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Mystery Fever In A Young Dog

by Debbie - June 25, 2018 View Case Report

I have a 13 month old F Belgian Shepherd who developed a fever of unknown origin and generalized back and leg pain within a month of vaccination. They live in a Lyme area but she had no know tick bite. She was treated with antibiotics and NSAIDs and gradually recovered. Four months later she had another episode of fever with generalized malaise and pain that they were not able to localize. Blood work was WNL. She was seen by an internist who had no answers and as she was responding once again to treatment indicated they would do joint taps if it happened again. She recently had her first heat cycle and as it was coming to a close spiked another fever but this time she had significantly elevated pancreatic parameters but in all other respects seemed the same as previous episodes and occurred almost exactly 4 months from previous episode.

Tongue: red
Pulse: fast and toned
Active points: BL17, GB25, maybe ST36 but best pulse response at GB25

I also treated GB21B and GV14 with Trammel inj in hopes of releasing heat. Her temperature was 39.7 C and dropped to 39.4 C within an hour of treatment.

I started her on Qing Ying Tang and asked the owners to continue Traumeel tabs daily until my next recheck in 2 weeks. She improved fairly dramatically so they cancelled their recheck with the internist. I saw her this weekend and her pulse was still toned but more normal rate. Her tongue was normally pink - maybe a little lavender in the center and GB25 was not hot or sensitive. However BL17 was still active and perhaps BL18 as well. She has finished her heat cycle but had started frequent urinations literally the day I saw her.

I'm not sure now whether to stay on the Qing Ying Tang or switch her to something more appropriate for the pancreatitis / possible cystitis like Si Miao San - or simply stay the course? For the time being I've kept her on the Traumeel / QYT and added Cranberry tabs. I'd like to keep her on the QYT to see her through another 4 months but not sure if that is appropriate.

Any thoughts would be appreciated.

Debbie

by naturevet

July 6, 2018

Hi Debbie,

It sounds like you're doing well with this case. The response to QYT suggests a deeply penetrated pathogen, so no more vaccinations, ideally. To address the pancreas and interior stasis suggested by the tongue, there are two options:
1) Yi Guan Jian, if you think she is Blood or Yin deficient. This can happen after a prolonged bout of fever, and is built into the design of QYT a little, but maybe not enough. If her pulse was now very weak, I'd consider that (although you said it was toned).
2) Xiao Chai Hu Tang. This is a good pancreatitis remedy, and has the advantage of regulating the immune system at a higher level, hopefully ending up in stopping the recurrences. It can also harmonize the lower burner a bit, by opening the Dai Mai. If, on the next exam, it was BL 19 that improved the pulse, then I'd definitely add it in

Homeopathic China officinalis helps cases just like this as well, and fits the cyclic fever and suggestion of Yin deficiency

Hopefully that helps you out. Let us know how it goes, and if you need any more help!

Steve

by Debbie

July 6, 2018

Thanks Steve!

So, should I add in the XCHT and wean off the QYT or stay on both?

This dog also developed a strange obsession with flying bugs (not imaginary) 2 weeks after Rabies vaccination and 2 weeks before the first episode of FUO. Apparently this past week, a fly in the house completely debilitated her ability to function normally and she retreated into her crate to hide. I'm certainly thinking that the overall picture is one of vaccinosis but don't understand the pathogenic theory that would take us to pancreatitis? Their rDVM had told them to take the dog off raw food but they are anxious to go back on it because they are having to prepare separate meals for her different from the other dogs in the household.

This dog was being trained for SAR, to take over from their 8 yr certified dog. She is concerned she will never overcome this phobia and asked if vaccinosis can be 'cured'? Your thoughts?

Debbie

by naturevet

July 6, 2018

Hi again,

XCHT is useful for some cases of severe anxiety, so it would still be on my radar. I'd use it with QYT

Shao Yang disharmonies, for which XCHT is used, are blockages in the middle layer (if thinking of the body as a sphere) and in the middle burner, if thinking of it as a column. The stasis in the middle burner can manifest as hepatitis, pancreatitis and nephritis, as those three organs are all geographic neighbors.

Steve

by Debbie

September 11, 2018

So we were doing really well with this young dog so they decided to spay her last week. She was still on QYT and XCHT but half dose. They have also had her on Thuja and Traumeel once daily. She was using Aconitis compositum as needed when she would freak out inside the house over flying bugs. They upped her Traumeel temporarily starting on the day of surgery. She spiked another fever 2 days after surgery and developed a soft cough. I did an acupuncture treatment on her (Red tongue; fast toned superficial pulse; BL17; GB21; ST44; ST36). Increased her QYT and XCHT and added Echinacea compositium. Her temperature dropped within a few hours and she seemed normal for 1-2 days but the temperature is spiking again (40.3C) and she has a more pronounced cough. She is still eating but is much quieter. I'm not sure where to go from here? We were watching for another bout based on her previous 4 month cycle but this is a bit earlier. Each incident has been triggered by something like vaccination, estrous cycle and now surgery.

by naturevet

September 11, 2018

Hi Debbie,

The superficial pulse and apparent response to QYT and XCHT suggest you might want to sub- in Chai Hu Jia Long Gu Mu Li Tang for the XCHT. It is calming, cooling, descends Yang, and is antimicrobial, so it's a good fit if XCHT is not quite enough right now.

Remember as well to try homeopathic China (Cinchona) for the cyclic fevers of apparent Shao Yang origin.

Steve

Chai Hu Jia Long Gu Mu Li Ta

by Debbie

September 11, 2018

Thanks! I'll let you know how it goes - I think she has picked up the Cinchona but not started it since everything was going so well. D

by Debbie

October 20, 2018

Just wanted to give you an update on this girl. Looks like we've got her over another hump. The fever and cough settled over the week after switching her to CHJLGMLT and increasing the QYT. She also started bleeding from her vulva and developed explosive diarrhea but we got her started on bone broth and Slippery elm and it resolved during that same time period. Except for the fever and diarrhea, Zena was not nearly as achy as in previous episodes and the whole episode was abbreviated.

We are gradually reducing her dose of QYT and she should be finished it shortly. I have kept her on CHJLGMLT for the time being and the two homeopathics Thuja and China. Her obsession with bugs is resolving though the bugs themselves I think are starting to hibernate. She has started to chew on her front legs (anterior radius-carpii) to the point of developing a lick granuloma. I am wondering if it is related to the IV injection site (post surgery) but she seems to only do it when she is out in the truck and minimally when indoors. Not sure what to make of that but will give it abit more time to see if it stops.

Fingers crossed we aren't revisiting this issue in January (her 4 month cycle). I'm thinking I'll keep her on the Cinchona minimally once she has finished the CHJLGMLT or switch her back to the XCHT once I've had a chance to reassess her. Your thoughts?

Thanks for your help!
Debbie

by naturevet

October 22, 2018

Hi Debbie,

If her pulse becomes deeper and toned, then XCHT is a better choice. If she is due for a flare up in January, then I'd recommend keeping her on XCHT through that period. If her pulse is still more superficial (whether toned or toneless), then I'd continue the CHJLGMLT instead of using the XCHT.

If her pulse ever gets weak and thin, she may need Blood tonification. In that case, I'd use XCHT and Si Wu Tang together, instead of CHJLGMLT or XCHT alone. Check for Blood deficiency (pulse, tongue, response to Blood tonifying points) as a cause of the itch or anxiety that is prompting the licking

No problem to continue the China

If you can get through to late April with no incident, then she may be able to come off the herbs for a few months

Steve

by Debbie

December 5, 2018

I totally don't understand what is going on with this dog ... Zena got into a fight with a kennel mate and had to go in for stitches and was given antibiotics and NSAIDs. While the incision is healing well, within 48 hrs her temperature started to rise - hovering between 39.5-40C, which is better than previous episodes and she is lethargic but still eating. Which again is better than previous episodes. Slight softening of stool but no diarrhea or vomiting. We had not changed her herbs yet because I haven't been able to examine her yet. She was still on QYT and CHJLGMT but we doubled up on the dose. The stranger sign was when she started scant bleeding again from her vulva. Technically she would be due to come into season but was spayed in September. The rDVM confirmed normal vaginal cytology - no bleeding when checked and we are awaiting results of blood results. I am continuing to treat this as an immune mediated problem presumably triggered by a deep pathogen invasion - originally thought to be a vaccinosis. I don't even know how to explain it from an allopathic standpoint?

Any thoughts on pathogenesis from a TCM standpoint would be appreciated.

by naturevet

December 9, 2018

Hi Debbie,

That is a mystery, for sure. I guess if it resolves, then we'll just take note and carry on. The vaginal bleeding, and the febrile episodes triggered by stress, make me think she might benefit from the combined use of XCHT and another formula called Bu Zhong Yi Qi Tang. The latter boosts normal immunity, while the former tempers excessive unproductive responses. The latter addresses diapedesis, or the passage of blood through intact vessel walls in the absence of trauma and infection. It also is a good anti-stress formula for dogs, as well as being anxiolytic, and I note that a lot of her episodes occur at times of physiological stress, like when being spayed or having the bite wounds addressed

The next time you see her, if you do acupuncture, sedate SP 4, ventral to the head of the medial-most metatarsal. If she has a wiry pulse, and it improves, then it's indicated, and I would pair it with either the CHJLGMLT or the XCHT, to create a balanced pair of formulas (in that one harmonizes Wood Yin and the other Wood Yang; and one descends, while the other raises)

Hope that idea helps

Steve

Bu Zhong Yi Qi Tang

by Debbie

January 23, 2020

This case continues to be very challenging though she is generally doing quite well. I just thought you would appreciate an update. We used CHJLGMLT and BZYQT and removed the QYT. Sedation of SP4 did improved her wiry pulse. She did very well and we passed her 4 month mark without event. She had another bout of vaginal bleeding and fever (despite being spayed) a few months later when we reduced her dose of both. We just went back up to full dose and she continued to do well until Dec 2019 when she started to bleed again ... this time no fever and they had run out of CHJLGMLT. Her rDVM is investigating the potential of ovarian remnant syndrome thought the antimullarian test came back negative. She still has anxiety over flying insects (bites at the air) but only when she is outside of home. Which isn't great for a SAR dog. We've got her back on CHJLGMLT and will await results of an abdominal ultrasound in February. Thanks for all your help! Debbie

by naturevet

January 24, 2020

That's great news, Debbie. She certainly seems much healthier than she was

If any lesions show up on ultrasound, let us know. There are some other things you can try

Steve

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