Then his first clinical signs were dropped carpi/ tendon laxity. I can't even get into all the details of his workup from different specialists but here is what I have gathered from history over the last 1.5 years:
Musculoskeletal:
Carpal Tendon laxity
Painful and weak in multiple limbs - at some point this was diagnosed as autoimmune
Severely thickened elbows which seemed to progress rapidly - decreased ROM/crepitus
Reluctant to lift head but no overt pain noted.
Extreme lethargy - just lays on floor for entire exam. In part O feels is too painful to stay standing.
Is hot - spends time on cold floor and soft bed
Digestive / Skin:
Chronically picky appetite and current dec. appetite. Will only eat in the evenings.
Thinned haircoat at time of diagnosis, and now full but unthrifty looking, Small dandruff flakes and some areas of yellow crusted scabs.
Elbow calluses that have gotten swollen and infected.
Commercial dry dog food ( I know where to go with this part at least) all his life. He was diagnosed with Cushing’s (thank you for the amazing webinar) and is currently on a high dose of Trilostane. Too high for my liking with a post at 0.6.
Cushing's was confirmed on ACTH stim. Was severely PU/PD, and polyphagic at time of diagnosis. None of that now. Chemistry panel - normal. Thyroid runs on low side but full thyroid panel comes back normal. Current UA normal USG.
Newest things in last 2 weeks - Has ejaculated while lying down on 2 different occasions. And has weird firm nodules on his nasal planum. We don't live in obvious fungal land.
Current Meds:
Cyclosporine - maybe for skin, maybe joints - not entirely sure why : /
Trilostane
Gabapentin, Codeine, Carprofen
Tongue - lavender, swollen sides, moist, warm
Pulse - Superficial and weak, very mild tone, normal - quick
Pulse Improved with Tonification BL 20 and Sedation BL 25
I am pretty confident I can see the damp heat in this guy, but I am also stuck with feeling like I have a severely deficient dog, KI and SP Qi Def. I do not know how to get the life force back in him. His owner is open to everything and the main concern being his overall demeanor and lack of Qi. We started acupuncture and laser for pain and appetite. She is interested in feeding a raw or home cooked diet but feels strongly that he just won't eat it.
I started Si Maio San and was going to have her start Lui Ju Zi Tang in a week. Is that too much tonification too soon? Would there be a better formula for him? I am also cutting back on his trilostane because of the most recent lab values and lack of appetite. I would like to cut back on cyclosporine too as I am not really sure why he is on it, but do not want to change too much too fast.
I know this is a cluster of a case. He just came to me. Thank you for any input you may have.
Kindly,
Rachel