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Lymphangiectasia

by landauvet - November 1, 2009

Hi Steve,

I am in the middle of trying to help a dog being treated for lympangiectasia of the duodenum and with gastrointestinal ulceration.
The dog is a 10 year old FS Springer Spaniel.

She started with vomitting and diarrhea in 11/07 along with otitis externa, back pain. She has had repeated doses of antibiotics for the diarrhea. Pepsid for the upper GI.
In September of this year, she started vomitting again for 8 days prior to seeing primary. She had decreased appetite and increased thirst. Went to Tufts in Mid October. Abd. u/s showed stomach and duodenal erosions and lymphangiectasia. Biopsies taken confirming the lymphangiectasia diagnosis. Rx; Metronidazole and pepcid. Recommended a low fat diet. On Tuft's recommendation RX: pred 60 mg/day x 5 days, then 40 mg x 5 days and taper to the lowest effective dose. The dog weighs a little over 40 lbs.

The day prior to my first visit with this dog, her belly became very distended. She was still on the high dose pred. Belly was tapped. High protein transudate seen. She was still leaking fluid from her abdomen from the tap sites.
The dog was depressed with severe distention of the abdomen but able to breath, get up and down and do her business.
There was a long history of vomiting with grass eating. Her body was weak. She liked to lay out in the cold to cool her belly. Otherwise she sought the heat.
I started her on WLT, acupunctured GB-25, BL-20,21, SP-6, ST-36

Damp Heat and deficient Spleen.

Owner opted to decrease pred dose to 20 mg/day. Appetite and abdominal swelling much improved the same day as treatment. Three days later, dog develops diarrhea. Not increased frequency, but every time she poops, it is diarrhea (watery). Appetite starts to wane, weight loss becoming more evident. I rested her from the herbs for 24 hours to see if the herbs were creating a problem. No change. Swithched to SRT 2 days ago. I have not had the opportunity to recheck the dog because the owner spaced last appointment.

The initial appointment seemed to help her dramatically with the abdominal distention and appetite. Would SLBZ for the diarrhea help? I will hopefully see her in the next few days.

Any help would be much appreciated.
Thanks,
Kevin Landau

p.s.I don't think Bupleurum Combo is the answer to this one!

by naturevet

November 2, 2009

Hi Kevin,

Congratulations on the great results you got with just one treatment! Can you acupuncture the dog regularly? That way, even if the perfect formula eludes you, you can still get some benefits.

Regarding the perfect formula, you didn't mention pulse and tongue, so that will make this a bit more of a guess.

First, I'll give you my take on the pathogenesis of this condition from a TCM perspective. In the long initial run-up phase over the past several years, the dog was probably suffering from run-of-the-mill diet-induced Damp Heat. Most GI inflammatory processes, especially ulcerative ones, arise this way in small animals.

The origin of the Damp (Heat) is digestive weakness (Spleen deficiency) caused by long-term inappropriate diet. Another sequela of Spleen deficiency, which is further damaged by unrelenting Heat, is the sinking of Ying Qi into the abdomen. You'll remember that Ying Qi essentially equates to plasma, which was essentially what you found in your abdominal tap. Normally this Ying Qi rises to the Lung to facilitate the formation of Blood, which makes the Liver happy, which ensures Qi flow. When it sinks instead, it actively stagnates in the abdomen, releasing Heat which the animal is seeking to cool by lying on a cold floor. This stasis is propagated by Liver Blood deficiency. The stagnant Qi also impairs Spleen (digestive) function, as does unrelenting Damp Heat, and the circle is complete.

So, goals are to drain Damp, raise the Qi, perhaps tonify the Blood, clear Heat, and tonify the Qi.

Bu Zhong Yi Qi Tang covers most of those bases, except for the Heat-clearing and Damp-draining ones. There are modifications that can be made to the formula that are listed in Bensky, or you can just try it and see what happens. If you do the latter, the dog will probably eventually back-step into the earlier Damp Heat phase, making the formula less digestible, at about the same time as the lymphangiectasia is subsiding. You could then switch to the Damp Heat formula of your choice. If you switch to not only a low fat but a low carb diet, and to the least processed form of food the dog can digest, then you'll remove the major cause of Damp Heat, resulting in the formula being that much more likely to be well tolerated. Remember that minimal processing favors the Spleen, particularly in its raising or assimilating effects, and that heavy processing works against the Spleen by promoting a strong down-bearing influence.

Hope that makes sense and somehow helps you out. Could be a good case. Love to hear back on it.

Steve

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