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Another Dermatitis!

by landauvet - June 19, 2009

Hi Steve,

Sugar is a 3 year old wire haired Jack Russel Terrier
PC: Dermatitis since a pup
Armpits and groin get cherry red and occasionally raw in clearly demarcated circles. Redness around eyes and to external ear canals is common also. Itchy and will lick at arms and groin.
Related problems: Occasional reverse sneezes. Lately needs to go out in early am to eat grass. No vomiting seen.
Pulse is wiry, but easy to feel. More wiry the deeper you feel, although also superficial and strong.
Has been on modified LDXGT for two weeks. I stopped this a few days ago due to the upset stomach and she also started pooping in the house overnight. This formula has not helped her skin. She also has had 1 mg pred every 1-3 days for the last 3 months to control her skin inflammation. (she weighs about 12 lbs.) I also had her on CSWLT for about a month with no clear improvement.
Active points: BL -40, GV-14. In general, she has not responded with acupuncture as far as the itchiness and redness.
Tongue: Large, congested underside, reddish top and dry. Sl lavender.

Since she is eating a lot of grass now, my instinct is to put her on San Ren Tang.

I have tried many other formulas over the last year or two to no avail (XCHT, Hoxsey, Combination of Silarex, Qi Bao Mei Ran Wan, and LDXGT, Jing Tangâ€™s Damp heat Skin, and others. She has been allergy tested and desensitized over the last 1.5 years with no improvement. Diet: Frozen raw plus a bit of good quality kibble. Skin did not improve on all raw either.

Thanks for any insights!

Kevin Landau

by naturevet

June 19, 2009

Hi Kevin,

The deep wiry pulse indicates a need to push blood out to the skin, in very real terms. variations of LDXGT don't do that. Tonics like QBMRD might, but you lose that effect as soon as you combine them with something that doesn't, like Hoxsey or LDXGT. This is one reason I'm not a big fan of mixing formulas, although it's a common practice (in North America, anyway). It's because if a mixture of formulas and approaches doesn't work, you haven't learned anything about what will in the process. When you used the other formulas in isolation, we learn immediately what's not going to be helpful by the animal's reaction to that particular formula. For me, that learning process is a priority if I'm going to resolve things for the animal long term.

Anyway, I digress. The Yin deficiency, Blood deficiency, Blood Heat type of approach remains untested. That's what I'd try next, unless you've already used Qing Ying Tang. If you haven't, that's where I'd start.

Hope that is somewhat helpful. Hang in there,

Steve

by naturevet

June 19, 2009

By the way, San Ren Tang is fine to try, too. It has the right impact on the pulse and fits the grass eating and reverse sneezing. But the absolute lack of any response to Damp Heat approaches including diet change, plus the evidence of pronounced Heat and Stasis (tongue color; points) makes me want to try QYT first. Drying formulas can aggravate the Stomach to produce the nausea and digestive upset you're seeing, so we can't just assume that side effect is due to Damp.

S

by landauvet

June 19, 2009

Steve, T
hank You so much for the replies. I tried QYT for a period but not this year. I certainly can try it. The other thing Sugar does is she loves to lie in the sun or next to a heater even when her skin is very inflamed. I will keep her on the SRT for the weekend because I am going away for a few days and won't be monitoring her directly.

Thanks a million.
Kevin

by landauvet

September 7, 2009

Hi Steve,

I wanted to continue consulting with you regarding Sugar.
She has been on QYT for about a month with no big changes to her skin and a few significant flair-ups. Prior to this, she was on SRT which seemed to be the most helpful formula to date to stabilze her skin. Even when her skin has been "stable", Sugar has required prednisone every 1-3 days at 0.15 mg/kg dose.

Today, I rechecked her. Tongue: dry, red, lavender hue on top
Pulse:excess, slightly wiry
Points: Sedating Bl-40 decreased the intensity of the pulse
GV-14 BL-20 and 21

Sugar has had a lot or persistent skin rashes that have been unresponsive to food allergy protien elimination (beef, lamb, chicken). She does seem to flair after meals. The last few weeks she has seemed out of sorts emotionally. She has been following me around the house constantly and seems anxious. I am worried that I have had to keep her on this low dose pred treatment for the last 5 months or so.

Any advice on herbal therapies to try next would be greatly appreciated.

Kevin Landau

by naturevet

September 7, 2009

Was this the dog that we discussed in class?

If so, and SRT worked the best, let's modify it by adding Yin Chen Hao (Capillaris) as discussed, and see if it does a better job of expelling that Wind Damp Heat.

Steve

by landauvet

August 3, 2012

Hi Steve,
I am still struggling to manage Sugar's skin. I have been relying on 1 mg pred every other day and atopica once daily for the last say 2 years. Of late, Sugar has seemed off in her energy level and a bit depressed. There is a feeling of cranial abdominal distention which is not tender. Her energy and attitude have improved when I cut back on the Temeral P significantly. She is very red on the direct margin of her eyes. Groin is a little red and she is itchy as per usual. Her ventral skin is warm and puffy mildly. Tongue is pink and dry. Left pulse is thinner and weaker than the right. Both are thin, deep and a bit wiry. Pulse is strengthened from BL-17 and SP-6 tonification.
She has been off herbs for the last 6 months or so because I could not figure out what seems to help her as much as the drugs. Now I am concerned about the long term effects of those drugs and want to get control over the situation if possible.
No seasonality, heat seeking, and this problem seemed to coincide with a bad rabies vaccine reaction as a pup so I have always thought of this as an autoimmune issue.
The formulas that I am presently considering are SRT plus yin Chen Hao, BZYQT to help with the abdominal stasis and DGSYS to help the blood and the stasis.
Thanks for your thoughts.
Kevin Landau

by naturevet

August 3, 2012

Hi Kevin,

The adverse response to steroids suggests a Damp consitution. I'm assuming you're using a home made or raw low starch diet here. It's the secret to success long term with these dogs, and results will be feeble in the end without it.

Did you try SRT before? If so, and if it was unrewarding, then I'd try Chu Shi Wei Ling Tang now. It can boost cutaneous Blood flow and digestive function, ala your acupuncture points.

CSWLT plus diet change - it's what I'd try next.

Steve

by landauvet

February 10, 2013

Hi Steve,
Quick update on Sugar. I brought her in to her primary care vet last month to evaluate her for PU/PD. CBC normal, chemistry normal, U/A normal except for mildly dilute urine (1.021)She was getting 1/2-1 mg pred 2-3 times weekly. She was on a raw diet and her skin was not great but manageable on pred. She was also on Nettles, CSWLT or SMS.
I decided to try her on a limited ingredient diet on my primary's recommendation. She is on Natural Balance fish and sweet potato kibble and canned. No pred for last month and continued on SMS, nettles, adrenal support and probiotic.
She is still intermittently itchy but her skin is holding its own and generally she is better. I appy topical steroid to her inner thighs every week or two.
Any thoughts on long term management as far as herbs and diet?
Thanks,
Kevin

by naturevet

February 12, 2013

Hi Kevin,

That's great that you identified a food allergy. I'd continue with the herbs you're using on the assumption they will help prevent acquisition of new sensitivities by optimizing gut function. I would hope you'd see yet further improvements over the next couple of months.

Steve

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