Abstract
A twenty-six year old, 3.9 kg, male, African penguin (Spheniscus demersus) became acutely and progressively paretic in the hind limbs. Initial physical and neurological exams showed decreased proprioception, normal withdrawal reflexes and no palpable orthopedic or musculoskeletal abnormalities. The penguin, a lifelong resident at the New England Aquarium, was otherwise healthy except for mild obesity and left eye blindness due to a traumatic injury as a chick. Radiographs, hematology and plasma biochemistry were unremarkable. Magnetic resonance imaging conducted three and fourteen days post presentation showed a contrast enhancing, intramedullary lesion located at the level of the cranial synsacrum with secondary cord swelling appreciated by the thinning of the ventral and dorsal fat fluid lines just cranial to the region of contrast enhancement. Cytological examination of cerebrospinal fluid collected near the lesion resulted in a mixed cell pleocytosis (WBC 17 cells/µL; RR psittacines 0–8 cells/µL) with increased protein (168.7 mg/dL; RR psittacines 8–20 mg/dL, chickens 179–189 mg/dL).1,7 Differential diagnoses included inflammation, tumor or trauma. Spinal diseases are not uncommon in penguins, but often have a poor prognosis.5,6 Surgical intervention was not recommended in this case due to location of the swelling and mortalities reported with vertebral repair attempts in birds.2,9
The animal progressed from normal weight bearing with difficult ambulation to non-ambulatory paraparesis with the left leg significantly more affected than the right. Treatments included enrofloxacin (5 mg/kg PO BID x 7d; started day 1), prednisone (up to 1 mg/kg PO BID x 27d; started day 3), doxycycline hyclate (25 mg/kg PO SID x 21d; started day 24), and terbinafine hydrochloride (16 mg/kg PO SID prophylactically for length of rehabilitation). Range of motion physical therapy and supervised swims were continued throughout the rehabilitation once vertebral fracture and severed spinal cord were ruled out. Slight improvement of the paresis was noted shortly after starting doxycycline.
Acupuncture therapy was started 30 days after initial presentation. Points used included BL11, GV14, GV20, SI3, BL62, Ki3, left GB30 and bilateral GB34 using Seirin #1 and #3 needles for 10–20 minutes as possible.4,8 Within one week, the penguin was ambulating without assistance. After five weekly sessions, the bird was allowed back into the exhibit and was soon entering and exiting the water normally, as well as maneuvering the habitat with little difficulty. Acupuncture has gained popularity in veterinary medicine over the past several years.10 It has been used in multiple species of birds including an African penguin with post-cesarean paralysis.3 The protocol in the current case was aimed at opening and regulating the primary acupuncture channel which governs the spine (i.e., on the head, at the level with the last cervical vertebra, and distal points on the ulnar metacarpus and lateral tarsometatarsus). The treatment was aimed at clearing the channel and spinal column from inflammation.
Due to the close start times of the doxycycline and acupuncture, it is unknown which was the cause of resolution, or if the combination is to be credited. However, this case shows that acupuncture has potential benefits as an adjunctive therapy in penguins with spinal cord swelling and hindlimb paresis.
Acknowledgments
The authors would like to thank the Animal Health and Penguin departments' staff and volunteers at the New England Aquarium, and Dr. Mark Troxol, the Neurology staff, and MRI technicians at the Massachusetts Veterinary Referral Hospital. The authors thank McManus Acupuncture and the Massachusetts Veterinary Referral Hospital for donating equipment and services to the New England Aquarium for the present case.
References
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