Acupuncture-for-Neurological-Disorders-madrid.ppt

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Acupuncture-for-Neurological-Disorders-madrid.ppt

  1. 1. Acupuncture for Neurological Disorders It matters not whether medicine is new or old, it only matters that it is applied for the benefit of the patient.
  2. 2. Neurologic Assessment <ul><li>Is it a neurologic disease? </li></ul><ul><ul><li>Seizures </li></ul></ul><ul><ul><li>Intention tremor </li></ul></ul><ul><ul><li>CN deficits </li></ul></ul><ul><ul><ul><li>Head tilt </li></ul></ul></ul><ul><ul><ul><li>Nystagmus </li></ul></ul></ul><ul><ul><li>CP deficits </li></ul></ul><ul><ul><li>Dysmetria </li></ul></ul><ul><ul><li>Paralysis </li></ul></ul>
  3. 3. Minimum Database <ul><li>CBC </li></ul><ul><li>Chemistry </li></ul><ul><ul><li>Bile acids </li></ul></ul><ul><ul><li>Cholinesterase </li></ul></ul><ul><li>Urinalysis </li></ul><ul><li>Chest and abdominal radiographs </li></ul><ul><li>Abdominal ultrasound </li></ul><ul><li>Heartworm test </li></ul><ul><li>Fecal </li></ul>
  4. 4. Ancillary Neurologic Tests <ul><li>Electrodiagnostics </li></ul><ul><ul><li>EEG </li></ul></ul><ul><ul><li>EMG </li></ul></ul><ul><ul><li>BAER </li></ul></ul><ul><li>CSF tap & analysis </li></ul><ul><ul><li>Cells & protein </li></ul></ul><ul><ul><li>Pressure </li></ul></ul><ul><ul><li>Cholinesterase </li></ul></ul><ul><ul><li>Titers </li></ul></ul><ul><li>Radiographs </li></ul><ul><ul><li>Skull & spinal films </li></ul></ul><ul><ul><li>Myelography </li></ul></ul><ul><ul><li>CT scan </li></ul></ul><ul><ul><li>MRI </li></ul></ul><ul><li>Muscle Analysis </li></ul><ul><ul><li>Enzymes </li></ul></ul><ul><ul><li>2M antibody </li></ul></ul><ul><ul><li>Anti-ACH receptor antibody </li></ul></ul><ul><ul><li>Biopsy </li></ul></ul>
  5. 5. When all else fails… Look at the patient!!!
  6. 6. Outcome of Neurologic Assessment <ul><li>Localization of Lesion </li></ul><ul><li>D </li></ul><ul><li>A </li></ul><ul><li>M </li></ul><ul><li>N </li></ul><ul><li>N </li></ul><ul><li>I </li></ul><ul><li>I </li></ul><ul><li>I </li></ul><ul><li>T </li></ul><ul><li>T </li></ul><ul><li>V </li></ul>O <ul><li>Def (Qi, Yin, Blood) </li></ul><ul><li>Jing Def </li></ul><ul><li>Def (Qi, Yin, Blood, Yang) </li></ul><ul><li>Def (Qi, Yin, Blood) </li></ul><ul><li>Stagnation (Blood) </li></ul><ul><li>Jing Def/Excess or Def </li></ul><ul><li>Phlegm Fire </li></ul><ul><li>Phlegm Fire </li></ul><ul><li>Trauma </li></ul><ul><li>Excess or Def </li></ul><ul><li>Wind Phlegm </li></ul>
  7. 7. Plan <ul><li>Differential Dx </li></ul><ul><ul><li>? </li></ul></ul><ul><li>Diagnostic Approach </li></ul><ul><ul><li>? </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>? </li></ul></ul>P <ul><li>Problem List </li></ul><ul><ul><li>? </li></ul></ul>
  8. 8. Seizures in Small Animals <ul><li>It is estimated that the overall incidence of seizure disorders in dogs and cats is around 1% </li></ul><ul><li>In pure breed dogs, this incidence may increase to 15-20%, due to the presence of inherited, primary epilepsy in those breeds </li></ul>
  9. 9. Lesion Localization in Seizures <ul><li>Cerebral Cortex </li></ul><ul><li>Diencephalon </li></ul><ul><ul><li>Thalamus </li></ul></ul><ul><ul><li>Hypothalamus </li></ul></ul><ul><li>Mesencephalon </li></ul>
  10. 10. Seizure Diagnoses Probably Symptomatic Epilepsy Symptomatic Epilepsy SEIZURES Primary Epilepsy Secondary Epilepsy Reactive Epilepsy Inactive Active
  11. 11. Seizure Diagnosis <ul><li>Minimum Database </li></ul><ul><ul><li>Abnormal in Reactive Epilepsy </li></ul></ul><ul><li>CSF tap & analysis </li></ul><ul><ul><li>Abnormal in Active Secondary Epilepsy </li></ul></ul><ul><li>CT or MRI Scan </li></ul><ul><ul><li>Abnormal in Active Secondary Epilepsy </li></ul></ul><ul><li>EEG </li></ul><ul><ul><li>Abnormal in Secondary Epilepsy </li></ul></ul><ul><li>All test are normal in Primary Epilepsy </li></ul>
  12. 12. Asymmetrical Seizures
  13. 13. Licking Seizure
  14. 14. Fly-Biting Seizure
  15. 15. Seizures and Signalment <ul><li>Primary Epilepsy- purebred dogs 1-3 years of age </li></ul><ul><li>Secondary Epilepsy- any age but especially under 6 months and over 3 years </li></ul>
  16. 16. Seizures- -TCM <ul><li>Represent various aspects of the Liver (Wood) system </li></ul><ul><li>Excess (3 types) </li></ul><ul><li>Deficiency (3 types) </li></ul>
  17. 17. Seizures- -TCM <ul><li>Excess </li></ul><ul><ul><li>Wind-Phlegm </li></ul></ul><ul><ul><ul><li>Tongue pale & greasy </li></ul></ul></ul><ul><ul><ul><li>Pulse wiry & slippery </li></ul></ul></ul><ul><ul><li>Phlegm-Fire </li></ul></ul><ul><ul><ul><li>Tongue red & greasy </li></ul></ul></ul><ul><ul><ul><li>Pulse rapid, wiry & slippery </li></ul></ul></ul><ul><ul><li>Blood Stagnation </li></ul></ul><ul><ul><ul><li>Tongue & Pulse like Wind-Phlegm </li></ul></ul></ul><ul><ul><ul><li>History of head trauma </li></ul></ul></ul><ul><li>Deficiency </li></ul><ul><ul><li>Liver Blood Def. </li></ul></ul><ul><ul><ul><li>Tongue pale & dry </li></ul></ul></ul><ul><ul><ul><li>Pulse weak & thready </li></ul></ul></ul><ul><ul><li>Liver & Kidney Yin Def. </li></ul></ul><ul><ul><ul><li>Tongue red & dry </li></ul></ul></ul><ul><ul><ul><li>Pulse weak & thready </li></ul></ul></ul><ul><ul><li>Kidney Jing Def. </li></ul></ul><ul><ul><ul><li>Tongue pale or red & dry </li></ul></ul></ul><ul><ul><ul><li>Pulse weak & thready </li></ul></ul></ul><ul><ul><ul><li>< 1 year of age </li></ul></ul></ul>
  18. 18. Seizures- -TCM <ul><li>Excess </li></ul><ul><ul><li>Wind-Phlegm </li></ul></ul><ul><ul><ul><li>expel phlegm, extinguish the wind, open the orifice and stabilize the seizures </li></ul></ul></ul><ul><ul><ul><li>Ding Xian Wan </li></ul></ul></ul><ul><ul><li>Phlegm-Fire </li></ul></ul><ul><ul><ul><li>clear the liver, drain the heat, transform phlegm and open the orifices </li></ul></ul></ul><ul><ul><ul><li>Di Tan Tang and Long Dan Xie Gan Tang </li></ul></ul></ul><ul><ul><li>Blood Stagnation </li></ul></ul><ul><ul><ul><li>expel phlegm, extinguish the wind, open the orifice, stabilize the seizures and invigorate blood </li></ul></ul></ul><ul><ul><ul><li>Ding Xian Wan and Tao Hong Si Wu San </li></ul></ul></ul><ul><li>Deficiency </li></ul><ul><ul><li>Liver Blood Def. </li></ul></ul><ul><ul><ul><li>tonify Qi and Blood and quiet the wind </li></ul></ul></ul><ul><ul><ul><li>Bu Xue Xi Feng San or Di Tan Tang plus Rehmannia 8 </li></ul></ul></ul><ul><ul><li>Liver & Kidney Yin Def. </li></ul></ul><ul><ul><ul><li>nourish Yin and extinguish wind </li></ul></ul></ul><ul><ul><ul><li>Yang Yin Xi Feng San or Di Tan Tang and Left Side Replenished (Zuo Gui Wan) or Tian Ma Gou Teng plus </li></ul></ul></ul><ul><ul><li>Kidney Jing Def. </li></ul></ul><ul><ul><ul><li>extinguish the wind and astringe or nourish the kidney jing </li></ul></ul></ul><ul><ul><ul><li>Di Tan Tang and Epimedium Powder </li></ul></ul></ul>
  19. 19. Epilepsy -- TCM <ul><li>Internal heat leading to generation of wind </li></ul><ul><li>Clear wind & heat and calm the Shen </li></ul><ul><li>Points </li></ul><ul><ul><li>Constitutional points </li></ul></ul><ul><ul><li>Clear wind & heat </li></ul></ul><ul><ul><ul><li>GB20, LI4, LI11, GV14, LIV3 </li></ul></ul></ul><ul><ul><li>Calm the shen </li></ul></ul><ul><ul><ul><li>PC6, HT7 </li></ul></ul></ul><ul><ul><li>Local points </li></ul></ul><ul><ul><ul><li>GV17, GV20, GV21, Long hui, GB9, GB13, BL5, GV1, ST40 </li></ul></ul></ul><ul><li>TCM Herbals </li></ul><ul><ul><li>Di Tan Tang (TCM phenobarbital) </li></ul></ul><ul><ul><li>Specific herbs for excesses or deficiencies present </li></ul></ul>
  20. 20. Ear Staple <ul><li>Shen Men </li></ul><ul><ul><li>Center of the ear </li></ul></ul><ul><ul><li>Staple or point AP can help control 50% of refractor epilepsy cases </li></ul></ul><ul><ul><li>Fold ear over & find center on inside </li></ul></ul>
  21. 21. Acepromazine in An Shen <ul><li>An Shen </li></ul><ul><ul><li>Half way around the back of the ear </li></ul></ul><ul><ul><li>Aim toward the opposite base of lips </li></ul></ul><ul><ul><li>Inject 0.1-1 mg diluted with saline to 0.5-6ml </li></ul></ul>
  22. 22. Basic Antioxidants <ul><li>Vitamin E 10 IU/lb daily </li></ul><ul><li>Vitamin C 5-10 mg/lb twice a day </li></ul><ul><li>Selenium 2 µg/lb daily </li></ul><ul><li>Beta carotene 250 IU/lb daily </li></ul><ul><li>B Complex 2mg/kg twice a day </li></ul><ul><li>Vitamin E 100-400 IU daily </li></ul><ul><li>Vitamin C 100-250 mg twice a day </li></ul><ul><li>Selenium 50 µg daily </li></ul><ul><li>Vitamin A 1000-5000 IU daily </li></ul><ul><li>B Complex 10 mg twice a day </li></ul>Dogs Cats
  23. 23. Additional Considerations <ul><li>Probably safe parasite control </li></ul><ul><ul><li>Interceptor </li></ul></ul><ul><ul><li>Frontline Top Spot </li></ul></ul><ul><ul><li>Revolution </li></ul></ul><ul><li>Should avoid </li></ul><ul><ul><li>Heartgard </li></ul></ul><ul><ul><li>Proheart 6 </li></ul></ul><ul><ul><li>Program </li></ul></ul><ul><ul><li>Sentinel </li></ul></ul><ul><ul><li>Frontline Spray </li></ul></ul><ul><ul><li>Advantage </li></ul></ul><ul><ul><li>Advantix </li></ul></ul>
  24. 24. Additional Considerations <ul><li>Diet </li></ul><ul><ul><li>Low-carbohydrate food </li></ul></ul><ul><li>Supplements </li></ul><ul><ul><li>Ginkgo biloba </li></ul></ul><ul><ul><ul><li>2-4 mg/kg q8-12h </li></ul></ul></ul><ul><ul><ul><li>Ginkoba or Publix brand </li></ul></ul></ul><ul><ul><li>Tofu or Lecithin </li></ul></ul><ul><ul><ul><li>20 mg/kg daily </li></ul></ul></ul><ul><ul><li>Acetylcysteine </li></ul></ul><ul><ul><ul><li>25 mg/kg q8h qod </li></ul></ul></ul>
  25. 25. Meningoencephalomyelitis <ul><li>Infectious Diseases </li></ul><ul><ul><li>Species Specific </li></ul></ul><ul><li>Steroid Response ME (SRME) </li></ul><ul><li>Necrotizing Vasculitis (SRMA) </li></ul><ul><li>Necrotizing ME (NME) </li></ul><ul><li>Granulomatous ME (GME) </li></ul>
  26. 26. Meningoencephalomyelitis <ul><li>Pain to paresis to plegia </li></ul><ul><li>Dx with CSF tap </li></ul><ul><li>Spinal radiographs normal </li></ul><ul><li>Myelography normal (might be contraindicated) </li></ul>
  27. 27. Meningoencephalomyelitis
  28. 28. CSF Tap <ul><li>Collection site for seizures is at the cisterna magnum. </li></ul><ul><li>Allows analysis for cells, protein and pressure. </li></ul><ul><li>Cytology and titers for infectious organisms can be obtained. </li></ul>
  29. 29. Menigoencephalomyelitis <ul><ul><li>Wind-Phlegm </li></ul></ul><ul><ul><ul><li>expel phlegm, extinguish the wind, open the orifice and stabilize the seizures </li></ul></ul></ul><ul><ul><ul><li>Ding Xian Wan </li></ul></ul></ul><ul><ul><li>Phlegm-Fire </li></ul></ul><ul><ul><ul><li>clear the liver, drain the heat, transform phlegm and open the orifices </li></ul></ul></ul><ul><ul><ul><li>Di Tan Tang and Long Dan Xie Gan Tan </li></ul></ul></ul>
  30. 30. Brain Abscess in a Foal
  31. 31. Brain Abscess in a Foal
  32. 32. Vestibular Disease <ul><li>Cardinal Signs </li></ul><ul><ul><li>Head Tilt </li></ul></ul><ul><ul><li>Nystagmus </li></ul></ul><ul><ul><ul><li>Horizontal </li></ul></ul></ul><ul><ul><ul><li>Rotatory </li></ul></ul></ul><ul><ul><ul><li>Vertical </li></ul></ul></ul><ul><ul><ul><li>Positional </li></ul></ul></ul><ul><ul><li>Circling (tight) </li></ul></ul><ul><ul><li>Imbalance & Incoordination </li></ul></ul>
  33. 33. Vestibular Disease Vestibular Disease Idiopathic V.D. Inner Ear Disease Central V.D. 8th Nerve only 8th Nerve, 7th Nerve & Horner’s Syndrome Anything Else Brainstem V.D. Cerebellar Disease
  34. 34. Idiopathic Vestibular Disease <ul><li>Acute Onset of Vestibular Signs </li></ul><ul><ul><li>Head tilt </li></ul></ul><ul><ul><li>Horizontal or Rotatory nystagmus with fast-phase away from head tilt </li></ul></ul><ul><ul><li>Nothing else </li></ul></ul><ul><li>Can Be Very Severe </li></ul><ul><li>Acute, regressive disease </li></ul>
  35. 35. Idiopathic Vestibular Disease -- TCM <ul><li>Wind (heat) invasion </li></ul><ul><li>Clear wind & heat and calm the Shen </li></ul><ul><li>Points </li></ul><ul><ul><li>Constitutional points </li></ul></ul><ul><ul><li>Clear wind & heat </li></ul></ul><ul><ul><ul><li>GB20, LI4, LI11, GV14 </li></ul></ul></ul><ul><ul><li>Calm Shen </li></ul></ul><ul><ul><ul><li>PC6, HT7, GV17, GV20, GV21 </li></ul></ul></ul><ul><ul><li>Local points </li></ul></ul><ul><ul><ul><li>TH17, TH18, TH21, SI19, GB2, Er jian, An shen </li></ul></ul></ul>
  36. 36. Inner Ear Disease <ul><li>8th Nerve Signs </li></ul><ul><li>7th Nerve Signs </li></ul><ul><ul><li>ear & lip droop </li></ul></ul><ul><ul><li>lack of palpebral reflex </li></ul></ul><ul><ul><li>nose turn </li></ul></ul><ul><ul><li>nostril flaring </li></ul></ul><ul><li>Horner’s Syndrome </li></ul>
  37. 37. Horner’s Syndrome <ul><li>Small Animals </li></ul><ul><ul><li>Ptosis </li></ul></ul><ul><ul><li>Myosis </li></ul></ul><ul><ul><li>Enophthalmos </li></ul></ul><ul><li>Large Animals </li></ul><ul><ul><li>Facial sweating (horse) </li></ul></ul><ul><ul><li>Lack of muzzle sweating (cow) </li></ul></ul>
  38. 38. Inner Ear Disease <ul><li>Most cases are secondary to bacterial infection (otitis media & interna) </li></ul><ul><ul><li>extension from otitis externa </li></ul></ul><ul><ul><li>pharyngitis with extension up the Eustachian tube </li></ul></ul><ul><ul><li>hematogenous spread </li></ul></ul>
  39. 39. Ear Polyps in Cats <ul><li>Benign growth in the external ear canal which causes signs by extension. </li></ul><ul><li>Can also be pharyngeal mass which grows into middle ear via the Eustachian tube. </li></ul>
  40. 40. Ear Polyps in Cats <ul><li>Treatment is surgical removal. </li></ul><ul><li>Damage can be permanent, if pressure necrosis has destroyed the inner ear structure. </li></ul>
  41. 41. Inner Ear Disease -- TCM <ul><li>Invasion of external pathogen leading to wind, heat, damp. </li></ul><ul><li>Heat boils the fluids leading to the accumulation of phlegm. </li></ul><ul><li>Quiet the wind, reduce heat, disperse damp and activate the blood to dissolve stagnation. </li></ul>
  42. 42. Inner Ear Disease -- TCM <ul><li>Points </li></ul><ul><ul><li>Constitutional points </li></ul></ul><ul><ul><li>Clear wind & heat </li></ul></ul><ul><ul><ul><li>GB20, LI4, LI11, GV14 </li></ul></ul></ul><ul><ul><li>Calm the shen </li></ul></ul><ul><ul><ul><li>PC6, HT7, GV17, GV20, GV21 </li></ul></ul></ul><ul><ul><li>Eliminate damp </li></ul></ul><ul><ul><ul><li>SP9 </li></ul></ul></ul><ul><ul><li>Activate Qi & blood </li></ul></ul><ul><ul><ul><li>ST36, ST40, Xin shu </li></ul></ul></ul><ul><ul><li>Local points </li></ul></ul><ul><ul><ul><li>TH17, TH18, TH21, SI19, GB2, Er jian, An shen </li></ul></ul></ul>
  43. 43. Central Vestibular Disease <ul><li>Postural Changes </li></ul><ul><ul><li>CP Deficit </li></ul></ul><ul><ul><li>Dysmetria </li></ul></ul><ul><li>Reflex Changes </li></ul><ul><ul><li>hyperactive reflexes </li></ul></ul><ul><ul><li>crossed-extensor reflexes </li></ul></ul><ul><ul><li>Babinski’s sign </li></ul></ul>Conscious proprioceptive deficit may be on the same or opposite side of the lesion .
  44. 44. Central Vestibular Disease MRI of Cerebellar Meningioma
  45. 45. Central Vestibular Disease -- TCM <ul><li>Can be wind, heat-damp or wind cold based upon the causative factor involved. </li></ul><ul><li>Points </li></ul><ul><ul><li>Constitutional </li></ul></ul><ul><ul><li>8 Principle </li></ul></ul><ul><ul><li>Zang-Fu </li></ul></ul>
  46. 46. IVD- -TCM Diagnosis <ul><li>Represents a “bi” syndrome often accompanied by “wei” syndrome </li></ul><ul><li>Under domain of KID (bones) & LIV (joints & free flow of qi & blood) </li></ul>
  47. 47. IVD- - TCM Patterns <ul><li>Excess types </li></ul><ul><ul><li>Wind-Cold-Damp </li></ul></ul><ul><ul><li>Blood stagnation </li></ul></ul><ul><li>Deficient types </li></ul><ul><ul><li>Yang deficiency </li></ul></ul><ul><ul><li>Yin deficiency </li></ul></ul><ul><ul><li>Yin & Yyang deficiency </li></ul></ul>
  48. 48. Fibrocartilagenous Emboli <ul><li>Vascular occlusion from IVD material </li></ul><ul><ul><li>IVD herniates into the venous sinus or the vertebral body </li></ul></ul><ul><ul><li>the venous sinuses have no valves </li></ul></ul><ul><ul><li>increased pressure forces material into spinal cord </li></ul></ul>
  49. 49. FCE <ul><li>Generally affects a radicular penetrating branch which leads to a quadrant (wedge) of infarction </li></ul><ul><li>Many will improve with time </li></ul>
  50. 50. Schatzie
  51. 51. IVD- -Wind-Cold-Damp <ul><li>Acute invasion of external pathogen leading to stagnation (cold slows blood flow which is worsened by accumulation of damp) </li></ul><ul><li>Tongue </li></ul><ul><ul><li>Greasy </li></ul></ul><ul><li>Pulse </li></ul><ul><ul><li>Slow & soft </li></ul></ul><ul><li>Rx principle </li></ul><ul><ul><li>Dispel W-C-D, activate blood & relieve stagnation </li></ul></ul><ul><li>TCM herbal </li></ul><ul><ul><li>Xiao Huo Luo Dan </li></ul></ul><ul><li>Acupuncture </li></ul><ul><ul><li>Hua-tuo-jia-ji, BL23, BL67, GB39, GV1, & GV14 </li></ul></ul>
  52. 52. Treatment of Acute SPI <ul><li>Antioxidant steroids (Solu Medral or Solu Delta Cortef) </li></ul><ul><ul><li>30mg/kg </li></ul></ul><ul><ul><li>15mg/kg every 8 hours for 24-48 hours </li></ul></ul><ul><li>Surgical correction </li></ul>Acupuncture needle in wei jian (tip of tail)
  53. 53. Intervertebral Disc Disease: chondrodystrophic dogs <ul><li>Collagen fibers of the nucleus pulposus metamorphs into hyalin cartilage </li></ul><ul><li>IVD looses elasticity and leads to damage of annulus fibrosus </li></ul>
  54. 54. IVD- -chondrodystrophy <ul><li>Annulus ruptures extruding degenerate nuclear material into the neural canal </li></ul><ul><li>This leads to pain, paresis or paralysis </li></ul>
  55. 55. IVD- -Pain Only <ul><li>Cage Rest for 30 days or 3 weeks after patient becomes clinically normal. </li></ul><ul><li>Acupuncture </li></ul><ul><li>Oral steroids and diazepam only under supervision </li></ul>
  56. 56. IVD- -Paresis <ul><li>Hospitalize </li></ul><ul><ul><li>Prednisolone (2 mg/kg divided 2-3 times a day) </li></ul></ul><ul><ul><li>Misoprostol 3-4 µg/kg twice a day </li></ul></ul><ul><ul><li>Diazepam 0.25-0.5 mg/kg TID </li></ul></ul><ul><li>Should improve in first 5-7 days </li></ul>
  57. 57. IVD- -Paralysis with Deep Pain <ul><li>Emergency </li></ul><ul><ul><li>Give Solu Medral or Solu Delta Cortef 30 mg/kg </li></ul></ul><ul><ul><li>Refer </li></ul></ul><ul><li>May observe for 24 hours to see if dramatic improvement </li></ul><ul><ul><li>If none, Emergency </li></ul></ul>
  58. 58. IVD- -Paralysis No Deep Pain <ul><li>Emergency </li></ul><ul><ul><li>Give 30 mg/kg Solu Medral or Solu Delta Cortef </li></ul></ul><ul><ul><li>Refer </li></ul></ul><ul><li>75% respond in first 24 hours </li></ul><ul><li>50% in first 72 hours </li></ul><ul><li>25% after that </li></ul>
  59. 59. Integrative Therapy of IVD Disease <ul><li>Acute IVD Disease is a surgical emergency </li></ul><ul><ul><li>Even with no deep pain there is a 75% chance of success within the 1 st 24 hours & 50% chance in the 1 st 72 hours </li></ul></ul><ul><ul><li>After 72 hours with no deep pain, the chances are no different </li></ul></ul><ul><li>Chronic IVD Disease may respond poorly to surgery </li></ul>
  60. 60. IVD <ul><li>After surgery, healing is needed </li></ul><ul><li>Physical therapy </li></ul><ul><ul><li>Passive movements </li></ul></ul><ul><ul><li>Massage </li></ul></ul><ul><ul><li>Standing exercises </li></ul></ul><ul><ul><li>Hydrotherapy </li></ul></ul><ul><ul><li>Walking </li></ul></ul><ul><li>Acupuncture </li></ul><ul><ul><li>Control pain </li></ul></ul><ul><ul><li>Stimulate nerves </li></ul></ul><ul><li>Magnet therapy </li></ul><ul><ul><li>North pole magnet stimulates nerve regeneration </li></ul></ul><ul><li>Healing touch </li></ul>
  61. 61. IVD- -Diet <ul><li>Basic antioxidants </li></ul><ul><ul><li>Vitamin E, vitamin C, vitamin B complex, selenium, beta carotene </li></ul></ul><ul><li>Anti-inflammatory membrane stabilizers </li></ul><ul><ul><li>Omega-3-fatty acids, gamma linolenic acid, coenzyme Q-10 </li></ul></ul><ul><li>Lecithin to help support myelination </li></ul><ul><li>Herbal medications to help immune system </li></ul><ul><ul><li>Astragalus, cordyceps mushroom, garlic </li></ul></ul><ul><li>Dietary cartilage </li></ul>
  62. 62. IVD- -Prevention <ul><li>Diet & weight control </li></ul><ul><ul><li>Low carbohydrate diet </li></ul></ul><ul><ul><li>Basic antioxidants </li></ul></ul><ul><li>Chiropractic care </li></ul><ul><li>Massage </li></ul><ul><li>Exercise </li></ul>
  63. 63. Hans
  64. 64. Hans <ul><li>Routine radiographs showed a narrowed IVD space at T11-12 with a cloudy IV foramen </li></ul><ul><li>Incidentally there was calcification of T13-L1 </li></ul>
  65. 65. Hans
  66. 66. IVD- -Blood Stagnation <ul><li>Most common type in chondrodystrophic dogs </li></ul><ul><ul><li>KID Jing deficiency leads to failure to nourish LIV leads to joint problems & stagnation </li></ul></ul><ul><li>Tongue </li></ul><ul><ul><li>Purple </li></ul></ul><ul><li>Pulse </li></ul><ul><ul><li>Wiry or Fast </li></ul></ul><ul><li>Rx Principle </li></ul><ul><ul><li>Activate blood, dissipate stagnation and resolve stasis </li></ul></ul><ul><li>TCM herbal </li></ul><ul><ul><li>Da huo luo dan (Double P formula #2) </li></ul></ul><ul><li>Acupuncture </li></ul><ul><ul><li>Hua-tuo-jia-ji, BL23, BL11, GB39, GV14, Wei jian, GV6, GV1, & LIV3 </li></ul></ul>
  67. 67. Cervical Spondylomyelopathy <ul><li>Young Great Danes and older Doberman Pinchers </li></ul><ul><ul><li>Young dogs is due to misarticulation and spondylolithesis </li></ul></ul><ul><ul><li>Older dogs is due to IVD disease and ligamentous hypertrophy </li></ul></ul>
  68. 68. Diagnosis of CSM <ul><li>Plain Radiographs </li></ul><ul><ul><li>mild changes which suggest problem </li></ul></ul><ul><li>CSF tap </li></ul><ul><ul><li>normal </li></ul></ul><ul><li>EMG </li></ul><ul><li>Myelography </li></ul><ul><ul><li>dynamic views </li></ul></ul>
  69. 69. Myelograpgy- -dynamic views Ventral Flexion Dorsal Flexion
  70. 70. CSM- -Treatment <ul><li>Surgery is designed to remove IVD protrusion and to lessen ligamentous compression </li></ul><ul><li>Best accomplished with distraction techniques </li></ul><ul><ul><li>“ Screw and Washer” </li></ul></ul><ul><ul><li>methylmethacrylate </li></ul></ul>
  71. 71. LS Stenosis A Pain in the Butt! DVM
  72. 72. LS Stenosis- -Cardinal Signs <ul><li>LS Back Pain </li></ul><ul><ul><li>pain on palpation at LS junction </li></ul></ul><ul><ul><li>pain on raising the tail head </li></ul></ul><ul><li>Diminished tail movement </li></ul><ul><li>Urinary and Fecal continency problems </li></ul>
  73. 73. LS Stenosis
  74. 74. LS Stenosis- -Diagnosis <ul><li>EMG </li></ul><ul><ul><li>fibrillation potentials and positive sharp waves caudal to LS junction, distal limb and tail </li></ul></ul><ul><li>Imaging techniques </li></ul><ul><ul><li>CT Scan </li></ul></ul><ul><ul><li>MRI Scan </li></ul></ul>
  75. 75. LS Stenosis- -Treatment <ul><li>Medical management </li></ul><ul><ul><li>corticosteroids & diazepam </li></ul></ul><ul><ul><li>carprofen & diazepam </li></ul></ul><ul><ul><li>acupuncture & TCM herbs </li></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>dorsal laminectomy ± stabilization </li></ul></ul>
  76. 76. IVD- -Yang Deficient <ul><li>Old age leads to KID deficiency </li></ul><ul><ul><li>General weakness & cold back </li></ul></ul><ul><li>Tongue </li></ul><ul><ul><li>Pale & wet (swollen with teeth marks) </li></ul></ul><ul><li>Pulse </li></ul><ul><ul><li>Deep & weak </li></ul></ul><ul><li>Rx principle </li></ul><ul><ul><li>Nourish Yang & warm KID </li></ul></ul><ul><li>TCM herbal </li></ul><ul><ul><li>Sang ji sheng san (lorathus powder) </li></ul></ul><ul><li>Chronic IVD </li></ul>
  77. 77. IVD- -Yin Deficiency <ul><li>Chronic illness or old age consumes KID Yin </li></ul><ul><ul><li>Weakness in back worse at night </li></ul></ul><ul><li>Tongue </li></ul><ul><ul><li>Red & dry </li></ul></ul><ul><li>Pulse </li></ul><ul><ul><li>Deep, thready & weak </li></ul></ul><ul><li>Rx principle </li></ul><ul><ul><li>Nourish Yin & tonify KID </li></ul></ul><ul><li>TCM herbal </li></ul><ul><ul><li>Di gu pi san </li></ul></ul><ul><li>Chronic IVD </li></ul>
  78. 78. Discospondylitis <ul><li>Infection of the intervertebral space </li></ul><ul><li>Common causes </li></ul><ul><ul><li>Staph. aureus </li></ul></ul><ul><ul><li>Strep. sp. </li></ul></ul><ul><ul><li>Corynebactrium </li></ul></ul><ul><li>Signs </li></ul><ul><ul><li>Pain (can be extreme) </li></ul></ul><ul><ul><li>Ataxia to plegia </li></ul></ul>
  79. 79. Discospondylitis <ul><li>Diagnosis can be made on plain radiographs </li></ul><ul><ul><li>May initially be normal, until 2-3 weeks of incubation </li></ul></ul><ul><li>Find organism via </li></ul><ul><ul><li>Blood culture </li></ul></ul><ul><ul><li>Urine culture </li></ul></ul>
  80. 80. Discospondylitis <ul><li>Also consider </li></ul><ul><ul><li>Nocardia or other fungal cause (aspergillosis) </li></ul></ul><ul><ul><li>Brucella canis </li></ul></ul><ul><ul><li>Spirocerca lupi </li></ul></ul><ul><li>Treatment (6-8 wk) </li></ul><ul><ul><li>Cephalosporins </li></ul></ul><ul><ul><li>Sulfa drugs </li></ul></ul>
  81. 81. Moose <ul><li>9 year old M/C Labrador </li></ul><ul><li>HBC 4 months ago </li></ul><ul><ul><li>Recovered </li></ul></ul><ul><li>Chronic, progressive paresis over 2 weeks </li></ul>
  82. 82. Moose- -Myelogram
  83. 83. Moose- -Surgical Observation Abnormal articular process at T12 Epidural mass
  84. 84. Moose- -Cytology <ul><li>Impression smears from both the articular process and the epidural mass revealed PMN with intracellular bacteria </li></ul>
  85. 85. Moose- -CT scan
  86. 86. Moose- -Post OP <ul><li>Antibiotics </li></ul><ul><ul><li>Sulfadimethoxine (Primor) 15 mg/kg q12h </li></ul></ul><ul><ul><li>Cephalexin 22 mg/kg every 8 hours </li></ul></ul><ul><ul><li>Use for 6-8 weeks </li></ul></ul>
  87. 87. IVD- -Yin & Yang Def. <ul><li>Aging leads to KID Yang & Yin deficiency </li></ul><ul><ul><li>decreases resistance & allows low grade infection to start </li></ul></ul><ul><li>Tongue </li></ul><ul><ul><li>Pink or pale </li></ul></ul><ul><li>Pulse </li></ul><ul><ul><li>Deep & weak </li></ul></ul><ul><li>Rx Principle </li></ul><ul><ul><li>Nourish Yin & tonify KID </li></ul></ul><ul><li>TCM herbal </li></ul><ul><ul><li>Double P #1 (hindquarter formula) </li></ul></ul><ul><li>Very chronic </li></ul>
  88. 88. CNS Neoplasia Today’s Frontier
  89. 89. CNS Neoplasia- -Dogs <ul><li>Dog has 1-18 months average survival time </li></ul><ul><ul><li>1-3 with nothing </li></ul></ul><ul><ul><li>6-9 with surgery </li></ul></ul><ul><ul><li>12-18 with radiation treatment </li></ul></ul><ul><li>All tumors are invasive (malignant) </li></ul>
  90. 90. CNS Neoplasia- -Cats <ul><li>Most common is meningioma </li></ul><ul><li>Usually extra-axial and benign </li></ul><ul><li>Seen in aged cats </li></ul><ul><li>Present with depression and dementia </li></ul>
  91. 91. Elvis
  92. 92. Elvis <ul><li>MRI revealed mass in the cerebral cortex </li></ul>
  93. 93. Elvis
  94. 94. Treatment <ul><li>Diet </li></ul><ul><ul><li>Low carbohydrate </li></ul></ul><ul><li>Supplements </li></ul><ul><ul><li>Antioxidants & membrane stabilizers </li></ul></ul><ul><li>Herbal medications </li></ul><ul><ul><li>Western- - Canine Cancer formula </li></ul></ul><ul><ul><li>Traditional Chinese medicine- - Stasis in the Mansion of the Mind </li></ul></ul>
  95. 95. TCVM Brain Cancer <ul><li>Max Formula </li></ul><ul><li>Stasis in Mansion of Mind </li></ul><ul><li>Wei Qi Booster </li></ul><ul><li>Western herbs </li></ul>or and and Transports to Head
  96. 96. Cancer Recommendations <ul><li>Low-Carbohydrate food (home prepared is best or use Pedigree Weight Loss Formula) </li></ul><ul><li>Canine basic antioxidant formula (Westlab Pharmacy 1-800-4WESTLA) </li></ul><ul><li>Canine arthritis formula (Westlab) </li></ul><ul><li>Canine cancer formula (Westlab)- -use at 2 times prevention dose </li></ul><ul><li>COX-2 inhibitor (daily- -particularly for carcinomas) </li></ul><ul><li>Melatonin at night (0.1-0.2 mg/kg) </li></ul>

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