I was just hoping for some guidance on a patient I saw this week. She is a 10 yo FS Lab owned by a local veterinary internist. She has history of ear and skin infections in the past. Starting a year ago, she developed hyphema and glaucoma in her left eye resulting in the need for enucleation. She had a shortened PT time at the time of surgery but the surgical site bled to the point of her needing transfusions in the post op time frame. No other bleeding issues after until this year. Shortly after the eye enucleation, she started with diarrhea and also protein losing nephropathy. She was diagnosed with Protein losing enteropathy and IBD and the proteinuria has resolved with treatment for the GI inflammation and she is on Telmisartan. During the work up for the diarrhea, a lytic lesion was found on the left 9th rib and was ddx with cytology as a plasma cell tumor. Additional radiographs have been taken but no CT scans. There is evidence of old fractures as well on the left 6th and 8th ribs. A ddx of multiple myeloma hasn't been confirmed and a local oncologist is treating her with Melphalan for primary plasma cell tumor. She was on Prednisone around that time as well but is off of that as well. Also during the work up her liver was aspirated though I would need to double check exactly why it was done. She developed a slow bleed after that but did not need transfusion and has been fine since in re: to other bleeding issues. The owner sought me out to help with pain management - hips and knees and she's tender in her back at the midthoracic to TL spine. Tongue is reddish lavender, pulses feel thin but taut. Hair coat is dry, thin and there is some increased pigmentation to the skin on her inguinal region. She is open to herbal medicine to support the patient but of course wants to run everything by the oncologist who is great but I doubt he'll have the foggiest idea of what I'm talking about. So. Her current meds are Melphalan, Telmisartan,Gabapentin, Pepcid.
In regards to herbs, I wanted to talk to her about medicinal mushrooms, Xiao Chai Hu Tang and possibly Xue Fu Zhu Yu Tang but just wanted some back up where I can. The odd history of bleeding has me worried and also I want to be as educated about this as I can since it's an internist and oncologist making the ultimate decisions. Please let me know if you need any additional information or have questions! Thanks so much!!!
Sincerely,
Krisi