Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. 10D2017037

Abstract:
Acupuncture was performed on Mya, a 15 year old FS mix, for the first time with very successful results in treating hindlimb paresis and hip pain.

History and Presentation:
Mya, a 15 year old SF German Shepherd mix was presented for difficulty standing after laying down, hindlimb lameness, decreased desire to walk/play and overall discomfort primarily in hindlimbs. Pain began approximately 3 years ago but has become significantly more limiting to her activity level in the last 6 months. Mya was a very active farm dog her entire life until she began having hip pain. Mya has been treated by her RDVM for suspected hip dysplasia though no radiographs have been taken. She has been treated with NSAIDs (Rimadyl) but has not had much improvement through medical treatment.

Physical Examination and Clinical Assessments:
Observing Mya at a walk, she is very stiff and reluctant to move through hindlimbs. She has mild proprioceptive deficits in hindlimbs (slow to replace on placement tests). She has significant muscle wasting through hindlimbs and hindlimb paresis. She is reluctant to lay down and must be coaxed by owner. She has mild bilateral muscle atrophy of temporalis muscles, tight muscle band through dorsal cervical musculature on right, mild tension through bracheoephalicus bilaterally. Tight/sensitive to palpation along medial border of scapula bilaterally. Tight, ropy bands through rectus femoris bilaterally, worse on the left. Muscle atrophy through epaxial muscles of lumbar spine and sacrum. Trigger points in vastus medialis and semimebranosus. Several trigger points in bices femoris bilaterally.

Medical Decision Making:  The primary source of Mya’s pain is her hindlimbs, especially the upper limb/hip area. She does have referred pain through epaxial muscles and muscles of the neck and forelimbs as well. Neuromodulation aimed at stimulating mechanoreceptors to alleviate pain and increase neurotransmission especially to hindlimbs.

Differential Diagnoses:
Hip dysplasia
Osteoarthritis
IVDD

Definitive (or Putative) Diagnosis (or Diagnoses):
Given Mya’s signalment (older GSD) and history of progressive hip pain the most likely diagnosis is hip dysplasia and resulting OA, but owners decline to pursue radiographs so definitive diagnosis can not be made.

Acupuncture Treatments:
Mya was treated with the following acupuncture protocol once monthly for 3 months (three times total so far though owner plans to continue monthly treament).
Combination of acupuncture and electroacupuncture to the following points using 30mm .20mm coated needles:
For systemic decrease of inflammation:
GV 20, GV 14, Bai-hui,
BL 13, BL 14, BL 15 for pain/tightness along medial border of scapula
BL 22, BL23, BL 25, BL27, BL28 for neuromodulation to lumbar and sacral spinal nerves
For hip pain:
Hip triad: BL 54, GB 29, GB 30 for hip pain
Additionally trigger points found on myofascial exam were treated with dry needling using 15mm 0.23mm coated needles

Outcomes, Discussions, and References:
Owners were thrilled with Mya’s response to acupuncture. The following day after her first treatment she went with her owner down to the barn for the first time in months and was far more active than she had been in a long time. They describe her general demeanor as being happier and feel that the acupuncture treatment made her more like the dog she had been in the past. She had a much easier time getting around and was far more active playing with the other dogs and her owner.  The treatment seemed to hold very well for two weeks but even at second treatment one month later Mya had far less pain on palpation and less trigger points. She was treated with the same acupuncture protocol and results were again very pleasing to the owner.

Describe Your Medical Acupuncture Experience:
In comparing my large and small animal cases I feel that the small animal cases are more immediately rewarding. In Mya’s case especially she was visibly much happier and more comfortable just 24 hours after her initial treatment and has responded very well where traditional management with medication was not able to provide much improvement with her comfort level. When I initially signed up for the course I decided to pursue the dual track because I thought I might do some acupuncture on my personal dogs and cats, but I did not feel that I would practice on many small animals since I am an exclusive equine practitioner. I have, however, been so impressed with the response of small animals to treatment that I have treated several dogs and a few cats when I am at the farm and have been using acupuncture far more in small animals that I initially intended.


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