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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.

Abstract:  One of my first patients upon completion of the Fall 2016 MAV clinical intensive is a Cavalier King Charles Spaniel (CKCS) with syringomyelia.  While medication was controlling her symptoms, the side effects of the medication were intolerable.  Improvement was noted within days of the first visit and have continued to improve and her medication has been tapered down.

History

Clover is 3 year old FS Cavalier King Charles Spaniel (CKCS) who was diagnosed in early 2016 with syringomyelia.  Clover had a full work up with an area neurologist including an MRI.  Her primary symptoms include hyperesthesia/excessive scratching on her hind legs, neck, and shoulders and weakness in her knees.  Clover has had some issues with luxating patellas which did not develop until after the syringomyelia signs started.  Her symptoms were well controlled with omeprazole, prednisone (2.5 mg twice daily) and gabapentin (25 mg PO q 12 h).  However, the family lost their sweet, cuddly, happy dog with prednisone.  The constant food seeking and general irritability was not sustainable for the family which caused them to look for other options.  Other than a routine ovariohysterectomy, Clover has no surgical history.  No history of trauma and no history of illness other than the syringomyelia.

Physical Exam

General physical exam was unremarkable other than some dry skin and local hair loss, likely due to scratching.  Imaging done at the neurologist did confirm diagnosis of syringomyelia.  Normal reflexes were present in all four limbs and cranial nerve exam was unremarkable.  Most noticeable was that the moment you lightly touched anywhere on either hind limb, Clover would begin scratching.  On myofascial palpation, there was generalized sensitivity in the lumbar region in the epaxial muscles.  There was also generalized tension and tenderness in the brachiocephalicus and sternocephalicus.

Medical Decision Making

For Clover’s first visit I tried to be cognizant of helping her without doing too much.  I wanted to focus on starting to address what I viewed as sciatic nerve dysfunction on the hind end as well as starting to address her cervical pain

Acupuncture Treatment

All of the needling was dry needling.  I started with Bai Hui for nerve dysfunction and GV 14 both for relaxation and to address cervical pain.  As this was well tolerated by Clover, I added in BL 10 to further address the cervical pain in tension.  I then added in BL 54, GB 29, and GB 30 to address sciatic nerve dysfunction.  I felt that increasing parasympathetic input was likely to decrease the hyperesthesia.  The final point for the first visit was ST 36 both as a master point, but also to try to help with the luxating patella.  I left the needles in place for ten minutes and once removed, I used my therapy laser on her lumbar region.

Clover’s second visit was four days later as they were so eager to get help for her.  The hind end hyperesthesia was gone as were the luxating patella issues.  Her family had also reduced her prednisone to once daily.  However, the hyperesthesia on the shoulders and chest was now much more noticeable. Myofascial palpation showed tenderness in the cervical region. Overall, Clover has much brighter and clearly happy to see us,  I continued treatment of the hip triad, ST 36, and Bai Hui to maintain the benefits seen to the hind end.  I added in LU 1 for cervicothoracic nerve input ant LI 4 for both the irritation along the LI channel as well as sympathetic regulation.  Treatment included GV 14 for cervical tension

Clover’s third visit was two weeks later.  The hind end hyperesthesia continues to be non existent.  Front end hyperesthesia is present, but greatly reduced.  Her family has now reduced her prednisone to every other day.  I maintained the prior points of Bai Hui, hip triad, and ST 36 for maintenance.  I again treated LU 1 which was very reactive that day on myofascial palpation.  At about the 7 minute mark, I could see her body releasing the needle.  Clover was comfortable enough to allow for placement of needles in local, non-named, cervical trigger points.  After needles were removed, I was able for the first time to do some gentle massage work on the brachiocephalicus and sternocephalicus.  Hyperesthesia on neck and chest were greatly reduced following treatment.  We are now aiming for an every 10 to 14 day maintenance plan

Outcome

No adverse events were noted, though I did let owners know that many pets want a solid nap after treatment.  In quantitative terms, Clover’s family has been able to reduce her prednisone dosage so that no side effects are noted from the medication.  Qualitatively her comfort level at home is improved and we’re even seeing some hair regrowth in the areas no longer subject to repeat trauma.  Adding in acupuncture while reducing prednisone was the only change in her treatment protocol.  The change in sciatic nerve input was noticed early on.

While syringomyelia was a problem I had heard of, Clover is my first patient with it.  When the owners described the hyperesthesia, I knew we were looking as a neuropathic issue and was optimistic that I could help her.  I am feeling much more confident about trusting my myofascial palpation skills to allow me to help a patient.  I can certainly see how a study could be done with acupuncture and owner assessment of quality of life at home.  Because this is a syndrome largely limited to one breed, research is limited.  Mostly I can find anecdotal reports in lay publications of acupuncture being helpful.  Most research seems to be sponsored by the breed clubs.  Below is the best I could find on the syndrome and using acupuncture as treatment.

http://www.sciencedirect.com/science/article/pii/S1090023307000111

vetrecordcasereports.bmj.com/content/4/2/e000329.abstract