Written by a Medical Acupuncture for Veterinarians course graduate. Signed release obtained from client/author. A2017015

Abstract:
Brief Description of the Case
A 10-year-old neutered male Black Labrador/German Shepherd Cross was presented for an unwillingness to run and jump as well as difficulty rising from laying down. He was previously diagnosed with spondylosis along the thoracolumbar spine. Upon presentation, he was painful in his neck, thoracolumbar spinal cord region and coxofemoral joint regions. Acupuncture, electrical stimulation, massage, kinesiology tape, joint supplementation, a prescription joint diet and an orthopedic dog bed were used as treatment modalities. Acupuncture points included BL-54, GB-29, GB-30, ST-36, GV-14, GV-20, BaiHui, and multiple trigger points along the neck, thoracolumbar spine and hind limbs. The second and third treatments included electro-acupuncture.
Brief Summary of the Results
The dog improved significantly after the second and third treatments. The owner reported that he was now jumping, running, and playing just like he used to as a younger dog. His stiffness when getting up was reduced considerably.

History Presentation:
“Harlow”, a 10-year-old neutered male Black Labrador/German Shepard Cross was presented to the veterinary clinic for two years of difficulty rising from a down position, less energy than he had in the past, and an unwillingness to run and jump as much as he used to. He was a farm dog that ran behind the horses for many miles per day since he was a puppy. Harlow had been kicked a few times in the past but no broken bones that the owner was aware of. In May of 2016, he had exploratory abdominal surgery for the removal of a softball-sized mesenteric abscess. At this time, he was diagnosed with spondylosis at T13-L1, L2-L3, L3-L4, and L4-L5. Otherwise, Harlow had been a healthy dog and was up to date on his canine viruses vaccination, rabies vaccination, and was regularly dewormed.

Physical Examination and Clinical Assessments:
7-04-17- On physical examination, all vital signs were within normal limits and Harlow as bright, alert and responsive. His temperature was 101.2’F, heart rate 100 beats per minute and respiration rate of 60 breaths per minute. His heart and lungs auscultated apparently normal. Harlow’s body condition score was 5/9. The owner reported that he had been eating, drinking, urinating and defecating appropriately. On myofascial examination, he had many trigger points in his shoulders bilaterally, along the thoracic spine and bilateral hips. The right wing of the ileum appeared to be more caudal than the left. He was very tense and had muscular hypertrophy around the ileal wings bilaterally.
7-11-17 On physical examination, all vital signs were within normal limits. The owner reported that Harlow seemed unchanged since first acupuncture treatment. On myofascial examination, Harlow only had trigger points in his hindquarters particularly around the wing of the ileum bilaterally.
7-18-17- On physical examination, all vital signs were within normal limits. The owner reported that Harlow seemed to regain his energy this past week and even acted like a puppy again. On myofascial examination, trigger points were found in the cervical region, caudal lumbar area, and hips bilaterally. The ileal wings appeared to be aligned.
7-21-17- The owner reports that Harlow is acting like his five-year old self again. He is excited for his next acupuncture treatment in a couple of weeks.

Medical Decision Making:
Harlow was started on Dasuquin joint supplements and Science Diet J/D dog food. The owner was told that he should have three acupuncture treatments one week apart and then every two weeks or once per month depending on how he was doing at home. Acupuncture would be targeting the coxofemoral joints, sacroiliac joints, and his trigger points. For the hind limbs, the sciatic, cranial gluteal, and fibular nerves were stimulated via acupuncture. The caudal thoracic and lumbar spinal nerves were targeted as well. Electro-acupuncture was placed surrounding the coxofemoral joints and on either side of the thoracolumbar spine to enhance the stimulation these nerves. Trigger points also had electro-acupuncture in attempts to loosen the muscle fibers and allow them to align properly. Massage was utilized to loosen dense fibrous connective tissue that could be restricting movement in Harlow’s hips from chronic pain and inflammation.

Differential Diagnosis:
Harlow was most likely painful due to the spondylosis throughout his lumbar spine, arthritis in his hips and compensation from hip pain through his shoulders and neck. Hindquarter radiographs would have been beneficial to fully assess arthritic changes in his hips.

Putative Diagnosis:
Multifocal lumbar spondylosis and coxofemoral joint osteoarthritis were most likely the causes of Harlow’s pain. This was diagnosed with the myofascial examination and radiographs. These conditions’ clinical signs matched well with the owner’s description of Harlow’s behavioral changes.

Acupuncture Treatment:
Using 0.16x30mm Seirin J-type needles, GV-14, GV-20, and BaiHui were placed. Harlow responded well to the first needles. Next, trigger points located in both shoulders were acupunctured as well as BL-20 bilaterally and trigger points surrounding the coxofemoral joints. Using 0.20×0.30mm Seirin J-type needeles, BL-54, GB-29, GB-30, and ST-36 were placed. Very similar points were used in all the following treatments with changes following the trigger points found on myofascial examination. Electrical stimulation with 2.5Hz was used after the first treatment. Harlow responded very well and slept through the acupuncture treatments.

Kinesiology tape was placed on the ileal wings and left on for 3 days to aid in myofascial release. The owner was told to massage the shoulders and hips once per day. It was important for the owner to allow Harlow access to an orthopedic dog bed so that his joints were not constantly compressed by hard concrete. A ramp should be used for Harlow to get into the back of the pickup instead of jumping. Low impact exercises such as swimming should be used instead of running for miles behind the horses.

Outcomes and Discussions:
Harlow had exceptional results from his acupuncture sessions. After talking to the owner four days after Harlow’s third acupuncture treatment, he reported that Harlow was a new dog. He was jumping into the back of the pickup truck again (although this was warned against), wanted to go swimming and horseback riding for hours and did not struggle when he attempted to get up from laying down. These positive results were a combination of acupuncture, a high quality orthopedic dog bed, joint supplements, a prescription joint diet, kinesiology tape and massage at home. Harlow had the advantage that his owner kept him very active and in a good body condition score. His owner was excited about Harlow’s future acupuncture treatments which will occur as clinical signs arise or at least once per month.

References:
1. Xie H., Preast V. Xie’s Veterinary Acupuncture. Blackwell Publishing. 2007. 341-349.
2. Millis D., Levine D. Canine Rehabilitation and Physical Therapy. 2nd ed. Elsevier. 2004. 636-640.
3. Small Animal Spinal Disorders. 2nd Ed. Elseiver. 2005. 185-186.


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