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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/4921.

Case Description

Lukey is a 6-year-old Chihuahua that presented for acute onset of cervical pain after sustaining blunt trauma. He is a fractious pet that required analgesics, acupuncture, and physical therapy to regain his range of motion and quality of life.

Case Summary

Lukey responded well to acupuncture and oral medications over a course of six weeks of treatment. Initially, he was too painful to move his neck at all (left, right, ventral, or dorsal flexion); had difficulty ambulating; and was fractious, anorexic, and depressed. At Lukey’s initial exam, mild neurological deficits were noted. Neurology consultation was recommended, but declined due to financial constraints. Acupuncture along with an anti-inflammatory and opioid were prescribed at the initial exam to help with pain management.

History

Lukey is a six-year-nine-month old neutered male Chihuahua that presented for acute cervical pain and difficulty ambulating after accidentally being stepped on by one of the children in his home. He has no previous history of illness or injury. Lukey was not on any medication at the time of presentation and was extremely painful and fractious. With subsequent visits, he became increasingly tolerant of being handled and willingly accepted acupuncture treatment. He lives in a home with two larger dogs, but was able to be separated during his treatment to prevent further injury. Due to financial constraints, lab work, radiographs, some pharmaceutical recommendations, and neurology consultation were declined by Lukey’s owner.

Physical Exam and Clinical Assessments

Quiet, alert, responsive, fractious, body condition score (BCS)-6/9; Vital signs within normal limits (WNL).

Lukey presented with a crouched stance, but was unable to differentiate whether the stance was due to pain or behavioral (fearful). He was fractious upon initial presentation and allowed minimal handling at a few select points. With each subsequent treatment, he became increasingly tolerant of handling and dry needling. Head carriage was low with a decreased range of motion, as patient resisted passive head movement laterally, ventrally, and dorsally. Cervical spinal pain was noted in the C-1 and C-2 area. Placing response was present in all four limbs, but delayed mildly with generalized weakness in all four limbs. Myofascial palpation revealed extremely taut bands over the left and right cranial, dorsolateral cervical musculature with numerous trigger points. Trigger points were also noted in the belly of the infraspinatus muscle and pre-scapular muscles on the right side, noted later in the course of treatment. Otherwise, the physical exam was unremarkable.

Medical Decision Making

The points selected for use in Lukey’s acupuncture treatment plan were made based on the influence of the points on local pain (local muscular trigger points in cervical musculature, taut bands, etc.), influence of the points on local and distal neurologic function (example, Baxie and Bafeng points), anti-inflammatory benefits (like ST-36), and neurological feedback ability (GV-14, BL-10, BL-27, BL-28, etc.).

Acupuncture Treatment

Dry needling was selected for use in Lukey’s treatment plan with concurrent oral medications for analgesia and inflammation (tramadol, prednisone). Electroacupuncture was not available at the time of his treatment plan. With subsequent treatments, more needles were placed as Lukey became increasingly tolerant of treatment and handling. First, a calming point, GV-20, was placed to help relax him at each treatment commencement. GV-14 was selected for this point’s ability to help with spinal segmental pain. Myofascial palpation revealed taut muscular bands that warranted local trigger point treatment along the dorsolateral cervical muscular areas with subsequent treatments (initially not tolerated). The right side was more taut than the left on initial presentation and throughout subsequent treatments, although improvement was consistently seen with each subsequent treatment. BL-10 and BL-11 were selected for Lukey’s treatment plan to address the local cervical pain and regional muscular tension. Due to suspected intervertebral disk disease, Bai Hui was selected for this point’s ability to influence caudal spinal neurologic function. BL-27 and BL-28 were elected to stimulate the distal spinal cord via S1 and S2 spinal nerves, respectively. ST-36 was elected for a general anti-inflammatory addition to the treatment plan. Bafeng and Baxie points were elected to stimulate distal thoracic and pelvic distal limb neurologic function, respectively.

Outcome, Discussion, Conclusion, and References

Lukey showed progressive improvement with each subsequent treatment duration of four weeks. Initially, he was hesitant to ambulate or move his head at all and was difficult to approach for treatment. He could not look laterally, ventrally, or dorsally at all (this was noted as he tried to bite the veterinary technician assisting upon the first treatment, but was unable to move his head laterally for success). Lukey was also unwilling to ambulate more than two-three feet until after his second treatment. His owner noted more of an “army crawl,” even at home where he does not show signs of anxiety. At his third and subsequent visits, treats were offered and Lukey willing looked laterally, dorsally, etc., to successfully obtain them. Prednisone and tramadol were concurrently administered during the duration of treatment for anti-inflammatory (and appetite stimulant properties) and analgesic effects. Likely, these medications influenced the positive outcome of the healing process, while the acupuncture points used helped to improve function and decrease atrophy of the spinal cord (1). The trigger points placed in the dorsolateral musculature, infraspinatus, and supraspinatus muscles were treated to encourage blood circulation in the local areas where needles were placed.

References:

(1) Schoen, Allen. Veterinary Acupuncture, Ancient Art to Modern Medicine. Missouri: Mosby, 2001. Print.

(2) Robinson, Nard. “Non-Surgical Options For IVDD: Keeping Hope, And Dogs, Alive.” Veterinary Practice News, May 2011.