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IVDD Dachshund

by marneemadsen - November 5, 2009

Hi Steve,
I just saw an older dachshund with herniation at T12-L1. He is 14 days post-op (left-sided hemilamenectomy). He still had sensory prior to sx. He is now paralyzed, has sensory and is starting to wag his tail. Mild elevation ALP and HCT 57, Alb 4.2.

He has damp signs - overwt, lipomas, soft stool,etc. Drinking more post-op and eyes have been goopy. His bark is weak since sx. He did get solumedrol during sx. Loves the heat, hx severe separation anxiety.

Tongue is lavendar on top and red underside.

Pulse in kind of a half sitting/lying position feels superficial and wiry initially, but then lacks tone - so slippery. Standing propped up, same pulse on Left, but Right is very deep, thin and wiry (which had been slippery lying down).

Active pts were hard as he was crabby - seemed like BL18T sunk the pulse, GB pts seemed active, and BL21.

Coat is growing in ok since sx - maybe not as thick of undercoat.

So a few questions: it seems like the more I am tuning in with the pulse, it can really be different from side to side. Can we interpret that based on Qi/Yang vs Yin/Blood right to left, or what are your thoughts?

I am not coming up with formulas I thought I might..like SMS? I saw him in July and they declined herbs at that time, but I had recommended SMS + DG.

Can you be Blood Deficient with a HCT of 50%?

Thanks much,
Marnee

by naturevet

November 6, 2009

Hi Marnee,

Active GB points in IVDD at that location are quite common. The dermatomes/neurotomes at that level include many GB points, in particular, GB 27, making it excellent for restoring normal circulation through the surgical site. We’d also wonder, however, if the slow recovery was due to vascular congestion and inflammation post-operatively around the cord, but your evaluation of the pulse and hair coat indicates that, if anything, peripheral blood flow is poor, and if we would achieve a lot more by bringing blood out to the musculoskeletal tissues rather than pushing it away. Your findings imply, then, that NSAIDs at this juncture would be detrimental, so I hope they are beginning to be discontinued.

In terms of a formula, the rest of the case makes me think of San Ren Tang as potentially the ideal choice. It addresses your perception that the dog is Damp, but is a good IVDD formula. As a Wind Damp expeller, it moves circulation peripherally in very real terms, helping to re-grow that fur and perfuse the surgical site to finish rebuilding tissues, flush out inflammatory mediators, neutralize free radicals, and oxygenate the tissues. It fits the slippery nature to the pulse but also the fact that you only feel it once you’ve pushed past the vascular tone that is present. This slippery-wiry pulse is the classic pulse associated with Damp accumulation and a secondary obstruction of circulation. The lavender tongue is the one classically described for San Ren Tang since the formula helps restore the normal descent of Qi along the longitudinal axis (Triple Burner) where it has been obstructed by Damp. In the process, the formula promotes normal respiration, GI motility, and urination patterns. If the dog has had any issues with these problems in the past, it would be one more reason to try San Ren Tang. The red tongue underside fits SRT as well, however, given the formula’s Damp Heat clearing abilities.

So San Ren Tang is where I'd start here. Hopefully this advice proves helpful. Please let us know how it goes. As well, in a case like this, I'd be needling them daily. Not sure if that's possible or not, but it would be ideal.

Good luck!

Steve

by marneemadsen

November 6, 2009

Steve,
Thanks - I just want to clarify about the pulse. It was superficial and had that slapping sensation, where you think it feels wiry but really there was no tone below it.

Only when he was standing outside did I get that deep, thin, wiry pulse only on the right.

Is that enough to still want to push the blood peripherally?

Theoretically, if the pulse is truly superficial and slippery, then we would want to drive it to the interior by draining damp, astringing, or building Blood...is that correct?

I am still integrating into my hands and brain the vessel tone vs the location of the pulse. It's confusing sometimes when the patient also has two very different pulses...in this dog, the deep, thin, wiry pulse was after treatment and after we moved him outside, so maybe showing a deeper pattern?

Marnee

by naturevet

November 8, 2009

At the very least, the pulse tells you that you need a blended approach, since both pulses must be considered accurate and reflective. SRT strikes that balance between dispersal and drainage. I know it's hard to understand how both states co-exist, but after all, that's what happens in inflammation. At one point, blood needs to be taken away. Later it needs to be brought back. And of course, in between those two states, it needs both.

S

by marneemadsen

November 12, 2009

Hi Steve,
I just saw this dog again - some mild improvement in they are seeing some motor to right rear (non-surgical side). He consistently pants for 20-30 minutes after eating San Ren Tang. There is slightly more hair.

Pulse is superficial and slightly slighlty wiry 90% of the hour I spent with him this time. The other 10% will move to deep, thin and wiry. BL 22 S,and BL40 T moderated pulse the best. BL18 active and sensitive, but could not tell..

Tongue was red/purple today.

Surgery site warm...

Wanted to make sure still on the right track - the pulse just doesn't seem right and I was hoping for more progress. I can only see him 1-2 times weekly because of everyone's schedules. Wondering about DHJST?

Thanks,
Marnee

by naturevet

November 12, 2009

For me, BL 22 always makes me think first of SRT. I look for purple or red tongues and tone in the pulse. So, if it were me, I'd keep going with the SRT for a while. I can't explain the panting, though.

S

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