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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/4914.

Abstract

This case study focuses on using dry needling acupuncture for pain control in a geriatric canine patient with severe osteoarthritis. This patient has suffered from chronic OA and difficulty ambulating for several years. After her first session, the owner reported marked improvement in her ability to run and jump, as well her overall mood. The owner reported that the patient was exhibiting behaviors and decreased signs of pain not previously seen for the last several months.

History and Presentation

Fawn is a 16-year-old spayed female Chihuahua. She has a history of recurrent pancreatitis, mild liver shunt, and bilateral MPLs that were corrected with surgery several years ago. She has no history of neurologic disease. Fawn’s owner presented her for acupuncture to help with chronic pain in her back, hips, and stifles. She had laser therapy a few years ago, but has never had acupuncture. She currently takes Denamarin and Lactulose for her liver shunt, which is mild and well controlled with medications. She eats Purina EN for her recurrent pancreatitis. Due to her special diet, we did not distract Fawn with treats or baby food. The owner did not have any canned EN with her. At home, Fawn can no longer jump on and off the couch unassisted, and she uses stairs to climb on the couch.

Physical Exam and Clinical Assessment

On physical exam, she has severe OA in her hips and stifles with a stiff, arthritic gait on ambulation. Both stifles are rotated laterally. She has moderate dental disease, cataracts OU, and hyperpigmentation on her ventral abdomen – along with a few papillomas on her trunk. Her exam is otherwise WNL, including ears, nose, neurological system, abdominal palpation, thoracic auscultation, urogenital system, and lymph nodes. Her cranial nerves and limb reflexes are all within normal limits. On myofascial palpation, she has mild tension and pain, as well as taut bands in her lumbosacral spinal muscles between L-5 andS-3. She also exhibits pain on palpation of the cranial tibialis muscles bilaterally. Her front limbs, cervical spine, and thoracic spine are not tender to palpation. Her CBC/chem shows mildly elevated ALT and mild thrombocytopenia, both non-clinical.

Medical Decision Making

Because Fawn’s pain is mainly isolated to her thoracolumbar region, hips, and stifles, I decided to focus on these areas. I wanted to address trigger points as needed, as well as provide nerve and connective tissue stimulation around the areas of chronic pain.

Acupuncture Treatment

Since this is Fawn’s first time with acupuncture, I decided to start with a few easy points to see how she responded. All points were dry needled with Seirin blue needles (0.20 x 30mm). We started with GV-20, GV-14, and Bai Hui. She was agitated at first, which mom reports as normal when at the vet clinic. About five minutes later, she had settled down. I inserted the sierin blue needles into BL-27 (bilateral), BL-54 (left side only), and ST-36 (left side only). At this point, she became more agitated, so I decided to stop and not complete the hip triad. Needles were removed after 20 minutes.

Outcome

Fawn’s owner reported that night that she was able to jump on the couch without the use of her stairs for the first time in several months. A few days later, she also noted an increase in her “peppiness” and reported that she was able to jump off the couch and walk to the back door on her own when she needed to urinate, rather than pace on the couch and whine. Fawn’s owner was very pleased with her response and said that she did not expect to see results this clearly. No adverse events were noted.

Because Fawn is limited in what medications she can take due to her liver shunt, her owner was very pleased with the outcome of our acupuncture session. Acupuncture is relatively low in adverse effects, low in cost, and effective at treating muscle pain in dogs (Xie & Wedemyer, 2012). This makes it an ideal treatment for many pets, not just those limited by organ disease. Fawn is not currently on other medications and is limited by her chronic recurrent pancreatitis when it comes to taking nutraceuticals and supplements. I used points specific to the lower spine, hips, and stifle to address her specific problem areas. Acupuncture improves pain from osteoarthritis in the knee (Cao, Zhang, Gao, et al). I was pleasantly surprised by how well she improved after her first session, and it helped me gain confidence in the practice and my ability to effectively make a difference. Clinically, alternative therapies such as acupuncture, laser, and massage are some of the only options available to a patient like Fawn due to her liver condition and pancreatitis.

 

References:

Xie, H. & Wedemyer, L. The Validity of Acupuncture in Veterinary Medicine. AJTCVM. Feb 2012.

Cao L, Zhang XL, Gao YS, et al. Needle acupuncture for osteoarthritis of the knee. A systematic review and updated meta-analysis. Saudi Med J. 2012;33(5):526-532.