Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request. Signed release obtained from client/author/4968.
Acupuncture treatments were performed on an 18 year old horse with behavioral changes and clinical signs suggestive of gastric ulcers. The goal of treatment is to lessen anxiety and improve gastrointestinal health and myofascial pathology. Acupuncture treatment began 16 months after the acute behavioral change. A thorough medical examination was not performed at the time of the initial onset. After 3 acupuncture treatments, one week apart, the patient’s behavior improved moderately.
Sully, an 18 year old Thoroughbred gelding displayed an acute behavioral change September 2015. Reasons for the change in behavior remain unknown. There were no changes in feed, routine or environment at that time. Vaccinations and routine dental care were performed annually. These behavioral changes were more consistently displayed under saddle although occasionally appeared when handled in halter and consisted of crow hopping, teeth grinding, head turning, tail swooshing, and spooking over external stimuli that he never reacted to in the past.
June 1, 2016 Sully had dental work performed by an equine dentist. Multiple steps and sharp points were diagnosed and treated. One month after dental treatment, Sully’s behavior improved by 90 %, and the owner noted him to be almost back to his normal self.
Three months later, October 2016, Sully was noted to be standing in his stall trembling, his appetite was decreased and his manure was soft. There were no changes leading to this event. This presentation remained present for two days before returning two weeks later for a 24 hour duration.
Another three months later, January 2017, Sully began to rear under saddle. Frequent teeth grinding returned. Sully was started on 100% aloe vera juice, 1 cup orally twice daily for treatment of potential gastric ulcers. Endoscopy for evaluation of gastric ulcers was declined by owner due to cost. Omeprazole treatment was declined by owner due to cost. Oral examination with dental treatment was recommended but not initiated by owner.
Physical Examination and Clinical Assessment:
Very mouthy and agitated behavior. Readily picks up all 4 limbs. Discomfort upon palpation of temporomandibular joint bilaterally, worse on left side. No discomfort or resistance noted upon lateral flexion, ventral flexion or full extension of neck. Muscle knot present within left front (LF) limb deltoid muscle and right front (RF) limb infraspinatus muscle. Discomfort upon palpation of withers and trapezius muscle, worse on right side. Lameness noted at the trot in a straight line, grade 3/5. Left hind limb lameness noted at the trot in a straight line, grade 3/5. Thorough lameness evaluation to further localize the lameness was declined by owner.
Medical Decision Making:
Approaching this case was difficult due to the owner’s financial constraints as well as resistance to thorough work up. Main differential diagnoses include gastric ulcers, primary dental pain leading to secondary myofascial pathology, primary LH limb lameness leading to secondary compensatory front limb strain, primary RF limb lameness, primary LH limb lameness, other. Acupuncture was initiated for the treatment of anxiety, presumptive gastric ulcers, and myofascial pathology.
Multiple dysautonomics occur with gastric ulcers. Inflammation will be present; the sympathetic nervous system will be in over drive. Discomfort originating within the gastrointestinal tract manifesting in outward behaviors such as teeth grinding and head turning result in temporomandibular pain and neck pain, leading to myofascial pathology and peripheral nervous system wind up. Myofascial restriction and pain within the neck can radiate toward the shoulders, causing discomfort within the trapezius muscle and surrounding tissue, resulting in front limb lameness. Primary dental pain can behave in a similar sequence, leading to the same clinical signs described above. Discomfort within the gastrointestinal tract and/or musculoskeletal system can lead to anxiety and agitation. Anxiety can lead to gastric ulcers.
Through stimulation of the vagal nerve, the pro-inflammatory effects of the sympathetic nervous system (SNS) can be dampened and the anti-inflammatory effects of the parasympathetic nervous system (PNS) heightened. Treating local trigger points invokes release of constricted muscle fibers, creating an analgesic effect. Increasing the PNS promotes a calming response, thereby reducing anxiety. Stimulating spinal nerves involving the gastrointestinal tract can promote healing of gastric ulcers via somatic visceral effects.
Acupuncture points used to target the vagal nerve include ST 7, TH 17, LI 16 and ST 36. Spinal points used to target the gastrointestinal tract include BL 21, BL 25, and BL 27. ST 36 was also used for its effect on the gastrointestinal tract. Points used to treat local pain include ST 7, LI 16, BL 10 as well as needling the muscle knot over the scapula within each front limb. Bai Hai was used for its effect on pelvic limb pain. The first three treatments were performed once weekly. Currently, treatments are being performed every two weeks. All treatment is performed using dry needling technique.
Outcomes, Discussion, References:
After the third acupuncture treatment, Sully’s behavior, including anxiety and agitation was noted to be improved. He began standing calmly without threatening to bite during halter placement and grooming. Rearing under saddle discontinued. Teeth grinding and head turning improved by 75%. RF limb lameness decreased to 1/5. LH limb lameness decreased to 2/5. Discomfort upon palpation of withers remained present.
Sully stood calmly during his 4th acupuncture treatment. These behavioral and musculoskeletal improvements are likely related to acupuncture treatment. Inflammation, anxiety, agitation, and myofascial pathology were specifically targeted as described above under the Medical Decision Making section. Due to this positive response, acupuncture treatments will be continued every two weeks with a gradual taper to the lowest effective frequency. A thorough palpation examination will be performed before each treatment to direct needle placement. Parasympathetic and gastrointestinal points will continue to be treated.
AAEP Lameness Scales
Schoen, Allen M. Veterinary Acupuncture. Mosby Inc. 2001.