Acupuncture Corner: Article 1
Basic Introduction
By Dr. Martha Gearhart
The International Veterinary Acupuncture Society (IVAS) certifies veterinarians in acupuncture through a formal course (four five- day lectures with associated readings and textbooks), a two day examination, submission and review of a written case report suitable for publication, and annual continuing educational requirements. We are happy and proud to announce that Dr. Gearhart has completed the course, passed the exam, and submitted her case report. We hope that full certification will be granted by your next newsletter.
What is acupuncture?
Acupuncture (acus = needle) is the stimulation of specific points on the body to bring about changes in the musculo-skeletal, nervous, endocrine, cardiovascular, and immune systems. Most acupuncture points are at nerves, particularly at nerve roots and branches. Stimulation may be done with needles, injections, electrodes, or even lasers, but whatever the method, nerves are stimulated. By providing feedback to the spinal cord and brain, a stimulated nerve in the finger can influence many more nerves than just that one.
How could a needle in the finger affect the heart? In the same way that a heart attack can be 'felt' in the arm. The nervous system is inter- connected, and acupuncture has taken advantage of this fact for 4000 years. It can't cure everything, but it can definitely help many conditions, as we will explore in future newsletters.
Please feel free to call Dr. Gearhart to find out if acupuncture may be helpful for your pet.
Acupuncture Corner 2
Annie Still and Electroacupuncture
By Dr. Martha Gearhart
Little
Annie Still is a Dachshund/ Pekingese cross, making her a prime candidate
for back trouble -- serious, life-threatening back trouble -- even though
she is only six years old. The cartilage in the intervertebral discs of
her back is not like that of a Labrador's. Her discs are rigid, inflexible,
and brittle, as are the discs of all Dachshunds, Bassett Hounds, Beagles,
Poodles, Pekingese, Shih Tzuhs, Llasa Apsos, and other similar dogs and
their crosses. These b r e e d s a r e k n o w n a s "chondrodystrophic"
because all the cartilage in their body is like that of a human dwarf, making
their legs short and their spines susceptible to a "slipped" disc.
Pressure on a chondrodystrophic disc during back movement can make the rigid
disc explode into the spinal cord, causing damage, pain, and even permanent
paralysis requiring emergency surgery.
There are three "weak" areas in a dog's spine where we most often find disc disease. These areas are the base of the neck, the bottom of the ribs, and the lower back just behind and inside the wing of the pelvis. Weakness occurs in these areas because the vertebrae transition from one type to another. At the base of the neck, cervical vertebrae become thoracic vertebrae. At the bottom of the ribs, thoracic vertebrae transition to lumbar vertebrae, while in the lower back lumbar vertebrae join sacral vertebrae. Each of these groups of vertebrae are shaped differently which results in more movement and less stability at these junctions and greater stress and pressure on these discs.
Annie's owners took her to the Animal Emergency Clinic of the Hudson Valley when they found her suddenly unable to walk on a Friday night. Dr. Tucker diagnosed her paralysis as a Grade 4 on a scale of 1 to 5. A Grade 1 is only slighty wobbly, as if the patient can not quite coordinate her feet. A Grade 5 has no voluntary movement and no deep pain sensation. Surgery is unlikely to help a Grade 5 patient. A Grade 4 is unable to move on their own but differs from a 5 in that they detect deep pain and surgery may be helpful. Dr. Tucker explained to the Stills that transferring Annie to a Boarded Veterinary Surgeon would most likely be needed, but that a CAT Scan to positively identify the safest, most complete access into her spinal cord would be necessary first. As this was a Friday night, this would require a trip to Westchester County or New York City to run such tests on a weekend.
The Stills decided instead to let Dr. Tucker administer emergency doses of two corticosteroids -- dexamethasone and prednisolone. Annie was to be strictly confined to a crate or carried safely. She was to be reevaluated at Pleasant Valley Animal Hospital or back at the Emergency Clinic on Saturday morning. If she deteriorated over night, the owners would drive to Katonah-Bedford, the specialty referral clinic in Westchester County.
When I examined Annie the next morning, she could almost support herself in a standing position when held up, making her a Grade 3 paralysis. Most importantly, she could wag her tail. The corticosteroids had successfully reduced swelling of the injured spinal cord. However, she had had a terrible night, panting and crying with pain. On examination, her most severe pain was located in the middle of her back where thoracic (chest) vertebrae became back (lumbar) vertebrae.
in exquisite pain. The Stills agreed to try electroacupuncture to see if this would at least ease her pain. They could still go to Katonah- Bedford on Sunday if Annie experienced no relief. Fortunately, the acupuncture eased her pain within two hours, and she slept through the afternoon. On Monday, she could almost walk, and the Stills canceled their CAT Scan and Surgeon's referral appointments. I continued electroacupuncture twice a week for a total of five treatments. How does electroacupunture differ from traditional acupuncture, making it the treatment of choice for Annie? First, applying mild electrical currents to acupuncture needles relieves pain more rapidly, and secondly, the rate of healing of damaged nerves occurs more quickly by forcing electrical conduction of nerves.
Traditional acupuncture relieves pain by releasing the body's own pain-killing morphine-like compounds called endorphins. However, endorphins alone will not give relief from the kind of excruciating pain that Annie was experiencing. Additional pain mediators in the spinal cord are recruited by using electric current at increasing frequencies. At 0.2 Hz, endorphin production is stimulated, at 4 Hz, enkephalins are produced, and at 20 to 80 Hz, serotonins appear. By gradually increasing the frequencies over forty minutes, all the pain-controlling chemicals in the spinal cord are operating to suppress pain. This will only occur if the spinal cord is not so severely damaged that the body is unable to respond.
Electroacupuncture also increases the rate of healing in a damaged nerve
or spinal cord. This benefit is greatest if applied soon after the injury.
Again, a series of increasing frequencies are used, but, additionally, the
current is increased to the point of muscle twitching and even mild discomfort.
We are forcing both the muscles to work as well as the associated nerves
to recognize and quickly re-learn the flow of ions - i.e. the circuitry
disrupted by the injury.
Annie, at her first session, was not treated with high intensity stimulation
- only with a set of increasing frequencies to try to control her pain.
We did not want to risk any treatment that might possibly increase pain.
However, all her subsequent sessions involved increasing electric intensity
as well as frequency. While we cannot know if Annie would have healed with
prednisolone and cage rest alone, we do know her first session of acupuncture
relieved her pain when nothing else had.
Today, six months after this crisis, Annie has a little wobble when she walks, but she and the Stills are very happy with her health. Her owners know that, due to her genetics, another disc could "slip" and leave her paralyzed, so they carefully limit her jumping as best they can. Within her new restrictions, she is athletic and full of life.
Accupuncture Corner 3
Erica Wong and Treatment for "Kidney Yang Deficiency"
By Dr. Martha Gearhart
What
does it mean to have a weak lower back and trouble walking? From a Chinese
perspective, it could mean "Kidney Yang Deficiency" since the
kidneys lie against the upper back. Erica, an eighteen year old tortoiseshell
cat owned by Maria George and Lauren Wong, could not care less whether we
call her condition Kidney Yang Deficiency or Spinal Spondylosis and Disc
Disease. She just know she hurts and has trouble getting around. And, oh,
by the way, her hips hurt, too. After all, she is eighteen!
Erica has been in kidney failure for over three years, but she is very tough, and her owners are very dedicated. Over the past three years, she has needed fluids, antibiotics, supplements, and laxatives. Like many tough old girls, she does not like special kidney diets; she does not like being medicated, and she does not like eating her specially-flavored supplements of glucosamine and vitamins to help with her arthritis and back pain.
Treating her for all her various problems was destroying the quality of her life, and so her caring owners began to ask about alternatives. Ms. George's grandmother receives acupuncture regularly, so she asked Dr. Gearhart if acupuncture might be helpful to Erica. Now, after a year of treatments every 2 to 4 weeks, the owners certainly think so. Previous X-rays of Erica's back show that her spine has many changes typical of elderly pets - narrowed disc spaces and bridging bony material between many vertebrae. She has no flexibility in her spine, and this creates tension across her hips due to her low-slung posture. When she walks, her back end droops and is very stiff.
Erica is a perfect example to explain the Western versus Chinese perspective on acupuncture and why it helps pets. Western research shows that acupuncture helps her in three major ways. First, by stimulating nerve endings (creating a very minor pain), pain awareness in the spinal cord and brain is dulled. Secondly, acupuncture needles also directly relax spastic muscles when they penetrate through the tense muscle tissue to get to an acupuncture point. Finally, by needling a nerve low in the leg as well as one near the spine, the circuit of communication between the leg and the spinal cord is activated and, often, rejuvenated.
The ancient Chinese, of course, did not have technology to measure electrical stimulation patterns in the brain and spinal cord. But they did have centuries of observing nature facilitated by a very sophisticated and stable civilization of governance by their Emperors. The court physicians employed by these Emperors codified centuries of observation and study of the human body.
Chinese physicians believed that the kidney was the root of all health. After all, it sits in the middle of the body and could reasonably be thought to communicate between the upper and lower halves of the body; one can not live without them; and the production of urine and the act of sexual reproduction certainly seem intimately connected. Moreover, many diseases such as heart failure and wet pneumonia result in fluid accumulation, so those diseases could certainly be seen as rooted in failure of the kidneys to excrete fluid from the body.
The Chinese word "yang" has many definitions, but "strength" is as good a translation as any for our purposes. Thus, Erica's hind end weakness, which begins at the level of her kidneys, could be translated as "Kidney Weakness" rather than "Kidney Yang Deficiency." Her acupuncture prescriptions have followed those recommended by the Chinese for that condition, and with only minor modifications, they have proven to help Erica. Her kidney failure has, of course, progressed slowly over this time, but she is still enjoying her windowsill and the company of her humans.
Acupuncture Corner 4
The Lingering Pathogenic Factor
By Dr. Martha Gearhart
Malarie
is a 5 year old Italian Greyhound owned by Kim and Tim Maxwell. Their kennel
of rescued Greyhounds is full of licensed therapy dogs qualified to visit
hospitals, nursing homes, and any place where someone would benefit from
a canine cuddle. Kim also works as the lead veterinary assistant and office
manager for Dr. Les Scherr, our colleague in Hopewell to whom we frequently
refer our bird and reptile patients. Malarie has benefited greatly from
Kim and Dr. Scherr's care over her lifetime, but she never quite got over
the Lyme Disease she contracted in 2000. In fact, it evolved into rheumatoid
arthritis. Despite many weeks of antibiotics, she continued to have crippling
flare-ups of hot, red, swollen joints in her front legs, primarily in her
carpal joints (wrists). Her blood tests continued to be positive for Lyme
Disease, but also became positive for Rheumatoid Factor, indicating her
immune system was now attacking her own joints. Eventually, her painful
carpal flare-ups could only be controlled with daily doses of cortisone,
causing the expected side effects - drinking lots of water, a thinning
haircoat, and a general lack of interest in play.
When I first examined her, no abnormalities - either from a Western medical or an Eastern acupuncture perspective - could be found. Since there was no pattern of illness, I used classic points that both Western and Eastern medicine have shown to stimulate the immune system. At her third treatment, Kim told me that, after her second treatment, Malarie initiated play with her dog friends for the first time in a year. When I examined her, her entire body felt extremely hot yet she did not have a fever. This was a new sign, so her point prescription was altered slightly in that third treatment. We also began to decrease her cortisone dose, continuing to do so gradually over the next five treatments. She has now been without cortisone for seven months, after having been on it for nearly 2 years. She will receive acupuncture only if Kim sees signs of returning discomfort or swelling in her joints.
Malarie is a young dog, so curing her through acupuncture is a reasonable expectation. What is the Traditional Chinese Medicine (TCM) concept behind this? Basically, the TCM understanding of health and disease is based in nature. In fact, for one of the most influential philosophies in TCM, that of The Eight Principles of Diagnosis, all disease is thought to be an invasion of Four Pathogenic Factors - Wind, Heat, Cold, or Damp. Since extreme exposure of even the healthiest and hardiest individual to any one of these elements will cause death, this model is a logical one for understanding disease.
There is no Lyme Disease in TCM. In fact, there is no concept of bacteria or viruses or fungal infections whatsoever. Instead, the patterns of Heat, Cold, Wind, and Damp in the diseased body are evaluated and treated symptomatically with points that, over the centuries, have been shown to dispel Heat (fevers, redness), Dampness (swelling, blisters), Wind (sneezing, trembling, seizures, flatulence), or Cold (chills, joint pain that improves with hot compresses). From a TCM perspective, Malarie had been invaded by the Pathogenic Factors of Heat and Damp (red, hot, swollen wrists). Have we successfully expelled Malarie's "Lingering Pathogenic Factor"? We certainly hope so.
Western research has shown that the so-called "Immune Stimulation Points" affect not only blood circulation (dispelling heat, cold, damp, and tremors [wind]) in affected joints, but also directly stimulate the immune system as well. White cell counts, immune-reactive proteins, and antibodies are all frequently improved by acupuncture, helping to fight infections and improve health generally. In the TCM sense, we hope we have expelled her Lingering Pathogenic Factor. In the Western sense, we hope we have stimulated and regulated her immune system sufficiently so that she remains healthy without antibiotics or cortisone, or even acupuncture, for many months or even years.
Acupuncture Corner: Article 5
Buddy Adams and Treatment for "Short Leg Syndrome"
By Dr. Martha Gearhart
In 1997, Stephen and Jennifer Adams adopted Buddy from the Dutchess County SPCA. The Adams' were not deterred by Buddy's advancing age or the obvious deformity of his right rear leg. In fact, all the Adams' dogs had once been homeless adults abandoned at a local shelter.
Stephen and Jennifer had radiographs taken of Buddy's leg that showed the leg had been fractured years earlier and had never healed normally. The deformed leg was almost four inches shorter than the normal leg and pieces of metal lodged in the leg suggested that Buddy's injury likely had been from a gunshot wound. Since all the muscles were scarred and contracted, there was little chance of returning the limb to its normal length. Buddy was stuck with a very short, awkward leg.
Nevertheless, Buddy did very well for many years. But, by 2000, when Buddy was approximately ten, he was having trouble getting around due to arthritis in his normal rear leg and, most severely, muscle spasms in his short leg and his back. Pain medications and supplements helped initially, but then the benefits of those products seemed to disappear.
In 2002, Dr. Gearhart began acupuncture on Buddy. She was in the middle of the six month International Veterinary Acupuncture Society (IVAS) course and Buddy became her first canine patient! He received his first major treatment while he was anesthetized for a dental cleaning and the removal of a small growth on his side. His muscle spasms were injected with a local anesthetic. Following the procedure, for the first time in over a year, Buddy's short leg was able to move forward instead of sideways due to muscle spasm. After that treatment, dry needles at acupuncture points were used during regular office appointments every one to three weeks, depending on how much difficulty he was having walking.
"Short Leg Syndrome" happens to people as well as dogs. In fact, a difference of as little as one-half inch between the length of a person's legs can sometimes create back pain due to the uneven gait that results. People can have special foot prosthetics and shoe adjustments made to correct for this, but Buddy can not. Fortunately, continued acupuncture treatments as well as his pain medication, supplements, and massages by his dedicated owners have all helped him to cope with his condition.