Signalment
- Species: dog
Disease Notes
- Certainty: tentative
- Final Status: slightly better as of day 56 of treatment
Treatment and Outcome
Problem Notes
- Autoimmune Poly Arthritis: 2 year old Golden Retriever with recurrent pyrexia. Had high CRP and lamness which resolved with single nsaid. Then returned with jaw pain and vet thought possibly masticatory myositis (with high temp again). High lymphocytes but no diagnosis confirmed. Put onto pred which helped, but I first saw dog just before they lowered the pred dose for the first time. Dog had brick red tounge and a Shao Yang full pulse. Put on voltrex and immunobalm. Saw 2 weeks later, still SY pulse but tounge now pink and more normal colour. Pred dose drop resulted in very very flat dog. I wondered about possible polymyositis> Ck was run and was mid high. Dog continunig to be flat but still no definitive diagnosis from main vet. I double voltrex and kept on QYT but dog has not improved and now starting azothiaprine which seems to be helping. There has not been any joint swelling, however I thought painful in elbows and spine. Also has on occasion seemed sore in jaw muscles but never what MM usually looks like. Main vet and I are both? on diagnosis, although auto immune looks the go unfortunately. Any input greatfully received.
Treatments
Notes:
Recheck today. Patient currently on azathioprine and has undergone one steroid reduction since previous visit. No definitive diagnosis has been reached, however marked masticatory muscle atrophy remains present and supports a diagnosis of immune-mediated masticatory muscle disease / inflammatory myopathy. IMP Arthritis still a possibility but immune spression with steroids did not allow full expression of disease. Polymyositis also considred but again, not diagnostic in bloods (CK has been elevated). Regular vet doing pred and azothaprine - Im just doing herbs and acupunture.
Clinically still appears warm with increased heat noted in feet, ears and joints. Tongue no longer brick red but remains on the red side of pink, suggesting reduction in heat compared with previous examination but ongoing inflammatory activity. Shao Yang pulse remains present, although notably less forceful than at previous visit.
Current herbal protocol unchanged:
Immunobalm maintained at ½ dose.
Voltrex maintained at double dose.
Milk thistle added due to rising liver enzymes.
Recent bloodwork showed RBC count bordering on anaemia but remaining within acceptable limits. Liver enzymes have increased, likely reflecting medication burden and/or ongoing inflammatory disease activity.
Acupuncture findings:
BL14 active.
GB31 strongly active. Full insertion resulted in marked weakening of pulse; pulse improved when needle was partially withdrawn.
GB6 active.
TH13 active.
Overall assessment:
Case appears improved compared with initial presentation, with reduced tongue heat and less forceful pulse. However, residual heat remains evident clinically and the Shao Yang pattern persists. Current findings do not support progression to a deficiency-focused treatment strategy at this stage. Continue current herbal protocol and monitor closely during future corticosteroid reductions, as risk of relapse remains present. Had urged whole food diet - O was using some but has gone back to some kibble as felt he wasnt full enough on whole food det.
Acupuncture points were stimulated