C O L D  R I V E R  V E T E R I N A R Y  C E N T E R

Kidney failure, disc disease in a dog

CASE REPORTS

• Allergies in a dog

• Allergies in a cat

• Arthritis

• Colitis. otitis

• Cushings disease

• Ear infections

• Feline chronic renal failure

• Heartworm

• Inflammatory bowel disease

• Kennel cough

• Kidney failure, disc disease

• Lymphangitis

• Lymphoma

• Oral papillomas

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Muppy, a 15-1/2 year-old spayed Terrier-mix dog has a 2-1/2 year history of chronic renal failure. She presented to CRVC in May 2000 when the owner sought a new approach to her disease. The week before her visit she had stopped eating her dog food and was having diarrhea. Nutritional therapy began immediately. For the next 18 months she was remarkably happy and active. On a routine exam in November 2001 we discovered advanced periodontal disease; three molar teeth required extraction. The dental procedure was performed and Muppy was discharged, bright and happy. On her return home she went for an afternoon walk. That evening, she jumped off a chair and suffered an acute onset of hind limb paralysis. By the next morning, she still could not move her rear legs and was not urinating.  This is the story of her wonderful recovery.

Living with kidney failure

This photograph (left) was taken just after Muppy recovered from the dental procedure. Her blood tests and urinalysis show an improvement in kidney function since May 6, 2000 (see below). Muppy eats a diet of home-prepared food and supplements. She has an excellent appetite and a healthy coat. While many feline and canine patients with chronic renal failure are diuresed on a regular basis (the kidneys "flushed out"), Muppy did not require intravenous or subcutaneous injections of fluids at home. Her renal function improved with nutritional therapy and healthy food.

Pelvic limb paralysis

When Muppy's caregiver called the next morning, her dog was still unable to stand or walk. Thoughts of a blood clot (thromboembolism), nerve root injury or degenerative disc disease came to mind. Muppy was soon in the car for the 2-hour ride to CRVC. 

Physical exam 

On examination, Muppy had paraplegia of the pelvic limbs. Her reflexes were normal, and there was sensation at the tip of the tail (an acupuncture point called Wei Jian). Radiographs of her thoracolumbar spine revealed a narrow intervertebral disc space at T9-10 but no mineralization; this was an acute disc prolapse. Her urinary bladder was distended. Muppy's anal sphincter tone was intact. The diagnosis was disc protrusion and spinal cord compression at the ninth thoracic vertebra causing pelvic limb paralysis.

Our first concern was whether Muppy would be able to urinate voluntarily. Dr. Kruesi began electroacupuncture at 8 paired points for 12 minutes. Next he injected 500 mcg of vitamin B12 and Urethralis suis (Heel Co.), a homeopathic preparation at her most depressed acupoint near the bladder, CV-4. Muppy was taken outdoors on a sunny November day (photograph left) assisted with a towel sling. She immediately voided a large volume of urine!

We demonstrated how to massage Muppy's legs and move each joint in passive range of motion exercises to stimulate circulation, lymphatic drainage, and help Muppy recover the feeling in her legs. Muppy was sent home with Liquidambar 15 (Institute for Traditional Medicine), a traditional Chinese medicine for circulation, lower back, and disc disease; a digestive enzyme to help break down the damaged cartilaginous disc material; and a homeopathic remedy for muscle fatigue.

Surgery, an option 

Muppy's owner wondered if surgery would help. What were the chances that her dog would walk again? How long would it take to recover? Dr. Kruesi gave a list of three highly qualified veterinary surgeons who had performed vertebral laminectomies under similar circumstances. We gave the owner Muppy's radiographs so she could get a surgical opinion right away. Muppy's owner called one of the surgeons to make an appointment. The surgeon said surgery should be done immediately after the injury if there is to be a good outcome. He was even willing to do the procedure that night, Thanksgiving eve. More important, the surgeon told Muppy's owner, "acupuncture never works".

By telephone Dr. Kruesi answered the owner's questions and speculations about Muppy's future. We asked: Who is Muppy? Is she a good candidate for back surgery? Muppy is 15 1/2 years old, with chronic renal failure for 2 1/2 years, degenerative joint disease of her left elbow and shoulder, chronic dental disease, and now cannot stand or walk with her rear legs. While surgery to remove a prolapsed disc may allow the spinal cord to heal, it was not the only option.

Acupuncture works

One day after Muppy's first acupuncture treatment she was voiding urine on her own, wagging her tail, and drinking well. Not favorable was the spasm and tension in her back muscles, and paralysis of the hind legs. Her attitude was good, her vital signs normal and she had increased sensitivity in her toes. We proceeded with a non-surgical approach to rear leg paralysis. Muppy had 4 more electroacupuncture sessions (total of 5) over the next 3 weeks. A summary of the restoration of neurologic function following acupuncture and nutritional therapy follows:

After 1 day:  Muppy is voiding urine on her own, has increased sensation of her toes. She's a bit depressed, and her caregiver is hand feeding her the supplements.

After 1 week:  Muppy is not bearing weight on her back legs but has a little anterior-posterior swing to her legs when towel-walked. She still knuckles her back feet (has proprioceptive deficits). She is eating well on her own.

After 10 days: Muppy has improved muscle tone and cutaneous sensation in her hind limbs. Her attitude is good and she loves having massage.

After 2 weeks:  Muppy is starting to bear weight on her back legs!

After 3 weeks:  Muppy now stands and walks several steps without assistance.

After 5 weeks:  Muppy is walking on her own, but ataxic when running (has a wobbly gait). She is showing an excellent recovery.

Muppy's response to nutritional therapy (see below) included improved urine concentrating ability. Her urinalysis on May 6, 2000 showed a pH = 5.0 (low) and specific gravity of 1.014 (low). On November 20, 2001 her urine specimen had a pH = 7.0 (normal) and specific gravity = 1.25 (normal).

Serum chemistry profiles

    *These values are at one end or outside of the reference range for dogs.

 William Konrad Kruesi, D.V.M.  / 2001