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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/4987.

Abstract:

A Chihuahua sustained a back injury that resulted in hind limb paralysis. She was treated with chiropractic care, laser therapy, acupuncture, physical therapy, and rehabilitation for three months. Her paralysis improved to the point where she is able to perform all of her necessary duties, but still has an ongoing lameness of the right rear leg.

History/Presentation:

Daisy is a 4-year-old, 6 pound, spayed Chihuahua.  On 9/14/16, she was stepped on by her 60 pound house-mate, and sustained an acute injury to her hind end. She was presented and treated for a right rear leg injury at a neighboring veterinary hospital. Radiographs were obtained and no abnormalities were noted. Buprenorphine was administered, and ice packing was initiated. In the afternoon of the day of admission, Daisy appeared to worsen and developed bilateral paralysis of both rear limbs. Differentials included thromboembolism, disc rupture, or spinal bleed. An orthopedic referral was recommended and a grave prognosis was given to the owner. The dog was treated with Famotidine and Dexamethasone Sodium Phosphate. The dog was sent home with oral Pepcid  and Azium. Daisy was treated six times over seven days with laser therapy targeting spinal trauma, and she started using the left rear leg but dragging her right rear leg. She was also treated with Famotidine and Sucralfate after developing black, tarry stools.

Physical Examination and Clinical Assessments:

On 9/23/16, the owner came to Broken Top Veterinary Clinic for a second opinion. On examination, Daisy was dragging her right rear leg, had intact deep pain, normal withdrawal reflexes, and normal patellar reflexes. No pain was noted in the leg but she was painful at the lumbosacral region. All other examination findings were within normal limits. Tramadol 6.25 mg was dispensed every eight hours, and cage rest was instituted. Steroids were not administered, given the history of a recent gastrointestinal bleed. Radiographs were repeated, and a radiology consult was conducted. No abnormalities were noted but, given the neurologic history, the radiologist was suspicious of either disc disease, a tumor, or myelitis in the region of T3-L3. Magnetic resonance imaging (MRI) was recommended. On 9/27/16, Daisy was placing her right rear leg better, though still ataxic. Strict cage rest was continued along with laser therapy. Prednisone was dispensed at 1.25 mg once daily. On 9/29/16, laser therapy was repeated and acupuncture was initiated. Daisy was much improved, occasionally knuckling and dragging her right rear leg, with visible atrophy of her right biceps femoris.

Medical Decision Making:

My approach and sequence of treatments was initially determined by the availability of the client. I started with dry needling, as I didn’t have any electro-acupuncture equipment yet. For the first two acupuncture treatments, I was treating lumbosacral pain, and trying to re-establish communication of the sciatic and fibular nerves on the right side. After Curacore Intensive, my treatment was based on thorough myofascial palpation and establishing neuronal connections, while keeping neuromuscular function in mind.

Acupuncture Treatment:

Initial acupuncture points treated were: BL21, BL27, BL28; ST36; BH; KI1. Dry needling was repeated six days later at points: BL21, BL25, BL27, SP10, KI1, KI3, BH, and over the right iliac wing (1,2). Needle sizes used were Serin 0.16, 15 mm, tubed. Prior to the first acupuncture appointment, Daisy was dragging her right rear leg. On the second acupuncture appointment Daisy had increased muscle tone and was instead carrying the leg. Three more laser treatments were performed and during this time Daisy was improving, but still occasionally dragging the leg. Steroids were continued every other day. On 11/3/16 recheck, radiographs were repeated. A possible opacity was noted at L6-L7, but no narrowed disc spaces were evident. The radiologist noted narrowed disc space at T13-L1. On video review, the neurologist noted proprioceptive ataxia and paresis in the right rear leg.

Acupuncture was re-initiated after completing Curacore Intensive, including electro-acupuncture.   Dry needling points were: BL 15, BL17, BL18, BL21, BL 23, BL25, BL26, BL27, hip triad (BL54, GB29, and GB30), BH, KI1, KI3, and Bafeng.  Electro-acupuncture points targeted were GB30, GB29 and BL54, with each point individually connected to Bafeng and KI1 points alternatively.  Electro-acupuncture, focused on the back, was performed from BL17 to BL21 and BL22 to BL27 (1,2). The days after initiating electro-acupuncture, the owner noted significant improvement, and treatments were continued weekly. Based on patient response, electro-acupuncture alternated between leg points and back points, for an additional total of four electro-acupuncture and dry needling treatments.  The owner saw no continued improvement and has opted to discontinue therapy.

Outcomes, Discussions and References:

Daisy initially improved with cage rest, laser therapy, and steroids. After her first acupuncture treatments she improved neurologically as a result of stimulating her flexors, which created a difference in her lameness from dragging her leg to carrying her leg. Upon further education, my treatment rationale evolved to electro-acupuncture of the sciatic nerve with extensor and flexor therapy in mind. I feel that the patient improved with all the therapies that were initiated, including cage rest, laser therapy, acupuncture, and rehabilitation

What I learned from this case is to do my own myofascial and neurologic exam, and to think through where the lesion is and what the outcomes of certain therapies might be. In the future, if I see a neurologic issue, I would initiate electro-acupuncture as my first therapy of choice. The other lesson I learned is, even if there have been many treatments already initiated, it is never too late to try acupuncture! From this case study I learned that performing acupuncture is a science as well as an art, and it will be an ongoing learning process.

References:

  1. Dharmandanda, Subhuti. Electro-acupuncture. Institute for Traditional Medicine, Portland, Oregon. Retrieved from http://www.itmonline.org/arts/electro.htm.
  2. Robinson, Narda. An Emerging Standard of Care for T-L IVDD. Veterinary Practice News. May 21, 2013.