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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/4992.

Abstract:

A geriatric Border Collie presented for myofascial exam and acupuncture treatment. The patient had a history of stiffness in the rear legs. She had been diagnosed with lymphosarcoma and the liver had been affected by the neoplastic process. The owner was seeking treatments for the dog’s stiffness and presumed arthritis as she was no longer a candidate for Non Steroidal Antiinflammatories (NSAIDS).

After receiving acupuncture treatments over several weeks the owner reported the dog was ambulating better. Her stiffness was reduced, her activity level increased and she resumed playing ball. Acupuncture seems to have helped this patient’s quality of life.

History:

Chai is an 11 year old, spayed, 44.1 pound Border Collie with reported stiff rear legs and stilted gait per owner. She is an avid ball player and experienced some stamina issues in recent months. Chai had exceptional preventative care and takes heartworm preventative regularly. She takes Denamarin for elevated hepatic values. She had a liver lobectomy to remove a hepatoma in 2015. She had no other reported trauma or surgery other than her ovariohysterectomy as a puppy. In October 2016 the owner noted Chai’s lyphadenopathy. Aspirates revealed lymphosarcoma. An ultrasound revealed Chai’s liver to be almost completely replaced with abnormal tissue. As NSAIDs are not appropriate for this patient, the owner attempted to give tramadol, which the patient resisted. She then presented for acupuncture to manage stiffness.

Physical Exam and Clinical Assessments:

The patient’s physical exam was within normal limits with the exception of generalized lymphadenopathy. Her lymph nodes remained unchanged throughout the treatment duration. She had significant fascial deficits paraspinally, particularly in the thoracic and lumbar areas along the bladder line. Her infraspinatus muscles bilaterally contained trigger points and intermittently throughout the treatment time frame. She was sensitive to myofascial palpation near the thoracolumbar paraspinal area continually. Her coxofemoral areas were also bilaterally sensitive, particularly dorsal to the greater trochanter. Placing, crossed extensor reflexes and proprioceptive assessments were within normal limits. Labwork revealed elevated Alk Phos and ALT, consistent with her condition. She was ultrasounded by a board certified radiologist and her liver was almost completely architecturally abnormal and filled with lymphosarcoma. She will begin vincristine with an oncologist when her lymph nodes become further increased. Her findings are consistent with lymphosarcoma and associated liver changes as well as myofascial sensitivity and pathology related to paraspinal fascial restriction and rear leg stiffness with probable forelimb compensation.

Medical Decision Making:

The acupuncture approach was based upon myofascial exam at each session combined with owner perception of response to treatments. By needling the fascial deficits along the paraspinal areas (Stomach Channel) the release of fascial restriction helped alleviate nerve compression of branches arising from these areas of the spine. Specific trigger points were also targeted to reduce myofibril bunching within the muscle bellies of the infraspinatus as indicated. This is a high energy breed so points were selected to increase general well-being and relaxation. This approach, along with high value treats, aided in Chai remaining calm for the treatment sessions. The remaining points were aimed at neuromodulating the myofibrils in the muscles affected by the sciatic and cranial gluteal nerves and increasing B endorphins via dry needling.  Occasionally, the sacroiliac nerves were also stimulated to help reset pain perception level. The specific goal was to decrease hip and rear leg pain and stiffness.

Acupuncture Treatment:

The points selected for acupuncture varied mildly between treatments based upon myofascial examinations. The patient was dry needled over 6 10-15 minute sessions approximately every 5-7 days. Ideally, acupuncture would have been performed twice weekly, but the patient was unavailable. Consistently, Gall Bladder (GB) 29, GB30 and Bladder (BL) 54 were needled bilaterally, along with Bai Hui. These points were to affect the hip triad and reduce pain and inflammation associated with the sacroiliac, sciatic and cranial gluteal nerves and the associated musculature. Bai Hui has the added benefit, along with Governor Vessel (GV) 14 (which was also consistently needled) of inducing a sense of well-being and relaxation. Bilaterally, BL23, BL25, BL27 and BL28 were needled as needed, determined by palpation of the paraspinal areas along the bladder line and fascial deficits that were palpable to release fascial restriction and nerve compression. Small Intestine (SI) 11 was needled directly into trigger points when a trigger point was palpated to release the myofibril bundle. This was sometimes bilateral or unilateral.  Treatments were needling only with no adjunctive laser or medication, although these were available. Myofascial massage was performed over infraspinatus trigger points. Needle type was alternated between Serin J Type #1 needles and Carbo CT-1 tubed 0.22mmx25mm needles. The Carbo needles were turned until de qi was achieved. The Serins were turned but no de qi was appreciated.

Outcomes, Discussions and References:

The patient was reportedly less stiff after treatment number 2. The owner reported extended activity and less stilted gait. She remained sensitive to palpation over the greater trochanter but the myofascial restriction paraspinally was reduced on subsequent examinations. No other treatments or medications coincided with the patient’s acupuncture treatment time frame so these results are likely due to ongoing acupuncture. The only adverse event observed was an attempt to bite on placement of the needles at BL23 over 2 sessions. Class IV laser therapy may be added later.

Clearly, acupuncture was able to neuromodulate the sciatic nerve and cranial gluteal nerve as this patient had significant relief in stiffness and pain of the pelvic limbs according to the owner. Bundled myofibrils were also released from trigger points as evidenced by the absence of trigger points and relaxation of the needles in these areas at the end of each acupuncture session. The same was observed where needles were placed for the myofascial restriction paraspinally. After most treatments, the areas of restriction would become level indicated the fascia had been released. While acupuncture cannot cure cancer, hip dysplasia or arthritis, it can provide significant control of pain and inflammation, improving the quality of life in patients.

References: 

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