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Atypical Cushings Case

by kphillips - August 18, 2018

I have a 14 year old Sealym terrier that has been referred to me for cushings treatment. I have had success with SMS, Long Dan and XCHT in lots of cases but this one is a bit different:

Symptoms: Drinks a lot but has a lot in short amount of time. increasingly polyphagic ( on mix of some good stuff and some bad stuff diet), tends towards constipation, history of atopy ( no symptoms at mo), possible sight issues, musculoskeletally good for age. Picks warm spots to sleep.

Clinical exam- loss of muscle mass along back , skin in good nick, some mild trunk alopecia, normal temp of ears and skin and feet, no dandruff
Pulse- wiry with good amplitude, but quite abrupt
Tongue- pink with lilac tones in centre
Biochem:
Positive for cushings based on LDDS and bilateral enlarged adrenals
increase UPC (and increasing as time goes on) UPCREAT ratio 5.57
increasing UCCREAT ratio (64)
increase ALP and ALT ( moderate, not massive like a lot I see)
no azotaemia
low SG
Low total T4

I was thinking initially wei ling tang for insulin sensitizing effects in chilly animal and tendancy towards atopy- but also thinking XCHT for protienurea ( maybe with added Qin Jiao) but neither really fit in my limited experience. Help!

by naturevet

August 21, 2018

Hi Kelly,

Right now, the dog strikes me as Hot (polyphagia, thirst) and deficient (constipation, loss of muscle mass, elderly with weakness).

Thinking about the dog as a Tai Ji symbol, the only way you can be Hot and deficient is if your Yin is damaged, which can be secondary to Heat. The lack of Blood creates the chilly skin externally, even as the dog is overall Hot. That sharp toned pulse is common in animals with exuberant Yang secondary to a lack of Yin

So, Yin deficiency may be the branch here, with Damp Heat still being the root. But you wouldn't use SMS alone at this stage. While it's appropriate for the root, it doesn't match the branches, and the dog could end up being more symptomatic.

To treat it now, I'd try Zhi Bai Di Huang Wan. It can be used with SMS, if you don't want to wait until you just have the root staring at you. If I'm right, though, ZBDWH alone should effect some improvements.

Hope that helps!

Steve

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