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Systemic Lupoid Onchodystrophy In A Dog

by Dreudog - September 22, 2014 View Case Report

Hi Steve,

I'm treating a 7 yr old MN Great Dane with suspected SLO; no proper biopsies, as the owner did not want to amputate a toe for the P1 histopath.

His first lesions popped up last summer, with swelling, erythema and serous discharge on 3 rear toes (2 feet) Biopsies of the local soft tissue showed granulomatous inflammation. He was treated w/ multiple rounds of antibiotic; not much change until winter, and then he was noticeably better, altho' he did not heal up completely. Early this summer, his swelling, erythema and pain worsened again.

When I saw him fist 6/25, he was quite lame, had several digits on both rear feet that were quite swollen, red, painful and had a serous, non-smelly discharge. Front feet are not affected. He is sweet, calm, had a mild brown ear discharge, a few elongated nipples . Pulse was superficial to middle, thin, sl. tense but also somewhat slippery.

At that time, we started epsom soaks, probiotics, enzymes, niacinamide and Vit E, and Si miao San. Thru the summer, we've continued that protocol, but he was only able to tolerate 2- 2.5 tabs SMS BID (127 lb dog), or would be nauseous and have small bowel diarrhea. Same for any attempt to add in raw cooked commercial food. And same for supplements, like enzymes and liver support(diarrhea, nausea). BUT his feet are ~ 25% better, even in the heat of summer. The owner had noticed that his feet were worse on certain foods, so when he had such bad reactions to an attempt to go straight to raw/raw cooked, we put him on pork kibble. She is continuing to slowly add some raw cooked diet. Even tho' his feet still look pretty abnormal, he is much more active and playful, wants to go for walks again, etc. So I'm feeling that the SMS is a good fit, but wondering if we can make more rapid progress. Also, the owner reports that he seems a bit worse lately (much cooler here in recent weeks), altho' she feels it may be b/c he is so much more active in the yard and is beating up his feet, even w/ booties on.

So I'm thinking he needs more spleen support, but can't imagine these feet would tolerate any "tonifying". Do I need to look at some of the more obvious autoimmune formulas?What am I missing? And if this is autoimmune dz, I'm not sure how rapidly we might expect him to improve, in the best case scenario.

Suggestions?

Thanks,

:)Cathy

by naturevet

September 23, 2014

Hi Cathy,

The side effects of the diet, SMS, and all other supplements seem to point to an weakness of Spleen and Stomach Qi and Yang as the root condition; while the response to therapy suggest the 'branch' condition is Damp Heat. SMS addresses both, but far more the branches than the root.

To address the root, I'd recommend Chu Shi Wei Ling Tang. It combines well with Si Miao San, and should allow you to use larger doses and move the dog out of this perpetual state of acute inflammation. It's what I'd try next

Steve

by Dreudog

November 4, 2014

Hi Steve,

Taking me forever to report on this dog. We tried CSWLT, and at small doses he had exacerbations of his small bowel diarrhea (some accidents in house, but no straining, blood , mucous). Similar problems + nausea on any decent dose of SMS (e.g.; more than 1 tab, 130 lb dog). He seems to overreact to everything we do, including supplements. The owner feels his feet are somewhat better, but expected his usual improvement at the onset of colder weather, and hasn't seen that this yr .

So his feet still LOOK pretty bad, but he is definitely less painful on the small dose of SMS, niacinamide, Vit E, supplements and hypoallergenic protein (the owner had seen his feet clearly worsen on certain proteins in the past). He wants to go for walks and play, which is improvement since first seen. He still has swelling, redness and some weeping of serous fluid from the affected feet, but the SMS is helping some. The owner is slowly trying to transition to mostly cooked raw, but cost is a factor for her and it's difficult to find hypoallergenic proteins in our area at Great- Dane -friendly prices! So I'm sure the continuation of some dry diet is not helping him.

So, do we need to go another herb direction? Can I add a spleen tonifier like LJZT to his SMS, or will it worsen the excess state? He's the sweetest boy, and we're both getting frustrated.

Thanks again,

:)Cathy L.

by naturevet

November 4, 2014

Hi Cathy,

Please remember to actually update the case on this dog - what you used and what's happening - so it shows in the database. If you click 'View Case Report' above, and then 'Edit', it won't take you more than a few minutes to officially record your comments above.

As for what to do next, the only situation which both formulas could aggravate is a Yin deficiency, since both are drying. Otherwise, they are separate in their effects - one tonifies or expels, one drains, one warms, one cools; dyring is the only effect they both have

Given the nastiness of the lesions, I wonder about Qing Ying Tang next. It moistens but still has the vigorous cooling effect that SMS provides.

I guess my only other thought is Bu Zhong Yi Qi Tang, given the small bowel diarrhea. It moistens as well, with its content of Dang Gui. It's normally the first thing I use in onchodystrophy, but the severity of the lesions was putting me off. Nevertheless, given how consistent the diarrhea is, it's probably a worthwhile consideration.

Either of these formulas can be introduced with the SMS for now, while you're testing them out.

Steve

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