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Episodic Collapse In A Dog

by Cbecker - May 3, 2024 View Case Report

Hello Steve, I have a 10-yr old FS lab/pit who presented with an acute 3cm x1.5cm2 very firm, non-painful, non-ulcerated mass on her lower lip. The histopathologist determined it to be a severe hypersensitivity reaction to an insect bite. She is a 75% SP personality—tends to gain weight, many lipomas, loves to eat, though the O reports she seems to be more anxious as she ages. Diet is a dehydrated base adding cooked/raw meat (usually turkey), with added fish oil. Her tongue presented as red to pale with a light white coat; the color fluctuated throughout exam. Her pulse was soft, normal rate, the depth was middle to deep. We started her on pred, which she had only a mild increase in water consumption, and the mass became slightly softer after a few days. About 5 days after starting pred, she had what sounds like a syncopal episode; per the O’s description of the episode, she may have been overheated. The following day she stumbled but did not collapse. O stopped pred. Work-up after 2nd episode: CBC showed she is mildly anemic, low normal platelets, and no sig changes on Profile. EKG normal during exam, and abdominal radiographs showed decreased serosal detail at cranial aspect of abdomen—US unremarkable. Thoracic rads normal.
I would like to treat for excess first with SMS for the mass, but will then transition to Qing Ying Tang. I feel like we are headed towards an Evan’s Syndrome, which I will check with a repeat CBC soon.
Thank you for your guidance.

by naturevet

May 5, 2024

Hi there! I agree that SMS is the place to start, not only because of a potential aggravation from pred, but also because of the dog's general body type, pulse and tongue findings, and the tendency to have such a pronounced response to an insect bite. Usually it's the innate immune system fueling that, and excesses in the innate immune system correlate with Damp Heat from the Chinese medical perspective.

If SMS helps, then the diet is still too processed for this dog, and they will need to move away from dehydrated foods.

As for follow up formulas, another consideration to get rid of the lump is Xian Fang Huo Ming Yin. SMS may help with any thromobocytopenia, but as you said, if blood counts get more comprehensively bad, Qing Ying Tang is the next choice for that

Hopefully this helps you out. Please let us know how things go!

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