So I am going to repost my "Summary".
Problem Notes
Blepharitis: Dry, red eyes chronically.
Chronic Otitis Externa: Seems to do better with conventional medicine but keeps reappearing
Chronic Urinary Tract Infections: Patient keeps licking at vulva and being treated for chronic UTI at conventional vet with steroid and antibiotics.
TMJ Pain: Severe TMJ Pain with chattering frequently. Takes food very timidly and chews softly.
Treatments
BGT/SMS/Qing Ying Tang/Hoxsey
First appointment in January 22 2022: Owners have been dealing with issues conventionally since November 2021.
Started around November/October. Dog was rabies vaccinated around that time. Has always had a fear of water. Chatters teeth when she is nervous/painful. Eats very gingerly. Noted that the ulcers were on the sides of her tongue. Owner makes homemade frosty paws treats and the last time the cups splintered. Owner wondered if this could have been the cause. She takes treats very gently. Owner noted that she did get better on steroids and antibiotics.
Owner has cluster migraines. May not be cause but dog is very empathetic.
Pulse is very toned and decreased on the left. TMJ is very sore. She chatters her teeth when TMJ is palpated. She has red weepy eyes a good deal of the time per owner. Tongue is pale pink with red tip and sides. Liver Blood Deficiency with heart and liver heat?
Placed her on Bu Gan Tang at this point.
February 27 2022:
Ears are better but mouth has flared up again. Eating fresh pet select and sardines. She has halitosis and drool today. Noted lesions on her tongue again and she is drooling frequently. She is not scratching at her ears anymore. Owners occasionally give her a baby aspirin if needed for pain. Almost done with Bu Gan Tang Herbal powder.
She was vaccinated in September of 2021. Could be a correlation. May need to treat homeopathically for vaccinosis.
Pulse is decreased on the left showing a Yin and Blood deficiency. This can be causing the Damp Heat and Stomach Fire causing the mouth lesions. Lots of drool in the mouth that is copies and sticky. Noted ulcerations on the edges of the tongue indicating Liver heat. Could be Liver over acting on Spleen causing these issues. Nose is warm and dry.
Changed to SMS at this point.
March 27 2022;
Her mouth has not seemed to improve. She was recently just treated for an urinary tract infection with antibiotics and steroids. She is chewing at her right dewclaw. Her tongue is still moist and ulcerated with foul odor and salivation. She is chattering her teeth again and her gums are severely red and inflammed. No vomiting or diarrhea. She is eating and drinking well and is now on Si Miao San. She is on Fresh Pet Select but owner keeps dry out in case she wants it. She has a notable gagging cough as well.
We are going to stay on the SMS but we are going to try a chronic homeopathic. If needed we can also add Hoxsey to the SMS.
Severe ulcerations and thick coating with cracks on the tongue. Pulse is slippery. Owner noted that Molly also had a recent right sided nose bleed. Continued SMS and did some homeopathic treatments.
April 27 2022;
Molly still has CUPS and is chattering her teeth. She received Belladonna 1M and this did not seem to work. She then recieved Mercury 10M and had a reaction to that. In between appointments she had an ear infection and is being treated with antibiotics and Temaril-P. This was approximately 2 weeks ago. She seems to be eating and drinking well.
With the added steroids and antibiotics we can't be sure about the homeopathic remedies. She is still on SMS currently. We are changing to a stronger herbal that goes towards Stomach Heat. We will need to give this at least 2 weeks to see if it works.
She is also licking in the inguinal region.
Owner stated that she sounds like she has water in her nasal passages at night and early in the morning.
Tongue is still red and ulcerated in the liver region and has a think white coating that is peeling in the stomach and Spleen. This is damp Heat and severe stomach heat. Pulse is slippery.
Changed to QYT.
Today's Recheck May 2022:
Molly is doing better in some ways and not in others. She has had a few nose bleeds and they just started the new herbal on May 6th. She has decreased her eating and had another ear infection which is being treated with steroids and antibiotics. She still has severe gingivitis although it looks like her tongue maybe healing. Owner noted that she is still chattering..
We have tried BGT/SMS to no avail over a few months.
We tried multiple homeopathic remedies including treating for vaccinosis with no help.
She is currently on a whole food non processed diet.
The owner keeps going back to conventional vet and they keep putting her on steroids and antibiotics which help a little short term but have not touched her CUPS.
She is a very active young dog but her mouth is causing her severe pain.
I just dropped the SMS and put her on QYT 3 weeks ago. Her tongue may be healing a little but all other issues are still present. We are increasing her dosage of QYT (Natural Path) to 1 tsp twice daily and adding in Hoxsey. She is a picky eater but will eat apples so I am adding those and pears for cooling, have tried watermelon and cucumber but she won't eat them. Her diet protein is chicken with spinach and blueberries.
She isn't easy to feel a pulse on but from my notes it looks like it is usually either decreased on the left deep and toned or has a slippery component.
I know this is Stomach Fire/Damp heat with a Liver and Spleen Yin Deficiency component but I just can't seem to get a hold of it. The owners are great and just want her to feel better. She is thin and has no lesions dermally. She is a great dog that is a little timid but it hurts me to hear her chatter her jaw and grind her teeth due to the pain. She occasionally burps as well.
I typically laser her mouth every appointment if she is in the mood and I do acupuncture. Her pulse widens and broadens with BL 40, BL 17. I do ST 40, GB 20, Er Jian, Li4, and other points depending on what issues she has for the day. Sometimes she lets me do Liv 13 or Liv 3 and some spleen points.
So, I am going to try the QYT for another month with an increased dosage (I thought the owner was doing 1 tsp BID and they were doing 1/2 tsp BID) and we are adding in Hoxsey. Are there any herbals I can add in? My last CUPS case (why do I keep getting these?) Did well on QYT and SMS.
If you need any more notes let me know. This was just what I could summarize. This all started in November of 2021 so it hasn't been a year yet.
Acupuncture points were stimulated
Manipulation or massage was performed