Question Details
Recurrent Pneumonia In A Dog
by dmtdvm - December 10, 2018    View Case Report
Stella is a 5.5 yr old Bernese Mountain dog who has had recurrent episodes of pneumonia since age 2 and 1/2. Her 1st episode was in Dec 2015. Since then she has had pneumonia 3 additional times. All resolved with Baytril and Clavamox.

Her previous hx includes an episode of facial nerve paralysis, which resoled w/o treatment. Several bouts of otitis treated with Claro. Multiple episodes of coughing, sneezing and nasal discharge. She was on metoclopramide for "transient megaesophagus", which the owner stopped because she thought it made no difference. She is currently on Dasaquin, omeprazole, omega 3 FAs and Proviable. Her diet is Wellness salmon and sweet potato dry.

During my initial exam: She has increased thirst. The owner thinks her symptoms get worse with the change of seasons. She had 2 episodes of pneumonia in Dec, one in Feb and one in July. The episodes begin with a weak cough, some shaking and then she refuses food. She has mucoid ocular discharge and her eyes sometimes look red. She has occasional urinary or fecal accidents in the house. Her BMs are normal. No vomiting, burping, belching, or flatulence. She likes to be confined and snuggle in corners. She is not very social with other dogs. She sneezes a lot when she first goes outdoors. She gets hot easily, prefers cold. She doesn't like her head touched.

PE- Copious mucoid nasal discharge, more from right nostril than left. Pink conjunctive both eyes. Small amount of discharge both ears, canals slightly red. HR 104, lungs-NSF. Right elbow thickened compared to left. No active points.
Tongue-pink, slightly red underside, not swollen
Pulse- not forceful, soft, possibly slippery

TCVM dx: Lung Qi/WeiQi def. with damp heat

I started her on Standard Process Immune Support and San Ren Tang.
At a recheck 2 weeks later she was no worse but no change in cough or nasal discharge. I switched her to Xiao Chai Hu Tang. After 2 tablets BID for 24 hours she stopped eating. I sent her to her regular vet who diagnosed pneumonia and she was started again on antibiotics. I am open for suggestions, continue the XCHT?

Many thanks,
Diane
Replies
by naturevet
December 17, 2018
Hi Diane,

XCHT was my first choice, but the pulse doesn't quite fit, unless Yang is trapped on the surface, in which case I'd expect it to be more forceful. I feel that the Shao Yang is probably playing a role, though, and we may have to revisit it once the pulse becomes stronger.

Right now, she seems a little Damp. I think San Ren Tang is a good choice for her, given all the mucous. If it seems to be somewhat helpful, you can augment it to address pulmonary problems and sinus problems a bit more

The other thing that can fit that pulse is Blood deficiency, but it's the wrong time of year for it. If you try SRT, and she gets worse somehow (on that drying treatment), then it will tell us she is Blood deficient instead.

If SRT does help, then the diet is the next thing to fix. She would need to move to something other than canned or kibble that is low starch

Hope that helps

Steve
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