Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017021
Abstract: Diesel is a 10 year old MC dachshund with no history of back pain or injury but has slowed down in the last 6 months per owner. His physical exams have never indicated any major issues and the owner is interested in seeing if there is something muscular going on and if something other than typical medications can help Diesel. It was found that Diesel had some muscle tension and trigger points down his back and the owner elected to go forward with basic massage and acupuncture. Diesel came in once weekly for 3 weeks to see if this would help him regain some of his energy. After the treatments, the owner noticed an improvement in his energy and with the length of his walks.
History and Presentation: Diesel is a 10 year old MC dachshund that presented for a 6 month history of not wanting to walk as fast or as far as he usually does. He usually goes on 2 mile walks several times a week and short walks daily. After moving to Colorado about 7 months ago, he did not want to walk as far or do hikes. He also doesn’t pull on his leash like he used to. Other than this, he has been acting normal. He still jumps up on furniture and plays with his toys. He has no history of back pain or injury and no pertinent medical history. He is not on any medications and eats Hill’s Healthy Mobility for small dogs, ¼ cup twice daily.
Physical Examination and Clinical Assessments:
Eyes: Menace intact OU. No ocular discharge.
Ears: No ceruminous debris AU.
Oral cavity: MM pink, moist, CRT <2 seconds. Mild-Moderate dental calculus.
Integ: Healthy skin and coat.
LN: No peripheral lymphadenopathy.
Resp: Eupneic. Normal bronchovesicular sounds in all fields. No crackles or wheezes.
CV: No murmurs or arrhythmias. Strong, synchronous, symmetric femoral pulses.
Abd: Soft, non-painful. No masses, organomegaly, or ascites palpable.
U/G: No discharge.
M/S: Ambulatory x 4 with no lameness noted. BCS 5/9.
Neuro: Bright, alert, responsive. Normal mentation, cranial nerves intact. No postural deficits. Tenderness over L3-L4, full cervical range of motion.
Hydration: Adequate hydration, <5% dehydrated.
Diesel had normal vital parameters on physical exam. His cranial nerves were intact and there were no CP deficits. Diesel shows normal walking and trotting motions with no lameness. He had no pain or discomfort on cervical manipulation. Diesel showed possible slight tenderness to palpation over his L3-L4 area of spine and tight muscle banding over his thoracic longissimus muscle, bilateral lumbar epaxial/longissimus muscles and both gluteus medius muscles. No other diagnostics were pursued at this time as the owner declined other treatments at this time and elected to move forward with acupuncture.
Medical Decision Making:
Based on physical exam findings and Diesel’s breed, it is likely that Diesel has either myofascial restriction or pain as a result of a mild disc herniation. It is likely Diesel has pain along his longissimus muscle if he is compensating and shifting weight. To help relieve his pain I will focus on trigger point deactivation along his longissimus and epaxial muscles and specifically focus on points in the region of L3/L4 to reduce inflammation and aid in pain management. By using this approach, I will be able to relieve myofascial restriction in the process by activation of local mediators.
Differential Diagnoses: My top differentials include L3/L4 disc herniation vs. myofascial restriction as a result of his achondrodysplasia vs. musculoskeletal injury. I was able to come to these conclusions based on his myofascial palpation and the localization of his pain. In addition, his breed has a high incidence of disc herniation which is also very high on my list.
Definitive (or Putative) Diagnosis (or Diagnoses): Due to his breed my top differential would be L3-L4 disc herniation. Diesel does not have any symptoms at this time other than pain so the disc likely has not fully herniated.
ST36: Master point for inflammation. It is likely that diesel is experiencing a level of inflammation.
BL11-15: I used these point as both local trigger points and to relieve myofascial restriction. BL 11 is specifically for local tension as pain.
BL 18,19,20,21: I used these for his thoraco-lumbar pain throughout his longissimus and epaxial muscle. De Qi was stimulated on many of these points as we get closer to his localization.
BL23: Used for lumbar and pelvic pain. This was my starting point to focus on L3/L4 without getting too close to where his primary pain is.
BL25: My distal point for his L3/L4 pain.
GB 29: Used this point primarily as a trigger point but also due to neuromuscular innervation of the cranial gluteal nerve.
GV14: Primarily for neck and back pain.
GV20: Placed this at the beginning of every appointment to relieve stress and agitation.
GV3-GV4: Specifically for lumbar pain.
BaiHui: Specifically for lumbosacral pain
Diesel returned once weekly for three weeks with the same treatment protocol performed.
Outcomes, Discussions, and References: This treatment protocol was a success. Diesel is on no other medications at this time but he was instructed to stay rested for 6 weeks to ensure a full disc herniation does not occur which could result in paralysis if this is in fact the cause. At the second visit another exam and myofascial palpation were performed. His taught muscle bands along his epaxial and longissumus muscles were significantly improved. In addition, his L3/L4 pain was still present but significantly reduced. By the third visit, Diesel only had a very mild response to L3/L4 palpation. There were no adverse events and Diesel is continuing acupuncture and remaining stable without any medications.
Describe Your Medical Acupuncture Experience: This was an interesting experience as I had never used acupuncture in a possible spinal injury patient. I am convinced that it is effective and I plan to use this treatment plan in the future.
There are several clinical trials that use electro- acupuncture for acute spinal cord injuries including the article, “Clinical Trial of Acupuncture for Patients with Spinal Cord Injuries.” They were able to determine that patients who had an acute event and were started on acupuncture early, had a significantly improved recovery.
Wong, Alice M. K., et al. “Clinical Trial of Acupuncture for Patients with Spinal Cord Injuries.” American Journal of Physical Medicine & Rehabilitation, vol. 82, no. 1, 2003, pp. 21–27., doi:10.1097/00002060-200301000-00004.