Django was an 11-year-old neutered male German shepherd with persistent proprioceptive deficits following surgery three years earlier for IVDD at T12-13 and L1-L2. On presentation, Django was having difficulty walking, seemed in pain when rising, and was less interested in going for walks. On occasion, he was also defecating in the house.

On physical examination, Django had decreased muscle mass in both hind limbs and was sensitive on palpation along the thoracic and lumbar spine, with a limited range of motion in both hips. He was currently at a suitable lean body weight.

Recent blood work including CBC and biochemical profile revealed no concerns. His owners declined X-rays due to his temperament and their concerns over sedation and costs. His current diet consisted of a commercial lamb and brown rice kibble to which the owners were adding kelp and herring oil along with the occasional raw food patty.

Django’s initial treatment plan included:

• A homemade diet, properly balanced and formulated to contain therapeutic levels of EPA as well as antioxidants, and the addition of a green lipped mussel supplement as a source of glycosaminoglycans and other anti-inflammatories.

• Twice weekly sessions of acupuncture coupled with Class 4 laser therapy. Acupuncture points were chosen primarily on the distal limbs, while the laser therapy concentrated on the thoracic and lumbar spinal region.

Django’s owners noticed significant improvement after the first treatment. He continued to improve over the course of six treatments with no further fecal accidents and at least 50% improvement in overall energy and activity levels. Django continued to have periodic treatments over the next few months before presenting with some acute pain, including left hind end lameness and arched back. Further treatment included:

• Therapeutic laser for thoracic and lumbar spinal areas.

• Aquapuncture utilizing a combined homeopathic mixture of Traumeel® and Zeel® injected into local acupuncture points around the left stifle and hip.

• Meloxicam dosed at 0.1 mg/kg once daily for two to three weeks. Django again improved significantly and after a couple treatments went back to maintenance laser therapy on a monthly basis.

The following spring, he started having some fecal incontinence again and also showed increased signs of discomfort in his back end.

Treatment included:

• Meloxicam dosed at 0.1 mg/kg once daily.

• Gabapentin 200 mg twice daily.

• Underwater treadmill and other rehab therapy performed weekly.

• Continued maintenance with laser therapy every few weeks. Django did very well with this therapy for several months when he suddenly presented with very acute cervical and shoulder pain.

Treatment this time included:

• Continuation of Meloxicam and Gabapentin.

• Combined acupuncture and laser therapy.

• TCM herbal formula designed for cervical neck pain.

Once again, Django had an excellent response and did well for a few more months before presenting with sudden marked tetraparesis, unwilling to walk on his own and uninterested in eating. Electro-acupuncture was performed along the thoracolumbar spine and hind legs, and a single IV injection of Traumeel® was administered. Following this treatment, Django got up on his own and was able to walk out of the clinic. He seemed remarkably better next day. This treatment was repeated the following day. Django was maintained on Metacam®, Gabapentin, Traumeel® oral tablets, Cervical Formula and a Glucosamine, MSM and Chondroitin product until he was eventually euthanized a couple months later. This case demonstrates the success of a multimodal, integrative pain management program that likely allowed this dog to remain mobile and comfortable for well over a year beyond what was otherwise possible.