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Old Skin Dog

by mikemesley - June 10, 2009

Brief one.

Old dog,12yo GSD female neutered. Recent Hx of severe pruritic dermatitis and increased lymph node size genralised (biopsy = lymphoid hyperplasia), with bloods only suggestive of some strange low-grade inflammatory process (fibrinogen etc.). Treated skin presuming this might be enough for generalised lymphoid hyperplasia- cephalexin and cortisone only when required to manage self mutilation.
Greasy coat with low grade pyoderma resolved well, hair regrew on tail and lymph nodes down now after 6 weeks antibiotics. Hasn't required cortisone for over 4 weeks.

So I was initially thinking Yin deficiency/Blood deficiency (history of increased appetite but with minor weight loss) but today I reexamined and found -
Pale lavender tongue, some sticky white coating. Pulse very surprisingly to me was very full and slippery, maybe even superficial. Probably slow pulse.

What is going on? Diet is predominantly dry food so Damp Heat potential high.
SMS. WLT or even CSWLT - probably more cold presentaiton than hot? Does CSWLT have enough Blood/Yin tonifying to achieve what I'm aiming for?

OK - so it wasn't brief after all!

Thank you Steve and everyone for being part of my learning. Awesome!

Mike

by naturevet

June 9, 2009

Hi all,

First off, Mike, when the pulse is superficial like that, then the goal in countering the skin inflammation is actually to move the Blood centrally. So formulas with a strong warming aromatic influence, and also a hydrating influence, will generally aggravate the situation. So unless the pulse behaves as Marnee describes, then I'd steer clear of all Blood and Yin tonics, CSWLT, and even SRT, all of which often increase cutaneous Blood flow. Instead, you need a bitter/bland type of formula, such as SMS, as Erin mentioned. SMS can be very helpful in peripheral lymphadenopathy as well. To increase its efficacy there, we can combine it with Hoxsey. Hoxsey is more moving and cooling, and fits a purplish tongue well. It's also strongly anti-inflammatory, as is the SMS.

As for diet, I agree that it's probably a major contributing factor. Processed carb-based dry diets invariably are, when the problem is severe inflammation.

So given the historically greasy coat (which virtually confirms Damp Heat), I'd go with SMS plus Hoxsey. Even though the dog is elderly, it should respond well by my reckoning.

Hope I'm right! I'll give you your money back for this consult if I'm not!

Steve

by bannink

June 10, 2009

Hi Mike,

I am no great skin expert and I find these cases confusing as well. So I am going to go out on a limb for my own learning and give Steve more work to do to help us both out! Hope you don't mind.

My guess would be initially you were seeing a lot of Blood heat (intense itch and self mutilation seems like Heat in the Blood --> Heart Fire). I am just a little confused by the observation of "low grade pyoderma" and prior mention of l self mutilation. But I am assuming severe skin lesions and inflammation based on lymphadenopathy. Are there lesions or itch now? Heat can also cause increased hunger with inability to gain weight, hair loss, and can dry the blood and create Blood deficiency signs.

I am wondering what Steve would say about using Si Miao San with Dang Gui for Spleen support, drain Damp (and Heat) and tonify and move blood to start with, then re-examine and move to a more tonifying formula later if needed depending on what happens with the tongue and pulse. I think your idea of CSWLT would fit a lot of those categories as well but SMS I think moves Blood a little better and the tongue makes me think there is some stasis. I am not really sure how else you would determine which of these formula were better as they seem to otherwise do similar things. With the CSWLT might we expect to see more GI Phlegm obstructing Stomach signs like vomiting or poor appetite? Steve, can you help?

Erin

by marneemadsen

June 10, 2009

HI,
I have found Steve's technique of tonifying SP/ST warming pts like ST 36 and checking pulse is reliable way to see if CSWLT might work. I have been surprised how well some dogs with pretty drastic skin lesions who appear so hot do with this
formula (one particular GSD included).
MY 2 cents,
Marnee

by bannink

June 10, 2009

Thanks for the tip Marnee!

by bannink

June 11, 2009

Steve,

How much do you read into the pale tongue? Would you think functional blood deficiency due to stasis that might be expected to resolve once you get things moving? I think pale tongues in cases like this causes a lot of confusion - because we think blood, Qi or Yang deficiency. This patient does not seem particularly Qi deficient, and certainly seems Hot so not Yang deficient. So that leaves Blood deficiency. And I think the question is always when to treat that deficiency. The answer here would be to just clear the excess and move the stagnation (lavender tongue) and see what is left over? What is confusing is that when we think Si Miao San we (or at least I) often feel better with a nice Hot Damp looking tongue - Red and thick - or at least red.

Erin

by mikemesley

June 13, 2009

Thanks too you all.
Significant in steering me away from the Damp Heat issue in the first place is the lok of the dog - overall you would call it deficient, and more accurately you would think Yin deficiency. Is a very thin animal, and had been losing weight despite increased appetite. Also the fact that cortisone was tolerated seemingly very well, as were antibiotics. I think in my initial post I didn't make this very clear.

What makes me feel OK about SMS though is the SP tonifying effect, and also I believe it can therefore also be Blood tonifying. I guess if the Yin deficiency is due to prolonged heat internally then this is a round about way of getting to deal with what I think is probably Blood deficiency - if not also Yin deficiency.

Makes it more confusing again?

I think I will begin on SMS and see where we head from there, either planning to add Hoxsey if heat clearing is further required, or maybe add Dang Gui if Blood deficiency emerges as a real issue.

Thanks again to you all.

Mike

by naturevet

June 13, 2009

Hi Mike and Erin,

Given the confusion in this case, it's important to just start with something. If you don't end up resolving everything, you'll end up accentuating what it was that you missed.

As for the pale tongue, I sometimes don't interpret that too heavily, given that there are several variables that impact it. For example, if only the top of the tongue is examined, it can look pale due to the thickness of the epithelium. The underside is a much better guide to true tongue color in both animals and humans.

Good luck, Mike, with the SMS. Hopefully you'll see some benefits.

Steve

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