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Transcript of Acupuncture for Neurological Disorders It matters not whether medicine is new or old, it only...
Acupuncture for Acupuncture for Neurological DisordersNeurological Disorders
It matters not whether It matters not whether medicine is new or old, it medicine is new or old, it only matters that it is only matters that it is applied for the benefit of applied for the benefit of the patient.the patient.
Neurologic AssessmentNeurologic Assessment
• Is it a neurologic Is it a neurologic disease?disease?– SeizuresSeizures– Intention tremorIntention tremor– CN deficitsCN deficits
• Head tiltHead tilt• NystagmusNystagmus
– CP deficitsCP deficits– DysmetriaDysmetria– ParalysisParalysis
Minimum DatabaseMinimum Database
• CBCCBC• ChemistryChemistry
– Bile acidsBile acids– CholinesteraseCholinesterase
• UrinalysisUrinalysis• Chest and Chest and
abdominal abdominal radiographsradiographs
• Abdominal Abdominal ultrasoundultrasound
• Heartworm testHeartworm test• FecalFecal
Ancillary Neurologic Ancillary Neurologic TestsTests
• ElectrodiagnosticsElectrodiagnostics– EEGEEG– EMGEMG– BAERBAER
• CSF tap & analysisCSF tap & analysis– Cells & proteinCells & protein– PressurePressure– CholinesteraseCholinesterase– TitersTiters
• RadiographsRadiographs– Skull & spinal filmsSkull & spinal films– MyelographyMyelography– CT scanCT scan– MRIMRI
• Muscle AnalysisMuscle Analysis– EnzymesEnzymes– 2M antibody2M antibody– Anti-ACH receptor Anti-ACH receptor
antibodyantibody– BiopsyBiopsy
When all else fails…When all else fails…
Look at the patient!!!Look at the patient!!!
Outcome of Neurologic Outcome of Neurologic AssessmentAssessment
• Localization of LesionLocalization of Lesion• DD• AA• MM• NN• NN• II• II• II• TT• TT• VV
OO
• DefDef (Qi, Yin, Blood) (Qi, Yin, Blood)
• Jing DefJing Def• Def Def (Qi, Yin, Blood, Yang)(Qi, Yin, Blood, Yang)
• Def Def (Qi, Yin, Blood)(Qi, Yin, Blood)
• Stagnation Stagnation (Blood)(Blood)
• Jing Def/Excess or DefJing Def/Excess or Def• Phlegm FirePhlegm Fire• Phlegm FirePhlegm Fire• TraumaTrauma• Excess or DefExcess or Def• Wind PhlegmWind Phlegm
PlanPlan
PP
• Problem ListProblem List– ??
• Differential DxDifferential Dx– ??
• Diagnostic Diagnostic ApproachApproach– ??
• TreatmentTreatment– ??
Seizures in Small Seizures in Small AnimalsAnimals
• It is estimated that the It is estimated that the overall incidence of seizure overall incidence of seizure disorders in dogs and cats disorders in dogs and cats is around 1%is around 1%
• In pure breed dogs, this In pure breed dogs, this incidence may increase to incidence may increase to 15-20%, due to the 15-20%, due to the presence of inherited, presence of inherited, primary epilepsy in those primary epilepsy in those breedsbreeds
Lesion Localization in Lesion Localization in SeizuresSeizures
• Cerebral CortexCerebral Cortex• DiencephalonDiencephalon
– ThalamusThalamus– HypothalamusHypothalamus
• MesencephalonMesencephalon
Seizure DiagnosesSeizure Diagnoses
SEIZURES
Primary Epilepsy Secondary Epilepsy Reactive Epilepsy
Inactive Active
Probably Probably Symptomatic Symptomatic
EpilepsyEpilepsy
Symptomatic Symptomatic EpilepsyEpilepsy
Seizure DiagnosisSeizure Diagnosis
• Minimum Minimum DatabaseDatabase– Abnormal in Abnormal in
Reactive EpilepsyReactive Epilepsy
• CSF tap & analysisCSF tap & analysis– Abnormal in Active Abnormal in Active
Secondary EpilepsySecondary Epilepsy
• CT or MRI ScanCT or MRI Scan– Abnormal in Abnormal in
Active Active Secondary Secondary EpilepsyEpilepsy
• EEGEEG– Abnormal in Abnormal in
Secondary Secondary EpilepsyEpilepsy
• All test are normal All test are normal in Primary Epilepsyin Primary Epilepsy
Asymmetrical SeizuresAsymmetrical Seizures
Licking SeizureLicking Seizure
Fly-Biting SeizureFly-Biting Seizure
Seizures and Seizures and SignalmentSignalment
• Primary Epilepsy- Primary Epilepsy- purebred dogs 1-3 purebred dogs 1-3 years of ageyears of age
• Secondary Epilepsy- Secondary Epilepsy- any age but any age but especially under 6 especially under 6 months and over 3 months and over 3 yearsyears
Seizures- -TCMSeizures- -TCM
• Represent various Represent various aspects of the aspects of the Liver (Wood) Liver (Wood) systemsystem
• Excess (3 types)Excess (3 types)• Deficiency (3 Deficiency (3
types)types)
Seizures- -TCMSeizures- -TCM
• ExcessExcess– Wind-PhlegmWind-Phlegm
• Tongue pale & Tongue pale & greasygreasy
• Pulse wiry & slipperyPulse wiry & slippery
– Phlegm-FirePhlegm-Fire• Tongue red & greasyTongue red & greasy• Pulse rapid, wiry & Pulse rapid, wiry &
slipperyslippery
– Blood StagnationBlood Stagnation• Tongue & Pulse like Tongue & Pulse like
Wind-PhlegmWind-Phlegm• History of head History of head
traumatrauma
• DeficiencyDeficiency– Liver Blood Def.Liver Blood Def.
• Tongue pale & dryTongue pale & dry• Pulse weak & threadyPulse weak & thready
– Liver & Kidney Yin Liver & Kidney Yin Def.Def.
• Tongue red & dryTongue red & dry• Pulse weak & threadyPulse weak & thready
– Kidney Jing Def.Kidney Jing Def.• Tongue pale or red & Tongue pale or red &
drydry• Pulse weak & threadyPulse weak & thready• < 1 year of age< 1 year of age
Seizures- -TCMSeizures- -TCM• ExcessExcess
– Wind-PhlegmWind-Phlegm• expel phlegm, extinguish expel phlegm, extinguish
the wind, open the the wind, open the orifice and stabilize the orifice and stabilize the seizuresseizures
• Ding Xian WanDing Xian Wan– Phlegm-FirePhlegm-Fire
• clear the liver, drain the clear the liver, drain the heat, transform phlegm heat, transform phlegm and open the orificesand open the orifices
• Di Tan Tang Di Tan Tang and and Long Long Dan Xie Gan TangDan Xie Gan Tang
– Blood StagnationBlood Stagnation• expel phlegm, extinguish expel phlegm, extinguish
the wind, open the the wind, open the orifice, stabilize the orifice, stabilize the seizures and invigorate seizures and invigorate bloodblood
• Ding Xian WanDing Xian Wan and and Tao Tao Hong Si Wu SanHong Si Wu San
• DeficiencyDeficiency– Liver Blood Def.Liver Blood Def.
• tonify Qi and Blood and tonify Qi and Blood and quiet the windquiet the wind
• Bu Xue Xi Feng San Bu Xue Xi Feng San oror Di Di Tan Tang plus Tan Tang plus Rehmannia 8Rehmannia 8
– Liver & Kidney Yin Def.Liver & Kidney Yin Def.• nourish Yin and nourish Yin and
extinguish windextinguish wind• Yang Yin Xi Feng SanYang Yin Xi Feng San or or
Di Tan Tang and Left Side Di Tan Tang and Left Side Replenished (Zuo Gui Replenished (Zuo Gui Wan) Wan) or or Tian Ma Gou Tian Ma Gou Teng plusTeng plus
– Kidney Jing Def.Kidney Jing Def.• extinguish the wind and extinguish the wind and
astringe or nourish the astringe or nourish the kidney jingkidney jing
• Di Tan Tang Di Tan Tang andand Epimedium PowderEpimedium Powder
Epilepsy -- TCMEpilepsy -- TCM
• Internal heat leading to generation of windInternal heat leading to generation of wind• Clear wind & heat and calm the ShenClear wind & heat and calm the Shen• PointsPoints
– Constitutional pointsConstitutional points– Clear wind & heatClear wind & heat
• GB20, LI4, LI11, GV14, LIV3GB20, LI4, LI11, GV14, LIV3– Calm the shenCalm the shen
• PC6, HT7PC6, HT7– Local pointsLocal points
• GV17, GV20, GV21, Long hui, GB9, GB13, BL5, GV1, GV17, GV20, GV21, Long hui, GB9, GB13, BL5, GV1, ST40ST40
• TCM HerbalsTCM Herbals– Di Tan Tang (TCM phenobarbital)Di Tan Tang (TCM phenobarbital)– Specific herbs for excesses or deficiencies presentSpecific herbs for excesses or deficiencies present
Ear StapleEar Staple
• Shen MenShen Men
– Center of the earCenter of the ear
– Staple or point AP Staple or point AP can help control can help control 50% of refractor 50% of refractor epilepsy casesepilepsy cases
– Fold ear over & Fold ear over & find center on find center on insideinside
Acepromazine in An Acepromazine in An ShenShen
• An ShenAn Shen
– Half way around the Half way around the back of the earback of the ear
– Aim toward the Aim toward the opposite base of opposite base of lipslips
– Inject 0.1-1 mg Inject 0.1-1 mg diluted with saline diluted with saline to 0.5-6mlto 0.5-6ml
Basic AntioxidantsBasic Antioxidants
• Vitamin E 10 IU/lb Vitamin E 10 IU/lb dailydaily
• Vitamin C 5-10 Vitamin C 5-10 mg/lb twice a daymg/lb twice a day
• Selenium 2 µg/lb Selenium 2 µg/lb dailydaily
• Beta carotene 250 Beta carotene 250 IU/lb dailyIU/lb daily
• B Complex 2mg/kg B Complex 2mg/kg twice a daytwice a day
• Vitamin E 100-400 Vitamin E 100-400 IU dailyIU daily
• Vitamin C 100-250 Vitamin C 100-250 mg twice a daymg twice a day
• Selenium 50 µg Selenium 50 µg dailydaily
• Vitamin A 1000-Vitamin A 1000-5000 IU daily5000 IU daily
• B Complex 10 mg B Complex 10 mg twice a daytwice a day
DogsDogs CatsCats
Additional Additional ConsiderationsConsiderations
• Probably safe Probably safe parasite controlparasite control
– InterceptorInterceptor– Frontline Top Frontline Top
SpotSpot– RevolutionRevolution
• Should avoidShould avoid
– HeartgardHeartgard– Proheart 6Proheart 6– ProgramProgram– SentinelSentinel– Frontline SprayFrontline Spray– AdvantageAdvantage– AdvantixAdvantix
Additional Additional ConsiderationsConsiderations
• DietDiet
– Low-Low-carbohydrate carbohydrate foodfood
• SupplementsSupplements
– Ginkgo bilobaGinkgo biloba• 2-4 mg/kg q8-12h2-4 mg/kg q8-12h• Ginkoba or Publix Ginkoba or Publix
brandbrand
– Tofu or LecithinTofu or Lecithin• 20 mg/kg daily20 mg/kg daily
– AcetylcysteineAcetylcysteine• 25 mg/kg q8h 25 mg/kg q8h
qodqod
MeningoencephalomyelMeningoencephalomyelitisitis
• Infectious DiseasesInfectious Diseases– Species SpecificSpecies Specific
• Steroid Response ME Steroid Response ME (SRME)(SRME)
• Necrotizing Vasculitis Necrotizing Vasculitis (SRMA)(SRMA)
• Necrotizing ME (NME)Necrotizing ME (NME)• Granulomatous ME Granulomatous ME
(GME)(GME)
MeningoencephalomyelMeningoencephalomyelitisitis
• Pain to paresis Pain to paresis to plegiato plegia
• Dx with CSF tapDx with CSF tap• Spinal Spinal
radiographs radiographs normalnormal
• Myelography Myelography normal normal (might be (might be contraindicated)contraindicated)
MeningoencephalomyelMeningoencephalomyelitisitis
CSF TapCSF Tap
• Collection site for Collection site for seizures is at the seizures is at the cisterna magnum.cisterna magnum.
• Allows analysis for Allows analysis for cells, protein and cells, protein and pressure.pressure.
• Cytology and titers Cytology and titers for infectious for infectious organisms can be organisms can be obtained.obtained.
MenigoencephalomyelitMenigoencephalomyelitisis
– Wind-PhlegmWind-Phlegm• expel phlegm, extinguish the wind, open expel phlegm, extinguish the wind, open
the orifice and stabilize the seizuresthe orifice and stabilize the seizures• Ding Xian WanDing Xian Wan
– Phlegm-FirePhlegm-Fire• clear the liver, drain the heat, transform clear the liver, drain the heat, transform
phlegm and open the orificesphlegm and open the orifices• Di Tan Tang Di Tan Tang and and Long Dan Xie Gan TanLong Dan Xie Gan Tan
Brain Abscess in a FoalBrain Abscess in a Foal
Brain Abscess in a FoalBrain Abscess in a Foal
Vestibular DiseaseVestibular Disease
• Cardinal SignsCardinal Signs– Head TiltHead Tilt– NystagmusNystagmus
• HorizontalHorizontal• RotatoryRotatory• VerticalVertical• PositionalPositional
– Circling (tight)Circling (tight)– Imbalance & Imbalance &
IncoordinationIncoordination
Vestibular DiseaseVestibular Disease
Vestibular DiseaseVestibular Disease
Idiopathic V.D.Idiopathic V.D. Inner Ear Inner Ear DiseaseDisease
Central V.D.Central V.D.
8th Nerve only
8th Nerve,7th Nerve &
Horner’s Syndrome Anything Else
Brainstem V.D.Brainstem V.D. Cerebellar DiseaseCerebellar Disease
Idiopathic Vestibular Idiopathic Vestibular DiseaseDisease
• Acute Onset of Acute Onset of Vestibular SignsVestibular Signs– Head tiltHead tilt– Horizontal or Horizontal or
Rotatory nystagmus Rotatory nystagmus with fast-phase with fast-phase away from head tiltaway from head tilt
– Nothing elseNothing else
• Can Be Very SevereCan Be Very Severe• Acute, regressive Acute, regressive
diseasedisease
Idiopathic Vestibular Idiopathic Vestibular Disease -- TCMDisease -- TCM
• Wind (heat) invasionWind (heat) invasion• Clear wind & heat and Clear wind & heat and
calm the Shencalm the Shen• PointsPoints
– Constitutional pointsConstitutional points– Clear wind & heatClear wind & heat
• GB20, LI4, LI11, GV14GB20, LI4, LI11, GV14– Calm ShenCalm Shen
• PC6, HT7, GV17, GV20, PC6, HT7, GV17, GV20, GV21GV21
– Local pointsLocal points• TH17, TH18, TH21, SI19, TH17, TH18, TH21, SI19,
GB2, Er jian, An shenGB2, Er jian, An shen
Inner Ear DiseaseInner Ear Disease
• 8th Nerve Signs8th Nerve Signs• 7th Nerve Signs7th Nerve Signs
– ear & lip droopear & lip droop– lack of palpebral lack of palpebral
reflexreflex– nose turnnose turn– nostril flaringnostril flaring
• Horner’s Horner’s SyndromeSyndrome
Horner’s SyndromeHorner’s Syndrome
• Small AnimalsSmall Animals– PtosisPtosis– MyosisMyosis– EnophthalmosEnophthalmos
• Large AnimalsLarge Animals– Facial sweating Facial sweating
(horse)(horse)– Lack of muzzle Lack of muzzle
sweating (cow)sweating (cow)
Inner Ear DiseaseInner Ear Disease
• Most cases are Most cases are secondary to secondary to bacterial infection bacterial infection (otitis media & (otitis media & interna)interna)– extension from extension from
otitis externaotitis externa– pharyngitis with pharyngitis with
extension up the extension up the Eustachian tubeEustachian tube
– hematogenous hematogenous spreadspread
Ear Polyps in CatsEar Polyps in Cats
• Benign growth in Benign growth in the external ear the external ear canal which canal which causes signs by causes signs by extension.extension.
• Can also be Can also be pharyngeal mass pharyngeal mass which grows into which grows into middle ear via the middle ear via the Eustachian tube.Eustachian tube.
Ear Polyps in CatsEar Polyps in Cats
• Treatment is Treatment is surgical removal.surgical removal.
• Damage can be Damage can be permanent, if permanent, if pressure pressure necrosis has necrosis has destroyed the destroyed the inner ear inner ear structure.structure.
Inner Ear Disease -- Inner Ear Disease -- TCMTCM
• Invasion of external Invasion of external pathogen leading to pathogen leading to wind, heat, damp.wind, heat, damp.
• Heat boils the fluids Heat boils the fluids leading to the leading to the accumulation of accumulation of phlegm.phlegm.
• Quiet the wind, reduce Quiet the wind, reduce heat, disperse damp heat, disperse damp and activate the blood and activate the blood to dissolve stagnation.to dissolve stagnation.
Inner Ear Disease -- Inner Ear Disease -- TCMTCM
• PointsPoints– Constitutional pointsConstitutional points– Clear wind & heatClear wind & heat
• GB20, LI4, LI11, GV14GB20, LI4, LI11, GV14– Calm the shenCalm the shen
• PC6, HT7, GV17, GV20, PC6, HT7, GV17, GV20, GV21GV21
– Eliminate dampEliminate damp• SP9SP9
– Activate Qi & bloodActivate Qi & blood• ST36, ST40, Xin shuST36, ST40, Xin shu
– Local pointsLocal points• TH17, TH18, TH21, SI19, TH17, TH18, TH21, SI19,
GB2, Er jian, An shenGB2, Er jian, An shen
Central Vestibular Central Vestibular DiseaseDisease
• Postural Postural ChangesChanges– CP DeficitCP Deficit– DysmetriaDysmetria
• Reflex ChangesReflex Changes– hyperactive hyperactive
reflexesreflexes– crossed-extensor crossed-extensor
reflexesreflexes– Babinski’s signBabinski’s sign
Conscious proprioceptive deficitConscious proprioceptive deficit
may be on the same or opposite sidemay be on the same or opposite side
of the lesionof the lesion..
Central Vestibular Central Vestibular DiseaseDisease
MRI of Cerebellar MeningiomaMRI of Cerebellar Meningioma
Central Vestibular Central Vestibular Disease -- TCMDisease -- TCM
• Can be wind, heat-Can be wind, heat-damp or wind cold damp or wind cold based upon the based upon the causative factor causative factor involved.involved.
• PointsPoints– ConstitutionalConstitutional– 8 Principle8 Principle– Zang-FuZang-Fu
IVD- -TCM DiagnosisIVD- -TCM Diagnosis
• Represents a “bi” Represents a “bi” syndrome often syndrome often accompanied by accompanied by “wei” syndrome“wei” syndrome
• Under domain of Under domain of KID (bones) & LIV KID (bones) & LIV (joints & free flow (joints & free flow of qi & blood)of qi & blood)
IVD- - TCM PatternsIVD- - TCM Patterns
• Excess typesExcess types
– Wind-Cold-DampWind-Cold-Damp
– Blood Blood stagnationstagnation
• Deficient typesDeficient types
– Yang deficiencyYang deficiency
– Yin deficiencyYin deficiency
– Yin & Yyang Yin & Yyang deficiencydeficiency
Fibrocartilagenous Fibrocartilagenous EmboliEmboli
• Vascular occlusion Vascular occlusion from IVD materialfrom IVD material– IVD herniates into IVD herniates into
the venous sinus or the venous sinus or the vertebral bodythe vertebral body
– the venous sinuses the venous sinuses have no valveshave no valves
– increased pressure increased pressure forces material into forces material into spinal cordspinal cord
FCEFCE
• Generally affects Generally affects a radicular a radicular penetrating penetrating branch which branch which leads to a leads to a quadrant (wedge) quadrant (wedge) of infarctionof infarction
• Many will improve Many will improve with timewith time
SchatzieSchatzie
IVD- -Wind-Cold-DampIVD- -Wind-Cold-Damp
• Acute invasion of Acute invasion of external pathogen external pathogen leading to leading to stagnation (cold stagnation (cold slows blood flow slows blood flow which is worsened which is worsened by accumulation of by accumulation of damp)damp)
• TongueTongue– GreasyGreasy
• PulsePulse– Slow & softSlow & soft
• Rx principleRx principle– Dispel W-C-D, Dispel W-C-D,
activate blood & activate blood & relieve stagnationrelieve stagnation
• TCM herbalTCM herbal– Xiao Huo Luo DanXiao Huo Luo Dan
• AcupunctureAcupuncture– Hua-tuo-jia-ji, BL23, Hua-tuo-jia-ji, BL23,
BL67, GB39, GV1, & BL67, GB39, GV1, & GV14GV14
Treatment of Acute SPITreatment of Acute SPI
• Antioxidant Antioxidant steroids (Solu steroids (Solu Medral or Solu Medral or Solu Delta Cortef)Delta Cortef)– 30mg/kg30mg/kg– 15mg/kg every 8 15mg/kg every 8
hours for 24-48 hours for 24-48 hourshours
• Surgical correctionSurgical correction
Acupuncture needle inAcupuncture needle inwei jian (tip of tail)wei jian (tip of tail)
Intervertebral Disc Intervertebral Disc Disease:Disease:chondrodystrophic dogschondrodystrophic dogs
• Collagen fibers of Collagen fibers of the nucleus the nucleus pulposus pulposus metamorphs into metamorphs into hyalin cartilagehyalin cartilage
• IVD looses IVD looses elasticity and elasticity and leads to damage leads to damage of annulus of annulus fibrosusfibrosus
IVD- -chondrodystrophyIVD- -chondrodystrophy
• Annulus ruptures Annulus ruptures extruding extruding degenerate degenerate nuclear material nuclear material into the neural into the neural canalcanal
• This leads to This leads to pain, paresis or pain, paresis or paralysisparalysis
IVD- -Pain OnlyIVD- -Pain Only
• Cage Rest for 30 Cage Rest for 30 days or 3 weeks days or 3 weeks after patient after patient becomes becomes clinically normal.clinically normal.
• AcupunctureAcupuncture• Oral steroids and Oral steroids and
diazepam only diazepam only under under supervisionsupervision
IVD- -ParesisIVD- -Paresis
• HospitalizeHospitalize– Prednisolone (2 Prednisolone (2
mg/kg divided mg/kg divided 2-3 times a day)2-3 times a day)
– Misoprostol 3-4 Misoprostol 3-4 µg/kg twice a µg/kg twice a dayday
– Diazepam 0.25-Diazepam 0.25-0.5 mg/kg TID0.5 mg/kg TID
• Should improve Should improve in first 5-7 daysin first 5-7 days
IVD- -Paralysis with IVD- -Paralysis with Deep PainDeep Pain
• EmergencyEmergency– Give Solu Medral or Give Solu Medral or
Solu Delta Cortef 30 Solu Delta Cortef 30 mg/kgmg/kg
– ReferRefer
• May observe for 24 May observe for 24 hours to see if hours to see if dramatic dramatic improvementimprovement– If none, EmergencyIf none, Emergency
IVD- -Paralysis No Deep IVD- -Paralysis No Deep PainPain
• EmergencyEmergency– Give 30 mg/kg Give 30 mg/kg
Solu Medral or Solu Medral or Solu Delta CortefSolu Delta Cortef
– ReferRefer
• 75% respond in 75% respond in first 24 hoursfirst 24 hours
• 50% in first 72 50% in first 72 hourshours
• 25% after that25% after that
Integrative Therapy of Integrative Therapy of IVD DiseaseIVD Disease
• Acute IVD Acute IVD Disease is a Disease is a surgical surgical emergencyemergency– Even with no deep Even with no deep
pain there is a pain there is a 75% chance of 75% chance of success within the success within the 11stst 24 hours & 50% 24 hours & 50% chance in the 1chance in the 1stst 72 hours72 hours
– After 72 hours After 72 hours with no deep with no deep pain, the pain, the chances are no chances are no differentdifferent
• Chronic IVD Chronic IVD Disease may Disease may respond poorly respond poorly to surgeryto surgery
IVDIVD
• After surgery, After surgery, healing is neededhealing is needed
• Physical therapyPhysical therapy– Passive Passive
movementsmovements– MassageMassage– Standing exercisesStanding exercises– HydrotherapyHydrotherapy– WalkingWalking
• AcupunctureAcupuncture– Control painControl pain– Stimulate nervesStimulate nerves
• Magnet therapyMagnet therapy– North pole North pole
magnet magnet stimulates nerve stimulates nerve regenerationregeneration
• Healing touchHealing touch
IVD- -DietIVD- -Diet
• Basic antioxidantsBasic antioxidants– Vitamin E, vitamin C, Vitamin E, vitamin C,
vitamin B complex, vitamin B complex, selenium, beta selenium, beta carotenecarotene
• Anti-inflammatory Anti-inflammatory membrane membrane stabilizersstabilizers– Omega-3-fatty acids, Omega-3-fatty acids,
gamma linolenic acid, gamma linolenic acid, coenzyme Q-10coenzyme Q-10
• Lecithin to help Lecithin to help support myelinationsupport myelination
• Herbal medications Herbal medications to help immune to help immune systemsystem– Astragalus, cordyceps Astragalus, cordyceps
mushroom, garlicmushroom, garlic
• Dietary cartilageDietary cartilage
IVD- -PreventionIVD- -Prevention
• Diet & weight Diet & weight controlcontrol– Low carbohydrate Low carbohydrate
dietdiet– Basic antioxidantsBasic antioxidants
• Chiropractic careChiropractic care• MassageMassage• ExerciseExercise
HansHans
HansHans
• Routine Routine radiographs radiographs showed a showed a narrowed IVD narrowed IVD space at T11-12 space at T11-12 with a cloudy IV with a cloudy IV foramenforamen
• Incidentally there Incidentally there was calcification was calcification of T13-L1of T13-L1
HansHans
IVD- -Blood StagnationIVD- -Blood Stagnation
• Most common type Most common type in in chondrodystrophic chondrodystrophic dogsdogs– KID Jing deficiency KID Jing deficiency
leads to failure to leads to failure to nourish LIV leads to nourish LIV leads to joint problems & joint problems & stagnationstagnation
• TongueTongue– PurplePurple
• PulsePulse– Wiry or FastWiry or Fast
• Rx PrincipleRx Principle– Activate blood, Activate blood,
dissipate stagnation dissipate stagnation and resolve stasisand resolve stasis
• TCM herbalTCM herbal– Da huo luo dan Da huo luo dan
(Double P formula (Double P formula #2)#2)
• AcupunctureAcupuncture– Hua-tuo-jia-ji, BL23, Hua-tuo-jia-ji, BL23,
BL11, GB39, GV14, BL11, GB39, GV14, Wei jian, GV6, GV1, Wei jian, GV6, GV1, & LIV3& LIV3
Cervical Cervical SpondylomyelopathySpondylomyelopathy
• Young Great Danes Young Great Danes and older and older Doberman PinchersDoberman Pinchers– Young dogs is due to Young dogs is due to
misarticulation and misarticulation and spondylolithesisspondylolithesis
– Older dogs is due to Older dogs is due to IVD disease and IVD disease and ligamentous ligamentous hypertrophyhypertrophy
Diagnosis of CSMDiagnosis of CSM
• Plain Plain RadiographsRadiographs– mild changes mild changes
which suggest which suggest problemproblem
• CSF tapCSF tap– normalnormal
• EMGEMG• MyelographyMyelography
– dynamic viewsdynamic views
Myelograpgy- -dynamic Myelograpgy- -dynamic viewsviews
Ventral Flexion Dorsal Flexion
CSM- -TreatmentCSM- -Treatment
• Surgery is designed Surgery is designed to remove IVD to remove IVD protrusion and to protrusion and to lessen ligamentous lessen ligamentous compressioncompression
• Best accomplished Best accomplished with distraction with distraction techniquestechniques– ““Screw and Washer”Screw and Washer”– methylmethacrylatemethylmethacrylate
LS StenosisLS Stenosis
A Pain in the Butt!A Pain in the Butt!
DVMDVM
LS Stenosis- -Cardinal LS Stenosis- -Cardinal SignsSigns
• LS Back PainLS Back Pain– pain on palpation at pain on palpation at
LS junctionLS junction– pain on raising the pain on raising the
tail headtail head
• Diminished tail Diminished tail movementmovement
• Urinary and Fecal Urinary and Fecal continency problemscontinency problems
LS StenosisLS Stenosis
LS Stenosis- -DiagnosisLS Stenosis- -Diagnosis
• EMGEMG– fibrillation potentials fibrillation potentials
and positive sharp and positive sharp waves caudal to LS waves caudal to LS junction, distal limb junction, distal limb and tailand tail
• Imaging techniquesImaging techniques– CT ScanCT Scan– MRI ScanMRI Scan
LS Stenosis- -LS Stenosis- -TreatmentTreatment
• Medical managementMedical management– corticosteroids & corticosteroids &
diazepamdiazepam– carprofen & diazepamcarprofen & diazepam– acupuncture & TCM acupuncture & TCM
herbsherbs
• SurgerySurgery– dorsal laminectomy ± dorsal laminectomy ±
stabilizationstabilization
IVD- -Yang DeficientIVD- -Yang Deficient
• Old age leads to Old age leads to KID deficiencyKID deficiency– General weakness General weakness
& cold back& cold back
• TongueTongue– Pale & wet Pale & wet
(swollen with (swollen with teeth marks)teeth marks)
• PulsePulse– Deep & weakDeep & weak
• Rx principleRx principle– Nourish Yang & Nourish Yang &
warm KIDwarm KID
• TCM herbalTCM herbal– Sang ji sheng Sang ji sheng
san (lorathus san (lorathus powder)powder)
• Chronic IVDChronic IVD
IVD- -Yin DeficiencyIVD- -Yin Deficiency
• Chronic illness or Chronic illness or old age consumes old age consumes KID YinKID Yin– Weakness in back Weakness in back
worse at nightworse at night
• TongueTongue– Red & dryRed & dry
• PulsePulse– Deep, thready & Deep, thready &
weakweak
• Rx principleRx principle– Nourish Yin & Nourish Yin &
tonify KIDtonify KID
• TCM herbalTCM herbal– Di gu pi sanDi gu pi san
• Chronic IVDChronic IVD
DiscospondylitisDiscospondylitis
• Infection of the Infection of the intervertebral spaceintervertebral space
• Common causesCommon causes– Staph. aureusStaph. aureus– Strep. sp.Strep. sp.– CorynebactriumCorynebactrium
• SignsSigns– Pain (can be Pain (can be
extreme)extreme)– Ataxia to plegiaAtaxia to plegia
DiscospondylitisDiscospondylitis
• Diagnosis can be Diagnosis can be made on plain made on plain radiographsradiographs– May initially be May initially be
normal, until 2-3 normal, until 2-3 weeks of weeks of incubationincubation
• Find organism Find organism viavia– Blood cultureBlood culture– Urine cultureUrine culture
DiscospondylitisDiscospondylitis
• Also considerAlso consider– NocardiaNocardia or other or other
fungal cause fungal cause (aspergillosis)(aspergillosis)
– Brucella canisBrucella canis– Spirocerca lupiSpirocerca lupi
• Treatment Treatment (6-8 (6-8 wk)wk)– CephalosporinsCephalosporins– Sulfa drugsSulfa drugs
MooseMoose
• 9 year old M/C 9 year old M/C LabradorLabrador
• HBC 4 months agoHBC 4 months ago– RecoveredRecovered
• Chronic, Chronic, progressive progressive paresis over 2 paresis over 2 weeksweeks
Moose- -MyelogramMoose- -Myelogram
Moose- -Surgical Moose- -Surgical ObservationObservation
Abnormal articular process at T12
Epidural mass
Moose- -CytologyMoose- -Cytology
• Impression Impression smears from both smears from both the articular the articular process and the process and the epidural mass epidural mass revealed PMN revealed PMN with intracellular with intracellular bacteriabacteria
Moose- -CT scanMoose- -CT scan
Moose- -Post OPMoose- -Post OP
• AntibioticsAntibiotics
– SulfadimethoxinSulfadimethoxine (Primor) 15 e (Primor) 15 mg/kg q12hmg/kg q12h
– Cephalexin 22 Cephalexin 22 mg/kg every 8 mg/kg every 8 hourshours
– Use for 6-8 Use for 6-8 weeksweeks
IVD- -Yin & Yang Def.IVD- -Yin & Yang Def.
• Aging leads to Aging leads to KID Yang & Yin KID Yang & Yin deficiencydeficiency– decreases decreases
resistance & resistance & allows low grade allows low grade infection to startinfection to start
• TongueTongue– Pink or palePink or pale
• PulsePulse– Deep & weakDeep & weak
• Rx PrincipleRx Principle– Nourish Yin & Nourish Yin &
tonify KIDtonify KID
• TCM herbalTCM herbal– Double P #1 Double P #1
(hindquarter (hindquarter formula)formula)
• Very chronicVery chronic
CNS NeoplasiaCNS Neoplasia
Today’s FrontierToday’s Frontier
CNS Neoplasia- -DogsCNS Neoplasia- -Dogs
• Dog has 1-18 Dog has 1-18 months average months average survival timesurvival time– 1-3 with nothing1-3 with nothing– 6-9 with surgery6-9 with surgery– 12-18 with 12-18 with
radiation radiation treatmenttreatment
• All tumors are All tumors are invasive invasive (malignant)(malignant)
CNS Neoplasia- -CatsCNS Neoplasia- -Cats
• Most common is Most common is meningiomameningioma
• Usually extra-Usually extra-axial and benignaxial and benign
• Seen in aged Seen in aged catscats
• Present with Present with depression and depression and dementiadementia
ElvisElvis
ElvisElvis
• MRI revealed MRI revealed mass in the mass in the cerebral cortexcerebral cortex
ElvisElvis
TreatmentTreatment
• DietDiet– Low carbohydrateLow carbohydrate
• SupplementsSupplements– Antioxidants & Antioxidants &
membrane stabilizersmembrane stabilizers
• Herbal medicationsHerbal medications– Western- -Western- -Canine Canine
Cancer formulaCancer formula– Traditional Chinese Traditional Chinese
medicine- -medicine- -Stasis in Stasis in the Mansion of the the Mansion of the MindMind
TCVM Brain CancerTCVM Brain Cancer
• Max FormulaMax Formula
• Stasis in Stasis in Mansion of MindMansion of Mind
• Wei Qi BoosterWei Qi Booster
• Western herbsWestern herbs
oror
andand
andand
Transports Transports to Headto Head
Cancer Cancer RecommendationsRecommendations
1.1. Low-Carbohydrate foodLow-Carbohydrate food (home prepared (home prepared is best or use Pedigree Weight Loss Formula)is best or use Pedigree Weight Loss Formula)
2.2. Canine basic antioxidant formulaCanine basic antioxidant formula (Westlab Pharmacy 1-800-4WESTLA)(Westlab Pharmacy 1-800-4WESTLA)
3.3. Canine arthritis formulaCanine arthritis formula (Westlab)(Westlab)
4.4. Canine cancer formulaCanine cancer formula (Westlab)- -use at (Westlab)- -use at 2 times prevention dose2 times prevention dose
5.5. COX-2 inhibitorCOX-2 inhibitor (daily- -particularly for (daily- -particularly for carcinomas)carcinomas)
6.6. Melatonin at nightMelatonin at night (0.1-0.2 mg/kg)(0.1-0.2 mg/kg)