Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4931.
Spock is a three-year-old neutered male Rat Terrier Mix that presented for acute hindlimb paralysis on 8/25/26. Spock was diagnosed with suspected IVDD. Spock had no motor function, but had superficial pain of hindlimbs at his initial presentation. Owner elected for crate rest, medical management, and acupuncture over surgical correction. Acupuncture was performed on 8/25/16, 8/26/16, 8/27/16, and 8/29/16. Spock was noted to be first time standing immediately after 8/27/16 acupuncture treatment, and first time ataxic walking immediately after 8/29/16 acupuncture treatment.
Spock presented for not walking on hind legs. Owner reports patient was normal walking/running this morning. Patient went to kennel normally when owner left for work. When owner returned, patient could not use back legs. Owner reports patient was whining more day before and day of paralysis, but did not think much of it at the time. Patient is on no medications at this time.
Physical Exam and Clinical Assessment
Wt: 7lb 130z T:101.8 F P: 180 R: 40 CRT: <2 MM: pink/moist BCS 3/5
Physical Examination: BAR, Cardiothoracic auscultation has no significant findings; Right and Left Grade 1 Medial Patellar Luxation; no other significant findings
Paraplegic with superficial pain intact. Both sciatic and patella reflexes appear normal to increased. No cross-extensor reflex appreciated. CP deficits in both hind limbs.
Taught bands in left and right triceps. Mild to moderate Kyphosis noted at level of T11-T13. Patient has guarding behavior on palpation near T-11 through L-1.
Owners were offered and declined spinal radiographs. Patient is thought to have IVDD at the level of T11 through L-1.
Medical Decision Making
Spock is paraplegic with superficial pain sensation intact. Owners declined surgical referral and elected for conservative management. Treatment included: cage rest, Rimadyl (6.25mg PO BID), Methocarbamol (125mg PO TID), Tramadol 1(2.5mg PO TID), and acupuncture. On 8/26/16 evening Prazosin (0.5mg PO BID) was added to protocol for concern of UMN bladder signs. Dry needling was performed at the first treatment to get the patient acclimated to acupuncture. The remainder acupuncture sessions were electro-acupuncture based. Electro-acupuncture was performed with mixed settings of high and low frequencies (dense disperse setting) in order to provide more controlled nerve stimulation. Low frequency settings are thought to provide longer lasting affects with a slower onset of effects. The high frequency setting would provide a quicker onset of pain relief with shorter duration of effect. Four sessions were performed once every 24-48 hours in the first five days, and follow up acupuncture sessions will be performed once to twice every one-two weeks for the next month and then once every three-six months thereafter for a maintenance therapy. Treatments are focused around suspected IVDD location and Ba Feng points in order to provide analgesia and nerve stimulation to the spinal cord and associated peripheral nerves that have been affected by suspected disc compression. Laser therapy was not available, but would have been considered for triceps and caudal thoracic and cranial lumbar vertebral segments in order to increase blood flow and promote healing.
8/25/16 (initial treatment):
Dry needling for 10-15 minutes was performed with Seirin D-type (0.16) X 15 mm in order to adapt patient to acupuncture. Needling was stopped earlier than intended due to patient’s temperament. Points were selected based upon patient’s guarding behavior/tenderness to palpation at caudal thoracic spinal segments and cranial lumbar spinal segments. Calming points were attempted, but patient resisted needling at GV-20 and Bai Hui. The following points were used by dry needling: BL-18 (2 times) and BL-22 (2 times) in order to treat around suspected site of injury. Patient would not tolerate any further points at this time.
Post treatment myofascial exam was unchanged. No other significant findings.
Electro-acupuncture was performed with Pantheon 8c.Pro Electrostimulator for 15-20 minutes on Mixed settings of 1Hz and 25Hz. HWATO (0.20) X 25mm needles were used at B-18 (2 times) and BL-22 (2 times) to treat around suspected spinal cord injury. Electrodes were placed bilaterally connecting BL-18 to BL-22 on each side of the body. Dry needling was performed in all Ba Feng points with Seirin D-type (0.16) X 15mm needles to provide distal nerve stimulation. Patient would not tolerate any other points. Patient appeared more relaxed during electro-acupuncture session. Post treatment myofascial exam was unchanged. No other significant findings.
Electro-acupuncture was performed with Pantheon 8c.Pro Electrostimulator for 15-20 minutes on Mixed settings of 1Hz and 25Hz with HWATO (0.20) X 25mm needles at BL-18 (2 times), BL-22 (2 times), ST-36 (2 times), and all Be Feng points. Electrodes connected BL-18 to BL-22 bilaterally and central Ba Feng point to ST-36 bilaterally. Ba Feng to ST-36 electro stimulation was kept at maximum toleration by patient to allow for a small twitching response to allow for maximal nerve stimulation to peripheral nerves. These points were selected to increase sympathetic tone. Patient was noted to stand immediately post treatment.
Electro-acupuncture was performed with Pantheon 8c.Pro Electrostimulator for 15-20 minutes on Mixed settings of 1Hz and 25Hz with HWATO (0.20) X 25mm needles at BL-18 (2 times) and BL-22 (2 times) connected bilaterally (BL18-22). All Ba Feng points were dry needled with Seirin D-type (0.16) X 15mm needles. Patient was noted to have some voluntary motor and correct his proprioception when walking immediately post treatment.
Outcomes, Discussion, and References
Immediately post treatment on 8/27/16 Spock was standing for the first time since the incident. Spock returned to original sitting position 10 minutes after that treatment in his cage. On 8/28/16 Spock was noted to stand on his own more and to urinate on his own. Immediately after the treatment on 8/29/16, Spock was noted to walk on his own and correct his proprioception. After 10 minutes the patient was not able to walk again, and sat in his cage for the remainder of the evening. Medications previously mentioned were provided during the entire treatment, but patient was noted to have to most dramatic improvement of clinical signs immediate post acupuncture therapy. It is thought acupuncture in conjunction with medical management has a statistically significant better outcome for returning to normal function quicker than medical management alone (1,2). Spock was thought to have the most dramatic improvement of clinical signs immediately post acupuncture sessions; thus, it is thought to have a very strong impact on his immediate progress.
1) Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs
Ayne Murata Hayashi, Julia Maria Matera, and Ana Carolina Brandão de Campos Fonseca Pinto
Journal of the American Veterinary Medical Association, September 15, 2007, Vol. 231, No. 6 , Pages 913-918
2)Clinical Effect of Additional Electroacupuncture on Thoracolumbar Intervertebral Disc Herniation in 80 Paraplegic Dogs
Hyun-Jung Han, Hun-Young Yoon, Joon-Young Kim, Ha-Young Jang, Bora Lee, Seok Hwa Choi, and Soon-Wuk Jeong
The American Journal of Chinese Medicine 2010 38:06, 1015-1025