The TCVM approach to treating geriatric patients

When treating geriatric patients, TCVM can help diagnose and alleviate pain, while also restoring the animal’s quality of life.

As a veterinarian, I find that treating geriatric patients is among my most challenging and rewarding missions. Restoring joy and mobility to a grateful animal, along with the recognition that he is now pain-free, is the underlying motivation behind my life’s work. Moreover, the animals’ owners are so thankful to have additional quality time with their babies that they are likely to remain our clients forever. I know these patients come to my clinic in order to finish their lives in a loving, supportive environment. Just as there are midwives who aid with the transition into life, I feel like a midwife to death, the one who gently guides animals toward their final portals in life. For these reasons, I have embarked on a journey to love and care for geriatric souls, using a TCVM approach.

The temperature questions

As with youthful patients, we begin our work with the basic Yin and Yang questions and establish where the geriatric patient is. Ask the following temperature questions:

  • Is the animal heat- or cold-seeking?
  • In what weather conditions does he feel best?
  • Does he pant at night or is he under the covers?
  • Check the tongue for color and hydration. Red or pale? Dry or wet?
  • Has there been any change in behavior?
  • Has he exhibited aggression toward housemates and/or humans?
  • Does he seem to be in pain?

First, treat the pain

Always treat pain first. Pain is a stasis – a stagnation of the flow of Qi, blood flow or joint motion. Many geriatric patients are in pain due to a decrease in fluids (Yin) and not enough motion (Yang). These areas of stasis become stagnant, “stuck”, and they hurt. Pain can be caused by an area of Damp Cold stasis, or an area of Hot Dry stasis where too much Heat has depleted the Blood. Initiating movement in the area of stasis is a simple way to start the process of healing pain.

Bi and Wei SyndromesConsider the tongue and pulse when diagnosing stasis. The pulse often has an irregular, choppy, thin quality to it when an animal is in pain. The tongue may show redness and Heat. Establish the location, nature and extent of the pain through close observation of movement and behavior.

In geriatrics, behavior changes can be signs of pain or a loss of sensory organ function. Aggression toward a playful younger animal in the house can be the older one saying, “That hurts! Leave me alone!” Changes in urination or defecation habits may also be caused by pain. For example, I recently worked with an older poodle that had been rescued from desperate circumstances as a young animal. She had recently begun urinating in the house and on the deck. Her owners had enrolled her in an obedience class in an attempt to stifle this behavior; however, radiographic images revealed an old poorly-healed pelvic fracture her owners had been unaware of. The cold weather, coupled with the slippery stairs leading to the yard, made it difficult for the dog to urinate anywhere else. Letting her out through a different door – one without stairs – remedied the behavior in short order.

Treatment modalities for pain

The modern veterinarian has a variety of treatment approaches at hand to combat pain in geriatric patients. Once the diagnosis has been made, practitioners may select from multiple treatment modalities, including conventional medicine, acupuncture, physical rehabilitation, chiropractic treatment, prolotherapy, nutrition, homeopathic  and herbals to develop a tailor-made plan to meet the individual patient’s needs.

Conventional approaches include the use of NSAIDS, opioids and Adequan. A multimodal approach will combine the different modes and sites of action of the various agents in order to increase pain relief while reducing dosages and possible side effects. Owner education is an important aspect of the multimodal approach. Teaching owners how to recognize pain and educating them on topics such as weight control, exercise, and environmental management (e.g., flooring, bedding, etc.) is a critical part of effective treatment.

Acupuncture

The TCVM approach to geriatrics should always include the use of acupuncture. Electroacupuncture is one of the most effective methods of moving areas of stasis and quickly increasing the pain threshold. More-than-adequate research documents the efficacy of acupuncture as a method of pain relief. Acupuncture analgesia is seen more intensely along the meridian of the point being stimulated. Consideration should be given to the points used, and if they should be local or along muscle channels.

There is also evidence that acupuncture may assist in recovery from spinal cord injuries, which are common in geriatric patients. Dogs with spinal cord injuries who received a combination of conventional veterinary treatment and electroacupuncture had better recovery in urinary control, conscious proprioception and ambulation when compared with those who received conventional treatment alone.1

The main meridians that are effective from a TCVM perspective are the Yang meridians, which are responsible for gross motor muscle movements. The ability to get off the floor, squat to potty, and walk up stairs involve the following meridians:

  • Bladder meridian – controls the major superficial back muscles
  • Stomach meridian – the psoas and quadriceps
  • Gall Bladder meridian – the lateral muscles of the body, including the gluteal muscles

The most effective points are the major points in the muscles from the proximal to the distal meridian:

  • BL11
  • BL23
  • BL28
  • BL40
  • BL54
  • BL60
  • GB29
  • GB30
  • GB34
  • ST36
  • KD3

Second, establish a TCVM diagnosis

Constitutional elements

The constitutional element of the animal should be taken into consideration when making a TCVM diagnosis. A patient’s element can be a clue to the TCVM diagnosis.

  • Water — Kidney: Is the animal fearful? Does he have a history of inappropriate urination or urinary incontinence?
  • Wood – Liver and related behaviors: Does he have a short fuse? Terriers in particular have a temper and are often Wood animals.
  • Fire – Heart: Older Fire animals were previously very active and energetic, but have lost that essential nature.
  • Metal — Lung: Is the animal aloof? Has he developed respiratory symptoms, particularly as he has aged?
  • Earth – Spleen: Has the animal’s digestion been affected as he has aged? Are his stools dry and hard or too wet?

The TCVM diagnosis is always valuable. There seem to be two schools of thought on the core cause of deficiency in traditional Chinese medicine — one that focuses on the Kidney and the other the Spleen. The Spleen school sees the Spleen as the center of deficiency because it is responsible for the transportation and transformation of Gu Qi (food); this is an important consideration when evaluating the diet of a geriatric animal. In aging humans, the digestion of protein is reduced due to a decrease in hydrochloric acid. I find this to be true in aging animals as well. Simple strategies such as changing the animal’s diet to something more easily digested (from dry to wet), and feeding smaller more frequent meals can be beneficial. Also, cooking and serving the food warm can help feed the Spleen, thereby increasing Postnatal Kidney Qi and replenishing Kidney Jing.

Patterns of deficiency

Most of our geriatric patients will have deficiency patterns. First, the Qi is deficient, then the Blood becomes deficient and stagnant. The body fluids, not being nourished by the Blood, will dry up and condense to phlegm. The Jing, not having nourishment, will then become deficient. Most geriatric patients have some degree of deficiency, and zeroing in on the correct one can restore their vitality. Below are the different patterns of Kidney and Spleen deficiencies. Those that are starred are the most common:

  • Kidney Yang Deficiency*
  • Kidney Yin Deficiency*
  • Kidney Qi Not Holding Firm*
  • Kidney Failing to Receive Qi
  • Kidney Jing Deficiency*
  • Kidney Yang Deficiency Water Overflowing
  • Kidney Yin Deficiency Empty Heat Blazing*
  • Kidney and Liver Yin Deficiency*
  • Kidney and Heart Yin Deficiency*
  • Kidney and Lung Yin Deficiency*
  • Kidney and Spleen Yang Deficiency*

When determining the deficiency pattern of patients, remember that the Spleen is responsible for the Qi in the body, and for the transportation and transformation of food (without food, there would be no Qi). The Liver is like a tree, moving the Qi upward and outward through the body. When the Spleen is damaged, the Qi will be decreased due to impaired digestion. When Qi decreases, the Blood is affected and becomes deficient. The Spleen is very sensitive to Cold and Damp; it prefers Dry and Warm. Spleen deficiency patterns are therefore as follows: Qi Deficiency, Yang Deficiency, Damp Cold, and Damp Heat.

In veterinary medicine, older patients are some of the most challenging to treat. Begin by checking the tongue, feeling the pulse, and differentiating between Yin and Yang patients. When proceeding with treatment, use the points that work for you and try some of the empirical Wei points (see sidebar above). Proceed with a TCVM diagnosis, as this is always helpful when treating patients with multiple modalities. Remember, your first goal as a practitioner is to diagnose and alleviate pain. Your second goal is to restore the geriatric animal’s quality of life, using every modality available to you.

* This article has been peer reviewed

References

1Xie H,  Wedemeyer L.” The validity of acupuncture in veterinary medicine”. AJTCVM 2012;7:35-43.

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Dung HC.  Anatomical Acupuncture. San Antonio, TX: Antarctic Press, 1997.

Fratkin JP.  Chinese Herbal Patent Medicines. Boulder, CO: Shya Publications, 2001.

Han, Hyun-Jung. “Clinical effect of additional electroacupuncture on thoracolumbar intervertebral disc herniation in 80 paraplegic dogs”. AJCM 2010;38:1015-1025.

Hayashi AM, Matera JM, Fonseca Pinto, AC. “Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs”. JAVMA 2007;231:913-8.

Johnson JA. Chinese Medical QiGong Therapy. Pacific Grove, CA: The International Institute of Medical Qigong, 2005.

Kendall D.  Dao of Chinese Medicine. New York, NY: Oxford University Press Inc, 2002.

Maciocia G. The Foundations of Chinese Medicine. London, England: Churchill Livingstone, 1989.

Maciocia G. The Foundations of Chinese Medicine. 2nd ed.  Churchill Livingston, 2011.

Schaeffer R.  IVAS Teaching Manual, Sess. 4, pp. 612-614, 2010.

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Xie H, Preast V. Traditional Chinese Veterinary Medicine. Reddick, FL: Jing Tang, 2002.

 

 

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