Signalment

• Age: 7 years
• Sex: female spayed
• Breed: Maltese Mix
• Species: dog

Disease Notes

• Certainty: confirmed
• Final Status:

Treatment and Outcome

Problem Notes

• Mentation: I hope I'm not presenting this twice, everything I wrote disappeared so here it goes again.
  Sophie presented to me a month ago after acute onset seizures, mentation changes including circling and mental dullness. She was diagnosed with sterile inflammatory brain disease by MRI and CSF tap.She also has syringomyelia the length of her cord but it is believed to be incidental, not currently the problem. She was given Mannitol, IV steroids and oral Keppra. After improvement she was sent home but represented nonambulatory and was hospitalized with the same treatment again. She improved again but again worsened at home and was given a grave prognosis. Her owner did not want to give up so she presented to me. She was receiving Prednisone 1.5mg BID, Keppra 10mg BID, Leflumide, Prilosec . She was mentally dull, ambulatory but constantly circling left, superficial wiry pulses and pink, slightly pale tongue. I started XCHT at ¾ tab BID and changed her to a home cooked turkey and potato diet. A week later she presented to my colleague with bloody diarrhea. She was started on Metronidazole SOD, probiotics, canned I/D and the herbs were discontinued. I examined her 3 days later. She was much more mentally appropriate, still circling, still hade bloody diarrhea and eating I/D stew. I stopped the pred for 48 hours and restarted at 1mg once a day. She did great with the diarrhea but had a seizure so I increased the pred to 1mg twice daily and restarted the XCHT once daily. All other meds the same. She has done well and is handling the herb SID with no problems. The stool is normal off the Metronidazole. I rechecked her yesterday, she can walk straight for short distances before curving left. She has no menace but is visual and normal PLR’s. She has no CP deficits but no placing on the right. She is much more mentally appropriate, curious but she is hypersensitive and barking much more that she used to. In the exam room she barked unless I was actively engaged with her. . Her owner said she was always nervous at the vet but would never vocalize this much. This is not normal behavior for her. Pink tongue (same), very superficial wiry almost bounding pulses. So, too much Yang in the head (trapped in the upper burner). I am increasing the XCHT by adding ¼ tab in the PM as her second dose of the day and increasing by ¼ tab every 3 days. I know there is more I should be doing but what? A derivative of XCHT? Adding SMS? I am restarting a cooked diet but want the XCHT up first. My colleague will add acupuncture. Are there points to be sure to get in? Thank you for your help. It is invaluable to my cases, Kathy