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Polyarthritis

by marneemadsen - October 28, 2009

Hi,

8 yr old Bearded Collie, agility dog who slid down a hill into a fence last July, then into an irrigation box this past May. Had been strong and agile. Received rabies vaccine in Feb.

Had epistaxsis starting in May - rhinoscopy found lymphocytic inflammation. Went on to develop jt effusion R stifle, R hock, L elbow. Had scopes and biopsies - lymphoplasmacytic synovitis, rhinitis. Platelet count 109,000, HCT low 40's for past year or two. Has had some inflammation in bladder, no overt bacteria.

Hx good response to carprofen, not dermaxx. Diarrhea with Abx always. Hx colitis: mucus, odor, no blood.
Stool now ok unless exercising, then progressively softer.
Muscle wasting rear end, stiffness worse with rest, better movement, stiff after resting post exercise.
Temp Pref: lies with back against slider, then to in front of the fireplace! Back and forth. No significant heat intolerance while exercising over past year.

Pruritis past 2-3 weeks over TH and ST channels at elbow and knee.

T - purple with deep cracks
P wiry, superficial and slippery deep/lacks tone when compressed.
Active pts: BL 18, BL 19S, BL 20 S all good effect to soften and pull in pulse. Other GB pts active and I thought maybe better with ST 36 T?

Diet is raw entire life and digests ok except veggies, which are the dehydrated raw.

I started XCHT + QJ and was not sure about SP formula as he had both Heat and Cold signs...I went with SMS+DG because of the jt effusion, but what to do about previous response to abx? I told her to monitor stools, etc. Also trying Rhus Tox 30 C.

Thinking Shao Yang pathogen from vaccine - underlying Blood Def/Damp Heat is possible?

Appreciate any additional thoughts...

Marnee

by naturevet

October 29, 2009

Hi Marnee,

Complicated case!

For the most part, it reminds me of a classic Yi Yi Ren Tang patient: a mixed bag presenation consisting of Wind Damp invasion (sudden onset, joint effusion, points, slippery pulse); Stasis (history of traumaain patterns, chronic inflammatory tendencies, response to NSAIDs, tongue); and Spleen deficiency (loose stools worse with fatigue, aggravation by antibiotics); and Blood deficiency (anemia).

Yi Yi Ren Tang treats a Tai Yang invasion, however, and the dog is showing signs of added Shao Yang issues (BL 19, TB channel, desire for heat alternating with cold). Also, you have the autoimmune or immune-mediated pathologies, which are commonly associated with a Shao Yang pathogen.

It's important in a case to think first of goals, then of formulas. If your choices address the various goals with a minimal use of herbs, then you should see some response, regardless what you use. Goals are to expel a Wind Damp pathogen from the Shao Yang and Tai Yang, move Blood, tonify Blood, drain Damp and clear Heat.

Looking at your formula choices, they should achieve most of those goals, so I'd see what happens with what you've done already.

For future reference, Yi Yi Ren Tang does address Heat, to the extent that it clears its underlying cause (Damp) with its content of Yi Yi Ren (a cooling herb). Given that the Shao Yang symptoms are relatively muted, it's possible that adding one or two herbs could alter the formula sufficiently to clear the Shao Yang - e.g. Bupleurum or Qin Jiao (Large-leafed Gentian).

What I like about your choices, however, are their appropriateness to the symptoms - lameness and nose bleed (SMS). Yi Yi Ren Tang is more highly suited to overt joint swelling and lameness, not so much to nasal bleeding, although the Dang Gui could help here, conceivably.

So that's my take on the situation. If you (and the above discussion) are on the right track, you should see some results with this dog with what you've done.

Good luck and keep us posted.

Steve

by naturevet

October 29, 2009

Thought I'd resubmit the first paragraph without the typos:

For the most part, it reminds me of a classic Yi Yi Ren Tang patient: a mixed bag presentation consisting of Wind Damp invasion (sudden onset, joint effusion, points, slippery pulse); Stasis (history of trauma, pain patterns, chronic inflammatory tendencies, response to NSAIDs, tongue); and Spleen deficiency (loose stools worse with fatigue, aggravation by antibiotics); and Blood deficiency (anemia).

by citydvm

November 5, 2009

H,
i was just reading your discussion and wanting to increase my knowledge of energetic concepts, had a side question about the raw food diet and its impact on the existing spleen deficiency.
would this dog do better with a non-raw diet?
thanks.
Voltaire

by naturevet

November 6, 2009

Hi Voltaire,

Raw diets can be Spleen supportive, as long as the animal is not cold. Raw diets slow gastric-emptying time, protecting the ability of the Spleen to be able to raise to the Lungs any Qi it manufactures. Heavily processed diets, in contrast, are TOO digestible, favoring rapid bowel transit (lots of research out there on that), and thus reducing the ability of the Spleen to assimilate (i.e. 'raise the clear', raise the Ying Qi). These ideas weren't considered in the classics, because 2500 years ago, the notion of highly processed food was inconceivable. So the classics strictly thought of cold food as spleen weakening. The Spleen frienly effect of unprocessed diets on GI motility is something that could only be appreciated in the modern industrial era of food processing.

S

by marneemadsen

April 2, 2010

Hi Steve,
Just an update and need help with this guy. I have been treating him every 4-6 weeks since October and he has improved a lot with energy, stamina and pain. He has persistent joint effusion stifles, hocks, elbows. Worse at stifles where it is causing patellar lux. Joints are hot to the touch. I think there may be less fluid than when we started, but still significant. I have tried the following:
YYRT, SMS, XCHT, CHJLGMLT, SRT.

Last visit, he had developed scrotal edema and walls of scrotum are turgid. He saw repro specialist who found edema in inguinal canals as well and prostate enlargement. There were intraprostatic cysts. He also has been licking scrotum and prepuce. No bacteria was found on culture. His albumin is low at 1.7. Need to get urine results. He often humps after eating meals and will get paraphimosis for several hours.

He has on and off soft stools.

Tongue at last visit was lavendar with cracks top, and red underside.
Pulse is soft, slippery and deep. Will sometimes get thin and wiry.

He is on YYRT and SMS at the moment - thinking Damp heat lower jiao.
The owner started finasteride on the repro person's advice.

It looks like he might have PLN now...can I use SRT if pulse not wiry?

Any other thoughts on pulling this all together?

Thanks,
Marnee

by naturevet

April 3, 2010

Hi Marnee,

If we set aside the joints for a second, the signs of inguinal issues, prostate issues, and paraphimosis are all associated with Liver excess. The two forms of that are Stasis or Damp Heat. LDXGT is the ultimate LV DH drainer, but I wouldn't expect it to do much for arthritis. But Hoxsey might. I would wonder about that next.

Otherwise, using a Liver Qi or Blood stasis formula is a possibility, to test and see what it would do for any of these symptoms. If you used Xiao Yao San, or Jia Wei Xiao Yao San, they have Bupleurum to help assist in the manufacture of albumin. That would be my other idea.

You've already come at this from a Damp Heat perspective. The LV Stasis approach is the only one that you haven't explored. I'd use that route if you think this is more about albumin. If you think it's full on inflammation, then Hoxsey is the next route to go in, but the pulse seems awfully tiny for that.

GXZYT is another possibility, or SFZYT if the dog is cold. Again, I don't know what to expect from the joints, however, unless the fluid in there is due to low albumin.

Over to you....

S

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