by Heather Smith Thomas
A growing number of veterinarians are using non-traditional and complementary techniques in treating animals, often combining these with traditional western medicine. One of the most useful complementary modalities is acupuncture. Dr. Tia Nelson, Helena, Montana has been using acupuncture for more than a dozen years in her practice, often in conjunction with chiropractic care. “Acupuncture can be done in many different ways. We can use needles, lasers, simple pressure with fingertips or a pencil,” she says.
Acupuncture complements other techniques. For instance, chiropractic and acupuncture work very well together, with better results than using either one by itself. They are synergistic. You get more beneficial effect; it’s like 2 plus 2 equals 5. “Acupuncture is also completely different from our traditional treatments and is often very helpful,” Nelson says.
Acupuncture is a controversial modality because it doesn’t fit readily into the science of western medicine where studies can be done with treated animals versus a control group, or with some given a treatment and others a placebo—doing comparisons to see if a certain treatment really works.
It’s hard to quantify or measure effectiveness of acupuncture with our traditional use of trials and study models. “Therefore, some people are hesitant to use any kind of treatment that can’t be proven with a placebo/control double-blinded study,” Nelson says.
Dr. Clara Fenger, owner of Equine Integrated Medicine, PLC (Georgetown, Kentucky) uses acupuncture frequently in treating horses, but says there is still a lot of controversy regarding its use in veterinary medicine.
“Some people think acupuncture is not a valid treatment. They feel it should be considered malpractice. Some claim that it’s not really 2000 years old. That statement is true because the standard of medicine is continually changing and adapting. Everything we use in diagnosing and treating medical problems is always in progress—whether vaccines, surgery, antibiotics. It’s the 2013 version of what we’re continually learning about medicine. Acupuncture today is modern as well as ancient. Nothing is really 2000 years old because if I am using it today it is also modern. It’s been adapted/changed—which is beneficial as we learn more, and improve our methods,” she points out.
Nelson credits acupuncture with saving numerous animals in her practice. “I’ve had horses, dogs and cats respond to acupuncture when nothing else worked. I had some severe colics in horses that needed surgery, but surgery was not an option. We tried acupuncture and they got better; those horses are still alive and doing well,” she says.
She has been participating in an on-line veterinary discussion about acupuncture and its uses. “Some of these veterinarians are old-timers (practicing since the 1960s) who were skeptical about acupuncture and then decided to take a course in it so they could understand it. They were surprised to find out how much of this philosophy they already use. They had been trained in western medicine and hadn’t even thought about Chinese medicine,” says Nelson.
“When I took an acupuncture course at Colorado State University in 1999 I thought it would be just a bunch of ‘New Age’ people taking it. But one man from eastern Montana was an old cow doctor. He decided to take the course because he was interested in many things. He said he’d had a pony brought to him that was choking. He treated it for 24 hours with traditional/conventional medicine protocols and was at the point of putting the pony down because the condition was not resolving. But he had an acupuncture book he’d ordered, that he hadn’t had a chance to look at, so as a last resort he consulted that book,” Nelson says.
“There wasn’t anything about choke, but there was information about acupuncture points for treating megaesophagus (failure of the sphincter between the esophagus and stomach to relax when the animal swallows, with subsequent enlargement of the esophagus). So he put some regular hypodermic needles into those points—because he didn’t have any acupuncture needles. He didn’t think it would work, but he was ready to try anything because this pony was going to die. Twenty minutes later the choke cleared. He told us he doesn’t know if it finally resolved and was going to clear up anyway, but he had done everything within his power to clear that choke, for more than 24 hours, so he was sold on the validity of acupuncture—and took the acupuncture course,” says Nelson.
“My first experience with acupuncture was when I fractured the radius cap in my elbow. It was terribly painful for about 8 weeks. I was on pain medication, but it wasn’t stopping the pain and I couldn’t work because it hurt so much. A friend of mine suggested I try acupuncture. I didn’t want to pay somebody money to stick needles in me. My friend told me that he thought a person’s mind is like a parachute; it works better when it’s open. He said, ‘Here’s the deal. I’ll make the appointment; you go, and if it doesn’t work I’ll pay for it.’ So I went, and it was an hour and half appointment. About 20 minutes into it, the pain in my elbow was gone, and never came back,” she says.
“This was pain that wouldn’t respond to non-steroidal anti-inflammatory drugs or muscle relaxants. Before the acupuncturist got done with me the pain was completely gone. That’s when I decided to learn more about it,” says Nelson.
She isn’t able to save every animal she treats with acupuncture, but feels it helps most of them. “There are some that I don’t think would be alive today if we hadn’t done acupuncture,” she says.
ORIGINS OF ACUPUNCTURE
This method of treating people and animals began well over 2000 years ago, as evidenced by ancient lithographs and carvings in stone. “We can’t tell if the procedure was being done with actual needles or some other structure—putting these into certain areas of the body to relieve pain and produce other physiological responses,” says Fenger. “There is plenty of documentation, but if you read the modern-day translations of these writings, they are hard to interpret.”
We are not sure where or when this type of treatment began. According to Dr. Narda Robinson (Director, CSU Center for Comparative and Integrative Medicine, Colorado State University), documents from several other countries show that stimulating certain sites on the body (acupuncture points) was done outside of China as well.
Acupuncture works, but how and why it works is a matter of current debate. The so-called ancient ideas about disease resulting from blockages of invisible energy within the body as it moves along unseen meridians are being questioned by medical scholars. Robinson says that Dr. Deke Kendall (with a PhD in Oriental Medicine) has shown that the idea of energy-meridian ideas were not part of the ancient Chinese philosophy of acupuncture, but arose from a mistranslation of Chinese terminology into French during the 1930’s by Georges Soulie de Morant.
Morant tried to make acupuncture palatable to the physicians of his day, and harnessed the then-popular notion of human energy and equated “Chi” with energy, though he admitted that his choice was “for lack of a better word”.
“He thus promoted the idea that Chinese medicine did not require an understanding of physiology and anatomy, even though historical evidence reveals that ancient Chinese physicians knew that acupuncture was physiologically based, affecting blood, breath, and nerve functions,” says Robinson.
After the Republic of China replaced the old ruling dynasty, the government tried to raise the standards of medicine—following introduction of western medical practices brought to China by missionaries in the late 1800’s. There was a move to abolish the old ways. Fenger says that before Mao Tse-tung came to power, the Chinese were actually trying to suppress acupuncture in an attempt to show the world that they were modern. “When he took over he wanted the world to know that China was better than everybody else in everything (whether it was Olympic athletes or medicine), and he decided to make acupuncture an organized modern form of medicine,” she says.
“This was actually a service to acupuncture because he brought it into the light. Practitioners brought their acupuncture methods from Mongolia, Korea, and Tibet into more of a western approach. The western method for teaching medicine is to have a university, and a curriculum—and courses, which are organized in textbooks. This was the beginning of modern-day acupuncture,” explains Fenger.
“Acupuncture for animals in veterinary medicine simply mirrors acupuncture in humans. Wherever it was used on humans, it was also used on animals—especially food animals (which included horses in early times) rather than pets. Use of acupuncture on pets is a very new thing,” she says.
“In western culture we marginalized acupuncture, until the Open Door policy with China under President Nixon. When he went to China, a member of his delegation became quite sick and was cured with acupuncture as the sole means of treatment. This made a big impression. The Open Door policy toward China that Nixon started is when acupuncture began to be more recognized in the U.S. in humans and animals,” she says.
The first IVAS (International Veterinary Acupuncture Society) course was conducted in 1973, after a famous acupuncturist, Marvin Cain, went to China to learn techniques and started teaching acupuncture in the U.S. “Marvin was one of the biggest movers in that organization. Several veterinarians attended that first course. Just like everything else, these courses have changed and evolved substantially since the first one, due to advances in figuring it out.” Veterinarians attending these courses continue to share and pool their experiences.
“The chances are good that if I figure something out—and have success with acupuncture in treating a condition I’ve never used it on before—someone else has probably had the same success. I doubt if I’m the first one to figure it out. I just might be the first one who speaks English and has western medical training,” says Fenger.
“Also, if you are a teacher of any class, you’ve become better at it 30 or 40 years later than when you first started. Thus the course has changed over the years, along with the fact we have better translations now of the ancient Chinese documents. These factors have helped change acupuncture and its acceptance over the past 50 years, with the evolution and better organization of the material, the better translations and understanding of the original concepts, and the collaboration of American English-speaking western-medically-trained veterinarians who are catching on,” says Fenger.
“In the past 5 years there has been more serious evaluation of acupuncture. Obviously they didn’t do double-blind control trials 2000 years ago. As China changed from supporting the standard old form of acupuncture and tried to pull it into the 21st century, there have been more double-blind randomized clinical trials of acupuncture in humans. There hasn’t been much study yet in animals; it’s taken longer because it boils down to funding. But the number of scientific papers on acupuncture in humans has mushroomed in support of this modality,” she says.
HOW ACUPUNCTURE WORKS
Acupuncture points and acupressure points are the same. According to Robinson, these are sites on the body that we can stimulate or press to produce a physiological response. “It might be over a muscle, nerve, or blood vessel. There’s nothing mystical about how this works,” she says.
There are nerves, blood vessels, etc. beneath the dots and lines of ancient charts showing acupuncture points and channels. “That knowledge, coupled with background in anatomy and physiology, takes the guesswork and mystery out of acupuncture. The body reacts in predictable ways when acupuncture is used to relieve pain, relax muscles, improve digestion and dissipate stress,” says Robinson.
“Acupuncture affects the nervous system by changing levels of neurotransmitters and how the nerves respond to pain. It also relaxes muscles and improves circulation. The idea of moving Chi is a myth,” she says.
Fenger says, “According to one translation of the Chinese, throughout your body you have an energy flow, called Chi. We don’t have a western medical correlation to that. People may think of it as an outdated concept from 2000 years ago. Or, we can think of it as the life force. People who practice acupuncture in traditional Chinese medicine say that it’s Chi. When Chi stops flowing, the body dies,” says Fenger.
“In the traditional Chinese way of thinking, the body has Chi and it has blood. Chi is the life force—the power or energy—that drives the blood, and everything that functions in the body. Chi has to flow in certain patterns. In traditional Chinese medicine, Chi is flowing along the meridians of the body in a directional way,” she says.
“As a holistic practitioner, I use both the western and Chinese approach because it gives me more information. Then I treat the horse with whatever might be necessary. If it’s a Chi problem I would choose acupuncture points that are stimulatory to Chi. If the horse has an excess of Chi—like a hyper racehorse trying to jump out of the stall—I use acupuncture points that would be more calming and help decrease the Chi. Use of other acupuncture points would depend upon the specific condition,” she explains.
Chinese medicine also adds herbal therapy. “I tend to use herbal therapy only when all of my western medicine techniques fail. Some of my Chinese practitioner friends tell me that I should intervene sooner with herbal remedies. Maybe I should, but I have a PhD and Board Certified in Internal Medicine and have a difficult time abandoning those methods and years of training and going straight to herbal medicine. But there have been times that the herbal remedies have worked where western medicine failed.” Thus it is good to have another tool that can be used.
SPECIFIC USES FOR ACUPUNCTURE IN HORSES
Nelson uses acupuncture on some horses regularly. “I see these horses once a month and work on anything that needs to be adjusted with chiropractics or do acupuncture once a month on a maintenance program. Some horses have issues with arthritis that I treat as needed. But we are also a full service western practice and do joint injections and use bute or whatever medication might be useful—whatever will help that individual horse. Acupuncture is just another tool in my box. I use it on emergencies now with colics because it has worked on colic cases in which I was sure the horse was going to die,” she says.
“There is a lot of discussion right now about the efficacy of acupuncture in helping empty the equine uterus that is full of fluid and won’t respond to oxytocin and other common treatment protocols,” she says. There are many uses for acupuncture that seem to help horses.
Bruce Connally, a veterinarian in Buffalo, Wyoming who specializes in equine sports medicine, has been using acupuncture since 1999. He uses it for treating pain, and as a diagnostic aid—when trying to locate the cause of a problem. “There are trigger points all over the horse’s body. Some are along the back and hips and these are fairly easy to figure out. There is also a trigger point in the side of the neck that affects the stifle, and that’s not quite so easy to understand, but I have seen it work,” he says.
“There is a trigger point in the shoulder and another in the girth area that are related to front foot pain. A person can make a case for why that might be logical, if the horse is using his legs differently,” he says. These are some of the trigger points Connally uses, when looking for discomfort and dysfunction.
“The Chinese focus doesn’t work that well for me; I am not very good at figuring out which way the life forces go, etc. This is not my thing. So I look for trigger points, especially the ones associated with pain. My main purpose in using acupuncture is to treat pain. I don’t use acupuncture for treating liver dysfunction, constipation or many of the other things some veterinarians use it for. I am mainly an orthopedic acupuncturist and I do it with trigger points,” says Connally.
“A book written by a medical doctor named Mark Seem discusses osteopathic acupuncture (trigger point acupuncture) and this book really hit home with me and that’s what sent me down this road.”
A horse he recently treated with acupuncture had back pain, and was bucking when ridden. “I was able to find some back pain, but also found a tremendous amount of front foot pain. The horse’s front feet were hurting so he was using his back differently, and this made his back sore. One problem led to another.”
Connally had the horse’s owner change the shoeing, and did some cortisone injections into both front feet, and then he used acupuncture on the horse’s back. “This horse is a jumper and he’s sound now, and jumping again.” Acupuncture helped relieve the back problem that was caused by the foot problem.
The important thing is a proper diagnosis. “Acupuncturists who simply start with acupuncture are sometimes just treating the signs rather than getting to the root of a problem. So acupuncture for me comes second, in terms of treatment. It comes first for diagnostics (often helping pinpoint a sore area) but second for treatment,” he says.
“Most of the acupuncture work I do is for sore backs. I have never found anything that could make a sore back respond any quicker than acupuncture. Sometimes I use dry needles, and sometimes I do needles with electrical stimulation, using an electro-stimulator attached to the needles,” says Connally.
With the dry needles he uses a traditional acupuncture needle. Some veterinarians use a more modern version. “I like the traditional stainless steel needle with a copper hub or handle. This is basically a 30-gauge needle, with is very small diameter. The ones we use on horses are often 2.5 to 3 inches long, but half of that length is handle. One of the reasons I use these is that they conduct electricity very well. You know that when you wrap a copper wire around a stainless steel wire you can create an electrical current, like the alternator in your car. The theory is that we can create a micro-current at that spot, to stimulate nerves. I like the traditional needles because of this point of view—which is a Chinese way of thinking. I could probably do the same thing, and it would work the same, with plastic-handle needles, but I haven’t used them very much,” he says.
“When using the dry needle, I stick it in through the skin and work it down into different areas. Sometimes I go just through the skin, and at other times I may go into the tissues an inch deep or even more. I work that needle a bit, and if I am just doing dry needles I work it up and down in the trigger point,” he explains.
These acupuncture points are all named. A person taking an acupuncture course learns where all of these are located on the body. “As a trigger point acupuncturist, sometimes I don’t stick as closely to the named points as I do to the various points that respond to my touch. If I find a painful point, where the Chinese would say the energy is blocked and can’t flow, there’s usually some sort of muscle knot or some other abnormal situation making this point very tight. Many of these points are tiny collections of nerves and blood vessels in one little spot.”
There are many of these all over the body. “If you put a dry acupuncture needle into one of these spots and move it up and down and wiggle it around—pecking at the tight spot—it’s amazing that the horse doesn’t think it hurts. I can work it around and the tightness will go away,” says Connally. This doesn’t seem to produce a pain response like you’d expect to see when jabbing a needle into the body.
“These are very thin needles, much smaller than we use for giving injections, so they don’t stimulate much response. Occasionally, however, I have a horse that tries to kick when I’m doing it. There are a few horses that do not like acupuncture. I had one patient that really hated acupuncture, but his owner liked me to work on that horse because afterward the horse would really feel good. But all the time I’d be doing the acupuncture on his back, I was trying to keep from getting kicked. Yet when I’d get done with that horse, he performed marvelously in the show ring.” Even though it hurt at the time, the acupuncture treatment relieved the back pain that was bothering the horse.
Connally says sore backs are often secondary to something else like sore hocks or front foot soreness. “We are usually just treating a secondary symptom, some other problem that’s made the back sore. The pain relief helps the back, while we deal with the primary problem,” he explains.
“There are other acupuncturists who use it more broadly than I do, but it is a good tool in my toolbox. It has helped me identify back pain in many horses. I was not very good at recognizing and pinpointing back pain in horses until I started doing acupuncture. It has totally changed my physical exam and helps me recognize and identify back pain—and made me so much better at diagnosing it. I am sure I missed a lot of things before I started using this,” he says.
Fenger uses acupuncture daily in her equine patients, for treatments and as a diagnostic aid. “I check acupuncture points each time I examine a horse. In horses there is a very predictable reactivity to various acupuncture points associated with certain problems. For instance, I am often looking at lameness or subclinical problems in which the horse is not visibly lame but something is not right. I check acupuncture points first, on every horse, and this gives me a wealth of information,” she says.
“It may tell me exactly where the horse is lame, or where he is experiencing discomfort. Then I can switch to western techniques. If the acupuncture tells me it’s in the foot, I can then x-ray the foot. This gives me a place to start,” she says.
She is also certified in chiropractic care. “Sometimes acupuncture points come up in several different places and may indicate that the horse needs an adjustment. If it’s the hock, I will adjust the hock, but if that doesn’t work and I still have tight acupuncture points I might use x-ray, ultrasound or use some other modality to figure out what the problem is. With many of these horses I also inject the joint,” she says.
She often uses acupuncture to diagnose a problem and then treats it with a western medical approach. Some of her patients are not high-level competition horses and she treats them with acupuncture and chiropractic adjustments rather than using joint injections because they may not have to compete immediately; there’s more time to resolve the problem. “Rather than inject the hock, we may change the shoeing, adjust the horse, do some acupuncture, and then reassess the problem. It may depend on how much hurry the owner is in,” she says.
“I tend to do more aggressive western interventions in horses that are in high-level competition. They may be racehorses, or showing every weekend, and the owner wants the horse ready for its next competition. The horse that doesn’t have a big show coming up may not need an injection. We can put that horse on a schedule of chiropractic adjustments and acupuncture treatments. These are the two extremes of how we can apply the techniques,” she says.
Some of the specific things she gets called on for acupuncture include mares with excess fluid in the uterus. “Some mares have a hard time getting rid of fluid after breeding. I use electro-acupuncture to stimulate fluid release. This gives obvious and quick results. Within 15 minutes of when I finish the acupuncture, we can ultrasound the mare and see the difference. Usually the mare will posture and urinate right after the acupuncture, and the uterus will cramp a little and when you ultrasound the mare 15 minutes later the extra fluid is gone,” says Fenger.
She also uses electro-acupuncture for yearlings with asymmetrical throat function. “The throat has arytenoids, which are cartilages moved by muscles. The horse is an obligate nasal breather (unable to breathe through the mouth). When the horse swallows, the arytenoids are pulled toward one another to close off the airway—so the horse can swallow without fluid going into the windpipe. When the horse is galloping at high speeds, these cartilages move completely out of the way, to create the largest possible opening for air flow into the lungs,” she explains.
The movement of these cartilages is dependent upon certain nerves in the throat. “The nerve originates in the brain stem. It comes out of the skull, runs down the neck, into the thorax (chest cavity), goes around the aorta and then comes back up the neck and innervates the larynx in the throat. This is the longest nerve in the horse’s body. It also runs right next to the artery and vein in the neck,” she says.
If a yearling is growing very fast, the bones, muscles, ligaments, etc. are growing faster than the nerves. Nerve tissue is the slowest-growing type of structure in the body. “If the horse is growing fast as a yearling, in some individuals the very long nerve can’t quite keep up. When we scope those horses there’s asymmetry; the left side doesn’t move the same as the right side. At yearling sales, this situation can kill the possibility of a good sale for that horse—even though the vast majority of those horses grow up to be completely normal when nerve growth catches up with the rest of the body,” says Fenger.
“If I can stimulate that nerve with electro-acupuncture, this can make that slow-function horse completely normal within a short time. I do acupuncture on many yearlings before the sales. Some of them I treat on and off through the season before the sale, just to keep everything functioning properly until they catch up,” she explains.
This is another instance where acupuncture results are quickly obvious. “We can scope these yearlings and diagnose this problem—and I can do acupuncture and someone can scope them again the next day and see the improvement; it’s immediate. I think the acupuncture stimulates the muscle and nerve, and puts the nerve into overdrive. We are sending an electrical current into that nerve. Repeated treatments with this can be very helpful, if a young horse is affected. I think multiple treatments would be better than doing only one treatment just before the sale. Repeated treatments would keep that nerve tuned up and growing faster,” she explains.
If an adult horse has a “slow” throat due to asymmetry of nerves, it’s probably a more permanent problem. In an adult show horse, for instance, Fenger treats this problem periodically, perhaps the day before a competition. “I may treat a certain horse on a regular basis, once every month or every two months just to help that horse perform better,” she says. If the horse has this problem as an adult, the resolution is temporary.
“One of the most common things I do for show horses is acupuncture their backs. The Bladder Meridian runs from the eye down the neck and back where the saddle sits. This is where a horse may get Chi flow problems. Rather than using electro-acupuncture, I use aqua-acupuncture, in which we use vitamin B12 as the water/fluid. I inject the acupuncture points with this vitamin, to allow for Chi release. I’ll put a needle into the point, inject a little bit of B12 and leave the needle in place until the muscle releases it.
“In some horses the needles simply work their way out by themselves after this insertion/injection. On others it just takes a bit of light pressure; you give a little pull on the needle and it releases. It’s as if the muscles grab onto the needles when you put them in, and then when the muscles relax the needles come out or you can readily pull them out,” she says.
“Treating a horse’s back with acupuncture is always helpful. On the horse’s back I always do acupuncture and/or chiropractic first. It’s more effective, on the back, than our western medical approaches for back pain,” Fenger explains.
“Acupuncture is also effective in some cases of head-shaking. It’s amazingly affective for anhidrosis (inability to sweat). I don’t have an explanation for this one; it just works. Like any other treatment for anhidrosis, it works much better if the horse is only mildly affected or only recently developed this problem. It doesn’t work quite as well if the horse has had the problem for several years. I would still treat that horse with acupuncture, but wouldn’t have high expectation of completely resolving this problem, like it would if we address it immediately,” she says.
“Acupuncture works for back pain, neck pain, and navicular disease, though this requires multiple treatments. As a rule, I treat a navicular horse the first few times very close together, and then just a couple times a year,” says Fenger. The needles are put into soft tissue at the back of the foot and stimulated by electro-acupuncture for 30 minutes.
Dr. Sagiv Ben-Yakir, a veterinarian in Israel, uses acupuncture for neurological problems, skin problems and laminitis. He finds it helpful for horses that have damage to the facial nerve due to a blow to the face or dental surgery. “Acupuncture also helps horses with radial nerve damage in the foreleg due to a kick from another horse, falling into a hole while being ridden, sweeney (damage to the suprascapular nerve at the point of the shoulder) or ‘roaring’ due to laryngeal nerve damage,” he says.
The western medical approach to these conditions includes injecting steroids or other anti-inflammatory drugs, but has limited success. “Acupuncture just with needles, or with electro-acupuncture or injecting vitamin B12 into the affected area will increase the success rate tremendously. Most acupuncture points are located on nerves, and knowing their location allows the practitioner to treat the damaged nerve,” he explains.
“An example was an old horse that suffered a drooping lip on the right side of the face, following 2 surgeries for dental problems 9 months earlier. He had trouble eating and drinking, and the smaller nostril on that side gave him breathing problems. We had 6 sessions of electro-acupuncture one week apart and this horse came back to normal and began to regain weight, as the nerve healed,” says Ben-Yakir.
Acupuncture is helpful for skin problems and itching. “There is a phenomenon in horses that occurs when muscular pain is radiating out from a damaged area (such as from saddle pain) to another area in the body such as the base of the tail. By massaging that area (tail rubbing) the low-grade pain in the saddle area feels better. This is similar to massaging the lower back in people, or a dog chewing on its foreleg to relieve pain elsewhere in the body. Insertion of acupuncture needles into the affected muscle will relieve the condition and halt the muscle contraction that caused the pain,” he explains.
“Just inserting any needle into any tissue in the horse’s body will lead to an opening of the blood vessels. This can help with any disease that has caused constriction of blood vessels, such as laminitis,” he explains.
Click here to read the complete article from the Equine Chronicle November/December 2013 Issue, Vol. 16 Number 7.