Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4S2018008

Abstract:
Jade is a 13 ½ year old F/S Pitbull Terrier mix. I treated her for multiple leg lameness, most pronounced at her left front leg. She is a very nervous patient and everything needed to be done in a gradual, slow manner.
Jade responded very well to her acupuncture sessions. She was very relaxed and sleepy towards the end of each session. Her owner reported that she was more perky and willing to walk. She also noted that the left front leg lameness was improved, although still always present.

History Presentation:
Jade is a 13 ½ year old F/S Pitbull Terrier Mix. She was adopted as a puppy by her current owner. She has a history of severe allergies, anxiety, bilateral TPLOs (left in 2014, right in 2015), hypertension, and degenerative joint disease. She has been allergy tested and treated with allergy injections. She also sees a holistic DVM once a month. She has had acupuncture before and her owner reports that she “tolerated it”. Her owner remembers that the needles were silver in color. Jade has had a progressively more difficult time walking over the past several years. She has had a lameness at her left front leg for at least two years. She will often not want to walk and her owner will carry her. Her owner is a canine massage therapist and tries to massage Jade at home once weekly, although this is inconsistent. Jade has also developed a finicky appetite. Jade’s owner would like to try acupuncture to improve Jade’s quality of life.
Medications (owner is not certain of exact doses): Apoquil, Benazepril, Gabapentin, Galliprant, Adequan

Physical Examination and Clinical Assessments:

Pain Score: 1.75

General Appearance: Bright, alert and responsive, nervous and trembling
Body Condition Score: 2.5 out of 5
Hydration: Hydration appears normal
Eyes: Nuclear sclerosis both eyes
Ears: No abnormalities noted within the external ear canal or on the pinna
Nose: Exam within normal limits
Oral Cavity: There is no dental disease present and exam within normal limits
Cardiovascular: No murmur ausculted, normal sinus rhythm and strong synchronous pulses
Respiratory: Lungs auscultate clear and eupneic
Abdomen: There are no masses and no fluid wave palpated. All structures palpate within normal limits.
Urogenital: The external urogenital system is within normal limits
Rectal: A rectal exam was not performed
Musculoskeletal: There is multiple leg lameness – most pronounced at the left front leg. She stands with both elbows abducted, elbow flexion is decreased bilaterally. Jade is uncomfortable on palpation over the biceps tendon bilaterally. There is mild lordosis. There are prominent dorsal spinous processes. There is generalized muscle atrophy. Both stifles are mildly thickened. Hip extension was not performed today to avoid patient stress. Jade can transition from a stand to a down and vice versa without support.
Neurologic: There are no cranial nerve deficits or conscious proprioception deficits present at time of exam. Crossed extensor is negative, withdrawal is positive at all four legs
Integument: Alopecia at all four paws, the skin at her paws is mildly erythematous and thickened
Lymph Nodes: All peripheral lymph nodes palpate within normal size and density

Myofascial Exam: Jade’s muscles are generally tight and there is generalized muscle atrophy. There are multiple taut bands at the cervical spine and Jade is sensitive at the caudal cervical spine at C4-C7. There are taut bands in the biceps bilaterally in addition to the bilateral supraspinatus and infraspinatus muscles bilaterally. There are taut bands cranial and caudal to the scapula bilaterally. The rhomboids are tight. The quadriceps are also tight bilaterally.

Definitive (or Putative) Diagnosis (or Diagnoses):
Degenerative joint disease
Suspect chronic biceps tendonitis
Suspect caudal cervical spinal disease
Multiple areas of myofascial restriction

Differential Diagnoses (D Dx):
Neoplasia; Infectious (Lyme disease, septic arthritis); Autoimmune (immune mediated polyarthritis)

Medical Decision Making:
My initial acupuncture approach was based on what Jade would tolerate. She was initially very sensitive to the needles and very gentle palpation so her first session did not have a lot of points. I started with central, calming points and then worked on her painful joints and areas of myofascial restriction. At her third session, I was able to use slightly larger needles and Jade tolerated them very well. As we progressed, I tried to incorporate more points for her non-orthopedic issues (allergies, hypertension, and anxiety).

Before 2 Video

Acupuncture Treatments:
May 14, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.14x30mm)
GV 14: a good first point to try to see how she responds, central point, anti-inflammatory for arthritic pain and allergies, will also help with her neck and back pain
GV 20: for calming as she is very nervous
BL 21 (bilateral): central point, for discomfort at the thoracolumbar spine, to help with poor appetite
BL 13 (bilateral): central point, to help with the discomfort at her rhomboids and pain at her cranial thoracic spine

Bai Hui: central point, will communicate with GV 14, good for her hind limb pain and local pain
BL 54 (right): for hip pain
SI 11: (bilateral): for the bands and discomfort at the infraspinatus
S1 12: (bilateral): for the bands and discomfort at the supraspinatus
LI 11 (bilateral): to help with lateral elbow pain; anti-inflammatory and immune modulation due to history or allergies and arthritis

May 16, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.14x30mm)
GV 14; GV20; Bai Hui; LI 11 (left) (reasoning as in previous sessions)
BL 23 (bilateral): back shu point for the kidney for renal support as she is on multiple medications, local discomfort at the lumbar spine
Cervical spot at C6 (bilateral): to help with tight bands and neck pain
Cervical spot at C4 (bilateral): to help with tight bands and neck pain
LI 10 (left): to help with lateral elbow pain
GB 21 (bilateral): to help with the muscle tension cranial to the scapulae

May 22, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.14x30mm)
GV 14; Bai Hui; LI 11 (left); LI 10 (left); SI 11 (bilateral); SI 12 (bilateral): (reasoning as in previous sessions)
ST 36 (right): to help her bilateral stifle pain, to support her GI as she has a finicky appetite, to help with her inflammatory problems and possibly hypertension
LI 15 (right): to help shoulder pain, will work well with TH 14
TH 14 (right): to help shoulder pain, will work well with LI 15
PC 3: to help with bicipital tendon pain
GB 29 (right): to help her hip pain and local muscle pain
GB 30 (right): to help her hip pain and local muscle pain

May 24, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.16x15mm, 0.14x30mm)
GV14; GV 20; Bai Hui; LI 15; SI 11 (bilateral); SI 12 (bilateral); LI 11; ST 36 (left); BL 21 (bilateral); BL 13 (bilateral); LI 15 (left); TH 14 (left); GB 30 (left); GB 29(left): (reasoning as in previous sessions)
BL 25 (bilateral): central point, to help with mid-lumbar spinal pain
Cervical points at C4 and C6: to help with trigger points and cervical spinal pain
BL 15 (bilateral): central point, to help pain and myofascial restriction at the thoracic spine, to help Jade’s anxiety

May 30, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.16x15mm)
GV 14; GV 20; Bai Hui; SI 11 (bilateral); SI 12 (bilateral); BL 13 (bilateral); BL15 (bilateral); LI 11 (left); LI 10 (left); BL 21 (bilateral); BL 23 (bilateral); GB 29 (bilateral); GB 30 (bilateral) (reasoning as in previous sessions)
BL 10 (left): to help with cervical pain and tension
BL 18 (bilateral): central point, for pain at the thoracic spine, to support her liver as she is on multiple medications
BL 25 (bilateral): central point, to help with lumbar spinal pain, Jade also has a finicky appetite and this point may help with intestinal discomfort
June 6, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.16x15mm)
GV 20; GV 14; Bai Hui; BL 23 (bilateral); BL 25 (bilateral); SI 11 (right); SI 12 (right);
LI 11 (left); LI 10 (left); ST 36; BL 15 (bilateral); TH 14 (right); LI 15 (right): (reasoning as in previous sessions)
GB 30 (left): to help her hip pain and local myofascial restriction
Cervical points at C4 and C6 (bilateral)
Trigger point at right cervical spine: to relieve local pain
HT 3 (right): to help medial elbow pain, to help Jade’s anxiety

June 19, 2018 (Dry Needle Acupuncture; Seirin 0.16x30mm, 0.16x15mm)
GV20; GV14; Bai Hui; BL 23 (bilateral); SI 11 (bilateral); SI 12 (bilateral); LI 15 (left); TH 14 (left); LI 11 (left); LI 10 (left); HT 3 (left); ST 36 (left); BL 15 (left); BL 18 (bilateral): (reasoning as in previous sessions)
Three cervical points (left) at C4, C5, and C6: to relieve local pain and myofascial restrictions
One cervical points (right) at C5: to relieve local pain and myofascial restrictions
BL 14 (left): central point, to help with the discomfort at her rhomboids and pain at her cranial thoracic spine
BL 27 (bilateral): central point, for discomfort at her sacral spine, to treat her small intestine as a possible cause of her decreased appetite – will work well with ST 36

After video

Outcomes, discussions, and references:

Jade showed progressive improvements in her willingness to walk after each acupuncture session. She even started trotting for a few steps at a time after her second acupuncture session and her owner has to carry her less frequently. Her owner reports that Jade is perkier at home since starting acupuncture. The lameness at the left front leg has improved but is not resolved. As acupuncture is the only change to Jade’s treatment plan, I attribute her improvement to acupuncture.
Jade was initially very anxious – she was shaking and fearful at the start of her first acupuncture session. She fell asleep by the end of her first session and over time became very comfortable during her sessions.
Based on Jade, I think further research on acupuncture for canine and feline orthopedic pain is in order. Research on acupuncture for canine anxiety in and out of the hospital setting would be beneficial. Additionally, Jade has had acupuncture before but never relaxed for it so research on needle size and stress to the patient may be indicated.

Lane, David M. and Sarah A. Hill. “Effectiveness of Combined Acupuncture and Manual Therapy Relative to No Treatment for Canine Musculoskeletal Pain.” The Canadian Veterinary Journal. 2016 Apr; 57(4): 407-414.

Nuno E.O.F. Silvia, Stelio P.L. Luna, Jean G.F. Joaquim, Heloisa D. Coutinho, and Fabio S. Possebon. “Effect of Acupuncture on Pain and Quality of Life in Canine Neurological and Muskuloskeletal Diseases.” The Canadian Veterinary Journal. 2017 Sep; 58(9): 941-951.


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