Select Page

Written by a Medical Acupuncture for Veterinarians curse graduate.  Author’s name available upon request.  Signed release obtained from client/author/4392.

Abstract

“Moly”, 10yd Canine FS, Belgian Shepherd (Malinois), suffers from rear leg lameness, weakness and pain due to osteoarthritis (OA) in the hip joints and right stifle joint (suspected partial CCLR), back pain due to suspected TL IVDD, and also behavior problem: noise phobia.

Treatment was combined by physical therapy, analgesic drugs, acupuncture and Electro acupuncture (EA). Results: immediate and profound relief effect, though for short term only, to the noise phobia problem. Mild improvement with pain, neurological deficits and lameness.

History Presentation

“Moly”, 10yd FS, Belgian Malinois, is a retired military working dog. Her duty was mainly as a search & rescue dog. Since retired 3 years ago, Moly is my pet. She lives with me and my family indoor. The daily routine starts with of a 20 minutes’ walk combined with some physical exercise every morning, a short walk in noon time, and a 20 minutes’ walk every evening. Appetite is normal. Normal urination and defecation.

Short time after her arrival, she demonstrated signs of noise phobia, mainly whenever there are either thunderstorms or fireworks noises. The signs include panting, shivering, mydriasis, and looking for hideouts. During the past six months, she developed “cold” right hind (RH) lameness that deteriorated with time. She has treated with Carprofen on and off.

Physical Examination and Clinical Assessments

  1. Bright alert respond, but always tense and stressed during a physical palpation.
  2. “CCLR sit” with RH leg extended.
  3. Showing profound difficulty rising up from lay down to stand position: front legs drag the rear part of the body up and forward.
  4. Lameness 5/5 on RH leg. Changed to 2/5 after 5-7 minutes of walking.
  5. Complete CP deficit on RH leg, slow correction (3-4 seconds) on LH leg, withdrawal reflex is present, exaggerated patellar reflex on RH, normal on LH.
  6. Generalized muscle atrophy on all 4 limbs.
  7. Medial buttress and mild crepitation during flexion-extension of RH stifle joint. Signs of discomfort and pain during extension.
  8. Trigger points and high tenderness to palpation mainly on Longissimus and Iliocostalis mm. from T9-L2. Taut band on epaxial muscles next to T9-T10. Triceps mm. bilateral, Infraspinatus mm. bilateral, Left superficial and middle Gluteal mm.,

Findings on survey x-rays: Moderate OA changes on right coxofemoral joint and mild changes on the left, mild OA changes on right stifle joint. Moderate spondylosis changes between vertebras L7-S1, L5-L6, mild changes between T13-L1.

Blood work: CBC and biochemistry parameters WNL.

Problem list:

  1. Rear legs weakness
  2. Neurologic deficits on rear legs
  3. RH leg lameness
  4. Muscle atrophy
  5. Back pain
  6. Trigger points on back, shoulders, brachium bilateral, right thigh
  7. Noise phobia

Clinical assessments:

  1. Suspected TL IVDD as the cause for the neurological deficits and the back pain.
  2. Hip dysplasia and partial CCLR are the cause to the pain and discomfort which lead to RH leg “cold” lameness.
  3. Degenerative myelopathy cannot be ruled out at this point, and should be part of the differential diagnosis, as the cause of the generalized muscle atrophy on all four limbs, and paraparesis.

Medical decision making:

Medical treatment combines physical medicine: acupuncture and EA, massage (LLLT is not available in my country – Israel, yet), physical exercise and analgesic drugs.

  • Rationale of choosing acupuncture and Electro acupuncture (EA):
  1. Homeostasis: inflammation modulation, analgesia, sedation. Neuromodulation: cross talk between peripheral nerves (radial n., fibular n.) and the spinal cord, that than affect the NTS and the nucleus of the Vagus CN in the brain.
  2. Pain (neuropathic & myofascial) control and relief. Needling effects fascia, nerve – vessel – mast cell complex, TRP channels.
  3. Neuroprotective of the spinal cord. Decrease the inflammation: inhibition of astrogliosis, inhibition of JNK activation in astrocytes, downregulate PDGF & GFAP, upregulate cGRP.
  4. Control the muscles atrophy: physical exercise, massage, EA
  5. Regain neurological function
  6. Decrease the level of anxiety and noise phobia.

Acupuncture treatment plan:

Points Indication Method: Dry needling (D) or EA Frequency of dry needling Frequency of EA Remark
GV20, GV14, GV4, Bai Hui, LI4, ST36 Homeostasis, sympathetic regulation D 2-3/week
BL17, 18, 19, 20, 21, 22, 23 Back pain D & EA 2-3/week 1/week Left and right inner lines
BL54, GB29, GB30 (“Hip Triade”) Hip joint pain, Trigger point on Gluteal mm. D & EA 2-3/week 1/week Right side
ST34, ST36, SP9, SP10, GB34 Stifle pain D & EA 2-3/week 1/week Right side
BL40, ST36 Pelvic limb pain and paresis, stifle pain D & EA 2-3/week 1/week Both sides (left or right intermittently)
BL60+KI3 Pelvic limb pain and paresis D & EA 2-3/week 1/week Both sides (left or right intermittently)
SI9 Trigger point on Triceps mm. D & EA 2-3/week 1/week Left shoulder

 

Treatments were performed 2-3 times a week. Dry needling using needle type Seirin 0.2 X 30mm. EA treatment for a total of 20 minutes, using ITO ES-130 device, needle type Hwato 0.2 X 30mm, using intermittently low frequency (estimated ~ 3 HZ) for 5 minutes following by medium frequency (estimated ~ 80 HZ) for 5 minutes.

    

Other treatments:

  1. Physical exercise, once a day: 20 minutes of walk – trot – gallop running, chasing a tennis ball uphill, massage to the neck, shoulders, antibrachium, epaxial, hip and thigh, quadriceps and hamstring mm.
  2. Analgesics drugs: Carprofen 50 mg SID to BID and Amantadine 100 mg SID

Outcomes and discussions:

Immediate and profound relief to the noise phobia – anxiety signs, was gained by needling GV20 and GV14. Shivering usually stopped 2-3 minutes after needling, followed by mild sedation and profound tranquilization effects that last for 20-30 minutes. About 5 minutes after needling GV20 I usually added needles in ST36 and LI4 as well.

Regarding the lameness, paresis and neurological deficits of rear legs, there is only mild improvement at this time. Adverse reaction to EA was noticed at the first treatment, even to a very low frequency, before any sign of muscle twitch: mydriasis, panting and restlessness were seen. “Moly” is a retired military working dog, and might connect it to a possible trauma due to a use of shock collar? This led me to lower the frequency of EA treatment to once a week with no more than one lead at a time, at the first few treatments, than included the other two leads, to make it three leads every treatment, 1-2 times/week.

Unfortunately there is a lack of availability of Laser therapy devices in my country. To the best of my knowledge there is currently not a single veterinary clinic that use or practice laser therapy in the state of Israel, at present time. Physical modalities that combine LLLT with acupuncture could have been for the benefit of “Moly” as well as lavender oil, especially due to the sensitivity and signs of stress that were related to the use of EA.

References:

  1. Lane DM, Hill SA.Effectiveness of combined acupuncture and manual therapy relative to no treatment for canine musculoskeletal pain. Can Vet J. 2016 Apr; 57(4): 407-414.
  2. Lawrence leung. Neurophysiological Basis of Acupuncture-induced Analgesia – An Updated Review. J Acupunct Meridian Stud 2012; 5(6): 261-270.
  3. Narda Robinson. Acupuncture for Pain. Veterinary Practice News. 04.17
  4. Narda Robinson. Evidence Points to Acupuncture for Disk Disease. Veterinary Practice News. 2009.06.10
  5. Hayashi AM, Matera JM, and Pinto AC.  Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs.  J Am Vet Med Assoc.  2007; 231:913-918.
  6. Ma R,Liu XClark JWilliams GMDoi SA. The Impact of Acupuncture on Neurological Recovery in Spinal Cord Injury: A Systematic Review and Meta-Analysis. J Neurotrauma. 2015 Dec 15;32(24):1943-57. doi: 10.1089/neu.2014.3866. Epub 2015 Aug 28.
  7. King CH,Moore LCSpence CD. Exploring Self-Reported Benefits of Auricular Acupuncture among Veterans with Posttraumatic Stress  J Holist Nurs. 2015 Nov 3. pii: 0898010115610050.