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Front End Weakness

by raustin - April 26, 2017

Hi There,
I am hoping to get your thoughts on this case. The is a new patient to me. He is a 12yr old MN Border Collie mix that is presenting for front end weakness. He has been evaluated by a neurologist who says there is C4-6 narrowing of disc spaces. No MRI.

Past HX
2 yr ago - IMHA secondary to Vax reaction. Was put on steroids and Cyclosporine and responded but SE of diarrhea and anorexia. When stopping the immunosuppressives, dog then had a bout of aspiration pneumonia and then a bladder infection. Has to now stay on Tylan or has diarrhea. Also on omeprazole.

Current HX
Past few months - front end weakness. Worse in the mornings, stiff. Then after long walks will slow and stumble. If laying on side, cannot get himself up. Never vocalizes. Occasional lip curl when on side and o tries to help right him (I am thinking pain)
Diet = Purina EN (presuming since IMHA)

Exam
Nervous, trembling, but allows exam and acupuncture w/o complaint. BCS 4.25/9. muscle mass 1/3. Weak on all 4 limbs and has trouble getting up but then ambulates gingerly. Normal ROM to neck and does not vocalize. Carries head in normal fashion. Spine hurts from thoracic-lumbar spine though.
Tongue - small, dark pink, some moisture,
Pulse - deep, toned, weak, fast, not super thin
Skin - unkept coat but no obvious dander
Aside from the active Bladder meridian everywhere, no obvious hot/cold points.

So I am thinking a Shao Yang Syndrome - Excess? I thought excess because his current issue is the weakness to his limbs, but some of the other history would almost point to deficiency?

I tried my diagnostic points and didn't get much change in his pulse. Maybe sedating GB 34 brought the pulse more to the periphery. Maybe thats just because I wanted to think that ; ). I did not see a change in pulse from any of the following - Sedate or Tonify of BL 40, Sedating BL 18, T BL23.

Thoughts?
Thanks a million!
Rachel

by naturevet

April 26, 2017

Hi Rachel,

Do you have access to chiropractic services? Some gentle manipulation with an Activator may help him out considerably. Most forelimb weakness issues extend from the neck and nerve root impingement. Loss of neck mobility may not be overtly palpable, until a detailed exam vertebra by vertebra is performed.

As to herbs that can help, the season of onset suggests a possible Shao Yang issue as does a lot of the history, but the treatment (XCHT) is quite drying and dispersing. With a pulse that weak, I'm worried the formula will scatter the dog's Blood and possibly aggravate things if used alone. To temper that, you can try using Si Wu Tang at the same time. It will lend some antispasmodic and Yin tonifying effects, but hopefully the Huang Qin in the XCHT will prevent any diarrhea from using Blood tonics. Use about 65g of XCHT per 35g of Si Wu Tang. If loose stools do occur, you can also just add about 18g of Bai Shao to 100g of XCHT, eliminating any Dang Gui that might cause diarrhea.

I'm pretty sure you'll need some sort of Blood or Yin tonifying effect. Muscle spasms (which are always from Blood and Yin deficiency) can be worse in the spring, as Yang moves outward first to the body exterior. Any Yin deficiency there becomes even more accentuated, and muscles become stiff. The improvement with gentle exercise, and the worsening with sustained exertion fit not just Stasis or Bi conditions, but muscle spasm from Blood or Yin deficiency. The frail musculature also suggests the primary concern is Yin deficiency.

Also consider a real food diet and a visit to someone who can do gentle (long lever) chiropractic, or at least try an Activator on the dog, seems indicated.

Hope that helps,

Steve

by raustin

April 28, 2017

Thanks Steve,

I do not do chiropractic and almost commented earlier that I knew you would say to add that. I will see who I can find that may offer something.

Are you saying that I am a partially correct with the SY Disturbance? or just letting me down easy ; ) and I really need to focus on the Yin Deficiency?

I don't really have access to single herbs at this moment. Should I stick with more of a straight blood and yin tonic then like a LDHW or YGJ because that is more likely the cause of this dogs M/S and Neuro issues? Or do I still want to address the other things and then could I try a my XCHT BID and one of these others SID in the pm? Obviously realizing, I may cause diarrhea.... And when I go to grab XCHT would Benefits Hips and Knees be better since it has the added anti-inflammatory property?

Thanks again.
Rachel

by naturevet

April 28, 2017

Hi Rachel,

I totally see the SY disturbance, too - just the complication of Blood and Yin deficiency, which the usual formulas may aggravate

Any Yin tonic may help, but especially an antispasmodic. How about Bu Gan Tang? Do you have that one? Otherwise something with Bai Shao - Si Wu Tang should be accessible to you. If no to both of those, then I guess go with YGJ. If the latter, then definitely also start XCHT or Benefit Hips and Knees, so you can get some musculoskeletal action going.

In short, I like your ideas, and you're totally on the right track as far as I can tell :-)

Steve

by raustin

May 1, 2017

Thanks!.

I totally have Bu Gan Tang. And will soon get Si Wu Tang on my shelf too. Thanks. I will let you know how it goes.

Rachel

by herblmt

May 15, 2017

Hi
In a case like this I would use Double PII by Chi herbal in small dose and cervical formula.Laser as well
Cervical formula will be from Chi institute as well.
They work very well
Please roule out any bone carcinoma first.
Good luck
Lavinia

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