Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017001
Abstract: Ginger is a 12 year old, white, female spayed, toy poodle weighing 3.5 pounds. The caretaker for over one year, transports Ginger for all of her veterinary needs. Ginger receives fatty acid supplementation, gabapentin, and tramadol. However, Ginger does not receive her medication consistently. Often, she does not receive medication on the weekends or on other days when Patty is not there. Ginger has been able to run up and down the stairs at home, which she has not been able to do for the past three years, according to Bob. She is much more comfortable on a daily basis and appears less kyphotic than she did before beginning her acupuncture sessions. At this time, Ginger is returning every 1-2 weeks for an acupuncture session. Each session is approximately 45 minutes in length.
History and Presentation: Ginger has a history of moderate periodontal disease, bilateral medial patellar luxation (MPL), bilateral nephrolithiasis, and IVDD. She has always been a picky eater, according to the caretaker. Ginger presented to me on 9/1/17 for a wellness exam and routine lab work. At that time, I discussed Ginger’s kyphosis, and mobility issues. After discussing with Bob that acupuncture was another option, he consented to a trial of acupuncture sessions. I also discussed laser therapy; however, Bob declined laser therapy sessions, as he did not see improvement with this modality in the past. Ginger had been previously seen for back pain and radiographs were performed on 8/23/2016. Collapse of L2-L3 intervertebral disc space with a large amount of spondylosis deformans and narrowing of L4-L5 with a moderate amount of spondylosis deformans were noted by a radiologist’s report. Also, bilateral MPL and well-defined regions of mineralization within both kidneys were noted in the radiologist’s report. Seven sessions of laser therapy were administered between April and May 2016. Ginger was prescribed Metacam® and tramadol for pain control. Convenia was administered for the treatment of a urinary tract infection. Recent blood chemistry performed on 9/2/17 revealed mild renal azotemia. A complete urinalysis and urine culture were not suggestive of any current urinary tract infection (performed 9/5/17).Ginger is no longer receiving Metacam® and is currently receiving an Omega 3 fatty acid supplement (one Welactin® capsule daily on food), gabapentin 10 milligrams (mg) by mouth every 12 hours, and tramadol 5 mg by mouth every 8 hours.
Physical Examination and Clinical Assessments: Upon physical examination, kyphosis was noted to be severe, crepitus was palpated along the thoracolumbar spine and upon manipulation of both stifles. Ginger was thin, weighing 3.5 pounds, with a body condition score of 3/9. Bilateral hindlimb muscle atrophy was present. Bilateral MPL (grade 2/4) were present. No conscious proprioception deficits were present and patient was ambulatory. Ginger had hyperreflexia in both hind limbs upon neurologic examination.
Medical Decision Making: According to Ginger’s owner, drug therapy alone is not resulting in as good of a quality of life for Ginger as he would like. Ginger is currently receiving tramadol and gabapentin for pain management. Non-steroidal anti-inflammatory drugs (NSAIDs) are being avoided for long-term use at this time due to concerns for renal health. Additional imaging was discussed and declined. Bob declines laser therapy, as he did not see an improvement in the past with laser therapy. Acupuncture and neuromodulation targeted at the spine, hips, and knees was elected as an addition for pain management and improved mobility.
Differential Diagnoses: My differentials included intervertebral disc disease (IVDD), chronic changes associated with osteoarthritis of the spine and stifle joints, and less likely, trauma and/or neoplastic processes based chronicity and presentation.
Definitive (or Putative) Diagnosis (or Diagnoses): Based on physical examinations and response to treatments, my putative diagnosis is: IVDD with osteoarthritis of thoracolumbar and lumbar spine and stifle joints. Bilateral MPLs.
Acupuncture Treatments: 8 treatments on the following dates: 9/5/17, 9/7/17, 9/11/17, 9/14/17, 9/19/17, 9/26/17, 10/10/17, 10/23/17. Needles used: Serin 0.2 x 30 mm, Acupuncture Points: GV 20, GV 14, and Bai Hui (parasympathetic neuromodulation), Thoracolumbar Bladder line BL 18-BL 25, BL 60 targeting the epaxial muscle tissues to release neuromuscular tension and relieve pelvic limb pain through stimulation of peripheral nerves, including fibular and tibial nerves, Bilaterally: GB 29 (cranial gluteal nerve), 30 (sciatic nerve), ST 34 (femoral nerve), ST 36 (fibular nerve) for pain relief within pelvic limbs and overall neuromodulation of inflammatory processes. Sensitivity to ST 36 was found on more than one occasion.
Outcomes, Discussions, and References: Although Ginger still has abnormalities of her spine, including kyphosis and occasional return of more severe pain when she does not receive acupuncture as frequently, overall her quality of life and mobility have greatly improved. Neuromodulation of upper motor neuron disease, pain management, and improved mobility have been successful using acupuncture in this case. Chronic lower back pain relief via acupuncture has been scientifically shown to be effective in humans.1Another study suggests that acupuncture may even be more effective than non-steroidal anti-inflammatory drugs at relieving back pain in humans. 2 This may be extrapolated to veterinary medicine.
1. Hutchinson AJ, Ball S, Andrews JC, et al. The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature. J Orthop Surg Res. 2012;7:36.
2. Lee JH, Choi TY, Lee MS, et al. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013;29(2):172-185.