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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/4951.

Abstract

Cashew, a one-and-½-year old neutered male Dachshund was diagnosed with IVDD. The patient was treated over the course of two months initially with pain medication, rehabilitation, and acupuncture. Assessment exams were performed initially and by the end of treatment course prior to discharge. The assessment tools utilized included full neurologic and orthopedic exam, myofascial palpation, gait assessment, and form to analyze neurologic function (FINFUN- The Finnish Neurological Function test).

History Presentation

Cashew presented for acute onset of paraparesis on hindlimbs on 5/20/26. In addition, he was lethargic, was urinating on himself, and seemed to be very painful. Cashew was presented at the clinic within 12 hours of clinical signs. Cashew lives in an apartment and there’s very little chance of toxin exposure. He was up to date on his vaccines, heartworm, flea, and tick preventatives. There was no history of trauma.

Physical Examination and Clinical Assessment

T 100.2; HR: 110; RR: panting; BCS: 6/9. On general observation kyphosis of lumbosacral junction, guarded and crouched position, lower head carriage was noted. On myofascial palpation pain on LS area and muscle spasm were noted. Taut bands on the neck and cranial thoracic area over the scapula were palpated.  Cashew was ambulatory, but stumbling and falling at every other step. Pain score was 2/4, moderate pain with obvious discomfort on LS area. Neurologic lameness scores:  at stance and walk 4/5 and 3/5 at trot. Neurologic exam revealed decreased CPs and patella reflexes in both HL; cutaneous trunci stopped at L1-L2. FINFUN score 18/44.

Cashew assessment is of acute paraparesis with a definitive diagnosis open: (IVDD, vascular accident, infectious, Mass/neoplasia, FCE, other).

Medical Decision Making

Injection of Dexamethasone and gabapentin were given initially to decrease inflammation on the spinal cord and pain control. Laser therapy of 500 J dose over the epaxial muscles and LS junction was also used for the same benefits. TENS 10 Hz pulsed wave was used initially for pain control. Rehabilitation was performed twice a week and acupuncture was started immediately. All recommendations rationale take in consideration pain control, decrease inflammation, stimulation of the neurologic system, prevent disuse muscle atrophy, and ultimately return to function.

Acupuncture Treatment

Acupuncture treatment was provided weekly for a month and then every three weeks thereafter. Points chosen were: BL-10, BL-11, BL-12, BL-23, BL-29, BL-54, BL-60, GB-29, GB-30, BH, GV-20, GV-14, KI-3, LI-4.  The following points were selected because of local effectiveness in treatment the area of main concern. Some of the points were chosen for its thoracic focus other for its pelvic focus. Some points such as GV-14 and GV-20 were chosen for overall patient relaxation. LI-4 for its sympathetic regulation.  KI-3 and Bai Hui were chosen with voiding dysfunction.

Outcomes, Discussions and References

On 7/8/16, Cashew was back normal function. Pain score 0/4, neurologic lameness at stance, walk and trot score 5/5. Neurologic exam revealed normal CPs and spinal reflexes in all four limbs. FINFUN score 44/44. Myofascial palpation did not reveal any areas of pain, tension or muscle spasms. Cashew’s recovery was certainly due to a multimodal approach to pain and neurologic rehabilitation. Acupuncture did play a important role in pain management and from my prospective as a CCRP it also contributed to neurologic function improvement. Cashew was ready to start therapeutic exercises much earlier than similar patients in the past without acupuncture. These overall increased rate and speed of recovery. Although, these are anecdotal observations, acupuncture plays an important role used in conjunction with rehabilitation.

References:

1. Millis, D.L. Pain score, neurologic lameness score in: D.L. Millis, Levine (Eds.) Canine Rehabilitation and Physical Therapy. Elsevier, ; 2014.

2. The 8Th International Symposium on Veterinary Rehabilitation/Physical therapy and Sports Medicine. The Finnish Neurological Function test,; 2014