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Old Lab

by cchcs21 - June 23, 2009

Hello!

Please help - when you get a chance. This is my own dog.

Lucas is a 11 year old yellow Lab M/N who was born with a deformed lower jaw (undershot) and a small liver. As a youngster he did have problems with vomiting but that has really resolved with the use of quality diets. He does have intermitten diarrhea/soft stool (esp if he has eaten too much stool in the yard...). His past history also includes chronice severe ear infections that were pretty much constant regardless of diet or ear care products used. He is also slightly overweight. This has been a battle to control his weight.

In the last year, he developed arthritis and really slowed down. He also has numerous lipomas and adenomas. His hearing is decreased and mentation a bit slower. He tires easily and prefers to sleep than to play.

In Feb I started him on Si Maio San for the ears and they did improve (actually better than ever before - not 100% though). He also seemed to be perkier in general. His excessive gas has all but resolved as well. He eats less stool.

Recently, though, he is really not acting well. He still eats ravenously but moans a lot (when walking around and when plopping down). He has started having accidents in the house (soft stool and urine). And also urge incontinence. He is not that interactive with us - very quiet. His tongue is purple. He barely does the stairs. I did a chiro adjustment on him but it only minimally improved his sypmtoms. He did go up the stairs more comfortably.

His diet is 1/2 raw and 1/2 grain free kibble currently. He is on boswellia, arthri-ease powder (glucosamine), SP whole body support and livaplex. Two days ago, I started metacam but that is making him vomit. he also doesn't seem to feel better on it.

He seeks out cold tile floor mostly but will lie on a blanket or rug if they are not in the sun.

I have a blood panel pending.

I appreciate your help on this one and if there is something I haven't covered, just let me know. I don't know acupuncture so I can't tell you active points.

Thanks for your time and advice.

by naturevet

June 23, 2009

Hi there,

I'm wondering if there is a Liver Spleen disharmony going on here. Problems in one perpetuate problems in the other, making it a chicken-and-egg problem, but the small jaw and liver as a pup suggest the Liver Blood issue came first. If so, then an anti-Damp approach will have limitations in terms of efficacy. It will take care of the sequela of Spleen deficiency, but not the cause of it, which in this case appears to be Liver Blood deficiency.

Liver Blood deficiency creates Qi stagnation, which disrupts digestion. Proper digestion is heavily dependent upon proper movement (in the form of GI motility, the 'raising of extracted Qi to the upper burner', etc.). If this stasis persists, then the tongue will eventually become purplish and abdominal pain will start to become more frequent. Problems with motility become more frequent.

From a western perspective, you need a formula that addresses spasm and motility, as well as supports liver metabolism, to complement the work you've already done with inflammation. All things considered, Xiao Yao San should end up being a good choice for the dog. It harmonizes the Liver and Spleen, has the needed biomedical effects, but has a definite emphasis on the Liver. It will complement the effects of SMS, which you can continue. If I'm right, then you should see some improvements in your dog once you institute it.

Good luck!

Steve

by marneemadsen

June 23, 2009

Hi Steve,
Do you think the urinary and fecal incontinence and urge incontinence is due to Liver Qi stagnation then?

by naturevet

June 24, 2009

Hi Marnee,

Good question - I'd missed that on my hurried read through.

It could still be related to Damp, and just unresolved. Or, we could have the added element of Spleen Qi sinking. Basically that is a form of Liver Blood deficiency induced Qi Stagnation and Spleen deficiency, but where the stasis is in the lower burner. So given that, we might be better off trying Bu Zhong Yi Qi Tang instead of Xiao Yao San.

Another possibility is Jia Wei Xiao Yao San, where just a few added herbs take away a lot of the dog's heat and reduce urinary urgency.

At any rate, if we're on the right track, we'll see partial benefits from any or all of those options, I think.

Steve

by cchcs21

August 21, 2009

Hi Steve,

I have finally had a chance to do some reading on TCM and I am just trying to sort out how to organize the symptoms. So, can you you help me sort out this case?

I understand the liver blood def leading to the liver chi stagnation leading to the spleen and then the damp heat. So when I used the Si Maio San, the damp heat signs improved, leaving the Liver blood def/stag and spleen sypmtoms. That makes sense.

But, if I had chose a formula for him, I would have focused on something to tonify liver blood (something from the green category that addresses tonify and move/liver and spleen). For example: Dang Gui Shao Yao San (which seems to address liver spleen disharmony and is a liver blood tonic) Can you explain why you chose Xiao Yan San which is in the Move category with secondary tonify effects?

OK - next question - so he has been on the Xiao Yao San for two weeks. Here are the current symptoms:
belching Stomach Rebellious Chi
Vomiting(dry heaves) Sp/ST/Liver Qi Stag
nausea (severe) St disharmony (rebel Qi)
Seeks cold tile floor Heat
Still easily exhausted after exertion SP qi def/blood def/stasis/Kid ess def.
muscle atrophy hindlimbs SP chi def
Loose stools (soft,lt brown) SP
Hips/Low back pain Blood stasis
weak/wobbly Kidney ess. def

So it seems like there are a lot of Sp/st symptoms now. The loose stools are now constant and so is the nausea. He freq heaves, although doesn't usually bring anything up - or just small amounts. So is the rebellious stomach chi rising because the liver qi is still stagnant and not helping to move chi down? But you chose a formula that focused on moving, so why would it still be stagnant?

Another question - he is easily tired after exertion. Could that also be interpreted as "breathlessness"? He just comes in a plops down as if just walking was an exhausting event. He doesn't really pant like he used to and doesn't cough. So since there aren't other lung signs, we are not dealing with a lung involvement, right?
Another question: As I understand it Kidney essence deficiency can lead to liver blood def leads to spleen qi def. Since he seems to have some Kidney Essence def signs (liver blood def, can't stand long, decreased vitality/tires easily, weak hindlimbs/wobbly) could this be playing a role as well?

Lastly - where do I go from here? How do I know what to focus on?

Whew - thanks for your help!
Sandy

by naturevet

August 23, 2009

“….if I had chosen a formula for him, I would have focused on something to tonify liver blood (something from the green category that addresses tonify and move/liver and spleen). For example: Dang Gui Shao Yao San (which seems to address liver spleen disharmony and is a liver blood tonic) Can you explain why you chose Xiao Yan San which is in the Move category with secondary tonify effects?”

I see a lot of stasis there as well. In cases of constipation, it is usually Qi that is stagnant. XYS has a strong tonic nature (we originally had a green label on it), but also moves Qi and is famous for its benefits in constipation, so it seemed to me a good fit.

I agree you now have a lot of digestive symptoms present. That tells us the focus of the formula should be on the digestion. The fact that they materialized on XYS (a moistening tonic) tells us the dog may be Damp internally. Damp is an important cause of obstruction and would not just disperse itself with Qi movers. It would need Phlegm transformers; herbs to dry Damp; and herbs to drain Damp. His prior response to SMS tells us this Damp was present before.

“Another question - he is easily tired after exertion. Could that also be interpreted as "breathlessness"? He just comes in a plops down as if just walking was an exhausting event. He doesn't really pant like he used to and doesn't cough. So since there aren't other lung signs, we are not dealing with a lung involvement, right?”

If he’s developing Damp signs, in humans this includes a sense of bodily heaviness. Damp often leads to the patient feeling hot, as yours does, which limits their exercise ability.

“Another question: As I understand it Kidney essence deficiency can lead to liver blood def leads to spleen qi def. Since he seems to have some Kidney Essence def signs (liver blood def, can't stand long, decreased vitality/tires easily, weak hindlimbs/wobbly) could this be playing a role as well?”

You may be looking at two formulas for now. I would probably resort to San Ren Tang or Wei Ling Tang to sort out his digestive complaints, and team that up with Ba Wei Di Huang Wan (Rehmannia Eight), to further drain Damp and support the Kidney (the fire under the pot). One other option is to try Liu Jun Zi Tang (Six Gentlemen) since it deals with Phlegm and an unhappy Stomach while boosting the patient’s Qi. But if he’s not as much Qi deficient as Hot and Damp, it might not work.

Hope that advice serves you better,

Steve

by cchcs21

August 23, 2009

Steve,

Thanks for your help. I wasn't questioning your choices, just trying to learn.

Unfortunately, during the time in Mona's class, I didn't have time to study outside of class. Feb to July are the busy times for my business. So, now it has slowed down enough for me to have free time to read. I have been reading Maciocia and starting to put together the understanding of the TCM theories. But getting from there to actually chosing the focus and the formula is not there for me yet.

So, I was just trying to understand what you were thinking, so I could learn from it. I hope that is OK?

I appreciate your advice and time so much.
Sandy
PS I was with Mona yesterday and she recommended the wei ling tang too - so I will start with that and the rehmannia eight. They say that dogs and their "owners" are alike and you put me on the rehmannia eight too - funny :)

by cchcs21

August 23, 2009

One more quick question - he is still on the SMS with the Xiao Yao San. Do I stop the SMS now that I am starting the WLT?

PS _ My email bug is fixed and I am recieving the notices the the replies are posted :)

by cchcs21

August 23, 2009

One more quick question - he is still on the SMS with the Xiao Yao San. Do I stop the SMS now that I am starting the WLT?

PS _ My email bug is fixed and I am recieving the notices the the replies are posted :)

by naturevet

August 23, 2009

Hi Sandra,

Glad the bug is fixed.

I was thinking you'd stop the XYS and SMS. As a general rule, though, if something is clearly beneficial, then I don't stop it, but institute what I think is called for next and see if it takes the animal further. If it does, then I complete the transition to the new formula.

Good luck!

Steve

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