Signalment

• Age: 10 years
• Sex: female spayed
• Breed: Domestic Short Haired
• Species: cat

Disease Notes

• Certainty: confirmed
• Comments: Spritzi
  
  Chief complaint and associated histories:
  - Chronic cough- has had a cough starting at 8 mo old.
  o Responded immediately to prednisolone (after conventional med work up to dx feline asthma).
  o Each time I tapered the pred, the cough would return.
  o Did not respond to Bu Fei San, partial improvement with Lily combination (Jing Tang), and most improvement with Breathe Easier B (Jing Tang). Still dependent on fluticasone inhaler daily.
  o Cough spells are infrequent and non-productive. Sound a bit raspy/phlegmy. She also sounds wet rattly in the morning when purring and swallowing now. (Damp)
  -
  o Attempt to taper to EOD low dose prednisolone has led to a return of the cough. Very infrequent and she has never had dyspnea associated with the asthma but it is evidence to me that the pulmonary inflammation is present.
  
  General history:
  - Good appetite now, has been a struggle in the past
  - No PU/PD
  - Stools have always been on the dry side. Better now but still probably not ideal moisture (Excess Heat vs Yin deficiency)
  - She had gingivitis as a kitten and now has what I would consider normal periodontal disease given her age (no stomatitis) (Excess Heat vs Yin deficiency)
  - She has vigorous dreaming often now (Blood deficiency?)
  - She is having hesitancy jumping but still makes it after a bit of wind up (Kidney deficiency)
  - Did not appreciate side effects to steroids at any dosing.
  - She hates acupuncture and will not allow me to do it!
  - She does not prefer cool; glues herself to the heating vents in the winter; has always loved the sun spots and heating vents!
  - Can be needy and clingy; Loves to be brushed
  - She can be feisty too; gets along with younger cat in house but doesn’t know how to play nice and can get jealous
  - Certain situations and people frighten her into panic but in general she will greet visitors and is curious
  
  Physical exam
  - Tongue- sometimes light to pale pink, other times red, generally moisture and size seem normal, edges are slightly rounded (not thin)
  - Pulse-
  o very difficult to find, deep, narrow and felt rounded with a bit of tone
  o rate is normal to slightly fast
  o I appreciated an irregularity in rhythm with palpation but auscultation was regular, no murmur
  - Not able to palpate for active points
  
  Medications/supplements
  - Prednisolone 1.25mg daily
  - Omega 3 fish oil capsule- 2 days on/1 day off
  - Doc Silver chew (CBD/mushroom blend)- 1 EOD
  - Three Seeds (Kan)- 1 tab BID
  
  Diet: (obviously not ideal but she is stubborn and has refused fresh foods)
  - 1/8 cup kibble (Hill’s GI Biome and adult maintenance corn/soy/wheat free)
  - 1 can variety of wet food split into two meals (3.5oz)
  - She will not eat fresh cooked meat except she loves salmon sushi
  - She goes nuts for crackers, chips, etc. maybe it’s the salt content?
  
  Questions:
  1. Vomiting seems much improved with Three Seeds but now as I try to taper the pred, her cough is returning. Should I keep her on this formula and add a second? Is it safe to keep her on Three Seeds long term if so?
  2. I am not sure of the diagnosis for the cough? Nor how it relates to the vomiting.
  a. Responds to pred- implies Heat and dryness/yin deficiency
  b. Responded best to Breathe Easier B herbal in past- Kidney (Jing) deficiency not grasping the Lung Qi
  c. Maybe started as Heat (cough, gingitivitis, dry stool as a kitten) and was root of it all. Vomiting and Damp Heat progressed later in her life
  d. Does she have signs of blood deficiency (intermittent pale tongue, vigorous dreaming). Is that playing a role here?
  3. How should I adjust her herbs? Just based on her response to pred, seems like I need a cooling, moistening formula for her lungs but Damp draining for the Stomach.
  
• Final Status:

Treatment and Outcome