Question Details
Eosinophilic Bronchopneumopathy In A Dog
by cprather - March 17, 2019    View Case Report
Emma presented to me as a second opinion 2 months ago with an acute onset of cough and lethargy. Radiographs revealed a generalized bronchointerstitial pattern to lungs. She was febrile and her bloodwork revealed an eosinophil count that was severely elevated.
She seems to be mainly a water constitution, very fearful and will bite.

Her tongue was pink. Her pulses were wiry. When I needled GB34 her pulses relaxed.
I put her on prednisone at 1.25 mg BID, doxycycline for 2 weeks, and started Minor bupleurum, hoping I could wean the prednisone out. Her cough resolved within a few days.

On the last CBC done 2 weeks ago, her eosinophil count was normal. She had a mild neutrophilia. Her tongue and pulses were similar. We have attempted to lower the pred dose to once daily but each time her cough returns.

Any advice or education you can give me would be helpful. Would Qing Ying Tang be a reasonable choice?

Thanks in advance.

Colleen
Replies
by naturevet
March 17, 2019
Hi Colleen,

My temptation would be to try Xue Fu Zhu Yu Tang, or even the modified version containing San Leng and E Zhu.

It pairs well with Xiao Chai Hu Tang in pneumonitis cases and I often use them together. I'd try that first

Steve
by cprather
March 17, 2019
Thank you Dr. Marsden!

Colleen
by cprather
June 24, 2019
Dr. Marsden,
An update on Emma. 3 months of Xiao Chai Hu Tang and Xue Fu Zhu Yu Tang have not changed her cough. We have been unable to wean the dose of pred down at all. The owner reports she is back to Coughing daily. The owner reports she is grumpy now. Her cough per the owner is a little productive occasionally. I did not hear a cough at all during my recent recheck so can't comment on the quality of it.
We have gone into Summer- very hot and dry as of about a month ago, which seems to coincide with her cough worsening.
Radiographs still show a mild bronchiolar pattern, improved from the original films , but not normal. Her CBC was wnl. The neutrophilia and eosinophilia have resolved.
Her tongue was lavender, no obvious coating. Her pulses were wiry.
I made another request for the owner to get her off of the kibble. She seemed to listen.
So I am confused at this point as we were making some headway but no longer. I had originally thought of putting her on Lilly combo to help moisten her lungs in our dry, hot climate, but when the owner stated the cough was productive, I was puzzled.
Can you help me understand what is happening?
Thank you very much for your help.
Colleen
by naturevet
June 24, 2019
Hi Colleen,

You have made significant head way, as per the Xrays and the normal CBC. That is, you have pruned the branches and are now trying to understand what the root of the problem is. We know the root is not related to the Shao Yang or to Liver Qi and Blood stagnation, since the cough is slowly worsening despite treating them.

Generally the Shao Yang has two common roots: Dampness and Phlegm accumulation, and Yin deficiency. Dampness and Phlegm can obstruct the Triple Burner, interfering with the descent of Lung Qi. Yin deficiency can cause Shao Yang issues, by failing to attract, enfold and hold Yang internally. Often the pulse for these cases is either very weak or very buoyant. The pulse for a blocked Triple Burner is usually wiry (reflecting deep interior obstruction) and seems to match what you're seeing.

Thus, given the productive cough and the pulse, I'd try San Ren Tang next. If it doesn't get anywhere, you can try Lily Bulb Combination (Bai He Gu Jing Tang), but by doing them in this order, you will have ruled out Dampness before you try a Yin tonic, thus making it less likely you'd aggravate the dog with the Yin tonic.

Hopefully that makes sense. If there is any significant response to San Ren Tang, then the diet is the main problem, so I'm glad she is finally open to making diet changes

Good luck and let us know what happens!

Steve
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