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PLE Herbal Selection

by Kiwivet - November 17, 2014 View Case Report

Hi Steve,
Lucee is a new patient to me. 10 y.o., F/S, Yorkie.
She was diagnosed with PLE 9/10/13. Vomiting and diarrhea; albumin 1.1, Glob 1.4; Pleural effusion, liver enlarged (ALT 55)
Her mother and brother both have PLE also. Current therapies at presentation Nov. 14, 2014; Prednisone 2.5 mg once a day (recently increased from EOD b/c albumin is decreasing from 3.0 at previous check), MCT oil, Hill's w/d dry. Nov 3, 2014: Alb 2.8, ALT 2.5,
Nov. 14: Liver very enlarged with sharp margins on xray otherwise naf, clinically no vomiting or diarrhea. Pet gets "roid-rage" on prednisone and so client really would prefer to minimize this drug.
BCS 5/9. Pulses - wiry (I'm not good at this part), T no coating.
So far, I have suggested she stop the w/d and rice that client has been giving. Temorarily change to 50:50 cooked ground turkey or chichen with canned pumpkin, MCT oil. digestive enzymes (RX Vitmamins; Gastriplex (Thorne), Probiotics (Mercola) and begin a series of B12 injections. Leave the pred alone for now. Will see how she does. Recheck bloodwork in two weeks.

I would like to incorporate Chinese Herbal Meds and would value any suggestions on balancing the diet.

What is best formula to start with? I was thinking San Ren Tang. I'm not sure what to make of her huge liver, with normal liver values.

How soon after starting the herb would you advise to begin to lower the prednisone?

(p.s. - your new text and webinars have enabled me to truly begin to incorporate formulas a lot now! My western educated brain needs to understand the physiology of the herbal action, and to know I won't do harm if I combine with drugs. The TCM thought process, tho fascinating, is like a foreign language to me. I've never been proficient with foreign languages. But the combination of the two approaches helps pull it all together. Thank you so VERY much for all that you have done and continue to do for our profession!!)

Kim

by naturevet

November 18, 2014

Hi Kim,

Thanks for the positive feedback regarding the integrative approach to Chinese medicine. I know we are all enthralled and entranced with Chinese medical theory, but I agree there needs to be some sort of grounding in science for most veterinarians to feel truly comfortable using herbs. Chinese medical theory is unparalleled, however, for providing a different context to start analyzing tough cases like this one. Hopefully I can help with that.

As to your questions, I wouldn't stop prednisone until you've gone beyond what it can accomplish. If you're seeing laboratory and symptom improvements yet prednisone levels have not been increased further, then you know you're getting somewhere and are less reliant upon them.

If this is an inflammatory condition, the long term metabolic impacts of steroids only help to ensure inflammation will resume as soon as they are removed. The changes you've done so far, though, are excellent, and will help to undermine those metabolic and inflammatory tendencies. I wouldn't be surprised if the owner reports an improvement.

Has the diarrhea been quite unrelenting for more than three weeks? If so, then the problem may be largely, or at least compounded by, a small intestinal bacterial overgrowth (SIBO). SIBO creates mucosal inflammatory changes indistinguishable from those of IBD that can result in PLE. If that's the case, given the involvement of Liver and Spleen (suggesting a disharmony between them), I'd wonder about using Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination). Affected animals can be irritable, and the pulse presents as wiry.

The enlarged liver throws me, too. With the sharp edges, I actually wonder if it is a normal finding - that is, if the liver is just naturally big in this dog. However, the aggression in response to steroids validates our including it as a consideration in the Chinese medical diagnosis, which means we potentially have to be careful of congesting it with tonics such as are in BZYQT. If you do use the latter, keep an eye on the liver enzymes to make sure they are staying in the normal range.

If the dog is much more angry than irritable, I would wonder about Chai Hu Shu Gan San. It still fits the bill of harmonizing the Liver and Spleen, but with less use of tonics. The pulse says you need an overall dispersing treatment which it provides, and the formula particularly decongests the liver. Its heavy content of Bupleurum is quite powerful in modulating autoimmune processes, while its content of Citrus will help to regulate gut motility and vomiting. So, all round, it's a good fit.

Lastly, if the pulse was positively bounding, and not just wiry or toned, then the dog may be in the throes of an acute Damp Heat issue. In that case, I'd consider Si Miao San, plus or minus Long Dan Xie Gan Tang. Generally, though, the season of onset favours use of either Chai Hu Shu Gan San or Bu Zhong Yi Qi Tang.

Hopefully this provides enough information for you to sort things out. Please update the case and record the outcome of whatever you use in the database

All the best,

Steve Marsden

by Kiwivet

December 4, 2014

Thank you VERY much Steve,
We saw Lucee 2 days ago and she is much better already and we haven't even added in the herbal med yet. Her bloated belly resolved by day 3 of the new diet. She has more energy and stools are normal. Protein levels have increased significantly as well. Will add results to my cases. We decreased her prednisone as of this recheck and will balance the diet and continue to recheck.

by Kiwivet

September 22, 2016

Chai Hu Shu Gan San was scripted out
The pet's albumin and globulin have been holding steady in the low normal range. The client has been seeing other doctors in the practice and she chose to do her own thing wrt homemade diet, which is likely pretty unbalanced. But despite that doing well from m.r..I don't believe she has continued with the herbal as it was scripted out over a year ago. She's tiny and only got 1/8 teaspoon twice a day but even then it should run out.

by naturevet

September 30, 2016

No worries about the herbs. In an ideal world, they are just a stop-gap measure to where a healthy diet can take over. That doesn't end up being the case all the time, of course, but in PLE you'd think that diet would be the primary consideration. So whatever is happening diet-wise, it looks like it's enough!

Thanks for sharing this case!

Steve

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