Introducing Lundy, a 20 Month Old Spayed Female Pitt Bull
Prior to adopting Lundy from a shelter in NC, the clients visited her before her spay surgery. She was normal in her movement as witnessed by the clients and the staff.
Lundy was spayed on Feb. 20, 2023. The day after the spay surgery , the shelter vet said she was bleeding and knuckling in the rear. Lundy was in heat at the time of the spay. The shelter had a local vet run blood work, perform x-rays and and do an abdominal ultrasound to try and find the cause of the knuckling. The shelter did not originally call the new potential owners to make them aware of her condition. The shelter assumed they would not want her. Lundy’s people said they wanted her very much and that they had the means to care for her. She was then adopted out. They then took her to their regular vet who recommended they take Lunday to a neurologist.
MRI at Southeast Virginia Neurology
Date of visit May 5, 2023.
Case History from Neurology
2 and 1/2 month to 3 month history of rear leg weakness with reduced pelvic withdrawal reflexes; non-painful, clinical signs began after spay surgery. Cerebrospinal fluid (CSF) cell count is within normal limits, toxoplasmosis/neospora/distemper all negative.
Clinically, Lundy was weak in the rear, walking on the tops of her rear feet often and dragging her rear legs instead of picking them up and placing her feet appropriately.
MRI Conclusion
No evidence of a lumbar or lumbo-sacral spinal lesion. No evidence of impingement of foramina impingement or abnormal foraminal enhancement to suggest foraminal radiculitis. Her right and left medial iliac lymph nodes were enlarged, more so on the right consistent with mild lymphadenitis. The sciatic nerve as it runs ventral to the sacrum as it extends to the pelvic canal is enhanced on both sides. Probable bilateral sciatic neuritis. No other cause for these findings are identified.
Diagnosis: Bilateral sciatic neuritis(inflammation), mild bilateral lymphadenitis of the iliac lymph nodes. The cause is unknown.
Treatment: Epidural Spinal Injection and Acupuncture Dry Needle
The neurologist gave an epidural spinal injection with steroids to see if it could offer any relief. Lundy was not painful, she was just weak and could not lift her rear legs to walk correctly.
When they saw no improvement from the steroid injection they sought out a local veterinarian that did acupuncture.
The clients had 6 acupuncture sessions with another acupuncturist in the area. The veterinarian selected dry needle technique as he thought she would not tolerate the electro-acupuncture method.
The clients noted that Lundy would still often walk on the tops of her rear feet without control and still exhibited weakness in the rear. The steroid spinal injection and the first dry needle acupuncture treatments did not help her. The owners came to see Dr. Cooke to see if there was a treatment to help Lunday function better.
Before Going to Cooke Vet
Taken August 6, 2023. Notice Lundy is walking on the tops of her feet and dragging her rear legs. She is too weak to pick up her rear legs.
Taken August 19, 2023. Notice Lundy in her boots dragging her rear legs more than placing them. Landing her stride in the rear on the tops of her rear feet versus placing them normally. Lundy cannot feel her feet as ‘to where they are in space’ to place them properly. Also notice her knees are very straight.
Taken August 19, 2023. She is weaker on her left side and places her left rear foot more on the dorsum (the top) than her right. The boots help protect the skin of her feet. The owners did a great job protecting her feet as she dragged them to prevent sores and wounds.
First Visit with Cooke Vet
Date of visit August 25, 2023. Her physical exam was normal except her gait:
Exam
- Weak in the rear, can’t pick up rear legs normally
- Her gait was very exaggerated, high stepping in the rear and placing her weight down quickly
- She walked on the tops of her rear feet often and would drag them to get them back into place at times.
Treatment
Hemo-acupuncture at BL-67 bilaterally, Balance method
Electro Acupuncture (EAP): Mix of Balance method and traditional AP focusing on lumbo-sacral area 20 Hz 10 min, 80/120 Hz 25 min
Herbals: Begin Double P from Jing Tang Herbal and Concentrated Hindquarter Weakness from Jing Tang Plan: Repeat EAP in 7 to 14 days. Begin herbals.
Plan: Repeat EAP in 7 to 14 days. Begin herbals.
Second Visit
Date of visit September 15, 2023. The clients noted that Lundy was 75% better for 1 week after EAP. She still knuckles but not as much. As time went by, she began to be weak and knuckle.
Exam
Her popliteal lymph nodes (LNs) bilaterally are enlarged. No clinical signs of illness noted. Lundy does have some sores on her toes from dragging her feet. There was a history of her iliac lymph nodes being mildly enlarged on her MRI in May 2023.
Treatment
Recommend fine needle aspirate (FNA) of LNs to diagnose. The client elected to do that today with us vs. her regular vet in NC. FNA aspirates obtained and sent to the lab.
Pending results.
Electro-acupuncture as before. Continue herbals.
Plan: Repeat EAP every 7 to 14 days. Continue herbals.
Phone Call Report
Date of call September 20, 2023. Discussed cytology results with clients:
Diagnosis for the LNs is reactive lymphoid hyperplasia.
Possible causes include infectious disease (eg. Ehrilica), immune-mediated diseases with reactive lymph nodes, or local lesion that the reactive node is draining. Since multiple lymph nodes are enlarged consider tick titers. Also consider wounds on her feet causing an immune reaction in the lymph nodes. We call ‘lymph nodes the infection police’. They filter local infection.
The clients note they do not see any other signs of ticks or tick borne disease such as malaise and lethargy. They are treating her toes for local small wounds from dragging. This is the likely cause of the enlarged LNs.
Plan: Cover with antibiotic doxycycline 100 mg twice daily for 14 days. Monitor LNs and for any possible tick related issues.
Third Visit
Date of visit October 6, 2023. Presented for third EAP treatment today.
Exam: She is walking less on tops of rear feet. She walks on top of Left rear more than Right Lundy has gone on 2 miles walks. The right rear is 50% better, she still stands on top of Left rear often. Mrs. Feels improvement. Mr. Is unsure!
Treatment: Electro Acupuncture. 80/120 hz 40 min
Continue herbs Double P and Hindquarter Weakness.
Plan: EAP every 3 to 4 weeks to spread out costs.
Fourth Visit
Date of visit November 8, 2023. Fourth AP today. Lundy always has boots on to protect her feet and toes.
Exam: Left popliteal lymph node larger than Right, but both smaller and closer to normal sized now Left rear toes are swollen from walking on the tops of the feet (dorsum)
Treatment: Electroacupuncture as before
Plan: Goals are walking normally for longer and walking stronger. Less dorsum walking. Finish Antibiotics for enlarged lymph nodes. Continue herbs.
EAP today: Used larger gauge needles 28 g. 80/120 Hz. 40 min.
Fifth Visit
Date of visit November 22, 2023.
Exam: The owners note Lundy is doing better. They may discontinue the herbs as they did not feel they were helping. She is knuckling less now on the back Left. 50% better with back Left. The owner notes what was done last time helped a lot!!
Treatment: EAP as last time: 28 g needles 80/120 Hz. 40 min.
Plan: Continue as before.
Sixth Visit
Date of visit December 22, 2023.
Exam: Knuckling is now worse on both left and right rear. Lundy has an infected and broken toe nail that is being treated by her regular vet. She is on Zeniquin and Amoxicillin antibiotics.. The owner notes that after last visit she was very active in the yard and then lost a toenail P3 on her left rear foot. After the toe nail infection, the owner notes the knuckling then worsened.
The owner notes the culture taken by her regular vet of the broken toe nail grew 3 organisms!
Exam: Neuro deficits in the rear. Both rear legs have conscious proprioceptive deficits. She is not repositioning her feet to stand on them correctly. She is holding her stance on the tops of both rear feet. She has gone backwards since the last visit. She cannot feel where her feet are in space.
Swollen left rear toe digit 4.
Treatment: EAP 80/120 Hz 50 min. RDVM placed her on an NSAID.
Plan: Continue as before.
Seventh Visit
Date of visit January 19, 2024. Broken toe nail left rear foot came off January 1st. Lundy finished the antibiotics this morning. She has 2 sores on her left rear foot. Overall the owner notes she is knuckling 80% less.
Exam: Left rear food dorsal foot is swollen, mild sores, and toes nails on digits 3 and 4 are missing. Digits 3 and 4 are the weight being toes.
Treatment: EAP 80/120 Hz 40 min, Added Laser to rear feet and sacral area. Bled BL-67 both feet. The owner notes that she acts almost crippled after a long walk. When she overdoes a long walk, she regresses.
Plan: Added Gabapentin for nerve pain.
Eighth Visit
Date of visit February 22, 2024. The owner has not needed to keep the bandage on her left rear foot. However, recently she did want to lick her left rear foot raw. Knuckling on her rear feet is now only 5 to 10% of the time!!! Last treatment we did worked great!
Exam: Rarely knuckles with movement now. Left rear foot wound looks good now. Treatment: EAP 45 min. Lasered both rear feet and lumbo-sacrum. Continue Gabapentin.
Plan: Electroacupuncture only as needed now!
Ninth Visit
Date of visit March 23, 2024. The owner wanted a tune-up acupuncture. Lundy is doing well overall! She only walks on the tops of her feet now when she is really, really tired. The owners are very happy with her response to acupuncture treatment.
Plan: Acupuncture as needed now. Continue Gabapentin.
Catching Up with Lundy
Taken November 18, 2024. Lundy’s case study is a great example of how electroacupuncture can help neurological problems when there is no Western treatment equivalent.
Steroids to help decrease the inflammation of the sciatic nerves did not help. The original dry needle acupuncture did not help. The MRI findings did not support a true disc compression of the spinal cord. So her case was a bit of a ‘head scratcher’.
Electroacupuncture works to stimulate the nerves and ‘wake them’ up. Helping to eliminate swelling and inflammation, decrease pain and pressure, and to heal local tissue by ‘moving the Qi’!
