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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/4981.

Abstract:

“Heidi”, a large breed canine with osteoarthritis, has progressed from frequent episodes of the hind limbs slipping out from under her and refusing to navigate stairs to gaining greater stability and endurance on regular walks.

History/Presentation:

“Heidi” is an 11 year old female spayed German Shepherd Dog weighing 78 pounds.  She is a family pet whose activity level has decreased, and therefore, regular walks with her owners have decreased.  She is also more hesitant to navigate stairs.

Her history includes a right elbow arthritic change diagnosed with radiographs March 3, 2011.  She only seemed to be in discomfort after excessive activity.  She was placed on a joint supplement to be used daily and carprofen to be used every 12 hours as needed.

In August of 2015 crepitus was felt when the right coxofemoral joint was manipulated and meloxicam was prescribed, instead of carprofen, to be used once daily as needed for comfort.

In August of 2016 the owner complained of hind end instability despite using the meloxicam and joint supplement consistently.

Physical Examination and Clinical Assessments:

“Heidi” presented on December 5, 2016 with a recent history of dragging the left hind digits to a greater extent than the right.  She was observed to be somewhat ataxic in the hind end and had proprioceptive deficits in a standing position.  Also there was decreased tail tone and ability to extend the hind limbs caudally.  Upon palpation, myofascial (MF) restriction was present over the cervical spine, scapulae and lumbar spine.  Rule outs included degenerative joint disease, osteoarthritis (OA) and degenerative myelopathy (DM).  Radiographs showed severe OA of both left and right coxofemoral joints and ventral spondylosis of intervertebral lumbar spaces L1-L2 and L2-L3.  No genetic testing was elected for DM.

Medical Decision Making:

The acupuncture treatment has been based on the source of primary pain and compensatory pain.  Local points were used over the hip triad and spine where the OA was diagnosed as well as where MF tension was determined to reside.  Central points were used to draw communication of peripheral nerve stimulus to the brain.  Peripheral points were used to enhance sympathetic stimulus of the appropriate nerves toward the central nervous system.  Points of autonomic influence were used to decrease sympathetic tone to initially calm the patient at the beginning of each treatment.  Myofascial points were chosen based on palpation of areas of restriction during each treatment.

Acupuncture Treatment:

The first treatment was December 7, 2016 and treatments have been performed in two week intervals including the following points.  Not all points were used during every treatment.

Central point Bai Hui was used because it is a major contributor to the hind end.

Peripheral points included Bafeng bilaterally to address bilateral hip dysplasia pain sympathetically.  Bafeng was also included for sympathetic stimulus considering no diagnostics for DM were elected to define if the patient is a genetic carrier.

Local points included the hip triad (BL54, GB29, and GB30) for hip pain, bladder (BL) 10 for compensatory cervical discomfort, BL17-23 for spondylosis and myofascial restriction.  Electro-acupuncture (EA) was used over the BL points alternating vertebral segments to address arthritic pain.  EA was also used to address hip joint pain between GB30 and BL54, both of which are fed by the sciatic nerve.  A mixed pattern between 2 and 100 hertz was used on the milliampere channels for 10 minutes.

Autonomic points included governor vessel (GV) 14, GV20 and large intestine (LI) 11 to decrease sympathetic tone, calming the patient, and to support the immune system.

Myofascial points included small intestine (SI) 11 and SI12 to address compensatory MF tension.

Each treatment was completed with a gentle massage combining effleurage, static pressure and kneading techniques.

Outcomes, Discussions and References:

As of the treatment on February 1, 2017 the owner reported that “Heidi’ is brighter, comfortable and is even chasing her tail.  She is back to climbing a flight of stairs to wake the owner in the mornings.  Upon physical exam she had significantly less MF tension through the cervical and lumbar regions.

This has been a very rewarding case to know that this patient has an improved quality of life since beginning acupuncture treatments.  I have learned that greater stimulus with EA will provide more pain relief through neuro-modulation than dry needling alone for the area of greatest discomfort.

References:  VetRec2001Oct13:149(15):452-6;   Xie, Huisheng. Acupuncture and Osteoarthritis. Proc. Of Australian Veterinary Assoc., 2011, Chi Institute, Reddick, FL USA.