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HL Weakness/degeneration

by landauvet - June 9, 2009

Bo 9 year old shepherd cross mc
PC Relatively sudden onset of HL weakness starting last winter
Related History: Around the same time as onset, did the splits on the ice. Since then, has been unable to trot or do stairs. Lags behind on walks. Suspected Lyme involvement with no response to doxycycline last month. Had a UTI at initial presentation which was being treated with Keflex. Primary vet concerned about Degenerative Myelopathy. There was marked trembling to both HLs at initial presentation and marked weakness to Hind end.
Diet up to that point was poor quality kibble.
Bo looked weak and relaxed in my exam room very easily. His back was cold, coat was dry and brittle. Pulse was weak and fast. Tongue did not look remarkable. Panting a lot in my office. Chiropractic and acupuncture performed treating mostly for kid yang def (BH, BL-39, 36, GV-4, LI-10, GB-25 Bl-40, and SP-6)
Ba Wei Di Huang Wan was prescribed.

I rechecked Bo 10 days later. Although his demeanor seemed improved and he was more eager and energetic, Boâ€™s gait and trembling seemed unchanged. He panted a lot again. This visit, I noticed a lot of heat radiating from the belly and flanks. Pulse was slippery and of moderate depth. Tongue was lavender with a thick white coating. Bl-40 was active and improved the pulse with sedation. Liv-3 tonified. I added Si Miao San and swithched Bo to a partially raw diet.
After this appointment, Boâ€™s owner started to worry that Bo seemed very thirsty. He would drink a lot, then need to pee in about 1 hour after the drink or else! He read on line that the herbs could be the cause of the thirst and peeing. I lowered the dose of herb for a bit, no change noted and we continued at the original dose.
Third visit. Quivering seems much improved although overall strength and function has plateaued. Pulses still slippery, tongue red. Acupunctured active Sp-3,6, St-36, LI-11, and BL-18.
Talked to Boâ€™s owner tonight. He wants to stop the herbs because â€œthey donâ€™t seem to be helping and he is really concerned about the thirst and peeingâ€. I told him to stop the herbs for a few days then check in with me.

I donâ€™t know what to think about this thirst. Or the plateau. I thought damp heat was the key after the second visit, although he does not seem to show me a clear response. What do you think?

by naturevet

June 10, 2009

Hi there,

Ordinarily, we give SMS to relieve thirst and polyuria, as you know. So it may be a coincidence, or that there's another pathology there that SMS is simply not helping, and maybe even bringing out. The drying effects of SMS could potentially create Yin deficiency, and that could potentially create thirst. The only other type of scenario where we get PU/PD is a Triple Burner obstruction. That and the associated Gall Bladder channel obstruction is actually quite common in the 'trembling hind leg' type of dog. If it was going on, you'd see active GB points. Chai Hu Jia Long Gu Mu Li Tang would be the formula for that, and it can be more effective in animals with slippery pulses, especially if they are also superficial.

As far as the owner's perception that he's not improving, I don't think you can say that. You've seen definite progress. Certainly some of these dogs that have splayed and are no trembling may continue to be affected for six months or more without effective treatment, so I'd say you're getting somewhere. A plateauing after improvement implies you're on the right track and not using something completely inappropriate. So rather than stopping the SMS, I'd roll in the CHJLGMLT (or, say, Zhi Bai Di Huang Wan if you think they're Yin deficient). That way, you won't lose whatever ground the SMS created. Dogs that benefit from SMS can end up needing Yin tonics, not from the SMS, but because the longstanding Damp Heat created Yin deficiency that isn't really apparent until you drain and dry all that pathological Damp.

Hope that helps you out and gives you some idea of what to try next.

All the best,

Steve

by landauvet

June 23, 2009

Hi Steve,
It has been a little while since this dog's owner checked in with me. He stopped all the herbs because Bo was drinking more and more and thought the herbs were the cause. He just got diagnosed with Cushing's by low dose dex suppression test. Sounds like the damp heat diagnosis was correct afterall. Going forward, what should I try to do differently? He was on SMS and ZBDHW. His main complaint was HL weakness then PU/PD. He fed Costco crappy dog food for a long time. He is in the process of making changes and I will definitely get him on a raw food diet. What else?

Kevin

by landauvet

June 24, 2009

Hi Steve,
The last entry did not seem to get on the new posts, so I am sending this to make sure you see the last post. Thanks.
Kevin

by naturevet

June 24, 2009

Hi Kevin,

A raw diet, SMS, and ZBDHW if there is secondary Yin deficiency should be adequate to improve things. Diet is crucial - without it the above protocol won't work.

If the problem is an adrenal tumor as opposed to the pituitary, we've generally needed to introduce a Blood mover like Ge Xia Zhu Yu Tang and a low dose of Trilostane to put weight back on the animals and counter the weakness. But it sounds like this case isn't so extreme.

So I'd simply insist that at the very least the SMS and raw (or home-cooked grain-free) diet are introduced, then give the animal a few weeks. I thought you said he had already made this switch, though. If he hadn't, that would explain the lack of response. Or if the diet was at least half 'crappy kibble' and only half raw, that would explain it, too. At any rate, to resolve Cushing's will require a year or so, so you're looking for improvements over that period of time, not a resolution of all his issues in a month.

Hope he gets with the program. At least you were vindicated, anyway!

Steve

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