I saw this 10 yr F(S) husky x for the first time 7 weeks after a slip and fall on icy stairs left her unable to stand on her own with hindlimb rigidity and hind quarter hyperesthesia ( worst over sacrum) and muscle atrophy/ spasm. She needed to be helped up and supported with a towel or waist band, was knuckling consistently with the LH and intermittently with the RH. She had occasional fecal incontinence but was able to urinate normally, though not able to bend hind limbs to squat. She had received weekly laser treatments from rDVM and was on Meloxicam and Gabapentin with no improvement . She had a bald tail and areas of alopecia/ thin haircoat dorsally and on sides of trunk. She had hyperkeratosis of nasal planum. Bloodwork was WNL. Her tongue was pale pink, moist with a bit of saliva bubbled on top, slight lavender tinge and a bit flabby. Her pulse was a bit weak, sl deep, a bit wiry, and did improve with GB points and Sed BL-40. I started her on Duo Huo Ji Sheng Tang and added in Bu Gan Tang . The response of pulse to GB points made me think Shao Yang involvement but the weakness and Blood deficiency seemed too pronounced, to start with XCHJQJT or XHLD. After 4 acupuncture treatments she was still needing support to get up and stand, but her hindlimb rigidity and hyperesthesia had moderately improved, she was consistently placing RH normally and was squatting to urinate so flexing hind limbs better. Hair was starting to regrow. Pulse and tongue much improved. Then the dog had another fall while owners getting her down the stairs to go pee and was back to square one plus crossing over hind limbs and pulse profoundly weak. and deep, still wiry. Further acupuncture hasn't shown much improvement. XCHJQJT , DHJST , BGT haven't brought any change. She was off all herbs for awhile when she had an early morning seizure which she very rapidly recovered from. Happy attitude, good energy, good appetite and stools, no urinary incontinence. I do housecalls and the house and steep yard are not conducive to using a cart. Owners would like to continue trying treatment. She is tending now to be a bit heat avoiding, but we have had hot humid weather. I have looked at XFHMY +/- YYRT with that really weak pulse. Any thoughts you might have would be appreciated. rDVM recommends euthanasia. Many thanks as always, Llewanda
Question Details
Acute Hind Limb Paresis In A Dog
by
LJH
-
June 30, 2023 View Case Report
I saw this 10 yr F(S) husky x for the first time 7 weeks after a slip and fall on icy stairs left her unable to stand on her own with hindlimb rigidity and hind quarter hyperesthesia ( worst over sacrum) and muscle atrophy/ spasm. She needed to be helped up and supported with a towel or waist band, was knuckling consistently with the LH and intermittently with the RH. She had occasional fecal incontinence but was able to urinate normally, though not able to bend hind limbs to squat. She had received weekly laser treatments from rDVM and was on Meloxicam and Gabapentin with no improvement . She had a bald tail and areas of alopecia/ thin haircoat dorsally and on sides of trunk. She had hyperkeratosis of nasal planum. Bloodwork was WNL. Her tongue was pale pink, moist with a bit of saliva bubbled on top, slight lavender tinge and a bit flabby. Her pulse was a bit weak, sl deep, a bit wiry, and did improve with GB points and Sed BL-40. I started her on Duo Huo Ji Sheng Tang and added in Bu Gan Tang . The response of pulse to GB points made me think Shao Yang involvement but the weakness and Blood deficiency seemed too pronounced, to start with XCHJQJT or XHLD. After 4 acupuncture treatments she was still needing support to get up and stand, but her hindlimb rigidity and hyperesthesia had moderately improved, she was consistently placing RH normally and was squatting to urinate so flexing hind limbs better. Hair was starting to regrow. Pulse and tongue much improved. Then the dog had another fall while owners getting her down the stairs to go pee and was back to square one plus crossing over hind limbs and pulse profoundly weak. and deep, still wiry. Further acupuncture hasn't shown much improvement. XCHJQJT , DHJST , BGT haven't brought any change. She was off all herbs for awhile when she had an early morning seizure which she very rapidly recovered from. Happy attitude, good energy, good appetite and stools, no urinary incontinence. I do housecalls and the house and steep yard are not conducive to using a cart. Owners would like to continue trying treatment. She is tending now to be a bit heat avoiding, but we have had hot humid weather. I have looked at XFHMY +/- YYRT with that really weak pulse. Any thoughts you might have would be appreciated. rDVM recommends euthanasia. Many thanks as always, Llewanda
Replies
by
LJH
June 30, 2023
Sorry, there was acute onset. The case is chronic. On x-ray is severe spondylosis, L
by
naturevet
June 30, 2023
Hi Llewanda,
If there is still some response to Shao Yang points, starting the case by using XCHT with Gui Zhi and Bai Shao might be a good idea, and then as improvements are seen and the pulse becomes more superficial, switching back to (or adding in) Du Huo Ji Sheng Tang.
Your idea is also a good one, so it's a matter of which you prefer. If your last visit still shows a moderation of the pulse with GB points, I'd go with Chai Hu Gui Zhi Tang first. You can make that by mixing 12g of Gui Zhi and 15g of Bai Shao into 100g of Xiao Chai Hu Tang
Hopefully this helps you out!
If there is still some response to Shao Yang points, starting the case by using XCHT with Gui Zhi and Bai Shao might be a good idea, and then as improvements are seen and the pulse becomes more superficial, switching back to (or adding in) Du Huo Ji Sheng Tang.
Your idea is also a good one, so it's a matter of which you prefer. If your last visit still shows a moderation of the pulse with GB points, I'd go with Chai Hu Gui Zhi Tang first. You can make that by mixing 12g of Gui Zhi and 15g of Bai Shao into 100g of Xiao Chai Hu Tang
Hopefully this helps you out!
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