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Non Healing Wound In Geriatric Dog In A Dog

by jandvm - July 16, 2016 View Case Report

14 yo golden retriever Fs lovely gentle personality, non healing necrotic pus draining from 3-5 fistulas in10x8 cm lesion L lateral thigh, owner treating with topical herbs, C&S scant numbers of Actinomyces, not able to do sensitivity. I had her on Clavamox prior to c/s, didn't clear it

other hx: spondylosis nose to tail, bilateral OA hips, stifles, elbows, shoulders, elongated spleen and slightly enlarged liver, thickened stomach wall on rads; she is deaf, cataracts, thick dry skin, prefers cool, drinks a fair bit, restless at night, anorexia off an on

Clavamox gave her a bit of diarrhea and fatigue, poor appetite SP Qi def

put her on XFHMY to clear Phlegm, Blood stasis - result she looked like Yin def fire

I put Corky on ZBDHW as you suggested , by itself for a few days, she takes minute amounts, like 1/8-1/4 tsp. Then added in a little SMS/DG in am, ZBDHW PM. Owner said she got Damp on ZBDHW, dry and tired on SMS/DG. Owner doesn’t want more antibiotics. So I have been acupuncturing and owner flushing with things like peroxide, aloe, probiotics – she has her own ideas.... Corky is not eating too well, though better lately, energy up and down, tongue is muddy pinkish, flabby wrinkly, white coat, a little lavender in the centre, body with a few small cracks. Pulse is weak, hard to find, thin, I can feel it a bit then it disappears, then I can feel it again, then disappears – not sure what this means?

Because of the first rads that showed elongation of the spleen and possible liver enlargement, and thickened stomach wall, and Clin chem and cbc – low rbc, hgb, platelets, ALP was elevated a bit, also amylase and high normal lipase – (I asked owner to repeat the rads, but she hasn’t at least yet).

I am considering TBO and using XCHT – even though pulse does not fit
My other big consideration is BZYQT or LJZT though I would like to have huang qi and dang gui.
And then there is ZBDHW if I need to continue to tx Yin deficiency

My TCM dx is KI Qi/Yin/Yang/Jing deficiency, Qi and SP Qi deficiency, Blood deficiency with some Damp, Heat, Phlegm and stasis of Blood (and Qi), TBO With the overall deficiency, I don’t really want to use antibiotics either, though I think the infection is wearing her out. But instead, use herbs to change the terrain.....

Overall she is weak, frail, patient though happy, restless at night, drinks a fair bit, eating a bit better past few days, doesn’t like heat. Lesion continues to drain some mucopurulent exudate, and is slightly red, so healing maybe very slowly. I know she is in some pain with this infection, I have suggested to owner to use XFHMY topically dilute mixed with water to flush- owner a bit reluctant to use this formula given her bad response orally. Owner doesn’t want NSAIDS. I was thinking of Yan Hu Suo, but not unless I use something to tonify Blood also.

Would you mind giving me your thoughts on how to help her?

Thank you
Janet

by naturevet

July 30, 2016

Hi Janet,

I still see Heat and deficiency there, so while you may not have had any luck with ZBDHW, it cautions us to use Huang Qi, which is a very Yang and heating herb

Some ideas spring to mind:

For single persistent skin lesions in hot dried out dogs, I have had success with Qing Ying Tang, although the pulse is a little weak for it. But it's a strong consideration given everything else you describe, except the Spleen Qi deficiency. Inappetance, though, can be due to many things

Xiao Chai Hu Tang is the first thing I thought of, given the pains. I had one Actinomyces case of years duration clear up quickly on it

Xian Fang Huo Ming Yin can address Dampness and Phlegm, spondylosis, infected wounds, and weak pulses

QYT would have the strongest effect on the bone marrow in correcting anemia, but you may see a benefit from XFHMY, too, although it uses Dang Gui Wei instead of Dang Gui Shen

Yi Guan Jian could be used with or following QYT, if QYT proved helpful, to quickly restore normal bone marrow and digestive function

Hope that helps,

Steve

by jandvm

July 30, 2016

Hi, Steve
Thank you. I had put her on XCHT, owner started slowly at 1/8 tsp eod. After 3rd tx owner said the dog went hot red and dry, panting again, like with XFHMY which is the first formula I tried and she went like Yin deficient Fire.

Saw her Wednesday, ie 3 days ago, temp 39.7, lots of pus from wound. Owner let me do repeat cbc and c/s - anemia, low rbc, pcv; high wbc, neuts. C/S one organism high numbers of Strep canis, and another organism being cultured, don't have final on it yet. So wanting to use antibiotic, and think owner will agree. I will need to do SP support since on 1st antibiotic 2 m ago, she went off food, lethargic, a bit of diarrhea. Was thinking LJZT or BZYQT? With or without ZBDHW. I think with the reactions to the drugs and the formulas she is both needing SP tonifying and KI Yin tonifying.

Also I think owner is looking for what is going wrong vs what/how the formulas can help. I agree though the XFHMY was not a good one for her with her reaction.

I have asked the owner to see one of the conventional vets in the practice where I work from, so she can hear from him a second opinion. She wants to go as natural as possible and has her own mind on things....Rdvm I have suggested to him smears/biopsy to check for neoplasia, consider foreign body

So any further thoughts on possibly using a SP support while on antibiotics. With/without ZBDHW. She is very weak, hard to get up in hind legs. But a lovely patient gentle dog, so trusting, almost plaintive asking to be helped. Would really like to help her have some quality pain free disease free life for a while longer.

Thanks again
Janet

by naturevet

July 30, 2016

Can you try Yi Guan Jian instead, I'df she's so hot and dry? Otherwise Si Jun Zi Tang

S

by jandvm

August 30, 2016

30 Aug 2016
Euthanized today. See update.

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