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Symmetric Lupoid Onychodystrophy In A Dog

by zenpony2000 - June 24, 2021 View Case Report

Maggie is a 5.5-year FS black and white boxer. She came from a breeding farm. At a young age she has had issues with her health. She was diagnosed recently w/ SLO- Symmetric Lupoid Onychodystrophy via biopsy. All 4 feet and all toes/toenails are affected at this point, at least 1 toenail is sloughing off weekly, making walking extremely painful for her. She also been diagnosed via echo w/cardiologist to w/ Mild Mitral valvular endocardiosis, aortic hypoplasia. She has had major gastroenteritis flareups throughout her life as well. She has started to burp recently which may be due to the antibiotics she has started. Prior to the SLO she was reluctant to jump up on couch/bed was diagnosed with hip dysplasia and some changes "narrowing" of lower lumbar. Laser and VOM has helped this per O. The last 4-6 months she has undiagnosed blood in urine. She has had abdominal u/s of bladder and kidneys, urine cultures etc, no cause found.
Meds and supplements she is on, O could not give me dosing/mg etc.
Doxycycline BID
Niacinamide daily
Vitamin E
SP EPA/DHP
SP Cardiac Support
Proviable.

On PE P is shy but not aggressive. Likes some dogs others not so much. She currently has to wear a e-collar, or she will chew her feet. O notes she loves to snuggle lay in sun, lay in front of fireplace (strong blood def.) Water and food intake normal. O working on transitioning to more species app. diet. aka getting off kibble. Her body is neither hot nor cold to touch. Her mouth is sticky to dry ( O noted she has never drooled like their other boxers), small teeth and missing some, never formed. Her feet are hot, sore to touch, nails/toes red. I have pictures but wouldn't load up right here on case details. Her pulse is fast, choppy.

I do feel that she has underlying liver blood Deficiency. I do feel that she has some degree of damp with underlying occasion GI issues and her feet do have some sticky red region, not all dry. She is oozing at some of her nail beds. Damp heat vs blood heat? She has undiagnosed blood in urine so trying to rid heat out of bladder.
Treat with blood heat formula? vs Liver Blood Def?

I also feel that she has major Jing Def. from the start. She came from puppy mill, black and white boxer (whiter), small teeth and missing some, early dx hip dysplasia, congenital heart conditions. So, should we treat for the underlying Jing Def. as well?

I do have this written up in my cases as well, wanted to add photos of her feet as well, but wouldn't upload photos.

Thank you!
Sarah Urban

by naturevet

June 26, 2021

Hi Sarah,

Thanks for this case. I'm not sure why the files didn't upload. If the photos are too large, the server refuses them. Maybe that was the issue. There should have been an error message. If you want to let me know what it was, I can look into it.

Meanwhile, I like your thinking for this tricky case, and agree there might be a couple of layers. The first seems more 'excessive' and the underlying is likely 'deficient'. We need to start with the latter, and become more fully focused on the former as signs improve.

Given the hematuria, fast and choppy pulse, and chronic paw inflammation, I'd suggest starting with Qing Ying Tang. It addresses Blood Heat with secondary Blood Stasis and Blood/Yin deficiency, associated with chronic dermatitis of an immune mediated nature.

Because of the burping, hip dysplasia, and likely constitutional issues, I'm wondering if you will need to use Xiao Chai Hu Tang as well. It treats Shao Yang disharmony, which includes deeply penetrated pathogens. Such deep pathogens are the leading cause of Blood Heat, so using the two together should more completely address the problem.

Later, when all the inflammation has died down and symptoms have abated, we may find ourselves using a Kidney tonic to 'complete' the case, but for now, I'm thinking XCHT + QYT will create a pretty comprehensive improvement. Hopefully that is how things turn out!

Steve

by zenpony2000

January 1, 2023

NEW QUESTION
So she has been doing great, heat has diminished, all unknown blood in urine has disappeared. Toenails have grown out.

She has developed some interdigital cysts that wax and wan, sore and painful - thinking damp heat. Her tongue is darker pink sticky. Her pulses are still fast and slippery, shorter. Pulses seem to vary. Shes had very mild white ocular discharge. Sclera is clear. Her skin and coat are fine, no lesions on body, just feet. Even though we took care of heat I am thinking there is damp settling in feet. Should I consider Si Miao San but support for Yin. def. as well?

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