Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017025
Abstract: Kodi, a 12-year-old male castrated Black Labrador/German Shepherd mix, presented for a primary complaint of chronic, gradual, weakness of his hind-end, with a history of bilateral tibial leveling plateau osteotomy (TPLO) surgeries. Throughout the course of three treatments, Kodi gained energy and comfort in his everyday life and showed increased strength in his hind end. His owners have been very pleased.
History and Presentation: Kodi, a 12-year-old male castrated Black Labrador/German Shepherd mix, presented for a primary complaint of chronic, gradual, weakness of his hind-end. His first TPLO (right) was performed in June of 2013 after a chronic lameness developed, and the second TPLO (left) was performed one year later. Kodi is otherwise a healthy and happy dog with no other significant or relevant medical illness or trauma. He receives Cosequin DS daily (500mg glucosamine, 400mg sodium chondroitin) and intermittent Previcox (227mg) as needed. He receives physical therapy twice a month that includes pulsed electromagnetic field therapy, massage, laser (focused on his pelvic limb joints and hip), and underwater treadmill exercise. His owners also perform passive range of motion exercises and hind end strengthening exercises at home 3-4 times/week, and he goes on a 20min walk every evening. Kodi was bright, alert, and responsive on presentation ambulating comfortably.
Physical Examination and Clinical Assessments: On physical examination, Kodi’s vitals were within normal limits (T: 101.6F; P: 80bpm; R: pant), and there were no significant abnormalities found with the exception of multiple benign previously diagnosed and mapped lipomas. Neurologic examination revealed normal facial expression, musculature, and symmetry, no overt cranial nerve deficits appreciated, no ataxia appreciated at the walk, conscious proprioception and withdrawal reflex tests within normal limits in all four limbs. Range of motion mildly decreased in bilateral stifle joints (flexion and extension). All other organ systems were within normal limits. Kodi mildly abducts both hindlimbs, has a decreased cranial phase of stride in the right hindlimb, and moves in a relatively stiff quality of movement that is consistent.
Myofascial palpation: (5/28) Multiple tension bands appreciated in bilateral triceps muscles, discomfort noted on palpation near lumbosacral spine (BL 25, Bai Hui, BL 27) slightly more exaggerated response on the left, multiple tension bands appreciated in bilateral quadriceps (especially vastus lateralis) and biceps femoris muscles. He turned his head and his muscles twitched when I palpated over his gluteal muscles bilaterally (more exaggerated response on the left) in the region of GB 29, GB 30, and BL 54. (7/1) Same as 5/28 exam without the tension bands in the triceps muscles. (7/29) Additional caudal thoracic and lumbar sensitivity along the inner bladder line. No tension bands appreciated in the triceps muscles.
Medical Decision Making: Kodi is a calm and friendly dog that can get nervous quickly, and he had not received acupuncture before these treatments. His tension bands found in his pelvic limb are likely due to him constantly going up and down stairs, supporting and stabilizing his stifles as best he can during movement, and his increased effort during physical therapy sessions (especially the underwater treadmill). His tension bands in his triceps muscles are likely due to compensation when he tries to off-weight his hind end to some degree to relief some of that weight bearing.
For central points I chose GV 20 (also for calming), and Bai Hui (centering and balance, lumbosacral pain, pelvic limb pain). For autonomic I additionally chose ST 36 (also for it’s indications for stifle pain and pelvic limb dysfunction). For peripheral points and local points I chose to start with SP 10 in addition to ST 36 for stifle pain (in future treatments I hope to add SP 9 and ST 34.), and BL 54, GB 29, and GB 30 along his gluteal/pelvic limb) tender areas in addition to along the tension bands found on myofascial palpation. I would like to do massage along the muscular tension bands as well. For his forelimb I chose SI 9 and along the tension bands, as well as LI 4 for peripheral radial nerve and autonomic stimulation.
Differential and Definitive Diagnoses:
-Chronic stifle and accompanying muscle weakness from past TPLO surgeries
Acupuncture Treatments: Please see medical decision making as well. I used Seirin 0.15 x 30mm with insertion tubes because he is a large nervous dog who has not had acupuncture prior to these treatments. 5/28: GV 20, Bai Hui, BL 25, BL 54, GB 29, GB 30, ST 36, SP 10, SI 9. He became very nervous after I placed SI 9. Needles were in for 10minutes. Was in right lateral so these points were on the left.
7/1: GV 20, Bai Hui, GB 21, BL 25, BL 27, GB 29, GB 30, BL 54. He was much calmer during this session. He was sternal during this treatment, became very relaxed after GV 20 was placed, and seemed to really enjoy this treatment. Needles were in for 15minutes.
7/29: GV 20, GV 14, GB 21, BL 21, BL 23, BL 25, BL 54, GB 29, GB 30. Kodi fell asleep after about 4 minutes into placing the needles and the treatment overall. He then woke up 10 minutes later and licked my hand and was very relaxed. Needles were in for 20 minutes.
Outcomes, Discussions, and References: Kodi gained comfort and increased range of motion in his hind end (mainly hips) and overall quality of life due to these treatments. The days after his treatments his owners reported he had an increased amount of energy and happiness, and ambulated more smoothly.