Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4387
A 17 year old Domestic Long Hair neutered male cat received 3 acupuncture treatments at two week intervals as palliative care for hyporexia secondary to confirmed chronic kidney disease and suspected neoplasia. Treatments initially resulted in almost immediate return of appetite and later bowel movements that persisted for about 7 days.
Mangia (17 yo, DLH, m/n, fel) was presented for acupuncture by her owner (also a horse owner and client of the acupuncturist’s mobile equine veterinary service) after a visit with her small animal veterinarian. The cat had been losing weight for several months and at the time of the appointment with her small animal veterinarian, weighed 6 lbs 4 oz. A complete blood count and serum chemistry were performed where mild anemia and marked azotemia were discovered. The cat was diagnosed with chronic kidney disease. No other diagnostics were recommended at that time (per the owner’s recollection). In the intervening weeks leading up to the acupuncture appointment the cat’s appetite became poor leading the owner to inquire about acupuncture during a visit to check on a lame horse.
Upon physical examination the cat’s pulse (200 bpm) and respiration (20 bpm) were within acceptable limits. Temperature was not taken. The cat’s body condition score was assessed to be 2/9 and he appeared to be adequately hydrated. Abdominal palpation revealed subjectively small kidneys and a mass in the cranial abdomen (repeatable on follow-up examination) and a moderate volume of hard but normally sized feces in the colon. His hair was rough and unkempt. The initial myofascial exam revealed tenderness to palpation at the thoracolumbar junction (TL junx) and both greater trochanters. Weakness was noted bilaterally in both hind limbs but no other neurologic abnormalities were appreciated.
Medical Decision Making:
Based on history and previous diagnoses along with my physical and myofascial exams, targeted areas included those with a somatovisceral relationship to the kidneys (to hopefully improve renal perfusion), a somatovisceral relationship to the intestinal tract (to increase peristaltic contraction, relieve abdominal cramping from presumed ileus) and areas of somatic dysfunction at the TL junx and around both coxofemoral joints.
Differential Diagnoses based on history, physical and myofascial examination
- Azotemia (r/o Chronic Kidney Disease r/o proteinuric vs non proteinuric, r/o hypertensive vs normotensive)
- Intra-abdominal neoplasia.
- Hip pain (r/o coxofemoral osteoarthritis, ileopsoas dysfunction, other).
- Thoracolumbar pain (r/o myofascial restriction, IVDD, spondylosis deformans)
Diagnosis: A definitive diagnosis was not achieved in this case. Initially a urinalysis and abdominal, spinal and hip radiographs were recommended to better define the problems identified on the previously run blood work and physical exam but were declined by the owner. Thus, chronic kidney disease was suspected based on previous blood work but unable to be staged. The somatic dysfunction in the thoracolumbar region and both hips noted in the myofascial exam was likewise not better defined with imaging. Ileus was presumed secondary to probably chronic kidney disease and/or a neoplastic process in the abdomen.
The initial acupuncture treatment included GV 20 (calming), Yin Tang (calming), GV 14 (test response to needles) BaiHui (pelvic limb hip pain), GV 4 (kidney; TL junx pain), BL 23 (kidney; TL junx pain), BL 52 (kidney; TL junx pain), GB 25 (kidney; TL junx pain) and ST 36 (to promote peristalsis). The needles (0.18 mm x 30 mm Seirins) were applied by dry needling. We elected to treat him at 2 week intervals and all of these points were used at the subsequent appointments. For the last 2 acupuncture treatments BL 54 (hip pain), GB 29 (hip pain), GB 30 (hip pain) were added to better address the discomfort and dysfunction noted in the coxofemoral region.
Outcome and Discussion:
The only adjunctive treatment outside of the acupuncture treatments was the light acupressure massage of ST36 and along the “Kidney Tiara” near the TL junction. This was taught to the owner by the acupuncturist and she was encouraged to do it daily. The short-term outcome of each acupuncture treatment was gauged to be excellent. After the initial treatment, Mangia, who hadn’t eaten much of anything for about 3 days, immediately went to his food bowl and ate about 2 tablespoons of wet cat food. This improvement in his appetite was steady for about 3-4 days and then gradually declined leading up to the 2nd treatment. The 2nd and 3rd treatments were not as rewarding immediately but the owner reported an improvement that lasted for 3-4 days. The owner called about 1 week following the 3rd treatment to request euthanasia for the cat. This eventuality was not surprising considering the nature of some of the presumed pathologies and the owner was very appreciative of having another 5 weeks of what she gauged to be quality time with her pet. This case highlights the opportunity for well- received palliative care provided by acupuncture to extend quality time shared between a pet and it’s owner. It is unclear, but doubtful, that acupuncture extended this particular pets life, but it most certainly improved it and likely helped ensure a dignified end.