By:
Dr. Pasco Shira
Netanya, Israel
Abstract
Cognitive dysfunction syndrome is a condition related to the aging of a dog’s brain, which ultimately leads to changes in awareness, deficits in learning and memory, and decreased responsiveness to stimuli. Western medicine still didn’t succeed in finding the cause of this syndrome, and its diagnosis is based on ruling out other diseases. The symptoms are usually change of behavior, and the treatment is based on calming the dog and supporting him.
In this case report we used acupuncture as a supporting treatment for the dog’s symptoms of dementia. The TCM theory is that with increased age the Jing becomes deficient and the Essence in the kidney declines. There is a strong relationship between Blood and Essence, when the Essence declines the result is yin and Blood deficiency. The Blood deficiency impairs liver function, and will result in decreased flow of Qi and Blood which damage the normal nourishment of the organs, that in this case causing disturbance of the Shen. In this case, it can be seen clearly that the relationship of the kidney and the liver is as the relationship of mother and child.
Milu, a male dog, 12 years old. The dog was referred for acupuncture treatment due to changes in his behavior and anxiety, especially during the night. He was diagnosed with a Cognitive Dysfunction Syndrome. Acupuncture therapy was used to successfully treat, as a complementary treatment, the behavior changes as a result of dementia. A 3 weeks course of every week, dry needle acupuncture therapy was used. After one treatment we were able to see the improvement, and until today the dog continue to preserve a good quality of life.
History
A 12 years old neutered male mixed breed dog was presented for an acupuncture consultation with one-month history of night walking anxiety and behavior changes. The dog also had history of coughing one year ago that didn’t improve with antibiotics. There was a suspicion that the cough was as a result of heart problem but X- ray and U.S showed no findings. The cough disappeared after a while without any special treatment. The dog was diagnosed with dementia after all laboratory test showed no findings. In the last month the dog was treated with alprazolam 0.05 mg\kg twice a day and selegiline 0.35 mg\kg once a day without any improvement in his condition.
Clinical Signs/Diagnostics/Diagnosis–Conventional (western)
The main complaint was that the dog don’t sleep during the night, and disturbers his owner (the client) in such a way that he can’t sleep either. Patient’s symptoms: night walking, anxiety, loss of hearing, behavior changes, for example: going inside the cat’s litter box, hiding in strange places, and has a need for more attention than usual during the day. X-ray and blood tests showed no findings. We suggested MRI or CT to rule out tumor but the owner refused due to economic issue, and for a fear of the anesthesia for a dog at this age. Based on the dog’s history, physical exam and laboratory test the diagnosis was Cognitive Dysfunction Syndrome.
Clinical Signs/Diagnostics/Diagnosis – TCM(eastern).
As described in the previous paragraph, the main symptom was the night walking and the anxiety attacks during the night. The owner also mentioned loss of hearing, dark urine (but without change of quantity), dark feces (not black) and the dog’s increased desire to sleep on beds, sofas and blankets with his owner.
Physical exam findings: dry nails with licking signs on the ventral part of the paws, dry mouth, thin and red tongue, thin pulse, secretions from the eyes that leave dark marks around the eyes, and the eyes lens are not clear (nuclear fibrosis process). During the physical exam we also found sensitivity through all the bladder meridian and we were able to feel a hole at level of Bl23 (the Shu point of the kidney) and bumps on the level of Bl17. The kidney, bladder, gallbladder and liver Mu point were also sensitive.
After consideration of all clinical signs and the findings of the TCM exam, we reached a diagnosis of yin and blood deficiency as a consequence of decreased kidney’s Essence which also influence liver functions (the mother-child relationship). This situation causes malnutrition of all organs, creating disturbances of Shen. The kidney’s yin deficiency is based mainly on the following findings: the hole in the kidney’s Shu point, the symptoms appear during the night, the need for attention, the dryness in different places, the loss of hearing and the dog’s increased fears.
Conventional (western) treatment.
No western treatment was done except for Benzodiazepam 0.5mg/kg as needed, for example: during night storms.
TCM (eastern) treatment.
The TCM treatment principles were: tonifying yin and blood and calm the mind. 0.14mm x 15mm Seirin needles were placed at a depth of 5mm. An even needle technique was used at all points for 10 minutes.
The acupuncture points used were:
THE POINT
THE PRINCIPLES
THE NATURE
LOCALIZATION
Bl23, Shen shu
Supplements kidney yin and essence
Shu point
1.5 cun lateral to the caudal border of the spinous process of the second lumbar vertebra.
Ht7, Shao men
Calms the shen and the heart by strengthening heart blood and yin
Yuan-source point
In the depression on the transverse crease of the carpal joint
Liv3, Tai chong
Tonify liver (the child of the weak mother)
Yuan-source, earth and shu -stream point
In the depression on the medial aspect of the second toe, proximal to the metatarsophalangeal joint.
Pc8, Lao gong
Calms the spirit
Ying – spring point
In the depression on the palmar surface of the foot between the second and the third metacarpal bones, proximal to the metacarpophalangeal joint.
Bl17,Ge shu
Tonify blood
Influential point of blood and Shu point of diaphragm.
In the depression 1.5 cun lateral to the caudal border of the spinous process of the seven thoracic vertebra.
St36, Zu san li
Tonify Qi blood and yin
He – sea point, earth point, master point for the abdomen and gastrointestinal tract.
In the depression just lateral to the distal aspect of the cranial border of the tibial tuberosity (tibial crest)
Li10, Shou san li
Tonify Qi
In the depression in the muscular groove between the extensor carpi radialis and the common digital extensor muscle of the forelimb 2 con distal to the transverse cubital crease.
Ht3, Shao hai
Clear and calms the shen
Water point, he sea point
Medial side of the forelegs, between the end of the transverse cubital crease and the medial epicondyle of the humerus when the elbow is flexed
Kid3, Tai xi
Tonify kidney essence
Shu-stream point, earth point and yuan – source point.
In a depression between the medial malleolus and the Achilles tendon at the height of the tip of the medial malleolus.
The first treatment included the use of: Bl23 to tonify kidney, and Ht7 to calm the spirit. Considering the fact that this was a first acupuncture treatment of an old dog, we tried minimizing, as much as possible, the amount of needles used. The owner said that he saw a small improvement 3 days after the treatment and that it looks like the dog responds well to the treatment. Our first follow up was a week after the first treatment. In the second treatment we used the following points: Bl23 to tonify kidney, Bl17 to tonify blood, Pc8 to calm the mind and Liv3 to help the flow of blood, yin and Qi to all organs. We did the third treatment a week after the second treatment. The owner’s observation was that after the second treatment the dog was more energetic but without any significant improvement regarding his night walking (spirit issues). In the third treatment, we used the following points: Kid3 to tonify kidney, St36+Li10 to create more Qi and Ht3 to calm the spirit. Ht3 is a water point, and we noticed, on the first treatment, that the point on the Ht meridian gives better effect on the spirit than the point on the Pc meridian. A few days after the third treatment we spoke with the client. He said that he can see some improvement, definitely more than he saw with only conventional medicine, and that he wants to continue with the treatments because there is still work to be done.
In conclusion the eastern medicine was able to diminish the quantity of drug used, and improve the life quality of the owner and the dog, but not resolve completely the problem.
Discussion
In this case report we were dealing with a disease that conventional medicine have no good solutions or explanations. Eastern medicine understands the mechanism of the body’s imbalance developed with aging. We are all born with a quantity of kidney Jing and we use it as we grow older. It is impossible to bring or create more energy from nothing, and that’s why this treatment can help, but not resolve the problem completely. In this types of cases the main goal is to restore the balance of yin and yang and to help the body generate more blood, Qi and their flow. To summer up my experience: the dog’s owner and I were satisfied from the results, taking into consideration that the dog is old and will need support of western and eastern medicine for the rest of his life.
References
1. Christina Matern. Acupuncture for dogs and cats, a pocket atlas.
2. Gregory, T. Acupuncture for geriatric problems. IVAS Course Notes: session 3 (2013-2014).
3. Jon, B. Sarah, H. Behavior problems in small animal, practical advice to the veterinary team. Foreword by Elsevier Saunders
