Question Details
Seizures In A Dog
by bfellis - December 17, 2022    View Case Report
Sunny (Sunkist)is a 7.5 yr FS who is the sweetest dog I’ve ever met. Goes to children’s Hospitals, nursing homes, VAs to truly bring joy to these people’s lives when there isn’t much to see on a day to day basis. She is very good at her job, but I believe she is such an empath she truly takes in peoples pain/sadness. Her seizures started about a year ago and we on Zonisamide as seizures were not Gran Mal and appeared to be focal. Seizure occur mostly in the morning but can also be triggered by loud noises. Seizures have progressed despite zonisamide 200mg bid Tian Ma Gou Ting Yin for Blood deficient seizures and Si Wu Xiao Feng Yin for Blood deficient dermatitis. I have also added 750 mg Keppra tid and recently 1250 mg KBr sid. Also on ElleVet CBD With no discernible improvement in seizures. They were certainly worse in late summer early fall (number and frequency) but not sure if meds are reducing seizures, though I’m sure they would be worse without ? Sunny has some of the worst large flakey dandruff I have ever seen. Not responsive to Omega 3s or herbs. She has lichenification on her abdomen and groin with large dark to pale flakes but also on dorsal surface as well. She has been on kibble with home cooked food for the last year with no noticeable improvement. I recently got her to switch to all non processed diet (mixture of commercial raw and home cooked and we are seeing some improvements with flaking. However, she is getting more and more anxious around the owner as an almost preictal type event and will clear obstacles to get next to her owner..often before a seizure but not always.
Her tongue is pale to lavender but more moist than dry with no coat.
Pulse is broad and toneless and short. Deeper I could convince myself it is a Ge Mai pulse as it became toned middle deep with tonification of GB 30. Tonification of SP4 extended the pulse. I sedated ST 36 and tonified GV3. Blood was then drawn for KBr level Which are acceptable and cbc/profile all normal. Not even a hint at liver dysfunction. After treatment, patient became anxious and you could see Wind invade the GB median starting around the ears all the way down to rear legs with quivering of semi’s, gluteals, biceps femoris. I applied pressure to the point on the ear for seizures (which I can never remember the name and haven’t been able to locate) and sedated BL15 as she became tachycardic. Seizures resolved within a minute.
Sunny doesn’t do therapy stuff anymore as any kind of stress (even trip here to clinic) seems to precipitate more seizures. Especially with AP/VSMT-we had elected to minimize treatments to not poke the dragon.
Would Chai Hu Jia Long Gu Mu Li Tang seem appropriate? I always have felt like these were Blood deficient seizures, but with majority occurring in the am, that would indicate more Damp? She recently had an evening seizure so there’s that. Tough case. Thanks for the help!!
Replies
by naturevet
December 19, 2022
Hi Brett,

It seems the two differentials are, as you say, Damp vs. Shao Yang disharmony. Since she is starting to respond (skin-wise) to the diet change, and her seizures are somewhat 'deficient' (i.e., controllable with your last treatment and focal to start with), Damp might be the place to start. I use Ban Xia Bai Zhu Tian Ma Tang from Natural Path for those. They are more apt to occur in the mornings and perhaps in the summers; more apt to have a deficiency aspect to them; and more apt to respond in some way to real food (e.g., skin lesions improving, etc.).

If that doesn't seem to improve things, or the anxiety is really becoming extreme, then start with Chai Hu Jia Long Gu Mu Li Tang. At some point, you may need to tonify Yin with Yi Guan Jian to help anchor Yang.

Hopefully one of those will be 'the ticket'

Steve
by bfellis
December 19, 2022
Thank you!! I’ll let you know how it’s going.

Brett
by bfellis
January 23, 2023
Sunny has been doing much better on Ban Xia Bai Zhu Tian Ma Tang. No grand Mal seizures but will have tremors in times of anxiety. Let’s owner know she is uneasy, but they resolve without intervention. She is on full raw / unprocessed food. I decreased Keppra from tid to bid and will recheck in 6 weeks. She is not on Si Wu Xiao Feng yin any longer and skin is still flaky, though better than 6 months ago. I would imagine I should stay away from tonifying herbs in a patient with Damp generated seizures?
by naturevet
January 23, 2023
Yes, I think so. Consider Chu Shi Wei Ling Tang, though. It can help with collarettes in some dogs and is sympathetic to the action of BXBZTMT

S
by bfellis
January 26, 2023
So as typical with Sunny, after visit to see me, where she is so happy to see me and literally all I do is gentle motion palpation and acupressure with pulse diagnosis, she had more episodes of anxiety but this time starting in the evening after dinner and continued with pacing and panting until 11:30. Then slept until 3 am and then up pacing and panting until 5:30. I’m thinking this puppy needs some CHJLGMLT in her life? Would that play well with Ban Xia Bai Zhu Tian Ma Tang. ? I also decreased Keppra from TID to BID. So I had her increase that back to tid for now.
Thank you,

Brett
by naturevet
January 27, 2023
Hi Brett,

They don't clash at all, so it might be worth giving that a try. It might also just be that her system hasn't adjusted to the lowered Keppra dose. Or that the BXBZTMT dose needs to be nudged up. The latter is probably the safest place to start, especially if you saw improvements on it

Steve
by bfellisdvm
January 27, 2023
Had a grand Mal this morning. Which she hasn’t had since adding BXBZTMT. I’m going to add CHJLGMLT and Iincrease the former.
Thank you

Brett
by bfellis
May 8, 2023
Sunny is doing as good as ever! Only 2 seizures in last 2 months. She is on a little kibble, mostly raw and home cooked. Coat and skin are as healthy as I have seen on this dog since she was spayed in 2016. She is on CHJLGMLT and BXBZTMTat 1.5 gm if each BID. Also KBR sid, Keppra tid and Zonisamide bid. She is able to visit Childrens Hospital 1-2 x per week and a nursing home 1-2 x/month.
Thank you for the help on this very challenging and very rewarding case!! Cheers!!
by naturevet
May 18, 2023
Nice! I'm glad everyone has been able to resume their normal lives! Here's hoping the good news continues!
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