Approximately 16 months prior to presentation, the 10 yr old male, neutered German Shepherd had a sudden onset of pain in his left rear limb. The referring veterinarian did not find any abnormality in the left rear limb and noted that it appeared to be sciatica. At the time, the dog was treated with oral meloxicam but did not tolerate this non-steroidal formulation, and was switched to daily subcutaneous injections of meloxicam for 3 weeks. The dog recovered and then one month prior to presentation, suddenly lost control of his hind end. It appeared to be more weakness than pain and progressed over the month. The referring veterinarian did not have a definitive diagnosis but began treatment with mavacoxib, sodium aurothiomalate (antiarthritic) and gabapentin. No improvement had been noted and the clinical signs had worsened, so gabapentin was discontinued. The urine was noted to be normal but the faeces had been mostly loose, with frequent bouts of diarrhoea. Carafate administration had improved the faecal consistency. There had not been any signs of urinary incontinence, although mild faecal incontinence was noticed. The dog has a very sensitive bowel and a long history of Inflammatory Bowel Disease. The diet included chicken, a variety of processed human food, and a small amount of Hills Science Diet. The dog is cool-seeking and likes to sleep on hard, cold floors. The dog has long drinks, but does not drink frequently during the day or night. There are fluctuations in the appetite, but at times it is very poor.
Physical and neurological exam: PE was unremarkable. The mentation was normal. There was severe ataxia in the pelvic limbs with the right side worse than the left. There was also weakness of both hind limbs (paraparesis). Conscious proprioception was absent on the right hind limb and significantly reduced in the left hind limb. Marked muscle atrophy was noted along the spinal musculature and bilaterally over the pelvis and hind limbs. No pain was found upon manipulation/palpation of the neck, spine, pelvis or limbs.
At this stage, a chronic progressive paraparesis was diagnosed with the definitive diagnoses including IVDD, degenerative myelopathy, myelitis and spinal cord neoplasia. Degenerative myelopathy was a likely diagnosis considering the signalment and presentation. Referral to a neurologist was declined by the owner. The owner wanted to try and increase the dog’s quality of life with Chinese medicine in combination with the current referring veterinarian’s therapy.
TCVM exam: This dog has a combination of predominate elements including Wood (barks and is very dominant to other dogs, can be very stubborn) and Fire (loves to be touched and be with people all the time). The ears were warm on palpation. The tongue was pale pink on the sides and lavender in the centre, and the lavender colour reduced during the consult. The tongue was quite flaccid and weak, hanging out of the mouth at times. Deep cracks were located over the entire surface of the tongue but the tongue was moist. The pads were not too dry but were warm. The coat was dry with very small flakes of dandruff in places. The pulses were bilaterally weak, thready and deep with the right side weaker than the left. The dog was panting during the consult. There was no sensitive pain on palpation.
TCVM Dx: Wei Syndrome, Spleen Qi and Liver/Kidney Yin Deficiency
Given there is a strong Wood constitution, there may have been a Liver-Spleen disharmony and over time, the Spleen has become weak. Poor quality elements of the diet would have also weakened the Spleen over time. The Spleen Qi Deficiency results in the Spleen failing to generate Qi and Blood, causing a muscle atrophy and weakness of the limbs. There is a strong Fire Element in this dog and the heat from the Fire Element may have insulted the Water Element (Ru cycle) and drained from its Mother Element, Wood, resulting in Kidney and Liver Yin Deficiency, respectively. As the Liver stores the Blood and controls the tendons and ligaments and the Kidney stores Jing, dominates the bones and rules the lumbar mansion, hindquarter weakness has ensued.
TCVM treatment plan:
The treatment was aimed at tonifying the Spleen Qi, tonifying the Liver and the Kidney Yin and strengthening the tendons, muscles, spine and hind end. Over the course of treatment, the following acupuncture points have been used. A combination of dry needle, electroacupuncture (EA) was used in the early stages and later, moxibustion (moxa) was added.
Back shu association points: BL-17 to BL-26
Qi tonification and strengthen Spleen: LI-10, ST-36, SP-3
Yin tonification: KID-3/6/7/10, Shen-shu, SP-6
Distal points: BL-40/60, KID-1, LU-9/SP-3, SI-3/BL-65, LI-4/LIV-3, GB-34/39, Liu-feng
Constitutional points: HT-7
Points to clear Heat: GV-14, LI-11, Wei-jian
Other points: Shan-gen, BL-54, GV-14/13/12/11/9/8/6/5/4/3/1
2nd treatment (a week later)
The owner reported that the dog was bright after the first treatment and did show some positive signs, he was moving more and seemed a bit stronger. There was not a major change but he was not as wobbly. The tongue had a red tip, cracks, and was pale purple over the body, and moist. The tongue was flaccid and weak, hanging out of the mouth at times. The ears were still warm and the body and back were warm. The dog was panting in the consult room. The pulses were still weak, with the right being weaker. The pattern was the same. The muscle atrophy was marked.
Hindquarter Weakness Formula was started at ¼ teaspoon twice daily and gradually increased to ¾ teaspoon twice daily.
3rd treatment (2 weeks later)
The dog had been doing very well and was now walking a lot better at home and at the park. His strength and co-ordination were improving. He was eating well. The tongue was dark pink-purple at first, and at the end it was dark pink with a very
Pale tinge of lavender at the centre. The ears were now neutral in temperature, as were the paws. The dog was still panting but the Yin Deficiency signs had improved.
The treatment plan at this stage was modified to include more distal points on the limbs. Herbal medicine was continued.
Ten weeks after the initiation of TCVM treatment, the pattern was the same, with the Qi Deficiency being more prominent than the Yin Deficiency. Moxa was added into the treatment protocol to help warm and increase the flow of Qi-Blood during times of Stasis (as there is profound Qi Deficiency in this dog, there is also Stasis/Stagnation reflected in the lavender tongue colour). As the Yin Deficiency had improved and he was on Hindquarter Weakness (Yin tonics), I concluded that it would be safe to use moxa, but to monitor it very carefully. Indirect moxa using a moxa stick was performed along the GV channel starting from the thoracic spine and moving caudally to Bai-hui, down both pelvic limb Yang Ming Channels and bilateral LI-10 acupuncture points in the front limbs.
The owner reported an extremely good response to this treatment with the dog being able to jump in and out of the car, onto the bed and being able to run for longer periods of time. Two weeks later, he was visibly stronger and the plantigrade stance had improved with an obvious gain in strength in the hind limbs (See below Figure). He is currently doing very well with regular sessions and Hindquarter Weakness Formula.
Figure. Plantigrade stance before (left) and after (right) treatment with acupuncture and moxa.