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Atopy Dermatitis In A Dog

by Amyw - July 14, 2020 View Case Report

He Steve and forum, please could I have some input on a case I ahve?

I have a French bulldog, FE 7yo, with pruritis and occasional dermatitis really since the owner got her. Various rounds of steroids have helped, and a few months of cytopoint. Currently she is on zd which the owner is also supplementing with turkey mince - but would prefer her to be on raw food. She recently had otitis media (dx on referral with advanced imaging) and has been on extended marboflox and potentiated amoxicillin) and also an episodes of mild respiratory distress diagnosed as chronic bronchitis which was treated with steroids. I saw her the day after the steroids finished.
Torticollis form OM and apparently damage to vestibular nerve from imaging, might recover, migtht not.
Had luxating patella when a young dog with surgery to repair.
She also had a disc protrusion in her neck last year.
Quite aloof character but has defended the owner and daughter from a mastiff attack and has an issue with Jack Russell terriers -would happily take one on given half a chance so there is a bit of fight and wood in her.
On steroids her skin is better, less pruritis but she does become PUPD and has slimy poop. Since stopping the CCS her pruritis has returned but only one small patch of erythema around her umbilicus region On exam.

Symptoms are all year round, she loves to sleep and is currently a poor eater (but hates the zd), her hair is also not growing back so well after clipping compared to last year.
Dreams a lot and vividly, nose slightly pale, footpads cracked and pale,
Slightly greasy feels to skin and small flakes of dandruff
Ears are very cool but owner reports at night feels really hot when snuggled up for cuddles on the sofa. Cool feet too but not a hot body at all, just warm

Tongue is not small, pale at times but red underside and shallow little cracks. Not overly wet, slightly dry. Lavendar tinge in the middle

Pulse is not full, superficial or bounding, but slightly fast (had just seen a ball to play with though), narrow, middle to slightly deep with vasotone and the left is weaker.

Back Shu points have heat at BL19 and BL 22, holes at BL 20 and 23

My thoughts are that this dog has damp heat but is also blood deficient with underlying SP Qi deficiency and KI deficiency. I had thought I’d put her on CSWLT but I saw a couple of cases on this forum using XCHT and SWT, and given her active BSP I’m wondering about using this combination instead. And moving her to a raw elimination diet too as food does flare her up (especially if she gets the cats food).

What would be your thoughts please? She’s a really lovely frenchie with little snoring or noise in breathing and a really nice owner who adores her. I’d like to get her comfy and reduced irritation ASAP! And feeling happy as that’s the owners main concern, that this dog is unhappy at the moment, withdrawing a little from engaging with life.
Thanks so much for your help! Amy

by naturevet

July 22, 2020

Hi Amy!

Sorry about the delay in getting back to you. These are strange times we are living in!

Thank you for the excellent work up. Very well done! I think we have enough information to proceed, thanks to your thoroughness.

If the dog has had skin problems in the past while on raw, then we can likely rule out Dampness for now, the greasy lesions and mucoid stool notwithstanding. Dampness is essentially uncontrolled inflammation secondary to metabolic issues stemming from a processed diet. Since the problem did not resolve on either the z/d or the raw (which really form two ends of a dietary spectrum) then we can conclude it's not purely a food issue. What to feed then? If there was a diet, whether homemade, raw or store-bought, that the dog did somewhat okay on in the past, just go back to that for the time being.

Meanwhile, I agree with you that the issue is most likely a Shao Yang disharmony. These almost always occur in tandem with a Blood deficiency, creating that mid-depth toned but not to full pulse that you detected. Shao Yang issues alone create a more forceful full pulse.

If our diagnosis is correct, we want it to be consistent with as much of the history as possible, including the dog's past. The findings that fit include the:

vestibular nerve damage from the otitis media

response to steroids

'bit of wood' in the personality

luxating patella

stasis in the tongue

heat at BL 19 and 22

mucoid stool (since Shao Yang disharmony raises predisposition to colitis)

pu/pd on the CCS

Dampness is commonly seen in the skin of these dogs, but the cause of the Spleen deficiency is a failure of Yang to move in and out of the body properly, creating increased predisposition to Source Qi deficiency at least once a day. The main consumer of Source Qi is the Spleen.

The Spleen deficiency produces Blood deficiency, and the Blood (i.e. Yin) deficiency aggravates the problems moving Yang. So, it's a vicious circle. The Ginseng in Minor Bupleurum will strengthen the Qi of the center, and the use of Si Wu Tang simultaneously will correct the Yin deficiency, while Minor Bupleurum as a whole will normalize the Shao Yang. Use two parts Minor Bupleurum to one part Si Wu Tang.

From a biomedical perspective, these cases are probably leaky gut cases, and likely involve a disturbed microbiome. Finding the food the dog does best is tantamount to fostering the growth of flora that are least irritating to the intestinal lining. Minor Bupleurum plays a key role in normalizing flora imbalances that create leaky gut; and subduing the propagation of the inflammation occurring at the gut into the skin. A probiotic might help here. I would choose Lactobacillus, since its numbers decline in response to raw feeding; and since it makes propionic acid, which is itself a mild immune suppressant, helping to normalize the immune system in the process.

Bottom line: hopefully within a few weeks, the dog should be improving. I would expect the balance issues to improve as well as Minor Bupleurum is the first consideration for resolving nerve inflammation.

Please let us know how things go and if you need any help as the case evolves. Meanwhile, keep up the great work!

Steve

by Amyw

July 24, 2020

Brilliant, thank you so much Steve, I've just got her started so I'll let you know how she gets on.

And thanks for your lovely words, you made me feel about 10 foot tall!

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