Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 4S2018005
History Prior to coming to our clinic:
He was seen last September (2017) at his regular clinic for scooting and occasional vomiting. The scooting was due to an anal gland abscess and was resolved with antibiotics. Over the next couple of months, a variety of bland diets and probiotics was tried and his symptoms got worse. He was vomiting daily when owner sought care at our clinic, with hopes that an alternative medicine clinic had a different approach to his case.
Summary of Patient Care at our Clinic:
We started seeing Rio in January of 2018, with the owner’s complaint of daily vomiting and sometimes regurgitation. On the first visit, we ran a blood panel which was normal. The owner agreed to a dietary change with supplements to start with. Rio came back for a recheck in 3 weeks. The owner reported significant improvement, but still, once a week during the last three week, he did regurgitate food. She agreed to abdominal radiographs and ultrasound, which were normal. The owner declined doing any further diagnostics. Acupuncture was offered as a treatment option, to stimulate movement of digesta in the correct direction. Owner agreed and after just three acupuncture treatments, the vomiting/regurgitating episodes completely ceased. He hasn’t had an episode since then. He did come in one month after last acupuncture for another treatment, for maintenance purposes and owner reports that he is doing well.
History prior to us:
9/7/2017 Seen for vomiting and hunched back and anal gland infection at prior clinic. Was treated with antibiotics for anal glands and placed on bland diet. Vomiting continued weekly.
11/2/17 Seen at prior clinic for chronic vomiting/regurgitation and they ran a BLOOD PANEL and CBC which was found to be all normal.
First Visit: Jan 17, 2018
History: Owner came to our clinic for first visit, with complaint of chronic daily vomiting/regurgitation. He was currently on Z/d diet and cerenia tablets
Physical Exam (PE): all normal, Bright. Alert, Responsive (BAR). Happy puppy.
DDX: partial obstruction, infection, megaesophagus, Addison’s, gastric reflux, dietary imbalances, congenital defect, cancer, pancreatitis, renal or liver disease
Diagnostics: Blood panel all normal, including pancreatic lipase test
Treatment Plan: Owner agreed to feeding Honest Kitchen (all-natural diet) and supplementing with Standard Process Enteric and Whole Body support. She also started him on a detox blend made by Animal Essentials. Owner told to recheck in 3 weeks and to call with any concerns.
Second Visit: Feb 2, 2018
History since last visit: Owner reports that the daily vomiting/regurgitation episodes are down from daily to just once a week. She also reports that he is more energetic so seems to feel better overall, which had not been a prior concern.
PE: All normal
Diagnostics: Radiology and US (ultrasound)
Radiology – all normal
US – all normal
Owner declined doing any further testing to get to the underlying diagnostic cause of the vomiting.
DDX – we can rule out pancreatic, renal or liver disease, Addisons unlikely, no sign of obstruction or congenital problem. So megaesophagus and gastric reflux are most likely at this point.
Treatment Plan: Offered the owner referral for Internal Medicine specialist and possible endoscope procedure but owner declined. Offered owner acupuncture, explaining that I was not yet certified. She uses acupuncture herself and was excited to try this for Rio.
Acupuncture Treatment #1:
Stomach 36 – for digestive benefits (in GI mobility) and anti-inflammatory benefits (for chronic GI irritation of lining of GI tract from months of vomiting/regurgitation)
Bladder 21 – Stomach Shu Point – to enable digesta to move in the correct direction
Bladder 20 – for digestive assistance
CV – 12 – Stomach MU point – owner to massage this location daily at home between treatments.
In this case, the dog doesn’t seem to be overly anxious, just a happy wiggly puppy but just in case there is any anxiety that is relating to his symptoms, I also chose to do GV14 and GV 20 to relieve anxiety.
He is a wiggly puppy so Needles were placed in BL 20 and 21 and GV 14 and 20 but Stomach 36 was treated with a 3B laser for 5 minutes.
He was sent home with instructions to continue Honest Kitchen and all three supplements as before since we did get a significant improvement with them. Owner to massage CV 12 daily. Owner to add in cruciferous veggies as treats.
Third Visit: Feb 19, 2018
History since last visit: Owner reports no further vomiting episodes, but he is scooting. She is excited about his progress. She has been doing the daily massages of CV12
PE – all normal
DDX – most likely resolved
Diagnostics – none today
1. Acupuncture – same points as above, since we are getting such a good result, except for GV20 as he is resistant to allowing that point today.
2. Anal gland expression – normal fluid, full glands
Come in for another acupuncture treatment in 2-3 weeks. Call with any concerns. Continue with diet and supplements as before, with the exception of discontinuing the detox blend.
Fourth Visit: 3/14/18
History: The owner reports one vomiting episode since last visit, but it did occur while being watched over the weekend by a dog sitter, so owner suspected that Rio was given food or treats not on his approved diet list.
PE – all normal
Diagnostics: none today
Acupuncture – same points as the original treatment, since we are getting such a good response.
Plan: Owner to come back in one month for another treatment. Also continue on supplements and diet as is.
Fifth Visit: 4/11/18
Owner unable to stay for full visit today – just saw tech for laser treatment of ST 36 again. Rio is doing well. Owner is going to be traveling so we will not be able to schedule another acupuncture treatment until May.
Six Visit 5/9/18
History: Owner has noticed that he is scooting again. He has not vomited since the original acupuncture appointment and the owner is happy. Owner hasn’t been as consistent on his massages.
PE: all normal
Acupuncture – same points as originally done, except GV 20 and GV 14, as he really isn’t an anxious dog in the clinic and owner says he isn’t at home either. Curious to see how he does after this treatment without these points. Laser on ST 36. Pictures and video taken today to submit for case study. Client signed waiver to be used as case study.
Rio had been treated with a variety of commercial diets and cerenia, as well as commercial probiotics, prior to being seen at our clinic. His symptoms progressively got worse over that six months span. His initial treatment plan included a natural diet and supplements for GI health and he did respond positively to this, however, the symptoms did not completely resolve. After starting acupuncture treatments, though, the symptoms did resolve and he continues to do well. While we never got a definitive diagnosis, we did get resolution of the problem.
The acupuncture points were chosen because they directly correlate with the mobility of the digestive tract. All needles were seirin 16mm diameter, 30mm length for all treatment dates. The needles were left in for 10 minutes, as this wiggly puppy wouldn’t sit still longer than that at a time. The laser has preset controls so wavelength is unknown to me, but the setting that was chosen was for pain. The laser is a 3B from Erchonia. The laser was applied for five minutes at each treatment date.