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Senior Pet With Pleural Effusion, Lytic Bone Lesion And Pulmonary Nodules

by vgdvm - February 2, 2021

Hi Dr. Marsden,

Luna is a 13 year old FS Labrador/Pit bull mix that is a Fire constitution. She has a life long history of being overweight (BCS 7/9) and multi-focal diffuse SQ lipomas all over her body that worsened significantly with age (they started popping up all over the body within the past few years). She was recently treated for a UTI that took a month to resolve.

About a month ago, she developed an acute cough that was loud and dry. It is intermittent but does seem to be worse during late into the night (between 1-5 am) and most recently she had coughing fits between 3-5 pm and worst one at 3-5 am. She drinks generously and pants a lot but doesn’t seem to have a temperature preference and likes the dog bed and floor equally per owner (prefers the bed). Appetite is normal and she loves to eat.

Today pet came in for an exam and diagnostics to determine the reason for her cough. No murmur was ausculted. She is not cyanotic, tachypneic and does not have labored breathing. Bloodwork showed mild hyperglobulinemia, but was otherwise normal, heartworm negative. Her tongue was dark red and dry. Her pulses were very deep, thin and fast. Thoracic rads showed pleural effusion with aggressive osteolytic lesion of sternebra and pulmonary nodules.

My goal for this sweet girl is quality of life - to improve Qi, Yin and get things moving. While addressing the presence of dampness and Phelgm in her body. Can I get your thoughts on what herbals I can initiate? She will be getting acupuncture weekly as well and we will be starting a home cooked diet.

Thanks so much!

Veronica

by naturevet

February 2, 2021

Hi Veronica

This looks like a challenging case. I imagine you'll have to take it in stages, rechecking the dog every few weeks and watching for a shift in symptoms and pulses that indicate a new layer of pathology is present, calling for a potential shift in approach.

Right now, the first layer of the case seems to be one of Stasis and Stasis Heat, signified by:

loud harsh cough

dark red tongue color

deep thin rapid pulse

pulmonary nodules

sternal lytic lesion

It's possible that an accumulation of Dampness and Phlegm caused the tendency to Blood stasis, but perhaps not, so we shouldn't presume it until we see it. That might take the form of a more productive cough so watch for that.

Meanwhile, we should look at Blood tonifying and moving formulas that clear Heat, in the form of Modified Xue Fu Zhu Yu Tang. Given the time of year involved here, I'm suspecting the difficulty in moving Blood out of the chest and into the periphery is compounded by a Shao Yang disharmony. The Shao Yang acts as a sort of gate controlling the movement of Yang and Blood to the body surface. If it is closed, then it gets bottled up inside. Around this time of year, Yang starts to mobilize in anticipation of warmer weather. If it is held back by a dysfunctional gate, Stasis and internal Heat signs appear.

If this thinking is correct, then the dog should improve on Xiao Chai Hu Tang and Modified Xue Fu Zhu Yu Tang, both of which are available through A Time to Heal. I'd recommend the granules, but if they are in short supply for a month or so, the Kan Essentials equivalents might suffice to get the ball rolling. XCHT is called Harmonize the Qi by Kan, and mXFZYT is called Dispel Stasis from the Palace of Blood. I'd suggest dosing heavily to start with. You can find dosing instructions for her weight using the Kan products for free on the Natural Path Herb Company website.

There's a possibility of Wei Qi deficiency here, but with all that Heat, we'd best hold off on Wei Qi tonifying herbs for the time being. If she cools off and the pulse remains weak, it's a consideration.

Let us know how this goes. Hopefully you can get her comfortable and stable. Take note of which points seem particularly beneficial in moderating her pulse

Steve

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