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Older Lab- Painful

by Cathy L. - November 23, 2009

Hi Steve-

I'm trying to treat a friend's dog who lives out of state; have not been able to help her much at all.

The dog is a 10 yr old SF Lab.

Her history:

Patchy alopecia for yrs, non-seasonal. Dx as "endocrine alopecia" by biopsy, but looks more like allergy to me. ACTH stim WNL, thyroid panel same.

For 1.5yrs she has had shoulder pain consistent with bicipital bursitis (rads neg, worse w/ exercise, pain intermittent). Last fall, she developed pain in other areas and has progressed. She had a neg tick snap test (missing a couple species for our area), no further titers done. Thought her local vet had done a Doxy trial, but don't see it now in her file.

Chiropractic care made her better at first, then she steadily slid backwards even w/ further adjustments.

Last PE: (summer):

- T: normal
- P: sl. fast and sl. rolling
- fattly lumps, oily coat, patchy alopecia
- sl. roaring resp. noise
- painful all 4; esp. L shoulder, both carpii (enlarged) and RH, cannot localize there.
- Triceps spasm

She has a very mild itch, ^ resp. noise on walks. Her pain is worse w/ rest, better w/ some motion.

She did not respond to an NSAID trial ( 1 week) or Turmeric. Also no response to low dose pred (.25 mg per lb. BID). You had recc. trying a muscle relaxant for her spasm- we did Robaxin and GPT, no change.

This dog is quite painful, so I'm feeling badly about my lack of success. The owners cannot do further diagnostics ( joint tap,etc) - young folks expecting their first child. They also are not able to do raw diet- we've had many discussions. She gets hi quality dry + a fair amt of meat and veggie scraps.

Have used the following herbs over time:

-SMS (pain ^ some per owner)
-STZYT, later added DHJST- no help
-XFHMY- no help
-XCHT- no help

So if I go back to the basic questions, she is HOT and EXCESSIVE, but the DEF is clearly there as well.

Possible TCM Dx for pain:

- Wind pathogen
- Qi def/stasis
- Blood stasis
- Spasm

R/O for the laryngeal paralysis:

-TB obstr
-Kid def
-Damp
-pathogen?

Am I missing any? It helps me to go tho those lists on these difficult cases.

Planning to Rx Tramadol, but other wise have no clue where to go from here.

Gratefully,

:)Cathy L.

by naturevet

November 24, 2009

Hi Cathie,

It looks like you've tried most strategies. The only thing that's left that fits the mixed bag presentation is Yi Yi Ren Tang. Generally dogs that benefit are Damp, have Wind Invasions, and a slippery (although often thin) pulse. Wind invasions in particular would not respond to NSAIDs. The dog is Damp, so did not respond to DHJST when you tried it (too Dampening?).

Either that, or if the pulse is much broader and slippery, then it is an SMS case. You can try higher doses. I find, though, that if you're fighting diet, you're doomed not to win, even if it is high quality. It's the processing as well as the grain that slowly kills dogs.

Steve

by Cathy L.

November 25, 2009

Hey Steve-

I tried SMS early on, and it seemed to make her more sore, unless it was coincidental w/ other treatments, weather changes, etc. I know you had said that exacerbations from its' descendinmg action are usually GI- can that happen in other areas as well, when wind pathogens are present? She certainly doesn't look yin def or cold to me, so I wondered why she was worse.

She was on DHJST for just a few weeks this last winter, as I thought her pulse improved a bit from "draining" BL40 w/ acupressure. She's so damp, she's hot already and I can't appreciate much for other kid def signs, so I'm unsure about using this one again.

So she needs a wind-expelling, damp heat drainer? Maybe YYRT next then.

:)Cathy

by naturevet

November 25, 2009

The other adverse effect of Si Miao San is to dry the patient. So, if musculoskeletal symptoms are clearly tied to its use, then it's likely due to these drying effects. Drying create spasms, treatable with herbs like Bu Gan Tang; or secondary Wind invasions due to the vacuity of Blood in the channels, treatable by formulas like Du Huo Ji Sheng Tang. So perhaps the improvement on DHJST was more real than you thought. A consideration, in case the YYRT doesn't work out...

Steve

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