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Polyradiculoneuritis In A Dog

by sara.baldey - September 17, 2018 View Case Report

Hi,

Last week I saw Millie, a 13.5y, female, speyed Staffy. In early April this year she had acute onset LMN tetraparesis and generalised weakness. She was treated at the local emergency centre and diagnosed with polyradiculoneuritis. Since this time she has made a steady recovery. Millie has had regular hydrotherapy, which the owners report has helped a lot. However, for a little while now, Millie has plateaued in her progress.

When I saw Millie the owners reported that she is eating normally, but there is still the occasional vomit of grass/food seen at home. The owner believes this is because Millie eats too quickly.
She is able to walk, stand and rise fine, though will sometimes become weak in the hind limbs and collapse.
She also has reduced hearing.
There are no respiratory problems, and Millie is able to able to urinate and defaecate fine. Faeces are "soft and runny".
She goes for a short, slow walk twice a day.
She has also lost a noticeable amount of weight since (esp muscle mass) since developing the polyradiculoneuritis.

On examination she had:
slow movements, low head carriage
-dull Shen
-cool feet and ears
-slightly dry nose
-hair was not growing back over areas that have been clipped from a few months ago
-active dreaming, sometimes vocalises in her sleep

P: deep, weak
slightly weaker on L compared to R
T: pale, thin white coat, tacky gingiva,
back shu: BL18, BL23
alarm points: CV6? (inconsistent)

From the history and exam I decided she has SP Qi deficiency, Blood deficiency and KID Qi deficiency.

I have to admit this is the first patient with polyradiculoneuritis I have treated. I would like to offer the owner some herbs to help with Millie's recovery and would really appreciate some advice on this, please. I was thinking about Liu Jun Zi Tang and Si Wu Tang? I also wondered about Yi Yi Ren Tang. Though I'm really not sure...

Many thanks, in advance!
Kind regards,
Sara.

by naturevet

September 20, 2018

Hi Sara,

I helped manage a case of this in Hong Kong. The dog made a gradual full recovery on Xue Fu Zhu Yu Tang.

Bu Zhong Yi Qi Tang is used for myasthenia gravis. If you sedated SP 4 on the dog, and the pulse became more moderate, then you could try that, as there are physical similarities

Normally Xiao Chai Hu Tang is the first formula I think of for nerve inflammation. It can be used with either formula

Hopefully this helps. I'm excited to see how you do!

Steve

by sara.baldey

September 21, 2018

Hi Steve,

Thank you for your advice!

I saw Millie again yesterday. When I sedated SP4, the pulse improved. So I will try Xiao Chai Hu Tang with Bu Zhong Yi Qi Tang.

I will not see her for a couple of weeks, but I will be sure to let you know how she goes.

Kind regards,
Sara.

by sara.baldey

October 26, 2018

Hi Steve,

Sorry for the delayed update. About two weeks after starting Millie on herbs (BZYQT + XCHT) the owner contacted me to say that Millie was being fussy with eating and this was making it difficult to give her the herbs consistently. She seemed to deteriorate over this time also. They were unsure about whether they wanted to continue treatment for her.

About a week later, they decided they wanted to give the herbs another try, for another two weeks. I spoke to the owner yesterday as they were approaching the end of this course of herbs. Over the last 3 days, Millie showed great improvement and was happier and showing great interest in food. However, yesterday she developed liquid diarrhea and became depressed again. They were very pleased with her improvement until the sudden onset of diarrhea. They asked if the herbs could do this. I wondered if the BZYQT may have caused the diarrhea? Is this possible? And, if so, can a symptom like diarrhea develop so acutely due to herbs?

I will be seeing them again next week. I have advised the owners to stop the herbs until I see Millie, and have advised that she come to the practice for an examination in the meantime.

I would really appreciate your insight and advice, please. I wonder if she is at a point where her herbs need to be modified? I will give you another update when I see Millie again.

Kind regards,
Sara.

by naturevet

October 27, 2018

Hi Sara,

If the BZYQT precipitated the diarrhea, it will be dose-dependent. Generally we stop the herbs until the diarrhea has resolved, then restart at a low dose, say 1/2 to 1/3 of what you're giving

If necessary, I can send a recipe of BZYQT that you can make by hand which should not cause any diarrhea, so there is another avenue here if the formula is not able to be tolerated. If that is the case, with even a low dose causing issues, then let me know whether the diarrhea is due to colitis or the small bowel instead, and I can then construct a recipe for you

If the diarrhea doesn't promptly resolve within 24 hours or less of being on the herbs, then there is some other cause

Hope that helps you out. It would be great for you to resolve this case

Steve

by sara.baldey

October 27, 2018

Hi Steve,

Thank you for your swift reply, I am very grateful.

I received a text from the owner today saying Millie is much better. It looks as though it may be a dose dependent problem with the herbs. When I see them next, I will ask the owners to give half the dose of BZYQT and see how she goes. If the diarrhea returns, I will be very keen to try the hand made formula.

Many, many thanks!
Kind regards,
Sara.

by sara.baldey

October 27, 2018

Hi Steve,

Thank you for your swift reply, I am very grateful.

I received a text from the owner today saying Millie is much better. It looks as though it may be a dose dependent problem with the herbs. When I see them next, I will ask the owners to give half the dose of BZYQT and see how she goes. If the diarrhea returns, I will be very keen to try the hand made formula.

Many, many thanks!
Kind regards,
Sara.

by sara.baldey

November 14, 2018

Hi Steve,

Just wanted to offer an update on Millie.

I saw Millie on the 2nd November, about a week after I advised to stop the herbs she was taking (BZYQT + XCHT) due to the presence of diarrhea. She looked a lot better than I was anticipating - Millie was quite bright and walking well.

On the day, when I spoke to the owner in person, I learned the diarrhea had been present for a lot longer than I realised, approximately 1-2 weeks. When the herbs were stopped the diarrhea improved, but not 100%. The owner said that Millie was only getting up approx 1-2 times/night to defaecate (vs 5-7 times/night!). I had a look at a faecal sample which was yellowish in colour, soft and not formed. Millie was still fussy with food, and her diet was consisting of mostly chicken and treats. The owner also said that Millie will chop and change from doing well to not doing well. When she is not well she will be wobbly, collapse, have decreased appetite, low head carriage and show signs of weakness and will stare at the wall.

When I examined Millie, her tongue was pale, tacky, with no coat. Her pulses were deep and weak, and the left pulse felt a bit choppy. An in-house blood test showed anaemia (HCT = 25), with very mild azotaemia. The bloods were sent to the pathology lab and the Pathologist suggested the bloods may indicate blood loss, haemolysis (which was considered much less likely) but could not rule out Iron deficiency.

I placed Millie onto metronidazole and discussed improving the quality of Millie's diet with the owner. I also placed her onto a nutritional supplement. The owner said that the very next day Millie was much better and her stools have been normal since being on the metronidazole, and her appetite is back. (I am absolutely sure the diarrhea was not related to the herbs she was taking). The plan is to repeat her bloods next week and see if there is an improvement in her anaemia. (The onwers do not want to do more at this stage). Millie is not on any herbs at the moment.

I will let you know how she goes.

Kind regards,
Sara.

by naturevet

November 14, 2018

Thank you for the update

A response to metronidazole indicates an acute GI inflammatory process, known as Damp Heat in Chinese medical parlance, which BZYQT would certainly would not help. You at least know it was not the cause of the dog's problems, since the problems persisted at least in part off the herbs. They were an aggravating factor, though, to the disease process. Damp Heat is more common in the month or two up to and through the summer solstice, so it makes sense that she is experiencing it now.

If Millie loses ground again mobility-wise, then Si Miao San may be appropriate. It was the original and only formula officially advocated for Wei syndrome, which was traditionally thought to be due to the desiccating effects of Damp Heat on the Qi, Blood and Yin, especially of the hind limbs. Dang Gui can be added to bolster hematocrit

If she is elderly and it is chiefly the hind limbs that are still weak, you can also consider Zhi Bai Di Huang Wan. It addresses Damp Heat aggravated by Yin deficiency, and contains Rehmannia, which is less likely to cause diarrhea than Dang Gui, but which still supports the hematocrit. It helps restore strength in hind limb neuropathies.

So, two ideas for you if the owners feel they want to try herbs again if Millie becomes weak again. The two formulas are compatible if you want to try them together. In hindsight, the weak pulse you were seeing was likely due to Yin being damaged by Damp Heat

Steve

by sara.baldey

November 15, 2018

Hi Steve,

Thank you for your insights and TCM explanations - these are so helpful. Its wonderful to have a plan if/when we are to resume herbs again.
Many thanks!

Kind regards,
Sara.

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