Sophie presented to me a month ago after acute onset seizures, mentation changes including circling and mental dullness. She was diagnosed with sterile inflammatory brain disease by MRI and CSF tap.She also has syringomyelia the length of her cord but it is believed to be incidental, not currently the problem. She was given Mannitol, IV steroids and oral Keppra. After improvement she was sent home but represented nonambulatory and was hospitalized with the same treatment again. She improved again but again worsened at home and was given a grave prognosis. Her owner did not want to give up so she presented to me. She was receiving Prednisone 1.5mg BID, Keppra 10mg BID, Leflumide, Prilosec . She was mentally dull, ambulatory but constantly circling left, superficial wiry pulses and pink, slightly pale tongue. I started XCHT at ¾ tab BID and changed her to a home cooked turkey and potato diet. A week later she presented to my colleague with bloody diarrhea. She was started on Metronidazole SOD, probiotics, canned I/D and the herbs were discontinued. I examined her 3 days later. She was much more mentally appropriate, still circling, still hade bloody diarrhea and eating I/D stew. I stopped the pred for 48 hours and restarted at 1mg once a day. She did great with the diarrhea but had a seizure so I increased the pred to 1mg twice daily and restarted the XCHT once daily. All other meds the same. She has done well and is handling the herb SID with no problems. The stool is normal off the Metronidazole. I rechecked her yesterday, she can walk straight for short distances before curving left. She has no menace but is visual and normal PLR’s. She has no CP deficits but no placing on the right. She is much more mentally appropriate, curious but she is hypersensitive and barking much more that she used to. In the exam room she barked unless I was actively engaged with her. . Her owner said she was always nervous at the vet but would never vocalize this much. This is not normal behavior for her. Pink tongue (same), very superficial wiry almost bounding pulses. So, too much Yang in the head (trapped in the upper burner). I am increasing the XCHT by adding ¼ tab in the PM as her second dose of the day and increasing by ¼ tab every 3 days. I know there is more I should be doing but what? A derivative of XCHT? Adding SMS? I am restarting a cooked diet but want the XCHT up first. My colleague will add acupuncture. Are there points to be sure to get in? Thank you for your help. It is invaluable to my cases, Kathy
Question Details
Inflammatory Encephalitis In A Dog
by
drakedoc
-
March 29, 2016 View Case Report
Sophie presented to me a month ago after acute onset seizures, mentation changes including circling and mental dullness. She was diagnosed with sterile inflammatory brain disease by MRI and CSF tap.She also has syringomyelia the length of her cord but it is believed to be incidental, not currently the problem. She was given Mannitol, IV steroids and oral Keppra. After improvement she was sent home but represented nonambulatory and was hospitalized with the same treatment again. She improved again but again worsened at home and was given a grave prognosis. Her owner did not want to give up so she presented to me. She was receiving Prednisone 1.5mg BID, Keppra 10mg BID, Leflumide, Prilosec . She was mentally dull, ambulatory but constantly circling left, superficial wiry pulses and pink, slightly pale tongue. I started XCHT at ¾ tab BID and changed her to a home cooked turkey and potato diet. A week later she presented to my colleague with bloody diarrhea. She was started on Metronidazole SOD, probiotics, canned I/D and the herbs were discontinued. I examined her 3 days later. She was much more mentally appropriate, still circling, still hade bloody diarrhea and eating I/D stew. I stopped the pred for 48 hours and restarted at 1mg once a day. She did great with the diarrhea but had a seizure so I increased the pred to 1mg twice daily and restarted the XCHT once daily. All other meds the same. She has done well and is handling the herb SID with no problems. The stool is normal off the Metronidazole. I rechecked her yesterday, she can walk straight for short distances before curving left. She has no menace but is visual and normal PLR’s. She has no CP deficits but no placing on the right. She is much more mentally appropriate, curious but she is hypersensitive and barking much more that she used to. In the exam room she barked unless I was actively engaged with her. . Her owner said she was always nervous at the vet but would never vocalize this much. This is not normal behavior for her. Pink tongue (same), very superficial wiry almost bounding pulses. So, too much Yang in the head (trapped in the upper burner). I am increasing the XCHT by adding ¼ tab in the PM as her second dose of the day and increasing by ¼ tab every 3 days. I know there is more I should be doing but what? A derivative of XCHT? Adding SMS? I am restarting a cooked diet but want the XCHT up first. My colleague will add acupuncture. Are there points to be sure to get in? Thank you for your help. It is invaluable to my cases, Kathy
Replies
by
naturevet
March 29, 2016
Wow, Kathy, you're really doing great here! I am impressed with your management of this case. You're doing everything right.
Your interpretation of the pulse is correct - too much Yang in the head. XCHT is getting you there, because it harmonizes the internalization and externalization of Yang. We can augment it, however, to accentuate the Yang internalization effects. The formula for this is Chai Hu Jia Long Gu Mu Li Tang.
The appearance of bloody diarrhea in this dog can be viewed by Chinese medicine as a 'latent tendency' becoming manifest, rather than a drug (or herb) side effect. Its appearance presents one more reason why we would want to use CHJLGMLT, since it turns out to be useful in inflammatory bowel syndrome to normalize gut flora.
Thus, rather than being a mystifying complication, the diarrhea helps us instead to be more clear about where we should go with our treatment. Assuming the thinking will turn out to be correct, it is just one more reason why Chinese medicine is so fascinating and fun. Much better to be filled with confidence by mystifying symptoms, rather than thrown by them!
Please let us know how it goes, and have a great week in the interim
Steve Marsden
Assuming
Your interpretation of the pulse is correct - too much Yang in the head. XCHT is getting you there, because it harmonizes the internalization and externalization of Yang. We can augment it, however, to accentuate the Yang internalization effects. The formula for this is Chai Hu Jia Long Gu Mu Li Tang.
The appearance of bloody diarrhea in this dog can be viewed by Chinese medicine as a 'latent tendency' becoming manifest, rather than a drug (or herb) side effect. Its appearance presents one more reason why we would want to use CHJLGMLT, since it turns out to be useful in inflammatory bowel syndrome to normalize gut flora.
Thus, rather than being a mystifying complication, the diarrhea helps us instead to be more clear about where we should go with our treatment. Assuming the thinking will turn out to be correct, it is just one more reason why Chinese medicine is so fascinating and fun. Much better to be filled with confidence by mystifying symptoms, rather than thrown by them!
Please let us know how it goes, and have a great week in the interim
Steve Marsden
Assuming
by
drakedoc
March 29, 2016
Thank you Steve. I just ordered the CHJLGMLT. My colleague will be performing acupuncture on 4/2. Any "must needle" points? Thank you, Kathy
by
naturevet
March 30, 2016
You should be able to confirm this is the right strategy if you tonify GB points and see a subsidence in the pulse. For example, try tonifying GB 20 while sedating GV 20. Also, tonifying GB 41 will likely benefit, as well as BL 19. Lastly, tonification of Yang Ming points should help, too, such as ST 36 or 41
If the pulse calms down after that treatment, the formula should work well
Steve
If the pulse calms down after that treatment, the formula should work well
Steve
by
drakedoc
April 20, 2016
Sad news, Sophie presented seizuring with 107 temp while I was out of town. She then broke with bloody diarrhea. She was given mannitol again but just did not bounce back this time and the owners elected to let her go but they were grateful for the extra 2 months with her. Kathy
by
naturevet
April 24, 2016
Hi Kathy,
I'm sorry you weren't able to get farther with this case. Clearly it was a very tricky one
Steve
I'm sorry you weren't able to get farther with this case. Clearly it was a very tricky one
Steve
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