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Slowing Down In A Dog

by CorinneC - May 12, 2021 View Case Report

MeiMei is a 13yo F/S Cocker spaniel with a history of ITP and IMHA that has been thus far managed with Prednisone 2.5mg EOD, Azathioprine 25mg EOD, Si Wu Tang, and Yi Guan Jian. Last August 2020 she was anesthetized to have multiple warty adenomas removed from all over her dorsum. At her recent annual exam, I found her to be "doughy", her owner describes her as "puffy". She had lost 1kg body weight but looked and felt heavier. Her dorsal coat was thin and rust brown (compared to her chocolate thick and fluffy ventral coat) and the fur had never regrown at any of the clipped sites for wart removal. The fur had been clipped at the groomers as well last summer and had also never regrown. This was initially my reason for adding Si Wu Tang then. Her ALKP has gradually climbed over the winter to 1600. She has less stamina on a walk, a decreased enthusiasm for food (except treats), and just seems dull.

Her pulses were feeble, somewhat slippery feeling, but her tongue was light lavender-purple and dry with fissure lines, not overtly swollen.

When I first met her 3 years ago she had MRSA ear infections and was such a mess, so she has come a long way with initial SMS and CSWLT, as well as Mupuricin/Burrows ear solution. I had also added Benefit Hips and knees in there for awhile as it became such a messy case. For over 2 years she was well regulated but now I think she is Damp again and verging on Cushingnoid? Does this sound right to you?

These cases have so many layers and I am very worried about changing anything too drastically because her ITP and IMHA have been so well controlled. Can you please share some guidance on this complicated case?

by naturevet

May 14, 2021

Hi Corinne,

The dorsal discoloration and lack of hair regrowth are consistent with Wind Damp Heat. The prior history of ITP, otitis, doughiness, and now the high liver enzymes are consistent with Damp Heat. Si Miao San + Mu Gua (20g per 100g) creates a formula that addresses Damp Heat + Wind Damp Heat invasion.

Now if the dog is still anemic, you could also add in 20g of Dang Gui per 100g of SMS. If the CBC is back to normal, you could wait on the Dang Gui, and just continue to monitor her and continue to rely on pharmaceutical support for the IMHA tendency. Continue to watch the CBC and if you start to see hemoconcentration, add in Qing Ying Tang, as the IMHA may be gearing up. QYT may nip the problem in the bud. Dose liberally with it if you use it.

Lastly, for every dog showing a response to SMS, as this dog did in the past, the ultimate answer to their problems going forward is a real food diet. The most we should be feeding them in the way of processed food is a freeze-dried diet.

Hopefully this helps!

Steve

by CorinneC

May 17, 2021

Thanks Steve! I had started her on Si Miao San before I heard back from you (glad to hear I was on the right track). I've asked Marci about the Mu Gua, hopefully NPHC has it? Otherwise I'm not sure where to obtain? I am keeping her on a Tony bit of Yi Guan Jian for now in the morning. She had a completely normal CBC on the recent blood work but she's crashed a few times with tapering of pharmaceuticals. I talked to the owner again and she is only on Azathioprine 25mg every third day and Pred 2.5mg every third day so very minimal dosing. I'd love to to her off Pred completely but will wait the next 1-2 months to see how she fairs.

Can I ask you to describe the Wind Damp Heat philosophy with her Doral coat? How does that work? Is is from Blood Stasis and lack of peripheral circulation that predisposes to Wind Damp Heat?

I've convinced the owner to take her off the little bit of kibble she's been on and stick with the home cooked diet I originally prescribed. Fingers crossed!

by naturevet

May 17, 2021

Hi there,

A brown discoloration of the fur often signifies Heat.

The dorsum is vulnerable to Wind invasions as it is considered the exterior-most surface, relative to the sides and the ventrum. It is harder to get a decent Blood and Wei Qi supply to, so pathogens invade there more easily, even though from a conventional point of view, any point on the body surface seems it must be 'equally peripheral' to any other.

Put these two ideas together - Heat particularly affecting the dorsum - and you get Wind Heat invasion. Since the dog is Damp, it is likely a Wind Damp Heat invasion. Given the poor hair growth and likely Dampening effects of tonics, Mu Gua is the best choice to address the Wind Damp Heat, given its propensity for treating that diagnosis while promoting hair growth. Marci should be able to source it for you

Hope that helps!

Steve

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