Question Details
Recurrent Pneumonia In A Dog
by Dreudog - July 24, 2020    View Case Report
Hi Steve,


This is a 7 yr old MN Malamute.

He started coughing a few days after boarding in January 2018 (deep winter here) and developed presumed pneumonia (no fever, consolidated R middle lung lobe). He responded to antibiotic therapy and the relapsed in Feb. Treated again, responded. Good all summer until another relapse September 2019; still no fever but a wet, huffing type of cough, ^ interstitial pattern. Antibiotics Sept/Oct. ..... better ..... recurrence again in December w/ fever and consolidation in cranial lobes. Better again, then cough returned after a cold, damp camping trip. Tracheal wash and culture March 2020, further antibiotic therapy based on culture. He is off antibiotic now.

I met Sanuk last week:

- Sweet, calm
- bilateral flank alopecia (chronic and non- seasonal)
- lungs clear, no fever
- mild seborrhea
- Pulse; thinner, deeper
- Tongue pink, not esp. thick or wet

He's had some unexplained soft stools recently (small bowel type). He runs hot. Skips an occ. meal. (currently dry, owner is transitioning to commercial cooked raw).

So I'm seeing:

- spleen qi def, mild damp
- triple burner obstr. w/ blood deficiency? (no behavioral support, but his pulse is definitely not strong). Shoulder season worsening, recurrent pneumonia/bronchitis.


Maybe XCHT + SWT? Other?


Thnx,



Cathy L

PS; thnx also for the most excellent liver seminar.
Replies
by naturevet
July 26, 2020
Hi Cathy!

Glad you liked the liver seminar. Hopefully it serves you well!

With a pulse that is deep and thin in the middle of summer, we know this dog has problems exteriorizing Qi and Blood, making it prone to interior congestion (in the Lungs, causing consolidation) in the winter. That could be caused by a Shao Yang excess, as you say. I, too, see the Blood deficiency in the truncal alopecia; and the bit of Dampness; and the Spleen deficiency, causing the soft stools. The question is how it all fits together, and more importantly, where to start.

My first temptation given the pulse and soft stool is to look at this as, in part, a Wei Qi deficiency. This condition tends to be worse in fall through spring; and would make the dog vulnerable to invasion even from a simple camping trip. It would explain the recurrent nature of the pneumonia, since Wei Qi deficiency is tantamount to local (i.e. epithelial) immune deficiency. Antibiotics generally require an intact immune system to work well, and the TTW apparently showed lingering infection in spite of treatment, calling for another round of antibiotics.

How I would piece all this together, then, is to look at the dog right now as having Spleen Qi sinking. This is not only Spleen deficiency, creating a secondary Blood deficiency and tendency to mild Dampness development, but also a problem of interior Stasis, leading to the pneumonia, unexplained soft stool, deep toned pulse, and superficial Wei Qi deficiency.

Spleen Qi Sinking is, in part, Liver Qi stagnation, so Qi and Blood do not circulate well, leading to Wei Qi deficiency on the surface, and a vulnerability to infection, particularly in the Lungs. Shao Yang disharmony can aggravate that tendency to central Stasis, but isn't needed right now to explain pretty much all we are seeing. You might notice as the dog gets stronger that it's pulse becomes a deep, toned full Shao Yang pulse, requiring us to 'finish the case' with Minor Bupleurum. But it may get better just with BZYQT.

If the pulse were much stronger, I'd start with a Shao Yang approach, but as it is, my temptation is to try Bu Zhong Yi Qi Tang first. If it's the right formula, the stool should firm up and the pulse should lift after a couple of weeks. If it does, and assuming the dog doesn't then start showing signs of a pure and simple Shao Yang disharmony, I'd use BZYQT right through fall and into winter, to try to prevent pneumonia from recurring. Meanwhile, and microbes in the Lungs that are latent should get cleared through the immune stimulating effects of BZYQT.

If that doesn't help, or there are some immediate adverse developments, which would suggest we are tonifying an excess, then I'd be tempted to use Xue Fu Zhu Yu Tang and Xiao Chai Hu Tang in tandem. As you've noted, though, there seems to be a Spleen deficiency element here that is strong enough to serve as a treatment focus, and XCHT is not quite up to that. If the diarrhea had been large bowel, that would have been different, but because it's small bowel, my temptation is to try BZYQT first

Hopefully that makes sense and gives you some guidance on how to proceed! Let us know how it goes!

Steve
by Dreudog
November 11, 2020
Hi Steve and group,

Plz see my update on Sanuk from 10/28 exam. Just after that a time, his cough returned (no changes made at exam). No fever yet, normal attitude but hacking cough 2-3 X per day. Vision loss is same; rDVM assumes SARDS, owner cannot afford ophtho referral.

Original pneumonia began September of 2019. R/O TBO?

Thnx,


Cathy L
by naturevet
November 11, 2020
Hi Cathy,

Given the pneumonia and risk of a 'Yang rising' kind of problem, Minor Bupleurum seems like a prudent next step

Steve
by Dreudog
November 12, 2020
Will do; thanks !!!
by Dreudog
April 9, 2021
Please see case updates on Sanuk. :)
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