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Hip Dysplasia And Allergic Dermatitis In A Dog

by CIVTdvm - November 2, 2020 View Case Report

Hello, this is my own dog Roxy - rescue - approx 10 yr old, F.S Husky X Kelpie.
I am wondering if Benefits Knees and Hips WITH Si Wu Xiao Feng Yin would be okay to give Roxy at the same time? The cross over ingredients are Bupleurum and Jujube so I am unsure of the safety to use concurrently.
She has moderate to severe allergic dermatitis (every August->December). Generalized erythema, chews at her abdomen and dorsal forelimbs - moderate-> intesne pruritus, no pustules (but will develop if she wasn't on vanectyl-p
- very sensitive of prednisone with pu/pd; does seem to be responsive to Cytopoint injections (effects only last 3-4 weeks).
Constitution - Wood + Fire - dog/leash aggressive, separation anxiety
Tongue - usually light lavender/pink
Pulse - deep, toneless-->wiry
SDMA has elevated since the spring time so want to avoid NSAIDs at this time. The last two years, I have tried a combo of Chu Shi Wei Ling Tang and Si Miao San, but this year, after CSWLT she developed intense heat signs for 6-7 days (acute colitis, panting, restlessness, insomnia) so I switched her to Si Miao San for a week or so and but it resolved even before I did this. Currently she is on Dasuquin and Gabapentin, I just started her on Xiao Yao San and San Ren Tang together a few days ago because her itching is more pronounced.
She has hx of right stifle cruciate injury (mild with recurrent flareups). She really resents acupuncture dry needling and I do not have a therapeutic laser at this time. She really enjoys Tui-na massage therapy and I am now doing this daily for her.
Her BCS is 5/9 but she has generalized muscle atrophy (mild) - able to palpate femoral head recently. Pronounced trigger points of her quadratus lumborum and quadriceps. Vocalizes on deep palpation of her femoral head and surrounding areas.
*As an aside, she also has pronounced halitosis for 4-5 years (no better/worse) with only mild dental disease.
*recent abdominal ultrasound revealed no abnormalities (no tumors)
diet: honest kitchen turkey + rayne gastrointestinal sensitivity (turkey, grain free)

QUESTION:
What herb or combination of herbs is BEST for managing BOTH her hip arthritis and her skin allergies?

Thank you so much in advance! I really appreciate your help!
Sincerely,
Christiane

by naturevet

November 2, 2020

Hi Christiane,

I like your idea of trying a version of Minor Bupleurum for her. Maybe Benefit Hips and Knees, given the knee and hip pains. Minor Bupleurum treats Shao Yang disharmony, which is associated with

Cruciate tears

Hip dysplasia and pain

Nephritis

Late summer and fall dermatitis, responsive to immune suppressants

Aggression and anxiety

Colitis

Insomnia, panting, restlessness

I realize the latter symptoms were in response to CSWLT, but Chinese medicine doesn't believe in side effects so much as it endorses the idea of latent tendencies that herbs (and drugs) can aggravate (unless they are a good it, in which case they ameliorate them).

I would start with the Minor Bupleurum or equivalent, then, then add in Si Wu Xiao Feng Yin later if needed. Yi Guan Jian is another alternative to use as a Blood tonic. The reason I would add them in separately is that you can interpret the cause of any change in symptoms, allowing you to learn from the case regardless what happens. If you use two things together and something goes wrong, you don't really know which treatment is the problem.

Hopefully that makes sense. Please let us know how it goes!

Steve

Xiao Chai Hu Tang

by CIVTdvm

November 3, 2020

Hi Steve,
Thank you so much for your quick reply - I really appreciate it!
I will start her on Minor Bupleurum and see how she responds. I will keep you posted!
What can you make of her chronic, severe halitosis with relatively mild dental disease and normal renal parameters and normal abdominal ultrasound?
Thanks in advance!
Christiane

by naturevet

November 3, 2020

Hi again,

The halitosis may be referable to Food Stasis in the Stomach. The Shao Yang controls the decent of Qi down through the Middle Burner, in which case harmonizing it through the use of Minor Bupleurum may help. The high SDMA may be the earliest sign of renal inflammation, which the herbal formula may put a stop to.

Let us know how it goes!

Steve

by CIVTdvm

November 4, 2020

Hi Steve, that makes sense. Minor Bupleurum sounds like a perfect fit for Roxy right now. I won't receive the herbs for a few more days and her skin is very hot right now and she's constantly chewing at herself in distress. Would it be safe to give another Cytopoint injection tomorrow when I will be starting Xiao Chai Hu Tang very soon?
Would you recommend waiting to see her response to XCHT before starting her on cartrophen injections or okay to give concurrently as they have different mechanisms of action, cartrophen being more of a chondroprotective?
Thanks again
Christiane

by naturevet

November 4, 2020

I think you can proceed with your conventional treatments. There shouldn't be any adverse interactions. You can detect the benefit of the herbs by any decreased future dependency on the drugs

S

by CIVTdvm

November 13, 2020

Hi Steve,
I started the Benefit Knees and Hips herb two days ago. Roxy is tolerating it well so far. I am giving her half tablet BID - she is 15 kg). For her, would you recommend increasing to TID?
She is still considerably polydipsic and has not had any vanectyl-p since OCt30. So I am hoping that the herbs will help with any potential irritation to her kidneys from the Heat Excess she had previously. Otherwise she's doing okay - still very sensitive with trigger points in hind end (cartrophen injections have been started) and still itching but not as much (cytopoint on board). I will keep you posted on her response. How long before adding in SWXFY do you think I should wait?
Thanks so much in advance!
Christiane

by naturevet

November 16, 2020

Hi Christiane,

I would start the SWXFY as well. If you don't see improvements, increase your dose. For dogs that size, I usually use 2 tablets twice daily of the Kan products. You could use full doses of each formula.

Work your way up gradually if you're worried. I think you can easily give 1 tablet, though, and wouldn't expect much in the way of improvements until you're at least at a tablet twice daily

Fingers crossed things go well! They should!

Steve

by CIVTdvm

November 17, 2020

Hi Steve,

Thank you for your response.
Before starting the SWXFY, I know there is a risk of patients developing heat signs. With Roxy previously developing heat signs on CSWLT, do you think it's still worthwhile? The other hesitation that I have is that she has a history of a soft tissue sarcoma in 2017 (removed).
There's a hemorrhagic SC/intradermal mass that I'm monitoring - FNA came back without any signs of neoplasia, however, I'm wondering if there are any contraindications using SWXFY in patients with confirmed or suspect skin tumors? (concern with enhanced blood flow to this area).

She's been waking up around 2am the last few nights asking to go outside and slightly flatulent - not sure if urinating or defecating at that time as haven't been able to go out with her at that time.

The Kan Herb label dose for Benefits Knees and Hips is 1/2 tab BID - TID for her weight range - so you want me to increase this to 2 tablets BID then?

Last - her blood and urine results (from yesterday) are below:
SDMA now 12 (prev 14)
creatinine 74 (prev. 65)
urea 6.4 (pre 6.4)
fT4 6.7
USG 1.027
crystals - struvite 21-50/hpf (history of constant high struvite count for last two + years)
pH - 8.0

With Benefits Knees and Hips helping manage thyroid illness + the addition of 1/2 teaspoon of kelp SID, do you feel it's still necessary to add levothyroxine at this time? She has moderate generalized muscle atrophy and recent weight gain and increased drinking.

Today's exam:
tongue: pink-red
pulse: moderate, slippery - toned, deep - toneless

Also - I haven't done any radiographs yet but concerned about L-S spondylosis as well. I am debating adding an NSAID...

Thanks in advance!

by naturevet

November 18, 2020

Hi again!

No rush on the SWXFY if you don't want, but it is not particularly heating. CSWLT is, but SWXFY is not, really.

As for using a Blood tonic formula in a patient with a potential tumor, we do that all the time when we use Xue Fu Zhu Yu Tang to treat mast cell tumors. So it's only with rapidly growing malignant tumors that we don't want to push the blood supply toward them. If this one is slow-growing and small, with no palpable heat or inflammation associated with it, then SWXFY might actually help you control it better.

The waking at 2 am and the vague heat signs have me thinking, however, that she might benefit from a formula called Wu Mei Wan. It doesn't really address skin disease or musculoskeletal issues, but could address these other symptoms you're seeing, including the polydipsia. You may want to see if you can source that.

As for the fT4, you don't mention the units it was measured in, but if it falls in the normal range, no need to jump in with levothyroxine. Often, correction of underlying problems normalizes thyroid function, so if it were my dog, I'd keep pushing for a complete solution to their complaints, and then see what the thyroid does.

Regarding dose, I find the recommendations on Kan labels are too low. They are prorated down in a linear fashion by Kan from human doses, but that's not really an accurate way to go. I use the dosing recommendations located here

I hope that helps you out!

Steve

Wu Mei Wan

by CIVTdvm

November 19, 2020

Hi Steve,
Thank you for your reply. I really appreciate all your help. To update you, the fT4 levels are slightly below range (units = pmol/L) but I understand your point to this. I have her on kelp so will monitor things going forward. With regards to Wu mei wan - I am not particularly keen on trying more herbs - over the past few months she has been on several herbs and I feel that instead of helping her, they are making things worse. It has been frustrating for me. To confirm - the first night, she woke me at 3am then again at 5am, the two subsequent nights, she woke up at 5am and then last night she woke up at 3am....asking to go outside - I can't follow her outside because I have a baby at home. However, her stools are normal during the day, no gas, no soiling around her hind end, and the recent u/a ruled out a UTI. She is outside a little longer than normal but returns and drinks lots of water then goes back to bed. The only time she paces is when she's asking to go out, otherwise she rests well, her nose is moist and there is no panting. She just started this Nov. 15th. She started on Benefit Knees and Hips Nov. 12 and I did start her on CBD Nov. 14. I feel like she's doing very well (re: pain control) on CBD so I want to keep her on that and since I haven't been using the full dose of the Kan herbs yet, I do not think it is that it's helping her joints at this time and I have nothing else to blame for her night signs, except that. I am frustrated however because I feel I hurt her kidneys having her on CSWLT in Sept and thought Benefit Knees and Hips would be protective as you mentioned if any renal inflammation, but now I'm not sure what to do. I also wanted to mention that since September, her calcium has decreased from 2.4 to 2.0mmol/L and her globulins 23 (from 29) and albumin 29g/L (32g/L) and total protein 61g/L (from 52g/L). I blame these changes on the herbs because although a history of IBD, her protein levels have been very stable for the past 3 years and other than the brief diarrhea during heat signs, no other GI signs to correlate this with. I am scared that the CSWLT did damage to her intestines and kidneys and I feel awful because I feel like I made things much worse for her. I know the healing powers of Chinese medicine for myself and for my patients but I'm still new to Chinese herbs and I feel like I am making my pets guinea pigs with these herbs and it has been frustrating. I just feel quite disillusioned and would appreciate some more guidance on how to manage Roxy. For Lionel, he is doing fine on the YGJ so I'll continue that for a month or so then stop all herbs for him. I feel the herbs are very powerful and if I fail to recognize a sign in a timely manner than it will be deleterious.
Thanks in advance!

by naturevet

November 19, 2020

I hear your concerns. Maybe the best thing to do for now if you're worried is stop the BH&K, and see what actual benefits or side effects are being produced.

Adverse events from herbs resolve in 24 to 48 hours. Lingering problems following herb use are actually due to a previously undiagnosed condition that was brought to the fore by the herbs, but now needs attention. It sounds like you might have a leaky gut going on with GI inflammation. Since CSWLT apparently made it work, we can surmise it is an acute inflammatory process, which fits with the 5 am aggravation.

Si Miao San is the most likely solution, and we have used it to get rid of polydipsia, too. But given your distrust of herbs, maybe the thing to do is stop them, so you can see what is truly going on with your dog independent of their use. Again, anything that lingers after 48 hours is a disease symptom, not an adverse event.

I suspect discontinuation of the BH&K will not change things that much. If that is the case, SMS would be my next recommendation, if you see your way to trying herbs again

As for your pets being guinea pigs, that is of course always the case whenever we try anything new for them, be it a diet or a drug. It's always a test, until it ends up working. Only then is it therapy.

Steve

by CIVTdvm

November 19, 2020

Hi Steve, thank you for your quick reply and your recommendations. To confirm, should I discontinue SWFXY as well as BH+K? How long should she be on SMS to resolve the acute inflammation? I just don't want to dry her out too much. She does usually do well on that (I had her on SMS after the CSWT in Sept)
Thanks in advance!

by naturevet

November 19, 2020

Yes, discontinue the other items for now and try the SMS. Let's see what happens then we can go from there. Zhi Bai Di Huang Wan is a good option for dogs that have Damp Heat but get dried out on SMS

Steve

by CIVTdvm

November 21, 2020

Hi Steve, thank you for your email. I have her on the SMS and she appears to be doing okay. Roxy did not wake me up the last two nights which is good but she has quite foul smelling gas today but normal stools so I do not know if that is a result of the SMS or if it's related to her leaky gut. No vomiting and appetite is still great as always.
Today her tongue is pink/red and her pulse slippery (deep) yet toned in the moderate depth position.
I just discovered a fractured 204 with moderate gingival inflammation associated with it so now I have to do a dental in her and will x rays her T-L and lumbosacral region and her hips at the same time. She is very stressed and anxious at the clinic so I have to give her gabapentin and trazadone the morning of surgery. ( I also will do a mass removal for her SC mass at the same time)
With her current lower albumin levels I'm not sure when to do her procedure but don't want to wait too long. My question for you is would SMS be safe with Metacam. I feel she needs an anti-inflammatory. CBD is helping but not enough. She is becoming slightly aggressive due to the pain as well. I wanted to start Galliprant but it is contraindicated in pets with low albumin as it is highly protein binding.
Thanks in advance!
Christiane

by naturevet

November 24, 2020

Hi there,

There is no contraindication in using SMS with Metacam. You should be fine to use both together.

Good luck with the dental! It may actually help with her stomach issues, too

Steve

by CIVTdvm

August 17, 2021

Hi Steve
Here's an update:
Roxy's dental was never done until one month ago - I postponed it - she had 8 teeth removed (incisors and premolars). Her dental mass was gingival hyperplasia which is great. She had 3 small lumps around her shoulder blades from the area I gave cytopoint injections in - one kept growing so I had all removed. The injections likely went somewhat intradermal (because she is very, very needle adverse and reactive with injections) instead of fully subcutaneous which likely lead to the inflammation. The biopsy results came back as: hemangioma and fibrolipoma and cyst - also great news. She recovered from surgery and her dental very well. She's had no issues as of late except diarrhea on Royal Canin Vegetarian that I had her on, so switched back to Kirkland turkey and she's great on this clinically even though I had her on the Purina HA - then she got sudden softer stools with loads of mucous - so she's more sensitive to diet changes as of late - never previously an issue.
Her medial shoulder instability injury from March 2021 has recently flared up but with rest, rehab and massage and her joint supplements, she should be fine - otherwise doing great. No respiratory issues, no vomiting, good energy; still very active dreamer.
Her seasonal allergies are starting again (ragweed season) - so I am unsure how to best proceed:
she's been off metacam long enough that I can start her on vanectyl-p if needed - this is the most reliable medication; her maintenance dose is 1.5 pills EOD. However, in 2017 she got a UTI and I blamed the vanectyl as previously she's been fine. She does have chronic alkaline urine - around pH 9.0 but had a cysto done in July and u/a and all normal. (in July had a full x ray and ultrasound and blood work testing done because the vet that examined her thought she had an abdominal mass on x rays - but it was just her stomach (i'm still on mat. leave) and she had very bad diarrhea (very rare for her).

option 2: re-start cytopoint injections - these seem to work the best managing her BUT she absolutely HATES injections and I would have to orally sedate her each time which is doable but still quite stressful for me (and her) and I don't have anyone to help me with this at home...plus she seems very reactive from injections in general...

option 3: re-try apoquel - with her hx of STS of right stifle from nov 2017, I don't really want her on an immunosuppressant drug (even if very targeted) - plus I really don't feel it was ever effective (hence why I've always been looking for alternatives)

options 4: bathe often and use anti-histamine - in the past benadryl did not seem to work but can give that or Reactin another try and use essential oil lavender / oatmeal shampoo

option 5: try herbs again - very hesitant as sept 2020 when I tried CSWLT and SMS she developed intense Heat Signs and it was a very miserable time for the both of us - I am open to trying other herbs but those and then the XCHT that I tried gave her insomnia and restlessness which was frustrating.

She's currently on: (just restarted these)
Cosequin
Flexidin advanced
CBD treats (with burdock root, astragulus and tumeric)

Any thoughts?

Thanks so much in advance

Christiane

by naturevet

August 20, 2021

Hi Christiane,

I'm glad things turned out well so far for your dog.

If she got worse on the three formulas above, the only trait they all have in common is that they are drying. That would suggest you need a Yin or Blood tonic for your dog. Although quite weak, omega 3 fatty acids are Blood and Yin tonics (as is CBD oil). If she is better on the omega 3s, then it bodes well for a Blood tonic (like Si Wu Xiao Feng Yin) making her feel better, and not worse. Or if the lesions are quite severe, then a formula called Qing Ying Tang.

I guess I would start with that, then. A trial run of omega 3 fatty acids, with the view to adding things in that work well with them, if they provide a small degree of relief

Steve

by CIVTdvm

August 20, 2021

Hi Steve,
I agree with your recommendations.
I believe she is sensitive to fish as seems to be more itchy in general with fish oils. Would it be reasonable to give her an ALA supplement instead like this one?
https://ca.iherb.com/pr/flora-udo-s-choice-udo-s-oil-3-6-9-blend-180-vegetarian-softgels/3061?gclid=Cj0KCQjwpf2IBhDkARIsAGVo0D1DVzGkTKukQlwkLBgHhrJRTKbz5VJYxViAnULsuc3XOZUBZo1n-_saAuLUEALw_wcB&gclsrc=aw.ds
omega 3, 6, 9 with flaxseed oil and evening primrose oil.
I did start her on vanectyl-p 3 days ago as she was severely irritated - no lesions, just warm skin and extremely pruritic. I do have CBD and can re-start her on that now. Unfortunately due to the ordering with NPHC, I am unable to get SWXFY right now, so I will start with CbD and this omega blend if you deem it safe and slowly taper vanectyl-p and see how she does.
Thanks again!

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