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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/4993.

Abstract:

Chewie, an 8 year old, neutered male whippet, presented to a local emergency clinic with a history of a right forelimb lameness with rigidity and pain on cervical range of motion.  The initial lameness progressed over the next 48 hours to forelimb paresis with decreased reflexes and proprioceptive (CP) deficits.  Chewie was treated with 3 sessions of electroacupuncture (EA) in the first 7 days.  By the second session Chewie was able to stand with minimal assistance.  After the third session Chewie was able to ambulate without any assistance.  Chewie’s sessions are currently ongoing with continued progress noted.

History and Presentation:

Chewie, an 8 year old, neutered male whippet, presented on 11/27/2016 to a local emergency clinic with a right forelimb lameness.  Medical history indicated that he had been painful the evening before and the owner administered an unknown dose of aspirin.  On the morning of presentation Chewie jumped off of the bed and became non-weight bearing on his right forelimb and was reluctant to move.

Medical record review indicated rigid paresis was noted in the right forelimb   No pain, swelling or crepitus was indicated.  Pain on palpation of the cervical spine and on flexion and extension was discovered.  The remainder of the general physical exam was unremarkable.

Cervical spinal radiographs taken by the referring veterinarian revealed no obvious bony abnormalities.

Chewie was started on Methocarbamol 250mg orally every 8 hours, Gabapentin 100mg orally every 12 hours, and Carprofen 25mg orally every 12 hours and was transferred back to his regular veterinarian for follow-up care.

A phone call was placed on 11/28/2016 by Chewie’s regular veterinarian to check on his condition the following day.  The owner indicated he appeared stable at that time.  He was trying to move but was unable to support his weight on his front legs.  The owner’s impression was that his hind legs appeared to be functioning normally.

Recheck exam later that day by the referring veterinarian revealed 50% loss of proprioceptive (CP) responses and motor function in Chewie’s front legs and 30-40% loss in his hind legs with decreased deep pain sensation in the forelimbs according to the referral record.  Options were discussed with the owner including continued medical management with steroids, referral for surgical consult, or referral for acupuncture and rehabilitation therapy.  Owner opted to pursue medical management with steroids and integrative therapy.  Prednisone 10mg every 12 hours was dispensed and carprofen discontinued.

Physical Exam and Clinical Assessments:

Chewie presented for his first acupuncture evaluation 12/1/2016.  On exam he was bright and alert with normal vital signs.  Neurologic exam revealed normal cranial nerve function, bilateral forelimb paresis with diminished responses, minimal deep pain perception and absent tendon reflexes and no crossed extensor reflex.  He had spastic reflexes in the hindlimbs, rigid paresis and slow, but present CP reflexes and deep pain response.  Lordosis was noted from T1-T5.  Myofascial exam revealed trigger points and a prominent strain pattern in the latissimus dorsi region behind the scapulae and in the rhomboids as well as muscle fasciculations and spasticity in the cranial thoracic region.

Chewie presented for his second session 2 days later on 12/3/2016.  At that time he was still weak and reluctant to rise and knuckled over in both front legs.  He was hyporeflexive bilaterally in the front, hyperreflexive in the rear.  He was able to stand and took a few voluntary steps forward with assistance.

Examination of Chewie at his third session, on 12/5/2016, revealed voluntary motor function in the left front leg and both hind legs while his right front leg still had decreased motor and no CP responses. Chewie was able to stand with minimal support and could voluntarily ambulate without assistance during this session indicating improved strength and coordination.

Medical Decision Making:

Based on the findings of Chewie’s neurologic and myofascial exam the lesion was localized to the C6-T2 spinal region.  Because of the severity and progression of his neurologic deficits the decision was made to treat with electroacupuncture to stimulate healing of the suspected damaged spinal segments and provide proprioceptive feedback from the forelimbs to the spine.  The recommendation was made to perform 3 treatments in the first 7 days and then determine the frequency of follow up treatments based on response.

Acupuncture Treatment:  The following treatment plans were implemented in Chewie’s care.

Session 1:  Points selected include (central) BL12-14 (bilateral), BL19-21 (bilateral), Bai Hui; (peripheral) Baxie X 3 (left), (myofascial) local trigger points at SI12, SI11 and caudal cervical spinal point in the region of C5 on the right; (autonomic) GV20, GV14, ST36 (right).  EA BL12-14 bilateral, mixed frequency 4/100hz, 10 minutes, Hwato .22x25mm

Session 2: Points selected include (central) BL11-15 (bilateral), GV14; (peripheral) Baxie X 3 (right); (myofascial) trigger points @ C3-4 laterally and SI12, SI9 bilaterally, also TP caudal to the scapula and in the latissimus dorsi muscle between BL17 and SI9. EA BL11-15 bilaterally, mixed frequency 4/100hz, 10 minutes, Hwato .20x25mm

Session 3: Points selected include (central) GV 14, BL11-13, BL17-18 bilaterally; (peripheral) Baxie x 3 (right); (myofascial) TP @ GB21 (right); (autonomic) GV14/  EA BL 11-15 and 17-18 bilaterally, mixed frequency 4/100hz, 20 minutes, Hwato .22x25mm

Outcome and Discussion:

Prior to initial acupuncture evaluation, Chewie had a progression of clinical signs while on medical therapy.  With the introduction of acupuncture his motor function, pain control and proprioception began to improve almost immediately.  After his first session, he went from non-ambulatory tetraparesis to standing without assistance and voluntary forward movement.  As a result of this case I learned that early intervention with acupuncture in patients with neurologic deficits is important to facilitating their recovery, prevent atrophy and musculotendinous deformations that often result from prolonged disuse and contribute to difficulties in ambulation and proprioceptive retraining.

References:

  1. Vet. Sci. 2016; 17(3): 337-345

Evidence-Based Complementary and Alternative Medicine 2013, Article 1D