IBD in Cats Often Responds Well to Acupuncture!
Julie Hermansen, DVM, cVMA
August 8, 2024
Watch Henry’s Video Short HERE
Abstract: A 13-year-old male neutered cat with a history of inflammatory bowel disease characterized by intermittent vomiting. His owner noted recently that his hair coat was not as nice as it used to be. No gait abnormalities were noted by the owner, however, abnormalities, as well as myofascial restrictions, were noted by a veterinarian. His owner’s goal was to maintain or increase his quality of life. After acupuncture sessions, his owner noted that he was ambulating with greater ease, he was playing more with the new kitten, and there were fewer instances of vomiting.
History: Henry is a 13-year-old male, neutered domestic long hair cat. In 2020 he presented with the symptoms of weight loss, hyporexia, and vomiting, and after a medical work up, he was diagnosed with having a chronic enteropathy thought to be inflammatory bowel disease. Treatment was initiated and his current treatment is 2.25 mg chlorambucil by mouth every 48 hours, 250 mcg vitamin B12 by mouth every 24 hours, and 1 mg budesonide by mouth every 24 hours. His clinical signs have been relatively well controlled, with the frequency of vomiting decreased but still present. He also regained weight from 8.5# in June, 2023, to 9.56 # in May, 2024.
Overall, his owner believes that he has a good quality of life and was improving with treatments. His appetite was found to be good, in fact, he had been eating more since his owners recently brought home a kitten – he has been eating some of the kitten’s food. He did note, however, that Henry’s hair coat was not smooth, and since acquiring a new kitten, he did notice that Henry was not very active. He did not notice that there were gait abnormalities at home. Henry’s owner enquired about acupuncture as he wants Henry to have the best quality of life possible.
Physical Evaluation: Henry presented in May, 2024, for his physical exam, blood work, and acupuncture on 100 mg gabapentin given orally 2 hours prior to leaving home. He historically has been nervous at the veterinary clinic. His owner took videos at home of him walking so that his gait could be evaluated in an environment in which he is comfortable. These videos show that when he walks, the thoracic limbs cross over each other. The pelvic limbs show a stiff gait. He holds his tail down when he walks, even when he seems happy.
On physical exam, Henry was alert but mildly subdued on gabapentin, responsive, and hydrated. He had a grade 1-2/6 systolic heart murmur. There were no abnormalities seen with his eyes, nose, ears, throat, respiratory auscultation, abdominal palpation, or teeth. Sarcopenia was present on the epaxial muscles. Taught bands were palpable in the thoracolumbar region in the iliocostalis muscles. Pain was present at the thoracolumbar region, the lumbosacral junction, and the base of the tail. Heat was palpable at the proximal tail, sacrococcygeal region, the L5-L6 region, T12-L2 region, and C6-7 region.
His coat was clean. There was a hair coat change, in which his coat stood up, at L5-L6, and from the lumbosacral to sacrococcygeal region.
His neurologic exam revealed no obvious deficits in the cranial nerves. His patellar and biceps brachii reflexes were normal. He showed no crossed extensor reflex and there were no conscious proprioceptive deficits found. Laboratory diagnostics done on this day included FELV antigen, FIV antibody, and heartworm antibody tests, all of which were negative. A complete blood count revealed a mild normocytic, normochromic anemia (HCT 27%). His leukocytes were within the reference range. A chemistry panel, T4, and urinalysis were all within normal limits.
Problem list: Chronic enteropathy presumed to be inflammatory bowel disease; mild anemia, myofascial restrictions
Differential Diagnosis for clinical abnormalities found:
Vascular: Mild anemia, heart murmur; Infectious/Inflammatory: Inflammatory bowel disease/enteropathy (somatovisceral effect)
Neoplastic: Potential for GI lymphoma (biopsies were not done of bowel, so potential for neoplasia such as small cell lymphoma (T cell) exists)
Degenerative: Osteoarthritis
Iatrogenic/intoxication: Chronic steroid and chlorambucil use
Congenital: none – the signs have not been present since birth
Autoimmune: Immune complexes from inflammatory bowel disease
Traumatic: Injury from falling or playing hard with the new kitten
Endocrine/Metabolic: Development of diabetes mellitus and therefore diabetic neuropathy secondary to steroid use
Myofascia: Abnormalities in myofascia in the epaxial region, via somatovisceral reflexes, resulting in or contributing to chronic enteropathy.
Presumptive Diagnoses: Myofascial dysfunction due to Inflammatory Bowel Disease (via viscerosomatic reflex)
Medical Decision Making: Henry’s treatment plan was designed to address the myofascial dysfunction and gastrointestinal disease. Acupuncture has been shown, via neuromodulation, to alleviate signs associated with GI disease (Li et al, 2023). This includes an improvement to quality of life in patients who have inflammatory bowel disease (Song et al, 2019). GV14 was selected and was the first needle placed during treatments. The reason that it was first was to see how he reacted to needling as it is a location that most cats will tolerate. It is also a good central point and since there was some dysfunction in the thoracic limbs, stimulation of the cervicothoracic nerve roots would be beneficial to Henry. Further, this point helps with immunologic dysfunction, which is a factor in cats with inflammatory bowel disease.
Bai Hui was the next point treated. This point treats pelvic limb dysfunction. BL21 and BL25 were treated to address a region of myofascial dysfunction found during his exam. Also, these points have benefit to patients who have digestive problems. BL27 was used as it benefits patients with small intestinal issues. Also, because it can be used for sacroiliac dysfunction, there may be an added benefit to his pelvic limbs. BL35 was treated because during his exam he showed discomfort and evidence of dysfunction in the sacral region.
In the third session, because Henry was tolerating needling so well, additional points and a slightly larger needle were selected. GV 20 was used today to help further calm him (this point is known to decrease agitation). Initially, this point was not used as there was a concern that he would not tolerate the placement of it on his head. He did tolerate that needle very well. GVT/3 was used to address myofascial dysfunction found during exam in the proximal tail (heat and pain). (Robinson, 2017)
Acupuncture Treatments:
May 17, 2024: 0.12 x 15 mm Seirin J needles were used at GV14, Bai Hui, right and left BL21, BL25, and BL27. He growled quietly during treatment on a soft blanket which was on top of a heating pad, however, he ate Churu during the needling and sat relatively still for around 5 minutes after the final needle was placed. The treatment on this day was done around 45 minutes after his blood was drawn so he was a bit more upset than he usually is.
May 24, 2024: 0.12 x 15 mm Seirin J needles were used at GV14, BaiHui, right and left BL21, BL25, BL27, and BL35. Henry tolerated his treatment fairly well today for a total of 9 minutes once all needles were placed. He was fed Churu during the treatment and he occasionally had a low growl. Treatment was performed on a cozy blanket placed on a heating pad. Shortly after the treatment was complete, he was very relaxed and acted as if he was going to fall asleep.
May 31, 2024: 0.16 x 15 mm Seirin J needles were used at GV20, GV14, Bai Hui, and right and left BL21, BL25, BL27, BL35, and GVT/3. The session was done on the floor while he was on a blanket placed on a heating pad. Henry growled quietly for a brief time, however, he then relaxed and seemed content. He tolerated the needling for 22 minutes today. At this time, he stood up and walked off the blanket, so the needles were removed.
Outcomes and Discussion: Overall, Henry’s treatments were a success. While he normally is quite nervous at the veterinary clinic, by the third treatment he was more relaxed and receptive. There was a concern that he would not allow acupuncture treatments, but this proved not to be the case. His Dad reported that on the ride home he was quiet and calm. He normally vocalized in the car so this was seen as a positive response.
Henry’s Dad was pleased with Henry’s response to treatment. After the first treatment, he reported that he was doing very well. He seemed very comfortable that night, laying more sprawled out rather than sleeping in the loaf position. He also ate even better than he normally does. There was no vomiting or diarrhea
After the second treatment, Henry’s Dad reported that his coat looked better than it had been in the recent past. He was very active the next day and was playing with the kitten. He was eating very well and had no diarrhea. He did vomit once.
On the day following the third treatment it was reported that Henry was “going non-stop and chasing Sora (the kitten) around”. He was eating very well and, in the month following the third treatment, there was no vomiting or diarrhea reported, which was an excellent response. The post treatment videos show that he does seem more perky than in the pre-treatment videos and he is holding his tail straight up, indicating that he is happy and more comfortable.
The treatments gave Henry the intended goal of improving his quality of life. His gastrointestinal signs improved, his hair coat improved, and he was more active and playful. He did still have a gait abnormality in the thoracic limbs. I focused the treatment on the gastrointestinal abnormalities, myofascial abnormalities palpated on the trunk, and pelvic limbs. I did treat GV14 which can be used for thoracic limb abnormalities, however, for future treatments, I will also treat more points for the thoracic limb.
Henry will be coming in for regular treatments moving forward as he tolerates them well and overall has a positive response. For future treatments, I may also include laser and medical massage therapy.
References:
Li X, Liu S, Liu H, Zhu JJ. Acupuncture for gastrointestinal diseases. Anat Rec (Hoboken). 2023 Dec;306(12):2997-3005. doi: 10.1002/ar.24871. Epub 2022 Feb 11. PMID: 35148031.
Song G, Fiocchi C, Achkar JP. Acupuncture in Inflammatory Bowel Disease. Inflamm Bowel Dis. 2019 Jun 18;25(7):1129-1139. doi: 10.1093/ibd/izy371. PMID: 30535303.
Robinson, Narda G. Medical Acupuncture for Veterinarians: Canine Point Mini-Manual. 2017.