Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017019
A 7 year old spayed female Labrador Retriever was treated with dry needling and electro-acupuncture techniques once a week for four weeks. Results were positive in that the patient appeared to have improved over all well-being, decreased inappropriate urination and improved mobility at home according to the owner. In the exam room, the patient showed marked decrease in anxiety with consecutive treatments.
History and Presentation:
“Sydney” is a 7 year old female spayed Labrador retriever who presented for arthritis, obesity and a protein losing nephropathy that is currently being treated with Enalapril. She still has inappropriate urination at home despite treatment. Her urine sediment shows a low USG and still has proteinuria but no casts, crystals or bacteria present. The owner’s main concern is that she is starting to “slow down” and does not play with her housemate for very long before having to rest. She also has trouble getting into the car and up the stairs.
On her first presentation, Sydney is very friendly but anxious. She is obese so the myofacial palpation is difficult. She has mild arthritic changes to her stifles and hocks bilaterally with swelling and mild resistance to range of motion. Her most distinct pain can be palpated from her lumbosacral junction to her tail base. Mild trigger points can be noted in the triceps and in the dorsal cervical region. Otherwise, exam is within normal limits and she is neurologically appropriate.
Medical Decision Making:
Due to Sydney’s known protein losing nephropathy I wanted kidney Mu (BL23) and Shu (GV25) points and appropriate bladder points for spinal segment stimulation (caudal thoracic vertebrae). I also wanted to focus on the sacral points (bladder line) for her palpable pain in that area as well as for spinal segments innervating the bladder to help increase smooth muscle tone and possibly reduce inappropriate urination. As for her stifle and hock arthritis, local points spanning the joints would be helpful, especially since I can get good autonomic responses from these locations at the same time (ex. ST34/36, SP6/10). Ideally, dorsal cervical points and triceps would be stimulated for the apparent trigger points if tolerated. Owner has urinalysis and urine protein creatinine ratio repeated every 3 months. Tested lyme negative and owner has declined radiographs at this time. Blood chemistry within normal limits other than mild increase in ALP.
Differential Diagnoses for joint and sacral pain: Osteoarthritis vs Infectious/Inflammatory (ex Lyme) vs Neoplastic
Definitive Diagnoses: Protein Losing Nephropathy (historical)
I first placed GV20, GV14 and Bai Hui to see how well Sydney was going to tolerate dry needling. I started with 0.18 Seirins but due to her activity in the room, they came out almost immediately. She tolerated the needling itself well, especially when distracted with food, but she is still an anxious dog and will move about. I switched to 0.2 Carbo needles and replaced the needles with much better success. Patient did not tolerate GV25 well.
I then placed BL21, BL23, BL27 and BL28 bilaterally. There was some discomfort on placement of the caudal bladder points initially. I moved on to ST34/ST36 and SP6/10 which went well. I attempted to needle the triceps points but it seemed to make Sydney uncomfortable so I removed them. I placed BL10 bilaterally and allowed the needles to sit for 15 minutes. I did not want to push her too much with heavy needling on her first treatment. I massaged along her caudal bladder line, at GV25 and down her triceps while we waited which elicited profound relaxation.
On successive treatments, I added SI9 bilaterally and electroacupuncture from BL25 to BL28 with a mixed frequency of 4 Hz and 100 Hz. I also added more bladder line points including BL21-BL25 as she became more comfortable with her treatments.
Outcomes, Discussions and References:
According to the owner, Sydney has had less household urination incidents since the treatment started. The owner is very open about the fact that she does not provide the Enalapril judiciously due to her work schedule, but does think that the acupuncture has made a difference. Sydney had originally been urinating in the house about once a week but has gone two weeks without an incident at the time of this report.
As for the limited mobility and osteoarthritic changes, the changes were slow but very positive. However, she does play with her housemate (a young neutered male St. Bernard) for 30-40 minutes at a time now which she could not have done before. She also has the ability to “mount” her housemate which she has not been appreciated doing for over a year. Finally, she is much better at getting in and out of the car when she comes in for her treatments according to the owner.