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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/5000.

Abstract:

Amber is a 17-year-old spayed female domestic shorthaired cat with chronic osteoarthritis (OA) of the left stifle and right coxofemoral joints.  Positive changes in Amber’s comfort and gait were noted after each acupuncture session.  Benefits were most noticeable directly after treatment and remained strong for several days out.  Approximately 6-7 days after treatment, Amber’s overall visible benefit seemed to cease until her next acupuncture session was performed.

History and Presentation:

Amber was relinquished to a veterinary hospital after being diagnosed with diabetes mellitus.  Unfortunately, most of her prior history is unknown other than her previously being an outdoor cat.  Amber has mostly kept to herself in her bed and tends to move mostly at meal times and to use the litter box.  Radiographs taken in April of 2016, revealed chronic OA of her left stifle and right coxofemoral joints. A previous diaphragmatic hernia is also noted. Around April 2016, Amber had buprenorphine and gabapentin added to her daily treatments to help with her pain.  After several months of being on gabapentin another veterinarian placed her on meloxicam with blood level monitoring.  A week prior to the start of acupuncture her meloxicam was discontinued due to hematochezia and she was placed on an 8-day course of metronidazole 250 mg ¼ tab PO q12h.  Also of note, Amber will have occasional loose stool and periods where she is taken off insulin due to hypoglycemic events during blood glucose monitoring.  At the start of her acupuncture sessions her medications included: buprenorphine (0.3 mg/ml) 0.2 ml to the gum line q12h, Cosequin q12h, and glargine 1 unit q24h. Current diet: DM canned and Glycobalance dry.

Physical Examination and Clinical Assessments:

Amber is quiet, alert, and responsive and weighs 4.3 kg with a BCS of 4/9.  Mucus membranes are pink and moist with a CRT < 2 seconds.  There is no ocular/nasal or aural discharge noted. A grade II systolic murmur is present with no arrhythmia and lungs auscultate clearly with no crackles or wheezes.  Abdomen is soft and non-painful with no palpable masses/organomegally.  No overt neurologic deficits are noted.  There is diffuse muscle atrophy present and patient is walking with a stiff pelvic gait and forelimb crouching.  Myofascial examination reveals the following: vocalizing over lumbosacral region and both pelvic limbs, thickened and sensitive left stifle, tender to the touch cervical region, as well as generalized discomfort over her hind quarters.  Radiographic evidence was used as a guide in places where she wouldn’t tolerate much palpation.

Medical Decision Making and Acupuncture Treatment:

Chronic OA of the left stifle and right coxofemoral joints, as well as, an overall reactive cervical region and hind end were the main focus for acupuncture point selection.  Dry needling was the main method of treatment.  A Pantheon 4 Pro was purchased and was used in a later session and will continue to be part of the protocol in future treatments.  The main goal was to utilize neuromodulation and relieve some of her musculoskeletal pain via “nociceptive pathway inhibition at the dorsal horn and activation of descending inhibitory pathways”.[1] Prior to the initial treatment a small test session was performed on December 29, 2016 with only 3 points (GV 20, GV 14, and Bai Hui) to see how Amber reacted to the process; she handled the insertion of needles very well.  Treatments were recommended weekly for 3-4 weeks with the goal to decrease them to every other week and then monthly.

Each acupuncture session began with GV 20 for its calming and autonomic neuromodulation.  Next, GV 14 was selected for neck and back pain, anti-inflammatory effects and for her thoracic limbs which may be receiving some extra strain from her altered crouching gate. Bai Hui followed for the indications of lumbosacral pain and pelvic limb pain.  All 3 previous points were easy to access without manipulation.  BL 10 was selected for cervical pain/tension and accessibility.  BL 54 and GB 30 were chosen for hip pain and neuromodulation of the sciatic nerve.  The complete hip triad wasn’t utilized as too many needles in one area would impede other points from being placed due to a limited number of needles with cats; I found if I tried to get all 3 patience was lost.  ST 36 was selected for stifle pain, autonomic neuromodulation, and anti-inflammatory effects.  The aforementioned points were consistently used in her treatments.  The following were also used occasionally for the following reasons and if her position allowed: SI 11 (triceps trigger point), LU 5 (local elbow pain due to altered gait), GB 29 (hip pain and neuromodulating cranial gluteal nerve instead of sciatic nerve), GV 3 & GV 4 (lumbar pain, accessibility), and BL 60 (spinal and pelvic limb pain).

January 3, 2017:

GV 20, GV 14, Bai Hui, BL 54 (R/L), BL 10 (R/L), GB 30 (R/L)

January 9, 2017:    GV 20, GV 14, Bai Hui, BL 54 (R/L), BL 10 (R/L), GB 30 (R/L), ST 34 (R/L), SI 11 (R/L)

January 16, 2017:   GV 20, GV 14, Bai Hui, LU 5 (R/L), BL 54 (R/L), GB 30 (R/L), ST 36 (R)

January 23, 2017:   GV 20, GV 14, Bai Hui, BL 10 (R/L), GB 30 (R/L), ST 36 (L), GB 29 (L), GV 3, GV 4

January 30, 2017: GV 20, GV 14, BL 10 (R/L), and electro-stimulation: Bai Hui, ST 36 (R), GB 30 (L), BL 54 (L), BL 60 (L), ST 36 (L)

Outcomes and Discussion:

Amber benefited from her acupuncture sessions.  This statement is supported with consistent evaluation of gait and posture, mobility, comfort, and vocal reactions when picked up or touched.  Additionally, opinions of veterinary technicians whom see her daily and have no bias also noted improvement in her mobility and overall comfort.  This also includes the positive comments of a staff member who wasn’t aware of acupuncture being performed. Upon analysis evidenced in the videos, Amber appears to ambulate with less of a truncal sway, walk swifter with more of a continuous stride, and overall appears to seem more comfortable.  Anatomical differences, as well as preexisting medical conditions like advanced OA, prohibit her from appearing “normal.”  However, the degree in which she seems to be moving with these present anatomical changes are grounds for my recommendation to continue acupuncture.  Additionally, it is of great significance to comment on the degree in which Amber appeared to enjoy the sessions.  Amber normally does not like to receive medical treatments and can be quite vocal and resistant.  Yet, each week Amber sat very patiently throughout her session and purred. Her temperament during the sessions is an impetus that will allow me to not shy away from needling feline patients in the future.

References:

[1] White, Adrian, and Editorial Board of Acupuncture in Medicine. “Western Medical Acupuncture: A Definition.” Acupuncture Medicine 27.1 (2009): 33-35. Web.