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  1. 1. Nina Malik, DVM October 15, 2008 Atlantic Coast Veterinary Specialists
  2. 2. <ul><li>History of Acupuncture </li></ul><ul><li>Eastern Framework </li></ul><ul><li>Western Framework- Mechanism of Action </li></ul><ul><li>Acupuncture Modalities </li></ul><ul><li>Indications for Acupuncture </li></ul><ul><li>Case Studies </li></ul>
  3. 3. What We Learn <ul><li>Curriculum in Veterinary Medicine </li></ul><ul><li>Graduation Requirements </li></ul><ul><li>First Year Cr. Fall 5 Principles of Morphology I—B M S 330 6 Biomedical Sciences I—B M S 333 3 Physiological Chemistry—BBMB 420 1 Clinical Foundations—B M S/V C S 339 1 Clinical Imaging I—V C S 391 1 Case Study I—B M S 345 R Veterinarian in Society I—V C S 311 17 Cr. Spring 4 Principles of Morphology II—B M S 331 6 Biomedical Sciences II—B M S 334 3 Neurobiology—B M S 337 2 Veterinary Immunology—V MPM 380 2 General Pathology—V Pth 342 1 Case Study II—B M S 346 1 Veterinarian in Society II—V C S 312 19 </li></ul><ul><li>Second Year Cr. Fall 4 Veterinary Parasitology—V Pth 376 3 Systemic Pathology—V Pth 372 5 Veterinary Microbiology I—V MPM 386 2 Case Study III—V Pth 377 1 Veterinarian in Society III—V C S 313 15 Cr. Spring 3 General Pharmacology—B M S 354 1 Anesthesiology—VCS 398 3 Veterinary Microbiology II—V MPM 387 3 Public Health—V MPM 388 6 Principles of Surgery—V C S 397 2 Case Study IV—V MPM 378 18 </li></ul><ul><li>Third Year Cr. Fall 3 Clinical Path—V Pth 425 2 Infert. Diseases—V MPM 436 5 Clinical Medicine I—V C S 444 3 Surgery Laboratory—V C S 449 4 Disturbances of Reproduction—V C S 450/VDPAM 450 3 Pharmacology and Therapeutics—B M S 443 1 Veterinarian in Society IV—V C S 314 R Introduction to Clinics—V C S 440/VDPAM 440 R Seminar—V C S 385 21 Cr. Spring 4 Special Pathology—V Pth 422 3 Infectious Diseases and Preventive Medicine—V MPM 437 5 Clinical Medicine II—V C S 445/VDPAM 445 3 Veterinary Toxicology—VDPAM 426 2 Radiology—V C S 448 1 Ophthalmology—V C S 399 1 Veterinarian in Society—V C S 315 R Seminar—V C S 385 18 </li></ul><ul><li>Fourth Year The fourth year of the veterinary medical curriculum is designed to be flexible and to provide for species emphasis. Students must complete 38 credits during their fourth year. They must take a required block and at least one option block. The remainder of the fourth year credits are acquired by selecting additional option blocks, Veterinary Teaching Hospital clinical electives, off-campus clinical electives, or other electives. Additional off-campus clinical elective credits can be earned at approved government agencies, research laboratories, veterinary practices, and other university hospitals. </li></ul>Indications Applications Mechanisms of action
  4. 4. Journal of the American Veterinary Medical Association September 15, 2007, Vol. 231, No. 6, Pages 913-918 <ul><li>Abstract </li></ul><ul><li>Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs </li></ul><ul><li>Ayne Murata Hayashi, DVM, MSc, Julia Maria Matera, DVM, PhD, Ana Carolina Brandão de Campos Fonseca Pinto, DVM, PhD Department of Surgery, School of Veterinary Medicine, University of São Paulo, São Paulo-SP, Brazil 05508-900. (Hayashi, Matera, de Campos Fonseca Pinto) </li></ul><ul><li>Conclusions and Clinical Relevance —Electroacupuncture combined with standard Western medical treatment was effective and resulted in shorter time to recover ambulation and deep pain perception than did use of Western treatment alone in dogs with signs of thoracolumbar intervertebral disk disease. </li></ul>
  5. 5. What do these athletes have in common?
  6. 6. Ancient Healing Art <ul><li>Theories of circulation and pulse character postulated in China 4,000 years before Western medicine </li></ul><ul><li>Various nations claimed to be founders </li></ul><ul><li>Founders of acupuncture- Northern India or Tibet (Ayurvedic Medicine?) </li></ul>
  7. 7. Huang-de-nei-jing <ul><li>First written record of acupuncture over 2,200 years ago in China </li></ul><ul><li>Two books- Suwen is the most famous </li></ul><ul><li>Conversation with Yellow Emperor (3 rd millennium B.C.) </li></ul><ul><li>Physiology, pathology, diagnosis, and prevention of disease </li></ul><ul><li>Authorship- Yellow Emperor? </li></ul>
  8. 8. History of Veterinary Acupuncture
  9. 10. First Veterinary Acupuncture Textbook Sun-Yang, 650 B.C. Lyon, France, 1761
  10. 11. CBS 11:00 p.m. News- 9/24/08
  11. 12. The Eastern Framework <ul><li>Yin </li></ul><ul><li>+ </li></ul><ul><li>Yang </li></ul><ul><li>Dark </li></ul><ul><li>Descends </li></ul><ul><li>Cool, moist </li></ul><ul><li>Anabolism, rest </li></ul><ul><li>Substance- tissues </li></ul><ul><li>Ventral and Inner aspects of body </li></ul><ul><li>Light </li></ul><ul><li>Expands outwards </li></ul><ul><li>and upwards </li></ul><ul><li>Hot </li></ul><ul><li>Metabolism, movement </li></ul><ul><li>Head, Back, Outer </li></ul>
  12. 13. Qi <ul><li>Energy force running through body </li></ul><ul><li>Flow of Qi influences health of animal </li></ul>
  13. 14. <ul><li>Insufficient </li></ul><ul><li>Unbalanced </li></ul><ul><li>Obstructed </li></ul>
  14. 15. Meridians <ul><li>Qi travels in meridians/channels </li></ul><ul><li>Acupuncture points- locations where meridians come to surface/accessible </li></ul><ul><li>Needling points= manipulate Qi and restore balance </li></ul><ul><li>Allows body to heal itself </li></ul>
  15. 16. Veterinary Acupuncture Points <ul><li>Based on transpositional system (human) </li></ul><ul><li>Points located via anatomical landmarks and body measurements (cun) </li></ul>
  16. 17. GB 34 and BL 54
  17. 18. Pattern Differentiation <ul><li>TCM diagnosis is based on pattern differentiation, not on diagnosis of a particular disease as in Western medicine </li></ul><ul><li>One disease entity in Western medicine may have multiple underlying possible TCM patterns. </li></ul><ul><li>TCM Patterns are based on a number of different factors: </li></ul><ul><li>History </li></ul><ul><li>Diagnostic Tests (Radiographs, Bloodwork) </li></ul><ul><li>Physical Examination </li></ul><ul><li>Tongue and Pulse diagnosis </li></ul><ul><li>Lifestyle, external factors (damp weather), and personality/behavior </li></ul>
  18. 19. The Forest through the Trees
  19. 20. <ul><li>Anatomy of acupuncture points </li></ul><ul><li>Mechanisms of Action </li></ul><ul><li>Effects on the CNS </li></ul><ul><li>Endogenous Pain Inhibition </li></ul><ul><li>Segmental Analgesia </li></ul><ul><li>Local Tissue Effects </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Trigger Point Therapy </li></ul>
  20. 21. Anatomy of Acupuncture Points <ul><li>Not random points on the body </li></ul><ul><li>Areas of lower electrical skin resistance compared with the surrounding skin. Normal skin: 200,000-2 million ohms vs. 50,000 ohms </li></ul><ul><li>High electrical skin conductance </li></ul><ul><li>Many found in palpable depressions on the body </li></ul>
  21. 22. Anatomy of Acupuncture Points
  22. 23. Trigger Points <ul><li>Hyperirritable locus within a taut band of skeletal muscle or its associated fascia </li></ul><ul><li>Approximately 70% of acupuncture points correspond to trigger points </li></ul>
  23. 24. Mechanisms of Action <ul><li>Endogenous pain inhibitory system </li></ul><ul><li>Segmental analgesia </li></ul><ul><li>Local inflammatory effects </li></ul><ul><li>Autonomic nervous system to affect viscera </li></ul><ul><li>Relief from trigger points </li></ul>
  24. 25. Review of Nociceptors <ul><li>A-beta receptors </li></ul><ul><li>Large diameter, rapid conduction, myelinated </li></ul><ul><li>A-delta receptors </li></ul><ul><li>Medium diameter, medium conduction, </li></ul><ul><li>myelinated </li></ul><ul><li>Mechanoreceptors; mediate touch/pressure </li></ul><ul><li>Skin/fascia </li></ul><ul><li>Rapid pain response (“first pain”) </li></ul><ul><li>C-polymodal receptors </li></ul><ul><li>Small diameter, slow conducting, non-myelinated </li></ul><ul><li>Activated by thermal, mechanical, chemical stimuli </li></ul><ul><li>Mediate slow pain </li></ul>
  25. 26. Effects of Acupuncture on the CNS <ul><li>3 Regions of CNS Activated </li></ul><ul><li>Spinal Cord </li></ul><ul><li>Brainstem </li></ul><ul><li>Hypothalamus-pituitary </li></ul>Release of NT (endogenous opiates) Block Pain Messages
  26. 27. Endogenous Pain Inhibition <ul><li>A delta fibers carry pain impulse to lamina I of dorsal horn </li></ul><ul><li>Activate neurons of the neospinothalamic tract </li></ul><ul><li>Neurons have long axons that cross to opp spinal cord and ascend to the hypothalamus/pituitary by way of the brainstem </li></ul>
  27. 28. Hypothalamus and Pituitary <ul><li>Arcuate nucleus + pituitary contain all the beta-endorphin cells in the brain </li></ul><ul><li>Beta-endorphin release into blood and CSF </li></ul>
  28. 29. Endogenous Pain Inhibition <ul><li>Third CNS region activated is the brainstem </li></ul><ul><li>Input via the A-delta fibers to the dorsal horn of the spinal cord </li></ul><ul><li>Via the anterolateral fasciculus of the spinal cord to the brainstem </li></ul>
  29. 30. Activation of the Brainstem <ul><li>Stimulates descending </li></ul><ul><li>norepinephrine inhibitory </li></ul><ul><li>and serotonergic inhibitory </li></ul><ul><li>fibers </li></ul><ul><li>Travel in dorsolateral </li></ul><ul><li>tract of the spinal cord </li></ul><ul><li>Synapse on dorsal horn </li></ul><ul><li>interneurons </li></ul>
  30. 31. <ul><li>Combined result: beta-endorphin, NE/5-HT3 inhibitory fibers </li></ul><ul><li>Release of enkephalin and dynorphins from segmental interneurons of spinal cord </li></ul><ul><li>Bind opiate receptors on pain afferents </li></ul><ul><li>Pre-synaptic inhibition of A-delta and C fibers (temp, crude touch, aching, burning, chronic pain) </li></ul>
  31. 32. Naloxone reversal <ul><li>Naloxone reverses acupuncture analgesia </li></ul><ul><li>Evidence that pain inhibition is mediated through endogenous opioid neural loop </li></ul>
  32. 33. Suppression of substance P from afferent pain axon to inhibit pain impulse transmission to the brain for conscious perception
  33. 34. <ul><li>Anatomy of acupuncture points </li></ul><ul><li>Mechanisms of Action </li></ul><ul><li>Effects on the CNS </li></ul><ul><li>Endogenous Pain Inhibition </li></ul><ul><li>Segmental Analgesia </li></ul><ul><li>Local Tissue Effects </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Trigger Point Therapy </li></ul>
  34. 35. Segmental Analgesia <ul><li>High frequency (100 Hz), low intensity stimulation </li></ul><ul><li>Electroacupuncture (EAP) </li></ul><ul><li>Localized analgesia, rapid onset, ceases after stimulation has stopped </li></ul><ul><li>Brainstem activated </li></ul>
  35. 36. <ul><li>Stimulates NE and 5HT inhibitory fibers in brain stem </li></ul><ul><li>Dorsal horn of spinal cord </li></ul><ul><li>Mediation by GABA in the spinal cord </li></ul>
  36. 37. <ul><li>Activates the dynorphin synapses in the spinal cord </li></ul><ul><li>Relieves chronic pain possibly by selectively inhibiting input from C fibers </li></ul>
  37. 38. <ul><li>Mechanisms of Action </li></ul><ul><li>Effects on the CNS </li></ul><ul><li>Endogenous Pain Inhibition </li></ul><ul><li>Segmental Analgesia </li></ul><ul><li>Local Tissue Effects </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Trigger Point Therapy </li></ul>
  38. 39. Local Tissue Effects
  39. 40. Local Tissue Effects Microtrauma
  40. 41. Histology of Acupuncture Point
  41. 42. Vasoactive Effects 2 minutes-2 weeks 15-30 seconds 10 seconds-2 minutes PHASES 1. 2. 3.
  42. 43. Time-dependent Phases <ul><li>Vasodilation </li></ul><ul><li>Inactivation Nociceptive </li></ul><ul><li>of Reaction potentiation </li></ul><ul><li>Tissue Repair Chemotaxis </li></ul><ul><li>Solubility </li></ul>
  43. 44. Sum Total of Local Tissue Effects <ul><li>Improved local tissue perfusion </li></ul><ul><li>Increased local immune responsiveness </li></ul><ul><li>Muscle and tissue relaxation </li></ul><ul><li>Pain relief: increased perfusion and cessation of muscle spasms </li></ul>
  44. 45. <ul><li>Mechanisms of Action </li></ul><ul><li>Effects on the CNS </li></ul><ul><li>Endogenous Pain Inhibition </li></ul><ul><li>Segmental Analgesia </li></ul><ul><li>Local Tissue Effects </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Trigger Point Therapy </li></ul>
  45. 46. Viscerocutaneous Reflex <ul><li>General mechanism by which diseased organs are able to refer pain, sensitivity, or muscle contraction to areas of skin often correlating to acupuncture or trigger pt </li></ul><ul><li>The pain can be referred to areas that are far away or directly over the painful organ </li></ul>
  46. 47. Referred Pain <ul><li>McBurney’s point- right lower abdominal quadrant painful in appendicitis </li></ul><ul><li>Heart attack- Left arm, back, neck (not at chest) </li></ul><ul><li>“ Brain freeze”- ice cream </li></ul><ul><li>Diaphragm refers to right shoulder </li></ul>
  47. 48. Cutaneovisceral Reflex <ul><li>Reverse loop proposed </li></ul><ul><li>GV 26- hemorrhagic shock in dogs: increases cardiac output- blood pressure increases </li></ul><ul><li>PC-6 in cats: EAP inhibits frequency of transient lower esophageal sphincter relaxation </li></ul><ul><li>ST-36 accelerates colonic motility rats </li></ul>
  48. 49. Cutaneovisceral Reflex <ul><li>Needle in paravertebral muscle at myotome segmental level associated with muscular pain </li></ul><ul><li>Somatic nerve ending of a muscle stimulated </li></ul><ul><li>Afferent impulse to dorsal horn </li></ul><ul><li>Stimulation of contralateral anterior hypothalamus </li></ul><ul><li>Activation of somato-autonomic reflex </li></ul><ul><li>Cholinergic vasodilator nerves activated to spastic muscles </li></ul>
  49. 50. <ul><li>Mechanisms of Action </li></ul><ul><li>Effects on the CNS </li></ul><ul><li>Endogenous Pain Inhibition </li></ul><ul><li>Segmental Analgesia </li></ul><ul><li>Local Tissue Effects </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Trigger Point Therapy </li></ul>
  50. 51. Trigger Points <ul><li>Hyperirritable locus within a taut band of skeletal muscle or its associated fascia </li></ul><ul><li>Approximately 70% of acupuncture points correspond to trigger points </li></ul>
  51. 52. Taut Bands of Skeletal Muscle <ul><li>Damage to muscle </li></ul><ul><li>Calcium release from SR </li></ul><ul><li>Actin-myosin interact </li></ul><ul><li>Muscle contraction </li></ul><ul><li>Decreased perfusion to m. </li></ul><ul><li>Decreased ATP locally </li></ul><ul><li>Calcium can not return to SR </li></ul><ul><li>Actin-myosin do not dissociate </li></ul>
  52. 53. Formation of Trigger Point <ul><li>Trauma to muscle/fascia/tendon via acute injury or chronic strain </li></ul><ul><li>Release of mediators (bradykinin, PG, histamine) </li></ul><ul><li>Platelets and mast cells recruited </li></ul><ul><li>MPS released into spaces between muscle fibers </li></ul><ul><li>Fibrocytic nodules expand and stretch surrounding muscle </li></ul><ul><li>Decreased O2 to muscle </li></ul><ul><li>Local Acidity </li></ul><ul><li>Sensitized muscle nociceptors and converted to trigger points </li></ul>
  53. 54. Pain Activation of Trigger Points <ul><li>Trauma to muscle/fascia/tendon via acute injury or chronic strain </li></ul><ul><li>Release of mediators (bradykinin, PG, histamine, etc) </li></ul><ul><li>Sensitize C-Fibers Sensitize A-delta fibers </li></ul><ul><li>Slow transmission to Fast transmission to </li></ul><ul><li> limbic system parietal lobe </li></ul><ul><li>Frontal lobe </li></ul><ul><li>Sharp, short duration pain </li></ul><ul><li>After short delay: </li></ul><ul><li>Persistent, dull aching pain, </li></ul><ul><li>Near or distant to activated trigger point </li></ul><ul><li>Abnormally sensitive reflex arc </li></ul>
  54. 55. Types of Trigger Points <ul><li>Active- causes pain without manipulation </li></ul><ul><li>Latent- not obviously painful to patient. May be painful on palpation. May cause restriction of movement and eventual weakness. </li></ul><ul><li>Often refer pain to specific area depending on location of trigger point. (GB 21) </li></ul><ul><li>Structures Affected: </li></ul><ul><li>Skeletal muscles </li></ul><ul><li>Tendons/Ligaments </li></ul><ul><li>Joint capsules </li></ul><ul><li>Periosteum </li></ul><ul><li>Skin (esp. scar-associated) </li></ul>
  55. 57. Treatment <ul><li>Needling trigger point disrupts the abnormally contractile elements or nerve ending </li></ul><ul><li>Stops feedback loop </li></ul><ul><li>Dry needling </li></ul><ul><li>Aquapuncture </li></ul>
  56. 58. <ul><li>History of Acupuncture </li></ul><ul><li>Eastern Framework </li></ul><ul><li>Western Framework- Mechanism of Action </li></ul><ul><li>Acupuncture Modalities </li></ul><ul><li>Indications for Acupuncture </li></ul><ul><li>Case Studies </li></ul>
  57. 59. Acupuncture Modalities <ul><li>Dry Needles </li></ul><ul><li>China or Japan </li></ul><ul><li>Single-use, sterile, disposable </li></ul><ul><li>15-25 gauge </li></ul><ul><li>7-40 mm </li></ul><ul><li>Seirin J: 0.20 x 30 mm </li></ul><ul><li>Seirin D: 0.16-0.20 x 15 mm </li></ul><ul><li>Guide tube or without </li></ul><ul><li>Metal handles: EAP/Moxa </li></ul>
  58. 60. Acupuncture Modalities <ul><li>Dry Needles </li></ul><ul><li>Not painful </li></ul><ul><li>Deqi- arrival of Qi </li></ul><ul><li>Retained on average 10-30 minutes depending on pattern treating </li></ul><ul><li>Tonifying – shorter </li></ul><ul><li>Sedating – longer </li></ul>
  59. 62. Aquapuncture <ul><li>Fluid Effect: </li></ul><ul><li>Changes pH </li></ul><ul><li>Displaces tissue to produce pressure </li></ul><ul><li>Changes electrical potential </li></ul><ul><li>Prolonged effect </li></ul>
  60. 63. Electroacupuncture (EAP) <ul><li>Segmental Analgesia (100 Hz) </li></ul><ul><li>Passing of electrical energy through acupuncture points </li></ul><ul><li>Attach Accual to needles in place </li></ul>
  61. 64. Electroacupuncture <ul><li>Advantages: </li></ul><ul><li>Avoid manual manipulation of needles </li></ul><ul><li>Amount and quality of stimulation to needles: accurate and uniform </li></ul><ul><li>Higher and more continuous level of stimulation than manual </li></ul>
  62. 65. Electroacupuncture <ul><li> Indications </li></ul><ul><li>Paralysis </li></ul><ul><li>IVDD </li></ul><ul><li>Severe and chronic painful conditions </li></ul><ul><li>Surgical analgesia </li></ul><ul><li>Atrophied muscles </li></ul><ul><li>Contraindications </li></ul><ul><li>Cardiac Arrhythmias </li></ul><ul><li>Epilepsy </li></ul><ul><li>Shock </li></ul><ul><li>Pregnancy </li></ul><ul><li>Proximal to tumors </li></ul><ul><li>High fever </li></ul>
  63. 66. Electroacupuncture <ul><li>4 outputs; each with 2 needle clip leads </li></ul><ul><li>AC- alternates between positive and negative polarity (deep tissue penetration) </li></ul><ul><li>Amplitude adjustment </li></ul><ul><li>Frequency (Hz): pulses per second (high >15): sedate pain vs. (low<15): muscle atrophy </li></ul>
  64. 67. Electroacupuncture <ul><li>3 Modes: </li></ul><ul><li>Continuous - stable frequency; continuous stimulation (tolerance) </li></ul><ul><li>Dense Disperse - continuous stimulation with alternating high and low frequency bursts (avoids tolerance) </li></ul><ul><li>Intermittent - stable frequency; stimulation pulsed with rest periods (avoids tolerance) </li></ul>
  65. 68. Moxibustion <ul><li>Heating of acupuncture points </li></ul><ul><li>Artemesia vulgaris (mugwort; related chrysanthemum family) </li></ul><ul><li>400° F </li></ul><ul><li>Indications: </li></ul><ul><li>“ Cold” conditions TCM </li></ul><ul><li>Painful joints/muscular </li></ul><ul><li>“ Deficient” patients </li></ul>
  67. 70. <ul><li>Precautions </li></ul><ul><li>Vicinity of mm or sensory organs </li></ul><ul><li>Caudal back/abd in pregnant animals </li></ul><ul><li>Febrile conditions </li></ul><ul><li>Burn Fur </li></ul>
  68. 71. Infrared Light Therapy <ul><li>Another means of using heat to stimulate acupuncture points </li></ul><ul><li>Can use on individual acupuncture points or generalized areas </li></ul><ul><li>Mitochondria absorb light - covert to ATP - fuels cellular processes – release of NO- vasodilation </li></ul><ul><li>(reduce inflammation, improve local circulation, cell replication and repair) </li></ul>
  69. 72. Infrared Light Therapy <ul><li>FDA approved for specific indications in humans </li></ul><ul><li>Human therapy: Carpal tunnel syndrome, arthritis, TMJ </li></ul><ul><li>Veterinary Medicine: </li></ul><ul><li>Stimulation of acupuncture point </li></ul><ul><li>Needle phobic patients </li></ul><ul><li>Hard to reach acupuncture points </li></ul><ul><li>Corneal ulcers, Non-healing skin wounds, Superficial penetration </li></ul><ul><li>Repetitive Strain Injuries? </li></ul>
  70. 73. Infrared Light Therapy <ul><li>Disadvantages: </li></ul><ul><li>Size of diode cluster </li></ul><ul><li>Duration </li></ul><ul><li>Superficial penetration </li></ul><ul><li>Unit cost </li></ul><ul><li>Research- Equine/ Companion animal optimal settings </li></ul>
  71. 74. <ul><li>History of Acupuncture </li></ul><ul><li>Eastern Framework </li></ul><ul><li>Western Framework- Mechanism of Action </li></ul><ul><li>Acupuncture Modalities </li></ul><ul><li>Indications for Acupuncture </li></ul><ul><li>Case Studies </li></ul>
  72. 75. <ul><li>Endogenous Pain Inhibition </li></ul><ul><li>Segmental Analgesia </li></ul><ul><li>Local Tissue Effects </li></ul><ul><li>Autonomic Nervous System </li></ul><ul><li>Trigger Point Therapy </li></ul>Pain Control Musculoskeletal Disease Neurologic Disease Pain Control Musculoskeletal Disease Neurologic Disease Dermatologic Disorders Gastrointestinal Disorders Cardiovascular Disease Respiratory Disease Urogenital Disorders Pain Control Musculoskeletal Disease
  73. 76. Indications <ul><li>Musculoskeletal Disease </li></ul><ul><li>Post-operative orthopedic surgery </li></ul><ul><li>Osteoarthritis </li></ul><ul><li>Trigger Point Therapy </li></ul><ul><li>Joint dysplasia </li></ul><ul><li>Pain, Range of Motion, Improve Circulation, Promote Healing </li></ul>
  74. 77. Indications <ul><li>Neurologic Disease </li></ul><ul><li>Intervertebral Disk Disease </li></ul><ul><li>FCE </li></ul><ul><li>Seizures </li></ul><ul><li>Peripheral Neuropathies </li></ul><ul><li>Vestibular Disorders </li></ul><ul><li>Improve comfort in Degenerative Myelopathy patients </li></ul>
  75. 78. Indications <ul><li>Gastrointestinal Disorders </li></ul><ul><li>Nausea </li></ul><ul><li>Vomiting </li></ul><ul><li>Diarrhea </li></ul><ul><li>Constipation </li></ul><ul><li>Abdominal Pain </li></ul><ul><li>PC 6 – Inhibiting frequency of lower esophageal sphincter relaxation (cats) </li></ul>
  76. 79. Indications <ul><li>Dermatologic Disorders </li></ul><ul><li>Allergic Dermatitis </li></ul><ul><li>Chronic Skin Disease </li></ul><ul><li>Otitis Externa </li></ul><ul><li>Non-healing skin wounds (infrared) </li></ul>
  77. 80. Indications <ul><li>Cardiovascular/Respiratory </li></ul><ul><li>Rhinitis </li></ul><ul><li>Sinusitis </li></ul><ul><li>Bronchitis </li></ul><ul><li>Chronic coughing </li></ul><ul><li>Circulatory Disorders </li></ul><ul><li>Asthma </li></ul>
  78. 81. Indications <ul><li>Urogenital Disorders </li></ul><ul><li>Urinary incontinence </li></ul><ul><li>Urinary tract infections </li></ul><ul><li>Chronic kidney disease </li></ul><ul><li>Immune Stimulation - Increase in absolute lymphocyte number (21 d) </li></ul><ul><li>Behavioral Problems </li></ul><ul><li>Oncology Patients </li></ul>
  79. 82. The Forest through the Trees
  80. 83. Course of Therapy
  81. 84. Risks of Therapy <ul><li>One of the safest therapies available </li></ul><ul><li>Side effects are rare </li></ul><ul><li>Patient may be transiently sleepy or sore for 1-2 days </li></ul><ul><li>Expectations: duration of treatment / indications </li></ul><ul><li>Disclose cancer </li></ul><ul><li>Overuse of injured limb </li></ul><ul><li>Swallowed needles </li></ul><ul><li>Eye injury, pneumothorax, infectious arthritis </li></ul><ul><li>Broken needles </li></ul>
  82. 85. Case Studies <ul><li>10 year old, FS, Lab mix </li></ul><ul><li>History of elevated liver enzymes, otherwise clinically normal </li></ul><ul><li>Chronic issues: </li></ul><ul><li>Degenerative Myelopathy- mild HL ataxia; intermittent dorsal scuffing </li></ul><ul><li>Blind </li></ul><ul><li>Urinary incontinence </li></ul>
  83. 86. Case Studies <ul><li>AUS: hepatic mass </li></ul><ul><li>Referred to surgery at Atlantic Coast Veterinary Specialists: </li></ul><ul><li>Left medial liver lobectomy and mass excised from the quadrate lobe </li></ul><ul><li>Overnight post-surgery: Ambulatory with hind end sling; lying down in run </li></ul>
  84. 87. Case Studies <ul><li>Referred for acupuncture </li></ul><ul><li>Physical Exam </li></ul><ul><li>ambulatory without HL sling, but weak </li></ul><ul><li>HL ataxia </li></ul><ul><li>Atrophy bilat HL musculature </li></ul><ul><li>Dec extension shoulder </li></ul><ul><li>Dec extension bilat hips </li></ul><ul><li>Trigger points: Mild L. triceps m.; Bilateral quadriceps muscles </li></ul>
  85. 88. Case Studies <ul><li>Acupuncture Treatment </li></ul><ul><li>Arthritis in shoulders and hips </li></ul><ul><li>Trigger points in L. triceps and quadriceps </li></ul><ul><li>Underlying TCM patterns contributing to overall condition and HL muscle atrophy </li></ul>
  86. 89. Case Studies
  87. 90. Case Study #2 <ul><li>2 year old, MN, Basset Hound </li></ul><ul><li>Diagnosed with IVDD L1-L2 and L2-L3 </li></ul><ul><li>Surgical Decompression </li></ul><ul><li>Presentation 1 month </li></ul><ul><li>Post-op </li></ul><ul><li>Severely paretic in HL </li></ul><ul><li>CP deficits HL </li></ul><ul><li>No deep pain HL </li></ul>
  88. 91. Case Study #2 <ul><li>Acupuncture Treatment </li></ul><ul><li>Combination of dry needles and EAP </li></ul><ul><li>Lumbar back and distal leg points treated </li></ul><ul><li>Thus far: 2 dry needle and 2 EAP treatments </li></ul>
  89. 92. Case Study #2 <ul><li>Progress </li></ul><ul><li>After first couple of tx </li></ul><ul><li>Able to stand up on own and hold without falling over </li></ul><ul><li>After these four tx </li></ul><ul><li>Better motor HL </li></ul><ul><li>Deep pain </li></ul>
  90. 93. Case Studies- Other Species <ul><li>2 year old, FS, DSH </li></ul><ul><li>Initial presentation- severe gingivitis </li></ul><ul><li>Dental and medical management </li></ul><ul><li>2 acupuncture tx, 1 month apart </li></ul>
  91. 94. Case Studies- Other Species <ul><li>7 year old, MC, Mini Lop </li></ul><ul><li>Chronic head tilt, decreased appetite, decreased activity since a pasteurella ear infection a couple of years ago </li></ul><ul><li>Being treated with acupuncture monthly for past 18 months </li></ul><ul><li>Activity improved, Appetite improved, Head tilt improved but mild one present </li></ul>
  92. 96. Case Studies- Other Species
  93. 97. Questions?