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Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author.

Abstract

A patient was presented for acupuncture treatment for presumed lameness after frequent stopping while hiking. Physical exam revealed that the presenting complaint was likely due to brachycephalic syndrome. While the owner elected surgical correction to treat the patient’s brachycephalic syndrome, acupuncture was successfully used as an adjunctive therapy to help with post-operative pain and anxiety.

History

Odie, a three-year-old neutered male Boston Terrier, was presented for stopping while on hikes. This behavior had been occurring since his owner started taking him hiking. The patient tended to stop most frequently on longer and more difficult hikes and during hot weather. At times, he would refuse to walk and needed to be carried. His owner had not noted any limping. This behavior did not seem to occur on short, daily walks that were 15 to 30 minutes three times a day. The patient was taken on hikes approximately twice per week in a variety of conditions, with distances ranging from two to eight miles. The patient also had a history of generalized and separation anxiety, managed with training, as well as food and environmental allergies, managed with a commercial limited-allergen diet and oral cetirizine administered once daily during allergy season. The patient also received monthly heartworm prevention and topical flea and tick treatment during summer months.

Physical Exam/Clinical Assessments

Pulse and temperature were within normal limits. The patient was mildly tachypneic, with marked inspiratory and expiratory stridor. Referred upper airway sounds were auscultated in all four lung quadrants. The nares were stenotic bilaterally, with the right slightly worse than the right. The rest of the physical exam was within normal limits. Myofascial palpation revealed mild sensitivity from the cervicothoracic junction to around T-5 along with bilateral pectoral muscle and triceps trigger points. The lumbar region was moderately painful on palpation, from L-1 to S-1 and centered at L-2. Trigger points were present bilaterally in the hamstring group muscles. The patient was well muscled, with a BCS of 4/9. Neurological exam was unremarkable. The patient was anxious during the exam, despite use of treats and low-stress handling techniques.

Serum chemistry and complete blood count were within normal limits. A lateral thoracic radiograph did not indicate any evidence of lower airway disease, but the soft palate appeared markedly elongated.

Medical Decision Making

The pain noted on myofascial palpation could certainly be a contributing factor, but given the signalment, history, and physical exam, brachycephalic syndrome is most likely why the patient was stopping while hiking. Acupuncture can treat the secondary airway inflammation, but will not address the underlying anatomic cause. Needling causes micro-inflammation, leading to increased local blood flow and myofascial release. This results in increased nerve communication by releasing neurotransmitters and cytokines. This has an anti-inflammatory and, in the case of the patient’s musculoskeletal discomfort, an analgesic effect. While this initially happens locally, it initiates cascades of neurophysiologic changes that result in neuromodulation at the level of the spinal cord and brainstem and leads to an altered perception of pain.

Exam results and use of acupuncture were discussed with the owner. She elected a referral to pursue alar wedge and soft palate resection, but was also interested in pre- and post-operative acupuncture to help with the patient’s comfort level.

Acupuncture Treatment

Points selected for the patient’s first treatment: GV 14, 20; LI 20; Bai Hui; BL 10, 13, 15. LI 20, GV 14, 20, BL 10; and Yintang were selected to influence the upper airway and reduce inflammation. GV 14 and 20 were also chosen to increase parasympathetic drive and help with the patient’s anxiety. BL-13 was selected because it is the Back Shu point for the lungs. BL 13 and 15 and Bai Hui were chosen to help with the patient’s discomfort in those regions. Dry needling was utilized. The patient remained fairly anxious during the treatment.

The patient’s second treatment occurred one week later following the alar wedge/soft palate resection surgery. The above points were needled again, with the addition of LI-4, SI-9, ST-36, HT-7, BL 22, 25, 36. LI-4 was used for the patient’s facial discomfort, as it is the “master point” for the face. SI-9 and BL 22, 25, 36 were selected for the patient’s musculoskeletal pain in that region. ST-36 was selected for immune support following surgery and as a general homeostatic point. HT-7 was added to address the patient’s anxiety. Dry needling was utilized. The treatment occurred in the patient’s home, and he remained relaxed throughout the duration of the treatment.

Another treatment was performed two days later and utilized the same points as the previous treatment. Both post-operative treatments helped with patient comfort and general anxiety level. The owner noted less nose rubbing, wheezing, and pacing, and felt that less tramadol was needed following treatment.

The patient returned one month later for an acupuncture treatment for musculoskeletal discomfort. On exam, respiratory stridor was minimal. Myofascial palpation was similar to first presentation. The same acupuncture points were utilized with the addition of BL 23 and 27 to treat lumbar and lumbosacral soreness. The owner reported that the patient was more energetic and outgoing after treatment and intends to continue monthly acupuncture treatments.

Outcomes/Discussion

Following post-operative treatment, the patient was more relaxed, with less attempts to rub his nose. The owner also reported less nasal discharge following treatment. Stridor decreased following treatment as well, though this may be due to the patient being more relaxed and breathing more slowly during and immediately after the treatment rather than the anti-inflammatory effects of the acupuncture alone. Quantitatively, the patient needed less tramadol following acupuncture. After the final treatment one month later, the owner reported a positive change in the patient’s behavior.

This case is an excellent example of acupuncture used as an adjunctive treatment. The patient’s owner was extremely motivated and elected surgical correction of the patient’s brachycephalic syndrome. Acupuncture alone could help with secondary airway inflammation, but a lifestyle change – shorter hikes, avoiding hikes during hot weather – would have been necessary for the patient’s safety. However, the owner did not want to make this change. Acupuncture did improve the patient’s post-operative comfort. Likewise, acupuncture helped with the patient’s anxiety, but it is best used in combination with appropriate training to address underlying issues, such as under-socialization and separation anxiety.