Question Details
Collapsing Episodes In A Dog
by pindvm - March 4, 2021    View Case Report
Sofie is a FS, 7yo, Tibetan/Shitzhu. She presented for collapsing - first incident 4/2019 while in EC for possible CCL tear went into cardiac arrest. Dx from cardiologist 5/2019 meds started. Dxs myxomatosis mirtral valve degeneration with mod to severe cardiomegaly, long term skin allergies ( severe to salmon, peanut, tomato, cat dander, feathers, storage and dust mites, many atopies, moderate to barley, blueberry, cranberry, corn, green bean, green pea,kangaroo, lamb, pork, rabbit, cod, halibut, mackerel, tuna, squash (including pumpkin), wheat), primarily pododermatitis, ventral dermatitis and otitis. Allergies seem to flare Spring and Fall but also have problems in December. GI distress with colitis (mucoid) 1-3 times a year. Vet D level was low, started supplement then slightly high. Sees Chiropractor since 2019 - previous sciatica. Current treatments Pimodendan and BioCardia (2 Yrs), Theophylline (poor reaction to Terbutaline) and Benazepril (started 12/2020 per cardiologist), CytoPoint q 3-4 weeks for 2 years, Concentrated four Paws Damp heat, Vet D 75mcg SID, (last checked in Sept 2020 slightly above normal 161 ng/ml), Douxo Chlorohexadine/Climbaz Shampoo weekly, topical calendula for small infections, paw damp, probiotic mercola, Pure digestive enzymes, krill oil and ubiquinol, . Diet home cooking - Turkey, brown rice, potatoes, quinoa, oatmeal, broccoli, carrots, occasional dairy. Current status - collapses if gets very excited - playing, nervous, etc. may cough before, has urinated during once, usually paddles but doesn’t seem to lose consciousness, has slowed down on walks. Happens about 2-3 times a month. BM normal to soft, some gas - worse with stress. low water intake, Mild ventral erythema on abdomen and axilla, moderate palmar erythema all four paws - pelvic worse than front, hot and cobbled texture. mild erythema AD, dry cobbled texture. Pulses were slippery, deep weak, Yin weaker, Ki Yin weakest when we started now full, with Kin Yin still weakest. Tongue Med pink. Metal personality - patient, attentive until I am done with her treatment then wanders off. DX - Damp Heat, Blood stagnation in Upper Jiao. She is responding well to acupuncture. I am decreasing some of her supplements and trying to balance her diet. The weather is warming up here and Spring like. Owner just called and said her tongue has gone to dark red. I was thinking Si Miao San and XFZYT, stopping 4 paw damp. Would Sublime Joint still be appropriate for the recurrent skin infections?
Replies
by naturevet
March 4, 2021
Hi Deborah,

This seems like a textbook Shao Yang disharmony case to me. It's the main diagnosis to consider behind any condition with a risk of sudden death. Additionally, the following findings, when occurring together in the same animal, are almost pathognomonic:

  • Spring and fall allergies

  • Colitis

  • Food allergies (esp. if not responsive to or are recurrent on a real food diet)

  • Response to immune suppressive drugs

  • Cruciate tears

  • Ventral redness on the chest and abdomen, and especially when on the ventral neck


Shao Yang disharmony is a primary cause of cardiopulmonary pathology as well, especially where it can culminate in collapse with the risk of death

The main formula to consider for this is Minor Bupleurum (Xiao Chai Hu Tang). Long standing Shao Yang disharmony often creates, and then is aggravated by, Yin deficiency, which you are picking up in the pulse. A critical reduction in Stomach Yin in particular shows up as that slippery pulse and is what is causing the Heat in the Yang Ming organs that is manifesting as colitis (as well as the redness on the Stomach channel). To remedy that, consider Yi Guan Jian.

I'd start with both, but use a lower dose of YGJ until you can be sure that the colitis is not worsened in any way. Note that long term use of Damp drying and Heat clearing formulas can damage the Yin as well, aggravating and escalating Shao Yang disharmony until it manifests as something more serious.

To know for sure the above interpretation is correct, try treating any or all of BL 19, GB 34, GB 25. You should feel the pulse moderate with a needle placed in any one of them. I'm guessing sedation might produce the best effect, but you could try tonification. Likely the dog has issues with both the internalization and externalization of Yang, arising from a 'rusty' Shao Yang gate (which squeaks in both directions). Collapse occurs when Yang is trapped on the suface (responding to GB tonification) while allergies and pulmonary congestion are aggravated when Yang is trapped in the interior (responding to GB point sedation). Since Yin and Yang move in and out again over the course of one day, the dog has ample opportunity to manifest both types of pathology. Spring is overall a time when Yang entrapment is worse, though, so I'm guessing sedation will produce the best effect.

Hope that helps!

Steve
by pindvm
March 5, 2021
Apparently I am needing a Shao Yang lesson. Thank you so much. I will let you know how it goes.
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