Written by a MedicalAcupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obained fro client/author/4970.
An 11-year-old male neutered domestic medium haired feline presenting after three aortic thromboembolic events has absent conscious proprioception bilaterally in his pelvic limbs and an inability to ambulate appropriately. Through a series of weekly acupuncture and electrostimulation treatments, on a large array of points, improvement in myofascial palpation exam and in ambulation was exhibited.
An 11-year-old male neutered domestic medium haired feline presented post aortic thromboembolism for dragging of pelvic limbs and lack of conscious proprioception in pelvic limbs. The patient has had three incidences of saddle thrombus taking place in Winter 2012, Fall 2014, and Summer 2016. All incidences were acute and no connection of inciting event was discernable. The patient also has atrial fibrillation and mild heart enlargement that has been diagnosed, worked-up, and is under care by a veterinary cardiologist. Currently, heparin therapy is being used to treat this patient at 0.6 mL subcutaneously daily and Benazepril at half a 5-milligram tablet orally twice per day. This patient’s past surgical history includes an uneventful anesthetized neuter. The patient is kept indoors, but occasionally goes roaming on the owner’s property with supervision.
PHYSICAL EXAM AND CLINICAL ASSESSMENT:
On presentation for acupuncture treatment, the patient was calm, bright, alert, and responsive with pink, moist mucous membranes and a capillary refill time of less than two seconds. It was evident on gait analysis that the patient was struggling to gain proper placement of the pelvic limbs under his body when ambulating. The patient could rotate limbs at the level of the coxofemoral joints, but the dorsal surfaces of the tarsi dragged behind the patient. The dorsal surfaces of tarsi were alopecic and exhibited hyperkeratinized skin in the alopecic areas. Myofascial evaluation revealed several findings: loose musculature around the coxofemoral joints, tense tendons and musculature along the metatarsal to tarsal region, and palpable sensitivity to touch along epaxial musculature in caudal thoracic and cranial lumbar regions. It was suspected that, in addition to these findings, a degree of pain was likely.
MEDICAL DECISION MAKING:
When I first began treating this patient with acupuncture, I had not gone through practical training. My acupuncture treatments were largely experimental, focusing on very easy anatomical points to locate. As a result, I’m unsure if any real value was given to the patient with these early treatments. Post practical acupuncture training, my treatments were focused on promoting adequate circulation and blood flow to the pelvic limbs by stimulating neuromodulation of the connective tissue in the saddle thrombus prone area. The points picked to do this were: BL 25, BL 27, BL 28, Bai Hui, BL 57, GB 29, and GB 30. Distal points were utilized to promote perfusion of connective tissue from proximal areas of the body to distal regions. The points picked to do this were: LR 2, KI 3, KI 1, Bafeng, BL 67, and ST 36. My calming points and promotions of overall general good health were GV 20, GV 14, ST 36, and Bai Hui. Some of these points were well picked as they could serve dual purposes in categories previously described. Choosing both local and distal points along the bladder line further promoted perfusion of the connective tissue and neuromodulation as the pathologies associated with FATE typically follow this channel. Circling the dragon of the alopecic areas was used in conjunction with the distal point of LR 2 which, conveniently, was located in close proximity to the area of concern. Electrostimulation, although not used in every treatment, amplified the effects of neuromodulation and perfusion of each point and groupings of points stimulated.
Week 1: Bafeng, ST 36, GB 30, KI 1 (all bilaterally) *electrostimulation between GB 30 and KI 1 on both sides
Week 2: Bafeng, ST 36, KI 1, BL 25 (all bilaterally)
Week 3: Bafeng, ST 36, KI 1, GB 30, BL 25 (all bilaterally) *electrostimulation between GB 30 and KI 1 on both sides
Week 4: Bafeng, Bai Hui, GV 20, GV 14, BL 54, BL 67, GB 29, GB 30, KI 3 *electrostimulation between BL 67 on both pelvic limbs
Week 5: GV 20, Bai Hui, GV 14, BL 54, BL 67, GB 29, GB 30, KI 3
Week 6: GV 14, GV 20, Bai Hui, BL 25, BL 27, BL 28, BL 54, BL 67 *electrostimulation between BL 25 and BL 54 bilaterally
Week 7: GV 20, Bai Hui, BL 27, BL 28, BL 54, BL 67, GB 29, GB 30, Bafeng
Week 8: Bafeng, GV 20, Bai Hui, BL 27, BL 28, BL 54, BL 67, GB 29, GB 30, KI 3, LR 2, circle the dragon (2 additional points with LR 2) *points mainly focused on the right side of the body
Week 9: GV 20, Bai Hui, BL 27, BL 28, BL 54, BL 67, GB 29, GB 30, KI 3, LR 2, circle the dragon (2 additional points with LR 2) *points mainly focused on the right side of the body, but a few of the distal pelvic limb points were bilateral
OUTCOME AND DISCUSSION:
In the most recent acupuncture treatment, the patient was seen placing the right pelvic limb under his body with every step. Although taught tendons and musculature prevented completely normal ambulation, this was a huge improvement from initial presentation. Conscious proprioception is mildly delayed on the right side and present on the left. I don’t think acupuncture is going to be a replacement for lifelong heparin therapy in this case, however, it improved the patient’s quality of life significantly. The alopecia of the left pelvic limb was no longer noticeable and with continued ambulatory improvement of the right pelvic limb, alopecia may improve there, as well.
Throughout this experience, I learned that repetitive therapy produces the best results. At first, my treatments were more sporadic and not as thorough. With repetitive more thoughtful treatments, I saw noticeable improvements in ambulation of the patient. I did experience bleeding on several occasions from the acupuncture needles in this patient. Likely, heparin therapy was the reason behind so many of these incidences. I also learned that, just like traditional medicine, treatments change over time, depending on the presenting complaints and clinical signs of the patient. For this reason, the myofascial palpation before each treatment very important as it dictates your point selection and can change from week to week.
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