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Chronic Pruritus In A Dog

by CorinneC - March 24, 2022 View Case Report

Angus (a MN Bernese Mtn dog) was vaccinated with his 3rd DAP as a pup in Jan 2020. 3 weeks later he came in intensely pruritic, covered in red rashes and pustules over his ventral abdomen, caudal dorsum, and inner flanks. He was put on AventiClav and Pred by my associate. 1 month later he came to me for hematuria, was eating socks, and his skin was just starting to get itchy again. A U/A was WNL. I tried a probiotic and a soothing shampoo which helped somewhat to calm him down but he continued to eat and then poop socks, appetite was voracious, still intermittent hematuria, an pulling fur out in tufts as so pruritic. He had a lavender, wet, swollen tongue that was engorged on the underside. His pulses felt slippery to me. I put him on SMS and Aventi GI probiotics and a homecooked diet (from the kibble he had had since adopted).

Hematuria resolved quickly but scratching and shedding escalated. SInce his tongue was lavender I thought I may missed some Blood deficiency and added Dang Gui. No change, in fact even itchier! Most pruritic at sides of abdomen, thighs, inguinal with white flakey dander, heavy shed. Skin scrape negative. Just in case given Revolution. Even worse the next day!!!! AARRRGGHH!!!! I gave in...put on Pred March 2020 and there he has stayed and is quite content.

I did try Bu Yuan Huan Wu Tang in June 2020 - no change after 3 months with this. Then Apoquel trial by associate - not nearly as effective as Pred and would scratch through the night, pulling out fur again. Neutered Oct 2020 - pulses narrow and deficient for his size, underweight, tongue pink-lavender, slightly dry, normal size. Dorsum covered in flakey golden dander, cytology = 3+ cornified epith cells, NO yeast/WBC/RBC seen, no parasites. Coat generally dull and thin. Tried Si Wu XIao Feng Yin but seemed hard on his GIT - borborygmi and loose stool so stopped Jan 2021. Then in June 2021 I tried XCHT with SWT thinking this was an immune modulation issue but unable to wean off Pred after 2-3 months.

He lingers on Pred. A 2.5 year old dog. I hate that I'm unable to get anywhere with this dog and so I reach out for any thoughts you may have Steve :) No pressure, haha!

by naturevet

March 29, 2022

Hi Corinne!

I hear you about the pred addiction at so young an age, but is he having any side effects? We still want to solve the problem and get him off the drug regardless, but how he is handling it tells us a lot about him. Generally, pred tolerant dogs are either deficient, or CHSWT dogs. You've ruled out the latter.

As to the former, you've ruled out Blood deficiency, too, but I'm wondering about Wei Qi deficiency. You did try BYHWT, but it doesn't quite have the ability to throw off Wind pathogens that BZYQT does with its Qi boosting effects.

The other things that fit BZYQT include:

A slippery feeling pulse (due to the lack of astringing Wei Qi)

Sterile cystitis occurring with skin disease

Findings consistent with Blood deficiency, since Wei Qi travels with and helps guide the Blood, stopping it from 'scattering'

Post vaccine onset (in this case from immune suppression following vaccination)

Young age of onset ((which is more typical of a deficient case)

Clearly a Heat pathogen took advantage of the Wei Qi deficiency, which SMS cleared, but SMS also ended up probably damaging the Qi a bit. Pred helps, because the case is deficient, but pred is more of a Blood tonic than a Wei Qi tonic, although low dose corticosteroids do have an 'enabling' effect on a weak immune system. Apoquel made the dog worse, because it has immune suppressive effects with none of the 'tonifying' effects of pred.

Based on all that, the next thing I'd try is Bu Zhong Yi Qi Tang. Get it going for a couple of weeks, ensure there are no adverse effects (e.g., a flare up of inflammation) and if not, try gradually weaning off the pred. Hopefully you turn this ship around!

Steve

Bu Zhong Yi Qi Tang

by CorinneC

March 30, 2022

Hi Steve!

Thank you once again for your help. Angus tolerates his Prednisone well. Very few side effects except that he has poor muscle tone for such a giant breed and chronic dander. The BZYQT really makes sense. I will see if the owner will go for “yet another” herb trial and keep you posted :)
Corinne

by CorinneC

March 30, 2022

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