Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017013
Abstract: Bonnie is a 14 year old spayed female Samoyed who presented with a variety of geriatric concerns. Her owner’s primary goal was to increase quality of life. Bonnie is seen weekly and receives acupuncture with the goal of supporting her immune system, decreasing overall sympathetic tone, supporting function of her gastrointestinal and genitourinary systems, decreasing pain and increasing neurologic function of her rear legs. Because Bonnie has so many issues, her treatment can change weekly. Her father feels that acupuncture has increased her comfort level, rear leg function and appetite quite well. Her diabetes appears well controlled at this date. She still has some issues with chronic ear infections that have been flaring up in recent weeks.
History and Presentation: Bonnie is a 14 year old spayed female Samoyed who presented with a variety of geriatric concerns as well as chronic health issues including: urinary incontinence (since spayed at 8 months), diabetes mellitus (dx 2013), recurrent urinary tract infections (2013-2017), allergic skin disease (all her life), sensitive stomach (propensity toward gastritis – all her life), cataracts (dx 2013), osteoarthritis in hips and elbows (dx 2013), thoracic and lumbar spondylosis (dx 2013), and cognitive dysfunction (recent concern of owner). Her owner’s primary goal in seeking out acupuncture was to increase quality of life. She currently is taking the following medications: Galliprant 60mg SID and Humulin N 13u BID. She has just finished Ciprofloxacin and Amoxicillin for a severe urinary tract infection and the owner recently stopped giving joint supplements for fear they were upsetting her stomach or decreasing her appetite. According to her owner, her primary challenges are the following: rising from lying to standing when on slippery floors, stairs (slow to go up but especially unsteady going down), getting into the car, decreased/inconsistent appetite, and she lags behind or doesn’t want to go on walks or play at dog park like she used to.
Physical Examination and Clinical Assessments: Crepitus L and R elbow (worse on L), Decreased shoulder extension (bilateral), +++ Trigger Points in Latissimus (bilateral), Moderate pain with ventral pressure T8-12, Moderate pain L6-7, mild CP deficits in rear limbs (bilateral), Crossed extensor reflex present in rear (bilateral), Pelvis feels cranio-dorsally rotated on L. Heart and Lungs wnl. Moderate dental tartar. External ear canals mildly thickened with mild amount waxy debris.
Medical Decision Making: I wanted to come up with points, both central, peripheral and myofascial that could address Bonnie’s variety of conditions. My main goals were to support her immune system, decrease sympathetic tone and address the neurologic deficits in her rear. I also hoped to support genitourinary system with peripheral and central points in the rear that would also simultaneously address neurologic deficits. Finally, Bonnie has significant myofascial dysfunction in the cranial half of her body associated with overuse and unequal bearing of body weight in response to pain and neurologic deficits that must be addressed to improve quality of life. I made a list of potential points to consider: GV 20, 14, 4, Bai Hui; IVDD/Rear leg deficits – BL 18-25, 62, Bafeng, any points that stimulate sciatic nerve; Hips – BL 54, L-S Bladder Points, BL 62; GB 29-30, Bai Hui; Elbow – C6-T2, GV14, BL 10-12, LI 10-11, LU 5, SI 8; Digestive – Stomach Mu CV 12 & 22, Stomach Shu BL 21, PC 6, ST 36, SP6; Allergies/Immune Modulation – GV 20, 14, 4, Bai Hui, ST 36, PC 6, SP 6, BL23, LI 4, LI 10 & 11; Genitourinary Function – Lumbosacral points, BL 28, Bai Hui, BL 40, BL 60, Local trigger points; Electro-acupuncture could be beneficial.
Differential Diagnoses: Only new diagnosis at first visit: IVDD based on presence of CP deficits and crossed extensor reflex in rear; At future visits an acute on chronic ear infection was addressed.
Definitive (or Putative) Diagnosis (or Diagnoses): IVDD, osteoarthritis, diabetes mellitus, recurrent urinary tract infections, allergic otitis and skin disease, and cognitive dysfunction
Acupuncture Treatments: Bonnie is seen weekly at this time. At her first visit she was fairly nervous so the following points were chosen: GV 20 & 14, BL 16-20 & 23-25. I also did some grade 1-2 mobilization of spine and pelvic/sacrum, tail traction, therapeutic laser and massage of shoulders and latissimus (bilateral). We discussed adding electroacupuncture at a future date. Second visit: Grade 1-2 mobilization of spine and pelvic/sacrum, tail traction, GV 20, 14, 4 and Bai Hui; BL 18-21, 24-25, BL 54 & 62; ST 36 & 34 (L), PC 6 & LI 11 (L), laser and massage trigger points in latissimus and shoulders (bilateral). Third visit: similar to previous visit but able to do ST 36, PC 6 and LI 11 (bilateral). Fourth visit: similar to previous but added Bafeng on right hind (not able to get to left hind due to patient position). 5th visit: Patient was seen during
past week for severe otitis externa and superficial pyoderma – being treated topically by another vet. Acupoints chosen were similar to previous but added surround the dragon for both ears (TH 21, SI 19, GB 2, TH 17, GB 20).
Outcomes, Discussions, and References: Bonnie is an interesting case because she has such a variety of conditions and it was a challenge to try to find points that addressed multiple issues, simultaneously. Acupuncture is an ideal treatment for her because you can address both the myofascial and orthopedic/neurologic conditions, as well as the the internal endocrine, GI and genito-urinary issues at the same time. In general, her owner feels that she is less ataxic and is much more comfortable than prior to treatment. Additionally, she is eating well despite currently being on oral antibiotics which her owner says almost always causes gastritis. As a future goal, I would like to help more with her otitis and allergic skin disease. She is already on a hypoallergenic food and takes Apoquel. I have considered using the laser on her ears the next time she gets an infection and have discussed ear cleaning.
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