Question Details
Gagging In A Dog
by CorinneC - July 8, 2021    View Case Report
Finnegan is a 4yo MN Grench Bulldog that I started seeing in April for a second opion for IBD, hemivertebrae and history of IVDD and disc herniation. He was on a long list of meds from interanl med specialist = SQ Dex, Lukeran EOD, Losec SID, Gabapentin SID, SQ B12 q2wks.

Had been doing decently after rescued (med seizure for abuse, disc herniation, told to euth but o persued). Then vaccinated 2018 and allergies started - hives, facial swelling, U/S - sliding hiatal hernia, performed gastropexy. Then put on z/d, MTZ prn, and Losec SID. He became very skinny with Pica, ate a toy Dec 2018 - not actually scoped and removed until Mar 2019, then biopsied and diagnosed with lymphocytic-plasmacytic and eosinophilic enteritis and put on the above long list of meds. Only started Lukeran 2 moth prior to initial visit and lost ^^ muscle tone and ligaments starting to go acc to o. Presently can only eat scrambled eggs or emu with green beans, Honest Kitchen. After 2 months on any particular diet he starts to have a weird cough/gags, chews feet, regurgitates all night.

Finnegan tends to be an anxious boy, history of dog reactivity but has improved with training, likes to sleep on heating pads, less cuddly on chemo, poops out quickly (seems SOB to o) on a short walk, appetite voracious. In April he was SO skinny/emaciated with MCS 3/5. His tongue was light pink/lavendar, dry and pulses toned to taut (seemed to calm with SP4). His eyes were bright and vital however which I found amazing considering! I did dome AQ ( GV20, GV14, BL19, BL23, BL40, ST36, SP4, Rx'd Liu Jun Zi Tang and BZYQT. The LJZY seemed to make him itchy soon after starting so o stopped, but he had really good energy for 3 days after AQ. I added XYS instead thinking the LJZT was too tonifying but felt he still needed more SP and LIV support for Qi Stagnation??

By May he was gaining weight and seemed to be doing much better, calmer, less reactive and grumpy. O stopped chemo and dec Dex. Flash forward to June 16, good weight but belly skin turning black/licking at belly and feet again and gagging at night with white foam at nostrils, every night from ~8:30pm-3am. Seems like he's choking, trying to clear. Only getting Dex periodically. Thought ShaoYang disharmony so stopped BZYQT , cont;d XYS, and stated Open the Liver Canals. Yest back for AQ and still gagging! O tried more Losec, propping head up. Seems really tired on OTLC.

I', thinking this gagging is regurg?? PLEASE HELP!!!!!
Replies
by naturevet
July 9, 2021
Hi Corinne,

Open the Liver Canals contains Turmeric, which can be irritating to some stomachs. Keep that in mind and maybe try Minor Bupleurum instead, if the recommendation below doesn't work.

Meanwhile, given the prior response to Liver and Spleen harmonization, you could continue trying to make the Liver (i.e. Jue Yin) happy, by prescribing Wu Mei Wan. The latter is exceptional at dealing with middle-of-the-night regurgitation in people due to Liver excess. It can be further modified by adding Mu Li if you feel it's helping but not quite enough. For now, though, just try the basic formula.

Hopefully that helps you out. Continue the Xiao Yao San at the same time, since Liver (i.e. Jue Yin) excess is often caused by Liver Blood deficiency.

Congratulations on getting as far as you have with a very difficult case. You're an exceptional doctor! Let us know if you don't get results with the above.

Steve
by CorinneC
July 9, 2021
Thank you so much Steve. Wish I felt as confident about myself as you suggest ?? I will definitely start the Wu Mei Wan. Totally makes sense. And I like the idea of XCHT by itself. Why does turmeric cause irritation from a TCM perspective here?

Thank you SO MUCH as always! These cases are so hard but when they improve and start to thrive I am overjoyed!!! So grateful for (((TCM)))
by naturevet
July 12, 2021
Hi Corinne,

That side effect of turmeric is listed as a reported side effect in some databases.

From a Chinese medical point of view, because the herb is warming and aromatic, if the Stomach was actually Yin deficient, then it could aggravate that deficiency further (by 'evaporating' the Yin). This is more apt to be the case in an overall Blood and Yin deficient patient, which is commonly observed in animals with Jue Yin excess

Don't forget to rule out endoparasitism. This can potentially be present in animals benefiting from Wu Mei Wan

Good luck!

Steve
by CorinneC
July 12, 2021
Perfect! WMW sounds like the best option all around then. We started it on Saturday. I will update in a couple weeks.
by CorinneC
July 16, 2021
Finnigan is quieter and has become very lethargic since adding on Wu Mei Wan. Owner emailed and stopped all herbs (WMW, XYS, BZYQT). Still very congested and even smells like vomit now. I am not sure how to proceed with this very complicated case.
by CorinneC
July 16, 2021
Finnigan is quieter and has become very lethargic since adding on Wu Mei Wan. Owner emailed and stopped all herbs (WMW, XYS, BZYQT). Still very congested and even smells like vomit now. I am not sure how to proceed with this very complicated case.
by naturevet
July 16, 2021
Okay, I guess see what happens with nothing in his system. Maybe Cerenia to give him and the owner a break?

I'd also wonder about Liu Jun Zi Tang, on the principle that there are no side effects with herbs, just latent tendencies that are unearthed. Quiet makes me think Qi deficiency and LJZT addresses nausea and Damp (which can cause reflux). Just a thought if he doesn't bounce back

Steve
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