Dudley is a 12.5 year old ME Shih. Tzu
History;
Acute onset cough and collapse 9/10/23. Coughing fit brought up phlegm and blood. Treated with cough suppressants, antibiotics (Amoxyclav) and nasal oxygen at emergency centre, cardiac murmur also noted.
Went home with amoxyclav antibiotics and vetmedin, much improved.
Deteriorated from 21/10/23 despite continuing on medication.
Repeat emergency centre visit suspected tracheal collapse and he was sent home.Regular veterinarian then advised to stop antibiotics and Vetmedin in case an adverse reaction to these medications.
26/10/23 readmitted to emergency centre after further deterioration, struggling to breathe. Treated with IV antibiotics and nasal oxygen with good response.Radiographs show pulmonary congestion, not consistent with aspiration pneumonia.
Possible ddx include;
atypical bacterial infection, resistant infection or parasites
pulmonary hypertension
inflammatory lung disease with unusual lack of cough in history
cancerous infiltration of lungs (brochiogenic carcinoma, metastatic disease from elsewhere)
Returned home on Clinacin, Doxycycline, Prednisolone and Cerenia
Cerenia has been stopped due to inappetence / sedation on this medication. Owners also noted when given Vetmedin previously that he seemed wobbly on this.
Although he has a significant heart murmur (not present on check up 2 months ago), the specialist does not think the pulmonary congestion is pulmonary oedema related to congestive cardiac failure.
He has idiopathic epilepsy currently controlled with Pexion, Phenobarbitone and CBD.
He also has IBD and regularly has watery diarrhoea and inappetence.
Exam;
Grade 5/6 murmur, no arrhythmia, slight tachycardia
Increased lung sounds generalised, tachypnoea, dyspnoea. No cough in consult. Weight loss. Prednisolone has improved appetite but he is hot. Antibiotics - good response. Vetmedin - adverse reaction.
Tongue pale and lavender/blue
Pulse fine, slippery, superficial
My TCVM diagnosis is Damp Heat with Spleen Qi Deficiency, Lung Phlegm, Stasis in Upper Burner, Kidney Qi Deficiency, Heart Qi Deficiency, Global Qi Deficiency and Shao Yang Disharmony.
I started him on CHJLGMLT - I was also thinking about Voltrex, as this might be more anti-inflammatory for his airways? But thought CHJLGMLT fitted more for seizures, pulmonary congestion, the slippery pulse.
I also started LJZT as a general Qi tonic / Spleen Qi tonic
I am wondering about using XFZYT - I think it fits biomedically for possible pulmonary hypertension, support cardiac function, possible lung neoplasia BUT I am concerned this doesn't really address Lung Phlegm / Dampness, and could exacerbate this? Would Tan Yu Tang be more suitable - would this still support cardiac function at all?
Are there any other formulas that address Lung Phlegm?
Also, I think I read somewhere that an adverse reaction to pimobendan could indicate BZYQT, but I don't know why - what is the reasoning behind this?
Thanks so much for your help - I'm finding this a complicated case!
Sophie