Dry Needle Acupuncture in Locomotory Paresis Post Column Trauma in Dog Case Study Călin I. Hulea, Romeo T. Cristina *, Marius C. Pentea, Eugenia Dumitrescu Faculty of Veterinary Medicine, Banat s University of Agriculture and Veterinary Medicine, 300645-Timisoara, 119, Calea Aradului, Romania Abstract In this case study a dog from Timisoara, Romania, 4 years old, female, victim of an accident was taken in therapy. The dog was examined clinically and radiographically. Major clinical sign was that dog unable to lift the hindquarters and in terms of radiographic fracture was identified in the lumbar spine at L 1 vertebra, which led to the displacement of spinal canal and compression of the spinal cord. Treatment was established through the dry needle acupuncture technique perpendicular insertion into (Bladder channel, BL) acupoints, in our case BL: -18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30; 40; 47, 48, 49, 50, 51, 52, 53, 54 and respectively 60, for 30 minutes a session / day, consecutively, for 60 days treatment period. Treatment outcomes showed a clear increase in skin and neural sensitivity of the area, finally animal being recovered. Keywords: acupuncture, column, dog, fracture, paralysis 1. Introduction Also in Eastern and Western medicine paresis and paralysis are manifested by total or partial loss of movement possibility and body s sensibility or of a part of, due to the nervous system damage. In case of fracture or spine dislocation, they happen most often in the mobile regions conjunction with the less mobile ones. If traumatic agent acts on spine, or vertebra s structure components (body, bow, dorsal articular processes and intervertebral space) may be affected [1, 2]. Forces acting on the spine causing fractures are forces that produce flexion, extension or rotation of the spine. If the spine trauma acts in extension, it will result in the portion near the dorsal vertebral bodies, leading to distancing ventral, often with fiber ring breaking and pulpous nucleus externalizing, in which spine stability will be achieved by super-spinous and yellow ligaments. If the forces are acting on the spine in flexion, * Corresponding author: Romeo T. Cristina, Tel / Fax 0256277140, Email: rtcristina@yahoo.com compression taken by vertebral body will lead to its fracture. In this case the stability of the spine is supported by inter spinous ligaments and joint capsules [1-3]. Acupuncture is a therapeutic method perfectly applicable in the veterinary medicine and, in the opinion of the authors, would be beneficial in numerous diseases such as: gastrointestinal, respiratory, and neurological (including peripheral nerve paralysis, nystagmus, vestibular syndrome, epilepsy), musculoskeletal, reproductive, immunosuppressive, allergy, dermatological, urinary tract, etc. [4, 5]. In this respect, our aim was to verify the applicability of acupuncture, perfectly testable in our particular case. 2. Materials and methods The study was conducted from May to July 2012, on a mongrel dog, aged four years, female, 7.5 kg, without owner, brought and interned to Clinics of the Faculty of Veterinary Medicine Timisoara for investigation. From case history revealed that 407
presented animal suffered a car accident two weeks previously. Clinical and holistic examination After anamnesis, general clinical and holistic view of the patient considering all symptoms and behavior through known methods was accomplished [5, 6]. Clinical It was observed that the animal presented: urinary incontinence, decubitus wounds, to the thighs and lower limbs, and animal did not support the hindquarters. To simple compression of phalanges and to needle test stimulation of finger pads, animal does not presented any reaction or limbs withdrawing stimulus. Most probably, the injury affected voluntary motor function, damage involving paresis especially of the left side, forelimb, and a loss of tonus triggering, the flaccid state of muscles conducting to flaccid paraplegia. This state, in our opinion, was the result of partial injury associated probably with a transitory state (figure 1). Figure 1: Dog before acupuncture treatment Holistic Overall examination was to assess the general state of body fluids (Yin), the temperature (Yang), and the sensitivity (Qi) and to determine which meridians are involved, and in what part of the organism energy's normal production and circulation has been altered. We take the pulses and examine the orientation and disease characteristics [5, 6]. Skin examination revealed cold: dampness signs and pain with light pressure revealing the Qi involvement. Pulse taken of the femoral arteries at Inch (distal), have shown small left superficial pulses, Yin energy (Zang) moving upwards, slowly from the depths to the surface, from right to left. At the simple compression and palpation of phalanges, distal portion was cooler than the proximal portion revealing Internal Cold Emptiness. In TCM, weakness in the kidney yang and an overall deficiency in the Qi is followed by frequent urination or incontinence [5, 6]. During palpation, attention was given to the acupoints (xue) identification, and to the paths of meridians, which are deemed to be areas of energy unbalances and reflected energy. This major meridian, in our case, was the Bladder channel (BL) with a total of 67 acupuncture points [5]. In dogs, this meridian starts from the external angle of the eye, continues caudally over the head, parallel to the dorsal midline, passing over the wings of the atlas and extending to the neck s dorsal portion until BL-11 acupoints, caudal from shoulder s cartilage. From here meridian is divided into two branches: an inner branch which runs parallel to the backbone at a 1.5 CUN distance (1 CUN = 0,5 inch) lateral from dorsal midline, respectively an outside branch that goes like on the other side of the column to 3 CUN, lateral from dorsal midline. To popliteal fosse, the two branches meet, the meridian continuing distally its path along the metatarsal region on the pelvic limb caudolateral side [5]. Consequently dog was examined also radiographically. Radiographic examination X-ray was performed to Veterinaria Clinic Timisoara, using a high frequency, GAMMA LIGHT AD 100/20 (PHYSIA GmbH Germany) model, X-ray machine, to 1-3/kW incidence of 60 mill amperes/second. Radiographic examination revealed fracture of lumbar vertebra (L1) by subsidence, which leaded to light spinal canal displacement, vertebral bodies approaching in the dorsal portion, vertebral body fracture and light spinal compression, relatively frequently identified in dog s column traumatology [7] (figure 2). Figure 2: Radiographic image of the dog in the study 408
Treatment protocol was established using a set of points that are associated to the treatment of urinary incontinence and paresis of the hind limbs: thoraco-lumbar intervertebral disk disease, lumbar pain, sensory and motor disorders. Traditional Chinese Veterinary Medicine (TCVM) acupuncture treatment technique was used, with identifying of the meridian known as responsible for spine and adjacent regions affections after Xie et al. (2007)[5]. Table 1: Acupoints used to treat dog [5] Acupoints Depth (CUN) Attributes and indication BL-18 0.5 Gan-shu Back-shu association point for the liver; liver diseases, gall-bladder diseases, ocular diseases, hypertension, epilepsy, irritability, thoracolumbar intervertebral disk disease. BL-19 0.5 Dan-shu Back-shu association point for gallbladder; liver diseases, gallbladder diseases, liver yang rising, liver Qi stagnation, low-grade fever, thoracolumbar intervertebral disk disease. BL-20 0.5 Pi-shu Back-shu association point for the spleen; spleen deficiency, damp, pancreatic and digestive disorders, vomiting, watery or bloody diarrhea, edema, anemia, thoracolumbar intervertebral disk disease, jaundice. BL-21 0.5 Wei-shu Back-shu association point for the stomach; gastrointestinal and pancreatic diseases, loss of appetite, diarrhea, nausea, vomiting, constipation, abdominal pain, generalized weakness. BL-22 0.5 San-jiao-shu Back-shu association point for triple heater; edema, vomiting, diarrhea, thoracolumbar intervertebral disk disease, abdominal pain, endocrine disorders, intra abdominal masses. BL-23 1 Shen-shu Back-shu association point for the kidney; kidney Yin and Qi deficiency, renal diseases, urinary incontinence, impotence, edema, auditory dysfunction, thoracolumbar inter-vertebral disk disease, pelvic limb weakness, coxofemoral joint osteoarthritis. BL-24 1 Qi-hai-shu Sea of Qi. Qi deficiency, thoracolumbar intervertebral disk disease, abdominal pain, uterine diseases, diarrhea, hemorrhea. BL-25 1 Da-chang-shu Back-shu association point for the large intestine. Diarrhea, constipation, abdominal pain, thoracolumbar inter-vertebral disk disease, lumbar pain. BL-26 1 Guan-yuan-shu Gate of Yuan-source Qi. Kidney Yang and Qi deficiency, impotence, urinary incontinence, diarrhea, abdominal pain, lumbosacral pain. BL-27 1 Xiao-chang-shu Back-shu association point for the small intestine. Abdominal pain, diarrhea, urinary incontinence, hematuria, lumbosacral pain. BL-28 1.5 Pang-guang-shu Back-shu association point for the bladder. Dysuria, urinary incontinence, diarrhea, constipation, lumbosacral pain. BL-29 1 Zhong-lu-shu Diarrhea, hernia, lumbosacral pain. BL-30 0.5 Bai-huan-shu Urinary incontinence, hernia, impotence, retained testicles, sacrocaudal pain. BL-47 0,5 Hun-men Back-shu association point for the liver; liver diseases, gallbladder diseases, ocular diseases, hypertension, epilepsy, irritability, thoracolumbar intervertebral disk disease. BL-48 0.5 Yang-gang Back-shu association point for gallbladder; liver diseases, gallbladder diseases, liver Yang rising, Liver Qi Stagnation, low-grade fever, thoracolumbar intervertebral disk disease. BL-49 0.5 Yi-she Back-shu association point for the spleen; spleen deficiency, damp, pancreatic and digestive disorders, vomiting, watery or bloody diarrhea, edema, anemia, thoracolumbar intervertebral disk disease and jaundice. BL-50 0.5 Wei-cang Back-shu association point for the stomach; gastrointestinal and pancreatic diseases, loss of appetite, diarrhea, nausea, vomiting, constipation, abdominal pain, generalized weakness. BL-51 0.5 Huang-men Back-shu association point for triple heater; edema, vomiting, diarrhea, thoracolumbar intervertebral disk disease, abdominal pain, endocrine disorders, intra abdominal masses. BL-52 1 Zhi-shi Back-shu association point for the kidney; kidney Yin and Qi deficiency, renal diseases, urinary incontinence, impotence, edema, auditory dysfunction, thoracolumbar inter-vertebral disk disease, pelvic limb weakness, coxofemoral joint osteoarthritis. BL-53 1 Bao-huang Coxofemoral joint and lumbosacral pain, dysuria. 409
As technique it was chosen non-manipulated dry needle acupuncture (DNAP) treatment, using sterile acupuncture stainless steel needles, with dimensions of 0.30 x 40 mm, for single use (HUANQIU, Ltd, Beijing, China) perpendicularly inserted into the acupoints. In present case were addressed the following acupoints: BL-18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30; 40; 47, 48, 49, 50, 51, 52, 53, 54; 57 and respectively 60. BL-23 (Shen-shu), BL-28 (Pang-guang-shu) were chose as primordial acupoints for urinary incontinence, further acupoints being selected on the basis of individual response and the energy law of Chinese Traditional Medicine, our try being to develop a personalized treatment protocol for our subject [5] (table 1). The chosen treatment session duration was long, of 30 minutes/day, and lasted continuously, for 60 days. The duration of DNAP treatment accorded to individual response, which was evaluated by continually monitoring symptoms as they evolved during treatment and in the subsequent weeks. Noting that, in the first treatment part, dog do not showed any sensitivity and does not support at all the pelvic limbs after acupuncture, after the forth - fifth treatment, significant improvements were observed, mainly related to reduction of urinary incontinence and a gradually increased sensitivity of pelvic limb. Unfortunately the total support hindquarters were accomplished yet only for a very short period of time of 10-15 seconds, then movements being made only by animal s crawling. In time, state of animal, the tone and great functions were favorable, the animal being lively, with appetite and biological functions within normal parameters, after eleventh treatment, urinary incontinence being healed and also animals limb sensitivity and posture. Locomotory function could be restored functionally in the second part of treatment, after the application no. 52, the following eight acupuncture sessions settling the animal s entire recovery (figure 3). As a nice fact dog was kindly adopted after the treatment.our opinion this technique is working, being recommendable a medium or long period for treatment. Since the results by this acupuncture technique, could be daunting to some extent especially for beginner acupuncturists, electroacupuncture or surgical decompression can represent another viable solution in these issues [8, 9]. 3. Results and discussion Figure 3: Acupoints points addressed in treatment 52 and dog to control after 60 th treatment 4. Conclusions 1. As a conclusion, we can say that, in our case, simple dry acupuncture has been proven to be effective in dogs being reliable in uncomplicated column fracture associate with urinary incontinence. 2. Although the major functions are stimulated by acupuncture, the animal feeling well after the fourth-fifth intervention, the locomotory function could be fully restored much lately after 52 to 60 sessions of 30 minutes/day. References 1. Moore, MP. Approach to the patient with spinal disease. Vet Clin North Am Small Anim Pract, 1992; 22(4):751-780. 2. Laitinen, OM, Puerto, DA. Surgical Decompression in Dogs with Thoracolumbar Intervertebral Disc 410
Disease and Loss of Deep Pain Perception: A Retrospective Study of 46 Cases, Acta Veterinaria Scandinavica, 2005; 46:79-85. 3. Kraus, KH., The pathophysiology of spinal cord injury and its clinical implications., Semin Vet Med Surg (Small Anim), 1996; 11(4):201-207. 4. Janssens, LA. Acupuncture for the treatment of thoracolumbar and cervical disc disease in the dog, Probl Vet Med, 1992; 4(1):107-116. 5. Xie, H, Preast, V. Xie's veterinary acupuncture. First edition, Oxford, England, Blackwell Publishing, 2007:129-263. 6. Longo, F. The Palpation Examination in Veterinary Acupuncture, Yi Dao Za Zhi. 18 - October 2002 Laveno Mombello (VA), 13-14, www.gmt2000.it). http://www.siav-itvas.org/veterinary-acupunctureclinical-section/306-the-palpation-examination-in- veterinary-acupuncture.html Last accessed February 23, 2013. 7. Sande, RD. Radiography, myelography, computed tomography, and magnetic resonance imaging of the spine. Vet Clin North Am Small Anim Pract, 1992; 22(4):811-831. 8. Hayashi, AM, Matera, JM, Fonseca Pinto ACB. Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs. J Am Vet Med Assoc, 2007; 231(6):913-918. 9. Joaquim, JGF, Luna, SPL, Brondani, JT et al. Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits. J Am Vet Med Assoc, 2010; 236(11),1225-1229. 411