So I have this patient, Merlin who is a 12 yo, MN Cardigan Corgie. I have been treating him for the last several years for low back and hip pain. In the last 6 months he has really started to present with mixed clinical signs that I am having a very hard time sorting through. Prior to this, he is prone to fighting with his housemates and the family has to rotate their dogs around so that there is harmony between them. He has a history of Atopy and has had to be on Apoquel for years.
What I am seeing now is:
Intermittent enlarged LN- popliteals most often but sometimes submandibular and right prescapular
PU/PD, flaccid abdominal wall, seeming hot- like a Cushing's dog but cannot confirm on labs and Alk Phos is normal.
Seems hot and dry
Significant muscle wasting on his head and dorsal topline- he looks like he has cancer.
Right sided facial nerve paralysis and sagging.
Hair coat is more dry and losing much of hair- especially from his jaw down to the manubrium.
I don't know why I'm having such a hard time sorting out what to try re: Chinese herbs. RE: AP, I am trying to do points to nourish Yin and Blood. His tongue at my last visit seemed somewhat flabby, purplish lavender in center and redder around the edges. Pulse seems thin and deficient to me. I do not believe it to be wiry.
I've had Yi Guan Jian lurking in the back of my mind for him to try. I guess I keep having additional thoughts of cancer in the back of my mind too. I would love some thoughts and will try to sort out how to post pictures of him as well. I think the rDVM has recommended abdominal U/S, ACTH stim etc but the family is oddly reluctant. I'm not sure if it's because things are so much harder because of COVID and because of curbside service?
Thank you so very much. Please let me know if any additional information would be helpful!!