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Progressive Weakness And Vestibular Episode In A Dog

by kphillips - November 10, 2014 View Case Report

Madison is a 13yr old Bull mastiff, that historically has been overweight, and is still a little overconditioned. Her owners have noted gradual increase in hind end mobility issues which the original vet has prescribed NSAIDS. These have helped historically. A few months ago there was an episode of cystitis treated with antibiotics. She is on a crap diet of cheap kibble and tinned dog food. She has a really good appetite and a normal to slightly decreased thirst, faeces are normal and urination seems relatively normal to slightly decreased. She is more active in the mornings as this is when she goes for a walk, but struggles to get up initially, then improves, but goes down hill again if walked too far. She is settled at night, with regular dreams. Yesterday the owner noted a sudden collapse- lost balance and couldnt get up, and felt head was tilted to one side. Due to the sudden deterioration the owners assumed a stroke like episode. On clinical exam she could only stand with help, very weak behind and decreased proprioception on the left (more so behind). She has a very slight head tilt to the right, and during exam, mild nystagmus noted when stressed. I feel it may be a mild vestibular episode. She was sensitive to caudal abdomen palpation, had a great coat and no smell. Her pulse was very weak and deep for such a big dog, and hard to find while standing, but easier and thin while lying down. Her tongue was relatively thin with a purplish tinge. Help! This case seems to have some signs of kidney Qi/yin deficiency, but too much Yang in her head. On needling GB 36 the pulse seemed to get a bit easier to feel/ stronger.She had tender spots on BL 20 and 23. To me she is not clearly hot or cold, but more deficient with some excess. So with too much Yang in head, and a Yi deficiency- is this a triple burner obstruction/ GB channel obstruction? If so why the caudal abdo pain. I also feel with such a weak pulse I want to say blood deficient but she doenst have a pale tongue. Today I needled BL20, BL 23, GB 30, BL40 and seemed to get a bit of improvement in the pulse I was considering starting her on Xiao Chai Hu Tang- what do you think??

by naturevet

November 18, 2014

Hi there,

I agree that it looks like this dog has a Shao Yang issue. It's almost invariably behind vestibular syndrome. Points on the GB channel often become sensitive in Shao Yang disharmonies, such as GB 26-28 ventral to the ileum at the caudal abdomen. The lameness pattern and tongue color are most consistent with Stasis, which can occur in the GB channel as it crosses the hips and knees.

Shao Yang issues can occur in tandem with Blood deficiency, and sometimes we use XCHT with Si Wu Tang to address that situation. But I think you're right to start with XCHT, and would expect some improvements with it alone.

My only other thought is Chai Hu Jia Long Gu Mu Li Tang, given that it is the height of summer where you are, and that vestibular syndrome normally occurs when Yang is TOO dispersed, rather than not dispersed enough. But given the pain pattern, it suggests your dog's Shao Yang is malfunctioning both in the release and the return of Yang, so a harmonizing formula like XCHT seems the best bet for now.

Let us know how it goes!

Steve

Xiao Chai Hu Tang

by kphillips

January 12, 2015

Update- Madison is doing really well. I started her on Xiao Chai Hu Tang and within 2 days she was more mobile. A week to 10 days down the line she was walking and moving around with more ease and more strength than she was before the vestibular episode and has been ticking along nicely. The owners are over the moon. Recently however she has developed a urinary infection (heavy growth of rods) and squats to pee regularly and seems to have more heat signs- restless, panting red tongue.
I have switched her onto Si Miao San- is that the right move?

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