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Loss Of Body Condition In A Dog

by Dr. Krisi Erwin - April 6, 2021 View Case Report

Hello again!

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!!

Sincerely,
Krisi

by naturevet

April 6, 2021

Hi Krisi,

I agree that Yi Guan Jian springs to mind. It addresses Yin deficiency, which is a top consideration if an animal is losing condition despite eating well and having normal stools. Is that the case? If so, then reach for YGJ. YGJ also cools the Yang Ming, which can help control the high thirst and ventral neck dryness and alopecia.

A Shao Yang disharmony may also be present here. The Shao Yang controls Yang movements, which in turn very much depend on the 'holding power' contributed by Yin. Thus, a latent tendency to disharmony in the Shao Yang is often brought to light or aggravated by a Yin deficiency.

Shao Yang disharmonies interfere with the movement of Yang in both directions, both away from and toward the interior of the body. When Yang is trapped in the interior because of a malfunctioning Shao Yang, it can aggravate Yin deficiency of the interior, by drying out moisture reserves. A loss of moisture in the Yang Ming (Stomach channel) leads to high thirst and ventral neck redness with alopecia, among other symptoms. Normally, we expect a forceful 'full' pulse with simple uncomplicated Shao Yang disharmony, but where Yin and Blood deficiency have become bedfellows with it, the pulse becomes weak.

Other traits suggesting Shao Yang disharmony exists here include:

lymphadenopathy

systemic immune problems, ameliorated by i mmune suppressant medication

aggravations in spring and fall

central stasis, showing up as a purple tongue center

polyuria and polydipsia (the former from Heat trapped in the upper burner or Stomach, and the latter because of impaired delivery of Yang to the Kidneys to generate Qi)

Secondary Qi deficiency, causing symptoms like abdominal flaccidity

For sure, follow your instincts and start Yi Guan Jian, but consider adding in Xiao Chai Hu Tang afterwards to take things to the next level

Hopefully that helps!

Steve

by Dr. Krisi Erwin

April 7, 2021

Thank you so much!! I'll bring the Yi Guan Jian with me next week to his appointment and I will report back. I've prepared them for the potential Xiao Chai Hu Tang as well. I really appreciate it!!

Sincerely,
Krisi

by Dr. Krisi Erwin

May 26, 2021

Hello! I wanted to give you an update on Merlin. He is still PU/PD and thin. Hair coat is better but not growing back along his ventral chest. Horner's and facial sagging are resolved. LN have been normal. Pulse this week was soft, deep, stronger on the left than the right and Tongue redder pink edges with a purple/lavender center, wet and sl swollen. Should I deploy the XCHT? Thanks again for your help!

Sincerely,
Krisi

by Dr. Krisi Erwin

May 26, 2021

Oh- and I do think there has been no further loss of muscle mass or condition. Still decreased muscling in the paraspinals and the masseter region but not worse. Abdominal muscles sl less flaccid.

by naturevet

May 29, 2021

Hi Krisi,

Let's add in XCHT and see what happens. Continue the YGJ. I'd expect to see improvements in the PU/PD, paraspinal muscle loss, and ventral hair regrowth.

Great job so far on a super tough case that would completely befuddle most practitioners!

Steve

by Dr. Krisi Erwin

May 29, 2021

Thank you! I will add in the XCHT and report back. I do wish the family would do some imaging on the dog just to get a better idea of what we are dealing with but it's just not in the plan for now, which I respect. They will be happy to add in another herb. Thanks again!

Krisi

by Dr. Krisi Erwin

June 22, 2021

Hello! Just an update- Merlin has been on the XCHT at 500mg PO BID (sl low dose for him but I didn't want to cause diarrhea) and he is still on the Yi Guan Jian 500mg PO BID. Decreased PU/PD already and he goes out and urinates once and doesn't have to urinate multiple times. Today, I think still a bit plump in the right submandibular and right popliteal lymph nodes. Body condition still pretty poor muscle wise. Horner's still resolved. The owner reports some peach fuzz coming back on his belly but I didn't appreciate that today. It's only been 2 weeks though so the body condition and hair will take time. Since there is some improvement already, I was going to stay at the 500mg PO BID dose (he's in the mid to upper 40lbs) another 2 weeks until I seem him again and bump him up if not really improving? Pulses seemed more even today. Soft at the higher levels and more wiry at the lower levels and I cannot compress them on either side. Tongue kind of dry, lavender.

Again, thanks a million for guiding all of us with these cases!!!

Krisi

by naturevet

June 23, 2021

Hi Krisi

That's great news! Yes, I'd keep going. To enhance hair growth and relax any muscle tightness, you could add about 15g of Mu Gua per 100g of Yi Guan Jian. Otherwise, feel free to continue as you are and see how far you get on the current mix. If there is a plateau, then bump up the XCHT to the full 1000 to 1200 mg BID

Congrats again on your success!

Steve

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