Question Details
Severe OA With Joint Fibrosis
by CBecker - May 19, 2021
Hello Steve, I have an 11 yo, Lab-Border Collie with severe OA of elbows and stifles with joint fibrosis of the stifles so severe that both of her stifles will not flex past 90 degrees. Her tongue is usually pink and her pulses are almost nonexistent. She has very large flakes along her dorsum. She is currently on Gabapentin, Denamarin and Oxycontin (?). The owner is still concerned about her pain level, and I would like to help her improve her cognition.

I was debating using Xiao Huo Luo Dan, but you have stated in your Guide to not use in Blood Def animals (although I know flakes may indicate Damp and not Blood Def). Do you think You Gui Wan with added Boswelia would be a better fit?
Thank you as always for your advice.
Replies
by naturevet
May 20, 2021
Hi Cheryl,

The pain pattern might help you figure this out. If the dog is at its best on waking in the morning, although it may prefer to sleep in, then something like the You Gui Wan approach is better. If the dog is very stiff on rising and improves with motion, then XHLD is a better fit. If the dog is suspected of having had a polyarthropathy at some point (like rheumatoid arthritis), then with the weak pulse, Yi Yi Ren Tang is a good fit.

Hope that helps. If you know what points the pulse responds to (along with the method of stimulation), then I might be able to narrow it down for you

Steve
by CBecker
May 29, 2021
Hello Steve, At my last AP session with this patient, I noticed after tonifying GB-34 her pulse became stronger. And the owner said Smidgen is always stiffer whenever she gets up after lying down, then improves as she walks around. There is no time of day she is better or worse, and the temperature does not seem to affect her. She is negative for Lyme.
I think I will try XHLD for her, do you agree?

Thanks, Cheryl
by naturevet
May 29, 2021
Hi Cheryl,

My interpretation of the pulse getting stronger with tonification of GB 34 is that you are effectively bottling up the patient's Yang, creating more stasis, which is reflected in a stronger pulse. We want a supple pulse, not a strong one. Although you can't be sure until you try, I suspect that sedation of GB 34 would have improved the pulse, and that Shao Yang disharmony is the cause of the dog's stasis.

Essentially, the Shao Yang is like a layer of shrink wrap between the interior and exterior. When You tonify it, it constricts more tightly. In orthopedic cases, we often want the opposite - a slackening of that wrap, such that Yang can escape, pushing Blood before it, into the body periphery and joints.

Even from a conventional perspective, chronic inflammation and degenerative joint disease are blood deprivation states, where there is way too little blood flow, and of a very poor quality, to be able to 'actively resolve' chronic inflammation and provide tissue nourishment. The dog improving as it moves and worsening as it rests (during which blood pools internally) is a clear indication that improved joint circulation is needed to improve joint function.

Based on that, then, NSAIDs should be used only as absolutely necessary to control pain, since the have the opposite effect on joint circulation. Formulas like Xiao Chai Hu Tang and Xiao Huo Luo Dan activate the active resolution of inflammation, gradually reducing pain and improving joint flexibility and suppleness. I would use them both together in this case. XCHT opens the shrink wrap such that Blood can move more effectively peripherally. XHLD is an analgesic and Blood mover (to the periphery). When using Nat Path versions, XHLD promotes (along with Bupleurum in XCHT) the reversal of endothelial dysfunction and the active resolution of inflammation.

Hopefully you see some benefits. I would continue using chiropractic and acupuncture while you use herbs, to confirm their benefit over the coming weeks, as well as to promote circulation in their own right. Chiropractic also helps ensure pain is increasingly isolated just to the joints, and that surrounding musculature is as strong as possible in stabilizing them and restoring the dog to function. Other rehab techniques can be useful here as well, as long as their effect is to promote peripheral circulation. Do not use protocols for treating acute inflammation unless the dog somehow worsens from the above, as it will set back the restoration of circulation. Even then, just use them temporarily, before relying again on herbs, acupuncture and chiropractic

Hopefully that helps you out!

Steve
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