Do you agree with my treatment plan and TCVM dignosis? Is it possible that she is being overstimulated at AP points internally (due to sutures, etc., from her spay surgery)? The owner is very concerned about the abrupt change that took place after her spay surgery a year ago, and is concerned that she is unpredicably nervous and potential dangerous (biting).
Any input would be appreciated.
Kate Alden, DVM, CVA
IVAS, San Antonio 2008
Acupuncture Evaluation and Treatment
Date: 2/18/2010
Patient Name: Maddie Latzig (Stephanie)
Signalment: 2 year old female spayed yellow lab
History: Maddie presented today after a 1 year history of flank biting. The episodes of biting began immediately after her spay surgery on 2/26/009. According to the medical report from UWSVM (12/29/09), the spay done at Animal Medical and Surgical Clinic in Wisconsin Rapids was routine with no acupuncture, epidural or perisurgical thrashing or trauma. Administered drugs included hydromorphone and domitor premed, ket/val induction, and isoflurane maintenance anesthesia. In additional history from Dr. Kim Kraus, on April 27, 2009, Maddie was chasing a ball, ran into a trailer hitch, and began limping. Hip films on 5/7/09 revealed normal acetabular seating of the femoral heads.
Maddie continued her behavior of biting at her sides (L>R) and chasing her back end. She was taken to another veterinarian who recommended that a behaviorist evaluate her; behavioral modification was recommended. Her behavior did not improve and she was subsequently taken to a chiropractor. Maddie appeared to get worse after the adjustments.
Maddie experiences occasional bouts of vomiting (yellow in color) and prior to her chiropractic adjustments, she was noted by her owner to leak urine/urinate in the house. The urine leaking has subsided and her last vomiting episode was about a month ago. Maddie is an otherwise healthy, bright and energetic dog.
Maddie’s general physical exam was within normal limits. There was no evidience of fever, joint pain, CP deficits, focal back pain or abdominal pain. Upon palpation of the flank region, she would turn and look at her side, appearing hyperesthetic or uncomfortable. Rectal exam was within normal limits.
A CBC was fount to be within normal limits, as was her complete biochemical panel. Fecal float was negative for ova. Both a bile acid test as well as cPLI tests were within normal limits. An abdominal ultrasound revealed a normal abdomen, and no ovarian remnant was found. A neurology consult revealed cranial nerves, postural reactions and spinal reflexes were within normal limits. She had mild to moderate discomfort/hyperesthesia on palpation of the lumbar spine area. Because of her discomfort, Maddie has demonstrated occasional aggression.
Upon presentation today, Maddie is somewhat nervous, pacing and hiding under a table. There was no sign of aggression. Palpation along her BL channel revealed no particular deficiencies. She is sensitive on palpation of her flank areas (L>R). According to her owner, she prefers sun and warm locations. She tends to be quiet, timid, less confident. She tends to be thirsty, with a good and sometimes ravenous appetite. Her feces and urination are normal. She is not on any medications currently. She tends to be patient, but barks as strangers. She is easily excitable. She is somewhat insecure, and sensitive to needling. She appears to be Shen disturbed. Her tongue is pink and wet with no coating. Her femoral pulses are medium in strength, superficial, and slightly slippery. Her hair, skin, ears, eyes, nose gums and lips are normal. Her oral cavity is wet. Her voice tends to be loud. She has no cough. She frequently vomits in the morning.
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Physical exam:
Weight – 65.4#
Temperature: 100.1
Pulse: 80 .
Respiration: pant
Mentation – BAR
Body condition – 5/9
EENT – normal
CV – normal sinus rhythm, lungs clear
GI/abd – normal on palpation
CP’s - not checked
Tongue – pink, wet, no coating
Femoral Pulses – medium in strength, superficial and slightly slippery
Other – sensitive on palpation of flank area (L>R). has a history of biting a small child over food challenge. Postured to bite adult male who was threatening her.
Western Diagnosis – pain/discomfort of unknown origin in flank areas.
TCM Diagnosis – Water personality, Heart Yang deficiency, Shen disturbance
Treatment:
Point Location Technique Purpose
GV20 Dorsal midline of the skull in the notch between the sagittal crest and the frontal crest Dry needling 20 minutes Sedation
YinTang Between eye brows Dry needling 20 minutes Calm the mind
GV20 On the dorsum of the neck, in the large depression just caudal and lateral to the occipital protuberance medial to the cranial edge of the wings of the atlas Dry needling 20 minutes Shen disturbances, mania; dispel external in internal wind.
HT7 On the lateral transverse crease of the carpal joint and approached via the large depression lateral to the tendon of the flexor carpi ulnaris muscle Dry needling 20 minutes Shen disturbances, anxiety, restlessness, behavioral problems, mania
HT6 Caudolateral border of the thoracic limb, .5 cun proximal to HT7 Dry needling 20 minutes Shen disturbance, Heart fire
HT5 Caudolateral aspect of the thoracic limb, 1 cun proximal to HT7 Dry needling 20 minutes
Clears Heat from Heart
BL14 Dorsolateral aspect of spine, 1.5 cun off midline caudal to T4 EAP, 10 Hz, d/d, 20 minutes Association point for Pericardium
BL15 Dorsolateral aspect of spine, 1.5 cun off midline caudal to T5 EAP, 10 Hz, d/d, 20 minutes Association point for Heart
Results: sensitive to needling. Unable to needle flank area. Treated with cold laser, acute pain, 6W. Very sensitive to this treatment.
Plan: Revaluate and treat in 1 week.
Calm Dragon, 1 tablet BID