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Dobermann With Behavioural And Lameness Issues

by mikemesley - May 27, 2009

A 4yo Dobermann, Female desexed. My recent Hx included below.
Reason: Behavioural abnormality
Appointment Notes: sounds like sepeation anxiety, but gets worse and begins before she is even left now
History : Has become more and more obsessed about Tanja - sort of sounds like separation anxiety but really hyperactivity is most obvious change and is not always or only associated with Tanya's arrival, departure, presence or absence. Seems to happen periodically during the day - no time where beter or worse - maybe less during the day. Shoulder lameness (diagnosed as biciptal bursitis/tendonitis by another vet) seen by me on replay from camera - initially 3-legged lame on R fore limb when rising from bed, then gets to using it a little but when still holds it non-weightbearing again. This hasn't been very much improved by the injection given 2 weeks ago this time. The behaviour has been notably more manic over past 2-3 weeks; Tanja not sure if related exactly to the timing of the procedure or not.
History : Other side Hx includes - very gassy farts all the time, especially bad with thunderstorms, poo OK - tending to dry rather than runny, very attached to Tanja and to other dog Alfie, OK with other dogs after a few minutes, good woth other people if Tanja is nearby - very protective of home if no one is in. Lifts leg to pee like "marking". Tanja has tried Vit B injections (?) and valerian use- no improvements. Maybe increased drinking - certainly does a big drink each night when Tanja returns. Appetite always good and puts on weight easily if she is fed too much. Diet - mix of veges, dry food and meat - in approximately 1:2:2 ratio of volume.

Physical findings
Tongue - purple, coating normal to a touch wet, not pale.
Pulse - wiry but full and perhaps superficial.
Acupuncture - poor candidate - not happy.
Dx - stasis obvious, but feel Hx is confusing about damp heat v blood deficiency being primary. I suppose this means SP def is primary?

Have trialled initially on Bu Gan Tang - no worsening of symptoms seen, but no vast improvement either. It seems valerian was only used for 2 weeks - possibly not long enough to see results, but I had thought it most likely to be effective in cases where Blood deficiency is primary?

If I were loking at lameness as primary, I would consider use of Yi Yi Ren Tang with mixed signs, but don't see any use for it in behavioural issues. My next thought was to try perhaps Si Miao San - SP tonic as well as Damp clearing etc.

Any thoughts would be appreciated.

Mike Mesley
Jindabyne, Australia

by naturevet

May 28, 2009

Hi Mike,

You're right that there appears to be several diagnoses at work here from a TCM perspective - Stasis (-> tongue color, pulse); Liver overacting on Spleen (-> gas with stress or tension); and Blood deficiency (with secondary timidity and anxiety).

On a side note, the association of severe agitation with pain may mean Tramadol is an option for pain control. In people that appears to be when the drug works the best, as suggested by meta-studies of existing trials. It works even better when the pain is the cause of the agitation, but that isn't necessarily the case here. Still, it may be worth a try.
Otherwise, we're looking at herbs.

A western herb option is Centella asiatica (Gotu Kola). It's specific indication in humans includes pain from ligamentous or tendonal injuries and connective tissue structures, combined with overall anxiety. Ironically, in studies on the relief of anxiety in people by Gotu Kola, the participants were not as aware as the researchers that their stress response had decreased. The participants were assessing it subjectively and the researchers through stress responses to stimuli. So definitely no placebo there. Anyway, it's quite safe, so I'd probably track some down.

In terms of treating the dog overall, we're looking at a harmonizing formula, given the presence of multiple diagnoses. The one that really springs to mind is Xiao Yao San (Rambling Ease Powder; Angelica and Bupleurum), or even Jia Wei Xiao Yao San, which is more cooling and directed at Heart Fire, which we may have here as well given the intensity of the animal's responses to situations. Either formula nourishes the Liver Blood, resulting in a secondary relief of Qi stagnation that allows the Spleen to function more normally. The latter version also clears Heat generated by longstanding Stasis and which is agitating the Heart.

From a western point of view, new research (2008) has shown that Xiao Yao San has a similar effect on brain cells to clomipramine, a drug commonly used to treat OCD. So does St. John's Wort, and that's my last idea for you here. This herb deals with anxiety as well as pain from neuralgia. If there is nerve root impingement going on, this western herb may help. The only issue with this herb is photosensitization. Given that it's winter for you now, that shouldn't be a problem. Has the dog seen a chiropractor? I'd advise it to eliminate neck fixations as a cause of root signalment and forelimb lameness.

Good luck with this challenging case. I feel these are good ideas and should get you somewhere.

Cheers!

Steve

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