Question Details
Lab W/ GI Sensitivity +...
by rcvvmd - November 23, 2009
Good morning! Need help with new patient... Kona is a 3 y.o FS yellow lab (English) with a history of severe GI
illness after the following: ivermectin based heartworm preventative,
Advantix, Frontlline topspot, NSAID's (Rimadyl & Previcox), vaccines -
DA2PP (no lepto or lyme), and Merial Rabies vacc. These have been
given separately and together - same reaction. The owner describes
multipe 72+ hr. stays at the hospital, on IV fluids after these
reactions which consist of blow-out liquidous diarrhea, profuse
vomiting, lethargy, inappetance, dehydration. She also has sensitivity
reactions to flavored, basted commercial treats (you know- the super
smelly bright red and yellow stuff...). She also is very reactive
(cutaneous) to bug bites/stings outside, landing her at the ER a few
times.

She has sought a 2nd opinion since the previous vet refuses to do
vaccine titers in the future and will not treat her without having
yearly vaccines an d q 6 mos. bordatella vacc. Her diagnosis was
chronic inflammatory bowel disease/ gastroenteritis, and Kona is to be
kept on Purina EN Rx diet for life.

Her owner says that between these reactions, she is fine, happy, seems
healthy, hungry, and putting on a lot of weight with EN . On PE she is
6/9 BCS, very soft, sweet personality, soft nonpainful abdomen. She
will hide in her crate when worried (after I pulled out my
stethoscope), but readily allows full exam . Her coat is quite n ice,
shiny, full, with some dark brownish pigmentation on her belly-no
lesions. Otherwise all normal. TCM exam: tongue is slightly smaller
than expected for her 90 lbs, very pink, no coating or abnormalities.
Her pulses are thin and deep, even - weaker intensity if anything. Her
afftect seems water-type, very much a family dog, good memory retention
per o., not a mean bone in her body.

Currently, we are weaning her diet back on to California Naturals
Chix/Rice LIGHT (21% Pro. 9% fat)- did well on this routinely, before
rx to E/N. We are cutting back to 2 - 2.5 cups daily from 3, and
adding 1 cup veggies ie green beans, some broccoli florets, celery, and
a frozen applesauce Kong at lunch, to prevent trash-snitching and
counter surfing. We are adding fish oil w/ ~600-700 mg EPA/day an d
considering home cooking in the future. She has been walking 45 min/
day and we are adding about 30-45 min ball-playing and fast walking 4-5
days/week.

She has been taking a probiotic OTC w/ 100 million active cultures/cfu
Lactobaccili (which if I recall, is a pretty low # of benign bugs for
a dog's GI...)

I am having trouble with a diagnosis for her pattern though... afraid
to commit! I feel she is somewhat Qi deficient, with phlegm
accumulation, and thought spleen qi def. but now not so sure. It seems
her immune system is actually SUPER competent to mount these whole body
attacks on any chemical stimuli. Help! Any herbal thoughts for her?
Right now, I am leaving well enough alone, but I want to strengthen her
stability before the next...who knows?

Thanks for help with this one,
Robin Valentine
Robin

Robin C. Valentine, VMD
Staff Emergency and Critical Care Doctor



University of Pennsylvania, 2002
Veterinary Hospital and School of Veterinary Medicine www.vet.upenn.edu

Emergency and Critical Care
Housecall and Relief Services available by appointment
Southeast Florida and Pennsylvania


Sanity is madness put to uses...
- George Santayana
Replies
by naturevet
November 24, 2009
Hi Robin,

Thank goodness they got a second opinion. That is one big whack of drugs! I can’t believe they’d do that more than twice!

If I were wanting to make this as simple as possible, I’d consider a homeopathic. Certainly I’d send them home with it in case it happened again. I’d especially consider Veratrum or Arsenicum. Arsenicum is helpful for vaccine-induced pathologies, if that is what is going on. The tendency to swelling from bug bites also suggests vaccines could be the culprit, since it’s evidence of a tendency toward hypersensitivity. In Chinese medicine, hives are a Wind Damp invasion, signaling a tendency to Damp internally, and also to a deficiency of Wei Qi. Certainly the severe vomiting and diarrhea counts as a Tai Yin invasion. So, the diagnosis for me would be Tai Yin invasion.

If it’s not the vaccine, it might be the NSAIDs, in which case the problem is a decrease in mucosal blood flow. We don’t really have to choose between these two possibilities, since treating for Tai Yin invasion will increase mucosal blood flow.

In summary, then, I think we need a formula that tonifies Tai Yin (Spleen) and Wei Qi (epithelial blood flow) to better resist invasion. Tai Yin formulas include strong Yang tonics like Li Zhong Wan (Cultivate the Middle Powder) or even Gui Zhi Tang (Cinnamon Decoction) with added Astragalus, but I think in this in-between phase, you could look at something as simple as Yu Ping Feng San (Jade Wind Screen Powder) or Dang Gui Yin Zi (Dang Gui Beverage). If the dog is Damp, YPFS is probably a better call. Another option might even be Bu Zhong Yi Qi Tang, if you wanted a teensy bit more pathogen expelling power from the Chai Hu or Sheng Ma it contains.

That’s probably what I’d try, besides equipping them with Arsenicum to use at the first sign of a problem. Naturally titers should be used in the future to determine the necessity for vaccination, as you discussed with the owner. Good luck. I’ve had cases like this in the past, and they’ve had no recurrences with the above type of approach.

Steve
by rcvvmd
November 25, 2009
Thanks; I appreciate these tips very much!
I can definitely see the use of the homeopathy here. I am just starting to grasp the 'layers' of pathogen invasion and so I
've reviewed the notes on Tai Yin and Wei Qi. I'll be asking the owners if they would consider a home cooked single antigen diet and some herb foro
by rcvvmd
November 26, 2009
....oops; cut off there. I am less familiar with homeopathy as I haven't treated anything but myself (my home in vivo laboratory...), and then, minimally. I'd give it a try. I have been looking for a source of Belladonna, too, as it was suggested as an adjunct with heat exhaustion cases/ shock. SOme of the herb formulas you mentioned I have on hand can try for Kona.

I also has a Wei Qi formula with Oldenlandia, Scutellaria, Citrus (Chen Pi) Angelica )Dand Gui), Codonopsis, Astragalus, Linderta, and Scrophularia: any thoughts on using this?

Best;
Robin Valentine
by naturevet
November 27, 2009
Hi Robin,

I know that formula is a popular one, but it's a modern formula that's all over the map in terms of ingredients and their effects. I can tell that whoever designed it was not thinking classical Chinese medicine, but more about modern research. Unfortunately (and ironically) the research shows that designing formulas using research as your main guiding principle tends to yield less than optimal results. That's why I favour classical formulas. Given your dog is between outbreaks, maybe that doesn't matter...there's not a lot to treat, so maybe you'd get away with a formula that is self-defeating in certain ways. But there are several herbs in there that have nothing at all to offer your patient. I'm more of a fan of making every herb in a formula count. Just my own bias, I guess.

Steve
Reply to this question.
You must be logged in to reply