Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017043

Abstract:
In this case, I was working a horseback riding club, on a 27 year old quarter horse gelding named Peanut. Peanut’s job is to serve as a slow paced, gentle ride for children and adults with special needs. Over the last several weeks, Peanut has been acting cranky when saddled. As a result, he has been stall rested since March 2018. Peanut is afforded excellent husbandry through quality diet, dental care, and hoof maintenance. The facility maintains excellent conditions and a safe environment for this horse.

After utilizing a combination of acupuncture and class IV laser therapy over 5 treatment sessions, Peanut has shown moderate improvement in demeanor, mobility, and pain. As of June 4, 2018, Peanut has been saddled and ridden at a gentle walk by an instructor every few days.

History:
Peanut is a 27 year old quarter horse gelding who provides weekly rides to children and adults with special needs. This horse was donated to the Equestrian Center several years ago. Previous medical history is unknown. Instructors at the riding center began noticing his demeanor increase in stubbornness over the last several months.

Physical Exam:
HR: 40 bpm, RR: 12 breaths/min, BCS 6/9, MM: pink/moist
The exam took place in a roping arena with soft, loose, dirt ground. The patient was led by an instructor and only walked. Peanut is never asked to trot or gallup with riders, so at a walk, no obvious lameness was observed. Obvious lordosis is present, as is a pendulous abdomen. The coat is normal. No significant abnormal findings on forelimbs, however both rear legs have mild peripheral edema around the hocks. Mild sensitivity was observed on dorsal back flicking, and upon rotational bending of lumbar vertebrae. Neck rigidity was noted with difficulty turning neck right and left in the C3-C4 region. Myofascial trigger points were observed along the bladder line, especially between BL16 and BL20. Exercise intolerance had to be considered, but given Peanut’s job expectations, it was difficult to determine. No obvious weakness, proprioceptive deficits, or ataxia was observed.

Medical Decision Making:
My first objective was to perform some dry needling at points to neuromodulate the parasympathetic nervous system. I wanted to determine how receptive the patient would be to acupuncture. Points like GV20, Bai Hui, and LI 16 were my points of choice to begin. I wanted to neuromodulate the cervicothoracic spinal nerves for neck pain and anxiety. I wanted to target some points down the bladder line to neuromodulate the mid thoracic spinal nerves and caudal thoracic spinal nerves for areas of local pain. I also felt this was an excellent opportunity to utilize class IV laser therapy down the dorsal back and over the cervical spine to increase blood circulation, promote analgesia, and accelerate the healing process.

Differential Diagnoses:

Osteoarthritis, Intervertebral disc disease, saddle fit issues, hereditary lordosis, gastroduodenal ulceration, congestive heart failure, myocarditis, cardiomyopathy, spinal tumors, parasitism

Putative Diagnosis:
Definitively diagnosing what is causing symptoms in this patient is difficult for me. I can assume saddle fit pain is causing some myofascial restrictions over the back, and that a combination of osteoarthritis and intervertebral disc disease could be occurring in the cervical spine and thoracolumbar spine. I found no neurologic deficits to make me think I was dealing with LMN or UMN disease, and can come to the conclusion that this horse is likely dealing with a number of degenerative processes. The mild peripheral edema around the hocks could point to local joint inflammation, cardiovascular disease, neoplasia, vasculitis, parasites, or other organ insufficiency. I am not equipped to perform imaging on this patient, and bloodwork was declined.

Acupuncture Treatments:
Treatment 1): To begin by increasing vagal tone, I dry needled Bai Hui and GV20. GV20 was used to decrease sympathetic tone by autonomic crosstalk with the vagus. I also used LI17 to decrease anxiety, for local pain, and to see how the patient would respond to acupuncture. LI17 is a reasonably safe starting point and activates cervicothoracic spinal nerves. I then proceeded to placing a few bladder points, like BL16 and BL17, to target mid thoracic nerves. At this point, I hit obvious trigger points that produced severe panniculus twitching and agitation. Seirin 0.2 x 30 mm needles were used and removed after approximately 5 minutes.

Treatment 2): I once again used Bai Hui, GV20 and LI17 points, but this time I used 0.16 x 30 mm needles. I waited 10 minutes and attempted placing the same size needles at BL16 when Peanut once again became extremely agitated. From this point, we walked him to some stocks where needles could be removed. After another 10 minutes, laser therapy was initiated with Companion CTX (Class IV) over the neck and back. Peanut handled this well and I was able to deliver 8000 J to the neck using 12 W power on continuous rate over 13 minutes. Over the back, I delivered 15000 J, using 12 W power on continuous rate over 27 minutes.

Treatment 3): Peanut was placed in the stocks and treated over the neck and back with the CTX laser at the settings mentioned above.

Treatment 4&5): Acupunture laser points were targeted with 2 W power, delivering 12 J over 12 seconds at a pulsed rate of 2 Hz at Bai Hui and LI17. The neck and back were again treated with the CTX at the settings mentioned previously.

Outcomes:
Peanut was very receptive to class IV laser therapy. Although he did not tolerate dry needling well, I believe the class IV laser therapy was a great alternative method to achieve pain relief . Dry needling seemed to consistently make Peanut very agitated and difficult to work with. The CTX laser was used to increase circulation, promote analgesia, reduce fibrous tissue formation, improve nerve function, and increase cellular metabolic activity. Photobiomodulation helped relieve pain by increasing Beta endorphins, decreasing bradykinin, normalizing ion channels, and helping normalize nerve signal transmission in the autonomic, somatic, and sensory neural pathways. Peanut will never be asked to perform at a higher level than gentle riding, but his behavior has improved. He also seems to be less sensitive in his neck and back after his therapy.


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