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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/4950.

Abstract

Xena is a senior German Shepherd who presented with severe hip dysplasia and difficulty ambulating in her hind end. She was adopted as a hit by car stray dog eight months prior. She demonstrated remarkable physical improvement over the course of her treatment with acupuncture, massage, increased physical activity, Omega 3,6,9, Gabapentin, and Glucosamine-Chondroitin.

History Presentation

Xena is an approximately seven-year-old spayed female German Shepherd who presented as a stray dog hit by a car June 2015. The patient presented unable to ambulate well without the support of a sling during the 10-day holding period. A broken pelvis was suspected. However, when X-rays were taken, severe hip dysplasia was found on X-rays, but no other skeletal changes were found. The patient also had broken teeth and some superficial abrasions. Her hind legs were severely atrophied, and the patient was found to be very underweight overall (2/5 body condition score).  She was then adopted by myself, a veterinarian working with the shelter and animal hospital. Broken teeth were extracted, and she was treated with pain medication and harness-walked when needed for the next month.

(Hip X-rays from May 2016)

Lab work was all normal, and an abdominal ultrasound was normal.

Her ability to ambulate in her hind legs gradually improved over the next few months, but progress plateaued in October 2015. Xena was unable to chase toys or jump up on furniture, such as sofas or beds. Though Xena’s gait improved, it was still abnormal. Carprofen and tramadol appeared to make minimal difference to her gait, energy or relative comfort and it was discontinued in October 2015.

Overall, her quality of life appeared good, though she was not allowed to go on long walks and was not allowed to play ball with the other resident dog, another adult German  Shepherd.  Xena’s hind leg gait remained abnormal, and she tired quickly when taken on walks. However, Xena did not appear to be limping or pained either at home or during walks.

Xena was assessed by two orthopedic surgeons, with the goal of a total hip replacement surgery, but she was deemed a non-candidate because of the amount of distraction between the head of the neck of the femur and the acetabulum. The only surgical alternative was a femoral head ostectomy, which is a salvage procedure.

After attending the MAV acupuncture clinical intensive April 2016, we decided to try more intensive multimodal management before pursuing a femoral head ostectomy.

Medical Decision Making

I decided to use a whole body approach to Xena’s wellbeing and rehabilitation and focused on building muscle, increasing fitness, and putting her on a steady regiment of Omega 3,6,9 fatty acid supplementation, glucosamine chondroitin, and gabapentin. I also decided to start acupuncture treatments on her.

Her myofascial exam revealed severe muscle knots and tenseness in the neck, upper back, and upper forelegs. Her hind legs had poor muscling and her hips were painful on extension. Similarly, her tail was painful when extended. She was also uncomfortable when gentle pressure was applied on her lumbar spine.

Physical rehabilitation experts recommended starting Omega 3,6,9 fatty acids, Glucosamine-Chondroitin supplements, and Gabapentin to reduce inflammation and increase general comfort level.

I started with small needles (red seirins) on only a few points to judge her tolerance to acupuncture treatments, with the goal of electro acupuncture on points on both the front and hind legs affected by her hip dysplasia.

Acupuncture Treatments

After the acupuncture clinical intensive, we started multimodal pain management therapy.  We began supplementation with Omega 3, 6, 9, glucosamine-chondroitin containing products, and gabapentin 300mg every eight-12 hours daily.

We also performed daily massage and began to do daily walks of increasing length.

We began weekly acupuncture sessions using 0.16 (red) seirin needles, starting with Bai Hui, Yintang, GB-29, GB-30, BL-54, BL-10, BL-15, BL-23, BL-25, BL-27, BL- 28, ST- 36, for two weeks, then expanding to include the forelegs as well (BL-11, BL-13, BL-14, BL-16, BL-17), Bai Hui, Bafeng, SI-11, SI-12, LI-15 and TH-14 from 5/8/16 to 6/26/16.

Bai-Hui, Bafeng, ST-36, and Yintang were selected for their generalized effects on the entire dog.

GB-29, GB-30, BL-54 were selected for hip pain focus on both sides.

BL-10, BL-15, BL-23, BL-25, and BL-27, BL-28 were bladder line points to treat discomfort and tension in her back and hip region. They were later expanded to include BL-11, BL-13, BL-14, BL-16, BL-17 bilaterally. She tolerated these treatments very well, and they were an effective way to treat her tension and discomfort.

The treatment was slowly expanded over the course of her treatments to include her front legs and shoulder region, which appeared to have the most tension and muscle knots. I added SI-11, SI-12, LI-15, TH-14 to treat foreleg and shoulder pain and tension.

I also administered gentle range of motion exercises in her hips twice a week, and practiced regular rolling massage (myofascial release technique) on Xena.

The patient tolerated needling in her hind legs much better than foreleg points, which she attempted to nip out. I slowly increased the needle size to 0.18 (yellow) Seirins, then to 0.2 Hwatos. The patient did not tolerate electroacupuncture stimulation and became restless when this was attempted. The sessions took place over 8 weeks (8 sessions).

Gradual improvement in muscle tone, strength, and flexibility were observed. The patient overall seemed more energetic and began to use her hind legs more readily.

Outcomes, Discussion and References

Over time, Xena’s ability to ambulate has steadily improved.  She has gained weight (from 47 to 55 lbs, BCS 2.5/5) and increased muscle tone, and overall become more active. Her walks have increased in length from two blocks to 10 blocks comfortably, without any limping or lameness.

I have noticed that she is now able to jump onto the bed, into my lap, and up and down in excitement when I come home. She is also able to jump up on the couch and in and out of vehicles unassisted. When she is taken outside to play fetch with the other German Shepherd in my household, she often runs quickly enough to reach the ball first.

While it is likely that the other modes of pain management played a role in her improvement, she had previously been managed with tramadol and carprofen with minimal improvement. It is far more likely that the acupuncture treatments, physical therapy techniques, massage, and increase in low impact exercise played the greatest role in her recovery and rehabilitation.

Jaeger, Larsen and Moe, 2005, found a correlation between acupuncture (in this case, implantation of gold beads), and improvement in clinical signs of hip dysplasia in canine patients of both genders and all age groups.  Haltrecht (1999) reports that musculoskeletal problems like hip dysplasia tend to respond well to acupuncture treatment. They recommend a protocol and time table similar to the one used on Xena.

Janssens (1986) also reported that the hip joint, knee joint and shoulder joint of the dog tend to be particularly responsive to acupuncture, and that the average number of treatments for each patient tended to be two-five treatments.

This case has been instrumental in understanding that adequate quality of life is distinctly different from great quality of life. Xena is now at least as physically able and willing to fetch a ball, jump, and play as her canine companion who does not have orthopedic problems, which is an unexpected outcome.  A quiet, relatively sedate dog has become an energetic and active dog, who is interested in playing with toys and going on long walks.

Therefore, I conclude that the improvements in Xena’s mobility, hind limb strength and comfort are likely due in large part to her acupuncture treatments.

Xena, pre-treatment and preadoption. BCS-2/5 with severe muscle wasting in the hind end, superficial abrasions and severe hind leg lameness. Photograph from June 2015

Xena during acupuncture treatments, distracted by a small rodent in the room.

Xena post-acupuncture treatments, successfully able to jump on the couch and bed (her favorite spots now). 8/19/2016

Bibliography

Haltrecht, Helaine. “Veterinary Acupuncture.” The Canadian Veterinary Journal 40.402 (1999).

Jaeger, G. T., S. Larsen, N. Soli, and L. Moe. “Double-blind, Placebo-controlled Trial of the Pain-relieving Effects of the Implantation of Gold Beads into Dogs with Hip Dysplasia.” Veterinary Record 158.21 (2006): 722-26. Web.

Janssens, L. A. A. “Observations on Acupuncture Therapy of Chronic Osteoarthritis in Dogs: A Review of Sixty-one Cases.” J Small Animal Practice Journal of Small Animal Practice 27.12 (1986): 825-37. Web.