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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

Acupuncture, in combination with conventional medical treatments, was used to successfully manage laminitis pain in a horse suspected of having Equine Metabolic Syndrome.

History/Presentation

A 20-year-old Andalusian quarter horse cross gelding presented for acute onset of forelimb pain and reluctance to remain standing. He had a three-year history of bilateral forelimb laminitis each spring, upon exposure to fresh green grass. These previous episodes had been treated medically with flunixin meglumine and removal from pasture for three-six months. While never diagnosed, it was suspected that the horse had metabolic syndrome resulting in insulin resistance and predisposition to laminitis. Previous to this episode, the horse had been on grass pasture for several weeks.

Physical Exam and Clinical Assessment

Upon examination, the horse was in sternal recumbency and reluctant to stand. When encouraged to rise, he stood with his hind feet forward under his abdomen, bearing the majority of his weight on his hindlimbs by rocking back on his front heel bulbs to decrease pressure on his front toes. His rectal temperature was 100.8 degrees Fahrenheit, respiratory rate was elevated to 40 breaths/minute, and heart rate was elevated at 60 beats/minute. He had normal gastrointestinal sounds in all abdominal quadrants and was observed to defecate normally upon standing. He exhibited mild pupil dilation, suggestive of pain as well as flared nostril breathing and reluctance to move. He had bilateral forelimb flexor tendon sheath edema and coffin joint effusion. He had elevated digital pulses in all four feet, but stronger in the front compared to the hind. He was able to stand to have hoof testers applied to each of his front feet, but not the back. He was bilaterally painful over the toe and white line as well as painful over the frog and caudal heel. His myofascial examination revealed extensive triceps, gluteal and quadriceps muscle rigidity as well as stiffness and pain to palpation of his neck. He exhibited the classic “rocked back” posture, resulting in over exertion of hindlimb muscles and triceps in an effort to remove as much weight from his front feet as possible. The remainder of his physical exam was normal.

Medical Decision Making

Front foot radiographs to definitively diagnosis and assess the extent of laminitis were declined by the owner due to financial constraints. A combination of conservative medical treatment and acupuncture was decided upon.

Acupuncture Treatment

The horse was bedded deeply to provide hoof support and decrease pressure sores from recumbency. His hooves were trimmed to decrease toe pressure and maximize sole support.  Support bandages were placed on all four distal limbs, and ice boots were applied to all four feet for 48 hours. His diet was changed to only low carbohydrate soaked grass hay. The horse was given a combination of flunixin meglumine (250 mg IV every eight-12 hours for 14 days) for pain and acepromazine maleate (30 mg IM q six-eight hours for three days) for mild sedation and to decrease blood pressure. No other medication was prescribed. In an effort to decrease muscle pain and rigidity and promote normal circulation to the feet (specifically the lamina), acupuncture was performed every three-five days for two weeks. Based on the myofascial examination, the horse needed pain relief and muscle relaxation in the neck, shoulder, and hindlimb muscle groups as well as relief from laminar pain, venous congestion, and coffin joint effusion through neuromodulation of the coronary plexus/vascular ring and palmar digital nerve. Dry needling of the Ting points (HT-9, SI-1, TH-1, LI-1, LU-11) bilaterally was repeated every three days for one week before the horse became resistant to needle placement. Treatments were performed using 0.23mm x 4mm diabetic lancet needles that were placed and left in for 12-20 minutes. Dry needling of the neck muscles bilaterally (TH-16, SI-16, ST-10), shoulders/triceps (BL-11, GB-21, left SI-11, and right SI-12, left TH-14, and right LI-15) ,and hindlimb muscles  (Bai Hui, GB 30, right BL-36, and left BL-39, BL-40) provided the horse with muscle relaxation and pain relief through neuromodulation of the sciatic and femoral nerves in the hindlimb, scapular, and accessory nerve in the shoulder and cervical nerves in the neck.  These points were dry needled using 0.25mmx30mm purple seirin needles. Not all points listed were treated all at the same time, but needles were inserted and left for 10-15 minutes, then removed and placed in new locations for a total treatment period of 20-30 minutes, every three-five days for two weeks.

Outcomes, Discussions, Conclusions

Because the horse was treated with medications in addition to acupuncture, it is impossible to determine which therapy (or combinations of therapies) helped the most. When the acupuncture treatments were initiated, the horse was generally in sternal recumbency. During each of his five treatments, he stood willingly within 10 minutes of needle placement and remained standing and eating for the duration of treatment and two-three hours afterwards.  This contrasted sharply with the days he did not receive acupuncture would spend nearly all of the day down, standing only for briefs moments to urinate, with extensive quadriceps muscle rigidity and triceps muscle fasciculation. There was subjective decrease in the strength of digital pulses from the beginning of each treatment to the end and an objective decrease in heart rate from an average of 60 beats/min at the start of a session to 40 beats/min at the end of a session. Per the owners, the treatment of this laminitis episode (with the addition of acupuncture), compared to previous years resolved 10 days faster and seemed much less severe.

Despite the fact that this case of laminitis was treated with a multi-modal therapy approach, it is irrefutable that the addition of acupuncture decreased the horse’s response to pain as quantified by a decrease in heartrate and an ability to stand for greater lengths of time on the after acupuncture. Acupuncture in horses is regarded as generally safe and relatively benign, ideal for cases, such as laminitis, that are complex or don’t always respond to conventional therapies. In light of the recent increase of laminitis due to an upswing in equine metabolic syndrome and Cushing’s disease, acupuncture is undoubtedly a beneficial, scientifically validated, and useful modality for managing pain and laminitis in horses.

 

 

 

References:

Kelley, Kirstin. What You Need to Know About Alternative Medicine for Equines.  Veterinary Practice News.  Published: April 22, 2016.  Accessed http://www.veterinarypracticenews.com/what-you-need-to-know-about-alternative-medicine-for-equines/

Stacey Oke, DVM, MSc. Equine Insulin Resistance and Metabolic Syndrome. Veterinary Practice News. Published Aug 4, 2016.  Accessed at http://www.veterinarypracticenews.com/brushing-up-on-insulin-resistance-equine-metabolic-syndrome/

Paz, C.F.R., Magalhaes, J.F., H.M.F., Rocha Junior, S., Belknap, J.K., Alves, G.E.S. and Faleiros, R.R. (2016) Mechanical nocicipetive thresholds of dorsal laminae in horses after local anesthesia of the palmar digital nerves or dorsal branches of the digintal nerve. Vet J. 214, 102-108.