I have a patient- a 5 yo FN labrador, previously healthy- with a recent diagnosis of MMM- although in retrospect signs have been present a few months. Her owners with to avoid use of pred and associated sidde effects. I have managed these previously usually with either QYT ( if acute inflamed) or BGT (if painful). Like many immune mediated cases- she presents with conflicting TCM signs- she has a pink tongue and dry mouth, hot ears, her masseter and temporal muscles are reduced in bulk and painful on firm pressure, - but open mouth is all OK her pulse is deep, slightly thin and toned but also feels slippery, and she is shedding hair- was more toned after Ax st 36 LIV 3 BL 18. She has profound lack of energy. I have had her on QYT at one teaspoon 2 x daily for 14 days- in that time her signs have neither progressed nor improved. Can I combine QYT with BGT to address the Blood deficient signs ? Or should I used a harmonizer for now XCHT? Thanks
Question Details
Masticatory Myositis
by
KarenG
-
May 16, 2018
I have a patient- a 5 yo FN labrador, previously healthy- with a recent diagnosis of MMM- although in retrospect signs have been present a few months. Her owners with to avoid use of pred and associated sidde effects. I have managed these previously usually with either QYT ( if acute inflamed) or BGT (if painful). Like many immune mediated cases- she presents with conflicting TCM signs- she has a pink tongue and dry mouth, hot ears, her masseter and temporal muscles are reduced in bulk and painful on firm pressure, - but open mouth is all OK her pulse is deep, slightly thin and toned but also feels slippery, and she is shedding hair- was more toned after Ax st 36 LIV 3 BL 18. She has profound lack of energy. I have had her on QYT at one teaspoon 2 x daily for 14 days- in that time her signs have neither progressed nor improved. Can I combine QYT with BGT to address the Blood deficient signs ? Or should I used a harmonizer for now XCHT? Thanks
Replies
by
naturevet
May 18, 2018
Hi Karen,
Yes, I'd try the BGT before anything else. Let us know what happens. We may need to get creative!
S
Yes, I'd try the BGT before anything else. Let us know what happens. We may need to get creative!
S
by
KarenG
June 16, 2018
Hi Steve,
after 8 weeks on QYT and BGT, her MMM antibody levels remain high ( > 1:500 where > 1:100 is significant). Clinically there has been no progression of her signs, and importantly no oral pain, but only a little improvement- she has regained some energy.
I'm worried that she may progress to massater muscle myositis and fibrosis- which will be very difficult to treat. I'm considering stopping the QYT BGT and replacing with SMS + XCHT, but also using pred for a few weeks to try to reduce the Ab levels?
Do you have any suggestions?? :))
her most recent t/p was tongue: livery red colour and P: superficial and toned. She has halitosis ( probably because no bones at present) and flatulence, and bilateral Horner's syndrome which waxes and want ie worse if tired or stressed/excited.
after 8 weeks on QYT and BGT, her MMM antibody levels remain high ( > 1:500 where > 1:100 is significant). Clinically there has been no progression of her signs, and importantly no oral pain, but only a little improvement- she has regained some energy.
I'm worried that she may progress to massater muscle myositis and fibrosis- which will be very difficult to treat. I'm considering stopping the QYT BGT and replacing with SMS + XCHT, but also using pred for a few weeks to try to reduce the Ab levels?
Do you have any suggestions?? :))
her most recent t/p was tongue: livery red colour and P: superficial and toned. She has halitosis ( probably because no bones at present) and flatulence, and bilateral Horner's syndrome which waxes and want ie worse if tired or stressed/excited.
by
naturevet
June 22, 2018
Hmm. With a neurological component, trying XCHT might not be a bad idea. It can be used in tandem with either of the other formulas, if you feel they were at all helpful
Autoantibody production should make us think of the GI, so with her flatulence and halitosis, I'd wonder about directing some of your energy there. Where a favourable response is seen to Blood and Yin tonics, the appropriate formula is Yi Guan Jian, which can fit the pulse and tongue you're seeing. So I'd be curious to see if even just YGJ tilts things in your favour..
If you get to a point where the GI signs resolve, the antibody titer should be lower in as little as two weeks.
Note that Yin deficiency can worsen on XCHT, so either use the YGJ first to see what happens, or use them in tandem
Hope that helps!
Steve
Autoantibody production should make us think of the GI, so with her flatulence and halitosis, I'd wonder about directing some of your energy there. Where a favourable response is seen to Blood and Yin tonics, the appropriate formula is Yi Guan Jian, which can fit the pulse and tongue you're seeing. So I'd be curious to see if even just YGJ tilts things in your favour..
If you get to a point where the GI signs resolve, the antibody titer should be lower in as little as two weeks.
Note that Yin deficiency can worsen on XCHT, so either use the YGJ first to see what happens, or use them in tandem
Hope that helps!
Steve
by
KarenG
June 28, 2018
Update on this case..
We swapped out the QYT for XCHT. Continued the BGT and mushrooms. Immediately reduced energy and pawing at face. So I resumed the QYT and stopped the XCHT on weekend and immed improved.
So my thoughts are that there is ongoing inflammation. She is tolerating jaw massage and stretch and will begin Immunocare tomorrow. Also to have CRP tomorrow to get a baseline to see if I can use this to monitor her progress and assist with Rx making decisions.
I am holding off pred for now.
Cheers
Karen
We swapped out the QYT for XCHT. Continued the BGT and mushrooms. Immediately reduced energy and pawing at face. So I resumed the QYT and stopped the XCHT on weekend and immed improved.
So my thoughts are that there is ongoing inflammation. She is tolerating jaw massage and stretch and will begin Immunocare tomorrow. Also to have CRP tomorrow to get a baseline to see if I can use this to monitor her progress and assist with Rx making decisions.
I am holding off pred for now.
Cheers
Karen
by
naturevet
June 28, 2018
Hi Karen,
If QYT is definitely helping, but not enough, try doubling the dose. Go up as needed to achieve the desired effect
Steve
If QYT is definitely helping, but not enough, try doubling the dose. Go up as needed to achieve the desired effect
Steve
by
KarenG
June 29, 2018
Thanks Steve will do. :))
Reply to this question.
You must be logged in to reply