Question Details
Damp Stasis And Deficient Skin Lesions In A Dog
by fdzenitsky - February 1, 2022    View Case Report
HI Steve,

Jhett Jensen is a patient I've been fumbling with for a while. His background is in my Cases w/ recent updates, if you could please take a look and link to this thread.

I'm pretty sure we have immune dysregulation (probably since before a year of pointless chemo), such a mixed bag, no real improvement on raw diet, tonifying, draining, boosting wei qi. Most improvement on a Bupleurum formula, I probably changed horses too soon. I think I want to go back to a SYD formula, but there may be a better option given the rash of hematomas and his high anxiety - always, just a whole lot of nervous energy. After treading for this long, I thought best to maybe run this one up the pole, for reals this time!

Many thanks, Franchesca
Replies
by naturevet
February 4, 2022
Hi Franchesca,

I agree with your analysis. Overall, the dog does better when herbs and ambient Yin Yang movement support peripheral (and thus hepatic) circulation. Regulating the Shao Yang goes a long way to supporting peripheral circulation. The recent worsening this winter may have been because it was not being addressed, and it is now winter. The two factors together may have overwhelmed the otherwise appropriateness of Blood tonics and BZYQT.

If that is the case, then XCHT + SWT should help a lot. It's the first thing I'd try. If it works well, chances are it will be of enduring value

Let us know how it goes and good luck!

Steve
by fdzenitsky
February 28, 2022
Hey Steve, Help!

Our analysis and game plan is backfiring on us! After a few weeks on the CHSWT, this is feedback from Jhett's very frustrated owner...

"Jhett's itching is so bad and it is literally his whole body. If he isn't sleeping he is itching. He gave himself an ear hematoma. I noticed it this morning. I hadn't noticed him messing with his ears, usually I do and I know that's when they need cleaned. What do you suggest for hematomas? My 1st dog got one and we let it just be. It scarred a little funky but she was fine. Besides being on high dose prednisone, the only thing that has stopped Jhett's itching is a cytopoint shot. I know that goes against everything we have worked for but both he and I are miserable. I think I want him to go back on dry derma for his coat too."

Is this an aggravation from the CHSWT and why when he is clearly immune dysregulated - is it b/c I'm exteriorizing Yang that needs to be interiorized? What to do now? I am assessing Excess, Heat, Yin (and Blood) damaged or consumed by unrelenting Heat (tolerant of CS and cytopoint) and unable to anchor Yang internally, definitely Blood Deficient (skin improves w/ SWXFY), and definitely SYD. Should I switch to CHJLGMLT + SWT and add back SWXFY? I worry about tonifying an Excess at this time. Would QYT or LDEMS be appropriate given the extreme itch and heat - and now the aural hematoma? In these cases, do you find temporary use of CS useful to provide immediate relief while working to heal the patient? I have in the past, before starting TCM herbs, put him on 4mg of Medrol per day and it helped (he is 70 lbs.). Finally, for the hematoma, do you still recommend Yunnan along w/ Arnica or Hamamelis 30C and topically?

Thanks again for you input on this!
Franchesca
by fdzenitsky
February 28, 2022
Some more owner info for you, Steve - And my bad, the Medrol did not quell the itch after all. :( Thanks!

"Hematomas are stable on his belly, nothing else noted on his skin. Stools are still bulky but solid. His coat is very dry - white dander, esp. by his ears, it has a coarse texture to it, not soft. He looks good a day or two after a bath then it goes right back and bathing does not help the itch. Right now, his ears are warm, crusty. I cleaned them this morning also. Nothing pus like, just the dark brown gunk. He is itchy on his sides by shoulders, ears, all extremities from the elbow and knee to the paws, underside and on top, itchy around the base of his tail and licks his groin/butt area. This is consistent no matter what the weather or season. When he had those staph infections, the cytopoint shot cleared up the first set (the dermatologist gave me antibiotics but I didn't use them b/c the cytopoint did the trick) and the next time he had it when you saw him, the dry derma cleared it up.
"He eats the premade raw, I rotate between pork, turkey, bison and some lamb. I add one scoop of pre/pro biotics in the AM to help with his stool, 3-4 pumps of salmon oil each meal and the recent herbs you have him on.
"I stopped the medrol because I did not visibly see any change with him when on it so I wanted to stop to see if I noticed anything that way. I didn't notice one way or the other - it was only when he was on the higher doses during chemo that the itchiness improved."

He is (they are both) miserable! He has never been on antibiotics for the skin. Since it is cooling and drying, would a course of cefpodoxime be appropriate along w/ the herbs to try next?
by naturevet
March 1, 2022
Hi there!

A worsening on CHSWT would have to suggest acute skin inflammation, and an excess of blood flow to the skin. That makes me think of Si Miao San as a next step. The only issue is that he did not improve or resolve on the raw diet.

So, if the challenge is to increase skin circulation to combat infection and dryness, but in an anti-inflammatory sort of way, then Qing Ying Tang is a good next thing to try as it does treat Shao Yang disharmony. It just doesn't use Bupleurum to do it.

I like the idea of antibiotics and Yunnan Bai Yao as well.

Hopefully that helps you out!

Steve
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