On recheck in January, seizures are much less frequent, 1 in Dec., then 1 early Jan., that's it. He appears less anxious, T is lavender, dry; P is deep, slippery. Really no shift in blood tests and I am so surprised. erythrocytosis (HCT 61.2, RBC 9 M/uL, HGB 22.2 g/dL) and reticulocytosis (126 K/uL), cortisol insufficiency leukogram, and mildly more elevated AST, ALT, low ALP. Since no benefit of QYT, I'm not inclined to increase dosage or even continue and he appears to be more Blood deficient from T&P. Would GXZYT be a better formula? What do you make of the high cortisol w/ low ALP and insufficiency leukogram? Any other suggestions would be most appreciated!
Question Details
Persistent Erythrocytosis And Seizures In A Dog
by
fdzenitsky
-
January 30, 2021 View Case Report
On recheck in January, seizures are much less frequent, 1 in Dec., then 1 early Jan., that's it. He appears less anxious, T is lavender, dry; P is deep, slippery. Really no shift in blood tests and I am so surprised. erythrocytosis (HCT 61.2, RBC 9 M/uL, HGB 22.2 g/dL) and reticulocytosis (126 K/uL), cortisol insufficiency leukogram, and mildly more elevated AST, ALT, low ALP. Since no benefit of QYT, I'm not inclined to increase dosage or even continue and he appears to be more Blood deficient from T&P. Would GXZYT be a better formula? What do you make of the high cortisol w/ low ALP and insufficiency leukogram? Any other suggestions would be most appreciated!
Replies
by
naturevet
February 1, 2021
Hi Franchesca
Given the slight but comprehensive improvements in the indices, liver enzymes and seizures, I think you're on the right track with QYT and would not be so quick to assume you're missing something. You're definitely not on the wrong track, anyway.
The slippery pulse you're feeling can be associated with Stomach Yin deficiency as well as Blood deficiency. You may be thinking he has a Blood excess, but we can look at erythrocytosis in relative terms as well - not just as an excess in RBCs, but a decrease in plasma. Plasma requires significant protein synthesis by the liver, and the moderate liver enzyme elevations are typical of an underperfused liver that may then be compromised in how much protein it can synthesize. If that thinking is correct, a more basic tonic like Yi Guan Jian might help.
Stronger Yin tonics can help seal the deal on improving seizures and liver enzyme elevations, even though they also enhance bone marrow activity. Of course, that may help, in terms of improving the leukogram. Yi Guan Jian is often what I use as it is calming as well.
The disparity between cortisol and the leukogram, if adrenal in origin, may signal that the dog is over-reacting to stress, but otherwise under-secreting and exhausted at home. If the owner confirms that, then an adaptogenic formula may help - one with Ginseng. In that case, you could look at Tian Wang Bu Xin Dan or even Gui Pi Tang as the best tonic to use.
Since we're dealing with seizures, though, my temptation to would be to not risk overstimulating the dog, and to use YGJ instead. Tian Ma Gou Teng Yin in tandem with either Qing Ying Tang, Yi Guan Jian or both, should wipe out the seizures entirely.
Hopefully this helps you out. Thanks very much for bringing this case to our attention. Let us know how it goes!
Steve
Given the slight but comprehensive improvements in the indices, liver enzymes and seizures, I think you're on the right track with QYT and would not be so quick to assume you're missing something. You're definitely not on the wrong track, anyway.
The slippery pulse you're feeling can be associated with Stomach Yin deficiency as well as Blood deficiency. You may be thinking he has a Blood excess, but we can look at erythrocytosis in relative terms as well - not just as an excess in RBCs, but a decrease in plasma. Plasma requires significant protein synthesis by the liver, and the moderate liver enzyme elevations are typical of an underperfused liver that may then be compromised in how much protein it can synthesize. If that thinking is correct, a more basic tonic like Yi Guan Jian might help.
Stronger Yin tonics can help seal the deal on improving seizures and liver enzyme elevations, even though they also enhance bone marrow activity. Of course, that may help, in terms of improving the leukogram. Yi Guan Jian is often what I use as it is calming as well.
The disparity between cortisol and the leukogram, if adrenal in origin, may signal that the dog is over-reacting to stress, but otherwise under-secreting and exhausted at home. If the owner confirms that, then an adaptogenic formula may help - one with Ginseng. In that case, you could look at Tian Wang Bu Xin Dan or even Gui Pi Tang as the best tonic to use.
Since we're dealing with seizures, though, my temptation to would be to not risk overstimulating the dog, and to use YGJ instead. Tian Ma Gou Teng Yin in tandem with either Qing Ying Tang, Yi Guan Jian or both, should wipe out the seizures entirely.
Hopefully this helps you out. Thanks very much for bringing this case to our attention. Let us know how it goes!
Steve
by
fdzenitsky
May 6, 2021
Hey Steve!
I started this guy on YGJ and TMGTY in January and d/c the QYT. In March, his person reported he was doing well, only 2 seizures (1/31 & 2/7). On recheck 4/30, she tells me of seizures on 4/3, 10, & 22. Timing tends to be 3-4pm, one 3:30am, and the last one at 9pm. No GI or other issues. Persistent erythrocytosis (HCT 60, RBC 9.1 M/uL, HGB 22.2 g/dL) no worse but no better, cortisol insufficiency leukogram, and normal AST and ALT, still low ALP. But now, ALB is high at 4.4 g/dL. T is pale w/ a redder tip and quivering; P is deep, slippery.
I'm inclined to keep up the YGJ and TMGTY and perhaps add back the QYT, but am interested in your feedback. Also, what is the significance of elevated ALB in absence of dehydration? I see this a lot in well hydrated patients on raw diets, sometimes w/ high CHOL &/or TRI, but not always. Don't understand the significance.
Thanks!
Franchesca
I started this guy on YGJ and TMGTY in January and d/c the QYT. In March, his person reported he was doing well, only 2 seizures (1/31 & 2/7). On recheck 4/30, she tells me of seizures on 4/3, 10, & 22. Timing tends to be 3-4pm, one 3:30am, and the last one at 9pm. No GI or other issues. Persistent erythrocytosis (HCT 60, RBC 9.1 M/uL, HGB 22.2 g/dL) no worse but no better, cortisol insufficiency leukogram, and normal AST and ALT, still low ALP. But now, ALB is high at 4.4 g/dL. T is pale w/ a redder tip and quivering; P is deep, slippery.
I'm inclined to keep up the YGJ and TMGTY and perhaps add back the QYT, but am interested in your feedback. Also, what is the significance of elevated ALB in absence of dehydration? I see this a lot in well hydrated patients on raw diets, sometimes w/ high CHOL &/or TRI, but not always. Don't understand the significance.
Thanks!
Franchesca
by
naturevet
May 7, 2021
Hi Franchesca
I did a little digging on Pubmed. The herbs that are known to downregulate bone marrow activity are generally heat clearers and blood movers, which explains why QYT was holding the dog.
The seizure times seem to implicate the Jue Yin as a potential cause, which is treated by Wu Mei Wan. Looking at the formula, it has Heat clearers, and Ginseng to help with the underperforming adrenals. To adapt it to polycythemia, I would add 20g of Dan Shen (Salvia). I would use it and the TMGTY to help get the seizures under control. For some seizure dogs, I've used all three: QYT, WMW and TMGTY. I would stop the YGJ
Hopefully that moves everything in the right direction
As for raw diets, they do tend to raise RBC and even albumin levels, due to their higher protein levels. Even BUN can go up as a result of the higher protein intake and catabolism. Raw diets can also be fatty, accounting for the increase in cholesterol.
Hope all this helps you out!
Steve
I did a little digging on Pubmed. The herbs that are known to downregulate bone marrow activity are generally heat clearers and blood movers, which explains why QYT was holding the dog.
The seizure times seem to implicate the Jue Yin as a potential cause, which is treated by Wu Mei Wan. Looking at the formula, it has Heat clearers, and Ginseng to help with the underperforming adrenals. To adapt it to polycythemia, I would add 20g of Dan Shen (Salvia). I would use it and the TMGTY to help get the seizures under control. For some seizure dogs, I've used all three: QYT, WMW and TMGTY. I would stop the YGJ
Hopefully that moves everything in the right direction
As for raw diets, they do tend to raise RBC and even albumin levels, due to their higher protein levels. Even BUN can go up as a result of the higher protein intake and catabolism. Raw diets can also be fatty, accounting for the increase in cholesterol.
Hope all this helps you out!
Steve
by
fdzenitsky
June 29, 2021
Hi Steve, here's where we are w/ this case...
On 5/9, I started him on TMGYT and Wu Mei Wan + Dan Shen per your suggestion, but not QYT. I wanted to see the effects of the new formulas. Since then, increased panting in evenings, if not panting, breathing deeper, still rapid, and it resolves in 1-2 hrs. Owner feels he is generally "hot". He had been w/o seizures since 4/22, but they began again this month w/ a time of day shift, now in the evenings. The first was 6/7 at 8:30-9pm, in and out of seizures for an hour that only resolved w/ diazepam and CBD oil. Then 6/9, 11:45pm and 6/11, 10:30pm, both short typical seizures.
I checked him on 6/18. T is muddy lavender, P is mid-depth, slippery. His mucous membranes on right side only are inflamed brick red (new) w/ heavy calculus. Persistent erythrocytosis (HCT 69, RBC 8.8 M/uL, HGB 23 g/dL) so worse except for RBC, TP high at 7.5, cortisol insufficiency leukogram, and normal liver enzymes. For the first time T4 is low at 0.8 ug/dL
I was going to start him on the QYT that day, but owner wanted me to evaluate blood tests first. I am inclined to start it now. I wonder about potential negative effects of the TMGTY and WMW on his Heat and the seizures as well thought out and reasonable your thinking above was, that maybe they need to be balanced with the QYT for him. Also the time shift in seizure activity, maybe correlating w/ the panting episodes, is interesting, though I don't know what to make of it.
What do you think, Chief?
Thanks again!
Franchesca
On 5/9, I started him on TMGYT and Wu Mei Wan + Dan Shen per your suggestion, but not QYT. I wanted to see the effects of the new formulas. Since then, increased panting in evenings, if not panting, breathing deeper, still rapid, and it resolves in 1-2 hrs. Owner feels he is generally "hot". He had been w/o seizures since 4/22, but they began again this month w/ a time of day shift, now in the evenings. The first was 6/7 at 8:30-9pm, in and out of seizures for an hour that only resolved w/ diazepam and CBD oil. Then 6/9, 11:45pm and 6/11, 10:30pm, both short typical seizures.
I checked him on 6/18. T is muddy lavender, P is mid-depth, slippery. His mucous membranes on right side only are inflamed brick red (new) w/ heavy calculus. Persistent erythrocytosis (HCT 69, RBC 8.8 M/uL, HGB 23 g/dL) so worse except for RBC, TP high at 7.5, cortisol insufficiency leukogram, and normal liver enzymes. For the first time T4 is low at 0.8 ug/dL
I was going to start him on the QYT that day, but owner wanted me to evaluate blood tests first. I am inclined to start it now. I wonder about potential negative effects of the TMGTY and WMW on his Heat and the seizures as well thought out and reasonable your thinking above was, that maybe they need to be balanced with the QYT for him. Also the time shift in seizure activity, maybe correlating w/ the panting episodes, is interesting, though I don't know what to make of it.
What do you think, Chief?
Thanks again!
Franchesca
by
naturevet
July 1, 2021
I have another suggestion, Franchesca.
Since polycythemia can be considered, based on its pathogenesis, as a sort of benign tumor; and since the seizures are now late evening and night in onset; a Shao Yang disharmony may be present. Meanwhile, we have the cortisol insufficiency (calling for an adaptogen like Ginseng) and laboratory research indicating that heat-clearing herbs may control RBC proliferation. Put it all together, and it sounds like we should try Xiao Chai Hu Tang in this dog. It pairs well with Qing Ying Tang if you decide to go back to it.
I would try after adding about 20g of Tian Ma (Gastrodia), 12g of Gui Zhi and 15g of Bai Shao to handle those seizures. You should be able to stop the other formulas. We can even look at other Shao Yang formulas, but the latter has worked for me recently for Shao Yang related seizure events occurring in tandem with neoplastic tendencies and heat intolerance. I'd give it a try
Steve
Since polycythemia can be considered, based on its pathogenesis, as a sort of benign tumor; and since the seizures are now late evening and night in onset; a Shao Yang disharmony may be present. Meanwhile, we have the cortisol insufficiency (calling for an adaptogen like Ginseng) and laboratory research indicating that heat-clearing herbs may control RBC proliferation. Put it all together, and it sounds like we should try Xiao Chai Hu Tang in this dog. It pairs well with Qing Ying Tang if you decide to go back to it.
I would try after adding about 20g of Tian Ma (Gastrodia), 12g of Gui Zhi and 15g of Bai Shao to handle those seizures. You should be able to stop the other formulas. We can even look at other Shao Yang formulas, but the latter has worked for me recently for Shao Yang related seizure events occurring in tandem with neoplastic tendencies and heat intolerance. I'd give it a try
Steve
by
fdzenitsky
October 18, 2021
I've been crossing my fingers since July, but it appears that this patient being well managed on the XCHT, adding in 20g of Tian Ma (Gastrodia), 12g of Gui Zhi and 15g of Bai Shao and the QYT. I'm always in awe when I see such success in a most difficult case and you, sir, have my debt of gratitude!
I'll recheck him next month and check on the polycythemia. I'm sure his owner will ask if we just keep things up indefinitely or if there will come a time when we wean him off and see how he does. Is it okay to use these herbs long-term? I am mostly thinking of the QYT. I have another young dog patient I manage w/ QYT for masticatory myositis, he's been on it for 10 months now (along w/ low dose hydrocortisone). Although his symptoms resolved many months ago, his titer remains sky high and we are all afraid to stop treatment! So far, I see no ill effects of keeping him on it, but at some point it has to stop. What is your timeframe and indications to d/c QYT for MM and in Donald's case?
Many thanks!
I'll recheck him next month and check on the polycythemia. I'm sure his owner will ask if we just keep things up indefinitely or if there will come a time when we wean him off and see how he does. Is it okay to use these herbs long-term? I am mostly thinking of the QYT. I have another young dog patient I manage w/ QYT for masticatory myositis, he's been on it for 10 months now (along w/ low dose hydrocortisone). Although his symptoms resolved many months ago, his titer remains sky high and we are all afraid to stop treatment! So far, I see no ill effects of keeping him on it, but at some point it has to stop. What is your timeframe and indications to d/c QYT for MM and in Donald's case?
Many thanks!
by
naturevet
October 19, 2021
That's great news, Franchesca! Here's hoping you can keep your fingers crossed indefinitely?
No problem to continue the herbs indefinitely, too. XCHT and QYT are both harmonizing formulas, in that they take care of competing needs in different parts of the body, rather than having a single pointed effect. This is what makes them safe for long term use.
Thank you for updating on this case. May the improvements continue to hold!
Steve
No problem to continue the herbs indefinitely, too. XCHT and QYT are both harmonizing formulas, in that they take care of competing needs in different parts of the body, rather than having a single pointed effect. This is what makes them safe for long term use.
Thank you for updating on this case. May the improvements continue to hold!
Steve
by
fdzenitsky
February 21, 2022
Hello Steve,
On recheck in November, erythrocytosis persists and seizures are infrequent, not one for 6 weeks prior to
and 3 weeks after our appointment. At that time, Tis warm lavender w/ longitudinal cracks, purple-red underneath w/ veins; P is easily felt superficial, wiry and deeper is is slippery and deficient. After a rash of seizures in December, we began correlating some of the events w/ the owner leaving for work and talked about the dog's complete fixation on the owner. I made him up a custom formula of flower essences and he immediately calms down on them, much more relaxed, stopped urine marking in the house, and he was seizure-free for 6 weeks. Then, just one last month, that is it!
The problem currently is that he has developed consistently soft stools on the herbs, owner thinks it's the modified XCHT. When she stopped it last week in prep for multiple dental extractions (I didn't ask this of her), his stools were formed. Given the apparent success otherwise of what we're currently doing, I hesitate to stop now, but I think some Spleen support is needed. How to handle this? Can I add SWT to the XCHT (mod. already w/ 20g of Tian Ma, 12g of Gui Zhi and 15g of Bai Shao) and if so, how much? Or, do you have something else in mind? At last check in January T is red at tip and under, P is deeper, slippery, thin, taut.
Thanks again!
Franchesca
On recheck in November, erythrocytosis persists and seizures are infrequent, not one for 6 weeks prior to
and 3 weeks after our appointment. At that time, Tis warm lavender w/ longitudinal cracks, purple-red underneath w/ veins; P is easily felt superficial, wiry and deeper is is slippery and deficient. After a rash of seizures in December, we began correlating some of the events w/ the owner leaving for work and talked about the dog's complete fixation on the owner. I made him up a custom formula of flower essences and he immediately calms down on them, much more relaxed, stopped urine marking in the house, and he was seizure-free for 6 weeks. Then, just one last month, that is it!
The problem currently is that he has developed consistently soft stools on the herbs, owner thinks it's the modified XCHT. When she stopped it last week in prep for multiple dental extractions (I didn't ask this of her), his stools were formed. Given the apparent success otherwise of what we're currently doing, I hesitate to stop now, but I think some Spleen support is needed. How to handle this? Can I add SWT to the XCHT (mod. already w/ 20g of Tian Ma, 12g of Gui Zhi and 15g of Bai Shao) and if so, how much? Or, do you have something else in mind? At last check in January T is red at tip and under, P is deeper, slippery, thin, taut.
Thanks again!
Franchesca
by
naturevet
February 25, 2022
Hmm. I'd be tempted to just add 20g of Tian Ma to the QYT and use it, instead. QYT is part of my go-to protocol for seizures happening over the winter solstice, so you may not lose control of them if you added Tian Ma to the QYT and just used it alone.
As for what is causing the diarrhea, since Chai Hu Gui Zhi Tang is drying, warming and mobilizing, it must be due to Yin deficiency or Heat. QYT counters both of those, explaining potentially why the diarrhea resolved on it alone. Otherwise, if you're reluctant to stop the XCHT mix, I'd suggest adding Yi Guan Jian instead, since it moistens and cools the Stomach and Large Intestine, likewise also potentially helping to counter the diarrhea.
Hopefully one of those helps you out, and good job finding the flower essences in controlling the anxiety that precipitates the seizures!
Steve
As for what is causing the diarrhea, since Chai Hu Gui Zhi Tang is drying, warming and mobilizing, it must be due to Yin deficiency or Heat. QYT counters both of those, explaining potentially why the diarrhea resolved on it alone. Otherwise, if you're reluctant to stop the XCHT mix, I'd suggest adding Yi Guan Jian instead, since it moistens and cools the Stomach and Large Intestine, likewise also potentially helping to counter the diarrhea.
Hopefully one of those helps you out, and good job finding the flower essences in controlling the anxiety that precipitates the seizures!
Steve
by
fdzenitsky
February 26, 2022
A clarification, Steve. Both formulas were d/c, so can we know which one was causing the loose stools? I can have the dog start them one at a time first, but he is in need of the CHGZT in the next few days. So, I can let that one run out and see how stools are on QYT alone. I'm then unclear on what you suggest if keeping him on the XCHT mix. Do you mean adding YGJ to the existing mix in some proportion, adding it as a 3rd formula, or swapping it for QYT? I do agree w/ the Yin def. and/or Heat!
Thanks!
Thanks!
by
naturevet
February 26, 2022
Hopefully I am understanding the situation correctly now, namely that he is on nothing, but you want to start something back up, and you will run out soon of CHGZT almost immediately.
Assuming that is correct, it's preferable to try formulas one at a time when you think you're seeing some sort of adverse event, though its worth noting that many times these adverse events were not due to the herbs at all.
Still, on the assumption it was, tonics are more likely to cause diarrhea. Have them re-start QYT and see if it's well tolerated. if not, then you'll need to test the Chai Hu Gui Zhi Tang with added Tian Ma alone. If it is well tolerated, test the two in combination. If no diarrhea happens, there was another coincidental cause behind it.
If QYT is the one causing diarrhea, YGJ might, too. If CHGZT caused the diarrhea, the above comments all still hold
Hopefully that gets you going in sussing the whole situation out
Steve
Assuming that is correct, it's preferable to try formulas one at a time when you think you're seeing some sort of adverse event, though its worth noting that many times these adverse events were not due to the herbs at all.
Still, on the assumption it was, tonics are more likely to cause diarrhea. Have them re-start QYT and see if it's well tolerated. if not, then you'll need to test the Chai Hu Gui Zhi Tang with added Tian Ma alone. If it is well tolerated, test the two in combination. If no diarrhea happens, there was another coincidental cause behind it.
If QYT is the one causing diarrhea, YGJ might, too. If CHGZT caused the diarrhea, the above comments all still hold
Hopefully that gets you going in sussing the whole situation out
Steve
by
fdzenitsky
March 9, 2022
Some more clarification and an update, Steve! He was off both formulas around his dental, stools were formed during those days, but then both were started again. We then let the XCHT (mod. already w/ 20g of Tian Ma, 12g of Gui Zhi and 15g of Bai Shao) run out last week. Stools firmed up (aha!), but the long seizure-free streak ended the next day at 1pm w/ a 3-hr. ordeal, then most days since. Times are around 9am, 11am, 12:30am, 5pm. So, the QYT is tolerated well, but not holding back the seizures. So, I am going to add 20g of Tian Ma to the QYT and see what that does, fingers crossed, I'll LYK!
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