Written by a Medical Acupuncture for Veterinarians Course Graduate. Author’s name available upon request. Signed release obtained from client/author/4946.
Treatment of an older dog with known hip arthritis using acupuncture after medical management is no longer controlling her pain. Acupuncture in this dog has been an effective form of treatment and a non-invasive alternative to a total hip replacement recommended by the orthopedic specialist.
Bailey is a seven-year-old spayed female chocolate Labrador Retriever with a two-year history of difficulty rising, stiffness and trouble going up the stairs. The patient is hypothyroid and currently controlled on supplementation of Thyroxine. She is also being treated with Tramadol 150mg TID, Rimadyl 75mg BID, Free Form Fatty Acids 3412 mg SID, Dasuquin Advanced one pill SID. Bailey was also previously treated with Adequan and Gabapentin and the owner did not feel that these medications were helpful so they were discontinued. No environmental or other significant changes occurred in the patient’s life during this time.
PHYSICAL EXAMINATION AND CLINICAL ASSESSMENTS
Physical examination revealed a BCS 7/9, no overt lameness, discomfort of full extension of left and right hips, and mild iliopsoas pain on the left. Before acupuncture was started the myofascial exam also revealed significant lumbar back pain and trigger points. No other orthopedic or neurologic deficits were noted. Other physical exam findings were unremarkable. Radiographs revealed bilateral hip dysplasia with moderate degenerative joint disease. The stifles were unremarkable. In January 2015, she was referred to an orthopedic surgeon for evaluation. They recommended either continued medical therapy, total hip replacement or femoral head and neck excision. The owner planned on scheduling the hip replacement for the summer and would continue weight reduction and medical management until that time.
MEDICAL DECISION MAKING
Once acupuncture was offered the owner elected to pursue this treatment as a possible alternative to surgery. Acupuncture treatment was aimed at relieving her back pain and tension, improving her hip arthritis and alleviating the pain in her left iliopsoas area. This would be accomplished through the neuromodulation of the wind up within the spinal cord and by relieving local trigger points within the painful muscles. The plan was for treatment to be initiated biweekly until improvement was seen and then decrease her treatments based on her level of comfort.
Bailey enjoys standing for her acupuncture treatment while receiving a frozen Kong of her Hill’s Metabolic weight loss diet. She can be very anxious so she does not like to stay in one place too long. The acupuncture started with some relaxing and general parasympathetic points GV-20, GV-14 and Bau Hui. Then needles were placed in the hip triad (GB-29, GB-30, BL-54) bilaterally. For the lumbar pain needles were placed in the bladder line from bladder 22 to 25.5. The iliopsoas was addressed by placing needles in the outer bladder line from bladder 22 to 25.5 and two needles were placed locally in the area of the iliopsoas where pain was detected. Dry needling was performed using Blue Serein (0.20x15mm) and left in place for 15 minutes at each treatment. Bailey was treated twice weekly for three weeks then we attempted to decrease her treatments to once weekly. The owner reported that she was not getting around as well so we went back to twice weekly and she once again improved. Finally, we decided to try acupuncture once weekly and Companion laser therapy at the arthritis setting once weekly and she responded well to this protocol.
OUTCOMES AND DISCUSSION
The owner reports a significant response to Baileys acupuncture. She is able to rise faster and wants to go for longer walks and even gets up the stairs a little better. Her myofascial exam reveals no back pain and very few if any trigger points. She has greater extension in both rear legs and no notable iliopsoas pain on palpation. She does get a little sore the night of her acupuncture treatments but does great by the next day. Unfortunately, when acupuncture was attempted only weekly the owner said she was not doing as well. Currently she is receiving acupuncture once weekly and Companion laser therapy using the arthritis setting once weekly and consistently does well with this protocol. This case demonstrates there can be significant individual variance in treatment protocols by each patient and not all patients will be able to decrease their treatment frequency. It is easy to conclude that the favorable response of this patient’s clinical outcome was due to acupuncture since she remained on all of her other medications with no changes and without her acupuncture her clinical symptoms worsened.
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