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Acute Lameness With Chronic Issues; NSAID Made Bad

by Lisa - November 4, 2009

Hi. I need some herbal suggestions on a case that has me considering too herbs and I don't know which one to start with due to the concurrent issues with the case. So here goes . .

A 10 year 4 month old FS Airedale terrier presented to another DVM for acute onset of sudden lameness after getting out of fenced in backyard. rDVM performed rad's which indicated severe DJD bilaterally with hip dysplasia, concurrent symmetrical mild pelvic limb muscle atropy, and severe DJD at caudal lumbar spine. rDVM placed on Rimadyl, Tramadol, and Chondroflex. Three days later pet came down with severe bloody diarrhea and rDVM referred case to me for "alternative pain management". rDVM recommended 24 hr NPO and d/c'ed all medications.

On presentation to me, further info was gathered on the case. Per o pet's lameness issues started about 1 year previous but would resolve on its own so owner never pursued. Stools in past - before this bloody diarrhea event - had been intermittent loose stools with mucous (no blood) and would self resolve. Pet also has urinary incontinence issues and rDVM controls this with DES once weekly - which per o does control the issue completely. But o still feels pet is slightly PU/PD and always have been. Per o dog still produces large amount of urine at one time and will always urinate if outside but is no longer having any urinary incontinence IF taking the DES. Personality wise, the dog use to be more dominanting (protective of owner, picking fights with other owner's dog) but has calmed down now to get along with other dog in household and strange dogs in dog park - after o pursued obdience training and worked with someone. However, if other dogs go toward this dog's rear limbs or rear end, she would turn and growl at them. The dog prefers to sleep on a soft bed at night but will get up to seek colder locations in the bathroom at night and tile floors during the day (but will stay in the bed during winter/fall months when cooler). She no longer jumps up now on bed/chair. Uusally has a great appetite - except for now. Use to be overweight. Past history of chewing feet/licking belly/crusts over LS - but per owner resolved with Ezymes and Filling-in-the-hole (??). Pet eats Chicken soup for the Dog Lovers soul dry and can. Per owner since acute event occured when dog got out of fence and came home with painful lameness, now pet is seeking shade when outside in the yard.

TCM: Tongue = lavender to pink/purple with thin coating and moist cracks (pink on outter edges with no cracks, purple more centrocaudally and along cracks). Pulse = weak to almost absent that were better after acupressure of both BL 40's. Extreme pain at GB 40 left side only and bilaterally at SP9. Heat over right GB 30. Toe touching LR lameness which is significantly better with exercise.

I performed dry needle acupuncture where the patient told me to at the following: LI 4, ST 36, SP 6, SP 9, SI 3, BL 62, BL 11/12/19/20/21/22/25/40/54/60, PC 3, GB 29, GB 30, LIV 3, LIV 13, CV 12, GV 20.

So, I'm just wondering which herbal combinations would be best. I'm confused with all the historic deficiency signs and the acute damp heat. Clear the heat, then address the pain, then address the deficiency? My thoughts were to consider either Four Marvels Combo + Angelica and Mastic Combo vrs considering Benefit hips and knees formula + Eucommial and Rehmannia Combo (or Minor Bupleruum combo).

Any thoughts?

Thanks so much!

Lisa

by naturevet

November 6, 2009

Hi Lisa,

Great job presenting the case information. It really helps me help you. Nice work. I’ll share my interpretation thus far and give you some ideas to pursue.

First of all, the response to conventional therapy indicates general hemodynamic goal is to move blood peripherally, towards epithelial surfaces, including the skin and musculoskeletal system. In general, ‘tonic’ herbs and aromatic compounds achieve this, rather than the typical anti-inflammatory herbs and drugs. This approach is well suited to chronic low-grade inflammatory processes as well as pathologies that don’t respond to NSAIDs: spasm, calcification of ligaments (which lead to spondylosis), and degenerative changes.

It’s interesting that the pain was so severe at that location. Ordinarily, I’d wonder about spasm, but GB 40 is not exactly the place where I’d expect spasms to occur. Another possibility for severe pain arising from these types of pathologies is if there is nerve root impingement from low back stiffness. That would be enough to create severe sciatic pain referred to the distal leg, despite the primary problem being one of stiffness and not really acute inflammation. In that case, a chiropractic evaluation is in order if you can access it. In fact, acute pain following violent exertion can easily arise from a resultant chiropractic ‘subluxation’ or vertebral fixation. I’m almost certain that’s what’s happened.

In the event of sciatica, BL 40 can be a very useful point. Do you recall if you were tonifying or sedating the point?

We can be sure it’s not an acute inflammatory problem there, as the NSAIDs would not then have had their adverse effects. In acute inflammation, blood flow is pulled peripherally in general, which includes to the GI mucosa, allowing NSAIDs to be used without side effects in those cases. The tongue echoes this theory, by showing peripheral pallor and central congestion. The pulse does as well, by feeling weak to the touch.

The other symptoms similarly smack of ‘deficiency’ and thus a need to build the dog up. It’s common for animals who are aware of their loss of strength to lash out as sort of a self-preservation defensive move. In Chinese medicine, such loss of confidence in one’s abilities is indicative of Liver Blood deficiency. The urinary incontinence issues in turn fit with Kidney deficiency. DES is a Yin tonic. If we give it to an animal and they improve, we can be confident there is Yin deficiency. In Chinese medicine, Kidney Yin deficiency leads to Liver Blood deficiency; Water is needed to support Wood.

The digestive weakness gives us pause, given that the Spleen likes to be warm and dry to function properly, and thus would seem to if anything be aggravated by a Yin tonifying approach. The Spleen is reliant on a healthy Liver for the Spleen to function well however. There is a mutually constructive, or in the wrong circumstances, destructive relationship between the two. Given the absence of Damp signs in the diarrhea, I would wonder if the Spleen deficiency is thus arising from a Liver Spleen disharmony. Alternatively, it may be an issue of there not being enough fuel (Kidney Yin) to support the Fire that powers the digestion (Spleen). So what I’m driving at here is to proceed with caution because of the digestive weakness, but that it may well resolve if we take care of the primary complaints.

Regarding formulas to do that, there are several: Bu Gan Tang (Tonify the Liver Decoction); Zuo Gui Yin (Restore the Left Combination); Du Huo Ji Sheng Tang (Angelica and Loranthus Combination); and even Rehmannia Eight (which tonifies Yin as does all the Rehmannia formulas, but also has a spark for the lower burner that would ‘ignite’ the Yin to restore the Fire under the pot, and to foster continence. Your choice of Rehmannia and Eucommia is also a good one. All of these may work equally well. The exception is DHJST, which will work much better than the others if there is a Wind Invasion aspect to the case. In other words, if you sedate BL 40 to get the dog better, then DHJST would be the top choice in my book.

Hopefully this will be helpful advice. We’d love to hear how it goes,

Steve

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