He is also on apoquel for atopic skin disease. Now the diarrhoea is settled we have been trying to get on top of this (there was never any change in his need for apoquel whilst on CSWLT). I've tried various formulas and I'm just not getting anywhere. And I've even set him back with my most recent choice (I've copied notes in for recent appointments below). I decided that apoquel must be suppressing damp heat - I asked at my CIVT advanced herbal group session in The Netherlands and no-one knew what apoquel did from an energetic perspective -so I tried to treat the suspected underlying patten rather than the dog in front of me! (He's been a great case to learn from but what I suspected could happen did so it was useful to see that I can anticipate what might happen if I'm wrong). It turned out that LDEMS wasn't a good choice and he developed what looks like SP Qi deficiency.
notes from recent appointments:
19.02.19:
Doing really well wrt poops - on fully raw food now and no deterioration in poo - ff v good atm with good consistency and no smell.
Still on apoquel 5.4mgx2 Sid. If drops a dose then dose see pruritis, though o thinks recently has missed a couple of doses and been ok.
Has had set to with other dog recently - the JRT is the instigator but Kongo will retaliate to defend himself. usually is fairly submissive to other dogs but this JRT will go back at.
Came from Spain originall - desert area.
O keen to try to target skin a little more now. CSWLT will be helping skin - may be why has been ok with occ missed doses of apoquel, but lets see if any other formula a little better now.
Skin - usually c/s worst in Spring/summer.
Energy incr since starting herbs. No real change in energy but is becoming more of a mummy’s boy and sitting with her in the evening, pushes other dogs out the way if they are vying for fuss (blood def - anxiety?) Fairly submissive to other dogs (bar the JRT!)
Eating - more than packet advises and licks all over bowls too. Has recently stolen food (custard tarts) - first time ever
Drinking - n, non-descrtip
Poop - great
Seeing fine
Still dreams
Since fight with the JRT 3wks ago has been a little more aloof with other dogs (more metal). Generally happy chap (only sad if o stroking another dog!)
Ce: clear eyes, no signs heat
Ears 4 fingers hot
Sl red underside of chin - rubs on the floor
Moist nose though not really wet and black. No crusting noted
Axilla/groin where skin lesions occur, often pustules. 1dx red spot R axilla today.
Nails - v sl flaky and pads sl rough, a little pale, no cracks.
Likes to lie in the sun - heat seeker
T: pink - sl pale, dry, white coating more causally, sl lavender tinge mid tongue, sharp edges
P: slow, mid depth - to deep for maximum intensity. Thin but with+ firm to feel. Good tone to vessel wall I think.
Skin = sl greasy feel to dorsum 0- only slight, small dandruff flakes though not loads.
Warm body all over
BSP: Bl18r, Bl19l, Bl20b, hole YBH
Acp: Bl17b, Bl18r, Bl19l, Bl20b, YBH, SP10r, Ki3l, Bl60r, SP6l, LIv13r, LI10r, Bl40r. Pulse did impr after this - less deep more mid depth and less narrow.
Will look into herbs for this chap. Cont herbs as we are atm and review 6wks.
02/04/2019: faeces wise is on great form, off all herbs, normal poo, good energy levels. on raw food and nothing else with no problems.
skin - not great. if misses an apoquel then pruritis dev.
has been calmer in himself since other dogs on site have left - just him and Dilly now and both are calmer with less battling and less antagonism of other dogs when out - uninterested in other dogs when out.
dreams a lot
otherwise little else has changed.
ce: 3 fingers warm ears
sl red under chin still - thoguh does wear muzzle when out as precaution so ? is this causing irrtation? sl red in palmar/plantar i`d space all four feet and not keen for this to be looked at.
mild dandruff axillary region
pads sl dry adn cracked
nails v sl flaky
coat doesn't seem so greasy
T: pale pink, seems moist today, sl stringy saliva? no swollen edges. s`a coating more caudally. P: deep, thin, little intensity, R stronger
BSP: hole at Bl18r, Bl23b.
dx: liver bloods defiiency, no real signs of heat bar at feet, or damp heat anywhere - is on apoquel so how much is this masking? tongue looks like Qi def as moist, with some signs of damp, but SP looks ok as coping well with raw food and no other c/s of SP Qi def.
poa: nourish blood, clear wind, nourish WEi Qi.
ACP: SP10r, GV14, BL18r, Bl17b, Bl23b, LI11l, Gb34r, Th14r, Th5l. pulse better after tx - moderate depth, wider, better intensity.
herbs: Start Si Wu Xiao Feng Yin, 1g for first 5d then bid after this, review 3wks (phone ok), see ag 6wks. Adv that given rehmannia if any SP Qi def can cause Damp signs, but given no other c`s atm then feel ok to try this.
Other options if not helping - SMS, or Bai Hu Si Miao (esp given red feet)
29.05.19: Off all herbs again - o used up all the SWXFY, tried reducing apoquel to half dose after 10 days and skin flared up. not seeing any improvement with skin. Faeces still perfect and lively and happy. cut himself on L caudal axilary region last wk - sx went well though sl firm feeling underneath skin- mild suture reaction I suspect. comfy for gentle rolling to loose any scar tissue forming.
ce: ears 3 fingers warm, no obv dandruff at all - is this because has now been back on raw food for a good while and so yin/blood tonic food is resolving any blood def? nose fiarly black, pads and nails are the same as before though so still some blood def present.
t: pale pink, sl white coating and dry P: deep, weak thin.
BSP: hole at Bl23b, BL20r, Bl19l TrP GB29r
laser acp: Sp10l, Bl23b, Bl19l, Bl20r, Gb33r, Gb29r, Bl17b, SP6r
move to long dan er miao san in the hope that the apoquel is masking damp heat signs so if we tackle these and then drop off the apoquel shouldn't get a rebound damp heat eruption.
adv to keep on apoquel for now and revie 3weeks, will then look to reduce dosing. adv that skin can take a really long time to resolve - 6mo + 1mo per year of problems.
18.06.19:10d after starting LDEMS had sl soft motions and was sick, o reduced to sid dosing, all imrpoved. back to bid dosing and no issues with stools, althoguh today a little soft - o had to pull grass from bottom too - SP Qi def rearnig up?
sl off food too althoguh not if fed NAtures Menu so o moving to this
and seems calmer and more bid-able!
on 2 apoquel one day, 1 the next, no noticeable deterioration with skin. skin looks vg atm too - no evidence scabs, heat, i`d spaces also pretty calm - great.
ce: surprinsgly I think feels warmer today - more heat signs than ive seen with this chap. ears 4-5fingers warm, tongue pink though not red, sl dry, no cracks. pulses more superficial, still sl wiry, ? sl faster than n? I suspect rate the same.
no dandruff notes, dreaming less than did though still dreaming.
Bl20 small hole. Gb29r reactive and firm - excess. otherwise nad on BSP or Mu points
poa: cont LDEMS, if cont soft stools, quieter (is this Qi def? or calmer shen?), reduced appetite then either add in GPT or move to CSWLT.
cont apoquel for now as we are, aw to get reishi-cordyceps mix to add into food. see ag 4wks, then will try to drop to 1 capsule sid
30.07.19: o contacted AW at beginning of month, not doing so well, not eating well, mucus poops, low energy levels. opted then to move back to CSWLT and add in reishi complex as lots of favourable results with this in western herbal world in Uk atm apparently.
since restarting no real improvement - poos much better, though sl soft one y'day with stink smell. no obv mucus/blood etc. no flatulence
energy levels fine on walks but at home just sleeping really
appetite diffident. back onto raw last 3-4wks. Bella and Duke. no carbs but does have 10% beef in it.
last week in heat even apoquel not holding pruritis. seems better since cooled down at weekend.
other dog being much more dominant towards Kongo and he is just walking away accepting this. new dog in hosue alst 2d and when she battled back over food again he walked away.
vomited a cople of times - stealth vomiteer and o not seen - finds remnants after he has eaten it. so unsure if smell/colour (has had incidence of vomit smell though so presume some smell).
still calmer and more bid-able
seeking cold - lies on floor, went to cool places when hot weather recently
thirst normal, little and often drinks
urine normal
sleep normal, occ restless at night but being disturbed by wildlife in garden. o not aware of dreaming as sleeping in hall currently
o thinks is sad at the moment - nose put out by Dilly as she is really asserting herself now and Kongo is just ignoring and moving out of the way. Not even standing up to new foster dog either
weight gain - o putting down to not doing as much in the day, lying around
o noted slight halitosis
overall o feels like Kongo is just a bit toxins and needs to purge these
ce: demeanour slower, slightly less confident than I have seen before shen - ok, quiet for Kongo
incr BW
eyes bright with no discharge
no sight or hearing problems
ears 4-5fingers warm - really warm (in stark contrast to our v first appt)
nose black - not quite full glossy black but not obv pale. noist but not really wet, no crusting
T: n-small, pale pink to sl lavendar tinge mid tongue (got redder as going through appt)
no caoting - sl caudlly?
dry and no teethmarks etc
Skin - feels warm, sl greasy feel to dorsum (but only slight), looks dull coat wise and more grey to face/muzzle.
nails normal and footpads ok - sl pale?
warmth allt eh way to toes, no coldness to distal limbs
no hypochondriac pain, chst compressions fine, not stiff
sl halitosis, almost sl bitter smell, nothing marked, subtle smell only.
BSP: Bl18, 19, 23 all sl warm and slight hole at Bl23
pulse; thin, wiry, deep and suprinsgly slow. minimal finger lift. R weaker
laser acp: LI10r, LI11l - no obv change to pulse. Bl18r (pulse weaker after), KI3l - both pulses improved. Bl23b - little pulse change, SP9r - stronger pulse after, SP6r pulse impr as before. LIV13r pulse impr as before.
poa: cont herbs as we are, restart probiotics, aw to look into alternative formuals/seek advice as to whether we just need to use CSWLT for a protracted period or move to a different formula.
Help! I am a little baffled as to where to go next as there seems to be heat -warmer ears (and the very first time I saw him his ears were stone cold, they're now much warmer -and see to have done this since he was on LDEMS which I thought was a cooling formula and that what I'd done by using it was to Coll the cooking pot), yet tongue and pulse feel much more like a cold picture making me think stagnation. I can't decide whether to persist with CSWLT, move to SMS (but he just doesn't have enough warm signs for me to be confident with this), whether to use GPT as a spleen support with another formula to treat any underlying damp heat, or whether here is a better options. I also think that there's some Ki Qi deficiency that I need to be tackling as he looks a lot older than he is (very grey face) and his pulse improved significantly at the last appointment with KI3 and SP6.
Apologies for the longest post probably in the history of Cured Cases, and thanks for any help you might have!