Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017036
Abstract: Frosty presented with osteoarthritis (OA) along with other health issues. She receives laser therapy at the referring veterinarian (rDVM) and came to us for supplemental treatment including acupuncture. These treatments work to decrease her pain, which has allowed us to perform other therapies to improve her range of motion (ROM) as well as her quality of life.
History and Presentation: Frosty is a 13 year old female spayed Australian Shepherd mix who presented to our practice six months ago with OA, diverticulitis, hepatopathy, hypothyroidism and a history of previous obesity. She receives laser therapy twice weekly at the rDVM as well as acupuncture and underwater treadmill (UWTM) with our practice on a regular basis. Last month Frosty’s treatment was transferred under my care to see what more could be done.
Physical Examination and Clinic Assessments: Frosty presents bright, alert and responsive at each session. She has stage 4 dental disease, a heart murmur, and severe OA with decreased ROM. Her gait is stiff with minimal joint flexion, abducted elbows, and a straight stance in her stifles. Frosty doesn’t enjoy being touched and becomes very tense even when being pet. She consistently has a tight neck and back with taught bands throughout.
Medical Decision Making: Our goal is to make Frosty more comfortable. This includes targeting her painful joints as well as her neck and back which she is overusing due to compensation. We also take cues from the owner and rDVM who inform us to where Frosty is reacting each day in order to better target our therapy. This input along with the results of our musculoskeletal exam, which she receives at each appointment, guide our point selection.
Differential Diagnoses: Diagnoses could include causes of GI inflammation (diverticulitis vs gastrointestinal [GI] lymphoma), hepatopathy (diabetic vs heart disease), hypothyroidism, and inflammation of joints (OA vs septic arthritis vs spondylosis vs immune-mediated polyarthritis).
Definitive Diagnosis: Frosty is currently on thyroid medication to control her hypothyroidism and has been diagnosed with hepatopathy and diverticulitis at the rDVM. Due to her severely decreased ROM, stiff gait, age, stance, and history of obesity we concluded that Frosty has OA affecting the majority of her joints which is the focus of our treatments.
Acupuncture Treatments: It had been almost two weeks since Frosty’s last acupuncture treatment and owner felt Frosty was starting to decline so we decided to pursue acupuncture and UWTM. Acupuncture points selected were Governor vessel (GV) 14; Large intestine (LI) 15; Small intestine (SI) 9; Lung (LU) 5; Bladder (BL) 25, 36, 40, 54 & 60; Bai Hui; Gallbladder (GB) 29, 30, 31 & 33; and Stomach (ST) 36 & 40. UWTM set to 13” (inches) at 0.3 miles per hour (mph) for 2 minutes (min.), break, and then another 2 min. Plan to continue acupuncture and UWTM weekly.
Acupuncture was performed by dry needling using 0.16 millimeter (mm) Seirin needles in either 30 mm or 15 mm lengthen (depending on location of point selected) with points done bilaterally. For overall health and wellness I chose GV 14, Bai Hui, and ST 36. I included ST 36 for stifle pain, GI issues, inflammatory problems, and pelvic limb dysfunction which includes most of Frosty’s concerns. Then I focused on acupuncture points to help relieve pain from her arthritic joints. LI 15 for shoulder pain, SI 9 for thoracic limb pain, LU 5 for elbow pain, GB 33 for arthritic pain, BL 36 for muscle tension, and BL 40 & 60 for pelvic limb pain. The points BL 54 and GB 29, 30 & 31 were used for hip pain and BL 25 and ST 40 for intestinal health.
At her next session the acupuncture points selected were GV 14; LI 11; BL 18-21, 23, 25, 36, 40, 54 & 60; Bai Hui; ST 36; and GB 29 & 30. The needling method, size and point selection was the same as the previous treatment with BL 18-21 and 23 being added for comfort along her back due to compensation. I replaced LI 15 with LI 11 for elbow pain instead of shoulder pain and removed ST 40 and GB 21 & 33 because I was focusing along her back instead. Frosty was also placed in the UWTM at 13” at 0.5 mph for 2 min. break, then 0.4 mph for another 2 min.
The points selected for her next session included GV 14; LI 11; BL 60 and ST 36. I performed a smaller acupuncture session on this particular day because I added PROM (10 repetitions on each limb joint), grade I joint mobilizations for the hips, cryotherapy, as well as her usual UWTM session. I focused on main acupuncture points in order to cover pain from a wide variety of sources. Plan is for Frosty to receive acupuncture the following week.
Outcomes, Discussions, and References: Frosty continues to be on a maintenance laser, UWTM, and acupuncture treatment schedule and we perform goniometry and PROM periodically. Over the course of three months Frosty did lose flexion in her elbows, hips and stifles but she also gained extension in those joints. The owner also sees a difference in Frosty and believes she is more comfortable after her sessions. Acupuncture helps keep Frosty feeling comfortable which allows her to perform other therapies for joint health. Without acupuncture I believe Frosty would be too sore to perform some of the other exercises that we ask of her. Frosty has been a great case to study points that decrease inflammation in the joints as well as the GI tract. Furthermore, she helped me become more confident with distal limb point placement. I also feel this case corresponds with the study done by Helianthi on OA in humans (Helianthi, Dwi R., Christina Simadibrata, Adiningsih Srilestari, Edy R. Wahyudi, Rudy Hidayat. “Pain Reduction After Laser Acupuncture Treatment in Geriatric Patients with Knee Osteoarthritis: a Randomized Controlled Trial.” The Indonesian Journal of Internal Medicine 48.2 (2016): 114-121. PubMed. Web. 22 June 2017.) While they were using laser acupuncture as their method, we instead performed laser therapy alongside acupuncture needling. The research, although lacking long term follow-up, shows that acupuncture with the addition to laser does have an impact towards a better, more pain free quality of life.