I am treating Lexi, an 8 yr old FS lab for cirrhosis, and she has recently developed climbing liver enzyme levels and deep pyoderma in her feet.
I first started treating her 5/2008 when she presented for an aural hematoma and she was icteric. An ultrasound 5/08 supported severe hepatic cirrhosis. We were able to get her stable and pretty close to normal enzyme levels to be spayed 2/2009. At that time, the specialist also found and remove an anal gland adenoCA which showed evidence of lymphatic invasion, and a mammary lipoma. The owners declined chemo for the adenoCA due to the cirrhotic liver. AFter the surgery, she has been fairly stable on Bao Hu Jiang Jin Can, Jia Wei Xiao Yao San,or GXZYT as her CVM dx indicated.
Recently however, 9/14/09, her liver enzymes rose: ALT 468, ALP 748, tbili 1.2. Her tongue was red, dry body with slimy edges. She is an extremely enthusiastic dog, can't seem to contain her excitement. Pulses were rapid, L<R, thready and more superficial. CVM dx: Liver Yin deficiency unable to restrain Yang, Heart Fire/Yin deficiency, DH GB, Liver Qi-BlX. She has been on a home cooked diet since the beginning, with silymarin, samE, antioxidants. I started Standard Process Hepatic Support, Yin Chen Hao Tang 1 gm BID for GB DH, and made my own formula for the liver: 60 g GXZYT to invigorate Liver Blood, 15g Chai Hu to move Liver Qi, Bai Hao She She Cao 5 g with Gan Cao5 g to clear Damp/toxic heat,15 g Ling Zhi to lower liver nz and nourish Heart, 10 gWu Wei Zhi to astringe and consolidate the liver, and 10 g Da Bu Yin Wan to norurish Yin to put our Fire.
Ten days later, Lexi presented with purulent draining trtact on the dorsal surface of all 4 feet, rear>front, over the MT/MC-P joints. Her tongue was swollen, red with a wet tip. No sedation orchange in Shen. I interpreted this as a detoxification reaction of the Liver (liver governs the feet), and added 2 gm BID`SMS and amoxicillin.
I saw her again yesterday. The draining tracts are 40-60% improved but still moderate on the right hind foot. There is heat around the medial hocks (KID6, SP6), no active GB points. No unusual sedation, V/D. Hair is greasy, dull, shedding. Wt is stable. Tongue is large, dripping with small cracks, thin white coating, mostly red with a sl purple center. PUlses are rapid, thin. They are kind of hard to feel (weak?) and best fel superficially (thready?). Not choppy or wiry. Liver nz: ALP 1004, ALT >3000, GGT21, tbili 0.8.
A: DH GB improved with SMS, Yin Chen Hao Tang. Liver-Kidney Yin deficiency with Damp, less Heat, Liver QiX-Bl def, Yin deficiency not restraining Yang and not cooling Heart. I do not see signs of Qi deficiency yet. Toxic Damp Heat and local stagnation in feet?
I continued the silymarin, samE, antioxidants, hepatic support and diet unchanged. I discontinued the Yin CHen Hao Tang as the GB DH is resolved. I am not sure what to do with the liver-I know I need to nourish Liver Yin/Blood as I am worried with the cirrhotic liver that continuing to drain will be too drying, but I am afraid to nourish Damp Heat (feet). I saw the liver nz go up a bit a while back when I used SMS, and they went down again with a lower dose. I do not see any signs of Phlegm in my CVM exam, but I am wondering if that might be something to consider as this is a chronic disease with stagnation.
I was considering Xiao Chai Hu Jia Yu Jin Tang or Chai Hu Jia Long Gu Mu Li Tang, esp the latter, but there are no active GB points. This would, however, allow Yin/Yang to mix, generate Qi, and relieve trapped Yang energy in the Upper Jiao in the presence of Heat. Maybe combined with SMS+10gm Dang Gui?
Could this be more Blood Heat and need Qing Ying Tang?
Thank you for your help,
Jodi Van Tine, DVM, CVA, CVCHM!