an introduction to veterinary acupuncture l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
An Introduction to Veterinary Acupuncture PowerPoint Presentation
Download Presentation
An Introduction to Veterinary Acupuncture

Loading in 2 Seconds...

play fullscreen
1 / 97

An Introduction to Veterinary Acupuncture - PowerPoint PPT Presentation


  • 984 Views
  • Uploaded on

An Introduction to Veterinary Acupuncture Nina Malik, DVM October 15, 2008 Atlantic Coast Veterinary Specialists Outline History of Acupuncture Eastern Framework Western Framework- Mechanism of Action Acupuncture Modalities Indications for Acupuncture Case Studies What We Learn

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'An Introduction to Veterinary Acupuncture' - oshin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
an introduction to veterinary acupuncture

An Introduction to Veterinary Acupuncture

Nina Malik, DVM

October 15, 2008

Atlantic Coast Veterinary Specialists

outline
Outline

History of Acupuncture

Eastern Framework

Western Framework- Mechanism of Action

Acupuncture Modalities

Indications for Acupuncture

Case Studies

what we learn
What We Learn

Curriculum in Veterinary Medicine

Graduation Requirements

  • First YearCr. 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
  • Second YearCr. 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
  • Third YearCr. 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
  • 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.

Indications Applications Mechanisms of action

journal of the american veterinary medical association september 15 2007 vol 231 no 6 pages 913 918
Journal of the American Veterinary Medical Association September 15, 2007, Vol. 231, No. 6, Pages 913-918

Abstract

Evaluation of electroacupuncture treatment for thoracolumbar intervertebral disk disease in dogs

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)

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.

ancient healing art
Ancient Healing Art
  • Theories of circulation and pulse character postulated in China 4,000 years before Western medicine
  • Various nations claimed to be founders
  • Founders of acupuncture- Northern India or Tibet (Ayurvedic Medicine?)
huang de nei jing
Huang-de-nei-jing
  • First written record of acupuncture over 2,200 years ago in China
  • Two books- Suwen is the most famous
  • Conversation with Yellow Emperor (3rd millennium B.C.)
  • Physiology, pathology, diagnosis, and prevention of disease
  • Authorship- Yellow Emperor?
first veterinary acupuncture textbook
First Veterinary Acupuncture Textbook

Sun-Yang, 650 B.C.

Lyon, France, 1761

cbs 11 00 p m news 9 24 08
CBS 11:00 p.m. News- 9/24/08

http://wcbstv.com/seenat11

the eastern framework
The Eastern Framework

Yin

+

Yang

  • Dark
  • Descends
  • Cool, moist
  • Anabolism, rest
  • Substance- tissues
  • Ventral and Inner aspects of body
  • Light
  • Expands outwards
  • and upwards
  • Hot
  • Metabolism, movement
  • Head, Back, Outer
slide13

Qi

  • Energy force running through body
  • Flow of Qi influences health of animal
slide14

Insufficient

  • Unbalanced
  • Obstructed
meridians
Meridians
  • Qi travels in meridians/channels
  • Acupuncture points- locations where meridians come to surface/accessible
  • Needling points= manipulate Qi and restore balance
  • Allows body to heal itself
veterinary acupuncture points
Veterinary Acupuncture Points
  • Based on transpositional system (human)
  • Points located via anatomical landmarks and body measurements (cun)
pattern differentiation
Pattern Differentiation
  • TCM diagnosis is based on pattern differentiation, not on diagnosis of a particular disease as in Western medicine
  • One disease entity in Western medicine may have multiple underlying possible TCM patterns.
  • TCM Patterns are based on a number of different factors:

History

Diagnostic Tests (Radiographs, Bloodwork)

Physical Examination

Tongue and Pulse diagnosis

Lifestyle, external factors (damp weather), and personality/behavior

the western framework
The Western Framework

Anatomy of acupuncture points

Mechanisms of Action

Effects on the CNS

Endogenous Pain Inhibition

Segmental Analgesia

Local Tissue Effects

Autonomic Nervous System

Trigger Point Therapy

anatomy of acupuncture points
Anatomy of Acupuncture Points
  • Not random points on the body
  • Areas of lower electrical skin resistance compared with the surrounding skin. Normal skin: 200,000-2 million ohms vs. 50,000 ohms
  • High electrical skin conductance
  • Many found in palpable depressions on the body
trigger points
Trigger Points
  • Hyperirritable locus within a taut band of skeletal muscle or its associated fascia
  • Approximately 70% of acupuncture points correspond to trigger points
mechanisms of action
Mechanisms of Action
  • Endogenous pain inhibitory system
  • Segmental analgesia
  • Local inflammatory effects
  • Autonomic nervous system to affect viscera
  • Relief from trigger points
review of nociceptors
Review of Nociceptors

A-beta receptors

  • Large diameter, rapid conduction, myelinated

A-delta receptors

  • Medium diameter, medium conduction,

myelinated

  • Mechanoreceptors; mediate touch/pressure
  • Skin/fascia
  • Rapid pain response (“first pain”)

C-polymodal receptors

  • Small diameter, slow conducting, non-myelinated
  • Activated by thermal, mechanical, chemical stimuli
  • Mediate slow pain
effects of acupuncture on the cns
Effects of Acupuncture on the CNS
  • 3 Regions of CNS Activated
  • Spinal Cord
  • Brainstem
  • Hypothalamus-pituitary

Release of NT (endogenous opiates)

Block Pain Messages

endogenous pain inhibition
Endogenous Pain Inhibition
  • A delta fibers carry pain impulse to lamina I of dorsal horn
  • Activate neurons of the neospinothalamic tract
  • Neurons have long axons that cross to opp spinal cord and ascend to the hypothalamus/pituitary by way of the brainstem
hypothalamus and pituitary
Hypothalamus and Pituitary
  • Arcuate nucleus + pituitary contain all the beta-endorphin cells in the brain
  • Beta-endorphin release into blood and CSF
endogenous pain inhibition29
Endogenous Pain Inhibition
  • Third CNS region activated is the brainstem
  • Input via the A-delta fibers to the dorsal horn of the spinal cord
  • Via the anterolateral fasciculus of the spinal cord to the brainstem
slide30

Activation of the Brainstem

  • Stimulates descending
  • norepinephrine inhibitory
  • and serotonergic inhibitory
  • fibers
  • Travel in dorsolateral
  • tract of the spinal cord
  • Synapse on dorsal horn
  • interneurons
slide31

Combined result: beta-endorphin, NE/5-HT3 inhibitory fibers

  • Release of enkephalin and dynorphins from segmental interneurons of spinal cord
  • Bind opiate receptors on pain afferents
  • Pre-synaptic inhibition of A-delta and C fibers (temp, crude touch, aching, burning, chronic pain)
naloxone reversal
Naloxone reversal
  • Naloxone reverses acupuncture analgesia
  • Evidence that pain inhibition is mediated through endogenous opioid neural loop
slide33
Suppression of substance P from afferent pain axon to inhibit pain impulse transmission to the brain for conscious perception
slide34

The Western Framework

Anatomy of acupuncture points

Mechanisms of Action

  • Effects on the CNS
  • Endogenous Pain Inhibition
  • Segmental Analgesia
  • Local Tissue Effects
  • Autonomic Nervous System
  • Trigger Point Therapy
segmental analgesia
Segmental Analgesia
  • High frequency (100 Hz), low intensity stimulation
  • Electroacupuncture (EAP)
  • Localized analgesia, rapid onset, ceases after stimulation has stopped
  • Brainstem activated
slide36

Stimulates NE and 5HT inhibitory fibers in brain stem

  • Dorsal horn of spinal cord
  • Mediation by GABA in the spinal cord
slide37

Activates the dynorphin synapses in the spinal cord

  • Relieves chronic pain possibly by selectively inhibiting input from C fibers
the western framework38
The Western Framework

Mechanisms of Action

Effects on the CNS

Endogenous Pain Inhibition

Segmental Analgesia

Local Tissue Effects

Autonomic Nervous System

Trigger Point Therapy

vasoactive effects
Vasoactive Effects

PHASES

2 minutes-2 weeks

3.

10 seconds-2 minutes

2.

15-30 seconds

1.

time dependent phases
Time-dependent Phases

Vasodilation

Inactivation Nociceptive

of Reaction potentiation

Tissue Repair Chemotaxis

Solubility

sum total of local tissue effects
Sum Total of Local Tissue Effects
  • Improved local tissue perfusion
  • Increased local immune responsiveness
  • Muscle and tissue relaxation
  • Pain relief: increased perfusion and cessation of muscle spasms
western framework
Western Framework

Mechanisms of Action

Effects on the CNS

Endogenous Pain Inhibition

Segmental Analgesia

Local Tissue Effects

Autonomic Nervous System

Trigger Point Therapy

viscerocutaneous reflex
Viscerocutaneous Reflex
  • 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
  • The pain can be referred to areas that are far away or directly over the painful organ
referred pain
Referred Pain
  • McBurney’s point- right lower abdominal quadrant painful in appendicitis
  • Heart attack- Left arm, back, neck (not at chest)
  • “Brain freeze”- ice cream
  • Diaphragm refers to right shoulder
cutaneovisceral reflex
Cutaneovisceral Reflex
  • Reverse loop proposed
  • GV 26- hemorrhagic shock in dogs: increases cardiac output- blood pressure increases
  • PC-6 in cats: EAP inhibits frequency of transient lower esophageal sphincter relaxation
  • ST-36 accelerates colonic motility rats
cutaneovisceral reflex49
Cutaneovisceral Reflex

Needle in paravertebral muscle at myotome segmental level associated with muscular pain

Somatic nerve ending of a muscle stimulated

Afferent impulse to dorsal horn

Stimulation of contralateral anterior hypothalamus

Activation of somato-autonomic reflex

Cholinergic vasodilator nerves activated to spastic muscles

western framework50
Western Framework

Mechanisms of Action

Effects on the CNS

Endogenous Pain Inhibition

Segmental Analgesia

Local Tissue Effects

Autonomic Nervous System

Trigger Point Therapy

trigger points51
Trigger Points
  • Hyperirritable locus within a taut band of skeletal muscle or its associated fascia
  • Approximately 70% of acupuncture points correspond to trigger points
taut bands of skeletal muscle
Taut Bands of Skeletal Muscle

Damage to muscle

Calcium release from SR

Actin-myosin interact

Muscle contraction

Decreased perfusion to m.

Decreased ATP locally

Calcium can not return to SR

Actin-myosin do not dissociate

formation of trigger point
Formation of Trigger Point

Trauma to muscle/fascia/tendon via acute injury or chronic strain

Release of mediators (bradykinin, PG, histamine)

Platelets and mast cells recruited

MPS released into spaces between muscle fibers

Fibrocytic nodules expand and stretch surrounding muscle

Decreased O2 to muscle

Local Acidity

Sensitized muscle nociceptors and converted to trigger points

pain activation of trigger points
Pain Activation of Trigger Points

Trauma to muscle/fascia/tendon via acute injury or chronic strain

Release of mediators (bradykinin, PG, histamine, etc)

Sensitize C-Fibers Sensitize A-delta fibers

Slow transmission to Fast transmission to

limbic system parietal lobe

Frontal lobe

Sharp, short duration pain

After short delay:

Persistent, dull aching pain,

Near or distant to activated trigger point

Abnormally sensitive reflex arc

types of trigger points
Types of Trigger Points
  • Active- causes pain without manipulation
  • Latent- not obviously painful to patient. May be painful on palpation. May cause restriction of movement and eventual weakness.
  • Often refer pain to specific area depending on location of trigger point. (GB 21)

Structures Affected:

  • Skeletal muscles
  • Tendons/Ligaments
  • Joint capsules
  • Periosteum
  • Skin (esp. scar-associated)
treatment
Treatment
  • Needling trigger point disrupts the abnormally contractile elements or nerve ending
  • Stops feedback loop
  • Dry needling
  • Aquapuncture
outline58
Outline

History of Acupuncture

Eastern Framework

Western Framework- Mechanism of Action

Acupuncture Modalities

Indications for Acupuncture

Case Studies

acupuncture modalities
Acupuncture Modalities

Dry Needles

  • China or Japan
  • Single-use, sterile, disposable
  • 15-25 gauge
  • 7-40 mm
  • Seirin J: 0.20 x 30 mm

Seirin D: 0.16-0.20 x 15 mm

  • Guide tube or without
  • Metal handles: EAP/Moxa
acupuncture modalities60
Acupuncture Modalities

Dry Needles

  • Not painful
  • Deqi- arrival of Qi
  • Retained on average 10-30 minutes depending on pattern treating
  • Tonifying – shorter
  • Sedating – longer
aquapuncture
Aquapuncture
  • Fluid Effect:
  • Changes pH
  • Displaces tissue to produce pressure
  • Changes electrical potential
  • Prolonged effect
electroacupuncture eap
Electroacupuncture (EAP)
  • Segmental Analgesia (100 Hz)
  • Passing of electrical energy through acupuncture points
  • Attach Accual to needles in place
electroacupuncture
Electroacupuncture

Advantages:

  • Avoid manual manipulation of needles
  • Amount and quality of stimulation to needles: accurate and uniform
  • Higher and more continuous level of stimulation than manual
electroacupuncture65
Electroacupuncture

Indications

  • Paralysis
  • IVDD
  • Severe and chronic painful conditions
  • Surgical analgesia
  • Atrophied muscles

Contraindications

  • Cardiac Arrhythmias
  • Epilepsy
  • Shock
  • Pregnancy
  • Proximal to tumors
  • High fever
electroacupuncture66
Electroacupuncture
  • 4 outputs; each with 2 needle clip leads
  • AC- alternates between positive and negative polarity (deep tissue penetration)
  • Amplitude adjustment
  • Frequency (Hz): pulses per second (high >15): sedate pain vs. (low<15): muscle atrophy
electroacupuncture67
Electroacupuncture

3 Modes:

  • Continuous- stable frequency; continuous stimulation (tolerance)
  • Dense Disperse- continuous stimulation with alternating high and low frequency bursts (avoids tolerance)
  • Intermittent- stable frequency; stimulation pulsed with rest periods (avoids tolerance)
moxibustion
Moxibustion
  • Heating of acupuncture points
  • Artemesia vulgaris (mugwort; related chrysanthemum family)
  • 400° F

Indications:

  • “Cold” conditions TCM
  • Painful joints/muscular
  • “Deficient” patients
slide70

Precautions

  • Vicinity of mm or sensory organs
  • Caudal back/abd in pregnant animals
  • Febrile conditions
  • Burn Fur
infrared light therapy
Infrared Light Therapy
  • Another means of using heat to stimulate acupuncture points
  • Can use on individual acupuncture points or generalized areas
  • Mitochondria absorb light - covert to ATP - fuels cellular processes – release of NO- vasodilation

(reduce inflammation, improve local circulation, cell replication and repair)

infrared light therapy72
Infrared Light Therapy
  • FDA approved for specific indications in humans
  • Human therapy: Carpal tunnel syndrome, arthritis, TMJ

Veterinary Medicine:

  • Stimulation of acupuncture point
  • Needle phobic patients
  • Hard to reach acupuncture points
  • Corneal ulcers, Non-healing skin wounds, Superficial penetration
  • Repetitive Strain Injuries?
infrared light therapy73
Infrared Light Therapy

Disadvantages:

  • Size of diode cluster
  • Duration
  • Superficial penetration
  • Unit cost
  • Research- Equine/ Companion animal optimal settings
outline74
Outline

History of Acupuncture

Eastern Framework

Western Framework- Mechanism of Action

Acupuncture Modalities

Indications for Acupuncture

Case Studies

slide75

Pain Control

Musculoskeletal Disease

Neurologic Disease

Endogenous Pain Inhibition

Segmental Analgesia

Local Tissue Effects

Autonomic Nervous System

Trigger Point Therapy

Pain Control

Musculoskeletal Disease

Neurologic Disease

Dermatologic Disorders

Gastrointestinal Disorders

Cardiovascular Disease

Respiratory Disease

Urogenital Disorders

Pain Control

Musculoskeletal Disease

indications
Indications

Musculoskeletal Disease

  • Post-operative orthopedic surgery
  • Osteoarthritis
  • Trigger Point Therapy
  • Joint dysplasia
  • Pain, Range of Motion, Improve Circulation, Promote Healing
indications77
Indications

Neurologic Disease

  • Intervertebral Disk Disease
  • FCE
  • Seizures
  • Peripheral Neuropathies
  • Vestibular Disorders
  • Improve comfort in Degenerative Myelopathy patients
indications78
Indications

Gastrointestinal Disorders

  • Nausea
  • Vomiting
  • Diarrhea
  • Constipation
  • Abdominal Pain
  • PC 6 – Inhibiting frequency of lower esophageal sphincter relaxation (cats)
indications79
Indications

Dermatologic Disorders

  • Allergic Dermatitis
  • Chronic Skin Disease
  • Otitis Externa
  • Non-healing skin wounds (infrared)
indications80
Indications

Cardiovascular/Respiratory

  • Rhinitis
  • Sinusitis
  • Bronchitis
  • Chronic coughing
  • Circulatory Disorders
  • Asthma
indications81
Indications

Urogenital Disorders

  • Urinary incontinence
  • Urinary tract infections
  • Chronic kidney disease

Immune Stimulation- Increase in absolute lymphocyte number (21 d)

Behavioral Problems

Oncology Patients

risks of therapy
Risks of Therapy
  • One of the safest therapies available
  • Side effects are rare
  • Patient may be transiently sleepy or sore for 1-2 days
  • Expectations: duration of treatment / indications
  • Disclose cancer
  • Overuse of injured limb
  • Swallowed needles
  • Eye injury, pneumothorax, infectious arthritis
  • Broken needles
case studies
Case Studies

10 year old, FS, Lab mix

History of elevated liver enzymes, otherwise clinically normal

Chronic issues:

  • Degenerative Myelopathy- mild HL ataxia; intermittent dorsal scuffing
  • Blind
  • Urinary incontinence
case studies86
Case Studies
  • AUS: hepatic mass
  • Referred to surgery at Atlantic Coast Veterinary Specialists:
  • Left medial liver lobectomy and mass excised from the quadrate lobe
  • Overnight post-surgery: Ambulatory with hind end sling; lying down in run
case studies87
Case Studies

Referred for acupuncture

Physical Exam

  • ambulatory without HL sling, but weak
  • HL ataxia
  • Atrophy bilat HL musculature
  • Dec extension shoulder
  • Dec extension bilat hips
  • Trigger points: Mild L. triceps m.; Bilateral quadriceps muscles
case studies88
Case Studies

Acupuncture Treatment

  • Arthritis in shoulders and hips
  • Trigger points in L. triceps and quadriceps
  • Underlying TCM patterns contributing to overall condition and HL muscle atrophy
case study 2
Case Study #2

2 year old, MN, Basset Hound

Diagnosed with IVDD L1-L2 and L2-L3

Surgical Decompression

Presentation 1 month

Post-op

  • Severely paretic in HL
  • CP deficits HL
  • No deep pain HL
case study 291
Case Study #2

Acupuncture Treatment

  • Combination of dry needles and EAP
  • Lumbar back and distal leg points treated
  • Thus far: 2 dry needle and 2 EAP treatments
case study 292
Case Study #2

Progress

After first couple of tx

  • Able to stand up on own and hold without falling over

After these four tx

  • Better motor HL
  • Deep pain
case studies other species
Case Studies- Other Species

2 year old, FS, DSH

Initial presentation- severe gingivitis

Dental and medical management

2 acupuncture tx, 1 month apart

case studies other species94
Case Studies- Other Species

7 year old, MC, Mini Lop

Chronic head tilt, decreased appetite, decreased activity since a pasteurella ear infection a couple of years ago

Being treated with acupuncture monthly for past 18 months

Activity improved, Appetite improved, Head tilt improved but mild one present