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Dermatitis

by landauvet - November 25, 2009

Hi Steve,

I was hoping for some input on a tough skin case that also has some seizures. 1.5 yr old beagle mix. Had 1 seizure in April of last year. Dermatitis affecting face, ears, and perineum. She had multiple bouts of dermatitis where she would rub her muzzle so badly that she needed abx and pred. Dog would twitch frequently at rest (legs). Initially her pulse was deep and slippery. Tongue was red and dry.

SMS, TMGTY, and diet change. I sedated BL-40, tonified SP-20, sedated LI-4 and GB-20

She was unable to do raw food and would vomit immediately after eating. I switched her to SRT at the second appointment. During the next 6 weeks, she developed a UTI for which she was put on antibiotics and her face got very red and itchy. Her pulse was strong and slippery at the next appointment with a deeply red tongue. The itchiness to face was unchanged from the antibiotic therapy. Perianal itch continued to be a problem also. I switched her to QYT. The itch got worse. She seemed to get a loose stool from digestive support in the form of probiotics and a homeopathic detox kit. Went through another course of pred and antibiotics and is somewhat stable on Temperal P. Since she got an upset digestive tract from the last course of antibiotics, I switched her to CSWLT at our last appointment (in addition to the TMGTY)

There seems to be a serious flare-up at the start of winter for the last two years.

Ant thoughts would be greatly appreciated.
Kevin

by naturevet

November 25, 2009

Hi Kevin,

You're getting a firm indication that the cooking pot doesn't have much of a fire - hence the vomiting on raw food. That plus skin would make most people try out CSWLT, which you have just done. So I'd see what that accomplishes.

I'm not sure you'll be satisfied with the results, however. The reason why is the pulse. It suggests the circulation is already very peripheral, which is much of what CSWLT accomplishes in resolving chronic skin inflammation. So there may not be much of a change, or could be a mild worsening, as with QYT, which also moves circulation to the periphery.

So an anti-inflammatory treatment that warms the middle burner is called for. That's a recipe for SMS, but you've already tried it. The other thing that may work is Chai Hu Jia Long Gu Mu Li Tang, as discussed in your other case. As you know, this formula opens the TB to allow Yang to descend internally and generate the Source Qi. That's tantamount to stoking the fire under the pot, so we've covered that base. It also can be helpful as an anti-convulsive. We'd expect the upper burner to be remedied here, which includes the face and ears, but also anywhere on the skin, including even the perineum. So I'd give it a try and see what happens.

Steve

by MKinoshita

December 16, 2009

Hi Kevin,
To look at it in a slightly different manner... If the probiotic and homeopathic detox kit caused digestive upset, you might want to look at gentle drainage specifically of the liver and kidney emonctories.

Michelle Kinoshita

by landauvet

February 22, 2010

Hi Steve,

I wanted to continue consulting on this case. This dog is only itchy and red during the winter. According to the owner, there is no problem at all during the warm months of the year.
The dog's symptoms are only controllable on a low dose of Temeril P. 1 capsule every other day. This is a 5 mg antihistamine and only 2 mg prednisone. Even though the symptoms are under control as far as the rawness goes, the inner pinnae and oral mucus membranes are cherry red and warm. There is redness around the eyes and muzzle.
She was on the CHJLGMLT for 4 weeks before trying to come off the Temeril P and had a flair-up. Today, on the Temeril P, her pulses were slippery and strong. She still had active GB points (GB-25, GB-34). These moderated her pulses.
I put her back on the CHJLGMLT added Jing Tang's External Wind and am keeping her on the Temeril P. I am going to try her on raw food again (she through it up originally).

I feel like the answer to this dog should be in the historical fact that she has no symptoms in the warm months. It seems like a pretty low dose of Temeril P keeps things under control which is good, a low enough dose where she should not have a lot of side effects.

What are your thoughts? Thanks so much!

Kevin

by naturevet

February 23, 2010

Hi Kevin,

The dog had seizure issues before as well, which we were trying to address. What is their status?

If we just set the pulse findings aside for a moment, skin problems that are worse in the winter are often Blood deficiency symptoms. If the dog is maintained on a low intermittent dose of pred, and if there are minimal side effects to the pred, that is supportive of Blood deficiency as well.

Given the above, and also what you've tried in the past, I'd go with Si Wu Xiao Feng Yin next.

You don't really mention what of the dog's numerous other complaints is still present (GI, seizures), or what became of the CSWLT experiment. If there are still GI complaints, and the dog did okay on CSWLT, you could use it with SWXFY if you like.

Sorry I can't be more specific. This is obviously one of those cases I'd need to see to have more certainty, but hopefully this gives you some ideas.

Steve

by landauvet

February 23, 2010

Hi Steve,
I will try to clarify a bit.
There was only 1 seizure prior to the first visit. This was the main concern of the owner. Initially, there was a lot of involuntary muscle twitching in the exam room when at rest. This has improves also. There was also initially a history of vomiting and eating poop. This is better also. Since I started working with this dog 5/09, she has had some UTIs and urinary incontinence which has not been a problem recently, however, her skin is the thing I have been struggling with. It is intensely red and she will mutilate herself if it gets too red.
I don't think I felt the CSWLT worked well to address the skin complaint. QYT, SRT, and SMS have also been used. This is a young (2) dog who is otherwise looking very healthy and energetic, not overwight.

I suspect that the TMGTY which is what she was on initially help cause the UTIs, being too damp. I will find out soon if she can handle raw food.
If that helps clarify this dog, great! If not, I will take your previous advice.

Thanks,
Kevin

by naturevet

February 24, 2010

Hi Kevin,

TMGTY isn't all that dampening, so I'm not sure if there isn't another reason for the UTI.

Since we haven't tried SWXFY, I would say that's the next step given the winter aggravation.

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