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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/4960.

Abstract:

I have treated Spanky for 2 years with consultation from veterinary internal medicine and surgery specialists.

History Presentation:

17yo MN Chihuahua mix

His medical history includes: Cushing’s disease, elevated liver enzymes (Alkaline phosphatase, alanine aminotransferase), degenerative osteoarthritis, collapsing trachea, heart murmur, bilateral mature cataracts, pancreatitis, urinary tract infection, left anal gland adenoma, and mild anemia. Trilostane was stopped after an overdose required hospitalization. Spanky’s anal gland adenoma eventually resolved without any treatment. Gabapentin and tramadol were prescribed for the chronic osteoarthritis but neither was tolerated well. Rimadyl was continued as needed per the internist in the face of elevated liver enzymes because it is effective and well tolerated. The pancreatitis and anemia resolved with medical management. He is on daily Pimobendan, his diet is Hill’s Low Fat I/D with boiled chicken breast. Labwork is checked every 6 months.

Physical Examination and Clinical Assessments:

Weight: 6lbs
Abnormal physical exam findings:
Overall assessment: BCS 3/9, anxious
EENT: Heavy dental tartar, increased lens opacity OU
Cardiovascular: Grade III/VI focal T5 para-sternum systolic murmurs
Musculoskeletal: Generalized muscle wasting, stiff stilted gait, grade 1-2/4 multiple limb lameness, falls to the side at a walk, but ambulatory x 4, bilateral 3⁄4 medial patellar luxation, limited neck range of motion, droopy tail
Integument: Patchy alopecia, dry hair coat and skin
Neurological: Slightly delayed pelvic limb conscious proprioception

Myofascial palpation: Gentle palpation revealed thick, tight bands along the cervical thoracic junction, small bands around the thoracic lumbar junctions. Subtle trigger points were found around the scapula and gluteal muscle groups. Shoulder, hip, and stifle palpation elicited pain.

Medical Decision Making:

I chose Spanky as my case report because of his chronic condition and necessity of pain management. I thought he would benefit largely from the acupuncture treatment.

My goal was to address Spanky’s chronic pain condition, to improve his body function and his quality of life. He is a very small grumpy old dog that does not tolerate restraint. Accurate needle placement was challenging on his little distal limbs.
His treatment plan was based on the Percutaneous Neuromodulation Therapy. The focus was on the back and myofascial trigger points that were accessible. Activate the descending inhibitory pathways by placing needles into the vicinity of nerves that conducted impulses away from the affected areas that correspond to the distal limb nerves. Because of the difficulty in keeping Spanky from moving too much, the plan to add on electro-stimulation was aborted.

Acupuncture Treatment:

The entire treatment was completed with dry needling. I started with GV 14, BL 10, 11, 12-15, 18-19, 20- 21, 27-28, BaiHui, Cervical spinal nerve points on the first visit using Seirin needles to test his tolerance, went well. At subsequent visits, I gradually adding on the following points based on how tolerant Spanky was at that particular treatment. After the second session I started using “Ching Ming” acupuncture needles 1⁄2”, 1” purchased from Taiwan, which have more significant drag. Hand needles continued to be used for the tail points.

Lumbosacral, pelvic limb pain: Bai Hui
Neck pain, tension local pain: Cervical spinal nerve points, BL 10-11, GV 14 Shoulder pain: SI 9,11,12
Collapsed trachea, heart problem: BL 12-15
Liver problem: BL 18-19
Appetite stimulation: BL 20-21
Urinary problem: BL 27-28, GV 4
Lumbar pain: GV 3, 4, BL 23, local trigger points
Sacroiliac, tail dysfunction: BL 27, 28, 35, tail points
Pelvic limb pain: BL 52, 53, GB 39
Hip pain: GB 29, 30, 31, 33, 34
Stifle pain: ST 34-36
Agitation: GV 20

Outcome, Discussions and References:

I included two videos of Spanky walking before and after one of the sessions. Before the treatment he would stumble at a walk, drag his tail. Each session after removal of the needles, he immediately starts waggling his tail, and would walk faster and better. According to Ms. Dirksen, he would fall less and the improvement persisted for several days.

I started the treatment in December 2016, performed weekly to biweekly, for a total of 5 treatments. GV 20 was always a challenge to apply, due to his size and lack of cooperation. At the last two sessions, I was able to sneak needles on SI 9,11, 12, GB 31, 33.

Spanky does not tolerate massages after the sessions. If applicable, point wise, I would like to add on LI 10, 11, 15 for his shoulder, elbow pain. Stomach and Gallbladder channel (ST 36, GB 34), for his stifle/back pain and potentially can help his liver. Ideally, laser therapy, would be added to assist in neurological recovery through neuromodulatory analgesic and neural regeneration pathways. The plan would be to start with 1-2 watts 200mW for 10 minutes on each site of his elbows and stifles where are challenging to needle.

Reference:
1. Peter T. Dorsher, The Neuroanatomic Basis of the Acupuncture Principal Meridians: Curacore
2. Narda G. Robinson, ‘Person’-alities In Veterinary Patients: Veterinary Practice News 2010
3. Kwokming James Cheng, Neuroanatomical basis of acupuncture treatment for some common illnesses: BMJ journal
4. William Boggs, Willim F. Craig, Percutaneous Neuromodulation Therapy: Curacore
5. Narda G. Robinson, A Special Touch For Dying Animals: Veterinary Practice News 2012,
6. Narda G. Robinson, Overview of Complementary and Alternative Veterinary Medicine: Merck Veterinary Manual 2016,
7. Narda G. Robinson, Acupuncture : Merck Veterinary Manual 2016
8. Huisheng Xie, Lindsey Wedemeyer, The Validity of Acupuncture in Veterinary Medicine: AJTCVM Vol 7, No.1, February 2012
9. Jeanette Ezzoa, Brian Bermana, Victoria A Hadhazy , Alejandro R Jadadb, Lixing Lao, Betsy B Is acupuncture effective for the treatment of chronic pain? A systematic review: 2000 Elsevier Science B.V.