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Lab With Arthritis

by rmtran - June 16, 2009

Hi Steve,

I have a 11 years old MC Lab (maybe mix) with arthritis.

He had bilateral CCLR 5 years apart and had surgeries. He did ok after that, but arhritis is developing over time and having trouble getting around.

Had several acupuncture sessions last year by other vet and was placed on SMS and Western meds (Deramaxx and Tramadol) at the same time. The patient improved, but the client could not tell what helped.
Due to the cost SMS, it was discontinued soon after; no change in patient's mobility. Acupuncutre sessions did not make much difference, so it was stopped a year ago.

Hx of ALP elevation, proteinuria. Left elbow dysplasia as well.

Tongue-pink/dry
Pulse-wide but not fast, weaker on left
Panting constantly during the exam.

Very lumpy dog with distended abdomen, good with people and other animals, but very scared of noise and has separation anxiety. Likes cool and hard surface.

I think that there is Blood stasis due to Blood Deficiency, may be Qi/Yin Deficiencies as well, although PE findings really did not match.

Thinking about Stasis formula with blood tonifying effect, maybe some heat clearing effect...Does it sound ok?

I could not come up with one formula, and I need your help.
I am also treating this patient with acupuncture.

Thanks for your help!

Rieko

by naturevet

June 16, 2009

Hi Rieko,

The first blood mover I think of for labs like this is Xian Fang Huo Ming Yin. Apart from the tonic influence you're looking for, it's a good fit. If you use granular extracts, just add about 15g of Dang Gui to the XFHMY and you'll be all set.

Of course, if this client wants the most bang for her buck, then the dog should be on a low or no carb higher protein diet. Hopefully that's the case.

Good luck!

Steve

by rmtran

June 16, 2009

Thanks, Steve.

Believe it or not, I was about to dispense XFHMY until the client mentioned about storm phobia and anxiety issues.

I will try it with Dang Gui, and recommend food change!

Rieko

by rmtran

August 5, 2009

Hi Steve,

I would like to get some opinion about this patient before i see him again on Sat.

He had severe hematemesis, hematochesia with diarrhea a few weeks ago, and was hospitalized for 3days at ER. There, had blood work and rads, brief abdominal ultrasound. There were multiple honeycombed, cystic masses in slpeen and liver appeared to be mottled. The size of liver seems to be larger on rads.
He had developed arrhythmia while he was there; chest rads do not show obvious mets, but aorta is clearly prominent and displaced dorsally (no mass effect that I can see), and right atria appears to be enlarged.
They did not find a cause of bloody V/D; it sounded like more of a HGE case.

He is on XFHMY with Dang Gui, Probiotics, Metrondazole, tramadol. His stool is still soft, but better. This dog is off of Deramaxx since the episode, but he is not much worse in terms of arthritis.

We all suspect hemangiosarcoma in this dog, so I would like to modify my approach to address the new problems as well as his mobility.

The client noticed that he is drinking and urinating a little more than before. His blood work at the time showed elevated ALP-1900, ALT-115, mature neutrophilia (cannot remember the numbers) without left shift.

I know we can tell for sure what to do before seeing the patient, but I would like to get prepared. What should I looking for in this patient besides tongue/pulse and some active points?

I imagine some stasis in liver (enlargement/ALP elevation), HT Qi Deficiency (arrhythmia), SP Qi Deficiency or Damp Accumulation (loose stool)...

I will post more info once I see this patient in 2 days.

Thanks,

Rieko

by naturevet

August 5, 2009

Hi Rieko,

Try assessing the response of the pulse to sedation of BL

by naturevet

August 5, 2009

Not sure what happened there....

anyway, try assessing the response of the pulse to sedation of BL 18 and BL 17. Check each separately. They'll confirm whether we need a Blood moving strategy in general, and one that targets the Liver (e.g. GXZYT) in particular. You can also assess the impact of BL 20 on the pulse. If it is very weak, but improves when the point is tonified, then BYHWT is an option.

Check those things, as well as the case in general, and let me know what you think. Also, is the pulse slippery or wiry before you start? Superficial or deep?

S

by rmtran

August 13, 2009

Hi Steve,

I tried my best but it was so hard to recheck pulse with each needling...this patient tried to sit everytime!

Tongue-pink with pale rim
Pulse- slippery, somewhat wiry, weaker on left.

Ears/toes are normal.

HYperpigmented skin at ventrum and pendulous abdomen.

Draining of BL-18 helped to ease wiry feel, but still slippery.

Tonification of BL-23 improved general quality, but still slippery.

BL-40 no change.

Do not remember BL-20 was active or not...

He is XFHMY (now tablet form; Mona does not have granules now) with small amount of Dang Gui.

I looked back on record and his pulse started to show slipperiness about the time he started XFHMY.

By the way, he finally had a thorough abdominal ultrasound by our internist and was found that there was no splenic mass, nodules in liver that are most likely age change, and bilateral adrenomegaly. Urine cortisol/creatinin ratio suggests Cushing's (=27).

I am thinking he is damp, and I need to drain some. This dog is actually moving around as same as he used to without NSAID (he was on Deramaxx but discontinued 2 weeks ago due to GI issue), so I may not need too much moving here.

For him being more PU/PD lately, I will need to clear Heat as well.

Si Miao San? This was the formula that this patient was on one year ago and the client could not tell if herb or NSAID was helping back then. Due to the sign of blood deficiency, I would like to add Dang Gui to SMS (15g per 100g?). Would this sound ok??

The client was very happy that this dog did not have splenic tumor; his heart was also normal (no mass).

Thanks for the imput.

Rieko

by naturevet

August 13, 2009

Hi Rieko,

Your plan sounds fine, and the formula goes well with the XFHMY, too.

S

by rmtran

September 11, 2009

Hi Steve,

I saw this case today and the patient's never really recovered from diarrhea. No blood, but loose. Twice daily, and it sounds like small bowel origin. Metronidazole was tried without any benefit.

I told the client to discontinue XFHMY and SMS, and just continue Dang Gui based on today's findings:

T-pink
P-soft, but very difficult to palpate most of the time.

Interestingly, the client mentioned about nose bleeding. There are spots of blood (thick colored) about 4-5 times for the past 1.5 months. It seemed to be unilateral per the client.

Will Bu Zhong Yi Qi helps his diarrhea and nose bleeding here?

Thanks for your advise!

Rieko

by naturevet

September 12, 2009

Yes, I've used BZYQT in identical cases. It's worth a try. Otherwise, we may also consider some astringents. But if the client is game, then BZYQT is a good idea to try first,

Steve

by rmtran

September 13, 2009

Thanks!

by rmtran

July 13, 2010

Hi Steve,

Updates and questions:

This patient has settled with XFHMY and SMS with dang gui, tramadol, and very low dosage of Deramaxx (this always helps) for his mobility.

As for his diarrhea, he still on Tylan; once the client tried to taper it down, he developed severe diarrhea (this time without blood) and vomiting and was hospitalized, so she decided to keep the patient on it forever.

I tried BZYQ along the line earlier this year with no significant changed in stool...maybe I was not aggressive enough on dosage then.

I have been seeing the patient q4~6 weeks. Lately, the weather is hot and humid, and the client noticed that the patient pants less and move better than in Winter. He eats well all the time, but does not drink a lot.

This make me think that the patient has Stasis that aggrevates with cold weather, and has Yin Deficiency that gets wrose with dryness during the winter.

If so, I should get ready for more moistening, and worming formula for next cold season..., should I?

Yet this patient is full of lump (Damp) and always have pale pink mm (low normal PCV) with pink tongue.

Very confusing...

Rieko

by naturevet

July 13, 2010

Hi Rieko,

I'd also look at the winter aggravation as being because he has less circulation in the Tai Yang meridians at that time. So stiffness and pain will increase. In summer, especially now, the Tai Yang meridians are full of Qi and Blood, and so movement is smoother.

At the same time, we know he is Damp, and so melding the two together, we need a Tai Yang releasing anti-Damp anti-diarrheal herbal formula. The first one that springs to mind is Huo Xiang Zheng Qi San.

Another lesser used formula will release the Tai Yang and address Damp, but not help the diarrhea much. It will probably greatly aid mobility, however. It is Ma Huang Lian Qiao Chi Xiao Dou Tang. But I don't think you can access Ma Huang, so I didn't mention it before. If you can, you can try it out.

Hope those suggestions are more helpful.

Steve

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