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Pemphigus Dog

by landauvet - July 26, 2009

Hi Steve,

I examined a very desperate doggy today. Actually it was a recheck. 10 year old Choc Lab with a 2 year history of Pemphigus Folleacious. This dog has been living on 40 mg of pred sid for a long time (> than 1.5 mg/kg). If the owner lowers the dose, the dogâ€™s feet and lower legs swell and she chews them raw. Even at this dose of pred, she licks at her feet constantly. She has a very stiff and sore hind end. She has a fair amount of muscle atrophy and a pendulous abdomen. However, she could look a whole lot worse considering the dose of pred. This owner was seeing someone else for the last 8 months for low level laser therapy which was not successful in improving the situation. He is out of time. He is out of patience. He is out of money.

Three weeks ago I saw this dog. Pulses were slippery and deep. Tongue was red and thin. Dorsal hair coat was burned (red tinged, dry and brittle). Abdominomegally. She was eating crap (both her kibble and her poop). I switched her to a raw diet. Started Si Miao San. I also started her on a leaky gut supplement. Her legs and feet were not that warm even though they were swollen and hairless and a bit raw. No active points that I could feel.

There was some improvement after the first appointment. The owner lowered the dose of pred like he always does when things look a bit better (40 mg to 20 mg sid). She flaired up a few days later. She also ran out of Si Miao San a few days prior to the flair up. Owner is hugely discouraged even though I think things are not that bad. I could not see acupuncturing while on that dose of prednisone when I could not feel active points. Exam was similar to the first visit. He left today on 1.5 tsp BID SMS and 1cc Hoxsey BID for three days then 1.5 cc BID She weighs 60 lbs.

I see wind, stasis, and heat. The dog is restless and wonâ€™t sit still until it sleeps at night. I am not asking for much help. Just the one thing that I can add that might turn this around. He needs to be able to lower the dose of pred without a worsening of symptoms. Then he would be less discouraged and willing to go forward. Any advice would be great. Thank you many times over.

Kevin Landau

by naturevet

July 26, 2009

Hi Kevin,

How are you? It's been so long! (24 hours). What took you?

Regarding your dog, the SMS fits well, except for that deep pulse. I look at the deep pulse, the hair loss, and the burned coat and I wonder if the dog's Yin or Blood has been damaged by that longstanding unrelenting Heat. So I would consider cautiously adding about 15 to 20g of Dang Gui Shen to the Si Miao San and seeing what that did. Given the feet involvement, and the fact that the liver is intimately connected with the feet, and that Liver Blood is damaged by longstanding Heat, Dang Gui seems a good change to make.

Then I would give things a few weeks. I would ensure the owner understands these herbs may be needed for several months, and that in the initial stages, running out of herbs for a few days is likely to trigger a relapse. Likewise, ANY reduction in pred dose will result in a TEMPORARY increase in symptoms until the formulas 'catch up' in the repair process of the immune system.

As for the Hoxsey, no problem continuing it, but it doesn't hydrate, so I'd still get the Dang Gui plus SMS on board as well.

It's too bad the owner waited so long to consult with you. Hopefully he'll develop a bit more patience and confidence in the process, and that you'll start to rack up some more overt improvements.

All the best,

Steve

by landauvet

July 26, 2009

Steve,
I am sure that the dog's yin and blood are depleted. Can I use Si Wu Tang or DGSYS until the Dang Gui arrive? I was scared to go to tonics in case the proverbial poopy hits the rotor blades.

Thanks
Kevin

by landauvet

October 20, 2009

Hi Steve,

Update on this dog. After 2.5 months of SMS+DG, Hoxsey, and raw food diet, the dog is off pred and only mildly inflamed!!!! Paws are a little swollen but no rawness. The lower legs are a little scabby but not bad. Pendulous abdomen is gone, attitude is great, energy is good too. Unfortunately, the owner has not had any contact with me prior to the recheck. Even though the inflammation is dramatically improved, the dog is absolutely emaciated with a ravenous appetite. He was underfeeding the raw food diet, however, I think the emaciation is partly due to the long term pred therapy. I instructed him to significantly increase calories by upping the raw, adding good quality kibble, and oatmeal. I continued the dog on just the SMS plus DG until I thought through what will support her weight gain.

Tongue was nice and pink. Pulse was deep and had very increased tone (difficult to compress). No active points.
The owner was defeatist from the get go and wanted to euthanize originally. Today's appointment was to help him to decide if euthanasia was appropriate for this "incurable disease". I, of course, was absolutely ecstatic over how the inflammation was improved and encouraged him to feed more and continue on.

Any thoughts on herbal support at this point?

Kevin Landau

by landauvet

October 25, 2009

Hi Steve, any thoughts on this update?

by naturevet

October 25, 2009

Hi Kevin,

I wouldn't dare change the herbs, but agree with the increase in amount fed. Some dogs require some carbs in their diet to maintain their weight. If necessary, try adding a small amount of oatmeal or barley (cooked) to the diet. If he needs that to thrive, it suggests he is Yin deficient, and that you may want to look at Yin tonifying skin formulas down the road, the most famous being Qing Ying Tang. If you were to add something, that's where I'd go, particularly if the amount being fed was 3% of the dog's body weight per day or more.

Steve

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