Question Details
12 Yr QH Gelding With “EPM”
by bfellisdvm - July 7, 2022
I was called for acupuncture evaluation on this horse in southwest Ohio after the horses veterinarian diagnoses and treated for EPM, but it still had some rear end weakness, ataxia and a behavior pattern that started prior to diagnosis of EPM but remained after successful (?) treatment with coccidiostats and Vit E. The behavior is squealing intermittently and violently kicking one specific wall in the horses well kept stall where he is boarded with 3 other geldings. His chiropractor and craniosacral practitioners both felt as though “ something is trapped in the middle “ (very strange that two different modalities described the same pattern-with neither of them practitioners of TCM/TCVM) Upon exam, patient is in good flesh, BCS 5/9 with good muscle tone and mass-no atrophy of gluteals or quads typically seen with EPM- he is a little nervous / anxious but good for exam and palpation of all 4 limbs- though resented picking up L rear and moved away quickly when I tried initially. Eventually allowing me to pick up for a few seconds then slammed it down (right rear weakness I would surmise) His tongue is pale and dry with no coat. Pulse is broad and toned- GB 41 on R with 25ga 1/2” needle was not perceived or reacted to by horse but his head lowered, he took a deep breath and his pulse softened and slowed dramatically. I then needled TH 5 to open Dai Mai- he did perceive this needle and shook and stomped it out eventually. My diagnosis is Shao Yang obstruction and I started him on 9 gm Xiao Chai Hu w/ 15 gm of Qin Jiao per 100gm of base formula twice daily. His strength is dramatically improved at recheck 4 weeks later. No issue with picking up any limb. He is much more calm for exam as well (less Yang energy trapped up top-hopefully TH is opening and allowing descent of Yang energy. His stall kicking has decreased from 6-8 times per day (owner has Ring camera to alert her when it’s happening) to 2-3 times per week with much less severe kicking and not screaming/vocalizing as loud or as long. Compliance with herbs was excellent as horse readily accepted in a small amount if apple sauce. His tongue is more moist and less pale yesterday and pulse is still broad and toned. Softened and slowed even more this time with one needle in GB 41 on L. The owner ran out of herbs 5 days prior to my visit. I feel like we had a very good response and would like to continue as before. Question is do I need to continue the 9gm bid dose? If yes, can we decrease once signs abate ? Like once kicking stops can we go to 6 grams or 4 grams bid? I was planning to treat for an additional 8-12 weeks but wondering if a lower dose could be used to obtain same results. The horse is still on Vitamin E and 5000 IU/day and a joint supplement. Fed very little grain and uses a nutritionist to asses hay quality and a ration balancer (trace minerals, protein and fat). Thank you for your time and expertise. Couldn’t do this without your support.
Cheers,
Brett Ellis, DVM
Replies
by naturevet
July 8, 2022
Wow, Brett. A very impressive case. You chose exactly what I would have chosen, and it's clear it was the right choice, given the obvious improvements.

Lingering discomfort, as evidenced by the half-hearted continuation of the previous kicking, may be addressed potentially by acupuncture (e.g., at BL 28, GB 30 and any A Shi or trigger point that could conceivably release a muscle band that is clamping down on the sciatic nerve); and/or chiropractic (with particular focus on the sacro-iliac joints on both sides).

I would continue the herbs, yes. If the owner is concerned about cost, try a lower dose. If it was just that he accidentally ran out, then I would continue at the full dose until the kicking has largely resolved. That might happen with the next chiropractic/acupuncture treatment.

One last comment. If you're using Natural Path, because the herbs are twice as dense as regular granular extracts, you can give half the dose he's on now and still achieve the same dose level as with any other manufacturer's granular extract. If it's a hassle to give so much, that might help.

Keep up the great work, Brett! You're almost there. A very satisfying case for you, I'm sure!

Steve
by bfellisdvm
July 10, 2022
I am using Natural Path herbs at 9gm bid. I think I’ll continue that does until behavior resolved es or greatly diminished. I do chiropractic (VSMT) and would love to get my hands on his S/I , L/S but he has a human chiropractor (who is a classmate of mine from the Healing Oasis -we both learned under Pedro Rivera) so I’ll tread lightly until asked. I have drawn more to treating the Eight Extraordinary meridians, but certainly have treated those points (BL28,30, BH) when working on racehorses but usually would use aqua puncture and a twitch. Would dry needles give a similar response or would I need to add electric? I guess we will see. Thank you for your help and kind words. I’ll keep you posted and look forward to seeing you in Vermont in October!
Brett
by bfellisdvm
July 10, 2022
I am using Natural Path herbs at 9gm bid. I think I’ll continue that does until behavior resolved es or greatly diminished. I do chiropractic (VSMT) and would love to get my hands on his S/I , L/S but he has a human chiropractor (who is a classmate of mine from the Healing Oasis -we both learned under Pedro Rivera) so I’ll tread lightly until asked. I have drawn more to treating the Eight Extraordinary meridians, but certainly have treated those points (BL28,30, BH) when working on racehorses but usually would use aqua puncture and a twitch. Would dry needles give a similar response or would I need to add electric? I guess we will see. Thank you for your help and kind words. I’ll keep you posted and look forward to seeing you in Vermont in October!
Brett
by naturevet
July 10, 2022
Even dry needling will likely help, Brett.

See you soon and congrats again on such a great case outcome!

Steve
by bfellisdvm
August 24, 2022
Well, had an amazing response to dry needling. I used a 25 ga, 1/2 needle to tonify GB 30, BL 54 GB 27 and GB 2 and ST 2 (as a calming point). Bo tolerated needles surprisingly well and relaxed throughout the treatment for 20 minutes. The needles were turned in a clockwise and counterclockwise fashion to facilitate the grasping of Qi. I experienced some difficulty removing GB 27 on the L, but other than that, no issues perceived with treatment. Post treatment , Bo stood square with equal weight on all 4 limbs for 5 minutes. Turns out the 10 years they have had Bo he has never stood square and most frequently would off load L rear in stall and at pasture. Bo has continued on Xiao Chai Hu with 15 gm/100 of Qin Jiao, but at a reduced dose of 4.8 grams (4 large level scoops) bid. 48 hours later, owner reports Bo is not only better than before his EPM episode, but he is better than in the 10 years they have owned him. He would always require prodding to get him to lunge, gallop or trot/canter on lunge line or under saddle. Now, he is happy and eager to go and still resting with equal weight distribution more often than off loading L rear. The plan is to continue XCH w/QJ for 4 weeks and then taper to see if it is still needed (12 weeks of treatment total)
Two weeks later ( this past Monday, I get a text that Bo had to be euthanized due to kicking the wall (which had been doing considerably less with less intensity since starting treatment) which caused severe trauma to hoof wall, sesamoids and suspensory ligament. Just to keep us humble I suppose. Owners still very grateful for the effort and response to treatments.
by bfellisdvm
August 24, 2022
Well, had an amazing response to dry needling. I used a 25 ga, 1/2 needle to tonify GB 30, BL 54 GB 27 and GB 2 and ST 2 (as a calming point). Bo tolerated needles surprisingly well and relaxed throughout the treatment for 20 minutes. The needles were turned in a clockwise and counterclockwise fashion to facilitate the grasping of Qi. I experienced some difficulty removing GB 27 on the L, but other than that, no issues perceived with treatment. Post treatment , Bo stood square with equal weight on all 4 limbs for 5 minutes. Turns out the 10 years they have had Bo he has never stood square and most frequently would off load L rear in stall and at pasture. Bo has continued on Xiao Chai Hu with 15 gm/100 of Qin Jiao, but at a reduced dose of 4.8 grams (4 large level scoops) bid. 48 hours later, owner reports Bo is not only better than before his EPM episode, but he is better than in the 10 years they have owned him. He would always require prodding to get him to lunge, gallop or trot/canter on lunge line or under saddle. Now, he is happy and eager to go and still resting with equal weight distribution more often than off loading L rear. The plan is to continue XCH w/QJ for 4 weeks and then taper to see if it is still needed (12 weeks of treatment total)
Two weeks later ( this past Monday, I get a text that Bo had to be euthanized due to kicking the wall (which had been doing considerably less with less intensity since starting treatment) which caused severe trauma to hoof wall, sesamoids and suspensory ligament. Just to keep us humble I suppose. Owners still very grateful for the effort and response to treatments.
Any thoughts on something that could have been done differently? I fear I did not get the pathogen released sufficiently but sure made his ability to kick stronger than ever.
Thank you for your time and expertise,
Brett Ellis
by naturevet
August 24, 2022
Oh, Brett, that is too bad they lost him, but congratulations on such a fantastic response to your treatment! Once you have one or two great outcomes, you know the rest of your career is just about mastery, but that meanwhile you now have a richly rewarding career.
by bfellisdvm
December 29, 2022
Thank you
Brett
Reply to this question.
You must be logged in to reply

© 2021 - CuredCases.com         Problems with this site? Contact: webmaster@curedcases.com