Question Details
Intractable Seizures In A 22 Month Old MN Pittbull
by Dr. Krisi Erwin - May 26, 2021
Hello!

I tried to do the Ask a Case question post but it says I need to update my other questions. I did post 2 updates today but maybe not to the right place. I did have a question to ask, though, re: a case I saw today.

Rhino is a 22 month old, MN, Pittbull. My client adopted him last summer and he started with seizures shortly after. Initially they were a couple of times a week and he had an MRI with NSF. He has slowly increased the need for anti-seizure medications and the frequency of his seizures has increased. He now has them in his sleep (petite Mal) and is clustering with grand Mal when he is walking. He was recently hospitalized x 4 days and he is taking Keppra, Zonisamide, Phenobarbital, Potassium Bromide, and Topiramate. The neurologist is having her do rescue doses of his seizure meds and also giving him q 6 hour valium x 48 hours post clusters to try and avoid hospitalizing him again. He is not overly sedate in general on the medications but the Bromide has added some sedation (this was added in the last week). The Valium makes him almost non-functional. Very ataxic walking, muddled thinking and demeanor. I saw him on a valium day. He does have a history of both Ca Ox and struvite crystals and is on S/O diet and Potassium Citrate. Minimal history of GI sensitivity, no vomiting pre-seizure. Even as a bully breed, his skin has been generally quiet with no history of yeasty ear infections. He has had surgery for elongated soft palate. Any heat sensitivity seemed more related to breathing more so than feeling "hot." He is well muscled, hair coat is nice. He is very small in stature- 50lbs but short. He is not over weight.

The owner is seriously considering PTS but is willing to give the K Br a month to work. I did acupuncture him today. On initial presentation, tongue seemed lavender.Maybe sl dry. Pulse was super weak, not thin. It was deep. It felt softer and more full after I treated him. I started him on Ban Xia Bai Zhu Tian Ma Tang with adding Jiang Can today and Denamarin. I don't know that the Ban Xia is the right formula to use- he doesn't have a lot of the GI signs but I thought maybe the crystals could be dampness in the bladder? He didn't seem like an over the top dog like Long Dan Xie Gan Tang. He is pretty chill in general but when he plays with other dogs he will get overly excited to where he cannot focus. There is no aggression at all. Looking at Dr. Xie's book wondering if Di Tan Tang and Epimedium might be a back up plan? I will see him next week.

Sorry this is a bit disjointed- trying to get my question out to the ether between appointments! Thank you for any insight!!!

Sincerely,
Krisi
Replies
by naturevet
May 29, 2021
Hi Krisi!

Tough case! I hope the owner gives you some time to figure this out, as these clustering dogs can do amazing well - and quickly, too - once you find the right formula.

I see your thinking about LDXGT vs. BXBZTMT. See how that goes. If the dog is definitely better, keep going with it.

If the seizures ease a little, but not enough, Tian Ma Gou Teng Yin maybe more powerful, even though it does not address any Damp. If that turns out to help a lot, then you are looking at a Blood/Yin deficiency. Follow up use of Xiao Yao San with the TMGTY in that instance can help reduce Damp tendencies but still address the seizures. If the dog is Hot at that point, use of TMGTY with ZBDHW can cool him off and provide some Ze Xie to reduce the calcium oxalate crystals.

If there is no impact of Tian Ma containing formulas, but you intuitively still want to explore Dampness , try the LDXGT. It has Ze Xie in there to help reduce crystals. It can be used in animals whose pulses are deceptively weak, due to a damaged Blood supply from longstanding Heat and diets that are too low in protein.

If the dog improves from a Dampness or Blood/Yin deficiency approach, then a move to a starch-free real food diet is paramount, and may produce dramatic improvements. If it is an anti-Dampness formula that helps, food and snacks should be made 100% free of rice, corn, wheat, etc. Starchy vegetables like sweet potatoes are okay. White potatoes should probably be avoided. A move to that diet may not only pull the rug out from underneath the seizure tendency, but wipe out any traces of crystals.

Why would a real food diet help the crystal tendency? The high glycemic index of kibble, especially when it contains starch, has been shown to produce immediate post-prandial renal inflammation in dogs. Where this affects the tubules, the urine may be becoming seeded with proteinaceous nidi, around which calcium oxalate and magnesium ammonium phosphate then accrete. If the renal tubule inflammation is wiped out through diet change, there are no nidi, and thus no crystals. That's been my observation over the years, anyway.

The other possibility here is a Shao Yang disharmony creating the seizures, especially if they started in late summer or are more likely to happen between 7 pm and 1 am. For that situation, I use Chai Hu Gui Zhi Gan Jiang Tang, with added Tian Ma (20g per 100g of base formula).

As for Di Tan Tang, I have not found it helpful, but haven't tried it in many years.

Hope that helps you out!

Oh, and to officially update a case, you need to go to Cases -> My Cases, and then click 'Update'. Fill in the blanks or check the boxes as appropriate. It hopefully will only take a minute or two per animal. If you get any errors, take a screenshot, let me know what you were trying to do, and email it to the webmaster link below, so I can debug things for you. Hopefully you won't have any problems!

Steve
by Dr. Krisi Erwin
May 29, 2021
Ok! Thank you! I've known this client much of my career so she will keep going as long as we aren't getting ethically unfair to Rhino. I will see him this week again for acupuncture and will update again. I have LDXGT in stock. Will have to check re: the Tian Ma Gou Teng Yin. If the initial formula helps some but not enough would you add the Tian Ma Got Teng Yin to it or instead of it? I do have the Xiao Yao San on hand too. We will see- fingers crossed!

I will play around with the cases as well. I really appreciate it! Have a wonderful weekend!!

Sincerely,
Krisi
by naturevet
May 29, 2021
Hi again,

If it helped a little, I'd change BXBZTMT out for TMGTY. If it helped a lot, I'd add it in to see how much further control you can get. Diet change is mandatory, as much as you have control over that, if BXBZTMT helps a lot.

Good luck!

Steve
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