Nina Malik, DVM October 15, 2008 Atlantic Coast Veterinary Specialists

History of Ac p nct re !astern "ra#e$ork %estern "ra#e$ork& Mec'anis# of Action Ac p nct re Mo(alities )n(ications for Ac p nct re Case St (ies

%'at %e *earn
Curriculum in Veterinary Medicine
Graduation Requirements
First Year Cr+ "all 5 ,rinciples of Morp'olo-y )./ M S 000 1 /io#e(ical Sciences )./ M S 000 0
,'ysiolo-ical C'e#istry.//M/ 220 1 Clinical "o n(ations./ M S3V C S 004 1 Clinical )#a-in- ).V C S 041 1 Case St (y )./ M S 025 5 Veterinarian in Society ).V C S 011 16 Cr. Spring 2 ,rinciples of Morp'olo-y ))./ M S 001 1 /io#e(ical Sciences ))./ M S 002 0 Ne robiolo-y./ M S 006 2 Veterinary )## nolo-y.V M,M 080 2 7eneral ,at'olo-y.V ,t' 022 1 Case St (y ))./ M S 021 1 Veterinarian in Society )).V C S 012 14 Veterinary Microbiolo-y ).V M,M 081 2 Case St (y ))).V ,t' 066 1 Veterinarian in Society ))).V C S 010 15 Cr. Spring 0 7eneral ,'ar#acolo-y./ M S 052 1 Anest'esiolo-y.VCS 048 0 Veterinary Microbiolo-y )).V M,M 086 0 , blic Healt'.V M,M 088 1 ,rinciples of S r-ery.V C S 046 2 Case St (y )V.V M,M 068 18 V C S 222 0 S r-ery *aboratory.V C S 224 2 Dist rbances of 5epro( ction.V C S 2503VD,AM 250 0 ,'ar#acolo-y an( 8'erape tics./ M S 220 1 Veterinarian in Society )V.V C S 012 5 )ntro( ction to Clinics.V C S 2203VD,AM 220 5 Se#inar.V C S 085 21 Cr. Spring 2 Special ,at'olo-y.V ,t' 222 0 )nfectio s Diseases an( ,re9enti9e Me(icine.V M,M 206 5 Clinical Me(icine )).V C S 2253VD,AM 225 0 Veterinary 8o:icolo-y.VD,AM 221 2 5a(iolo-y.V C S 228 1 Op't'al#olo-y.V C S 044 1 Veterinarian in Society.V C S 015 5 Se#inar.V C S 085 18

Second Year Cr+ "all 2 Veterinary ,arasitolo-y.V ,t' 061 0 Syste#ic ,at'olo-y.V ,t' 062 5

Third Year Cr+ "all 0 Clinical ,at'.V ,t' 225 2 )nfert+ Diseases.V M,M 201 5 Clinical Me(icine ).

Fourth Year 8'e fo rt' year of t'e 9eterinary #e(ical c rric l # is (esi-ne( to be fle:ible an(

to pro9i(e for species e#p'asis+ St (ents # st co#plete 08 cre(its ( rin- t'eir fo rt' year+ 8'ey # st take a re; ire( block an( at least one option block+ 8'e re#ain(er of t'e fo rt' year cre(its are ac; ire( by selectin- a((itional option blocks, Veterinary 8eac'in- Hospital clinical electi9es, off& )n(ications ca#p s clinical electi9es, or ot'er Applications electi9es+ A((itional off&ca#p s clinical Mec'anis#s electi9e cre(itsof can action be earne( at appro9e( -o9ern#ent a-encies, researc' laboratories, 9eterinary practices, an( ot'er

<o rnal of t'e A#erican Veterinary Me(ical Association

Septe#ber 15, 2006, Vol+ 201, No+ 1, ,a-es 410&418

Abstract !aluation o" electroacupuncture treatment "or thoracolumbar inter!ertebral dis# disease in dogs
Ayne M rata Hayas'i, DVM, MSc, < lia Maria Matera, DVM, ,'D, Ana Carolina /ran(=o (e Ca#pos "onseca ,into, DVM, ,'D Depart#ent of S r-ery, Sc'ool of Veterinary Me(icine, >ni9ersity of S=o ,a lo, S=o ,a lo&S,, /ra?il 05508&400+ @Hayas'i, Matera, (e Ca#pos "onseca ,intoA

Conclusions and Clinical Rele!ance. !lectroac p nct re co#bine( $it' stan(ar( %estern #e(ical treat#ent $as effecti9e an( res lte( in s'orter ti#e to reco9er a#b lation an( (eep pain perception t'an (i( se of %estern treat#ent alone in (o-s $it' si-ns of t'oracol #bar

%'at (o t'ese at'letes 'a9e in co##onB

Ancient Healin- Art

8'eories of

circ lation an( p lse c'aracter post late( in C'ina 2,000 years before %estern #e(icine Vario s nations clai#e( to be fo n(ers "o n(ers of ac p nct re& Nort'ern )n(ia or 8ibet @Ay r9e(ic

H an-&(e&nei&Cin"irst $ritten recor( of

ac p nct re o9er 2,200 years a-o in C'ina 8$o books& S $en is t'e #ost fa#o s Con9ersation $it' Dello$ !#peror @0r( #illenni # /+C+A ,'ysiolo-y, pat'olo-y, (ia-nosis, an( pre9ention of (isease A t'ors'ip& Dello$ !#perorB

History of Veterinary Ac p nct re

"irst Veterinary Ac p nct re 8e:tbook

S n&Dan-, 150 /+C+

*yon, "rance, 1611

C/S 11E00 p+#+ Ne$s& 4322308

'ttpE33$cbst9+co#3seenat11

8'e !astern "ra#e$ork Yin $ Yang

*i-'t !:pan(s o t$ar(s an( p$ar(s Hot Metabolis#, #o9e#ent Hea(, /ack, O ter

Dark Descen(s Cool, #oist Anabolis#, rest S bstance& tiss es Ventral an( )nner aspects of bo(

%i

!ner-y force r nnin- t'ro -' bo(y "lo$ of Fi infl ences 'ealt' of ani#a

)ns fficient >nbalance( Obstr cte(

Meri(ians
Fi tra9els in

#eri(ians3c'annels Ac p nct re points& locations $'ere #eri(ians co#e to s rface3accessible Nee(lin- pointsG #anip late Fi an( restore balance Allo$s bo(y to 'eal itself

Veterinary Ac p nct re ,oints

/ase( on transpositional syste# @' #anA ,oints locate( 9ia anato#ical lan(#arks an( bo(y #eas re#ents @c nA

7/ 02 an( /* 52

,attern Differentiation
8CM (ia-nosis is base( on pattern (ifferentiation,

not on (ia-nosis of a partic lar (isease as in %estern #e(icine One (isease entity in %estern #e(icine #ay 'a9e # ltiple n(erlyin- possible 8CM patterns+ 8CM ,atterns are base( on a n #ber of (ifferent factorsE History Dia-nostic 8ests @5a(io-rap's, /loo($orkA ,'ysical !:a#ination 8on- e an( , lse (ia-nosis *ifestyle, e:ternal factors @(a#p $eat'erA, an( personality3be'a9ior

8'e "orest t'ro -' t'e 8rees

Anato#y of ac p nct re points Mec'anis#s of Action !ffects on t'e CNS !n(o-eno s ,ain )n'ibition Se-#ental Anal-esia *ocal 8iss e !ffects A tono#ic Ner9o s Syste# 8ri--er ,oint 8'erapy

Anato#y of Ac p nct re ,oints

Not ran(o# points on t'e bo(y Areas of lo$er electrical skin resistance

co#pare( $it' t'e s rro n(in- skin+ Nor#al skinE 200,000&2 #illion o'#s 9s+ 50,000 o'#s
Hi-' electrical skin con( ctance Many fo n( in palpable (epressions on t'e

bo(y

Anato#y of Ac p nct re ,oints

8ri--er ,oints
Hyperirritable loc s

$it'in a ta t ban( of skeletal # scle or its associate( fascia

Appro:i#ately 60H

of ac p nct re points correspon( to tri--er points

Mec'anis#s of Action
!n(o-eno s pain

in'ibitory syste# Se-#ental anal-esia *ocal infla##atory effects A tono#ic ner9o s syste# to affect 9iscera 5elief fro# tri--er points

5e9ie$ of Nociceptors
A&beta receptors *ar-e (ia#eter, rapi( con( ction, #yelinate( A&delta receptors Me(i # (ia#eter, #e(i # con( ction, #yelinate( Mec'anoreceptorsI #e(iate to c'3press re Skin3fascia 5api( pain response @Jfirst painKA C&polymodal receptors S#all (ia#eter, slo$ con( ctin-, non& #yelinate( Acti9ate( by t'er#al, #ec'anical, c'e#ical sti# li Me(iate slo$ pain

!ffects of Ac p nct re on t'e CNS

0 5e-ions of CNS Acti9ate( 1+ Spinal Cor( 2+ /rainste# 0+ Hypot'ala# s&pit itary

5elease of N8 @en(o-eno s opiatesA

/lock ,ain Messa-es

!n(o-eno s ,ain )n'ibition

A (elta fibers carry

pain i#p lse to la#ina ) of (orsal 'orn Acti9ate ne rons of t'e neospinot'ala#ic tract Ne rons 'a9e lona:ons t'at cross to opp spinal cor( an( ascen( to t'e 'ypot'ala# s3pit ita

Hypot'ala# s an( ,it itary

Arc ate n cle s L

pit itary contain all t'e beta&en(orp'in cells in t'e brain

/eta&en(orp'in

release into bloo( an( CS"

!n(o-eno s ,ain )n'ibition

8'ir( CNS re-ion

acti9ate( is t'e brainste# )np t 9ia t'e A&(elta fibers to t'e (orsal 'orn of t'e spinal cor( Via t'e anterolateral fascic l s of t'e spinal cor( to t'e brainste#

Acti9ation of t'e /rainste#

Sti# lates (escen(innorepinep'rine in'ibitory an( serotoner-ic in'ibitory fibers 8ra9el in (orsolateral tract of t'e spinal cor( Synapse on (orsal 'orn interne rons

Co#bine( res ltE beta&

en(orp'in, N!35&H80 in'ibitory fibers

5elease of enkep'alin

an( (ynorp'ins fro# se-#ental interne rons of spinal cor( pain afferents

/in( opiate receptors on

,re&synaptic in'ibition of

A&(elta an( C fibers @te#p, cr (e to c', ac'in-, b rnin-, c'ronic painA

Nalo:one re9ersal
Nalo:one re9erses

ac p nct re anal-esia

!9i(ence t'at pain

in'ibition is #e(iate( t'ro -' en(o-eno s opioi( ne ral loop

afferent pain a:on to in'ibit pain i#p lse trans#ission to t'e brain for conscio s perception

Anato#y of ac p nct re points Mec'anis#s of Action !ffects on t'e CNS !n(o-eno s ,ain )n'ibition Se-#ental Anal-esia *ocal 8iss e !ffects A tono#ic Ner9o s Syste# 8ri--er ,oint 8'erapy

Se-#ental Anal-esia
Hi-' fre; ency @100

H?A, lo$ intensity sti# lation !lectroac p nct re @!A,A *ocali?e( anal-esia, rapi( onset, ceases after sti# lation 'as stoppe( /rainste# acti9ate(

Sti# lates N! an(

5H8 in'ibitory fibers in brain ste#

Dorsal 'orn of spinal

cor(
Me(iation by 7A/A

in t'e spinal cor(

Acti9ates t'e

(ynorp'in synapses in t'e spinal cor(

5elie9es c'ronic

pain possibly by selecti9ely in'ibitin- inp t fro# C fibers

Mec'anis#s of Action !ffects on t'e CNS !n(o-eno s ,ain )n'ibition Se-#ental Anal-esia *ocal 8iss e !ffects A tono#ic Ner9o s Syste# 8ri--er ,oint 8'erapy

*ocal 8iss e !ffects

*ocal 8iss e !ffects

Microtra #a

Histolo-y of Ac p nct re ,oint

Vasoacti9e !ffects
'(AS S
0+

2 #in tes&2 $eeks

2+

10 secon(s&2 #in tes 15&00 secon(s

1+

8i#e&(epen(ent ,'ases
Vaso(ilation )nacti9ation Nocicepti9e of 5eaction potentiation

8iss e C'e#ota:is

5epair

S # 8otal of *ocal 8iss e !ffects

)#pro9e( local tiss e perf sion )ncrease( local i## ne responsi9eness M scle an( tiss e rela:ation ,ain reliefE increase( perf sion an( cessation

of # scle spas#s

Mec'anis#s of Action !ffects on t'e CNS !n(o-eno s ,ain )n'ibition Se-#ental Anal-esia *ocal 8iss e !ffects A tono#ic Ner9o s Syste# 8ri--er ,oint 8'erapy

Visceroc taneo s 5efle:

7eneral #ec'anis#

by $'ic' (isease( or-ans are able to refer pain, sensiti9ity, or # scle contraction to areas of skin often correlatin- to ac p nct re or tri--er pt 8'e pain can be referre( to areas t'at are far a$ay or

5eferre( ,ain
Mc/ rneyMs point&

ri-'t lo$er ab(o#inal ; a(rant painf l in appen(icitis Heart attack& *eft ar#, back, neck @not at c'estA J/rain free?eK& ice crea# Diap'ra-# refers to

C taneo9isceral 5efle:
5e9erse loop propose( 7V 21& 'e#orr'a-ic

s'ock in (o-sE increases car(iac o tp t& bloo( press re increases ,C&1 in catsE !A, in'ibits fre; ency of transient lo$er esop'a-eal sp'incter rela:ation S8&01 accelerates

C taneo9isceral 5efle:
Nee(le in para9ertebral # scle at #yoto#e se-#ental le9el associate( $it' # sc lar pain So#atic ner9e en(in- of a # scle sti# late( Afferent i#p lse to (orsal 'orn Sti# lation of contralateral anterior 'ypot'ala# s Acti9ation of so#ato&a tono#ic refle: C'oliner-ic 9aso(ilator ner9es acti9ate( to spastic # scles

Mec'anis#s of Action !ffects on t'e CNS !n(o-eno s ,ain )n'ibition Se-#ental Anal-esia *ocal 8iss e !ffects A tono#ic Ner9o s Syste# 8ri--er ,oint 8'erapy

8ri--er ,oints
Hyperirritable loc s

$it'in a ta t ban( of skeletal # scle or its associate( fascia

Appro:i#ately 60H

of ac p nct re points correspon( to tri--er points

8a t /an(s of Skeletal M scle

Da#a-e to # scle Calci # release fro# S5 Actin&#yosin interact M scle contraction Decrease( perf sion to #+ Decrease( A8, locally Calci # can not ret rn to S5 Actin&#yosin (o not (issociate

"or#ation of 8ri--er ,oint

8ra #a to # scle3fascia3ten(on 9ia ac te inC ry or c'ronic strain 5elease of #e(iators @bra(ykinin, ,7, 'ista#ineA ,latelets an( #ast cells recr ite( M,S release( into spaces bet$een # scle fibers "ibrocytic no( les e:pan( an( stretc' s rro n(in- # scle Decrease( O2 to # scle *ocal Aci(ity Sensiti?e( # scle nociceptors an( con9erte( to tri--er points

,ain Acti9ation of 8ri--er ,oints

8ra #a to # scle3fascia3ten(on 9ia ac te inC ry or c'ronic strain 5elease of #e(iators @bra(ykinin, ,7, 'ista#ine, etcA Sensiti?e C&"ibers Slo$ trans#ission to li#bic syste# "rontal lobe pain After s'ort (elayE ,ersistent, ( ll ac'in- pain, Near or (istant to acti9ate( tri--er point S'arp, s'ort ( ration Sensiti?e A&(elta fibers "ast trans#ission to parietal lobe

8ypes of 8ri--er ,oints

Acti9e& ca ses pain

$it'o t #anip lation *atent& not ob9io sly painf l to patient+ May be painf l on palpation+ May ca se restriction of #o9e#ent an( e9ent al $eakness+ Often refer pain to specific area (epen(in- on location of tri--er point+ @7/

Str ct res Affecte(E Skeletal # scles 8en(ons3*i-a#ents <oint caps les ,erioste # Skin @esp+ scar& associate(A

8reat#ent
Nee(lin- tri--er

point (isr pts t'e abnor#ally contractile ele#ents or ner9e en(in-

Stops fee(back loop Dry nee(linA; ap nct re

History of Ac p nct re !astern "ra#e$ork %estern "ra#e$ork& Mec'anis# of Action Ac p nct re Mo(alities )n(ications for Ac p nct re Case St (ies

Ac p nct re Mo(alities
)ry *eedles C'ina or <apan Sin-le& se, sterile, (isposable 15&25 -a -e 6&20 ## Seirin <E 0+20 : 00 ## Seirin DE 0+11&0+20 : 15 ## 7 i(e t be or $it'o t Metal 'an(lesE

Ac p nct re Mo(alities
)ry *eedles Not painf l De;i& arri9al of Fi 5etaine( on a9era-e 10&00 #in tes (epen(in- on pattern treatin8onifyin- N s'orter Se(atin- N lon-er

A; ap nct re

Fluid ""ect+ 1+C'an-es pH 2+Displaces tiss e to pro( ce press re 0+C'an-es electrical potential 2+,rolon-e( effect

!lectroac p nct re @!A,A

Se-#ental

Anal-esia @100 H?A

,assin- of

electrical ener-y t'ro -' ac p nct re points

Attac' Acc al to

nee(les in place

!lectroac p nct re
Ad!antages+ 1+A9oi( #an al #anip lation of nee(les
2+A#o nt an( ; ality of

sti# lation to nee(lesE acc rate an( nifor#

0+Hi-'er an( #ore

contin o s le9el of sti# lation t'an #an al

!lectroac p nct re
)n(ications 1+,aralysis 2+)VDD 0+Se9ere an( c'ronic painf l con(itions 2+S r-ical anal-esia 5+Atrop'ie( # scles Contrain(ications 1+Car(iac Arr'yt'#ias 2+!pilepsy 0+S'ock 2+,re-nancy 5+,ro:i#al to t #ors 1+Hi-' fe9er

!lectroac p nct re
2 o tp tsI eac' $it' 2

nee(le clip lea(s

AC& alternates

bet$een positi9e an( ne-ati9e polarity @(eep tiss e penetrationA

A#plit (e a(C st#ent "re; ency @H?AE p lses

per secon( @'i-' O15AE se(ate pain 9s+ @lo$P15AE # scle atrop'y

!lectroac p nct re
0 Mo(esE
1+ Contin o s& stable

fre; encyI contin o s sti# lation @toleranceA

2+ Dense Disperse& contin o s

sti# lation $it' alternatin'i-' an( lo$ fre; ency b rsts @a9oi(s toleranceA

0+ )nter#ittent& stable

fre; encyI sti# lation p lse( $it' rest perio(s @a9oi(s toleranceA

Mo:ib stion
Heatin- of

ac p nct re points Artemesia vulgaris @# -$ortI relate( c'rysant'e# # fa#ilyA 200Q " )n(icationsE JCol(K con(itions 8CM ,ainf l

)ND)5!C8 MORA

,reca tions 1+Vicinity of ## or sensory or-ans

2+Ca (al back3ab( in

pre-nant ani#als

0+"ebrile con(itions 2+/ rn " r

)nfrare( *i-'t 8'erapy

Anot'er #eans of

sin- 'eat to sti# late ac p nct re points Can se on in(i9i( al ac p nct re points or -enerali?e( areas Mitoc'on(ria absorb li-'t & co9ert to A8, & f els cell lar processes N release of NO& 9aso(ilation @re( ce infla##ation, i#pro9e local circ lation, cell replication an( repairA

)nfrare( *i-'t 8'erapy

"DA appro9e( for

specific in(ications in ' #ans

H #an t'erapyE

Carpal t nnel syn(ro#e, art'ritis, 8M<

Veterinary Me(icineE Sti# lation of ac p nct re point Nee(le p'obic patients Har( to reac' ac p nct re points Corneal lcers, Non& 'ealin- skin $o n(s, S perficial penetration 5epetiti9e Strain

)nfrare( *i-'t 8'erapy

Disa(9anta-esE Si?e of (io(e cl ster D ration S perficial penetration >nit cost 5esearc'& !; ine3 Co#panion ani#al opti#al settin-s

History of Ac p nct re !astern "ra#e$ork %estern "ra#e$ork& Mec'anis# of Action Ac p nct re Mo(alities )n(ications for Ac p nct re Case St (ies

!n(o-eno s ,ain )n'ibition Se-#ental Anal-esia

,ain Control M sc loskeletal Disease Ne rolo-ic Disease

*ocal 8iss e !ffects

,ain Control M sc loskeletal Disease Ne rolo-ic Disease Der#atolo-ic Disor(ers 7astrointestinal Disor(ers Car(io9asc lar Disease 5espiratory Disease >ro-enital Disor(ers ,ain Control M sc loskeletal Disease

A tono#ic Ner9o s Syste#

8ri--er ,oint 8'erapy

)n(ications
M sc loskeletal Disease ,ost&operati9e ort'ope(ic s r-ery Osteoart'ritis 8ri--er ,oint 8'erapy <oint (ysplasia
Pain, Range of

Motion, Improve Circulation, Promote

)n(ications
Ne rolo-ic Disease )nter9ertebral Disk Disease "C! Sei? res ,erip'eral Ne ropat'ies Vestib lar Disor(ers )#pro9e co#fort in De-enerati9e Myelopat'y patients

)n(ications
7astrointestinal Disor(ers Na sea Vo#itinDiarr'ea Constipation Ab(o#inal ,ain
PC 6 Inhibiting

frequency of lo er esophageal sphincter rela!ation "cats#

)n(ications
Der#atolo-ic Disor(ers Aller-ic Der#atitis C'ronic Skin Disease Otitis !:terna Non&'ealin- skin $o n(s @infrare(A

)n(ications
Car(io9asc lar35espirat ory 5'initis Sin sitis /ronc'itis C'ronic co -'inCirc latory Disor(ers Ast'#a

)n(ications
>ro-enital Disor(ers >rinary incontinence >rinary tract infections C'ronic ki(ney (isease )## ne Sti# lation& )ncrease in absol te ly#p'ocyte n #ber @21 (A /e'a9ioral ,roble#s Oncolo-y ,atients

8'e "orest t'ro -' t'e 8rees

Co rse of 8'erapy

5isks of 8'erapy
One of t'e safest t'erapies a9ailable Si(e effects are rare ,atient #ay be transiently sleepy or sore for

1&2 (ays !:pectationsE ( ration of treat#ent 3 in(ications Disclose cancer O9er se of inC re( li#b S$allo$e( nee(les !ye inC ry, pne #ot'ora:, infectio s art'ritis

Case St (ies
10 year ol(, "S, *ab #i: History of ele9ate( li9er en?y#es, ot'er$ise clinically nor#al C'ronic iss esE 1+De-enerati9e Myelopat'y& #il( H* ata:iaI inter#ittent (orsal sc ffin2+/lin( 0+>rinary incontinence

Case St (ies
A>SE 'epatic #ass 5eferre( to s r-ery at

Atlantic Coast Veterinary SpecialistsE *eft #e(ial li9er lobecto#y an( #ass e:cise( fro# t'e ; a(rate lobe O9erni-'t post& s r-eryE A#b latory $it' 'in( en( slin-I lyin- (o$n in r n

Case St (ies
5eferre( for ac p nct re ,'ysical !:a# a#b latory $it'o t H* slin-, b t $eak H* ata:ia Atrop'y bilat H* # sc lat re Dec e:tension s'o l(er Dec e:tension bilat 'ips 8ri--er pointsE Mil( *+ triceps #+I /ilateral ; a(riceps # scles

Case St (ies
Ac p nct re 8reat#ent Art'ritis in s'o l(ers an( 'ips 8ri--er points in *+ triceps an( ; a(riceps >n(erlyin- 8CM patterns contrib tinto o9erall con(ition an( H* # scle atrop'y

Case St (ies

Case St (y S2
2 year ol(, MN, /asset Ho n( Dia-nose( $it' )VDD *1& *2 an( *2&*0 S r-ical Deco#pression ,resentation 1 #ont' ,ost&op 1+Se9erely paretic in H* 2+C, (eficits H* 0+No (eep pain H*

Case St (y S2
Ac p nct re 8reat#ent Co#bination of (ry nee(les an( !A,
* #bar back an(

(istal le- points treate(

8' s farE 2 (ry

nee(le an( 2 !A,

Case St (y S2
,ro-ress After first co ple of t: Able to stan( p on o$n an( 'ol( $it'o t fallin- o9er After t'ese fo r t: /etter #otor H* Deep pain

Case St (ies& Ot'er Species

2 year ol(, "S, DSH )nitial presentation& se9ere -in-i9itis
Dental an( #e(ical

#ana-e#ent
2 ac p nct re t:, 1

#ont' apart

Case St (ies& Ot'er Species

6 year ol(, MC, Mini *op C'ronic 'ea( tilt, (ecrease( appetite, (ecrease( acti9ity since a paste rella ear infection a co ple of years a-o /ein- treate( $it' ac p nct re #ont'ly for past 18 #ont's Acti9ity i#pro9e(, Appetite i#pro9e(, Hea( tilt i#pro9e( b t #il( one present

Case St (ies& Ot'er Species

F estionsB