14 year old f/s pyrenean shepherd
wt 22.8 lbs
history
6/24/20 - chronic cough, coughs after drinking, vestibular syndrome, 4/6 murmur, normal rhythm, lungs clear, severe dental calculus
cxr - cardiomegaly, left atrial enlargement, no evidence of CHF, diffuse bronchointerstial pulmonary pattern
7/11/20 - echo - myxomatous valve disease, severe LA and LV dilation stage B2
bp - 200 mmHg - very nervous
meds started - pimobendan 2.5 mg PO BID, enalapril 2.5 mg PO BID
7/25/20 BP 130 mmHg
10/2/20 - coughs after drinking still, appetite sl. reduced, pants all the time, energy not what it used to be
tongue dark lavender, pulse superficial toned
12/19/20 - maybe panitng a little less - does better in cold weather, drinking more, appetite sl. decreased, trouble
going down stairs
exam - lenticular sclerosis, iris atrophy, heavy calculus/halitosis, iris arophy, 3/6 murmur, normal rhythm/rate, lungs clear, resents hip extension/decreased rom
soft sc mass left thorax - lipoma
tongue pink to red, pulse - strong, very toned/snappy
10/8/21 - coughing increased coughs up white phelgm occasionally, panting a lot, confusion worse, eyesight and hearing seems worse
PE - eyes/teeth as noted, 4/6 murmur, occasional abnormal rhythm, tiny adenoma with scales right pinna
tongue dark lavender with phlegm, pulse - toned, strong, mid depth, sl. fast
pea sized left anal sac nodule - fna - anal sac adenocarcinoma
cxr - moderate to severe cardiomegaly with left sided CHF
ECG - sinus rhythm with intermittent single APCs
Rx furosemide 20 mg PO BID
10/30/21 - great appetite, PU/PD, seems overall better, coughing a little more
pulse - toned, strong, fast, superficial, tongue big, lavender body, red tip
echo - myxomatous valve disease, severe LA/LV enlargement stage C
cxr - moderate tracheal collapse, replapsed cardiogenic edema, sl. hepatomegaly - liver included in rads
increased furosemide to 30 mg PO BID, prescrivbed hycodan 2.5 ml PO BID or as needed
recommended Nat Path modified xue fu zhu yu tang - shared the formula with Pan's owner who is a human acupuncturist and chinese herbalist -
she looked at the formula and recommended using xue fu zhu yu tang with 7 grams of Fu Zi and 5 grams of Gan Jiang. I went with this, but in restrospect this seems like it will
make it too warming. I will share her e-mail.
11/13/21 abdominal ultrasound to stage anal sac cancer - liver - hyperechoic lesions - non specific, kidneys - possible early renal disease, pancreas sl. heterogenous
1/14/22 - dry harsher cough increased in frequency, increased appetite, drinks alot especially after pimobendan, gets agitated at 5-8 pm, wants to go outside, likes to play
outside in the snow
PE - 5/6 murmur, arrhythmia, lungs clear, anal sac nodule sl. increased in size, sl. dull coat
tongue - dark/lavender to reddish, big/hangs out of mouth/over teeth, mild phlegm
pulse - toned, fast, strong, superficial
ECG - atrial fibrillation
superchem/cbc/t4 - ALP 166 (5-131) - was 174 on 10/8/21
BUN 37 (6-31) was 32 on 10/8/12
Calcium 12 (8.9-11.4) was 11.6 on 10/8/21 - had been elevated prior to anal sac nodule's appearance, but this may be causing the increase
platelets 644 (170-400)
Rx diliazem 15 mg PO TID
cxr scheduled
A - qi/blood stagnation chest - cough, cardiac disease, arrhythmia, tongue, pulse
damp/ phlegm/stagnation anal sac nodule, phlegm on tongue, lipoma, adenoma
agitated in the evening - heat/yin deficiency/triple burner obstruction
excellent appetite - heat/yin def/damp
PU/PD - heat/yin def
increased platelets - triple burner obstruction
vestibular episode - triple burner obstruciton
It seems some version of XCHT would be a good fit for her as would the Nat Path modified XFZYT.
What do you think?
questions - what are the TCVM DDX for arrhythmias - stagnation, qi deficiency?
HERE is the e-mail from Pan's Mom a human acupuncturist/herbalist:
Xue Fu Zhu Yu Tang is a good formula.
The theory looks like it is from the Traditional Chinese Medicine (TCM) Angle. All good.
And from the veterinary angle, that is your department.
What I can offer is an add from the Classical Medicine lineage.
Here is how I would assess the herbs via Classical Chinese Medicine - I practice both TCM and Classical. Apologies for the long winded explanation.
Tao Ren - a heavy duty blood mover, not as heavy as like an E Zhu
Dang Gui Shen moves, moistens, and warms - the primary blood herb, it does moisten the stool (not too much), but has that function, warming the blood alone can often help it move an if there is ‘crappy blood’ (too dry, stasis, or too cold or hot)
Hong Hua is a flower that means it’s direction is up and out so it helps spread the blood
Sheng Di huang - can be cloying hard to process but with Chuan Xiong and Chi Shao it can tonify and move, blood nourishing, to move the blood, there needs to be enough good blood to move
Bai Shao is fantastic for bringing water back into the blood and getting fluid where it should go - different from a diuretic method of moving fluids, different from just adding translucent moistening herbs but by bringing what is described as water that separates from the blood back into the blood. It is often described as getting the fluid that is not where it should be and getting it back in right relationship. That improves the quality of the blood, which is the goal. It changes a pathological substance into a physiological one ie makes it useful.
Chi Shao - similar to Bai Shao - it is red vs white and is more moving and has less of a function of absorbing but still has some
Chai Hu is a popular Liver Herb (store/release blood), which helps open the Shao Yang pivot - if the pivot is not open it will keep fluid backed up and headed back to the heart and lung, critical to keep that open
Huai Niu Xi also directs the blood downward to the lower body -
Jie Geng is an excellent choice, like Bai Shao it is a chalky herb that helps absorb fluid, and goes to the lung, aids the cough, also helps with phlegm which is translated in this case as fluid congestion in the lung or an accumulation of phlegm that can create a nodule possibly blocking the anal gland
Zhi Ke is an earth herb that along with Chai Hu helps get the fluid to move down, aids the yang energy from above - yang is the force moving the yin substance, so this is critical in getting proper digestive function which is often where fluid and dampness or blockage arise
Gan Cao is a harmonizer of all the flavors of the herbs to make them all function at their best, it actually generates fluids (steroidal quality0
The one missing item is a Rou Gui (Cinnamon Bark) or a Fu Zi (aconite) -something to build the fire below to heat the moisture to steam it up and out to moisten lung and to cool the heart fire.
With Gan Ca, these 3 herbs are great for anchoring the yang below the yin in Shao Yin (ministerial Fire).
Shao yin is Ki/Ht the place our yang from heaven roots below - it is the fire that warms us and births the yin which is the substance that nourishes the digestion Tai Yin (Lu/Sp) and Jue Yin (Lv/Pericardium).
This process allows the three yin to properly function. Once out of the 3 Yang conformations and into the 3 Yin conformations it is a later disease condition. Shao yin regulates the water and fire, aids the Tai yin the metal and earth in digestion and together they create fabulous blood which is jue yin (ministerial fire, Wood).
Xue Fu Zhu Yu Tang all about moving blood, and a small amount of nourishing.
The fire below that can get Pan’s root re connected is still to be addressed.
That said, formulas for pets are premade, I imagine, so there is little chance to tweak a formula.
Go with this formula and we can see what shows up.
Maybe there is a formula you have in you book with Rou Gui, Fu Zi, Gan Jiang, Gan Cao - Might be called a Si Ni Tang.
If there is we could try adding that after this - either alternate it as an add, or alongside it.