Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4367
Abstract: This case pertains to a spayed female domestic shorthair cat that has a history of Feline Idiopathic Cystitis (FIC). After just 2 acupuncture sessions, her clinical signs of FIC improved greatly, although they returned once treatments were discontinued. Further acupuncture treatments have been successful in eliminating her clinical FIC signs again.
History and Presentation: Millie is a 4 year old spayed female domestic shorthair cat who has had a history of FIC over the past 12 months. Clinical signs (inappropriate urination locations, stranguria, pollakiuria, crystalluria) developed following the arrival of a new baby in the household. No evidence of UTI has ever been present. She has a history of inter-cat aggression with another spayed female cat in the house, for which she was started on fluoxetine (5 mg daily) about 9 months ago. The fluoxetine has helped with the inter-cat aggression, but not the FIC. She has been treated during FIC flare-ups with buprenorphine, duralactin, acepromazine, subcutaneous fluids, and diet therapy (canned Purina UR).
Physical Examination and Assessment: Western physical exam provided no significant abnormalities – vitals were normal. This has been an on-going issue for which I have been treating this cat – no current flare up; therefore no current diagnostics beyond physical examination were performed. Myofascial examination revealed trigger points along the paraspinous muscles stretching from L1-L3 bilaterally. She was also sensitive at the lumbosacral junction.
Medical Decision Making: At the initial acupuncture assessment, Millie was not currently undergoing an FIC flare up, so no specific treatment was warranted. Fluoxetine at 5 mg daily was continued due to its benefits in harmonizing the household. The owner notes that despite less frequent urination and elimination occurring only in the box at this time, the urine spots that Millie produces have continued to be very small in comparison to the other cats in the house. Acupuncture was to be tried to see if we could improve her comfort and bladder inflammation to minimize future flares of FIC. The goal of acupuncture in this case was to neuromodulate the bladder primarily, using acupuncture points that would affect bladder innervation.
Differential Diagnoses: Historical diagnosis of FIC determined by lack of infectious cause for urinary symptoms and known stressors in her household.
Definitive Diagnosis: See above.
Acupuncture Treatments: Millie received 2 acupuncture treatments one week apart on 5/27/17 and 6/3/17. Dry needling was performed using tubeless red Serin (0.16 mm x 15 mm) needles. Needles were placed at Yin Tang, GV 20, GV 14, and Bai Hui for relaxation and parasympathetic modulation. Needles were also placed at GV 4, BL 23, BL 52, GB 25 (the “kidney tiara”), BL 27, and BL 28 (the bladder “shu” point). Needles were also placed at GV 3 and BL 24 due to trigger points in this area. All needles were left in place approximately 15 minutes (based on tolerance of the patient).
The basis for point selection was trigger point pathology in addition to knowledge of bladder innervation. The sympathetic fibers affecting the bladder arise from spinal cord segments stretching from T12-L2 and the parasympathetic fibers affecting the bladder arise from S2-S4.
Thus, needling in the paraspinous muscles innervated by these spinal segments can cause neuromodulation to the bladder via viserosomatic reflex arcs.
Millie’s third and fourth treatments were performed with the same needling technique 6/14/17 and 7/20/17.
Outcome, Discussion, References: Millie responded very well to her acupuncture treatments and seemed to enjoy them very much. After the first treatment, I was able to have her sit willingly in my lap and I was able to place needles in her without an assistant present (which was impressive, because Millie is not a very cuddly cat). Within 24 hours of her first treatment, her owner reported that Mille was producing normal sized urine spots in the litter box. This persisted following the second and third treatments at one and two weeks. In between the third and fourth treatments (5 week span), however, Millie’s urine spots became very small and frequent again, with one instance of urinating outside the box. After the fourth treatment, the owner reported improvement again within 24 hours. My impression of this outcome is that at least for now, treating her on a 3-4 week span may be helpful for maintenance of bladder health.
I was very pleased with the outcome of this case (and the fact that there was a relapse of clinical signs and secondary response which made me feel that the results observed were repeatable and real). I hope to be able to use Millie as a case study to discuss with other owners of FIC cats to help them to understand that acupuncture can be a helpful adjunctive therapy for FIC. If neuromodulation alone (or even in conjunction with standard medications) can make a dramatic difference in FIC cats, we can make a big difference in their lives (and those of their owners).
Two scientific reports that speak to improved effects of urination after acupuncture treatment include:
- Effect of acupuncture on rabbit bladders with urodynamic indexes by Meng X, et. Al., published in Journal of Traditional Chinese Medicine in 2013. In this study, they observed improved urination after acupuncture.
- Myofascial physical therapy in women with interstitial cystitis/painful bladder syndrome and pelvic floor tenderness by in Journal of Urology in 2012. In this study, they observed decreased pain, urgency, and frequency of urination associated with myofascial therapy affecting the spinal nerves that innervate the bladder.