Terry Durkes, DVM
909 N. Western Avenue
Marion, IN 46952, USA
e-mail : email@example.com
International Veterinary Acupuncture Society (IVAS) 25th Annual Congress
(reprinted with Dr. Durkes' permission)
Vertebral spondylosis, stifle problems and hip dysplasia
Osteochondritis and osteochondritis dessicans of the shoulder
Carpal and tarsal problems
Modifying the original technique started by Dr. Grady Young, we began gold bead implantation in 1975. The initial work was done on a group of 7 German Shepherds, all of which had hip dysplasia. When placing our gold beads, we did not know what to expect or what exact angle to use. Because there was no charge, the owners let us work with the dogs whenever we needed. Over a 6-month period we established a protocol which gave good results. Initially, we used only 2 gold beads/acupoint. Later we discovered that younger dogs needed more gold than older dogs. We then started placing 3 gold beads/acupoint used in our protocol for hip dysplasia.
In the initial protocol for hip dysplasia, we placed gold beads only in GB29, GB30, and BL54. At that time, we were having a success rate of about 75%. We started to expand the use of gold beads because of this success. Today the gold bead implant is our treatment of choice for hip dysplasia, osteochondritis and osteochondritis dessicans of the shoulder, arthritis of the elbow and knee, spondylosis of the back, wobbler disease, and epileptic seizures. It is used in all types of arthritis and chronic conditions, because these are conditions that all have excessive negative charge (localised alkalosis). The use of gold beads in a positive charged or acidosis condition only makes things worse. Gold beads should never be implanted when tumours are present or there is osteomyelitis.
For gold bead implantation, we strongly recommend that the initial implant be done under general anaesthetic and that the patient be clipped and surgically scrubbed over the implant area. Some veterinarians omit this and they have had some trouble with infections at the implant sites.
The implants can be done with 24-carat wire or by using Magraine gold beads on transparent tape. The 24-carat wire has the greatest positive charge because it is a purer form of gold, but it does cost a lot more. I use Magraine gold beads on transparent tape. It is much cheaper and we are getting good results. Magraine gold beads are actually gold plated magnets with a very low magnetic charge. We used to sterilise our gold beads before doing the implants, but we do not do it today. As long as we use gold beads that are placed on transparent tape, infection has not been a problem. We smear each gold bead with some antibiotic ointment and this may be why we have no trouble after implanting non-sterile beads. We have implanted several hundred thousand gold beads this way and have never had problems with infection. It is much easier to load the syringe with gold beads off of the transparent tape than from a sterilising solution or other methods of sterilisation.
In most situations, the gold beads are placed between muscle bellies and not into the muscle. The only exception is when placing the gold beads in some areas of the head, elbow, and knee. In many of these areas the gold beads are placed just under the skin. When placed there, it is easier for the beads to migrate from their proper locations. The placements of the gold beads are very precise. Misplacement by as little as 1/16th of an inch greatly reduces the clinical effect.
No blood should show when placing the needle into the acupoint, but some should ooze from the point after implanting the gold bead. Oozing should occur only after the needle is withdrawn from the acupoint. If blood does not ooze from the acupoints on withdrawal of the implantation needle, in my experience the implant gives poor results. In successful cases, from one to several drops of blood ooze from each point. The blood colour varies from red to very black, depending on the degree of congestion of blood and chi in the area. The darker the blood, the more the chi and blood is congested there, and the more pain is being caused from that point. When a point bleeds, it is important to let it bleed. Once the congestion is corrected, the bleeding stops.
This condition accounts for about 50% of the cases in which we implant gold beads. Our cases ranged from 4 months to 17 years of age. Most dogs were large breeds, or dogs >50 pounds body weight. We have treated 2 Pekinese dogs for hip dysplasia. The size of the dog does not have a bearing on the success of the gold bead implant. Age does have the greatest effect on the success of gold bead implant. We break the age group into 3 classes. Under 7 years of age we have a 98% success rate. From 7 to 12 years of age we have about 80% success rate and from 12-17 years of age we have about 50% success rate. The number one cause for our failures in hip dysplasia is secondary degenerative myelopathy.
Degenerative myelopathy is considered by most experts to be a totally separate condition, but I have never seen it show up as a condition by itself. There has always been another concurrent problem. In my opinion, degenerative myelopathy begins as a localised alkalosis in the hip joint. In a small percentage of the dysplastic dogs, the localised alkalosis starts to involve the local nerves and eventually spreads to the spinal cord. The alkalosis of the cord eventually causes demyelination of the cord. At some point we are unable to reverse the alkalosis and demyelination of the cord. When this happens, there is a progressive, irreversible degenerative myelopathy and the dog cannot walk. The gold bead implant will reverse the degenerative myelopathy in about 50% of the cases. We are not able to look at these dogs before the implant and know which ones we can help. We cannot help dogs if they are unable to support their weight and the rear legs are basically reduced to skin and bone with very little muscle. If the dogs still have some muscling and can intermittently get up, we can help about 50% of them.
An apparent but temporary success may follow gold bead implantation in a small group of dogs with degenerative myelopathy. They seem to be good for 3-9 months, but then they deteriorate. All such dogs have been about 9 years old. I have spent much time on degenerative myelopathy, but this is a major problem in small-animal practice. Let it not deter you from doing gold bead implants.
When implanting gold bead for hip dysplasia, we begin with 4 basic points: GB29, BL54, GB30, and GB33. These points need treatment in all dysplastic dogs. Other points that need to be implanted fall into 3 Zones. Zone 1 is dorso-anterior to GB29. Zone 2 is dorso-anterior and dorso-posterior to BL54. Zone 3 is dorso-posterior to GB30. GB31 and GB32 are the main exceptions to the rule; they need to be treated in some dogs.
The next set of points to be implanted are in 1-2 of three Zones around the hips. These points usually are Ahshi / trigger points. Zone 3 needs treatment least frequently. One rarely must use all 3 Zones. To find the next point, draw a line midway between GB29 and BL54 and go dorsal 0.5-1.0 inch. If a point is sensitive, place gold beads into it (A). Then search for point tenderness midway between BL54 and GB30. Go dorsocaudal to this area 0.5-1.0 1 inch. Implant gold beads into any sensitive point there (B). If point (B) does not show up, then there usually are no more points in Zone 3.
Then search for two sensitive points ventral and dorsal to point (A). Go halfway between GB29 and point (A) and search anteroventrally. Place gold beads in any sensitive point found. If there are no more sensitive points, move halfway between point (A) and BL54 and search anterodorsally. Implant any sensitive points found there. Implantation of the hips is complete when one can find no more sensitive points in the area.
When implanting gold beads for hip dysplasia, both hips should be treated at the same session. However, a single hip can be implanted in special cases. For example, some dogs have one normal hip and one bad hip. The bad hip may look like a dysplastic hip, but such hips were usually have been traumatised by their dam shortly after the birth of the pups. In those cases, only the bad hip needs treatment. Traumatic injury of one hip that has resulted in a femoral head resection or a hip replacement surgery may need to be treated with gold bead implant similar to hip dysplasia.
When we treat hips with gold bead implants, we see mostly local effects, and very little systemic effect. GB29, GB30, and BL54 work locally on the joint and the other trigger points work mostly on the surrounding muscle.
Vertebral spondylosis, stifle problems and hip dysplasia
About 30% of dysplastic dogs have vertebral spondylosis. On seeing a possible canine candidate for gold bead implant for hip dysplasia, always x-ray the back for spondylosis. For gold bead implantation to be successful in such cases, one must treat both the back and the hips.
One must also look closely at the stifles. Many dysplastic dogs tear the anterior cruciate ligament while trying to compensate for the hips. Even though they show radiographic signs of hip dysplasia, the major pain may be coming from a torn anterior cruciate ligament. This is usually the case when one hind leg has exaggerated pain. One must first repair the cruciate ligament and then also implant the gold beads at the hips at that time, or later. We usually repair the hips and knee at the same time.
This is the second most common type of arthritis that we treat. Even though spondylosis occurs in cats and all sizes of dogs, most cases are in the larger breeds of dogs. Spondylosis of the back seems to be an especially big problem in Golden Retrievers. Other breeds commonly affected are German Shepherds, Labrador Retrievers, Rottweilers, Collies, Old English Sheep dogs, Great Danes and Doberman Pinschers. These breeds account for 95% of my spondylosis cases. Most of these have concurrent hip dysplasia. However, the incidence of hip dysplasia is very low in Great Danes and Doberman Pinschers. Therefore these two breeds usually have spondylosis only. Rottweilers are a special problem breed. If they have hip dysplasia or spondylosis, they most likely develop stifle problems and wobbler disease also. In Rottweilers, these conditions can arise at the same time, or may be spread out over several years.
When doing the gold bead implant for spondylosis, we treat the inner Bladder Channel and some points on the Governing Vessel. Start implanting the beads at BL13 and implant each point back to BL28. The Governing Vessel usually needs to be treated in the area of the greatest amount of spondylosis. One may also find trigger points between the inner Bladder Channel and the Governing Vessel; these may need to be implanted.
We see some dogs that have no ventral spondylosis but have arthritis of the dorsal articular surface of the vertebrae. These are implanted in the same way as for spondylosis of the back.
This has many causes. The most common is failure to treat an ununited aconeal process. We see relatively few cases in dogs, but we can help most of them. The biggest problem is the long duration that the condition before help is sought. Severe ankylosis of the joint is present in 60-70% of the cases that we see. In those dogs, implantation can often relieve pain, but most continue to walk with a stilted gait. However, we can usually get them to walk normally if we can implant them before adhesions form in the joint.
It is difficult to say for certain if the anconeal process should be removed before gold bead implantation. We have implanted elbows that have not had surgery and elbows after surgery. Even though results in both cases were good, it is probably best to remove the anconeal process before gold bead implantation in very young dogs.
When implanting gold beads, one must treat both the medial and lateral side of the elbow. On the lateral side, the main points to treat are LU05, LI11, SI09, TH05, TH10. Also a series of trigger points distal to TH10 on the Triple Heater Channel need to be treated. They are all in the area of the elbow. On the medial side, the main points are PC03, HT03, SI08, and a series of trigger points proximal and distal to SI08. Many of the gold beads in the elbow area are placed just under the skin because of the reduced muscle tissue in this area.
Osteochondritis and osteochondritis dessicans of the shoulder
These conditions respond well to gold bead implants. We tend to see these animals before secondary complications set in. When implanting gold beads on the shoulder, we only implant the lateral surface. If joint mice are present, it normally is unnecessary to remove them before implantation.
When we first started implanting the shoulder, we implanted only one acupoint, SI10. For about 10 years, we had 100% success; then we had some failures. Today we implant several points around the shoulder. I don't know why we have to increase the number of points today compared to 14 years ago. Today the main points implanted with gold beads are TH14, TH15, LI15, LI16, SI09, SI10, SI11, SI12, SI14. Sometimes we have to treat LU01 and LU02.
This condition also responds well to gold bead implants. However, it is very rare to get a pure arthritis of the stifle. Most stifle arthritis is secondary to a torn anterior cruciate ligament. If one implants gold beads on the stifle of a young dog with a torn anterior cruciate ligament, one may have to repeat the implant 2-3 times to have success. After critically evaluating the cases, we feel that acutely injured anterior cruciate ligaments need surgical repair as the method of choice. Later, one should implant gold beads, if necessary.
For stifle problems (arthrosis, stiffness, pain), gold bead implants must be done on the medial and lateral sides of the joint. ST36, ST35, GB34, GB33 and BL40 are the main points for treatment on the lateral side of the stifle. Sometimes we find many trigger points around this area; these need to be implanted also. SP09, SP10, LV07 and LV08 are the main points for treatment on the medial side of the stifle. There are also many trigger points on the medial side of the stifle; these need to be implanted also.
If dogs have a torn anterior cruciate ligament for 3-24 months, we repair it surgically and implant gold beads at the same time. Success in these cases has been 100%. Surgical repair is not done if dogs have a torn anterior ligament for a very long period, and there is much capsular swelling with or without ankylosis. In those dogs, we just implant the gold beads. Later, to achieve the best results, about 50% of these dogs may require a second implantation.
Carpal and tarsal problems
Those joints rarely need treatment with gold bead implant for arthritis. However, those that we have implanted have all responded.
We implant gold bead implants in many dogs that have epileptic seizures. This is a very difficult area to work in, but the results can be very rewarding. The owners appreciate any improvement after therapy because there are few other successful options from which they can choose. Today, we see more complex types of seizure than was the case 15-20 years ago. Today most of our epileptic dogs have cluster seizures, whereas 20 years ago, cluster seizures were rare. The change prompted a change in our protocol for gold bead implant for seizures.
The clustering seizure patient is similar to a fibrillating heart; each seizure initiates from a different part of the brain. From the Channel viewpoint, different Channels are involved with each episode of seizures. Because of this, we treat all of the Channels instead of just one or two Channels, as was the case 20 years ago. In dogs with cluster seizures, gold bead implantation can terminate or reduce medication in about 25 and 50% of them, respectively but the remainder must continue their full doses of medication.
We see few problems in reducing the levels of phenobarb, primidone or dilantin. However, potassium bromide (KBr) is most difficult to reduce. The nervous system seems to become addicted to KBr and its reduction usually induces seizures in the patient. If, when reducing the KBr, the owner can tolerate the dog's seizures for about 1 month, the dog usually stabilises. However, most owners can not tolerate their dog's seizures, so we can not expect to reduce KBr levels in many dogs.
If a dog has a particular seizure pattern, such as a seizure every 4-6 weeks, one would gradually reduce the level of medication. After the initial dose reduction, one would wait for 8-10 weeks before further reducing the dose. One must ensure that the reduced dosage can still prevent seizures. If no seizures occur, the dose can be reduced some more.
GV20, GV14, GB20, GB14, BL04, BL06, and BL09 are the main head points for gold bead implantation for seizures. We may need to implant more head points (ST08, GV17, GV21, and GV23) occasionally. We also treat 3-4 paravertebral Shu-Association points that are specific for the Channels involved with the seizure. However, for dogs with cluster seizures, we treat all of the Shu-Association points, plus some Governing Vessel points along the back.
Because gold bead implants work slowly, dogs usually have some seizures during the first week post implantation. However, we see few seizures after one week post implant. Dogs that continue to have seizures must be reassessed, and further acupoints may need to be implanted.
We were unhappy with the outcome of seizure treatment in many dogs. However the owner was happy because our treatment was able to reduce the number, frequency and severity of seizures.
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