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GShepherd With GIT, Skin, Arthritis

by mikemesley - September 9, 2009

We have spoken about this dog before in this forum but the latest update is:
Recently changed fom SMS to CSWLT as I felt she was getting weak in the back end - and no signs of heat were apparent at that time. Certainly dampness has always been her main issue as far as I can tell, presumably due to chronic SP deficiency. Some Blood deficiency signs have come at times. We have improved the diet and now she gets minimal CHOs.
Since change onto CSWLT, and concurrent begin trial of pentosan polysulfate injections the hind limb weakness has really improved. We maybe could put this down to the pentosan except the O describes the onset of affect as being about 48 hours after first injection (also about 24 hours after CSWLT began!).
However - the skin has been more itchy and now she has some mil hotspots arising - has been a bit warmer and more humid here recently.

Other things direct from my Hx -

Slightly runny faeces - V describes as mucussy - ie probably colitis-type faeces.

V very happy with how she goes on her walks - we both feel cartrophen has been great for her.

History :
Other relevant Hx includes she is quite flatulent presently and I could hear high pitched noises from GIT without stethscope today.
TCM Assessment:
Tongue lavender - not overtly pale. Pulse full, slippery, regular. Hotspots are on side of tail and in approx GB 30-31 region. Tender at BL20. Eyes a bit runny - this is quite a consistant part or her Hx but has never needed Tx. No worries with AGs recently.

Does SMS + Dang Gui fit well here, or should I be looking for something that moves Qi a bit too due to flatulence etc. Maybe SMS does this anyway?

Any help would be greatly appreciated!

by naturevet

September 10, 2009

Hi Mike,

SMS seems a good idea again, given the symptoms and full slippery pulse. It should help. If it is too cooling long term, maybe the answer is to add more warming herbs (like extra Cang Zhu). But for now, I'd just go back to it, or to a combination of the two formulas.

Good luck!

Steve

by mikemesley

February 8, 2010

Hi Steve -

Another patient update, but I think it might be time to supplement SMS in our old friend with something a bit more tonifying.

This from my Hx.

Skin - pretty good. Slight point on R flank - maybe near GB31, resolving itchy spot. Also BL 62ish spot on L side is lick granuloma-type lesion. Resolving also.

Lameness - a bit stilted but still improved 6pm time in afternoon - acts like a puppy. I was not so happy with how she moved in clinic today - slower and more challenge rising, weaker hind limbs than I remember her.

Palpation/TCM
Tenderness from BL21-24 region today. Pulse weaker and deeper, maybe touch wiry. Tongue lavender.

Faeces - good. Did get a touch loose the other day when missed herbs for 3-4 days. No flatulence described recently.

Appetite occasionally not great. A bit slow to get going in the morning. Afternoon, as mentioned, is best time of day. 6pm ish.

-------

So my feeling was she needs some SP and KID tonification. Certainly Qi needs tonifying, perhaps not KID/SP yang as such just yet - but maybe?

So what are your thoughts about formulae. My ideas were BWDHW (fire the cooking pot) and assess response - particularly given 6pm (KID) improvements. Do you think in this case it may be beneficial to give the tonifying formula in the morning (as opposed to your normal recommendation?) and SMS+DG at night?

Other ideas were to look towards something more Qi tonifying like LJZT.

Other ideas?

by naturevet

February 9, 2010

Hi Mike,

All your ideas are sensible, and it may be a matter of just trying things out to see what works. Generally, if something is better in the evening, I think of deficiency stasis (such as might be amenable to a Wind formula, or a combination Blood tonic-Blood mover). Some Wind invasion animals are frequently better at this time of day, when Tai Yang energy has peaked and is strongest at pushing out pathogens.

As for tonics, my only concern is that the dog is so reliant on herbs to keep stools formed. That kind of animal usually can't handle the 'richness' of tonics, to put it simply.

SRT expels Wind a little, and protects the GI. The fact that you saw a response there means other related formulas and thrusts should work well. One option is the SMS plus DG you mentioned. The other might even be Huo Xiang Zheng Qi San, which I think of for Wind invasion, back issues accompanying GI inflammation.

Those are my thoughts. Hope they're helpful. Bottom line, go with your gut.

Steve

by mikemesley

May 24, 2010

Hi everyone on the forum - I haven't been around here for a while and I've missed it!

Further to this old dog - she has been going well on just SMS + DG, but again I feel a recurrence of hind limb weakness/pain has been associated with onset of cool weather here.

Thus I feel maybe Wind Cold is an issue here. I am reluctant to drop SMS + DG because she is better today than she was 2 years ago - which I feel suggests it has helped so much. But I would like to do more to help manage what possibly (in fact probably) is a deficiency stasis issue. She recently had a "bad day" with pain and stiffness in muscles of pelvis/hips which improved with acupuncture. Bl 40, BL 20, GB/BL points around hip joint. NSAIDs were also used in short term - and notably no diarrhoea or vomiting were seen on this course.
Will see her again today and maybe have more to add.
Is it possible a return to WLT or CSWLT might be useful here? I have found that it is what I need myself when the weather cools down here (SMS in the summer) unless I want to perpetually feel cold. Does it provide enough movement and expulsion of pathogenic factors though?

hope eveyone is very well,
Mike

by mikemesley

May 24, 2010

Update after having seen the dog.
Pulse is deeper than it has ever been. I would describe as deep, slippery, maybe empty?
Tongue lavender, minimal vessels on under side. Notable reactivity to palpation at BL 17 and BL18.
Is showing proprioceptive deficits today where she wasn't only 8 days ago - but the latest "episode" seems likely to relate to onset of this neurological problem.
Unsure if that makes much difference, or if anything has become clearer to anyone?

thanks
Mike

by naturevet

May 24, 2010

Hi Mike,

Where there is a confirmed response to Blood deficiency and anti-Damp herbs; where there is a response to NSAIDs (was there?); and where there is an aggravation from Wind Cold exposure, I think of two formulas:

One is Yi Yi Ren Tang, particularly if the pulse is slippery and weak, and if the dog has struck you as Qi deficient at times.

The other is Xian Fang Huo Ming Yin. This will benefit Wind cases as well, but I would expect more of a Blood stasis picture and more Heat signs.

Hope one of those fits,

Steve

by mikemesley

May 24, 2010

Steve,

Thanks for your reply - it is much appreciated! I do have a feeling that maybe YYRT is the solution I was looking for but not finding. Do you feel/ have you seen it being effective in cases of neurological signs in the hind limbs? I'm concerned I am deling with the onset of degenerative myelopathy or similar in this dog.

Thanks,
Mike

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