Case Details
Molly by fdzenitsky
Immune Mediated Polyarthritis
   

Signalment

  • Species: dog

Disease Notes

  • Certainty: confirmed
  • Final Status:

Treatment and Outcome


Problem Notes
  • Anal Gland Impaction: Molly, an 8YO SF Cockapoo had a history of Damp symptoms before developing IMPA in early 2020 about 2 months post mega vaccinations. She was managed w/ Cyclosporine and high prednisone (20mg/day) for a year and improved, but relapsed when pred was lowered. The pred caused weight gain, ^ALP, and pelvic/epaxial atrophy. I took over her case in July 2021, she was weaned off the pred by then, still on cyclosporine, not a lot of joint effusion but having a lot of trouble getting up and is plantigrade. She has prominent gluteal fat pads, which I was taught suggests anterior pituitary dysfunction. I wonder what you think about that? T is pale w/ red margins, white coat, dry; P is deep, thin, weak, slippery. Blood tests showed Deficiency, but symptoms were mostly Damp Heat.

    I researched on Cured Cases how to approach IMPA and started her on 5mg prednisolone (temporarily I hoped until the herbs took effect), YYRT and XFHMY and transitioned to a raw commercial diet. She was PU/PD/PP and panting on 5mg pred, so reduced it to 2.5mg/day and she was doing quite well. We can’t go to pred EOD w/o her backsliding. On recheck 4 weeks later, there is still a thermal increase at her hips, stifles, and elbows, less so carpal/tarsal joints, still struggling to rise. T is pale pink w/ lavender, gums warm pink; P is deep, deficient. At this time, I add SMS to be given in the evenings to extend the pred effect, I also add 20g of Yin Chen Hao Tang to the YYRT. This seems to work better for her.

    On recheck in December, her owner thinks she is doing well, but has random shivers. She had new warts/cysts on dorsal trunk and muzzle, a firm mass under the R gluteal pad, minimal effusion, so now I appreciate crepitus in L tarsal joint, reduced flexion L carpus, and 2/4 R MLP. I forgot to record T&P. Blood tests show even more Liver Blood Def. (quite low ALT, ALP, BUN, Cr, TRI, and MCHC; and RBC, HCT, HGB on low end or normal). At this time, I really want to add a Blood tonic, but hesitate, thinking it will negate the Damp draining and Heat clearing effect of the herbs v IMPA and the YYRT and SMS do have Tonify as a secondary effect.

    It's the holidays, CIVT is on break, I don’t phone a friend, I don't change anything. Then, earlier this month, she developed what looked like a Staph. Lesion on her chest that spread to the L axilla, very itchy. I didn’t see her and recommended a topical salve and to increase the SMS to BID. When I do check her 10 days later, the lesions are resolving, and skin is only mildly inflamed. T is pale lavender and fleshy; P is deep, wiry. She is getting around well, even trotting now. Still hesitating to tonify, I go w/ XCHJQJT v subacute Damp Heat w/ Wind Invasion. I also thought it appropriate v her immune-mediated disease and T&P. But now, more similar lesions near mole on her RF leg and she is scratching under her chin with new lesions there.

    This is where we stand. I’m confused by the opposing hemodynamic needs and my incomplete understanding of this case with such a mix of Excess and Deficiency. I really think she needs a Blood tonic. I seek to simplify w/o further aggravating this patient, first IMPA case for me. When and how to wean off the IMPA formulas, how to know their work is done? I am seeing some Stasis, but probably from Blood Def., I'm sure TBO is underpinning it all. I’m not seeing a clear benefit from diet though she has lost 3.5 lbs.