SIGNALMENT: "Carley" is an eight year old, 32kg, lab./ hound mix breed, spayed female dog.
HISTORY: "Carley" is up to date on vaccinations. She has a history of intermittent diarrhea. Her feces tested positive for Ancylostoma caninum (hookworms) and was treated with pyrantel. The dog ate BBQ with some rib bones during the day. The dog went outside at night and was observed straining to defecate. Ten hours later the owner reports "Carley" is unable to get up and that her stomach appears distended.
WESTERN MEDICAL EXAM: Patient is bright, alert and responsive, MM pink and moist, CRT < 2sec. HR 48b/m, Resp.32r/m, Temp. 102 F, and PLR within normal limits. Blood tests: CBC and serology within normal limits. She has a limited ability to lift her head and neck, flaccid paralysis of both fore limbs, and minimal response to painful stimuli. Rear legs appear within normal limits. No pain elicited to neck flexion or extension. Spinal radiographs were WNL.
NEUROLOGICAL CONSULT: Presumptive Diagnosis – Fibrocartilaginous infarction (embolism) of the lower cervical or upper thoracic spinal cord.
WESTERN TREATMENT PRINCIPLES: Supportive care and physical therapy.
PROGRESS: There was no visible improvement between first neurological consult and the second visit 14 days later.
Tongue: Pink, full, wet clear coating, tip is slightly redder.
Body: Mildly overweight, no reactive points found, dog is down in the front end, tail wagging fast, attempts to get up but front legs not working. Abdomen moderately distended.
Pulse: Right and left equally strong at superficial, intermediate and deep.
Diet: Commercial dry diet.
TCVM DIAGNOSIS: Local Qi stagnation with Phlegm.
TCVM TREATMENT PRINCPLE: Free the local Qi stagnation and remove the Phlegm.
ACUPUNCTURE: Dry needles, electro-acupuncture and hemo-acupuncture were used. 1 The point selections were based on circle the dragon principle and to free stagnation in the spinal cord. 1 See Figure 1.
Jing-jia-ji (Cervical Paravertebral Points)
Hua-tuo-jia-ji (Hua-tuo’s Paravertebral Points)
GV-16 Tian-men (Heavenly Gate)
Bai-hui (Hundred Meetings)
GV-1b Wei-jian (Tip of Tail) hemo-acupuncture with a 23 ga needle.
BL-11 Da-zhu (Big Shuttle)
Settings used for AP were the lower frequency (5-20 Hz) with intermittent stimulation to attempt to re-educate the motor neurons 45 mins. 1
Frequency of AP was every 3-4 days for a total of five treatment
Figure 1. "Carley" receiving Electroacupuncture.
HERBAL FORMULAS: Herbal formula Double P #2 and Cervical Formula were given starting on day 17. Five 0.5g capsules of Double p #2 and four 0.5g capsules of Cervical Formula were given twice daily.
PHYSICAL THERAPY: Four times a day for 5-15 mins all limbs went thru passive range of motion. The fore limbs and feet were massaged (this case was before Tui-Na). A walker for "Carley" was constructed from a human walker (see Figure 2.). "Carley" was placed into her walker three times daily so that she could go outside to urinate and defecate. Swimming therapy
Figure 3) was performed once weekly – during the 1st swimming session she started moving her L front leg (as if to doggie paddle) this was the first time she was able to control movement of that leg (Figure 3). My staff and I called this our "red neck rehab program".
Figure 2. Physical therapy in the walker.
Figure 3. Physical therapy in the pool.
OUTCOME: Sixteen days following the initiation of TCVM therapies, "Carley" was able to get up, stand, and walk without assistance (Figure 4). She was still mildly unsteady on her fore legs. She had to be leashed walked for one month because she would start to run and jump then trip over her front feet. One year later she appears normal at the walk, but some mild ataxia is seen at the run.
Figure 4. " Carley" on a walk with some assistance.
DISCUSSION: Fibrocartilaginous Embolism (FCE) is defined as an acute infarction and ischemic necrosis of the spinal cord. The infarction occurs as a result of fibrocaritilage lodging in the small arteries and veins supplying the spinal cord. 4, 5 Sources state that if no improvement is seen within the first 14 days following injury prognosis is poor. 4, 5 About, "50% of dog and cats with FCE recover sufficiently to be returned to their owners as acceptable pets". 4 Treatment recommendations are supportive care. Some sources state that glucocorticoids the first six hours and continued for 24 or 48 hours may be of benefit. 5
There was no improvement noted by the Neurologist at the 14 day recheck appointment. At this point in time her owners said that "Carley" had two more weeks of care to show some sign of improvement. The owner’s decision was based on quality of life issues, financial issues and the inability to care for her at home in her current condition. After two weeks they would request euthanasia.
The first AP treatment was preformed on day 14 one hour after the Neurologist last visit and was continued every 3 to 4 days (Mondays and Thursdays). Herbal therapy began on day 17 following injury. No improvement was noted until day 20. While "Carley" was in the pool, supported by a personal flotation device, she started to use her left front leg (attempting to swim). Acupuncture was used to free stagnation, move phlegm (FCE), and to return the proper flow of Qi. The Jing-jia-ji (Cervical Paravertebral Points) was used to "circle the dragon". Electro-acupuncture between Bai-hui (Hundred Meetings) and GV 16 was used to correct the flow of Qi and free stagnation.
The herbal formula Cervical Formula was used to nourish Blood, dissipate stagnation, and to direct the herbal medicines to the affected area. Double P #2 formula was indicated in this case due to its ability to treat acute spinal conditions. Using these two formulas together allows the herbs to resolve stagnation, activate Blood, and move Qi : Angelica, Carthamus, Myrrh, Olibanum, Draxonis, Pueraria, Chaenomeles, Clematis, etc. to direct their actions to the cervical regions due to the actions of herbs: Ligusticum, Pueraria, and Notopterygium.
1. Xie H, Preast V. Xie’s Veterinary Acupuncture. Ames, Iowa. Blackwell Publishing, 2007
2. Xie H, Preast V. Chinese Veterinary Herbal Handbook. Reddick, Florida. Chi Institute of Chinese Medicine, 2004
3. Xu, Z.L. Pocket Handbook of Chinese Herbal Medicine. Miami, Florida. WACLION International, Inc, 2005.
4. Nelson, R.W., Couto, C.G. Small Animal Internal Medicine, second edition.St. Louis, Missouri. Mosby, Inc, 1998
5. The Veterinary Clinics of North America. Small Animal Practice. Common Neurologic Problems. Philadelphia, Pennsylvania. W.B. Saunders Company, 2000.