– photos by Ann Greazel
Iowa State University, Lloyd Veterinary Medical Center
Acupuncture … The use of this word in regards to a possible treatment modality in human or animal medicine can incite some pretty strong discussions. A common reason individuals oppose the use of acupuncture is the relative lack of scientific studies to date documenting the facts of the practice. For many, this is a huge hurdle to overcome in the acceptance of this alternative therapy. The art of acupuncture has been used in humans and animals for over 3,000 years, and its popularity has dramatically increased in the past 10 years, especially in the equine industry to treat a variety of medical issues.
Acupuncture is the insertion of thin, sterile, stainless steel needles into specific locations on the body to alter the body’s physiological and biochemical properties primarily through the stimulation of the central nervous system (the brain and spinal cord). A majority of acupuncture points have been found to be located at sites rich in blood vessels and nerves. Since nerves innervate every organ in the body, we have a way of “modulating” the body through stimulation of particular nerves, increasing circulation and activating the tissue repair process. Acupuncture also causes a release of many neurochemicals, some of which are endorphins (the body’s “natural pain-killing” hormones). When the needle is inserted at the acupuncture point it causes micro-trauma; since this area is rich in nerves, it signals this to the brain which, in return, causes the release of chemicals and signals to “repair” this area and this extends the length of the nerve and to the organ that nerve innervates. The body acts to reduce inflammation and pain and return blood flow to normal. Side effects and complications are rare and for most animals, needle insertion is virtually painless. Acupuncture can be a good alternative for conditions that often do not respond well to conventional (western) veterinary medicine and is even better when used in conjunction with traditional therapies.
Those working with broodmares know that when fluid in the uterus is reported by their veterinarian, there will most likely be additional treatments aimed at ridding the uterus of that fluid in order to maximize conception rates. All mares have an inflammatory reaction in their uterus after they are bred, whether by natural mating or artificial insemination. Normal mares are able to rid their uterus of this fluid within 24 to 36 hours. Mares that retain fluid beyond this time frame are diagnosed as having post-breeding endometritis. This could be due to a variety of problems that include, but are not limited to, a pendulous uterus that hangs over the brim of the pelvis due to multiple pregnancies, a tight cervix that has been traumatized from prior difficult deliveries (dystocias), being an older maiden mare and decreased lymphatic function. Common western medicine therapies utilized to rid the mare’s uterus of this inflammatory fluid include: uterine lavages, repeated oxytocin or cloprostenol (Estrumate®) injections and exercise. Intra-uterine antibiotic infusions may also be utilized in conjunction with these therapies if a uterine infection is suspected or documented. Oxytocin and cloprostenol promote uterine contractility to help expel uterine fluid that accumulates. Oxytocin has a much more rapid effect, but its effects are short-lived; cloprostenol provides longer-lasting uterine contractility. All of these techniques are employed in attempts to create a healthy environment for the embryo when it enters the uterus about six days post-fertilization and thus increase conception rates. Fluid accumulation in the uterus indicates inflammation and conception rates will be decreased if the inflammation is not cleared in a timely manner. Cloprostenol should not be used after the mare ovulates because it will interfere with the function of the corpus luteum (CL) that forms on the ovary where the follicle that ovulated the egg is located; this CL is important in that it secretes progesterone, which is required to maintain the pregnancy once established. Intrauterine treatments, where the veterinarian goes through the cervix such is the case with uterine lavages and intrauterine antibiotics, and oxytocin administration, can only be performed for a limited period of time after ovulation is documented. Typically this is three days for most veterinarians; this allows time for the uterus to “quiet down” and the cervix to tighten before the embryo enters the uterus. Thus, about three days after ovulation, no treatments for fluid can safely be utilized without potential detrimental effects to the pregnancy. This is where acupuncture provides an additional “tool” in the reproductive veterinarian’s “tool box” of therapies to maximize conception rates.
Mares that are known to have problems with fluid retention and/or have not responded to typical western medications and treatments such as those previously described, are prime candidates for trying acupuncture therapy in their breeding management. Acupuncture is most often used in conjunction with the treatments listed above–not instead of them, but each case is unique and thus treated individually. A typical treatment plan is to perform one treatment while the mare is in heat (estrus) before she is bred; the next treatment is performed after ovulation is documented; and then the third and final treatment is performed three to four days after ovulation. This latter period is when other therapies cannot be utilized, as mentioned above, but acupuncture can help stimulate the uterus to expel any remaining fluid.
Before an acupuncture treatment is performed for uterine fluid issues, a Diagnostic Acupuncture Physical Examination (DAPE) is performed. This allows the individual performing the acupuncture treatment to determine if the mare has any “trigger points” which are sore focal areas in muscles; they are just like “knots” that humans experience in their necks and/or backs. Since acupuncture is attempting to return the body in whole to normal function, the acupuncture treatment will also focus on trying to relieve these muscle spasms in addition to enhancing the activity of the uterus.
Acupuncture treatments can be performed almost anywhere and are usually well-tolerated by most horses. Mares are either placed in stocks or left in their stalls for their treatment, depending on their overall demeanor as we want them to stand quiet during treatment. A majority of time, the mares are not sedated, twitched or restrained in any way other than a lead rope and halter. If uterine lavages are being performed during the heat cycle, the acupuncture treatments are typically performed after the lavages unless antibiotics are being infused after the lavage. In this case, the antibiotics are allowed to remain in the uterus for about six hours before acupuncture therapies are initiated. The acupuncture “points” utilized during the treatment incorporate both Traditional Chinese Medicine (TCM) theory and also anatomic/physiologic science. TCM believes that there are some points that are “heat-releasing” (heat associated with inflammation somewhere in the body), some points that are the “master” point for certain body systems/regions and some points that are “influential” for certain body functions. Many of these points are not located near the area of concern, in this case the ovaries and uterus. For example, an acupuncture point used to treat uterine fluid retention in TCM is named “spleen 6,” which is considered the master point for the caudal abdomen (that portion of the abdomen that is located near the pelvis) and the urogenital tract. This point is located on the inside of the hind leg just below the stifle area. Individuals may wonder how it helps treat a reproductive problem which has no correlation to the spleen, so why is it named "spleen?" This has to do with the ancient theories of TCM’s meridians and channels. Among other points recommended to treat reproductive issues are a variety of points along the top line of the lower back of the horse, several inches from the center of their back. This is where the current research is starting to provide anatomic/physiologic scientific validation behind why these particular points affect the reproductive tract. Researchers have found these locations to be where major nerves exit the spinal cord (part of the central nervous system) and course to and innervate the ovaries and uterus. Thus, it makes sense that if these nerves are stimulated via an acupuncture needle, you should have a response in the ovaries and uterus.
In addition to acupuncture needles we can also use, and most often do, electrostimulation. This therapy consists of placing acupuncture needles in the specific locations and then supplying a small electrical current between two locations. This helps to provide additional stimulation and thus intensify the signaling process. The electric current is supplied by a 9-volt battery-operated, handheld machine; this is the same machine that is used on humans during an electroacupuncture treatment. When receiving a treatment, the patient feels a slight tingling sensation; enough stimulation is provided to make the area between the two interconnected cables exhibit a slight twitch. Most patients tolerate this procedure very well and often become quite relaxed after a minute or so of stimulation.
The body is always attempting to maintain a state of functional balance, but sometimes there are anatomic and/or physiologic issues that provide an additional obstacle to maintaining a healthy condition–so some extra stimulation or assistance is required; this is the basis behind an acupuncture treatment. As in the case with fluid in the uterus post-breeding, we can only use certain drugs for a limited time and thus we need to look at alternative therapies to help us attain our goal.
The American Veterinary Medical Association (AVMA), which is the governing body of the veterinary community, considers veterinary acupuncture a valid modality within the practice of veterinary medicine and surgery. If used appropriately it can be an excellent adjunct treatment beyond standard western medicine. More individuals are becoming interested in acupuncture and other alternative therapies and, as a result, more scientific articles should be published in upcoming years which will provide morescientific support to its use in veterinary medicine. To date, many practitioners that are intimately involved in mare breeding management utilize acupuncture treatments in conjunction with conventional therapies to decrease uterine fluid and maximize conception rates. It is not a substitute for oxytocin, uterine lavages and other well known therapies, but rather an additional tool veterinarians can utilize in their practice today.
Dr. Galow-Kersch is a clinician in the theriogenology (reproduction) section at Iowa State University's Lloyd Veterinary Medical Center. She manages the stallion station and performs all small and large animal acupuncture treatments at the Center.