Pet Acupuncture for Urinary Incontinence

Acupuncture Was Used to Treat Urinary Incontinence in a Mixed Breed dog. 

Abstract:
Acupuncture therapy was used to successfully treat urinary incontinence in a mixed breed dog. A one month course of weekly, dry needle acupuncture therapy was used, followed by a 2 month course of dry needle acupuncture therapy every 14 days. The patient had one episode of urinary incontinence several days after the first acupuncture session. No further episodes of urinary incontinence were reported by the owner.

History:
A nine year old female spayed 22 kg mixed breed dog was presented for an acupuncture consultation with a history of urinary incontinence since sixteen months of age. Diagnostics were performed at that time which overall were normal. Phenylpropanolamine 50 mg by PO BID was recommended. Approximately 30 minutes after the first dosage was administered, the patient began to vomit and had severe generalized erythema. These clinical signs resolved without further treatment and Phenylpropanolamine was permanently discontinued. Since sixteen months of age the owner reports that Piper would have intermittent episodes of urinary incontinence at least several times per month. The urinary incontinence always occurred while the patient was sleeping.

The patient also has a history of bilateral cranial cruciate ligament ruptures that were both surgically repaired with the tibial tuberosity advancement procedure. The first surgery was September 2013 (left hind) and the second surgery was May 2014 (right hind). The owner feels that Piper is overall comfortable, but since September 2017 she seems to be favoring the left rear leg more then she used to. The owner feels that this is most noticeable when Piper has been lying down for a while and she first gets up from her nap. The stiffness in Piper’s hind end is also more obvious after over exercising. Piper’s current medications include Novox 50 mg PO SID, Glycoflex III PO SID and Adequan 1.0 mL SC q 4 weeks. The patient has been on the Glycoflex and Adequan since 2013. The Novox has been consistently administered since the beginning of December 2017. The current diet is Purina Pro Plan Focus Sensitive Skin & Stomach 2.5 cup BID. There have been no recent diet changes.

Western Diagnosis:

January 10, 2018
Piper was bright and alert. She maintains good generalized muscle tone. No lameness was seen. There was mild sensitivity when palpating the caudal lumbar spine, but the patient was not overtly painful. Abdominal Palpation was overall unremarkable. The owner reports that Piper has several episodes of urinary incontinence every month since she was sixteen months old. These episodes always occur while the patient is sleeping. The owner does not feel that the urinary incontinence episodes consistently happen after heavy exercise. The urine always appears dilute and there is no strong odor. Full blood work and urinalysis was last performed in July 2015 and was overall within normal limits. Hind limb radiographs were last taken in September 2017 and there were no significant radiographic findings reported. The hardware placed during the tibial tuberosity advancement procedures appeared to be in the correct position and no abnormalities were seen that would require the hardware to be removed. The owner declines further blood work and radiographs at this time. A diagnosis of urinary incontinence was made based on history, clinical signs and by ruling out other conditions.

Eastern Diagnosis:

January 10, 2018
Piper’s TCVM exam revealed that she was a happy excitable dog. Piper is a strong fire constitution. Piper stays active and gets approximately 30-60 minutes of “play”, which includes trotting, running, tug of war, in the yard daily. The owner does not feel that the episodes of urinary incontinence are directly related to Piper’s level of activity for the day. Since the urinary incontinence started at sixteen months of age, Piper consistently has at least several episodes of urinary incontinence monthly. The patient prefers warmth and soft surfaces. The weather and temperature does not seem to have an effect on the episodes of urinary incontinence or patient’s mobility. Her mobility appears normal while exercising. After exercise, Piper will lay down to rest and when she gets back up after resting, the owner notes the concern with mobility. Piper’s appetite is good. She drinks and urinates a normal amount. There is no vomiting reported and her stool consistency appears normal. The patient does consistently dream throughout the evening. Piper will run and vocalize in her sleep.

On examination, Piper’s tongue appearance was pink and moist. Her pulse was deep and equal between the right and left legs. Her pulse was slow at 90 beats per minute. Palpation of the epaxial muscles along the spine from the second lumbar vertebrae to the lumbosacral space was tender. There was a large palpable depression at Bladder 20 (right and left). No other acupuncture sites had noted deficiencies or tenderness.
A diagnosis of Kidney Yang Deficiency was made based on the urinary incontinence, history of weak knees (history of bilateral cruciate injury), the warm-seeking behavior and the slow and deep pulse.4,15,17,18

Western Treatment:
Continue Novox 50 mg PO SID, Glycoflex III PO SID and Adequan 1.0 mL SC q 4 weeks.
No additional Western treatment was recommended at this time.

Eastern (TCVM) Treatment:
Principles:
Kidney Yang Deficiency: Benefit Kidney Yang/Qi. Warm the Yang. Tonify the Qi. Pain relief and strengthen the hind end.

Acupuncture:
Dry Needle Acupuncture Treatment using Jing Mei Sterile Acupuncture needles 0.25mm x 15mm (copper Handle) were placed at a depth of 5mm using an even needle technique at all points except Bladder (BL) 60 and Kidney (KI) 3 for 15 minutes. The needle used at BL 60 was Jing Mei Sterile Acupuncture needles 0.25mm x 25mm and were inserted deeply enough to penetrate the leg medially at the KI 3 point. This needle remained in place for 15 minutes. Bilateral needle placement was used for the Back Shu points and all other needle placement was unilateral. The same needles and technique were utilized at each visit.
Points:

Treatments:
Session # 1 / January 10, 2018:
On the initial acupuncture session, I typically start with GV 14 because I find it is a good calming point and this point gives me a good first impression on how the patient will tolerate needle insertion. GV 14 also benefits yang because it is the meeting point of all the yang channels. GV 4 benefits Kidney Yang and strengthens the caudal back and stifle. BL 23 was used to strengthen the Kidney, as well as strengthen the lower back. ST 36 was used to increase Qi. SP 6 is the Master Point for the Caudal Abdomen and Urogenital areas, and was used to tonify the Kidney and Qi. SP 6 is also a good point to help with urinary incontinence. BL 40 is the Master Point for the caudal back and hip region, and was used to improve comfort in the caudal back, hip and stifle. SP 10 was used to help with urinary incontinence and a local point for the knee. The owner also reported that patient dreams frequently in the evening, so this point was also used to invigorate and nourish blood. Since the Kidney is deficient and the Kidney helps with the production of blood, the dreaming indicates that there is likely a secondary blood deficiency.2 BL 60 was used to strengthen the caudal back and alleviate pain and swelling throughout the body. The needle was inserted deeply to penetrate the skin and exit the skin through KI 3. KI 3 is the source point for the Kidney. This point was used to benefit Kidney Yang and strengthen the caudal back and knees.

Session # 2 / January 15, 2018:
Piper had one episode of urinary incontinence several days after the initial acupuncture session. The owner does not feel that there is any significant change in mobility. She is eating well, drinking normal and there is no vomiting or loose stool reported. Piper’s energy level is good. Physical exam was overall unremarkable. Her tongue was pale pink and swollen. There was no coating and a normal to increased amount of moisture. The pulse was deep and normal rate. There was no difference in the pulse between the right and left leg. Piper was sensitive on palpation around the hip region. Deep depressions were noted at BL 20, BL 21 and BL 23. GV 14 was the first needle inserted to serve as a calming point, and is the first needle placed on all future acupuncture sessions for this patient. This point also benefits Yang. BL 20 and BL 21 were used because there was a deep depression palpated at each point location and these points help to increase Qi. BL 23 was repeated to continue to strengthen the Kidney, as well as the lower back and knees. ST 36, SP 6 and BL 60 with KI 3 were repeated for the same reasons listed on the initial acupuncture session. PC 6 was used at this session for 2 reasons. The patient’s constitution is a strong fire, and I was hoping this would help to keep Piper calmer and more still during the acupuncture session. Also I wanted to see if this would have an impact on the amount that Piper dreams. GV 4, Bai-Hui, BL 40 and SP 10 were not used at this session. I knew that if Piper responded well to acupuncture, she would likely be a long term client, so I wanted to try to avoid acupuncture point fatigue. Also the owner reported an episode of urinary incontinence several days after the first session, so I wanted to change my point prescription to hopefully have a more successful response. Lastly by the time I had inserted all of the needles described above, I felt that the number of needles in the point prescription was adequate for the second session.

Session # 3 / January 24, 2018:
Piper had no episodes of urinary incontinence since the last acupuncture session. The owner reports that patient’s mobility is improved and she has been very playful. The owner has a video of patient playing outside in a way that she hasn’t done since she was a puppy. Piper was bright and alert. There were no changes on physical exam. There were no deep depressions palpable. Her tongue was pink and flabby with normal moisture. The pulses were deep and slow, but the pulse could be palpated at the superficial level. There was no difference between the left and right pulse. The Points repeated from last exam were GV 14, BL 20, BL 23, ST 36, SP 6 and BL 60 with KI 3. BL 21 was not used because there was no large depression or sensitivity at the point, so I didn’t feel that there was significant benefit in including it in the point prescription. PC 6 was also not used at this session because it was difficult to access the location on this patient and I did not feel that there would be added benefit. BL 11 was added to help with bone pain and relax the sinews. BL 26 was added to strengthen the lumbar region and help with urinary incontinence. The pulse at the end of the acupuncture session was normal rate and could be palpated more easily at the superficial level. The pulse was still strongest at the deepest level.

Session # 4 / January 30, 2018:

Overall Piper did well since the last acupuncture session. There have been no episodes of urinary incontinence. The weather since the last session has not been great, so Piper had not spent a lot of time outside. Even though Piper had limited activity outside, the owner feels that Piper appears comfortable. She is eating and drinking normal, and has a normal energy level. Piper’s physical exam was unremarkable. A large depression was palpated at BL 23 and Piper appeared mildly sensitive on palpation of the proximal femur (BL 54, GB 29, GB 30). Piper’s tongue was pink with normal moisture. Her pulse was normal rate and felt normal at all pressures. GV 14, BL 23, SP 6, ST 36 and BL 60 with KI 3 were repeated from the previous session. BL 40 was added to help strengthen the caudal back, hip and stifle. As mentioned previously, I want to alternate between different points that will benefit Piper’s hind end, to avoid Point fatigue. HT 7 was added to help calm Piper’s shen during the acupuncture session. PC 6 was used in a previous session and I did not feel that PC 6 made a significant difference in how calm the patient became. Also based on the location of PC 6, it was difficult to insert the needle. HT 7 was more easily needled in this patient and I felt that Piper was moderately calmer during the acupuncture session. Piper’s constitution is fire. If you look at Piper or talk about her during the acupuncture session, she gets very excited and it’s difficult for her to sit still and stay calm, with the end result of the majority of the needles falling out during the excitement phase. So I have learned that once I have inserted the needles, the best course of action is to completely ignore her until the needles are ready to be removed. Most times if she is being ignored, she will comfortably and quietly lay down. Since Piper has not had any urinary incontinence episodes in the last three weeks, the next acupuncture session will be in 14 days.

Session # 5 / February 13, 2018:
There have been no episodes of urinary incontinence since the last acupuncture session. Piper was definitely more stiff the last couple of days when getting up from a long nap. The owner does not feel that she was painful, but she does notice a slight difference in her mobility. Piper’s energy level is good and there are no new concerns reported by the owner. Physical exam remains overall normal. There was a moderate depression at BL 23, but no sensitivity. There was moderate sensitivity when palpating L3 to the lumbosacral space. There was also a strong panniculus reflex when palpating the lumbar epaxial muscles, which was not noted at previous acupuncture sessions. The tongue was pink and moist, with no coating. The pulse was normal rate and normal at all pressures. GV 14, BL 23, SP 6, ST 36 and BL 60 with KI 3, were all used with the same intentions as previous acupuncture sessions. HT 7 was continued because I did feel that it helped keep Piper calm during the session and the point location allowed the needle to be easily inserted. I feel that the slight decline in mobility reported by the owner, could either be because of the points selected at the last session or because this was the first week that there was 14 days between acupuncture sessions. I decided to bring back several points that were used in previous acupuncture sessions that may have significantly helped with patient’s mobility and comfort. These points include BL 11 and BL 40. BL 62 was used for the first time today to open the Yang Qiao Mai in order to help with mobility in the hind limbs. After I was reviewing the case several weeks later, I feel that it would have been better to use KI 6 and open the Yin Qiao Mai. The Yin Qiao Mai would better address a pathologic condition where the yang was deficient.1 Once the needles were removed, the panniculus reflex noted prior to acupuncture, was no longer present.

Session # 6 / February 27, 2018:
There have been no episodes of urinary incontinence. The owner feels that Piper has been more stiff and slower to rise over the last several days. Piper has not been vocalizing in pain or discomfort, and the owner does not report an obvious lameness. The only other change reported, is that Piper started eating dirt recently. The owner reports that Piper tends to eat dirt for a few days around this time of year, every year. There is no vomiting reported and stool is normal. Piper is also eating her normal diet well. Piper does continue to dream throughout the evening. There was a moderate panniculus reflex at BL 23 and on palpation of caudal lumbar epaxial muscles. There was a moderate to deep depression at BL 17 and BL 18. The tongue was pink with normal moisture and no coating. The pulse was slow and most easily palpable at middle and deep pressure. GV 14, BL 23, HT 7, SP 6, ST 36 and BL 40 were repeated from the previous session. BL 17 and BL 18 were chosen because deep depressions were noted on palpation. The consistent dreaming indicates that there is a blood deficiency.2 BL 17 is the Influential point for the Blood and tonifies the blood. Piper also started recently eating dirt and BL 17 helps to pacify the stomach. Bai-Hui had not been used since the initial acupuncture session, and based on Piper’s stiffness; I felt that it would be a good point to help with the hind end. Bai Hui tonifies the Kidney and helps with Yang deficiency.

Session # 7 / March 13, 2018:
There have been no episodes of urinary incontinence. Piper is still eating dirt, but less frequently then compared to the last acupuncture session. The owner feels that Piper did well with mobility for the 10 days after the last acupuncture session, and has been mildly more stiff the last couple of days. The owner administered Adequan 1.0 mL SC yesterday. There was almost no dreaming for 4-5 days after the last acupuncture session, and since then the dreaming has become more frequent. The patient’s energy level is normal and she is eating and drinking normally. There is no vomiting or loose stool reported. There was mild sensitivity on palpation of BL 23 and a deep depression at BL 17. The tongue was pink with no coating. It appeared less moist then previous exams but there were no cracks. The pulse was slow and most easily palpable at the deep level. The following points were repeated from the last acupuncture session: GV 14, BL 17, BL 23, Bai-Hui, ST 36, SP 6 and BL 40.

Session # 8 / March 27, 2018:
There have been no episodes of urinary incontinence. Piper’s mobility appeared normal until 2-3 days ago, and then the patient appeared stiffer. Piper never seems to have mobility concerns when she is playing with the other pets. After Piper is finished playing, she will lie down and the owner typically notes the stiffness when Piper awakes from her nap. After Piper walks around, the stiffness will slowly start to resolve. She is still dreaming regularly. The owner reports no other changes. There were no pain or heat signs noted on physical exam. There was a deep depression at BL 17, and mild sensitivity at BL 23. The tongue was pink with normal moisture. The Pulse was easily palpable at all levels, and strongest at the superficial level. The pulse rate was fast, especially compared to previous sessions. The following points were repeated from the previous session: GV 14, BL 17, BL 23, SP 6 and BL 40. GV 14 was repeated to continue yang support. BL 23 and BL 40 were repeated to help with Kidney yang and support the hind end. BL 17 was selected to tonify the blood. SP 6 helps to tonify Qi and Blood, while also strengthening the Kidney. BL 20 was selected to tonify Qi. The mobility concerns seem most noticeable after rest, and there seems to be improvement after the patient is moving, which means there is a level of stagnation. I decided to use the 4 gates at this session, LIV 3 and LI 4, to try to help move Qi and Blood throughout the body. Used together, LIV 3 and LI 4, should help to relieve soreness in all joints of the extremities. I had not used these distal points prior to this session, because I did not know how the patient would tolerate the insertion of these needles. Also when the patient is standing, she is typically moving around. When the patient is lying down, she is typically laying in a position that does not allow easy access to LIV 3. Today I was able to easily insert LI 4 on the left and LIV 3 on the right. I discussed with the owner about moving the acupuncture sessions to every 10 days, rather than 14 days. There have been no episodes of urinary incontinence, and if this was the only concern, I feel that we could start to lengthen the time between acupuncture sessions. Piper’s mobility seemed overall great when we preformed acupuncture every 7 days, but when we extended to every 14 days, the owner noted a consistent decline in mobility around day 10. The owner elected to monitor Piper and if at day 10 she appears to be stiffer, then acupuncture will be performed at that time.

Session # 9 / April 10, 2018:

There have been no episodes of urinary incontinence since the last exam. The owner occasionally notes that later in the evening Piper may seem stiffer, but overall her mobility appears normal. Physical exam was overall unremarkable. There were no sensitivity or deep depressions palpable on exam. The tongue was pink and normal moisture. The pulse was normal rate and palpable at all pressure levels. The middle level was the most forceful. GV 14, BL 23, SP 6 and ST 36 were repeated from the last session. BL 11 was used to soothe the sinews and ease bone pain. Bai Hui was used to tonify the Kidneys, activate Qi and Blood and alleviate pain. The 4 gates were used again at this session. I inserted all 4 points in a figure 8 confirmation. Piper tolerated the needle insertion for all four points well. Based on Pipers successful response to acupuncture, the plan is to continue acupuncture every 2 weeks.

Discussion:
In January 2018 Piper had an acupuncture consult for urinary incontinence. She first started having episodes of urinary incontinence at sixteen months of age. At that time a complete blood count, organ function profile and urinalysis were performed which were within normal limits. Phenylpropanolamine 50 mg PO BID was recommended. Thirty minutes after administering the first dosage, Piper vomited and developed generalized erythema. These abnormal clinical signs resolved without any further treatment, but the owner permanently discontinued the medication at that time. Since sixteen months of age, Piper has continued to have episodes of urinary incontinence. The owner reports at least several episodes of urinary incontinence monthly and although these episodes are always while Piper is asleep, the owner does not feel that there is any other pattern to these episodes. When the owner was made aware that acupuncture could significantly reduce or eliminate the episodes of urinary incontinence, she agreed to an acupuncture consultation.

Piper’s only other significant history is that she had bilateral cranial cruciate ligament ruptures in 2013 (Left hind) and 2014 (right hind). Both knees were repaired with the tibial tuberosity advancement procedure. After the first surgery, Piper was started on Glycoflex III PO SID and Adequan injections. The Adequan was initially started at a dosage of 1.0 mL SC twice weekly for 1 month and then extended to 1.0 mL SC q 28 days. Piper overall seemed comfortable after both surgeries, until September 2017. The owner noted that Piper seemed to be stiffer when rising and she seemed to favor the left hind limb. Hind limb radiographs were taken at that time which showed correct placement of the hardware and no other abnormalities. At that time the owner started to intermittently give Novox 50 mg PO SID, but in December 2017 Piper was consistently given Novox 50 mg PO SID to every other day. Overall the owner feels that Piper is comfortable but she does still seem stiff in the hind end when rising after a long nap.

Piper’s TCVM exam in January 2018 revealed that she was a happy excitable dog. Piper is a strong fire constitution. On physical exam her mobility was overall normal and no lameness was noted. She maintained adequate generalized muscle tone. Piper’s abdominal palpation was overall unremarkable. The urinary incontinence episodes are always while Piper is asleep but the owner feels that the episodes randomly occur. The owner does not feel that these episodes are related to strenuous exercise or to climate/weather changes. The urine during these episodes appears to be dilute, with no odor and there is a moderate amount of urine for a 50 pound dog. For the last seven years Piper has consistently had several episodes of urinary incontinence monthly. The mobility concerns seem to be related to Piper’s level of exercise. Piper seems to have no mobility issues when playing, but when finished playing she will lay down to rest, and when Piper gets up from her nap she seems to be stiffer in the hind limbs. The stiffness seems to improve after Piper walks around for several minutes. Piper prefers warm and soft surfaces. On examination, Piper’s tongue appearance was pink and moist. Her pulse diagnosis was deep and slow, and equal between the right and left legs. On palpation of the epaxial muscles along the spine from the second lumbar vertebrae to the lumbosacral space, Piper appeared tender. There was a large palpable depression at Bladder 20 (right and left). At the initial consult, no other acupuncture sites had noted deficiencies or tenderness.

Piper has a chronic history of urinary incontinence. She also has bilateral cranial cruciate ligament ruptures that have both been surgically repaired, and although her most recent hind limb radiographs show no significant abnormalities, the owner notes she seems to have mild difficulty with her hind limbs. Based on Piper’s history, current clinical signs and both the western and TCVM exam findings, Piper is diagnosed with Kidney Yang Deficiency.4,7,15,17,18 The Kidneys control the lower orifices, so when the Kidney Qi/Yang is deficient, urinary incontinence is seen.18 The reported mild difficulty rising and weakness in the hind limbs and lumbosacral area, is consistent with Kidney Yang Deficiency. The moist tongue and deep slow pulses are also consistent with Kidney Yang Deficiency.4,15 The Kidney controls the bones and lower back so deficiency leads to lumbar pain and pronounced hind limb weakness.16 Piper being Yang deficient creates an internal coldness, which is why she actively seeks heat.18 So the two main concerns with Piper, urinary incontinence and stiffness/weakness in hind limbs and stifles, are also the two common clinical signs seen when the Kidney is deficient. Part of Piper’s root cause for her chronic and current clinical signs could be a Jing Deficiency.7 Jing deficient pets have a disadvantage in regards to making blood. The kidney is responsible for providing the essence to the rest of the body, including for making blood. Piper’s chronic history of dreaming is likely due to a blood deficiency, which is secondary to the Kidney deficiency.2

Acupuncture points were chosen to help tonify Kidney Yang, benefit both Qi and Yang, and local points for pain relief and help with hind limb strength. The owner had pursued this consult specifically to help with the urinary incontinence and the expectation discussed with the owner was to reduce or eliminate the episodes of urinary incontinence. After discussing the benefits acupuncture could have on the current hind limb concerns, we agreed that another expectation was to improve Piper’s mobility in the hind limbs. Piper’s constitution is fire. In the first few sessions I was careful about the acupuncture points I chose to keep the session positive. Piper would also get very excited throughout the session if you look at her or if she thinks you are talking about her, so it was a challenge to keep her still. After the first 3-4 sessions we developed a fairly good routine to insert the needles with minimal challenge and to prevent her from shaking the needles out within the first couple of minutes.

I chose GV 4 and GV 14 to help tonify Yang. BL 23, KI 3 and Yao Bai Hui were selected to tonify the Kidney. I used the following points to tonify Qi; ST 36, SP 6, BL 20 and BL 21. SP 6 was also used to tonify blood, as well as BL 17. LI 4 and LIV 3, the four gates, were used to help move Qi and Blood throughout the body. Bladder 60 was a point that I tried to use at most of the acupuncture sessions, to help strengthen the caudal back and alleviate pain and swelling throughout the body. BL 40 was also a point that I used at several sessions. BL 40 is the Master point for the Caudal Back and Hip Region, so it helps with all problems of the caudal back, hip and stifle. BL 62 was used to open the Yang Qiao Mai, and it also helps with back and pelvic limb pain. After reflecting on this case, I think it may have been more appropriate to open the Yin Qiao Mai with KI 6. The Yin Qiao Mai would better address pathologic conditions where yin is in excess and the yang is deficient.1 BL 11 is the Influential point for Bones, and it can increase Qi, as well as well as help with all bone problems. SP 10 was used as both a local point for the knee and to help nourish and move blood. BL 18, the Liver Shu Point, was used to benefit the patency of flow of Qi and it helps with muscle and tendon problems. Lastly I used PC 6 and HT 7 during several sessions to help calm Piper’s shen. The points that I selected that specifically have western applications of helping with urinary incontinence include SP 6, SP 10 and BL 26.4

Overall Piper responded well to acupuncture. Prior to acupuncture, Piper had several episodes of urinary incontinence monthly since sixteen months of age. Piper had one episode of urinary incontinence after her first acupuncture session in January 2018 and has no episodes of urinary incontinence since. Piper had a seven year history of urinary incontinence prior to the initiation of acupuncture. Since starting acupuncture Piper has three consecutive months of no episodes of urinary incontinence. Piper was initially started on Phenylpropanolamine at sixteen months of age and based on an abnormal reaction, the medication was immediately discontinued. Based on the fact that the urinary incontinence was not hurting Piper, and to avoid administering any further medications, the owner accepted the several episodes of urinary incontinence that would occur monthly. After starting acupuncture, the urinary incontinence episodes were almost resolved, which I feel has increased both Piper’s and the owner’s quality of life. Based on a seven year history of urinary incontinence, I feel that without acupuncture, Piper would have continued to have several episodes of urinary incontinence monthly forever. Overall I feel that acupuncture also helped with Piper’s mobility. Piper was already on a non-steroidal anti-inflammatory prior to acupuncture. Since starting acupuncture, the frequency of the stiffness when rising was reduced. I feel that based on Piper’s diagnosis and acupuncture point selection, I helped to build strength in the hind limbs, as well as reducing pain and inflammation. The most recent hind limb radiographs reveal no boney abnormalities and no radiographic abnormalities to the hardware previously placed. As stated previously Piper is already on a non-steroidal anti-inflammatory and she has been receiving Adequan injections regularly for years. Based on these current treatments, there are limited options to help with Piper’s hind limb mobility. Also there are no western medications that can be administered that will help improve Piper’s strength. I believe acupuncture was a great addition to Piper’s chronic pain management plan, because it addresses any discomfort she may be having and improves her hind limb and back strength.
Acupuncture overall had a positive effect on Piper. As a result of the activation of numerous bodily systems, an acupuncture treatment with the primary concern of urinary incontinence was also able to address Piper’s mobility concerns. Rather than viewing the acupuncture channels as individual anatomical entities, it is best to view the channels as a physiological system unifying the other systems of the body as a cohesive whole.8 Also rather than viewing needle therapy as a treatment for disease, it may be more valuable to view needle therapy as helping to restore balance and homeostasis.8

When a needle is inserted into the skin, the mechanical coupling between the needle and connective tissue will cause winding of tissue around the needle, which is referred to as needle grasp. Winding may allow needle movement to deliver a mechanical signal into the tissue and may be a key to one of acupuncture’s therapeutic mechanisms.9 Needling activates locally a complex neurovascular immune regulatory response, which involves cutaneous inflammation and vasodilation, nociceptive excitation and pain relief, as well as tissue repair and wound healing.11 The concept that one needle is able to have a positive effect on both an internal organ and mobility, could be explained by the cutaneous visceral reflex.12 If a skin point shares the same nerve root as an organ, then needling this point, could have a positive effect on both of Piper’s main concerns. Also the high intensity of needle stimulation can contribute to the effect by nociceptive pain and inflammation. High intensity of needle stimulation will cause greater blood flow to the cortical regions. So another important mechanism of how acupuncture is able to treat numerous conditions in the body is by improving circulation.9 Increase in blood flow to painful areas should theoretically aid healing mechanisms, help to bring in nutrients and oxygen, remove metabolites and help the body to reach homeostasis.10

Needling acupuncture points can also affect the connective tissue. Research shows that there is more value to fascia then simply a displacement layer filling the space between individual structures. The fascia may function as a body-wide signaling network. The acupuncture channels are highly correlated to fascial planes. Acupuncture can cause stimulation of the fascia, and these pathways have a strong relationship to movement and can provide efficient pathways to deeper aspects of the fascia and viscera. This mechanism could also explain the positive effect that acupuncture had on both Piper’s urinary incontinence and mobility concerns.8
Piper’s urinary incontinence and mobility concerns are chronic issues. Chronic pain is a complex multifactorial condition that is not simply a sensation or a symptom. This type of pain works differently because the nerve signals are too weak, so the brain does not release pain relieving substances. Inserting needles into the skin at the peripheral sites increases the neural threshold, so that the signal can reach the brain. Specifically patients with chronic pain appear to demonstrate low levels of endorphins and inducing a small inflammatory reaction by inserting an acupuncture needle around the affected tissues can increase the levels of endorphins, which effectively provides pain relief.13 Although acupuncture can work quickly, the established chronic pain pattern requires repeated treatments in order to change the pattern. Repeated acupuncture may improve the nerve transmissions signal between the peripheral and central nervous system and reestablish neurological homeostasis and eliminate pain memory. Acupuncture points can stimulate the CNS to release biochemical into muscles, the spinal cord and the brain. These biochemicals can affect the experience of pain, or release other biochemicals that influence the body’s self-regulating systems.10 Acupuncture points induce a neurovascular immune response, promote blood flow, reduce pain, suppress inflammation, promote tissue repair and essentially support homeostasis.14 The neurochemical mechanisms of needling provide analgesia, promote homeostasis and tissue healing. The integrated nature of these mechanisms explain why problems as different as urinary incontinence and mobility concerns, are all improved in the course of needling treatment for pain management. Needling therapy restores the body’s control system and promotes self-healing.13 In summary, acupuncture was an effective treatment modality for Piper. Acupuncture improved her quality of life by resolving her urinary incontinence and improving the mobility and strength in her hind limbs. The owner was pleased with Piper’s results.

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