Signalment
- Species: dog
Disease Notes
- Certainty: confirmed
- Comments: Hey Steve!
I think a little background may be helpful in this case, it's certainly interesting! Jhett is a 7YO NM pit/lab mix I started seeing in 3/2019 for alternative therapy while in chemo for multiple myeloma. I was using various TCM formulas and other blood / immune boosters, for months and months, and could not make more than a dent in his hematology. 10/2019: I figured out that this dog never had cancer, it was chronic Ehrlichiosis, misdiagnosed by the oncologist who told the poor owner (w/o checking) that a tick-borne disease was very unlikely, so must be myeloma. Meanwhile, the poor dog was on chemo for a year...argh! During this time, needless to say, this guy was very, very Blood deficient w/ dry seborrhea, scales, some tiny blisters and dry collarettes (all ventral). He is on balanced raw diet since 3/2019.
Started treating ehrlichiosis. By 1/2020, his hematology was recovering, liver enzymes normal and skin improved. In 5/2020, CBC low normal, ALP mildly elevated (191 IU/L) and skin was diffusely scaly, non pruritic, no inflammation, thin coat. Started SWXFT. At next recheck 12/2020, no skin lesions, coat less thin overall, CBC normal, but liver enzymes are elevated (ALT: 143, ALP: 350, GGT: 16). At this point, I d/c the SWXFT and started SMS, adding in DGS when the owner reported dander, thinning hair, and itchy normal looking skin (my bad!).
Latest recheck 3/2021, skin is better w/ DGS, reduced itch, no new hair loss per owner. On exam, T is pale, P is deep, toned. The thin coat extends to the lateral trunk, hocks, lower posterior pinnae, elbows, and stifles; alopecia on ventrum and dorsal tail along the vertebral process and patchy alopecia on lateral forearms and hind legs; and skin is pigmented inguinal area. Now, worsening liver enzymes (ALT 364, ALP 894, GGT 49) and WBS and platelets are decreased. Interestingly (and I don't know what it means) Lymphocytes are low, but have been so in every CBC I've seen, 10 panels total.
So, did I screw up by taking him off the SWFXT too soon? My thinking was skin is fine, hepatobiliary is congested, move on. I also wondered if the SWFXT may have caused the elevated enzymes as a Blood tonic, but he was Blood deficient to me at the time (and still)! Was the SMS/DGS not the best formula here or would it be fine to continue in tandem w/ another formula or ursodiol? I expected I was going in the right direction and the liver and biliary would be happy again, and I could go back to SWFXT or another tonifying formula. But, the blood tests and skin are confusing and telling me I did not field this one very well. One last thing, he has begun relentlessly eating grass and that has never happened before, so Spleen deficiency while on a Spleen tonic? Please, enlighten me...thanks! :) - Final Status: no change as of day 290
Treatment and Outcome
Treatments
Notes: May 2021 recheck following 7 weeks on SWXFY and XCHJYJT, resolution of liver enzyme elevations and skin/coat is improved overall. Still mild fine dander, slightly oily coat w/ mild Staph. odor., a few red bumps on ventral abdomen, and loose stools. T is pale, fleshy; P is deep, wiry. Addressing the Damp tendencies, he is started on CSWLT.
Diet is largely raw
Notes: May 2021 recheck, dander less, he has a couple dry collarettes on his flank, no other lesions, coat is still sparse on ventrum. His stools are usually good, but has brief flairs of straining formed stools w/ bubbly liquid, foul smell. This typically resolves w/ 1 day of slippery elm. The R ear is yeasty and mildly inflamed. T is pale w/ hint lavender, fleshy; P is deep, slippery. Addressing Damp, Def., and stasis, he is started on DGSYS.
Diet is largely raw
Notes:
July 2021, increased dander, shedding, hair loss on legs w/ no lesions, stools normal using prebiotics. Formula changed back to SWXFY.
Sept 2021 recheck, skin/coat look good w/ a few scattered dry lesions on his ventrum, but his generally itchy, esp. ventral front feet. Liver enzymes are normal. He stays on the SWXFY.
Diet is largely raw
Notes: Nov 2021 recheck, owner reports recurrent hives w/ general distribution, esp. legs, that responds quickly to Benadryl. He has also developed bulky stools like a kibble fed dog. He has various skin lesions: a firm cyst rostral to R ear and another on L ankle (both granulomatous); a scalloped skin tag lateral trunk; several small hematomas and flat-topped, black lesions on ventral abdomen; 1 collarette ventral abd.; ventral alopecia w/ generally fine coat, mild yeasty odor, and fine dander. T is pale; P is deep, wiry. He is assessed to be Blood and Wei Qi deficient and started on BZYQT.
Diet is largely raw
Notes:
Jan 2022 recheck, the skin is no better, but only 1 hives incident the last 2 months. Coat is oily w/ fine dander, hematomas and raised, flat black plaques on ventral abdomen, inguinal, and lateral trunk, not inflamed or pruritic, but he is generally quite itchy w/ a yeasty odor. Stools are still bulky. Blood tests show a quiet liver, mildly low BUN, TRI, increased GLOB (same as in Sept. 2021), but now mild toxic changes in neutrophils. T is pale w/ rosier edges and hint of lavender distal; P is deep, wiry. The patient is out of herbs as of last week, time to completely rethink this case!
Recap:
• Jan 2020, start SWXFY. Skin largely resolved in 2020 on this blood tonic, but possibly caused elevation of liver enzymes, also possible seasonal influence (mild ALP elevation in May, worse by December)
• Jan 2021, switch to SMS, increased dryness, itchy. SMS + DGS, skin less dry and itchy, but alopecia ventral abdomen, dorsal tail, leg patches, thin coat elsewhere, inguinal lichenification, and increased liver enzymes (March – ALT, ALP, GGT); relentlessly eating grass; finishes SMS + DGS
• By end of March, he is just very itchy w/ hair loss and few dry scabby patches primarily lateral and inner thighs, chest, chewing on tail base and hocks. Started SWXFY and XCHJYJT, probiotic shampoo
• May 2021, coat and skin improved overall, still moderate fine dander and oily coat, but still itchy, mild Staph odor and few red pustules on ventral abdomen; random acute diarrhea; resolution of liver enzymes. Change to CSWLT
• June 2021, no lesions or odor, less dander, still itchy; stools mostly good, overall mild symptoms of Damp and Deficiency. Change to DGSYS
• July 2021, increased dander, hair loss w/ no inflammation or lesions, still itchy; stools normal. Back to SWXFY
• Sept 2021, less dryness, a few dry lesions on ventrum, regrowth of hair, still generally itchy; liver enzymes still in check. SWXFY is continued
• Nov 2021, recurrent hives, development of granulomatous nodules, ventral hematomas, and dark plaques in addition to previous skin issues; bulky stools. Suspect Wei Qi and Blood Def., Blood Stasis, and add BZYQT in tandem with SWXFY and digestive support
• Jan 2022, no improvement in skin or anxiety, stools bulky. Most improvement seen on SYD formula + Blood tonic, consider seasonal improvement effect (May-June). Most likely SYD, considering starting XCHT + SWT, unsure if additional herbs or formulas are needed in tandem
Diet is largely raw