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[Paper of the Week] Aquapuncture for acute diarrhea in dogs

Krenicki C, Xie H. Efficacy of GV-1 aqua-acupuncture for acute diarrhea in dogs: A controlled, randomized clinical study. Am J Trad Chin Vet Med 2023; 18(2):3-8. DOI: 10.59565/001c.84477

I love simple and useful papers like this one. Sometimes I feel that in academic research institutions where most of the veterinary research is being conducted, the research projects get a bit too complicated. Those of us on the front lines want answers to questions like “How do I get this dog to stop spraying diarrhea all over the house?” and not “What inflammatory biomarkers are elevated in acute enteritis?” Both questions are important, but only one answer is really helpful to the overnight ER doc.

The veterinary community is also making an effort to be good antibiotic stewards, so we want to find alternatives to the prescription of antibiotics. There are likely better ways to resolve diarrhea without the use of metronidazole. This study used vitamin B12, a common and inexpensive injectable supplement, and injected it into GV-1 which is an acupuncture point just above the anus. This technique is called aquapuncture. It allows stimulation of the point to be longer than using an acupuncture needle. Their control groups were dogs who received standard care (metronidaozle, a probiotic, and bland diet) and a group of dogs who received standard care but the vitamin B12 was injected elsewhere in the dog, not in an acupoint. The experimental GV-1 group also got standard care. Researchers asked owners to note how long it would take each dog to have their first normal stool.

Results were impressive, and dogs who were in the experimental group had normal stools in ~22 hours while the other groups were 68 and 59 hours.

Digging a bit deeper, I have a few comments. There were just not enough dogs in each group so while the results were statistically significant, there was a large range among each group. All these dogs were not that sick, all treated as outpatients. Really, they probably would have gotten better on their own. I would love to see a similar study among dogs with more severe forms of diarrhea requiring hospitalization as they need the most help. But this is a good start. Vitamin B12 is a nice choice of a liquid to give, but internists like me use vitamin B12 blood levels as a diagnostic tool. The amount of B12 used in this study was twice as much as the normal dosing in dogs with documented B12 deficiency. So, administering vitamin B12 to dogs routinely with diarrhea will mess up further testing. In the grand scheme of things, does it really matter? Probably not, but if the dog doesn’t get better and sees an Internal Medicine specialist, that specialist will need to know that the pet was supplemented with vitamin B12, whether or not it was in a acupuncture point! I end up testing vitamin B12 levels on a good majority of dogs hospitalized with diarrhea and/or vomiting and am often surprised at how often they are deficient (someone should do a study on that). Either our reference ranges are wrong, dogs develop vitamin B12 deficiency more quickly than expected, or vitamin B12 deficiency is much more common than we thought and may be a contributing factor in these dogs developing diarrhea in the first place.

Injecting into GV-1 is an easy thing for any veterinarian to learn even if they don’t ascribe to the theories of TCVM (traditional Chinese Veterinary Medicine). I would also love to see this study repeated with more dogs, sicker dogs, preferably no dogs getting metronidazole, and use saline instead of B12 (better yet, check B12 blood levels first). That would be really useful!

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