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Hindlimb Instability In A Dog

by sara.baldey - September 21, 2018 View Case Report

Hi Steve,

I have been seeing "Kenny", 15y 7m, male, neutered, Maltese X since August this year. Previous to this he was going to a Vet at another practice for acupuncture and herbs. He is currently on LWDHW and ChinaMed formula "Pain-Less" (Zhen Tong Yao Fang), prescribed by the previous Vet.

Kenny's primary problem is that he is very stiff, weak and unstable in his hind legs. He is also painful in the lower back and hind limbs. At home, he is apparently able to stand and walk to go to the toilet (with encouragement), but often struggles to get out of his bed to do this. When he sits on his rump, his hind legs will be stretched in full extension with his feet pointing to his head. Kenny also appears very anxious about impending pain if you try to handle and re-position him.

I have treated Kenny with acupuncture a few times, but don't think I am achieving much. (Very deflating!) Kenny is very old and frail. His owner dedicates herself to looking after him, she provides incredible nursing and care for him. They have an amazing bond. She is realistic though, and all she hopes for is to help him walk better so that he can go to the toilet better.

Kenny is always very sensitive over his lateral abdominal flanks and ribs. He is uncomfortable when I feel for his pulses in his groin. He has evidence of mild chronic skin disease, with inflammation and occasional scabs/crusts on his ventral abdomen and mild alopecia and inflammation of his feet in the hind limbs. His left hind limb is more painful than his right hind limb.

On his most recent visit:
The tongue was purple, moist, no coat
The left pulse was deep, wiry, weak, thin
The right pulse was superficial, wiry, weak, thin
There was sensitivity over the costal arch and lateral abdominal flanks (which were very tense)
There was no obvious response over back shu points. (Previously, points that have been repeatedly sensitive are BL23, BL20)

I suspect Blood Stasis, LIV Qi stagnation, possible LIV Blood deficiency, and Yin deficiency.

When I needled GB34 + GB30, this improved the pulse (though I could only check the one side). So I am also wondering about a TBO.

My thoughts are to try XCHT. Do you think I should also use a blood moving formula? Or do you think there is a better formula(s) to use in his case? I would be very grateful for your input and advice.

Many thanks!
Kind regards,
Sara.

by naturevet

September 21, 2018

Hi Sara,

I would start wiht Xiao Chai Hu Tang as you suggest, which fits the costal arch sensitivity.

I'm guessing there is an upper motor neuron issue which is creating the limb extensor rigidity, and that it is in the region of the T-L junction, causing problems to be referred to the lateral abdominal flank region. If that is the case, then we often augment XCHT by adding about 12g Gui Zhi and 15g Bai Shao to the XCHT. If you sedate BL 40, and the pulse improves further, I'd make the addition

XCHT can be helpful for skin issues, too.

Always, for these elderly dogs, I do gentle chiropractic or at least manual spinal mobilization. I don't know if you have access to those resources, but they can help dramatically. If you saw Kenny after those appointments, his acupuncture would work better, and the acupuncture would then help the chiropractic adjustments hold. Since he's so tiny, someone who uses an Activator to adjust their patients, and who has excellent palpation skills would be a real asset.

Since he's on a Blood mover (from Chinamed) and it hasn't really helped, I don't see this as a simple Blood stasis issue. It almost never is with dogs. Shao Yang disharmonies underpin many Blood stasis lameness conditions, so even if it were playing a role, Minor Bupleurum would be a good place to start.

Hopefully all this helps you out! Let us know how it goes!

Steve

Xiao Chai Hu Tang

by sara.baldey

September 24, 2018

Hi Steve,

Many thanks for your advice. I am very grateful!

I have started Kenny on XCHT. When I see him next I will sedate BL40 and check his pulse to see if we need to add Gui Zhi and Bai Shao to the XCHT.

I will certainly look into seeking a gentle chiropractor, as I don't have any contacts at this stage.

Thanks again for your insights with this case. I'm glad there is more to offer this sweet, little, old dog. I will be sure to let you know how he goes.

Kind regards,
Sara

by sara.baldey

November 14, 2018

HI Steve,

Just a quick update on Kenny.

I have not seen Kenny since my last post. I tried a few times to contact the owner. When I eventually did, she said that Kenny was doing a bit better. Kenny has had a couple of treatments with an Animal Osteopath, which the owner says has helped. The owner said she is planning to come back to see me, but I have not heard back as yet.

I will keep you posted.
Kind regards,
Sara.

by naturevet

November 14, 2018

Thank you for the continued updates!

Steve

by sara.baldey

February 3, 2019

Hi Steve,

Here is a final update on Kenny.

I received a phone call from the client on 17/1/19 to let me know that Kenny had passed away at home, in her arms at 3.30am. I had not seen Kenny since the above record of his visit. I did know that he went to see an Animal Osteopath, but am unsure how he responded to treatment after the first couple of treatments. The owner was too upset to discuss this with her. She did say she was very grateful for all that I did to help Kenny.

Thank you for all your help with this case. I am very grateful.
Kind regards,
Sara.

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