Question Details
Spinal Tumor Or Meningioencephalitis Of Unknown Origin In A Dog
by
LJH
-
May 8, 2023 View Case Report
Replies
by
naturevet
May 18, 2023
Hi Llewanda!
Sorry for this delayed reply. I like how you handled the case and would have done the same. I would at the very least continue your treatments and take the opportunity to see how her pulse evolves. If it turns into a more Bupleurum and Kudzu pulse, then you could switch over to it, but I've used the approach you're using in even pretty severe spinal cord inflammation. I certainly wouldn't subscribe to the guarded prognosis given the changes you were able to affect with your acupuncture.
If you were going to ramp up the anti-inflammatory effects of the current formula somehow, then you could order and add Ge Gen at least, maybe 15g per 100g of XCHT base. I'd expect that to help more than Qin Jiao. You could also get some Qiang Huo and add it in there and add it in there for the same reasons.
Bottom line: I'm optimistic you can greatly help this dog, and if they continue seeing you, it will give you a chance to monitor the pulse and see how it is evolving
I guess let us know how it goes!
Steve
Sorry for this delayed reply. I like how you handled the case and would have done the same. I would at the very least continue your treatments and take the opportunity to see how her pulse evolves. If it turns into a more Bupleurum and Kudzu pulse, then you could switch over to it, but I've used the approach you're using in even pretty severe spinal cord inflammation. I certainly wouldn't subscribe to the guarded prognosis given the changes you were able to affect with your acupuncture.
If you were going to ramp up the anti-inflammatory effects of the current formula somehow, then you could order and add Ge Gen at least, maybe 15g per 100g of XCHT base. I'd expect that to help more than Qin Jiao. You could also get some Qiang Huo and add it in there and add it in there for the same reasons.
Bottom line: I'm optimistic you can greatly help this dog, and if they continue seeing you, it will give you a chance to monitor the pulse and see how it is evolving
I guess let us know how it goes!
Steve
by
LJH
August 13, 2023
Hi Steve,
This dog has done really quite well clinically for the last 4 months but not fully resolved. I have had her on Xiao Chai Hu Tang with 12g Gui Zhi and 15g Bai Shao added to 100g base formula initially at 1/3 tsp BID, then rounded 1/3 tspBID, now at 1/2 tsp BID. Pulse has been moderate strength, slightly deep, and minimally wiry. Tongue pink to slightly pale pink, moist, minimal lavender tinge. Bright and alert, running after squirrels, able to jump onto bed and do stairs, playing with the other dogs. However they have not been able to reduce her prednisone much. Neurologist had started her on 25 mg pred SID, and currently getting 20 mg SID in evening( she is 10 kg). and owner notes slight weakness hind end LH>RH in the hour before her dose. When they tried to reduce Pred to 17.5 mg SID a couple of weeks ago, within days she was slightly dragging toes on the LH when walking, though corrected knuckling on all 4 feet, maybe slightly slower to do so LH. She then took a fall on the stairs that left her knuckling LH and yelping when picked up, reminiscent of her initial presentation before it fully progressed.
When I had tried adding Ge gen to the herb mix several weeks ago, after only 2 doses she developed urinary incontinence, which she had never had previously, and which resolved quickly when Ge gen was discontinued. After her hospitalization she became less tolerant of needling so I have lasered her acupuncture points. Currently BL-60, BL-40, LI-11, SI-3 BL-62, BL-17-BL-22, GB-30,34. Pulse improves with GB points, Sed BL-40 and last appointment Ton BL-23. Haven't really done much for neck points and maybe should be doing more again.
Neurologist wanted to start Apoquel before reducing steroid further, but owner declined as had serious issues with another dog on that med in past. Dog has had minimal hair regrowth in areas that were clipped and I wondered about introducing a bit of Bu Gan Tang or Si Wu Tang ? Concerns about increasing inflammation?
With the Blood/Yin deficiency she has tolerated the steroid reasonably well to date, compared to a Damp Heat dog, but obviously need to get it reduced if possible.
Would you recommend a chiropractic assessment/ treatment? Again I have wondered if it might flare inflammation, but after her fall I would expect some fixations. I haven't felt her pulse has been consistent with needing to change to Bupleurum and Kudzu. Any thoughts or suggestions you might have for this dog that could help get the steroid reduced while maintaining function would be much appreciated. I can still try adding Qiang Huo but owners were reluctant after the incontinence the Ge Gen brought on. Many thanks once again, Llewanda
This dog has done really quite well clinically for the last 4 months but not fully resolved. I have had her on Xiao Chai Hu Tang with 12g Gui Zhi and 15g Bai Shao added to 100g base formula initially at 1/3 tsp BID, then rounded 1/3 tspBID, now at 1/2 tsp BID. Pulse has been moderate strength, slightly deep, and minimally wiry. Tongue pink to slightly pale pink, moist, minimal lavender tinge. Bright and alert, running after squirrels, able to jump onto bed and do stairs, playing with the other dogs. However they have not been able to reduce her prednisone much. Neurologist had started her on 25 mg pred SID, and currently getting 20 mg SID in evening( she is 10 kg). and owner notes slight weakness hind end LH>RH in the hour before her dose. When they tried to reduce Pred to 17.5 mg SID a couple of weeks ago, within days she was slightly dragging toes on the LH when walking, though corrected knuckling on all 4 feet, maybe slightly slower to do so LH. She then took a fall on the stairs that left her knuckling LH and yelping when picked up, reminiscent of her initial presentation before it fully progressed.
When I had tried adding Ge gen to the herb mix several weeks ago, after only 2 doses she developed urinary incontinence, which she had never had previously, and which resolved quickly when Ge gen was discontinued. After her hospitalization she became less tolerant of needling so I have lasered her acupuncture points. Currently BL-60, BL-40, LI-11, SI-3 BL-62, BL-17-BL-22, GB-30,34. Pulse improves with GB points, Sed BL-40 and last appointment Ton BL-23. Haven't really done much for neck points and maybe should be doing more again.
Neurologist wanted to start Apoquel before reducing steroid further, but owner declined as had serious issues with another dog on that med in past. Dog has had minimal hair regrowth in areas that were clipped and I wondered about introducing a bit of Bu Gan Tang or Si Wu Tang ? Concerns about increasing inflammation?
With the Blood/Yin deficiency she has tolerated the steroid reasonably well to date, compared to a Damp Heat dog, but obviously need to get it reduced if possible.
Would you recommend a chiropractic assessment/ treatment? Again I have wondered if it might flare inflammation, but after her fall I would expect some fixations. I haven't felt her pulse has been consistent with needing to change to Bupleurum and Kudzu. Any thoughts or suggestions you might have for this dog that could help get the steroid reduced while maintaining function would be much appreciated. I can still try adding Qiang Huo but owners were reluctant after the incontinence the Ge Gen brought on. Many thanks once again, Llewanda
by
LJH
August 13, 2023
Sorry Atopica not Apoquell was suggested.
by
naturevet
August 18, 2023
Hi Llewanda,
If Ge Gen created issues, then Chai Ge Jie Ji Tang is probably not a great idea, although I have never seen or heard of that reaction to Ge Gen.
The reliance on a single dose of pred daily to remain normal makes me wonder if there is a chiropractic issue, so I would explore that, since if it's there, this could be an easy and quick fix.
The high tolerance of steroids suggests Blood deficiency, potentially. I would try Bu Gan Tang for its antispasmodic effects, to see if they helped mobility. If that's the right thing to do, the pulse should feel weak
Si Miao San is another consideration for an animal that is reliant on pred to be normal. If there is anything about this dog that strikes you as implying Damp Heat, I guess keep that in mind.
I think all I've done is repeat your suggestions back to you, but hopefully you find these ideas useful anyway
Steve
If Ge Gen created issues, then Chai Ge Jie Ji Tang is probably not a great idea, although I have never seen or heard of that reaction to Ge Gen.
The reliance on a single dose of pred daily to remain normal makes me wonder if there is a chiropractic issue, so I would explore that, since if it's there, this could be an easy and quick fix.
The high tolerance of steroids suggests Blood deficiency, potentially. I would try Bu Gan Tang for its antispasmodic effects, to see if they helped mobility. If that's the right thing to do, the pulse should feel weak
Si Miao San is another consideration for an animal that is reliant on pred to be normal. If there is anything about this dog that strikes you as implying Damp Heat, I guess keep that in mind.
I think all I've done is repeat your suggestions back to you, but hopefully you find these ideas useful anyway
Steve
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