Question Details
Retching And Regurgitation In A Dog
by LJH - July 31, 2024    View Case Report
Hi Steve,
I'm seeing a 10 yr M(N) Gr. Pyrenees x Maremma Livestock Guardian Dog, very active and healthy until last fall when he was neutered due to issues from enlarged prostate. He had low energy, waxing/waning appetite, not engaged in his work, moaning/groaning and developed a retch/ throat sound that improved a bit following treatment for suspected lungworm. Concerned he might be getting burrs stuck in throat/esophagus as very prevalent and he had tonsil/pharynx inflammation ( gastric reflux also a possibility). Stools unknown as LGD covers large acreage but before surgery he had dried loose stool in haircoat. None recently. Slight increase water consumption. He was started on Librela for hip DJD/ hindend stiffness that improved after initial movement then worsened with over exertion. In Dec he was quite depressed following the death of his longterm canine companion, and was Dx with Lyme. Responded quickly to doxy.
When I first saw him in April/24 he was low energy, had an excessive appetite, was heat seeking, had a thin very dry haircoat that felt sl greasy to the touch, nasal planum fading to pink, dreaming alot, no snoring, no Hx of ear issues but had started needing anal glands emptied regularly. He was continuing to retch( sounded like a drawn out moo) with variable frequency at various times of the day, sometimes keeping him awake at night/ early morning. He would sometimes regurgitate, or occasionally vomit, eat it and keep it down. Alot of borborygmus. Put on 10 lbs. Tongue pale, with lavender tinge centrally, moist, sl flabby. Pulse weak, deep, sl thin, sl wiry improved with GB points, sed BL-40, ton BL-23, dips at BL-18,20,23. Sensitive on palpation BL-18,25,27 GB-30, BL-54 I saw general Qi and Blood def, muscle spasm, Ki, Lu, SP/ST Qi def, Liv Blood def with some stagnation/stasis, Shao Yang issue with possible gastritis/reflux, Liv over acting on ST. Slight Damp I thought might emerge more as nourished Blood.
Recommended home cooked diet ( in past didn't tolerate raw). Slippery elm reduced retching so started Yi Guan Jian then added Xiao Chai Hu Tang for Shao Yang and hip/mobility issue which worsened retching so discontinued. Acupuncture BL-60/KI-3, BL-40,13, 17,18,25,27, GB-30,34 ST-36. Energy and attitude back to his old self, working all night, not moaning/groaning, retch and regurgitation very rarely. Appetite still somewhat increased.
Hot humid weather lead to hotspot L stifle. San Ren Tang worsened retch so restarted lower dose Yi Guan Jian. Early July energy dropped, tongue and mucous membranes pale, retch worsened again, regurgitation/vomit almost daily. Pulse back to weak, deep, sl wiry. Dx'ed Lyme flare up or new infection. Low RBC, Hgb, WBC otherwise bloodwork WNL. General weakness. Hasn't improved on doxy as much as first time. Currently off all herbs. Last few days hypermobility of L stifle has started similar to what another of owner's dogs displayed when had OSA. rDVM starting further work up. Any thoughts or suggestions you might have would be much appreciated. Many thanks, Llewanda
Replies
by naturevet
August 4, 2024
Hi Llewanda,

I think you're on the right track with Yi Guan JIan and treatment for a Shao Yang disharmony. Definitely dryness is worsened by both San Ren Tang and XIao Chai HU Tang, so the main focus of treatment somehow needs to be Yin tonification.

Shao Yang disharmony causes Yin deficiency in the Yang Ming, so it makes sense that Yi Guan JIan, which moistens the Stomach, would be so beneficial. The pulse suggests that is still the place to start, especially given the great results you had with the formula last year.

All that notwithstanding, the ultimate cause here of the dryness is Shao Yang disharmony, as evidenced in part by the Lyme infection, hip issues, and response to doxycycline. So you need to find a way to deploy it. You might have to combine XCHT with Si Wu Tang to create a moistening enough formula that the patient can tolerate it.

Another option, since you're seeing July aggravations, is to use Chai Hu Jia Long Gu Mu Li Tang as your Shao Yang formula. If you have Halscion on your shelf, it contains CHJLGMLT and YGJ, so you can perhaps get it done with one product. Halscion has a downbearing effect that can help subside the retching and regurgitation. I would be tempted to try it.

Hopefully that helps you out. Let us know how things go!

Steve
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