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Gagging In A Dog

by CorinneC - January 15, 2024 View Case Report

Tallulah is an 8mth old Golden retriever that I've seen since a pup. She has struggled with carsickness since little and it has never improved. She is fed a good quality raw diet and has had minimal vaccines. In August she started gagging, was slow to get moving in morning, preferring to sleep in. I initially boiled that down to teething. In Sept an elderly person fell on her and she tore her LH CCL! Her tongue was reddish-pink, moist, normal size, maybe a little thin; pulses were sl wiry. I have been working on this with acupuncture and TCM (most XHLD) + Cartrophen injections. In October, O came in because she'd not been eating very well, only 250g/day of raw. They had been supplementing more with chicken necks as she seemed to prefer these over meat patties. Her EN still seemed low in general for a young pup. BMs were really dark, almost black, but regular consistency according to O. Visually I did not think they were unusual. Bloodwork all WNL, gave Vit B12 and probiotics.

By November, she was having intermittent episodes - X4 in last month of suddenly waking up gagging & retching - wanting to go outside - eat grass - no V - can last for a few hours. She seemed really upset by this and restless. My boss rec'd a meal closer to bedtime, but this didn't seem to help. I just saw her beginning of January again and the episodes seem more frantic and hadn't lessened with food. I added on Yi Guan Jian and Probenz probiotics in the hopes that she was struggling with gastritis and reflux? Came in today, no change. I stopped Cartrophen this round in case this is having a strange effect on her GIT? I've not seen this before but dogs can get GIT upset on occasion with Cart so worth a try. Tallulah's tongue is still realtively pink, with sl red dry edges, moist centre, normal size; pulses are decently toned, a little narrow and wiry. I'm at a loss with this girl?? These reflux cases seem to be becoming more frequent and this pup is so young! Please help!
Corinne

by naturevet

January 16, 2024

Hi Corinne,

I think YGJ was a good call. It may not be addressing the underlying condition, which I'm seeing as either a Shao Yang disharmony or a Jue Yin excess. In a young dog, I normally expect a pretty pure deficiency condition, which Shao Yang disharmony doesn't quite fit with. Jue Yin excess can occur in young dogs, though, and fits with the overall tongue and pulse picture of Liver Yin deficiency and secondary Qi stagnation.

Jue Yin excess is most apt to peak around the winter solstice, and is aggravated by Yin deficiency. Yin becomes pressurized in the lower abdomen, pushing hard upwards, creating intense nausea. Yang is concentrated in the Stomach and Heart, producing 'heart burn'. Often people and dogs with this condition can't sleep well until dawn, making them very tired in the morning. Plus, it is a condition of Yin and Yang separation, since the pressurization of Yin prevents the entrance of Yang. That leads to Source Qi deficiency and fatigue.

From a conventional point of view, this Qi deficiency makes endoparasitism possible, so I guess that should be ruled out if it hasn't been already. It also is a diagnosis behind gastric ulceration, which you're kind of circling around with your suspicions of Cart being involved. Even though it's not an NSAID, from a Chinese medical point of view, it behaves like one and so can be a problem in the same conditions NSAIDs are.

The treatment is Wu Mei Wan (Mume Plum Combination) along with Yi Guan Jian. If you don't have that on hand, but you have Xiao Chai Hu Tang, you could try adding that in first, just in case this is a Shao Yang disharmony. If it doesn't work, remember WMW. Jue Yin excess is a bit better fit, since it gets worse right about now, when you're seeing this escalation.

I know you've been burned before by having too high expectations of WMW. Let us know if you try it this time and what happens! Fingers crossed this time it's a win!

Steve

by CorinneC

January 16, 2024

OK great! That all makes sense. So I would prescribe BOTH YGJ and WMW at equal volumes then?

by naturevet

January 16, 2024

Sure. Or maybe even a.60:40 mix of WMW TO YGJ?

S

by CorinneC

January 16, 2024

Thank you!! :)

by CorinneC

January 16, 2024

One more thing - only if you are bored, lol - could you explain Jue Yin excess as if describing it to an owner that has no TCM background. I am trying to explain it to myself and stumbling! Not sure how I'll explain it to her! And can you describe other clinical signs that may show themselves with Jue Yin excess? I have a patient on CHJLGMLT and BZYQT that did really well with allergies until this past December and now is licking her feet again madly, stools off and on loose. She has a flabby but normal sized, moist, reddish-pink tongue and toned but also a little taut pulses...would WMW work there as a topper?

by naturevet

January 17, 2024

Hi Corinne,

I'd wonder about bumping up the dose of BZYQT in that last dog you discussed, so you have more upbearing at this time when Qi and Blood are naturally 'cratering' in the body.

Regarding Jue Yin excess, you can sort of view it as a peristalsis issue, where aboral movement is reduced. In other animals, loose stools are constipation are features as well, making the problem system wide. It's probably that disordered peristalsis that predisposes the patient to endoparasitism.

Hopefully that's something the client can understand.

Steve

by CorinneC

January 17, 2024

That's perfect Steve, thank you SO much once again! And I actually switched that dog to Cessorex and Halscion yesterday...I'm not sure it was a perfect solution but I did feel like she needed more Blood tonification as well. Hopefully it's the right call. The owner is quite an admirer of yours. I guess she is tracking you online somehow?

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