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Fever Of Unknown Origin In A Dog

by Heather1 - September 5, 2016 View Case Report

Baylee is a 12 year old female Standard Schnauzer who initially presented with very painful panniculitis bilaterally in her flank region (inflamed subcutaneous fat) which was treated with tramadol, antibiotics, and prednisone.

She then developed a low grade soft tissue sarcoma (nerve sheath tumor) on her left ribcage behind her scapula which was surgically removed. She now has a fever of unknown origin that is responsive to prednisone. FYI…she also has some early spondylosis in her lumbar spine and 3+ proteinuria (USG 1.0133). She is being seen by an internal medicine specialist and they are now pursuing the proteinuria.

She is currently on prednisone 10 mg BID. I am treating her with probiotics, antioxidants, Standard Process Canine Hepatic and Immune Support and now XCHT (low dose) and acupuncture. I also have her off kibble and eating turkey with Sojos fruit and veggie mix.

I am planning to increase the XCHT and am looking to add another formula. I know the immune system relies on Yin and Blood and that Heat needs to be cleared. I’m thinking a formula with Rehmannia…a Yin Tonic. Her tongue tends to be slightly thick and purple with mild cracks and her pulse has varied somewhat, but it continues to be thin and tight and wiry with good rate and rhythm, fairly strong. FYI…GB 34 was sensitive when I prescribed XCHT and most recently, she reacted to SP 10. These are the formulas that I’m thinking of...

Yi Guan Jian
Qing Ying Tang
Liu Wei Di Huang Wan
Zhi Bai Di Huang Wan

Any thoughts regarding the best choice for Baylee? Thank you!

by naturevet

September 21, 2016

Hi Heather,

So sorry about this delayed reply. I've been a little swamped lately. The perils of returning from summer vacation!

Regarding Baylee, I think Xiao Chai Hu Tang is an excellent choice for starters, given the FUO, proteinuria, responsiveness to prednisone, tumor, involvement of the region of the GB channel, purplish tongue, wiry pulse, sensitivity of GB 34, and the panniculitis, especially if the latter proved sterile. Is the proteinuria significant relative to urine creatinine? If the UPC is > 3 or so, the use of XCHT is supported.

I think you may make a lot of headway with what you're doing now, and I would suggest you give your strategy a month or two to see the maximum level of gains you can achieve. From a Chinese medical perspective, it's important to remove the excess (in this case, a pathogen in the GB channel) before trying to address any deficiencies. I would then choose the follow up or companion formula based upon what conditions are lingering. For example:

Xian Fang Huo Ming Yin, if nodular panniculitis (sterile or non-sterile)

Rehmannia Six or Eight, if proteinuria (UPC <= 3 or so)

Xue Fu Zhu Yu Tang, if the nerve sheath tumor recurs (and given the response to SP 10)

Systemic immunity relies more on a well functioning Shao Yang organ network than absolutely anything else (whereas immunity of the epithelial surfaces is very much reliant on Blood, Essence and Qi, as you said, with the Shao Yang playing a secondary role). So you may well cut to the core of the problem with just this one approach, since XCHT clears Heat as well with its content of Huang Qin.

By all means, if new problems develop, feel free to let us know them, so we can suggest something new. Otherwise, when such an elegant solution presents itself, I find it irresistible to see just how much can be accomplished with how little. This is considered the highest possible art in Chinese medicine, and you appear to have the knack for it!

So hopefully you agree with my temptation would be to wait and see before adding anything. Otherwise, though, consider the above suggestions.

All the best,

Steve

by Heather1

September 23, 2016

No worries, Steve. I hope you had a fabulous vacation! I really appreciate your wisdom and thank you for your kind words and encouragement. :-)

Baylee is now on prednisone 5 mg SID (was on 10 mg BID until 9/12/16, then 10 mg SID). She's been on XCHT 1 tablet BID since 9/6/16. Baylee weighs 14 kg...FYI...

And of this morning, her fever has returned (103 degrees F) as the prednisone is reduced and she is now becoming anemic. The internist has added sucralfate with the thought that the prednisone has caused a GI bleed...thus, the source of the anemia. However, as we are decreasing the prednisone, the anemia is progressing.

RBC 3.76 (was 4.32 on 9/12/16) (5.65-8.87 M/uL)
Hct 25.9% (was 29.3%) (37.3-61.7)
Hgb 8.7 (was 10.1) (13.1-20.5 g/dL)

I saw her today for acupuncture. She is no longer sensitive at GB points. SP 10 was slightly sensitive on the right. Her temperature was 102.4 degrees F. Tongue was thick, medium pink, slight white coat in the center, slightly lavender. Pulse had a good rate and rhythm (96 BPM), felt to be in the medium position, good strength, slightly thin and tight and wiry.

I increased the XCHT to 1 1/2 tablets BID. I am debating between adding Zhi Bai Di Huang Wan or Qing Ying Tang. Her feet and ears weren't hot, possibly slightly cool...

The proteinuria is gong to be addressed next week, so I do not have any additional information at this time.

Any thoughts? Thanks again for your time and expertise. Have a beautiful weekend.

Heather

by Heather1

September 24, 2016

Hello again. I just received the complete CBC...it's a non-regenerative anemia. So, I'm concerned that the bone marrow is involved. She also has an elevated white count.

The good news is that last night, her temperature was elevated at 102.4 degrees F. Within an hour after the acupuncture, her fever dropped to 101.1 and her temperature is still normal this morning (99.8)! My client is very happy with these results. She will be consulting with the internal medicine specialist on Monday...

Thanks for your insights and help, Steve.

Heather

by naturevet

September 30, 2016

Hi Heather,

If the febrile episodes are resolving more quickly now, then that is a good sign.

If the anemia persists, a bone marrow stimulant that can help move numbers back to normal is Yi Guan Jian. It also helps with chronic renal failure, and is best held in reserve until UPC levels drop down to the 3's or lower.

Meanwhile, your dose of XCHT may be a little low. If the herbs are well tolerated, I'd consider giving a few tablets BID of each formula, to help get on top of things. The Yi Guan Jian can replace the Kidney tonics I recommended. Meanwhile, I'd stick with just the XCHT a while longer, rather than adding in the other formulas. Take it day by day, so we don't muddy the waters with too many formulas

If this were hemolytic anemia, then QYT and even Chai Hu Jia Long Gu Mu Li Tang would definitely be indicated right away.

Cheers

Steve

Yi Guan Jian

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