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I.V.A.S. ACUPUNCTURE CASE REPORT

I.V.A.S. ACUPUNCTURE CASE REPORT

Elisabetta Puggelli
DVM, Montemurlo - PO-, Italy

ABSTRACT

Dog. Female, boxer, 7.5 years old with nephrotic syndrome arising from leishmaniasis, treated for leishmania and Qi Deficiency with good results.


HISTORY


Astra is a 7.5 year old female boxer, non-spayed, with regular heats. She has been given all recommended vaccinations and heartworm prophylaxis. She is fed with homemade food (pasta, rice, vegetables, meat, rather than canned food).
She had never had health problems until the day she was taken to the clinic. Her symptoms were: inappetence, polydipsia, polyuria with loss of urine, especially during the night, dribbling after urination, frequent and copious clear urination, loss of weight, depression. She craved warm places, lay in the sun, and did not want to be taken for her daily walk.


EXAMINATION FINDINGS

When she was brought to the clinic, the Western medical physical examination showed that Astra was weak and thin. Temperature was normal, auscultation of heart and lungs was normal, abdominal palpation showed no irregular findings, as did eye examination. No otitis, regular stool, pale membrane mucosae, regular nodes, oral tract and pharynx normal, no neurological problems, coat was dry and lustreless, muscles were hypotonic. TCM examination indicated that the constitutional type related to the five elements of Astra was "earth type" (1). The patient had normal shen, was thin, weak, with lustreless coat, tired with slow movements, lethargic, with cold extremities. Her tongue was pale, thin. The pulse was deep, slow, empty. At palpation, points BL 20 and BL 23 were painful.


DIAGNOSTICS

A complete blood check was carried out (hemochrome, biochemical and hemostatic profile, see Table 1). The following values showed alterations: creatine, BUN, phosphorus, RBC; in addition, some coagulation values were abnormal.

All these values showed that Astra suffers from kidney deficiency with anemia. A urine check was carried out (see Table 2) which showed abundant proteinuria with low specific gravity. Echocardiography showed no irregularities. The abdominal ultrasound showed only a slightly hyperechoic renal cortex and small anechoic areas with slightly enlarged suprarenal glands (see Tables 3 and 4).

We performed a fine needle aspiration of the node and a bone marrow biopsy. These revealed the presence of leishmaniasis. We performed a serologic test for Ehrlichia canis, which was negative. The IFAT test (direct immunofluorescence) for leishmaniasis, performed by an outside laboratory, resulted positive with an antibody titer of 1:640.

WESTERN MEDICAL DIAGNOSIS
After all tests and complete examination, we diagnosed a nephritic syndrome resulting from leishmaniasis. Canine leishmaniasis is a systemic protozoal disease of mononucleate phagocytes. The most important characteristic of this disease is how and to what extent the host's immune system is affected. There can be various clinical manifestations of the disease, which can attack numerous different organs with varied symptoms.

EASTERN MEDICAL DIAGNOSIS
Leishmaniasis infection indicates a heat/dampness attack as a consequence of Wei Qi deficiency. Inappetence and depression account for the results of pulse examination that showed a Qi deficiency. Urine loss, especially during the night, reveals a Yang deficiency in the kidney. The pain felt at palpation of BL 20 reveals that the spleen is affected (leishmaniasis affects the reticuloendothelial system) and palpation of BL 23 reveals that the kidney is affected (nephritic syndrome). According to the eight principles, the pathology presented by Astra is internal, cold, Yin deficiency with Qi deficiency in the spleen.


TREATMENT PRINCIPLES/TREATMENT RESULTS

The main treatments are:

  • To benefit Qi, and especially Wei Qi
  • To benefit Spleen transformation and transportation function and dispel Heat and Dampness
  • To benefit kidney water metabolism function
  • To benefit kidney marrow functions
  • To heat kidney Yin and Yang

Main points used:

  • BL 20 (Pi Shu) 1.5 cun lateral to the caudal border of the spinous process of the 12th thoracic vertebra. Spleen shu point, benefits spleen function of transformation and transportation, nourishes blood.
  • BL 23 (Shen Shu) 1.5 cun lateral to the caudal border of the spinous process of the 2nd lumbar vertebra. Shu point of kidney, tonifies Kidney Yin, strengthens the marrow, benefits kidney function of dominating water metabolism, nourishes the blood.
  • BL 28 (Pang Guang Shu) lateral to the 2nd sacral foramen, in the depression between the medial border of the dorsal iliac spine and the sacrum. Shu point of bladder, regulates water passages in the Lower Burner.
  • ST 36 (Zu San Li) 3 cun below ST 35, one finger-breadth from the cranial crest of the tibia, in the belly of the m. tibialis cranialis. Earth point, He point, Horary point. It is a major tonification point. Tonifes Yin and Yuan Qi, tonifes Qi and blood. It strengthens the body, regulates Yin and Wei Qi.
  • CV 3 (Zhong Ji) 4 cun caudal to the umbilicus, on the midline. Alarm point of Bladder Meridian, resolves urogenital problems.
  • CV 6 (Qi Hai) 1.5 cun caudal to the umbilicus, on the midline. Sea of Qi, regulates and tonifes Qi. It tonifes Yuan Qi, blood, Yin.
  • SP 3 (Tai Bai) on the medial aspect of the second toe, distal to the tarso-metatarsal joint, on the postero-medial aspect of metatarsal II. Earth point, Source point, Horary point. Major point for tonifying the spleen. Benefits spleen transformation and transportation.

Chronology of treatments:

At first, before the diagnosis of leishmaniasis was confirmed, we started treating Astra for the kidney pathology with fluids therapy (physiological saline solution, lactated Ringer's solution and glucose solution) for a total of 60ml/kg die in the first four days, followed by a maintenance treatment of 35ml/kg die. Astra was also given albumin, as the tests continued to indicate a considerable hypoalbuminemia. (Baxter Human Serum Albumin 20% Solution®), 150 ml/die for 4 days.
Astra was also given Omega-3 essential fatty acid, ACE inhibitors, Benazepril chlorhydrate 10 mg/ die (Fortekor 20®), and followed a low-phosphorus diet (Hill's Prescription Diet K/D).

The dog showed no improvement. She still had little appetite, partly because she did not like the new food. She was thin, lethargic and continued to lose urine. I started to treat her with acupuncture: I administered moxibustion on BL 20, BL 23-28, CV 6 and CV 3. On the following day, the customer told me that the dog had not lost urine during the night, and so I continued to perform acupuncture with two more treatments, one five days after the other. The dog started eating again and was more lively.

Once we had the results from the laboratory, we began with the treatment for leishmaniasis: allopurinol twice a day (Zyloric®) to be continued for 12 months, metrodinazole (25mg/kg) and spiramycin (1,500,000 IU/kg) twice a day (Stomorgyl 20®) to be continued for 3 months. I continued with the acupuncture treatments, and the fourth treatment included moxibustion on BL 20-23 and CV 6. I used #8 Seirin needles (0.30 x 30mm) in points ST 36 (depth of 1mm) and Spleen 3 (depth 0.5mm) with tonification method (rapid-heavy thrust, slow-gentle lift, slow-small amplitude, clockwise, push needle slowly to proper depth, then rapidly pull it up to just beneath the skin, pressure, with channel course). In the meantime, as the dog had suspended fluids therapy, she was treated only with oral therapy at home and was taken to the clinic exclusively for the acupuncture treatments. The fifth and sixth treatments were performed weekly with the same methodology and same points as the fourth treatment.

At the end of the acupuncture treatment, while still doing oral therapy, the dog's weight increased and she recovered appetite, no longer lost urine, was lively, and did not crave warm places. The mucosae were not pale and she was willing to play again. The tongue recovered color and the pulse was fuller.

I must say that the owner of the dog is very happy with the results, as the dog, after six months, is still healthy. The blood examination still shows altered but stable creatine (3.00 mg/dl) and BUN (38.3 mg/dl) values. The antibody titer has gone down to 1/80.


DISCUSSION


When Astra arrived at the clinic, she showed symptoms that could possibly refer to a kidney pathology, confirmed afterwards by the lab tests. Considering that the dog lived in an endemic area for canine leishmaniasis, we thought of this possible differential diagnosis, taking into account that the ultrasound did not reveal major anomalies and the Ehrlichia test was negative. After leishmaniasis had been ascertained by FNA of the node and IFAT test, we deduced that the kidney pathology was connected to leishmaniasis.

Considering that the dog was weak, depressed, and showed little desire to move when she arrived at the clinic, while at the same time her Shen was normal, it was plausible to think of Qi deficiency. Qi deficiency is characterized by: pale face, pale tongue, lethargy, little desire to move, weak pulse (2). Kidney Yin no longer nourishes kidney Yang, and we thus have nocturia as a consequence of kidney Yang deficiency. Kidney Yang Xu is characterized by frequent urination, some dripping, increased frequency at night, pale urine color, increased volume (3).

The deficiency symptoms disappeared with tonification and by benefiting the deficiencies through moxibustion and with needles in tonification on BL 20,23,28- CV 3,6, -SP 3, ST 36. The animal's energy and tonicity was restored, and even though she was still under maintenance treatment and the values were still slightly altered but stable, Astra recovered her normal health as before the disease.

Considering that leishmaniasis is a disease that affects the immune system, I believe that an acupuncture treatment is very useful as it acts upon the balance of the body, succeeds in restoring energy, and in increasing immunity. Consequently. the animal can produce an effective and protective immunitary response, which is able to stop the disease from developing even if the animal has already been infected.

TABLE 1

HEMOGRAM


Value of the patient
Normal value
in the dog
RBC (mil/mm3)
3,650,000
(5.5-7.9)



MCV(fl)
70
(70-77)
HCT (%)
25.6
(37-55)



WBC (migl./mm3)
5,500
(6-16)
HGB (gr/dl)
7.5
(12-18)
MCH (pg)
20.6
(12.5-24.5)
MCHC (gr/dl)
29.4
(32-36)



PLT (migl/mm3)
129,000
(200-500)
MPV(m3)
9
(5-7)
PCT (%)
0.116
(015-030)


LEUKOCYTE FORMULA


Value of the patient
Normal value
in the dog
Segmented neutrophil
3,615
(3,000-15,000)
Lymphocyte
1,152
(100-4,800)
Eosinophilic granulocyte
262
(100-1,250)
Monocyte
209
(150-1,350)


BIOCHEMICAL PROFILE


Value of the patient
Normal value
in the dog
ALT
16
(<50)
ALP
80
(<170)
Tot. Protein
6.7
(5.5-7.5)
Albumin
1.7
(2.5-4)
Globulin
5.2
(2.54.5)
A/G Rapport
0.3
(0.5-1.7)
BUN
136
(<40)
Creatine
3.3
(0.5-1.5)
Glycemia
92
(80-110)
Calcium
9.8
(9.12)
Phosphorus
6.5
(2-6)
Hematic Potassium
147
(3.7-5.8)
Hematic Sodium
4.5
(141-154)


HEMOSTATIC PROFILE


Value of the patient
Normal value
in the dog
APTT (sec.)
17.2
(12.4-16.6)
PT(sec)
8.5
(5.4-7.4)
FDPs (mg/mL)
>2.5
(<2.5)
Monocyte
209
(150-1.350)
D-Dimer of fibrin
0.34
(0.01-0.33)
Antithrombin III (%)
63
(100-148)
Fibrinogen (mg/dL)
916
(150-400)


TABLE 2

URINALYSIS


Value of the patient
Normal value
in the dog
Specific gravity
1012
(1015-1040)
pH
6
(5.5-7)
Leukocyte
++
(neg.)
Nitrite
Neg.
(neg.)
Ketone
Neg.
(neg.)
Glucose
Neg.
(neg.)
Protein
+++
(neg.)
Bilirubin
Neg.
(neg.)
Urobilinogen
Neg.
(neg.)
Hb/Mb
trace
(neg.)


TABLE 3

ECHOCARDIOGRAPHY


TABLE 4

ABDOMINAL ULTRASOUND

 


HOURS ATTENDED
1999- Acupuncture course organized by SCIVAC- Cremona with IVAS speakers (C.Robinson, C.Muller, J.Still, U.Wurther, L.A.A.Jansen, A.M.Shoen, D.H.Jagger) (23-27 February, 26-29 May, 27-30 October).


2000- S.I.A.V. International Seminar on "Main locomotorium pathologies in the dog. Diagnosis and therapy in Traditional Chinese Medicine" held by Emil Van Den Bosch. (11 June)

2000- Bevas Course - Lectures of 28-29 October with Marvin Cain on "Five Elements and equine acupuncture"

2001- Veterinary acupuncture seminar on "Medical bio-cybernetic approach in the competition horse" held by Andreas Roesti. (17 February)

2001- Veterinary acupuncture seminar on "San Jiao syndrome in the dog" held by Andreas Roesti. (18 February)

2001- Workshop on "Practical bovine acupuncture" held by Oswal Kothbauer (11-12-13 May)

2001- Bevas Course - Lectures of 26-27 May with J.B. Limehouse and P.Taylor-Limehouse on "Urinary disease, Bi syndromes, 8 principles"

2001- S.I.A.V. Second International Seminar, "Clinical use of the five elements with horses" held by Peggy Fleming and Are Thorensen. (9 June)

2001- S.I.A.V. Second International Seminar, "Clinical use of the five elements with small animals" held by Peggy Fleming and Are Thorensen. (10 June)

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(1) S.I.A.V. Second International Seminar, "Clinical use of the five elements with small animals" held by Peggy Fleming and Are Thorensen (10 June 2001).

(2) Jim Skoien C.A. Dipl. Ac. ,"The Eight Principles", The I.V.A.S. Veterinary Acupuncture Course Notes, Page 4-5-16

(3) John B. Limehouse D.V.M.,"Urinary Disease", The I.V.A.S. Veterinary Acupuncture Course Notes, Page 8.1.4

Ultimo aggiornamento Giovedì 01 Dicembre 2011 14:40
 

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