Question Details
Left Side Paresis And Pain In A Dog
by pindvm - April 2, 2021    View Case Report
Tonka is an 11 yr old yellow lab, Fire Water personality. She hurt her front legs/neck 7/2020 climbing in and out of the pool. She was very lame for a while but it got better. 3/5/2021 it got suddenly worse. She is dragging the LT. LP is also weak. She is on 75mg Carprofen BID. She responded well to first acupuncture for a few days the started vomiting in the morning for 3 days last day vomited dark brown grainy. Recommended stopping Carprofen, started Duralactin which wasn’t strong enough. Restarted Carprofen lowerin* evening dose. Giving Slippery elm for ulcer. Started Xiao Chai Hu. Owner saw minimal response to second acupuncture. O is also dealing with having to move parent into hospice. Third visit she looks weaker but standing on paw more. Thin but eating well. Occasional dark stool. O has Xue fu zhu yu tang but hasn’t started. Wondering if Bu Gan would be a better choice? Also wondering about pneumopuncture over spinatus muscles - has anyone done this on a dog?
Replies
by naturevet
April 4, 2021
Hi there!

I think the XCHT is a great idea, given the:

  • Seasons of onset and aggravation (spring and fall)

  • Concomitant Stomach Yin deficiency, evidenced by GI ulceration and the time of vomiting (when Yang Ming or Stomach dryness) is peaking

  • Improvement with NSAIDs, which implies a Stasis condition of some type


The Stomach Yin deficiency is often tied to Blood deficiency in general. Bu Gan Tang won't particularly address the Stomach, but has Blood tonics that help resolve any associated spasm. Yi Guan Jian will resolve the Stomach issues, but doesn't have the antispasmodics. For me, then, I would try Yi Guan Jian and add in Mu Gua (maybe 15g per 100g) to have the best of all worlds, but if right now all you have is Bu Gan Tang on your shelf, at least start with that. Continue the XCHT at the same time.

Chiropractic is usually needed in these cases to provide rapid relief. Do you have a local resource you can send her to (if you don't do it yourself?). Otherwise, gentle manual mobilizing of the entire neck is called for, from the atlas on down. Basically you are trying to rock the vertebra, pressing down on the transverse processes and pillars, first on one side, then on the other. When you find one that doesn't dip on one side as much as it does on the other, it needs to be more firmly nudged downwards as you're manually mobilizing things.

As for pain killers, gabapentin may be a better choice for this dog, since the problem is most likely nerve root impingement, given the involvement of the neck, forelimbs, and (apparently) the Shao Yang. Maybe see if that drug gives the dog more relief, at which point you can start finding the lowest required dose of the NSAID, thus giving the stomach a break. The Blood and Yin tonic is still needed, though, even if the vomiting stops from the change in drugs.

If you're seeing limb atrophy, then there may be a peripheral nerve lesion. Rule outs would have to include a tumor. But if 'weaker' doesn't mean 'atrophied', then the above approach is the first thing I would try

Hope that helps!

Steve
by pindvm
April 7, 2021
Was Xue fu zhu yu tang a bad choice? She has Supraspinatus and infraspinatous atrophy. She can barely lift her L front leg. It was a bit better last time I saw her but still 5/6 lame. I recommended a chiropractor as well as an orthopedic/ Neuro consult.
by naturevet
April 7, 2021
Hi there,

Sounds like you may be dealing with a tumor of some type, maybe of the nerve sheath, or something surgical causing peripheral nerve root damage. A work up is a good idea.

It's not so much that we make wrong choices as it can take some time to find the right one, and the type of pathology we deal with doesn't always give us that luxury.

Minor Bupleurum is the default choice for any neurological lesion. I'd start that even as you deploy these other services. It is anti-cancer and a strong neural anti-inflammatory. Also, gabapentin and/or short term corticosteroids should probably even be considered

Hang in there. You might be able to turn this around

Steve
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