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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/4964.

ABSTRACT:

A 10-year old castrated Grade Quarter Horse (QH) with a history of anxiety presented for management of chronic pain stemming from an injury to the medial sesamoid area of his left hind (LH) fetlock 2 years prior. Conservative therapy consisting of pasture rest and NSAIDs was not successful in resolving the Grade 4/5 lameness. In addition, the horse’s anxiety seemed to worsen along with the development of weight loss and a suspected gastrointestinal upset/ulcer. In an attempt to manage pain and secondary strain patterns, acupuncture was added to a protocol of Veterinary Spinal Manipulation/Massage (VSMT/VMRT), laser and tPEMF (targeted Pulsatile Electromagnetic Frequency) therapy. Although the acupuncture increased the efficiency of the horse’s treatments and dramatically helped manage the compensation patterns, it was not shown to significantly improve the horse’s lameness over the course of 5 weeks. The most noteworthy effect of the therapy was on the horse’s anxiety and gastrointestinal issues as the horse became calmer, developed an improved appetite and started regaining weight. This case shows that acupuncture and other alternative therapies should not be limited to use in musculoskeletal problems, but can assist in the management of horses with behavioral and gastrointestinal dysfunction in order to improve their quality of life.

HISTORY/PRESENTATION:

A 10-year-old Grade QH gelding with a long standing history of unaddressed anxiety presented for alternative treatments to manage the chronic pain stemming from an injury of the medial sesamoid area of the LH fetlock 2 years prior. According to the owner, the gelding’s insecurities render him unusable as his explosive “spooking” often results in self trauma. During one such episode, the horse developed an acute Grade 4/5 lameness which progressed into the chronic dysfunction presented here. Due to the horse’s “pet” status, a full diagnostic workup was declined at the time of injury and the severity is still unknown. A basic lameness exam revealed pain in the ligaments of and including the medial sesamoid bone of the LH fetlock. The owners chose conservative pasture rest and used phenylbutazone for pain management. After a month, the lameness was not improved, other areas of the gelding’s body were getting sore and his volatile behavior seemed to worsen. Obvious visual problems were ruled out with an ophthalmic exam but the owner still didn’t want to pursue leg related diagnostics and chose to give horse a little more time off. VSMT/VMRT with laser therapy was employed twice over the course of the next year for management of the compensation patterns and owner started to work on a relationship with the horse to create stability in his environment. At one appointment, it was noted that the horse was refusing feed and lost weight in addition to showing more erratic behavior. Sharp molar points were floated and a switch to firocoxib and probiotics for suspected gastrointestinal upset/ulcer was made but they didn’t seem to affect the horse’s behavior or weight. Traditional ulcer treatment was declined. An Assisi tPEMF Loop was used on the medial fetlock near daily and oral Aloe Vera Juice and Magnesium was added to the diet. Believing that the increased anxiety and gastrointestinal issues (weight loss and feed refusal) could be stemming from the chronic pain, acupuncture was added to the protocol with a goal of managing the musculoskeletal concerns. Upon presentation for his first treatment, the gelding was very nervous and although thinner than normal, had a stout build with relatively small feet for his size. He tended to stand either hunched up or with weight kicked forward onto his right front (RF)foot. Myofascial exam revealed extreme muscle knotting in jaw, neck, triceps and trapezius/rhomboid muscles. The paravertebral muscles of mid to lower back were very sore and the muscles of the right hindquarters were larger than the left with knotting in the adductors and over the gluteal muscles. The left quadriceps muscles were weak. Movement of his lower lumbar vertebrae, pelvis and sacrum were restricted. His RH fetlock is starting to drop in comparison to the contracted left one. When walking, the gelding short steps and lands on the toe of his LH with scarring palpated in the area of the medial sesamoid. Swelling was found in the hock and stifle joints and discomfort was noted in the RH suspensory ligament.

MEDICAL DECISION MAKING AND CASE TREATMENT:

The gelding in this case has several issues to address, but with a history of explosive behavior and anxiety, a goal of creating relaxation and balancing out his sympathetically driven autonomic nervous system had to be top priority. If the gelding accepts the initial treatments, then the focus can shift to the peripheral injury, musculoskeletal compensation patterns and the gastrointestinal disturbance in hopes of taking down pain and lessening the horse’s daily anxiety. DAY 1:  After stimulating the parasympathetic nervous system by offering treats and patiently stimulating GV24/DaFengMen, the first 25X40 Hwato needle was placed easily into GV14 for its calming effect.  20X30 Serins were then placed into bilateral GB21 for its calming influence as well as its effect on the caudal cervical/cranial thoracic nerves. Laser and massage therapy of the mid to lower back was performed using a Class IV Cube 3 K-laser with wavelengths 660, 800 and 970 at a total treatment of 2604Joules over 6:12 minutes per section in attempt to decrease inflammation of the epaxial muscles. The gelding dropped his head and relaxed his lips so treatment moved forward by placing a 25X40 Hwato into Bai Hui for its influence on lumbosacral/pelvic limb pain.  Next, 20X30 Serins were used in the stomach Shu point, BL21 for its interaction with the nerves of the stomach and for management of thoracolumbar pain. The triple heater Shu point, BL22 was chosen for its adrenal influence in hopes of modifying the horse’s stress response. The large intestine Shu point, BL25 was chosen for its effect on the intestines and local/hind end pain and BL 26 was used to release a local trigger point and again, to help with hind limb dysfunction. The left GB30 and BL40 was chosen for its local pain effects (hip/stifle) and location over the sciatic and tibial nerves respectively. The laser was then used on the RH suspensory ligaments and again over the LH fetlock and sesamoids at 1008J over 2:48 minutes to decrease pain and stimulate a cellular healing cascade. For safety reasons, laser acupuncture was performed on the lower leg. A setting of 24 J for 30 seconds per point was used on bilateral ST36 for its role in autonomic regulation, gastrointestinal issues and hind leg dysfunction. The LH ting points and areas over the abaxial sesamoid nerve were also stimulated with the laser for peripheral nerve stimulation. Massage was performed on the jaw, neck, triceps and trapezius/rhomboids to counteract the strain pattern from the horse shifting weight forward off from hind quarters. After needles were removed, adjustment of the horse’s remaining joint hypomobilities were performed focusing on the pelvis/sacrum, lower back and upper cervicals. Post treatment, the horse’s lameness was still present but he was walked calmly back to pasture. WEEK 2; Owner claimed horse displayed less anxiety and moved around a lot more than had been prior to treatment, but did run through a fence earlier that morning. The RF leg had a small skin laceration, swelling and abrasions causing a little hesitation in movement not related to the initial lameness. Myofascial palpation revealed less muscle spasm and strain pattern than last exam. Needles were placed successfully using the same protocol as before except LI16 was used in place of GB21 and BL54 was used instead of GB30 and BL40. 20X30 Serins were also placed in triceps trigger points/SI9. The RF injury was lasered for wound healing. The gelding tolerated treatments very well. WEEK 5: By the third treatment, the owner expressed her pleasure with how her horse was doing. Although he still has a Grade 4/5 lameness, he seemed comfortable and is less reactive. He is eating well, gaining weight and went up a few notches in the herd hierarchy. The horse stood patiently for acupuncture and laser/massage as in week 2. Adjustments weren’t necessary this cycle.

DISCUSSION: When faced with chronicity of injury and not having a complete diagnosis, we are at a disadvantage when it comes to targeting treatment.  Regardless of what is presented, the addition of acupuncture and other alternative therapies can positively influence a case. In this instance, the gelding’s quality of life is improving even though the lameness didn’t resolve per se. Correcting the primary injury is often the determining factor in the success of a case, but in this circumstance, success is gauged by increasing an animal’s quality of life. By looking at the horse as a whole and addressing all the imbalances whether it is compensatory pain, gastric upset and/or anxiety, correction leads to a happier animal despite not repairing the initial problem.  It was also observed that infrequent treatment with laser and VSMT/VMRT was not as effective as a regular treatment interval with the addition of acupuncture to efficiently target the nervous system in multiple ways instead of just at the level of the spinal cord and at the site of the lesion. Since treatment intervals vary between practitioners and depend on patient response, determining a treatment frequency that will maintain this horse at a comfortable level (physically and mentally) while still trying to improve the lameness we were asked to correct is our challenge now.