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Written by a Medical Acupuncture for Veterinarians course graduate. Author’s name available upon request.  Signed release obtained by client/author/4985.

Abstract:

Bodhi, an 11-year-old intact male Labrador retriever, is currently being treated with acupuncture for multifocal arthritis as well as immune support and appetite stimulation while undergoing treatment for an anal gland adenocarcinoma with Palladia.  He is responding well to his treatments with increased mobility and consistent appetite.  Since beginning acupuncture and Palladia his lung metastases have decreased in size and the primary tumor is stable.

History/Presentation:

Bodhi is an 11-year-old intact male Labrador retriever whose owner sought in-home acupuncture treatment for his arthritis (elbows and stifles) and anal gland adenocarcinoma, diagnosed the week prior when he developed a fever and was evaluated by his primary veterinarian for lethargy and anorexia.  The fever was presumed due to a secondary infection at the primary tumor site.  Bodhi was started on a course of simplicef, zenequin and metronidazole.  An abdominal ultrasound at initial diagnosis showed an enlarged sublumbar lymph node and thoracic radiographs showed multiple metastatic lung nodules.  Bodhi’s owner elected against surgery and began therapy with Palladia under the guidance of a boarded oncologist.  Previous medical history includes bilateral tibial plateau leveling osteotomies (TPLO) several years ago and enucleation of his right eye due to an infection when he was just weeks old.  Chief complaints by the owner were poor appetite, occasional diarrhea and decreased mobility.

Physical Exam and Clinical Assessments:

Significant physical exam findings included bilaterally thickened and abducted elbows and medial buttress of both stifles.  Bodhi was mildly overweight with mild thoracolumbar lordosis and discomfort with light paraspinal palpation near the thoracolumbar junction.  He had a stiff and stilted gait in the forelimbs and had trouble rising from slick floors.  Myofascial palpation revealed a very tight shoulder girdle and trigger points in both triceps, supraspinatus and infraspinatus muscles.  Rectal exam was not performed and no anal sac mass was visible externally.  His right eye was previously enucleated.  There were no other significant physical exam findings.  Neurologic exam was normal.

Medical Decision Making:

Hours prior to Bodhi’s first treatment his owner had placed topical flea control all along his dorsal midline and, as a result, bladder points were not used during his first treatment but were included in subsequent treatments.  For his first visit I focused on getting him used to needling with calming points and chose immune-stimulating and appetite-stimulating points for his recently diagnosed neoplasia and initiation of chemotherapy.  Local and trigger points were also used to assist with back pain, stifle pain and elbow pain.  Bladder points were included in the remainder of his (4 total at time of case submission) and few other changes were made to the protocol aside from varying trigger point deactivation.

Acupuncture Treatment:

Bodhi has undergone 4 acupuncture treatments, each scheduled 7-10 days apart as his owner’s schedule permits.  Dry needling has been used for each visit with 0.16 x 30 mm and 0.20 x 30 mm needles.  Initial needles were placed at calming points to help Bodhi relax, which included governor vessel (GV) 14, GV 20 and bai hui.  Bladder (BL) points were then selected based on posture (lordosis around thoracolumbar junction), a tightened shoulder girdle, and other areas sensitive to palpation.  These points included BL 12, 13, 14, 21, 22 and 23.  BL 25 was also selected to modulate his mild diarrhea.  To address trigger points in his forelimbs (supraspinatus, infraspinatus, triceps) small intestine (SI) 11 and SI 12 were used along with specific trigger points in the long head of both triceps muscles.  To address the long-standing degenerative joint disease in his elbows and stifles several regional points were selected and varied at each treatment based on accessibility with his positioning.  Elbow points included large intestine (LI) 11, pericardium (PC) 3 and triple heater (TH) 10 while stifle points included stomach (ST) 34 and ST 36.  ST 36 was used in each treatment for appetite stimulation and immune-modulation.  Other immune-modulating points were also selected due to his neoplasia and chemotherapy treatment and included LI 4 and spleen (SP) 6 (in addition to already mentioned GV 14, GV 20 and ST 36).  Additional points used include lung (LU) 1 to modulate lung metastases and BL 60 and bafeng for back pain.

Outcomes/Discussion:

Immediately following his first treatment, Bodhi jumped up into a recliner he had not been able to get into for several months and fell asleep.  At his second treatment Bodhi’s owner reported he had an excellent appetite and his diarrhea had become less frequent. He is currently going for longer and more frequent walks than he was prior to acupuncture treatment. From these outcomes I learned how quickly the results from acupuncture can take effect and the degree to which owners can see a difference.  Between his third and fourth treatments Bodhi was seen by his oncologist.  His lung metastases had decreased in size and number and his primary tumor was stable.  A complete blood count (CBC) was within normal limits, indicating no adverse bone marrow events from the Palladia. These outcomes were encouraging and further helped me understand the benefits of acupuncture for cancer patients and, specifically, its neuromodulatory effects on the immune system.  A recently published journal article evaluated the effect of acupuncture on myelosuppression in patients with colorectal cancer undergoing chemotherapy.  The acupuncture group had a 1.5-fold reduction in leukopenia and neutropenia rates compared to the control group, as well as a 2-fold increase in natural killer (NK) cell rates (1).  These effects are thought to be a result of acupuncture inducing the release of endorphins through stimulation of the hypothalamic-pituitary-adrenal axis and consequently influencing immune cells by binding to opioid receptors on the surface of those cells and promoting expression of cytotoxic molecules from NK cells (2, 3).  Though research in veterinary patients is more scarce, it can be inferred that similar effects could be expected in cancer patients such as Bodhi.  Further medical research is warranted for evaluating the immune-modulating benefits of acupuncture for veterinary oncology patients.

References:

  1. Pais I, Correia N, Pimentel I, et al. “Effects of acupuncture on leucopenia, neutropenia, NK, and B cells in cancer patients: a randomized pilot study.” Evid Based Complement Alternat Med, vol. 2014, Article ID 217397, 9 pages, 2014.
  2. Levy. “The acupuncture approach to the hypothalamus-pituitary-adrenal axis and its interaction with the sympathetic and parasympathetic systems.” Journal of Biomedical Therapy, vol. 3, no. 1, pp. 22–25, 2009.
  3. F. Johnston, E. Ortiz SÃnchez, N. L. Vujanovic, and W. Li. “Acupuncture may stimulate anticancer immunity via activation of natural killer cells.” Evid Based Complement Alternat Med, vol. 2011, Article ID 481625, 14 pages, 2011.