TCVM – Assessment and Care For Older Patients
As the life spans of companion animals increase, geriatric health care becomes a focus of veterinary practice. With geriatric patients, the primary goal is to promote their quality of life rather than cure their diseases. A number of reports have demonstrated that Traditional Chinese Veterinary Medicine (TCVM) can help accomplish this goal.1-3
MEASURING QUALITY OF LIFE
The life quality score (LQS) system we created measures a geriatric patient’s quality of life (see table). This scoring system may be used to assess the patient’s baseline status as well the response to treatment. Instructing the pet owner to record the score on a daily to monthly basis can provide a valuable record of the patient’s ongoing status.
After using LQS with over 500 geriatric patients, we developed a guide explaining how the LQS numbers relate to a patient’s quality of life. We feel that geriatric cases with an LQS over 500 often have an excellent quality of life. However, patients with an LQS less than 100 generally have such a poor quality of life that we suggest the owners consider euthanasia for the sake of animal welfare. (See sidebar on page 49 for an example of how we used the LQS system for a canine patient with renal failure.)
THREE-STEP METHODOLOGY FOR DIAGNOSIS AND TREATMENT
The three-step methodology for diagnosing and treating a geriatric patient includes: 1) data collection, including conventional Western diagnostics; 2) TCVM pattern identification; and 3) treatment protocol.
Step 1: Use conventional Western diagnostics (e.g., physical exam, blood work, radiographs) whenever possible to make a definitive diagnosis.
Step 2: Use the four TCVM diagnostic methods (inspecting, hearing and smelling, inquiring, and palpating) to differentiate the TCVM pattern of disease.
Step 3: Use an appropriate and integrative treatment protocol based on the Western diagnosis and TCVM pattern.
The following example demonstrates how to approach this process:
A 14-year-old spayed female Labrador mix presented with acute onset of rear limb paresis, bilateral conscious proprioception deficits, and urinary incontinence (Deficiency). Her painful back and purple tongue suggested Qi-Blood stagnation (Excess).
At this point, the veterinarian could have offered the owners three options, depending on the latter’s goals and monetary constraints.
1. A neurological work-up, radiographs, myelogram, and/ or MRI may definitively demonstrate the location and severity of the lesion. Assuming that the diagnostics indicate intervertebral disc disease, there are two possible treatments: 1) give the dog a trial course of steroids and monitor the efficacy of the anti-inflammatory treatment; or 2) surgically remove the disc in hopes that it will relieve enough spinal compression to permit return of normal hind-end function.
2. Conduct a TCVM work-up to identify the TCVM pattern, then base the treatments on the pattern. In this case, the treatment strategy is to tonify the rear weakness (Deficiency) and resolve Qi-blood stagnation in areas that are painful on palpation. A combination of acupuncture, herbal therapies and Tui-na are non-invasive and provide analgesic and anti-inflammatory effects for the patient. Typically, three to six treatments can restore normal hind-end function.4
3. Utilize a combination of the first two options.
So which treatment is best? The radiographs, myelogram and/or MRI best demonstrate the lesion’s location. However, using TCVM to treat a differentiated pattern is a good choice because it is a) less invasive, b) less expensive, c) less likely to have deleterious side effects than more aggressive therapies (surgery and steroids), and d) possibly just as effective as conventional treatments. In this case, the owner chose the second option because it was less invasive and less expensive.
The dog’s TCVM diagnosis was Qi Deficiency with Local Qi-blood Stagnation. The following treatment regimen was applied:
• Electro-acupuncture (20 Hz for ten minutes and 80-120 Hz for another ten minutes) at the following pairs of points: Liufeng, BL-20, BL-21, ST-36 + GB-34, and KID-1 + BL-23.
• Herbal medicine: 1) Bu Yang Huan Wu, six capsules twice daily, and 2) Double P #2, six capsules twice daily.
• Instructing the owner in Tui-na so that he would use Ca-fa (rubbing) on the paws of both hind limbs for 15 minutes per paw, twice daily.
On the return visit one week later, this dog walked and ran like a puppy. The owner even feared he would lose his pet the day before the re-check because the dog was feeling so good she tried to attack an 8’ alligator!
Pain management and life quality are important aspects of long-term geriatric patient care in veterinary medicine. TCVM offers many benefits to geriatric patients and their owners. As seen in the case examples with this article, acupuncture releases endogenous opioid-like substances from the central nervous system to aid in pain relief, thus improving quality of life.5