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IMTP And IMHA Concurrently In A Dog

by kkeeney - April 30, 2019 View Case Report

Hi Steve,

Hope you are well!

Seda came to see me about three weeks ago with a history of autoimmune issues that had seemingly gone into remission as of the spring of 2018. Suspected to be vaccine induced. Hypothyroidism (on 0.3 mg thyroid supplement BID) Gets mix of home cooked food and taste of the wild kibble. Tends to be very worried. Super sweet, submissive with other dogs. hypervigilant. sleeps well. GI super stable, Noise sensitivity but otherwise no behavioral issues. os would like to heal her immune system and address thyroid dz.
O: BAR BCS 6/9 mm pink CRT<2
Teeth: 2/4 tartar mild gingivitis
H/L: HR 82 RR: pant Auscult inconclusive- heart sounds slightly muffled, resp WNL
Abdomen: tense on palpation- nervous
Pulses: toned, superficial, broad with wiry center
Tongue: dark red , moist
M/S: WNL
A:
H/O IMTP, IMHA,- both seemingly resolved/in remission
HypoT4 current tx 0.3 mg thyroxine BID
TCVM: Wind invasion, likely underlying blood def, open
P:
BL17/18, BL40, GV14, Gv20, GB34 (best moderator of pulse)
RX: XCHT: 1/4 tsp po BID
RX: Medi herb thyroid complex- 1 tab po SID

Last week Seda had an acute relapse of her IMTP and IMHA and was seen at emergency with epistaxis, anemia and 0 platelets. She is now on pred, mycophenalate, cycloporine and they are recommending a blood transfusion. The ER doctor insisted they take her off all supplements and herbs. I am wondering a few things.
1) Any advice on herbs? I felt that XCHT was safe to start with in this case, but maybe there was a better choice. I would like to recommend something with confidence, but I am nervous now.
2) She was stable and then relapsed after she started the new herbs- it was several weeks after but... Can you see anything that I may have done that caused that?
3) General feedback for me on this sad case? I hope she pulls through!

Thanks for your guidance!
Kelly

by naturevet

May 3, 2019

Hi Kelly,

Sorry to hear about your case here. The same thing has happened to me, too. I don't think you precipitated this crisis. IMHA and ITP tend to show up in spring and fall, and are almost invariably Shao Yang disorders, so your read of the pulse and prescription were basically correct. Vaccination is unnecessary to trigger the attack - only (apparently) the changing of the seasons and its attendant impact on physiology

For IMHA, I will use Chai Hu Jia Long Gu Mu Li Tang to help internalize the Yang, the need for which was indicated by the broad toned superficial pulse. It also has additional ingredients that will help keep RBCs in circulation, even if they are a little damaged, lessening the intensity of the anemia. So I opt for it rather than its core formula, Xiao Chai Hu Tang

I often pair it with Qing Ying Tang, too. If you implemented these two treatments now, they will probably work better than the drugs to stabilize the case again. We started to use these formulas prophylactically, throughout spring and fall each year, to prevent relapses

It's becoming apparent that diet has a role to play in the manifestation of Shao Yang issues. Ample soluble fiber seems the dominant concern, which can be missing in raw and kibble-based foods alike. We've started experimenting with putting more legumes in with raw diets to meet this need. The fiber together with the Shao Yang formulas helps to minimize the dysbiosis and leaky gut that seem to precipitate autoimmune problems

Lastly, for cases that stabilize, but without an improvement in hematocrit, we find Yi Guan Jian works to restore normal counts.

Hopefully this helps you out. Again, I don't think you did anything wrong (just not enough right in the time you had available as the crisis loomed). I still see lots of opportunity for you to step in if the owners are willing, as conventional treatment often only results in partial improvement, and consistent relapses. With the protocol outlined above, we've been able to make this problem non-existent or relegate it to the level of 'nuisance complaint' in animals that are prone, which this one clearly is.

Hope that helps you out!

Steve

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