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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. A2017045

Abstract: This case study demonstrates the use of acupuncture points associated with autonomic regulation to upregulate parasympathetic tone to mediate the effects of hyperaldosteronism on quality of life. Indices utilized as a measure of quality of life were body condition score, mobility, and family interaction. After four total sessions there was a positive increase in all parameters assessed along with a continued increase above baseline two months post cessation of therapy.

History: The patient is a 12 year old, spayed, domestic short-haired feline. In July of 2016 she became acutely blind due to retinal hemorrhage. Diagnostic testing revealed hypertension as the cause of her blindness, however her renal values and thyroid levels were within normal limits, and she was diagnosed with primary hypertension. Later in September of 2016 she suffered a stroke resulting in marked asymmetrical neurological deficits. Further investigation revealed her hypertension was not well controlled, with a systolic pressure in the 200’s and tachycardia. The underlying cause was found to be hyperaldosteronism. Since that time, she has been managed on a daily regimen of amlodipine, atenolol, spironolactone, and potassium (K+) gluconate supplementation. However, her neurologic deficits remained, as well as a dramatic decrease in activity, engagement with family, and appetite resulting in a loss of quality of life and a decrease in body condition from 7.5/9 to 3/9 at time of presentation for acupuncture treatment.

Physical examination was limited due to patient temperament and intolerance to handling. A limited neurologic exam revealed no deficits in proprioception and normal withdrawal reflexes in all four limbs as well as moderate ataxia in the hindlimbs with occasional stumbling to the right side. Myofascial palpation revealed marked bilateral hindlimb atrophy, soft musculature with no taunt bands, BCS (body condition score) of 3/9, and no pain on spinal palpation. Interestingly, the patient would compulsively and aggressively lick at front paws during caudal spinal palpation while purring even though patient is typically guarded to the point of biting when her caudal body is touched. At the patient’s last visit with her primary care veterinarian two months prior, her blood pressure (BP) and heart rate (HR) were within normal limits.
The owner’s desired goals of treatment were to improve quality of life with an increase in activity, engagement with family, and appetite as well as improvement of neurologic deficits for improved ambulation. Initial target acupuncture treatments were focused on increasing parasympathetic tone as adjunct therapy for hypertension and appetite stimulation, increasing cerebral circulation, and activation of thoracic and pelvic limb nerves to improve muscular tone and reduce weakness and ataxia.

Definitive Diagnosis: The patient has been diagnosed with hyperaldosteronism with secondary hypertension and tachycardia, blindness due to retinal hemorrhage, ataxia secondary to acute cerebral infarction, and hindlimb muscle weakness due to disuse, and possibly neural atrophy.

Accupuncture and Treatment:  The initial treatment plan included BL 36 and BL 25 for stimulation of hindlimb sensory and motor nerves. GV 14 and LI 4 were chosen to stimulate thoracic limb nerves both peripherally and from the brachial plexus nerve roots as well as for their autonomic effects of decreasing BP and HR and possibly stimulating appetite due to an increase in parasympathetic tone. Likewise, ST 36, BL 10, and GV 20 were chosen for their autonomic effects, particularly BL 10, with activation of the trigeminocervical reflex, and to increase cerebral blood flow in an effort to create balanced perfusion of the cerebrum and cerebellum to promote healing and as a protective measure against further ischemic events. Unfortunately the patient was intolerant of GV 20, BL 36, and BL 25. The treatment plan was revised to include Bai Hui at the beginning of the sessions to reduce anxiety and improve cooperation of the patient, with exclusion of GV 20, BL 36, and BL 25 after continued intolerance in the second session. Additionally, after the second session and discussion with the owner, the focus of treatment shifted towards primarily increasing parasympathetic tone as owner noted a mild increase in appetite and activity, and felt quality of life was improving. Remarkably, during stimulation of Bai Hui, the patient would compulsively lick at paws while purring, similar to her reaction to spinal palpation as described above, became calmer, and was more compliant during the session. Points utilized in subsequent sessions were Bai Hui, BL 10, GV 14, LI 4, and when possible, ST 36, with intermittent stimulation via gentle twisting of needles. Sessions averaged between 15 to 30 minutes, with increasing time across sessions. Three treatments were performed 1-2 weeks apart and the 4th a month later.
While the bilateral hindlimb weakness and ataxia remained unchanged, after the second session there was a mild increase in activity and appetite. After the 4th treatment, as well as two months thereafter, the patient now roams the house more, is more interactive with family including being more demanding of attention, has an increase in appetite, and a BCS of 4/9 from 3/9.

Outcome and Discussion: The patient’s hyperaldosteronism is still managed with amlodipine, atenolol, spironolactone, and K+ gluconate supplementation. The owner is pleased with the patient’s improvement and perceived increased quality of life. This case illustrates that while the quantitative parameters of a disease, in this case BP, HR, and serum [K+], can be effectively managed via medication, there can remain a qualitative dysregulation within the body resulting in a general sense of malaise with deleterious effects on quality of life. This case also supports the use of acupuncture to address such a qualitative dysregulation yielding an increased sense of wellness as is evidenced by the improvement in activity, demeanor, and appetite. If further investigation is pursued, assessment of quantitative parameters of BP, HR, serum [K+], and body weight should be utilized. Additionally, experimentation with decreasing medication dosing during the treatment period could also yield information important for determining if such conditions may be effectively managed via acupuncture alone or as an adjunct therapy with the intent of lowering the effective dose of medications.

References: Longhurst JC1, Tjen-A-Looi S (2013) Acupuncture regulation of blood pressure: two decades of research. Int Rev Neurobiol 111:257-71.
Qian-Qian Li, Guang-Xia Shi, Qian Xu, Jing Wang, Cun-Zhi Liu,* and Lin-Peng Wang (2013) Acupuncture effect and central autonomic regulation. Evid Based Complement Alternat Med 267959.