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  • October: Treatment of Fibrocartilaginous Embolism in a Dog with TCVM

October: Treatment of Fibrocartilaginous Embolism in a Dog with TCVM

Saturday, 01 October 2022 09:00

Treatment of Fibrocartilaginous Embolism in a Dog with TCVM
Rosemarie Niznik, DVM, CVA, CVSMT, CVFT. FCoAC

ABBREVIATIONS
CSF - Cerebral Spinal Fluid CP Conscious proprioception
FCE Fibrocartilaginous embolism MRI Magnetic resonance imaging
TCVM - Traditional Chinese Veterinary Medicine

IMG 1214Fibrocartilaginous Embolism (FCE) and infraction of the spinal cord is the most common nervous system vascular disorder of dogs. Young, large breed dogs, Miniature Schnauzers, and very rarely cats are presented with acute asymmetrical quadriparesis, hemiparesis, with paralysis for no apparent reason. Infarction of the spinal cord is due to the occlusion of other arteries of veins with fibrocartilage. The origin of the cartilage is unknown, although most theories suggest that is arise from degenerated intervertebral disk material that gains entrance to the spinal cord. A history of acute collapse with or without vigorous exercise in common.1

TCVM Etiology and Pathology

From a TCVM perspective, spinal cord ischemia results in Stagnation of Qi/Blood flow with Qi Deficiency locally that affects the spinal cord function. The Deficiency and Stagnation of the Qi/Blood depletes Gu Qi that nourishes the neurons and other cells of the region and degeneration and demyelination occurs. Kidney Qi Deficiency is also present if the animal has pelvic limb or generalized limb paresis or paralysis, Tan Huan Syndrome. 1

IMG 1239TCVM Pattern

Spinal Cord Qi/Blood Stagnation and Kidney Qi Deficiency

TCVM Treatment Principles

  1. Resolve Qi/Blood Stagnation to return proper Qi/Blood flow and resolve hemiparesis, quadriparesis, paraparesis, or paraplegia
  1. Tonify Kidney Qi to resolve hemiparesis, quadriparesis, paraparesis, or paraplegia1

Case Report

A 3 yr old MN Labrador retriever, “Buckeye”, was referred for treatment for acute tetraparesis and flaccid paresis. There was mild tremoring and and right third eyelid elevation. He was found by the pet sitter in the home unable to rise after running and playing ball outside on a golf course . Rule outs by the ER veterinarian were FCE, IVDD, acute toxicicosis of lawn chemicals or plants. Routine radiographs did not show any bone or disc abnormalities. The dog was treated with IV intralipid therapy with no improvement of clinical signs. The right side was affected more than the left side. Blood tests were done after intralipid infusion and the results were normal. MRI results showed a C6-7 intramedullary lesion, right side affected more than left side. . CSF tap results were consistent with an inflammatory processIMG 1261.

Conventional exam: Cranial nerve exam was normal No cervical or thoracolumbar pain. Non ambulatory all 4 limbs. Increased Right patellar reflex and decreased muscle tone and reflexes of the forelimbs. The withdrawal reflex and superficial reflex were WNL. Conscience proprioception (CP) was lost on right hind limb and delayed on right front limb. Absent panniculus. Gait with support was choppy in forelimbs and dysmetria in right rear limb. Diet: Purina One True Instinct and cooked chicken. The dog was not on any medication or supplements. He was supported with a Help ‘Em Up Harness for walks in the home and outdoors.

TCVM exam:

Earth Personality. Shen was excellent. Voice was strong. Appetite was good. There was normal urination and defecation.

Pulses: Bounding, stronger on left sideIMG_1273.jpg

Tongue color: pink edges with lavender center, moist, clear coating

TCVM DX:

Qi/Blood Stagnation cervical spine with Kidney Qi Deficiency

TCVM Treatment

Dry Needle Acupuncture treatment: GV-14, GV-20, Bai Hui, BL-23, GV-4, BL-54R, ST-36R, BL-60 to KID3, GB-29R, KID 1, PC-8, LI-11R, SI-9 R,

Liu Feng all feet (easy to needle this points)

Electrical Acupuncture at 20 Hz for 10 minutes and 80 to 120 Hz for 20 minutes: GV-20 to GV-14, GV-14 to Bai Hui, Bai Hui to BL-60, GV-14 to LI-11R

Aqua Acupuncture with 0.2 ml of diluted B12 with saline at GV-14, BL-40, BL-23, BL-24, BL-26, ST- 36, BL-602IMG_1295.jpg

Tui-na Home care:

Mo-fa along sides of body and limbs for 2 to 5 minutes

Tui Na along the Jing-jai-ji or Bladder Channel three times a day working up to 12 times per day

Nie-fa along Governing Vessel three times a day working up to 12 times per day

Duo-fa all 4 limbs three times a day working up to 12 times per day1,3

TCVM Food Therapy: Neutral to cool food items to support Qi and Blood: beef, eggs, carrots, sweet potatoes, squash

IMG 1261Food to support Kidney Qi Deficiency such as beef, chicken, sweet potatoes, carrots, squash, dates, figs.1

Reommended to top dress kibble diet with a few food items daily but no more than 10% of the daily calories.

Recommendation was Jing Tang Double P IIa and Jing Tang Cervical Formula.4,a Herbal Formulas were declined.

After treatment, Buckeye was taken outside and normal urination and defection noted! Owners were very happy as they were concerned dog was not defecating on a routine basis.

Treatments:

Buckeye was treated with acupuncture weekly for 6 treatments in March and April and then monthly in May and June. He was prescribed a home exercise program. He was also going for underwater treadmill session at local veterinary rehabilitation center. He steadily improved in neuromuscular function after each acupuncture treatment.                                                      

IMG 1248In subsequent appointments, the dog resisted acupuncture at Lui-Feng classical acupuncture points. This resistance coincided with increased function to the hind and forelimbs.

Additional acupuncture points utilized: LU-7, BL-20, BL-21, LI-10, GB-21, GB-30, GB-34, LIV-3

Additional Electrical Acupuncture Pairs: GV-14 to. SI-9, GB- 20 to SI-9, GB-21 to LI-11

Additional injections with 0.2ml diluted B12: GB-21, SI-9, An-Shen

The owner built a walker with PVC pipes and support ropes to allow Buckeye to stand and walk assisted in the home.

Follow up 3 months: Buckeye transitioned from underwater treadmill therapy to swim therapy. He was reluctant to use left back leg and held it flexed when swimming. He is walking assisted in house. He will walk around the yard and even chase squirrels. Stance: standing on all 4 feet with weight shifted to left side with left rear limb held rigid.

IMG_0578.jpgFollow up 4 years later - September 2022 - 60% better Conclusion

Acupuncture increases blood flow. Circulatory changes can also occur

local and distal to the acupuncture points stimulated.5 It is believed that increased blood flow caused by acupuncture flushes out the algesic substances and therefore relieves pain.In TCVM, this is interpreted as moving Qi and Blood Stagnation to provide pain relief.6

In FCE cases, the TCVM principles of treatment are to move stagnated Qi and Blood. If Qi and Blood are allowed to accumulate for a prolonged period of time, it can lead to Qi and Blood Deficiency. Since FCE leads to infarction of small arteries and veins and blockage of the free flow of Qi and Blood within the area, the main treatment goal is to unblock the Stagnation. This is done by treating acupuncture points local, cranial and distal to the lesion. In addition there are specific points that resolve Stagnation such as LIV-3 and GB-34.6

IMG_0594.jpgSince some dogs recover some degree of function with no specific treatment, the impact of the TCVM and other treatments on the recovery of this case is unknown. However since acupuncture, herbal therapy and

Tui-na have been shown to increase blood flow, the addition of these therapies to the treatment regime may reduce long-term residual damage in dogs with FCE. 6

 

About the Author

Dr. Rosemarie Niznik received her Bachelor of Science Degree with Honors from the Pennsylvania State University in 1984 and her DVM degree from the University of Georgia in 1990. Dr. Niznik is certified in Mixed Animal Veterinary Acupuncture and Food Therapy from the Chi University and Veterinary Spinal Manipulative Therapy from the Healing Oasis Wellness Center. She founded Harmony Rose Animal Wellness, a housecall integrative practice in 2015 that serves clients in Illinois and Wisconsin. She currently is a Chi University MS-TCVM student and Acupuncture Lab Teaching Associate and President-Elect of AHVMA. She goes by the nickname of “Dr. Rose” and lives on a 5-acre farm in Wisconsin with Chip, her husband, Grace, a Bernese Mountain Dog, and Wendy and Willa, two rescue cats. She is an  PSIA Level 1 Alpine Ski Instructor and teaches downhill skiing at Wilmot Mountain Ski Resort, a Vail Property,  in the winter months. 

 


FOOTNOTES

a.   Dr. Xie Jing Tang Herbal, Inc. Ocala, Florida, USA

References

  1. Xie, , Wedemeyer, L., Christman, C., Trevisanello, L., Practical Quide to Traditional Chinese Veterinary Medicine - Small Animal Practice, Chi Institute Press, Reddick, FL 2014, p. 158, 198-201
  2. Xie, , Preast V., Xie’s Veterinary Acupuncture, Blackwell Publishing, Iowa, 2007, p 143-234
  3. Xie, H., Ferguson, B., Deng, X., Application of Tui-na in Veterinary Medicine, 2nd Edition, Tianjin Jincal Arts Printing Co., Ltd, 2008, p. 9-47
  4. Ma, , Clinical Manual of Chinese veterinary Herbal Medicine, Fifth Edition, Ancient Art Press, Florida, 2020, p. 196, 203
  5. Schoen A. Veterinary Acupuncture Ancient Art to Modern Medicine, 2nd Ed. St. Louis, MO:Mosby Inc 2001:183-185.
  6. Medina, C., An Integrative Approach for the Treatment of Suspected Fibrocartilaginous Embolism of the Spinal Cord in a Dog, AJTCVM Vol 5, No.2, August 2010, p 55-60