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Acupuncture as an adjunct to treatment of lumbosacral and degenerative joint disease in a pug

Posted in Case Studies @ Jun 6th 2019 - By Dr Jennifer Robinson, Veterinarian (DE), CVE (IVAS) Melbourne Veterinary Acupuncture
Kevins Story

Case Study demonstrating how acupuncture can be successfully integrated into your veterinary practice.

Osteoarthritis (OA) or degenerative joint disease (DJD) is an often debilitating disorder of geriatric dogs of all breeds. It is the result of active biochemical and biomechanical processes which lead to destabilisation and destruction of articular cartilage, the extracellular matrix and subchondral bone.[i] Causes are multifactorial with mechanical, traumatic, hereditary and inflammatory factors involved. OA is a slowly progressive disease with varying degrees of severity.  On examination, pain, lameness and reduced range of motion of the joint are often readily apparent along with thickening of the joint, crepitus and effusion.

Lumbosacral disease involves degeneration of the lumbosacral junction and/or compression of the associated nerves. Common presenting signs are lower back pain, hind leg pain and weakness, hind leg ataxia, reluctance to jump or wag the tail and sometimes urinary and faecal incontinence.

Affected dogs are often large-breed older dogs, with German shepherds being overrepresented; the diagnosis is less common in smaller breeds. In general, affected dogs have a long-term history of pelvic limb weakness that may be intermittent. Typically, clinical signs progress over time.[ii]

Kevin’s story

Kevin is a 10-year-old male castrated pug. He had always been a very agile and energetic dog described by his owner as needing a lot of exercise in order to stay content and happy. He first started to present with intermittent RHL lameness and weakness in both back legs in early 2017. Symptoms were usually worse after exercise and improved with rest and medical treatment with Meloxicam (0.1mg/kg SID).

Following recommendations by the regular veterinarian, Kevin also commenced hydrotherapy and frequent massages at a canine rehabilitation facility as well as oral joint supplements (K9 Power JOINT STRONG™, a glucosamine/chondroitin/MSM product and later [JR1]  AntinolTM, a marine oil lipid and omega-3 FA product).

In September 2018 Kevin had clinically declined and he had reached a state of not being able to run, play or go for his normal long walks anymore. His right hindleg and lower back started to show noticeable muscular atrophy and he was struggling to get up after resting. The ataxia in his hindlimbs became worse. According to his owner, Meloxicam provided some improvement in movement, but the decline was readily apparent and concerning.

The Diagnosis

Kevin had radiographs performed under sedation in September 2018 and the changes seen (sclerosis of the vertebral end plates of the L7 vertebra and the sacrum with narrowing of the disk space, ventral spondylosis along the entire LS spine) were consistent with lumbosacral disease. Additionally, there was severe degenerative joint disease in both coxofemoral joints, worse on the right.  

Initial treatment

Kevin had been on Meloxicam 0.1mg/kg SID PRN since 2017, which was increased to daily dosing at time of diagnosis. Kevin was also commenced on a course of 4 weekly subcutaneous injections of Zydax (sodium pentosan polysulfate (100mg/ml)) at a dose rate of 3mg/kg. He continued to have oral joint supplements daily.

While this multi-modal treatment approach provided some relief for Kevin, the owner was still concerned about his quality of life, which at the time was severely affected by the fact that Kevin was not able to resume his normal activity and exercise level.

Treatment with acupuncture

Kevin was referred by his regular vet for acupuncture to see if it could relieve his symptoms and increase his quality of life. He received four weekly treatments initially; the treatment frequency was then reduced to fortnightly and is currently monthly.

After the first treatment, the owner reported that Kevin appeared much more comfortable and a lot less hunched over his lower back. He even made attempts to run and play over the weekend and his ataxia was noticeably reduced.

After the second treatment, the owner was able to increase Kevin’s walking time by a few minutes every day and Kevin had started stretching again in both front and back legs, which he had not done in many months. The owner did not observe any lameness in his right hindleg and only occasional mild stumbling. She had not felt the need to give Meloxicam since the 2nd treatment.

In the following weeks, the muscle atrophy of the right hindleg and lower back improved and Kevin’s symptoms of ataxia, right hindleg lameness and lower back pain resolved.

How is Kevin doing today?

Kevin is currently back to his 2017 level of exercise (one 40 minute walk per day and another two to three walks of 15-20 minute duration). He is able to run again and is much more agile. The owner has not seen Kevin move so freely since 18 months prior to starting the treatment with acupuncture. The owner only has to give Meloxicam very occasionally on days of higher intensity or longer duration exercise.

Kevin continues to receive monthly injections of pentosan polysulphate and daily joint supplements, and he is currently on a monthly treatment schedule for acupuncture. He has not shown any deterioration or flare up of symptoms since treatment started.

Conclusion

The overall result of treatment with acupuncture in this case was a significant reduction of lameness, pain and hindleg weakness in this patient with subsequent regain of mobility and reduction of muscular atrophy. Kevin was able to return to his normal levels of exercise and his quality of life has markedly improved.

[i]  “Canine Osteoarthritis: Understanding the aetiology, clinical presentation and diagnosis” Steven C. Budsberg DVM, MS, DACVS, October 1st 2004, dvm360

[ii] http://veterinarymedicine.dvm360.com/degenerative-lumbosacral-stenosis-dogs

About Jennifer

Jen graduated from veterinary medicine from the University of Hanover in 2013 and completed an internship at Southpaws Specialty Surgery for Animals in surgery, oncology and internal medicine in 2014. Dr Jen worked in general practice for several years, with a strong interest in integrative and geriatric medicine. During her work, Jen has encountered many cases, where conventional western medicine simply just wasn’t enough to help her patients. She undertook several courses in canine rehabilitation and completed her training in veterinary acupuncture through IVAS in 2017.

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