Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4957.
Justin presented for “getting old” and his owner wishes to improve his attitude and comfort, acceptance to being touched in his rear, and willingness to go on walks. Over the course of two treatment sessions, his owner states that he has improved to being eager to go on walks and will allow full body petting and grooming. Prior to his third treatment he had an acute flair up of chronic pancreatitis, becoming anorectic and requiring hospitalization by another DVM. During that treatment period acupuncture was used and he responded favorably, he started eating almost immediately!
Justin is a 14 year old M/N Standard Poodle retired from competitive obedience. His owner wishes to take a drug free approach in hopes of restoring his overall well being and comfort. He occasionally has difficulty jumping in the car and often lacks interest in going on daily walks. During grooming, he disapproves of having his tail manipulated in any way and does not want to be touched or pet in the hind end. He has been diagnosed with chronic intervertebral disc disease at the thoracolumbar (T-L) junction. He was on daily Rimadyl and mobility improved however, it caused gastrointestinal upset so owner discontinued its use just prior to starting acupuncture. He has a history of chronic pancreatitis, and has had several flair ups over the last year requiring hospitalization. He is on a low fat diet for maintenance.
Physical examination revealed bilateral nuclear sclerosis, several missing teeth that were previously extracted, and an abnormal orthopedic/myofascial exam. No conscious proprioceptive deficits were noted and appears neurologically sound on examination. He has a lean (3/5) body condition with sarcopenia in the hamstrings, quadriceps, and epaxial musculature. Both quadriceps and hamstrings are tender on palpation and feel ropey. He is very uncomfortable on palpation of his triceps, at the T-L region, and left coccygeus muscle region. He was also very tender with palpation around the right greater trochanter. He is warm to the touch over his T-L region as well as his sacrococcygeal joint. His pancreatitis was diagnosed based on his history of pancreatitis, physical examination findings (painful cranial abdomen), and an abnormal snap cPL test. He was hospitalized by another DVM for supportive care which included antiemetics, gastroprotectants, analgesia, and intravenous fluid therapy. I examined him on the following day and preformed his third treatment. He was not as bright or alert as normal; he was uncomfortable on palpation of his cranial abdomen and had a wet muzzle from drooling. He was tender on palpation of thoracic and T-L vertebral regions.
My approach was focused on the areas that seemed most uncomfortable at the time of treatment while maintaining an overall whole body homeostatic perspective. My goals were to reduce pain, inflammation, help restore function, and decrease discomfort of the triceps that are compensating for his weaker pelvic limbs. For his first treatment, he was lying comfortably on his left side and was not forced to move so treatment was focused on the right, recognizing that there will be some cross over affect to the left limb. To ensure he was accepting of the needles and this process, 0.16 x 30mm Searin needles were used on all points. Treatment included GV 14 for a test location and parasympathetic (PS) modification; Bai Hui for PS modulation and analgesia as it is centered over the cauda equina, LS pain, and rear leg pain/weakness. These were allowed to sit in place for a few minutes prior to proceeding. On the right BL 54 was used for local hip/gluteal pain, GB 29 for hip discomfort, GB 30 used to finish hip triad all for hip pain. GB 31 was used for local discomfort/hip pain. GB 30 was accessible on the left. Bilateral BL 20-23 was used for TL spinal segmental analgesia and there was a trigger point at L4 that was deactivated. A trigger point in each triceps region was needled and deactivated as they were no longer tender after the session. Following each of these sessions I preformed a short massage using petrissage along epaxial musculature and around hips. This was followed by gentle and relaxing effleurage along entire body that was presented to me. I explained to the owner how to perform this at home and she did this daily until the following session. Feedback was very positive from the owner, she stated that Justin’s attitude improved, he had increased mobility up/down the stairs, and voluntarily got up to go for a walk. He was much improved for the first three days but then the owner noticed increased resistance to being touched in the hind end.
One week later he received his second acupuncture treatment. He was far less apprehensive and willingly laid on the mat that was provided for him. This session was similar to the first although he had his pelvic limbs both under him so they were inaccessible. He was sensitive to palpation at his triceps, T-L region, area of the coccygeus muscle at the base of his tail, and around both greater trochanters. Treatment points were GV14, Bai Hui, and triceps trigger points, bilateral BL 54, GB 29, GB 30, and BL 20-23 all for reasons listed previously. I used Searin 0.16x 30mm for the triceps and 0.20x 40mm for all other points. Massage was preformed like the first session with the addition of massage at GV 2 to loosen the muscles locally and along the entire longissimus muscle. I then applied gentle tail traction and preformed range of motion exercises of his tail. He relaxed during this treatment and fell asleep. The owner continued to massage in the area of the coccygeus muscle and along the sacrococcygeal joint, apply gentle tail traction, and range of motion of his tail daily. She also continued massaging the entire length of the epaxial muscles, as well as the triceps, and down the hind legs. Response was again very positive! He is now allowing grooming of his tail and petting of his hind end which he seems to like (no twitching)! He is much more active, trotting on his walks (which owner is most pleased about), and at this point has been off of Rimadyl for 2 weeks. The warmth noted over his T-L and sacrococcygeal joint has resolved.
His third treatment occurred during hospitalization for pancreatitis. Bilateral PC 6 was used as the master point for the cranial abdomen and his right ST 36, the left was inaccessible. Both points were used to help with emesis, visceral pain, and appetite stimulation. BL 20 was used for anorexia and digestive issues. BL 17+1 was used as the back shu point for the pancreas, and LI 4 was massaged due to decreased tissue for needle placement. D Type 0.16x15mm needle was used for PC 6; all others used Seirin 0.20x 40mm. They were left in place for about 15 minutes. He appeared brighter following treatment and was eating food within 30 minutes!
Acupuncture and massage in this older patient was an effective alternative to conventional medical management of arthritis, pain, and general well being. According to a study in humans “Acupuncture care and usual care were both associated with clinically significant improvement at 12 and 24 month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up.[i]” Justin was my first case since completing the course. It was amazing to see how a dog that had been previously drug dependant for comfort responded very well to physical medicine modalities. It was a great bonding experience for the three of us, and treatment will continue on a weekly to every other week basis.
[i] Thomas KJ1, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technol Assess. 2005 Aug;9(32):iii-iv, ix-x, 1-109.