Penny is a 13yr old FS Mini Schnauzer who came to me in May for manic behavior (severe anxiety and digging behavior to the point of making her paws bleed, worst at night), chronic diarrhea w/ flatulence, weight loss, and poor appetite that's been well worked up by her GP, another integrative vet, internal medicine, and a neurologist. The mania is presumed to be secondary to GI signs. She's been on fresh foods for a while, but is super picky and goes on and off her food and mom keeps trying new ones to entice her.
1/16/24 she went to the ER for bloody stool and vomiting. ALP was 373 (high) and lipase 2933 (high).
4/4/24:
CBC normal.
Chem: BUN slightly high, Creatinine low nd of normal), K+/Albumin 4.2/ALP/triglycerides all a little high.
cPL normal
total T4 2.0N
Abdominal US: hepatomegaly, mild R adrenomegaly. Duodenum thickened w/ normal layering. Age-related renal changes. Renal mineralization.
- r/o enteropathy, reactive hepatopathy?
She was put on
- Renal mineralization.
- normal pancreas, but consider chronic pancreatitis
At some point she was put on gabapentin, melatonin, selegiline, omeprazole, sucralfate, digestive enzymes, probiotics, standard process pancreatrophin, amino Bplex- none of which helped significantly.
She has multiple lipomas. Hair thinning along dorsum. Dry, flakey skin. Mild dental tartar. BCS 3-4/9.
Tongue: very dry, deep cracks, red/purple/almost brown.
Pulse: slow, full/forceful
Cool-seeking. Lots of mucous in her poop.
TCVM: Severe Yin Def w/ wasting, Shen disturbance, SP Qi Def
I had her on a Western tincture (Marshmallow, Gotu kola, American skullcap, Baikal skullcap, Chamomile, Globe artichoke, Yellow dock, and Licorice) and Jing Tang's concentrated Stomach Happy, which initially helped reduce the digging behavior and improve her appetite but stool was still mucousy on and off. Pulse became more slippery and tongue became more purple in the center and red at the edges. I did two fecal transplants (Dr Margot Roman's MBRT protocol- rectal ozone, then rectal FMT) after AnimalBiome test showed imbalance & C. perf overgrowth. Stools were much more formed after the transplants.
In mid-July, pulse was full, a bit forceful, but slow; tongue was pale and swollen. She had been losing weight (15.4 to 14.4 lbs from May to mid-July). I had suspected gastric ulcers and she still had significant manic/OCD signs, so I changed her Stomach Happy to Yi Guan Jian + Jing Tang's Shen Calmer. Still on the Western tincture. Shen Calmer SIGNIFICANTLY improved her mania signs, but she had urinary incontinence, which resolved when I lowered the dose a bit. She began to regain weight (14.5lbs to 16lbs from mid-July to mid-August).
On 7/30, mom noted mild anisocoria. I didn't see any other neuro or eye signs at the time so we monitored.
By 8/14 mom was noticing a left head tilt and ataxia along with continued mild anisocoria, but all changes were very subtle to me and I'm not convinced the head tilt is "real" (she would tilt, but then right her head shortly after). Her appetite significantly dropped and mom couldn't get much into her anymore except the tincture and Shen calmer. She also had darker stools. Neuro saw her back and thought it could be an inner ear infection and put her on Baytril. X-rays of her head showed the bullae were pretty clear.
I think I'm just a bit lost as to what to do next. Go back to more of a Spleen Qi tonic- Liu jun zi tang? Or Yin - ZBDWH? I'm not sure what to make of these neuro symptoms- they're not very pronounced. Mom feels like she wants to eat, and will a bit once she starts, but she hesitates to start eating.