THE Association of British Veterinary Acupuncturists held its spring meeting at the International Conference Centre in Birmingham on 7th April. This was the day before the BSAVA congress so several specialist groups were at work around the building.
The ABVA had flown in Dr Anna Hielm-Björkman from the University of Helsinki. Anna says that her primary interest is in research into pain management in small animals and equines. She uses acupuncture routinely and is a pioneer of gold bead implants.
Gold bead implants have been used in dogs by veterinarians such as T. E. Durkes in the USA and J. Klitsgaard in Denmark who reported on his treatment of 400 cases of hip dysplasia. A. Thoresen described his work with 50 cases in Norway and E. Schultze in Germany has implanted around 4,000 dogs with gold beads.So this method, which is novel to us, has been widely used in the last 30 years.
At the ultra-structural level, G. Dansher, the histologist, traced gold to the lysosomes. Gold ions are released from the surface of the gold implant by a process called “dissolucytosis” and the ions are taken up by macrophages, mast cells and fibroblasts near the implant. They are also found in the cells of the proximal tubule of the kidney.
The bigger the surface of the implant, the more gold ions are released and the further away from the implant they reach. One of the reasons that gold is preferred to silver as an implant is because silver nanocrystals travel far more widely, inside and outside cells.
So, to go from theory to practice, we have the dual premise: acupuncture controls pain and goldimplantsgive an acupuncture effect that lasts for two to 10years. Anna says that you can put a goldimplant wherever you can put a needle.
Thorough clinical assessment of each case is essential, as the presenting problem may not be the only one: for example, hip dysplasia may be complicated by spondylosis or elbow problems.
The dog’s mobility is assessed by a standardised series of tests such as getting on to a low bed, going up and down stairs and rising from lying and by observing the gait at walk, trot and gallop. Neurological tests may be needed to rule out conditions such as degenerative myelopathy.
Mostly, Anna will use one to three sessions of normal needle acupuncture and if this works she puts in implants. At €350 to €450, gold bead implantation costs about half as much as repeated needle acupuncture over the two years so it scores on cost and convenience.
Hip dysplasia is the condition most frequently treated by gold bead implant (GBI) but elbow dysplasia, spondylosis, epilepsy, cauda equina neuritis, wobblers, chronicasthma, chronicurinary disease, and feline chronicgingivitis have all responded.
The gold to be implanted can be purchased from a jeweller. You need a 1mm diameter 24 carat gold wire. This needs to be cut into 2mm long pieces, and needs to be done before you need them to get them straight as the wire itself is curved and a curved piece will stick in the implant needle.
The needle needs to be a14 G hypodermic long enough to put the implant as deep as you want and then you need a stilette of matching length and diameter. It was suggested that a paravertebral needle would work well.
The dog is sedated with Domitor, placed in lateral recumbency for work on hips and elbows, sternal recumbency for back and head. The area to be treated is clipped and the relevant acupuncture points located.
Anna uses a Chinese point finder which measures variation in electrical resistance of the skin, so this must be done while the skin is dry; otherwise the points can be selected on an anatomical basis. The area to be prepared varies from keyhole to a 15cm diameter patch, depending on the surgeon!
Small stab markers
The points are marked with small stabs from a hypodermic needle as ink marks get washed off when the area is surgically scrubbed. Anna uses GB29, GB30, and BL54 for the hip. The remote point LIV 3 can be used with these or on its own (Are Thoresen uses only LIV3 and has a 90% success rate).
Points HT3, LU5, PC3, S18/TH10 and triceps trigger points are used to treat the elbow. BL points are used for the back. Anna usually implants three points for each condition with three bits of wire at each.
She says: “Please do not implant a hundred points”; but the three is not a rigid formula.
The gold is implanted aseptically, the site having been scrubbed and the implants and needles sterilised. The 14G needle is inserted in each of the marked sites and directed close to the joint or vertebra.
If you hit blood or synovial, withdraw the needle and re-insert it nearby. Avoid hitting cartilage, bone or nerves. The dog’s limb should be moved once the needles have been inserted to make sure that there is no interference from the implant.
Sedation is used rather than deep anaesthesia so that the dog can protest if the needle hits a nerve. When treating the hip, the needles should be directed towards the capsular attachment on the neck of the femur and towards the acetabular rim. An x-ray can be taken once the needles are in place and if all is well the three pieces of gold wire are put down each needle and then the stilette is inserted into the needle to keep the gold in place while the needle is withdrawn.
Opinions vary on how deep the implant should be: the Japanese favour superficial insertion, the Chinese go deep, into the belly of the muscle or till you touch periosteum.
Anna uses antiseptic cream on the wounds and tapes them over. A final x-ray is taken to make sure that the gold is in place. Then the sedation is reversed with Antisedan so that you can see that the dog is moving normally.
Implanting the ear is more delicate as the wire needs to be subcutaneous. Putting it into the cartilage is likely to cause sepsis. Ear implants can be very effective but sometimes they fall out.
Pain score system
Anna went on to describe experiments with GBI and how she has devised the Helsinki Pain Score so that she can get statistically sound responses from dog owners to use in assessing the efficacy of acupuncture and GBI treatments.
Her research is not a bed of roses! But her take-home message “Acupuncture works, gold bead implants work, go home and do it,” was thoroughly endorsed by Margot Young, a dog owner whose animal was treated with acupuncture to gain a new lease of life.
Margot had great difficulty in finding a veterinary surgeon to do the acupuncture and to remedy this situation she has set up Luna’s Fund (details can be found at www.lunasfund.org). This fund is to be used to do a survey among veterinarians practising acupuncture, to co-ordinate the data on their results and use the figures as evidence that acupuncture is effective. Then this can be used to inform the profession and animal owners about acupuncture and get it made more accessible for the animals which would benefit from it.