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Can SMS Cause Vomiting In A Dog?

by sophiek - November 7, 2024

Hi Steve,

I have a case "Simon" - a powder puff Chinese Crested with chronic allergic skin disease and suspicion of Cushing's (liver enlargement, ALKP+++, increased thirst and appetite) - though ACTH stim test was normal.

I saw him last week and his skin was actually pretty good (previously he has had multiple crusts over his body, red and inflamed skin ventral abdomen and groin, recurrent episodes of otitis) - presently just licking feet. Skin was worse when stressed. His stools tend to be soft with mucus. He responds to Apoquel and antihistamines.

Tongue was big, flabby, long with thin edges and a deep pink tip. centre of tongue pale lavender.
Pulse was hard to find, small, soft, compressible, deep, weak and slow.

I think this was a case where I went with the history / bloods rather than the tongue and pulse in front of me and I started SMS (for Damp Heat, the suspicion of Cushing's, previous skin and ear issues etc) and we are transitioning over to a fresh food diet.

He has had the herbs for 6 days and then had a few vomits and I'm wondering if it's related to the SMS. In hindsight perhaps there is Blood/Yin Deficiency (based on tongue and pulse) and the SMS is too drying if already deficient? Could it exacerbate a Stomach Yin Deficiency?

I'm not sure where to go now - I did think of Cessorex for adrenal support with some Blood tonics, but the pulse/tongue just didn't seem to fit a Shao Yang Disharmony. And concerned if I go to a Blood/Yin tonic then this could exacerbate some of the Cushingoid signs (enlarged liver, ALKP+++, polyphagia, polydipsia etc).

Thanks for any insight!!
And we definitely would love a pulse diagnosis workshop here in Australia sometime (pleeeeaaase!!!)!!

Sophie

by naturevet

November 7, 2024

Hi Sophie,

It would be fun to come back to Oz and do a pulse lab. Maybe CIVT will organize that some day!

Regarding SMS, since it is Cold, Internalizing, and Drying, it can aggravate a patient who is any or all of Qi, Blood or Yang deficient. It can aggravate Yin deficiency and it can also aggravate a Wind invasion (due to its internalizing nature, which allows a Wind pathogen to penetrate deeper). Have you checked the pulse since the aggravation? That should tell you a lot. If it was now a blatant Wind invasion pulse, for example, then you'd know you need a Wind expeller.

Did the skin improve at all on the SMS? If so, then we just need something to mitigate its effects rather than replace it entirely. A way to do that is to try Chu Shi Wei Ling Tang. Also, since the skin lesions are currently quite deficient and since you're moving to a real food diet, that formula is doubly appropriate. It Warms, Externalizes, Expels Wind and Tonifies Qi, so it counteracts a lot of what can go wrong with SMS, which probably explains why the two work so well together. CSLWT can also back up the insulin sensitizing effects of SMS to combat Cushing's. If the diet change has mitigated some of the current skin issues, then stick with the Dampness angle, and try CSWLT either with SMS or on its own.

I agree that the pulse does not sound like what we would expect in Cessorex, but we can see a very weak pulse in those dogs if there is very obvious Blood deficiency. Massaging GB points can tell you if that is what is going on, if the pulse then moderates.

Lastly, given the slow pulse, have you checked the thyroid levels? Presumably yes, but if not, it's something to check given the long history of skin issues.

Hopefully this helps you out!

by sophiek

November 7, 2024

Thanks again Steve for your quick reply.

Yes a full thyroid panel has been done and was normal.
I should be seeing the dog in the next couple of days so I will recheck pulse, and see if any pulse change with GB points.

It definitely helps me out - makes so much sense when you explain it, sometimes I just go round and round in circles when I'm trying to nut out a case!!

Thanks

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