Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017059
Abstract: George received acupuncture treatment for overall stiffness and difficulty jumping into the truck. Owner reported a significant improvement in energy level, stiffness when getting up from laying down, less limping and more willing to jump in and out of the truck.
History: George, a 9 year old Bernese Mountain Dog, owner, a bovine veterinarian, has had him since he was a puppy. Has always shown stiffness in his hindlimbs and it seems to be worse over the last year or so. She thinks there is a problem with his elbows as well, they rotate outwards. He also sometimes limps on his left front. He seems worse when he has been in his run outside all day with the neighbours border collies. He otherwise has not had any health issues that she is aware of. She is not interested in pursuing further diagnostics.
Physical Exam: George is a very friendly dog! He is mildly overweight with excessive rib fat coverage (BCS 6/9). He has moderate tartar build up and bad breath. He pants excessively when inside, but heart and lungs auscultate within normal limits. He has significantly reduced muscle mass over his hindend, very tight, ropey and sore hamstrings and biceps femoris. Mild buttress on right medial stifle joint. His lumbar spine is mildly roached and moderately sore to palpate, especially at T18-L2. His left elbow joint has firm boney enlargement and his left triceps muscle is extremely tight and ropey and stands not fully weight bearing on his left front. His brachiocephalicus muscles are tight and moderately sore to palpate. He stands with his elbows abducted, left more so than right. He is very straight through this hindlimbs and walks very stiff behind with poor hock flexion, his hindlimbs abduct when he travels. He occasionally has a left front lameness and prefers to amble and pace most consistently.
Medical Decision Making: Goals for his treatments were to target his hindend stiffness, particularly focusing on hip and stifle joints bilaterally, target femoral nerve, and thoracolumbar discomfort. His left triceps and elbow joint were targeted with acupuncture and massage therapy. Plan was to initially target cervical region with massage therapy since George has a very active tongue and long hair and there was moderate concern for him to try and lick out needles. We were able to introduce acupuncture in his cervical region in his second treatment session as he relaxed immediately during his treatments and tolerated the needles well.
Differential and Definitive Diagnoses: Given age and breed, suspect hip dysplasia as primary differential, however cannot rule out chronic degenerative cruciate ligament desmitis with secondary thoracolumbar pain. Left elbow dysplasia is most likely given age and breed, however, cannot rule out general OA, osteosarcoma, etc without radiographs. Overdeveloped front end is likely secondary to hind end discomfort causing shifting weight and pulling action for propulsion as opposed to power from behind.
Acupuncture Treatments: George was treated with dry needle acupuncture on a monthly basis when his owner was in town for work. His treatments were generally performed in right sternal/lateral as standing for long periods was difficult for him. Owner does not have access to laser therapy. Recommended and demonstrated massage therapy, but owner did not perform on a regular basis. Recommended owner take radiographs, declined at this time. Recommended owner put down rubber backed carpets on any hardwood or slippery flooring, especially at the bottom of the stairs to make getting up and down easier and put less strain on his muscles and joints.
– Bai Hui – calming, LS pain
– Left LU5 – local elbow pain
– Left LI 10 – elbow pain
– Left LI 11 – elbow pain
– Left HT3 – elbow pain
– Left +/- Right BL 54/GB 29/GB30 – hip pain
– Left and Right ST 36 – stifle pain, hindlimb dysfunction
– Left +/- Right BL 20, 21, 22, 23
+/- Left +/- Right BL 36/37 – hamstrings
+/- Left and Right BL10 – cervical muscle tension
+/- Left SI9 – local triceps hypertonicity
+/- Left and Right SP 10 – stifle pain
Outcomes, Discussions, References: Overall George responded very well to his acupuncture treatments. His owner reported that his energy level significantly increased in the week following his treatments. He ran up the stairs (always walked slowly), jumped much more easily into the truck and had an easier time getting up off the floor for the first few days following his treatments. His limp was reduced and did not seem to get worse again before our next treatment. His owner reported that she did not recognize the full extent of his soreness until after starting acupuncture treatments and noticing such a considerable improvement.