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Lymphangectasia-PLE

by swaneysue - July 30, 2009

Steve, good to see you at Mona's thanks for a great class.

Question on a 10 year old golden with a 2 month history of ascites dt lymphangectasia-Protein lossing enteropathy. He is sweet earth dog. Very warm to touch all over , panting , cool seeking, increase drinking.Tongue is red , Pulse deep slippery. Abdomin distended. coat dry thin. Lethargic, diarrhea with smell-better with pred.

Specialistr put on Pred and Imuran and low dose aspirn.

I changed the diet to homecooked, and started 4 marvels and acupuncture. Active points BL 20,Bl 22, little Bl 23. Pulse improve with Bl 20 , worse with sedate 40-weaker.

Improved for first 14 days then more panting , lethargy and abdomin is taking on more fluid. I have not seen the dog since the initial apt but would like some advice. The last dog I treated for this did well then crashed quickly. They both are very similar ,what appear to be hot , damp and weak. The formulas that help with abdominal effusions all look too warm. So I am not sure if they will aggrevate the heats signs. Could the yang have seperated on the surface with yin accumulation deeper ? and if so would it be ok to use a warmer formula to help drain the damp.

Other idea would be if active GB points would XCHT and Wu Ling tang work ? I would stay on 4 marvels too.

I have not had much luck with effusions.

thanks Sue

by naturevet

July 30, 2009

Hi Sue,

I'm not clear if you only saw the dog once, but if you did, then a 14 day improvement is excellent. More frequent acupuncture is clearly needed. If BL 22 and 20 both substantially improved the pulse, then San Ren Tang is the formula that comes to mind. It certainly drains Damp and fits the points. It also opens the TB to let water descend freely. From a TCM perpsective, it may have an anti-inflammatory enough effect to reduce the protein leakage across the gut wall. It fits the Damp Heat symptomology. Unless the dog declined after SMS was stopped, it's my best guess. If SMS was discontinued, and then the dog declined, then I'd go back to it for now.

That's all I can offer until you see the dog again. I'd stay away from the hot spicy damp formulas for now.

Good luck,

Steve

by swaneysue

August 1, 2009

Hi Steve thanks for the response , I saw the dog today. She is currently on Si Miao San , Geixia Zhu Yu Tang ¼ Bid ,Prednisone and pepcid. The internist took her off imuran a week ago. Stools are now normal, there are a lot less heat signs, fri night she started panting and owner felt abdomen was bloated more. I had her get blood work and xrays. The good news is the protein went from 2.2 to 4.3, albumin from1.2 to 2.2, her hct went from 45 to 40, normochromic normocytic. Wbc increace from 25,00 to 30,000 few bands. Alt went from 79 to 1150 , alkphos from 177 to 797. xray and ultrasound increase liver, no fluid.

They reduced prednisone but gave her atopica-of which caused vomiting and lethargy!!!

I just treated her .On exam she was is warm to touch , panting mild, belly bloated firm, sensitive to palpation. Coat little dry, not cool seeking as before, appetitie off , vomited at apt, energy down little. T=lavender/little red, P= very thin , jumps up at you in uppper middle zones but is weak ,thin / wiry in the deep position and confined.

Active points=BL18 19 20 21 22 , GB 34, Liv 13, 14

Treatment =tonify GB 34 and sedate Bl 18 , Bl 21 CV 12 ,and Liv 14

Pulse came up to middle , wider, rolling soften calmer

Added XCHT with Schisandra compound ½ tsp bid continyue 4 marvels and gei xiao zhu yu tang. Will add milk thistle if need.

Any other ideas ?

Thanks Sue

by naturevet

August 1, 2009

I guess go with your plan for now and see what happens. Keep San Ren Tang in mind.

S

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