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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/4973.

Abstract:

A middle-aged Beagle presented with a history of diagnosed cervical spinal pain. Acupuncture treatments focused primarily on forelimb, cervical and thoracolumbar points.  Results were immediate and lasted approximately seven to ten days. Recommendations were made to continue treatments while adding other medical management options, including laser therapy and at-home massage.

History & Presentation:  Frankie a 7 year old, male neutered, Beagle adopted in June of 2015 as a “failed” hunting dog. The adopting family are avid dog owners and initially surprised at how quiet Frankie was. He seemed to break the “Beagle stereotype” as they had never witnessed a howl or bark. Frankie refused to go for walks and spent much of his day laying down. The family assumed that the lethargy was a personality trait and were not concerned until a few weeks later. A collapsing episode resulted in a trip to the emergency clinic and a neurology consult. Magnetic Resonance Imaging (MRI) discovered a disk protrusion at his sixth and seventh cervical vertebrae with a moderate amount of ventral and right-sided cord compression.

Frankie was started on medical management and responded well. He was able to avoid surgery and was soon found to be running, barking and playing more eagerly. He was weaned-off  both Prednisone and Gabapentin and continued to do well without any intervention and minimal exercise restriction.

Frankie’s family recently noticed his demeanor becoming more quiet again.  There was less toy playing, running and excitement for walks. He avoided stairs and jumping on furniture. Frankie presented to our clinic for further treatment options of his suspected spinal discomfort. Other than monthly preventatives, current medical therapy included daily Dasuquin.

Physical Examination & Clinical Assessments:

On presentation, Frankie appeared quiet and preferred to lay avoiding interaction unless coaxed. This demeanor was reportedly normal, especially over the last six months. He had mild dental disease and was moderately overweight. There was no evidence of lameness nor neurologic deficits. He has had no further episodes of collapse reported since September of 2015.    Myofascial palpation highlighted multiple regions of concern. There was tension and taught, ropey bands along both cervical regions (brachiocephalicus and trapezius mm). Initially, no obvious trigger points were appreciated along his thoracic or lumbar spine. However, points along his thoracolumbar junction were later identified at follow-up treatments. Muscle condition was good and without any signs of significant or asymmetric atrophy. Most impressive was the extent of fasciculations on the lateral thoracic regions brought about by only light palpation.  This was repeatable and easily visualized. No further diagnostics were pursued other than ensuring baseline lab work and in-house tick panels were normal.

Medical Decision Making:

Myofascial examination demonstrated changes expected from the patient’s history of chronic intervertebral disc disease. Initial treatment was designed to focus on introducing the patient to dry needling as well as addressing cervical pain issues. Subsequent treatments were designed to broaden focus areas as chronicity and overcompensation had taken a toll. The suspected two intervertebral sites seen on MRI had effected the patient’s cervical carriage, shoulders and forelimb load-bearing as well as his lateral thoracic musculature.

Dry needling at various forelimb points was aimed to help reduce muscle tension and increase blood flow to these sites. This would in-turn help diminish the patient’s chronic pain and  attenuate inflammation. Acupuncture points focused more specifically at the known injury (6th & 7th cervical vertebrae) would treat the nerves and fibers correlating with these spinal segments.

Acupuncture Treatment:

Frankie received three acupuncture treatments which all included dry needling followed by massage. The patient was placed on thick-bedding in a quiet room with dimmed-lights. Seirin 0.18x30mm and 0.18x15mm needles were used and all points were needled bilaterally when applicable. Treatments were limited by the owner although weekly sessions were recommended.           The initial treatment (performed on 11/12/16) focused on introducing the patient to needling and assessing his general reaction. Calming points were selected including Bai Hui, Governor Vessel (GV)-14 and GV-20. Points which focused more specifically on cervical discomfort included GV-14, Bladder (BL)-10 and BL-11. Finally, BL-23 was chosen to help cover for any thoracic and/or lumbar pain that was likely present due to chronic over-compensation. The second acupuncture session (performed on 11/21/16) included all previously-used points. In addition, Gallbladder (GB)-21 and Small Intestine (SI)-12 were added to help with any regional shoulder discomfort caused by altered cervical carriage. The final treatment (performed on 12/21/16) included all previous points from the first two sessions. Shoulder discomfort was addressed as before, however, SI-11 was also added for more extensive coverage. Trigger points were identified and treated at BL-21, BL-22, BL-23 and BL-27.

Outcomes, Discussions, References:

Frankie proved to be a fantastic acupuncture candidate. He appeared less anxious and would often fall asleep to the point of snoring during treatments. No adverse events were noted. Myofascial changes were appreciable even before removing needles. Fasciculations previously seen with gentle palpation along the lateral thoracic regions were no longer noted. Video was taken to demonstrate the immediacy of treatment benefits.

The owners reported large improvements in overall demeanor and activity. Evenings that typically consisted of laying on the couch, now became running up and down the stairs and playing with toys he hadn’t touched in months. Owners also reported that on multiple occasions he stole from the trash and laundry. This behavior hadn’t been seen in over a year and was previously thought to have resolved due to progression in age and successful training.

We are confident that improvement was due to acupuncture as no other changes were made. Correlation with increased activity was evident as effects seemed to dissipate 7-10 days following treatment. We discussed dependable scheduling of appointments (i.e. every 7-14 days) would likely result in more consistent pain control. Laser therapy, in conjunction with acupuncture and massage, would also likely enhance and extend relief. Finally, weight management and avoidance of cervical collars were recommended.  At home-massage therapy was also discussed to promote benefits between treatments.

Relief can occur even from a single session of acupuncture. Previous research has explored whether the number of points correlates with degree of success. Subjectively, Frankie appeared to have as much improvement from his first as his last treatment which included many more points. Regardless, this case study demonstrates that acupuncture does not have to include treatment of every applicable point to achieve an attainable benefit. Finally, it reinforced the importance of serial myofascial examinations before, during and after needling as well as week-to-week.

References:

 Chu J, Schwartz I. The muscle twitch in myofascial pain relief: effects of acupuncture and other needling methods. Electromyogr. coin. Neuroohysiol. 42: 307-311, 2002.

MacPherson H, Maschino AC, Lewith G, Foster NE, Witt C, et al. (2013) Characteristics of           Acupuncture Treatment Associated with Outcome: An Individual Patient Meta-Analysis of 17,922 Patients with Chronic Pain in Randomised Controlled Trials . PLoS ONE 8(10): e77438. doi:10.1371/ journal.pone.0077438

Robinson, Narda, DO, DVM. “An Emerging Standard of Care for TL IVDD.”  Veterinary Practice News 21 May 2013. Web. 11 Feb. 2017.

Robinson, Narda, DO, DVM. “Non-Surgical Options For IVDD? Keeping Hope, And Dogs,  Alive.” Veterinary Practice News 23 May 2011. Web. 11 Feb. 2017.