I’m needing your advice on how to tackle many chronic issues along with the more acute to chronic medical issue that made the owner finally seek out my holistic care for her pet, and thus which herbs to start with and which to add in as we go along to allow the best treatment of so many issues. I will try to timeline this pet’s alignments as quick as I can so you have the general flow of which ailments came first/etc, and then cover his TCM assessment.
15 yr old 4 months Canine Miniature Pinsher, FS named Baby
Many years prior pet had Pyometra sx.
March ‘17 = Pet was determined to be PU/PD and had severely elevated liver enzymes, so had a ACTH stim testing performed to screen for Cushing’s Dz, was negative screen, liver aspirate nsf, and bile acids wnl’s.
Initially pet had just had chronic heart dz for many many years (initially just mitral valve dz with cardiomegaly; just managed on just Vetmedin for years)
Nov ‘17 = Splectomy for detected splenic nodule which came back splenic myelolipoma after removal; at same time pet was diagnosed with Hypothryoidism (confirmed via low TT4 and free T4) so thyroxine was started
Dec ‘17 = possible early pulmonary hypertension was detected via updated echocardiogram so Benazepril was started to add in with the already pet on Vetmedin
Early Feb ‘18 = perianal hernia developed and pet received surgical correction for that issue.
Mid Feb ‘18 = ongoing concern with progression to pulmonary hypertension so then added in sildenafil and spironlactone and a few weeks later pet presented with severe respiratory distress open mouth breathing (mild left sided failure wa noted with pulmonary edema AND right sided failure was also noted with ascites listed) and it was also determined via x-rays pet had “mild” probable bronchitis so rDVM decided to (for unknown justification to me with underlying heart failure) started pet on Prednisone (oh dear!). Not more than a week into the Pred then the pet developed her FIRST case of PANCREATITIS (severe) - which was also about 1 week AFTER the perianal hernia sx.
March ‘18 = 3 weeks post recovery from first pancreatitis event pet had ANOTHER bout of pancreatitis (#2) and renal values spiked so rDVM pulled pet off the sildenafil and benazepril, again hospitalized for the pancreatitis and NOW placed an esophageal feeding tube. Daily SQ fluids are being given to pet by owners at home per rDVM’s request and have continued to present day. Spinal rad’s also indicated mild discospondylosis.
April ‘18 = 3rd bout of pancreatitis and renal values were still remaining high and UTI was detected so AB’s given along with omitting the spirolactone from list of meds for pet.
Owner then decided to seek out an acupuncturist for a set of fresh eyes and elevation for what is now a persistently elevated spec cPL for over 1 month post LAST pancreatitis event despite pet now clinically “normal” for all symtoms (eating well, not lethargic, resolved vomiting, etc), sill has a non-signficantly elevated alk phos at 398 U/L, but feeding tube is still in place and now pet is ONLY on Vetmedin for the left and right sided CHF. Owner has feed the pet a home cooked diet for several years prior to any of these current medical messes, but switched over to can Science diet I/d when feeding tube and inappetence was high, and now pet is currently still eating that diet. Per owner, pet has always been a little on the anxious/nervous side and has historically always gotten pudding consistent stools when is nervous, along with flatulents, which resolve on their own once pet is no longer nervous. Pet is reported as friendly with humans and people, likes to sleep on soft bed with owners at night and usually has a very restful sleep (obviously not when the previous bouts of pancreatitis were going on, but now or when there wasn’t the immediate medical crisis). Owner also reports if pet drinks too much water after getting excited, then pet will cough/spit up a little water fluid. On TCM exam, pet has a lavender thin tongue but bilaterally equal and bounding femoral pulses, chilly distal rear extremities, moderate TL spinal weakness and epaxial muscular contraction with miminal pressure on bladder meridian. OU mucoid discharge but no signs of injected episeral vessels. Pet was nervous and shaking during exam and was hard to settle (did not relax).
I’m feeling this might now be a triple burner obstruction d/t all the chronic issues (most of which appear to be inflammatory in nature, and now our inflammation has moved way into the chronic stage). I performed my first acupuncture treatment (dry needle for splenic damp heat points and a little bladder/kidney/heart def too thrown in there for good measure) on pet yesterday so I don’t know how she is doing today yet, but I so want to help this pet’s multiple issues but not sure what is masking what, as I’m assuming all the heat excess signs are being covered up by the lavender tongue (due to underlying heart dz) or based on the chronic presentation of all these issues with it now a triple burner obstruction issue. Herbal wise, my first thought was to use WLT, but I’m not sure the anti-inflammatory or insulin sensitization is strong enough for this case to start with, and I should maybe start with SRT or SMS instead? Or should I be leaning toward XCHT or CHJLGMLT first then onto the other formulas once some inflammation is cleared as those would be better for the triple burner issue? I just would surely like to get that cPL down as that is the primary reason why owner sought me out, and I know there are some great herbs to help with that, but don’t want to mess up my order of attack here. I’m also having a hard time deciding because I know some of these herbal formulas would also lend toward either helping the CRF (which is currently more stable now that the UTI is cleared) or the other bigger concern of CHF left and right sided. So if you could also suggest an order of introduction, along with additional herbals (as I know not one or two formulas will likely cover all our possible needs here for this case, step by step) - as I also want to treat the CRF and the CHF too. I know this CHF with pet off all meds but Vetmedin is a ticking time bomb too. Thank you for any and all help!
Regards, Lisa