dysfunction was also important to the success of his therapy. Day 1: After gentle palpation of cat’s myofascial strain patterns, massage of his head and neck to stimulate the parasympathetic nervous system and tone down the sympathetic drive caused by the cat’s continued pain was enlisted. Particular attention was paid to his ears and GV20, GV14 and GB20.  Treatment focus then shifted to the lumbar spine in an attempt to decrease inflammation and stimulate healing of the damaged tissues. Due to the pain and extreme muscle knotting, laser treatment of the back was chosen. The treatment areas were divided into 3 sections (T12-L2, L3-L6 and L6-sacrum/hips/tail-head). A Class IV laser (K-laser Cube 3 with 660, 800 and 970 wavelengths) was used at a total of 770J in 2.5 minutes per section. Acupuncture was then performed: 0.16 X 30mm Serins were placed in BL22 (site of a cranial trigger point and the Triple Heater/Adrenal Shu point), BL23 (Kidney Shu point), and BL26 (caudal to the injury and part of the caudal trigger points). Bai Hui was also used to address the neurologic dysfunction of the hind limbs. ST36 was chosen for its influence on the fibular nerve and its use in gastrointestinal motility and pelvic limb dysfunction. GVT was used to stimulate peripheral nerves in the tail and the KI1 and Bafeng points were used to stimulate them in the pelvic limbs. After the first session was done, the cat was purring and seeking attention. Owners were left with instructions to stimulate the toes and tail, continue ROM and provide mental stimulation by getting him out of the cage. Day 2: The cat happily came out of the cage. Paravertebral musculature was much softer. Legs felt the same temperature as the rest of his body. Toe tickles caused left hind to shake. After massage of the cat’s head and neck, laser and gentle massage was performed on the paravertebral muscles. The cat reacted negatively to needles inserted cranial to the injury so the BL22 and BL23 points were stimulated using the laser with a treatment total of 24J for 30 seconds per point. .20 X 30 mm Serins were placed in Bafeng, KI1, ST36 and BL26. BL35 was added to stimulate sacral nerves and help with the tail dysfunction and BL54 and BL40 were used to influence the sciatic nerve. Owners were instructed to continue toe/tail tickles, ROM and start using a tPEMF Assisi Loop 2-4 times per day over the caudal half of the cat’s body. Day 4:  Cat was starting to drag himself around the floor and wanted to interact with people. Both hind feet now shake in response to toe and tail tickles. Tail has more tone and cat is urinating and defecating on his own. Due to new activity level, muscle knotting and trigger points are developing in the neck and triceps musculature. Laser, massage and acupuncture was performed as on Day 2, but laser therapy was added to the neck, shoulder and triceps areas. .20 X 30mm Serins inserted into BL54 and BL40 were used for electroacupuncture (EA) with an ITO ES-130 unit starting at a frequency of 1.3 Hz and an output setting of 2.5 for 5 minutes and then increased it to 23 Hz for 2 minutes. The cat is being weaned off from the prednisolone. Day8:  Pelvic limbs seem to be gaining tone. Lumbar musculature still soft and non-painful. Protocol remained the same as Day 4 but cat will now only allow needle placement caudal to Bai Hui so the laser was used to stimulate the cranial points. The cat did pull his feet away with insertion of KI1 and Bafeng points but didn’t object. Day 11: Cat began pushing against objects with his hind feet and can almost bear weight when supported. The muscle knotting in his triceps continues to be a problem as he uses his front end to get around. Treatment focus remained the same as Day 8. The next session is planned for 2 weeks.

Although the cat isn’t walking at this point, the owners are thrilled with the treatment results thus far. After going through a major surgery and not seeing improvement, the addition of acupuncture/EA and laser/tPEMF to a massage/rehab (physical and mental) protocol may have saved this cat’s life. Several papers have been written about the use of light and electromagnetic frequency on healing of tissue (some listed on www.k-laser.com and www.assisianimalhealth. com), and many areas of study are popping up in the realms of massage and rehabilitation, but knowing how to target the nervous system with acupuncture points (via needle, laser or massage) make treatment time more efficient and perhaps assists a practitioner in getting more reliable/reproducible results in a shorter period of time.