Question Details
Vestibular Syndrome And Congestive Heart Failure
by Pamela Page - May 27, 2009
Hello,
Thanks for hosting this forum, I appreciate learning from other people's cases. I would like opinions on a new case, a 15-year toy poodle with acute onset of vestibular symptoms on 5/12. She had another milder episode previously. Both featured a left head tilt. This one was very severe, she could not walk, was contorted to the left and could not straighten herself, was lifeless/comatose per owner, no nystagmus. Her regular vet put her on Baytril for a presumed inner ear infection. Owner had to syringe-feed her because she could not prehend food, nor manipulate it with her tongue when it was in her mouth, seemed to have difficulty swallowing. Now she can eat, but frequently smacks lips, and gulps as if nauseated. She also has chronic Hx of a deep gagging cough and has been diagnosed with congestive heart failure with right sided enlargement. She is on lasix, being transitioned to spironolactone due to hypokalemia. Was on enalapril, but discontinued because it made her disoriented. Is also on Denamarin for hepatobiliary disease. She has cataracts and poor vision, is easily chilled, prefers warmth. No heart murmur, some wheezes in right lung field. Tongue was initially purple, is now becoming pinker, with redder tip. Pulses are thready, weak, very thin. Sweet disposition. I have been doing acupuncture twice weekly and she has improved significantly in her vestibular symptoms, but I would like to prescribe an herbal formula to assist her recovery and help prevent recurrence. I was thinking this was upward disturbance of wind phlegm, and thought to put her on Kan Herb's Subdue Internal Wind (Ban Xia Bai Zhu Tian Ma Tang) Is this a good choice, or is there another that would be better?

Thanks!
Pam Page
Replies
by naturevet
May 28, 2009
Hi Pamela,

Lots going on in this little dog. An ideal formula would address everything simultaneously, or answer the question of 'Why did a dog with heart problems, this tongue, this pulse, and hepatobiliary disease find herself prone to vestibular problems?'. When I look at our options ( and even BXBZTMT, TMGTY, and even DHJST), the one that best picks up these other changes as well is Xiao Chai Hu Tang (Minor Bupleurum Combination). It harmonizes the upper and lower, and inner and outer, to ensure Yang can descend to engage with Yin and produce Qi.

This disruption in Yang Yin integration is caused by a middle burner obstruction, which often manifests as elevated liver enzymes. Qi fails to descend, producing hacking cough (in my experience, this is the most common cause of collapsing trachea, which XCHT is very effective at treating). It also produces stasis in the chest, since Qi is having a hard time descending and also disseminating outward. Congestive heart failure is consistent with that. Too much Yang in the upper body commonly manifests as neurological problems, including very commonly vestibular syndrome.

So you can see how XCHT would treat a lot of what you've got going on in the dog. If the dog has a wiry pulse that is relieved by needling Gall Bladder channel points, the efficacy of the formula will be confirmed, making it a safe choice to try.

Hope that helps you out!

Steve
by Pamela Page
June 2, 2009
Hi Steve,

Thanks for the ideas! I have NPHC XCHT granules on the shelf, or Kan herbs Open the Liver Canals. Would one be preferable to the other?

Thanks again,
Pam
by naturevet
June 3, 2009
Probably the granules are fine for now while we test the theory.

Good luck!

S
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