Shortly after my acupuncture final exam, I was asked to consult on a case at a local veterinary hospital. Molly was a 5-year-old Bassett Hound mix who had no function in her hind legs. She was brought to her primary care veterinarian a week before Christmas for back pain, but could walk normally. She was started on pain relievers and was placed on restricted activity.
Two days after Christmas, she could not use her back legs at all. There was no trauma or incident that they could identify as a cause. She was re-examined and baseline blood tests were overall unremarkable. Radiographs of her spine showed a narrow space between two vertebrae. At this point, a consult with a veterinary neurologist for potential surgery was recommended. This was not an option for the owner since the consult and surgical estimate was $5,000-$7,000 and this was beyond their capabilities. She was started on cortisone and antibiotics to prevent infections, tumors or anything that could be placing pressure on her spinal cord.
When there is inappropriate pressure on the spinal cord function can be impaired. The most common cause of pressure is a bulging or herniated intervertebral disc. Other causes can be infections, tumors, fractures or fibrocartilaginous emboli (FCE). Without a CT scan or MRI exam these can be very challenging to tell apart, but survey radiographs can be helpful.
As the pressure builds on the spinal cord, the patient will usually start with back pain and it may stop there. It can also progress slowly or rapidly to impair the spinal cord. The job of the spinal cord is to relay the message from the legs to the brain for interpretation like a cell phone signal. When the cord is impaired it’s like trying to talk on the phone with less than 5 bars of service, the message can be choppy or incomplete.
As the “signal” gets weaker the back pain can lead to a wobbly or ataxic gait because the patient doesn’t know where their feet are. This can progress to losing the ability to walk entirely and even the ability to perceive pain. The loss of pain for an extended period of time is a very poor prognosis.
If the pressure can be relieved the spinal cord regains its function in the reverse order that it lost it. Pain comes back first and then, hopefully, the ability to walk followed by the fine motor skills. Urination and defecation can be anywhere in between pain and fine motor as it depends on where the cord is damaged.
When I met Molly on January 2nd, she had lost the ability to feel pain 6 days prior. Ideally, she would have had surgery to relieve the pressure within 24-48 hours of losing that ability, but that was not an option for her family.
Although an MRI exam and spinal surgery were not an option, Molly’s family did not want to give up. I was asked to consult and see if anything else could be done. After examining Molly and discussing my thoughts and prognosis with them, I treated Molly with acupuncture and adjusted some of her medications. I placed her on low doses of cortisone, along with muscle relaxants and continued her on gabapentin to reduce any neuropathic pain.
Given her age, breed and progression of her signs, I was suspecting that a herniated disc was the cause of her problems. I recommended treating Molly three times to see if we could regain pain perception. If we could, then we could continue to treat her. If not, we would talk about the ability for the owners to provide long term care for a paralyzed, incontinent Molly.
When I saw her 3 days later, she had regained pain perception. This was excellent but we were still not out of the woods. I didn’t know if Molly would regain the ability to walk. I treated her again with acupuncture, including electro acupuncture and aqua acupuncture with Vitamin B12. This combination approach would provide different levels of stimulation to her body for varying lengths of time.
On her third treatment three days later, I repeated those acupuncture points and had a frank discussion with her owners. Molly weighed 50 pounds and can be challenging to move around. Her front legs were working perfectly and they had a harness to support her chest and back legs so that she did not scrape her body on the ground. At 50 pounds, she is not a dog they could pick up and carry around. We discussed using a cart (from Eddie’s Wheels) as a potential to assist in her mobility and also as part of her rehab. The cart could also support her long term if she did not make a full recovery. The owners would think about it and let me know.
At this time, I had given her family detailed instructions on doing range of motion exercises and other therapeutic exercises to help with Molly’s rehab. They were doing these every day along with providing her nursing care. In other cases, I have hospitalized patients to do this but given all the circumstances for this case this option was most feasible for Molly’s owners.
I saw Molly a week after her third treatment and now she could consistently wag her tail. She also had very weak but present motor function in her back legs. The owners were trying to figure out finances of a cart. With her improvement I recommended starting her on a Chinese herbal compound to assist her spinal cord healing. This would reinforce the acupuncture treatments she was receiving.
The following week, I measured Molly her for her cart and started the herbal treatment with her. Again, I repeated her acupuncture treatment and also started to taper off some of her other medications.
Due to some outside factors, I did not see Molly again for almost three weeks. I was surprised to see her WALKING into the treatment room! Molly had regained 80% of her motor function in 6 weeks. The average time for this type of recovery is usually 2-3 months. I was very pleased and we agreed to hold on having her cart shipped since she had done so well so quickly. I continued to treat her with acupuncture and scheduled to see her again three weeks later.
At this time, she had 95% of her function back and was in excellent spirits. We had weaned her off most of her pain meds but continued her herbal treatment. I will see Molly in another 3 weeks and then only as needed. I expect her to make a full recovery.
Each individual case is just that, an individual. I am always hopeful when I work with challenging cases, but, I have to admit, Molly’s recovery exceeded my expectations. I hope to be able to repeat this outcome with other patients through a combined approach of Western and Eastern treatment.
If you have any questions about spinal injuries and your pet that are NOT urgent, please contact me.
For more information on herniated discs please check out this website. http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=2373
For information on FCE check out this site. http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1663