Betsy, a very nervous and thin 9YO SF terrier mix, presented last fall w/ chronic draining tracts from a ruptured anal gland of ~4 years duration. Chronic abscess in the right caudodorsal lumbar soft tissues with a draining tract that extends to the level of the anus with extensive abnormal tissue changes along her right anus/rectal region and lower back/right hip region. The caudal draining tract bifurcates, with one portion extending to the anus and another along the proximal right pelvic limb Incidental CT findings include cholelithiasis and multiple nephroliths. She has a long-term history of Apoquel, since a puppy, for seasonal allergies but was on it all year-round until I weaned her off. History of sarcoptic mange, recurrent otitis, dermatitis... She also reacts poorly to vaccinations and parasite preventatives (lethargy and severe diarrhea)
My initial Dx: Damp Heat, invading Wind Heat pathogens, Wei Qi, Blood deficiency and Stasis. For all her -itis, chronic inflammation, infected fistula, and associated draining tracts, I found her to be very deficient back in August w/ a pale muddy T and thin, toneless P, and thought she was not strong or Hot enough for XFHMY, so began BYHWT instead along w/ 2 drops K Iodide, and silver sulfadiazine augmented with essential oils to infuse in the tracts every few days. This did little to resolve the skin but did tone her still deficient P, T still pale and muddy, so in Nov., I started a course of cefpodoxime and changed herbs to XFHMY. Some, but not significant improvement was seen and now I've made her Cold. Overall, not doing well this month, spends most time under blankets or by the fireplace, had a bout of constipation, draining tracts still open w/ a whitish discharge (that increases w/ stress), and a few raised skin areas on the right hip where new tracts may be threatening to open up. Great appetite, maybe her only joy these days.
I don't see Damp Heat anymore, just Deficiency w/ Stasis, sure SYD, causing her excess skin - or is it rather a deficient skin issue? I am at a loss...the formulas I think will most help resolve this chronic skin issue are too cooling for her constitution so I feel damaging, not a good fit. I am considering QYT next, again it's very cooling. But what if I added herbs to the formula to warm her up or does that defeat the formula's intended use? Can I use CHSWT and QYT in tandem and cover the bases or is there another approach you can suggest? I really want to help this little dog, she has been through so much her entire life and her people are committed, doing all I ask of them.
I'm rechecking her this week, so fingers crossed you can weigh in soon. Many thanks as always! Franchesca