Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017002

 

Abstract:
“Lola”, a 13 year old female spayed Labrador Retriever presented because she has not been jumping up on the bed or couch like she used to and has been slower to rise from a down position. After the four treatments she has received so far, she is more eager to go on walks and is jumping up on the furniture more readily.

History and Presentation:
“Lola”, is a 13 year old female spayed Labrador Retriever that has been a very active dog and goes on daily hikes with her parents and also enjoys running around at the ranch she lives at and wrestling with her dog siblings. In March 2011, she tore her left cranial cruciate ligament and underwent surgical extracapsular repair. In February 2012, she tore her right cranial cruciate ligament and underwent surgical extracapsular repair. In March 2013, the repair of her left cranial cruciate failed and her meniscus was torn in the process. At this point she underwent a TPLO of her left stifle. Post TPLO she had extensive rehabilitation with underwater treadmill, at home exercises, and laser.  She has remained active and relatively comfortable since that time but recently (within the last 6 months) has been requiring assistance to get up on furniture and is slower to rise but once she is up is still a very active dog. She occasionally receives carprofen for pain but this is not every day.

Physical Examination and Clinical Assessments:
On presentation, “Lola” showed some evidence of mild atrophy of her hind limb musculature. She occasionally would scuff her hind paws when she walked. She was bright, alert, and responsive and her vital parameters were within normal limits. Previous stifle radiographs performed at the time of injuries showed mild osteoarthritic changes. Radiographs were not repeated at this time. On palpation, there was significant medial buttress of both stifles and decreased range of motion of stifles and hips. This is most likely associated with the previously diagnosed stifle OA (osteoarthritis) and could also indicate some degree of hip OA but this has not been radiographically diagnosed. She was moderately reactive to light palpation of her thoracolumbar spine and had trigger points in corresponding epaxial musculature bilaterally. These are likely compensatory findings from her hind limb dysfunction. There was also some mild reactivity and restriction on motion of both elbows (most significant on the right). This could indicate a compensatory change from hind limb disease or could be a primary change.

Medical Decision Making:
I thought it was important when approaching this case to address her primary conditions (the stifle OA) as well as the compensatory conditions (hip, elbow, and thoracolumbar pain). Like we learned in the course, I wanted to treat “Lola’s” entire nervous system by addressing points centrally and peripherally. Her autonomic nervous system was treated to help calm “Lola” before any more needles were placed. Local myofascial dysfunction was also treated to bring the treatment full circle. By doing this, we will get the most effect possible because we are treating the entire animal.

Differential Diagnoses:
Stifle OA – previously diagnosed and suspected progression from initial injury presentation due to clinical signs. Owner declined further diagnostics.
Suspected hip and elbow OA – “Lola” demonstrates signs consistent with OA or degenerative joint disease (decreased range of motion and reactivity to palpation). Owner declined further diagnostics.
Definitive (or Putative) Diagnosis (or Diagnoses): Stifle OA – post multiple cranial cruciate surgeries. Previously diagnosed with stifle radiographs.

Acupuncture Treatments:
Lola was treated at two-week intervals using 0.20 X 0.30 mm Serin needles and a dry needle technique.
4/30/17: GV 20, GV 14, Bai Hui, Bilateral: GB 29, GB 30, BL 54, SP 10, ST 34, BL 40, SI 9, LU5, LI 10, BL 21 – 25
o Point Reasoning: decreased range of motion and tension of hips, stifles and elbows. Tension and local trigger points in thoracolumbar epaxial musculature.
5/14/17: Only able to treat the right side limb points because she told me she was done and I did not want to push her past her limit. GV 20, GV 14, Bai Hui, Right: GB 29, GB 30, BL 54, SP 10, ST 34, BL 40, SI 9, LU5, LI 10, Bilateral: BL 21 – 25
o Point Reasoning: Tension of hips and stifles. Tension in triceps and thoracolumbar epaxial musculature.
5/28/17: GV 20, GV 14, Bai Hui, Bilateral: GB 29, GB 30, BL 54, SP 10, ST 34, BL 40, BL 17 – 25
o Point Reasoning: Tension and decreased range of motion of hips and stifles. Tension of thoracic to thoracolumbar epaxial musculature.
6/11/17: GV 20, GV 14, Bai Hui, Bilateral: GB 29, GB 30, BL 54, SP 10, ST 34, BL 40, BL 60, BL 21 – 25
o Point Reasoning: Decreased range of motion and tension in stifles and hips. Tension in thoracolumbar epaxial musculature.

Outcomes, Discussions, and References:
After her first treatment, “Lola’s” owner reported that she seemed more eager to go on walks. Since her second treatment, “Lola” has been jumping up on the couch daily and has jumped up on the bed on several occasions without assistance or encouragement. On physical examination, there has been significantly less restriction and trigger points compared to originally. She enjoys her treatments very much and even falls asleep sometimes.

It is so rewarding to see an animal respond so well to acupuncture treatments. We hear about it all the time but this has been my first case that I have seen such a profound difference so quickly. I am so excited to continue treating her and continue using what I have learned for more patients. One thing that I learned is that your treatment may change depending on the day for that patient. Every day they could have different signs and problems and you have to change and adapt to what they are telling you.

Cao L, Zhang XL, Gao YS, et al. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Saudi Med J . 2012;33(5):526-532.
JANSSENS, L. A. A. (1986), Observations on acupuncture therapy of chronic osteoarthritis in dogs: a review of sixty-one cases. Journal of Small Animal Practice, 27: 825–837.

Lin X, Huang K, Zhu G, et al. The Effects of Acupuncture on Chronic Knee Pain Due to Osteoarthritis: A Meta-Analysis. J Bone Joint Surg Am . 2016 Sep 21; 98 (18): 1578-85.


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