Barry recovered from coma and hypoglycemic shock with the help of medical acupuncture and photomedicine.
Case Report for Medical Acupuncture for Veterinarians Course
Compiled by Christi Linley, DVM, cVMA
ABSTRACT: Barry, a 12-year-old neutered male DSH presented in hypoglycemic shock. He was severely hypothermic with persistent hypoglycemia and status epilepticus. He was treated medically for his shock, but remained mentally depressed, blind, and unable to walk. Acupuncture therapy was utilized to activate/stimulate his central nervous system to accelerate his clinical improvement. He has regained his mobility and his vision is returning. He responded well to acupuncture therapy and continues to improve with each visit.
HISTORY and PHYSICAL EXAMINATION: Barry is a 12-year-old neutered male domestic shorthair cat. He was diagnosed with diabetes mellitus in May 2023, and he has been well controlled on 2 units of Prozinc insulin twice daily since that time. On 7/18/2023, Barry presented comatose in hypoglycemic shock. His body temperature was unreadable, and his blood glucose levels were 24mg/dL. He was immediately started on warming devices, intravenous fluids with dextrose, and oral honey to the gums. After 45 minutes of warming, his body temperature was 89 degrees. As the day progressed, Barry began to have status epilepticus and was maintained on a propofol CRI to control the seizures. He required constant care and his owners considered euthanasia due to his guarded prognosis.
On the day following his presentation to the clinic, Barry was no longer having seizures and he was able to maintain his body temperature. He still required dextrose supplementation in his fluids in addition to several dextrose boluses. He was laterally recumbent with dull mentation.
The third day of hospitalization and treatment, Barry still required dextrose added to his fluids to maintain his blood glucose levels. He was able to sit sternal if he was propped up with towels. It also became apparent that Barry was blind. He could lick small amounts of food of a tongue depressor, but overall was still mentally depressed/dull. His first acupuncture treatment was completed on this day. On his fourth day of hospitalization, Barry would attempt to stand, but he was extremely ataxic. He could not stand unassisted, but he could sit sternal on his own. He was still mentally dull, but this had improved from the previous few days. He was able to maintain his blood glucose levels on Plasmalyte A with no dextrose supplementation. His second acupuncture treatment was completed on this day.
Barry stayed in the hospital over the weekend. We removed his IV catheter, as he would constantly become tangled up due to his ataxia. He maintained his blood glucose levels over the weekend, but he was still having difficulty ambulating. His mentation was improved, but still dull compared to his normal personality.
One week following Barry’s presentation for hypoglycemic shock and coma, Barry received his third acupuncture treatment. He was able to walk on his own while still exhibiting some mild ataxia. He is hypermetric in the front and high steps with his front feet. He was still blind at this time. He continued to improve daily. His mentation was still abnormally dull but has continued to improve with each treatment.
Barry was discharged to go home in the following days. He returned on day 11 for a follow up evaluation and acupuncture treatment number 4. Barry was more mentally alert during this visit, and his patience with the acupuncture treatments was decreased (this is more in line with Barry’s normal personality).
Barry was still blind, but I did suspect some very mild improvement in his vision. His appetite was noted to be improved. Barry also received 2 minutes of red-light therapy to his occipital region.
Barry returned on day 18 for a follow-up. His walking was much improved with no evidence of ataxia nor high stepping in the front limbs. His vision appears improved, but still reduced. He still refuses to use the litterbox but is doing well at home otherwise.
PROBLEMS LIST: Barry’s problems include hypoglycemic shock, coma, blindness, and diabetes mellitus (suspected to be in remission).
DIAGNOSIS: Hypoglycemic shock and coma resulting in damage to the central nervous system, blindness, and diabetes mellitus (suspected to be in remission). My main goal for neuromodulation was to help stimulate/activate the central nervous system with the express interest in helping the brain and spinal cord recover from the tissue damage caused by prolonged hypoglycemia. As a result, my acupuncture points were specifically chosen to target the CNS.
Acupuncture Treatment Number 1: Date of Treatment: 7/20/23. Presenting problem: Recovering from hypoglycemic shock/coma. Needle size: Red Seirin; Acupuncture Points: GV20, GV 14, GV 4, Bia Hui, BL 25 (bilat).
Acupuncture Treatment Number 2: Date of Treatment: 7/21/23. Presenting problem: Recovering from hypoglycemic shock/coma. Needle size: Red Seirin, Acupuncture Points: GV20, GV 14, GV 4, GV2, GV T/3, Bia Hui, BL 25 (bilat).
Acupuncture Treatment Number 3: Date of Treatment: 7/24/23. Presenting problem: Recovering from hypoglycemic shock/coma. Needle size: Red Seirin. Acupuncture Points: GV20, GV 14, GV 4, GV2, Bia Hui, BL 25, BL 13, BL 14, BL 15, BL 27, BL28 (BL pts bilat).
Acupuncture Treatment Number 4: Date of Treatment: 7/27/23. Presenting problem: Recovering from hypoglycemic shock/coma. Needle size: Red Seirin. Acupuncture Points: GV20, GV 14, GV 4, GV2, Bia Hui, BL 25, BL 13, BL 14, BL 15, BL 27, BL28 (BL pts bilat). Red Light therapy with VetLight for 1.5 minutes. Patient response: Well tolerated, but less willing to sit still for treatments.
Photomedicine Treatment: Date of Treatment: 8/3/23. Presenting problem: Recovering from hypoglycemic shock/coma. Acupuncture: Patient would not sit still for Acupuncture today. Proceeded with laser therapy. Laser Therapy: Red Light therapy with VetLight for 1.5 minutes; Laser over cervical, thoracic and lumbar spine. Laser settings: Time 1:45 minutes; Power 3 Watts, Pulsed Rate: CW, 315 Joules. Patient response: Well tolerated, very wiggly
OUTCOME: Barry did exceedingly well with his medical and alternative medicine treatment protocol. Barry started his journey in a coma with status epilepticus and progressed to walking and eating with regularity. While Barry still has progress to make, he continues to improve with each session. I truly believe that the acupuncture and laser/light therapy that Barry underwent had a key and integral role in his continued improvement and recovery. My ultimate hope is that Barry’s vision will return completely. However, even if his vision remains diminished, he has beaten the odds and returned home to his loving family. His family is thrilled by his progress and plan to continue acupuncture, laser, and red-light therapy to help aid his recovery.
MEDIA: Pictures of Barry’s first day of presentation July 18, 2023 (comatose) and receiving acupuncture July 20, 2023, July 21, 2023, July 24, 2023. Videos of Barry July 19, 2023 prior to acupuncture (laterally recumbent, but propped sternal with a towel); Barry’s gait July 24, 2023 (slightly ataxic, blind, high stepping); and his most recent evaluation 8/3/2023 (improved vision, resolved high stepping and ataxia).
REFERENCES:
- Laser Acupuncture at GV20 Improves Brain Damage and Oxidative Stress in Animal Model of Focal Ischemic Stroke. Published by Elsevier B.V in 2017; written by Jinatta Jittiwat. While this article does not specifically address cats in hypoglycemic coma, it does suggest that GV20 is a good acupuncture point for improving brain damage.
- Advances on the Acupuncture Therapies and Neuroplasticity: Role of Acupuncture in the Management of Severe Acquired Brain Injuries (sABIs). Published 2018; Written by Loredana Cavalli. This paper discusses the role of acupuncture in the treatment of acute brain injuries by reducing neuroinflammation, intracranial edema, oxidative stress, and neuronal regeneration.