Laurie's Blogs.

I have been asked to treat a facial paralysis case. Millie is a 7 y old Golden Retriever with a history of bilateral hip replacements 3 years ago. She now presents with very acute left side facial paralysis - so drooping eye, dry eye, hanging lip and drooling, No Horner syndrome. No ear issues and no change in last 8 weeks for better or worse so neurologist puts it down as idiopathic paralysis. I found no literature on physio/ rehab management of these canine cases but plenty on Bell's Palsy. This dog has got definite cervico-thoracic junction issues and some lumbar discomfort and obvious pelvis issues. There is some lumbar alopecia so I have requested a thyroid profile. In humans there are articles on neuromuscular retraining and chiropractic and acupuncture. This week her TMJ felt very restricted and released easily on left, Right atlas motioning was strongly resented and there was reaction to T3 motioning. Acupuncture has already improved her hind limb stance after first consult. I have used electro acupuncture on areas innervated by facial nerve  and tried to figure out how I can try her to work her face: making her lick sideways, toothbrush and ice cubes, stroking left side face, rolling skin, etcetera. Any advice would be very much appreciated. I am planning to treat every thing I feel is restricted in neck and if you blind folded me and asked me if she could be a Horner I would say yes, based on palpation, but there is zilch evidence of Horner.  

VD

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Hi V,

As for the Bell's Palsy case.  Sometimes it can be idiopathic (and not a Horners - secondary to trauma or tumour)... which would be a much better scenario.  So why not treat as it's just idiopathic Bell's Palsy?  Actually there is some theory that there is a viral connection potentially.  What you're doing sounds good.  If you have e-stim, I'd e-stim the facial muscles as well.  I think acup is good for these cases too, and laser or other stimulus directly to the Facial nerve where it exits the skull just in front of the ear / TMJ area (I'd use 8 J/cm2).  Have the owners apply peanut butter on the affected side of the face, nose, gums... to encourage use of that side of the face. (In people we have them do facial exercises in front of the mirror...and to make all sorts of exaggerated movements.  You could also try just putting 'stuff' on the muzzle and face to have the dog simply 'play' with moving their facial muscles.

And as for the lumbar alopecia, we can see trophic changed in people (and I say dogs as well) with nerve irritation / inflammation.  In people, we look for 'peau d'orange' marks or 'match stick' marks on the skin (wee small dimples or indents the size of the head of a match), as well as shiny hairless patches.   I have treated dogs with hairless patches over the back before, and when you get things settled, you can also improve the alopecia.  (Worth throwing in the back of your mind for thought processing as a potential correlation.)

Hope this helps!

Laurie

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One Month later:

I love the subject of your newsletter. These articles were literally what I fell on when researching it. I personally think the outcomes in dogs are worse because vets do not treat necessarily in our way. Humans find it much more debilitating and esthetically affecting so they get treated intensely. Dogs are just not treated, hence poor outcomes...

Update on my case you helped me out on:

I did the peanut butter exercise, rolling of skin left side face daily, tapping of face, slight vibration irritation with back of electric toothbrush and brushing face, and put on Bu Gan Tang supplement and anti viral herbal mix.

Thyroid panel done and started on supplement, though results were borderline.

Acupuncture was done three times weekly.

Adjustments of neck and mobilisations of TMJ joint were performed.

After no improvement for several weeks before seeing me, she is now 50 % improved. 

-VD