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Refractory Allergic Skin Disease

by Pamela Page - December 6, 2009

Hello,

This is my second post,first one did not go through apparently. I am hoping for some help for Sargeant, a 5 year old lab mix who first came to me in 2006. After I was unsuccessful in achieving any improvement in his skin, I referred him to a different vet. for homeopathy. She also did not have any success, and now he is back consulting with me again. In the interim, he was also hit by a car, and had his right hind leg amputated. But his skin problems remain the same. He is generally symptom-free in winter, but otherwise gets bright red uncomfortable rashes on his ventral abdomen, thighs, axillae, legs and feet primarily. These lesions can come and go rapidly. Sometimes he gets more generalized itch and lesions, which may be associated with flea outbreaks. His diet has been at times completely home-prepared, at other times commercial, depending on owner's means and ability. Nothing has seemed to have any effect except for Cephalexin. This summer he was periodically on low doses of prednisone, which helped some, but not as much as Cephalexin. He has periodic flare-ups of otitis (yeast. Also sometimes needs anal gland expression. He is an extremely sensitive dog, really dislikes acupuncture, so I now do it only very sparingly. He also has significant separation anxiety, and does not interacts inappropriately aggressively with other dogs. His tongue tends to be pale pink, pulses are full, and during skin flare-ups have an interesting sensation of turbulence or friction, as if particulate debris were moving through the vessel. He has an excellent appetite, not very thirsty, seeks warmth, feet are cool to touch, knee and elbows warmer. So in 2006 we tried in sequence: Si Miao San, Long Dan Xie Gan Tang, and Modified LDXGT, and Qing Ying Tang, along with nettles and various other supplements and anti-histamines. This year, we have tried San Ren Tang, and then Hoxsey formula, plus probiotics. Again, the only thing that seems to have any real effect is Cephalexin. This owner really would like to find a non-drug solution for her dog's allergic skin disease. Thanks for any suggestions!!
Pam

by naturevet

December 7, 2009

Hi Pam,

I certainly see why you tried so many Damp Heat formulas, given the breed; the ventral lesion distribution; and the response to cold bitter agents. I still feel that is what you are dealing with.

There are several approaches to that, most of which you've tried. But they all have their times when they work well and times when they don't. Right now, the pulse would suggest that Si Miao San should be beneficial. We look for that superficial slippery pulse as the big indicator. You didn't specifically identify the pulse as slippery, but your description of particulate matter slipping by in the vessel is very reminiscent of the ancient Chinese description of a slippery pulse being like a fish that swims through your hands as you try to catch it. So if SMS wasn't tried when the pulse was like that, I'd give it another go.

Some other thoughts: when I can't get anywhere with appropriate formulas, almost invariably the animal has a food sensitivity, and I have to (1) put the animal on a no grain diet; and (2) start eliminating likely candidates. I usually have the owner make their own homemade diet and then make sure there is no beef or lamb in it to start. Some animals have had issues with chicken in our practice, too, but beef is the most common culprit.

Regarding homeopathics, was Sulphur used? It's a good Damp Heat remedy.

Lastly, to heighten the antimicrobial and anti-itch effect, you could add Yin Chen Hao to the formula. But if the last time you used SMS, the pulse was wiry or deep, then I'd try it again 'straight up', along with a diet change. Certainly I always have to get the dogs off processed kibble to get any results with Damp Heat cases.

Hope this advice proves useful,

All the best,

Steve

by Pamela Page

June 30, 2010

Hi Steve,

Here is an update on sargent. Thanks to your suggestion, we have finally seen a change. Summer is here, his worse itchy, rashy time, and we finally got him weaned off the Cephalexin, and he was maintaining fairly well for some months on the Si Miao San with Yin Chen Hao. Now he is getting pretty itchy again, but his skin lesions are a bit different. No bright red rashes on ventral abdomen like he had before. The lesions seem to be moving cranially - his ventral thorax has a rash consisting of small raised bumps, no redness. He is primarily itchy on ventral thorax and front legs now. Of greater concern, owner observed one early morning where he had a brief episode of staring and head tremors. Since then she has recorded 3 additional episodes during the night where he seemed to have whole body tremors. However, she acknowledges that as she herself is a deep sleeper, she cannot say for sure that he wasn't merely dreaming, but she thinks that he is developing some mild seizure activity. Blood and thyroid screens all came back normal. He is on a 100$% home-prepared diet. Any suggestions for herb changes at this time? Tongue and pulse are still pretty much the same.

Thanks much!
Pam

by naturevet

July 1, 2010

Hi Pam,

Was this a fairly recent change, such as in the last week or two?

Seasonally, we are moving into one of the times of year when we can have Yin deficiency showing up. It's a major cause of petit mal seizures or absence seizures, especially those occurring in the early morning hours.

SMS is a strongly drying formula, and could accentuate a predisposition to this. Yet we know the dog is primarily Damp. So an option is to add 20g of Dang Gui to the SMS, instead of the Yin Chen Hao, in order to address this potential tendency. It might help resolve the rash, too. Often, dogs that respond to SMS initially later need either the addition of a Blood tonic like Dang Gui, or the use of Chu Shi Wei Ling Tang, in order to resolve their skin lesions entirely.

So, with the information presented, that's what I'd try next. Hopefully it helps.

Thanks very much for following up. I appreciate it.

Steve

by Pamela Page

July 1, 2010

Hi Steve,

Yes, the possible mild seizure activity has just been in the past 3 weeks. Your ideas and suggestion sounds good, and we will try it.

Thanks again
Pam

by Pamela Page

September 28, 2010

Hi Steve,

Things are not going well with sargeant. His skin has continued to worsen since I last wrote to you. The raised, almost hive-like bumps on his ventral thorax persisted. His otitis flared up, and his itch became out of control. Owner finally put him back on cephalexin and pred which helped with the skin, and the bumps on the thorax went away. Meanwhile he continues to have these mild neurological episodes on a weekly basis. On his last visit here, owner felt his itch was pretty well controlled with the cephalexin and every other day prednisone, however, he still licks and chews some, including his feet. And I found some new lesions - a blood-filled pustular-like lesion near his axilla, and his toes are swollen at the junction of skin and pad and oozing a little bit of serosanguinous fluid. Help!! Any more ideas, or should I really just give up?

Pam

by naturevet

September 29, 2010

Hi Pam,

What are you using currently?

S

by Pamela Page

September 29, 2010

Hi Steve,

He is on the Si Miao San with 20g Dang Gui. Although he may have run out by now. Also Cephalexin 500 BID and prednisone 10 mg, every 2-3 days now, I think. He is on a home-prepared diet, and I have recommended she consult with a nutritionist to rule out any deficiencies.

Thanks,
Pam

by naturevet

September 30, 2010

Hi Pam,

I think you're a little way from giving up just yet. Basically, that's the owner's call.

I just had an idea:
The lesions moving cranially on the ventrum, the rash on the medial forelimbs, and the seizure like episodes - these all may signify Heat trapped in the upper burner. If we were to shave the dog and stand him up, after all, that's immediately what we'd see: ears, arms, chest, and head all affected.

Coming on in late summer suggests possibly a Fire pathogen, and the need for a Shao Yang formula. One option is Chai Hu Jia Long Gu Mu Li Tang. I guess that's what I'd try next. Fire pathogens attack the upper body, when the body is having trouble descending Yang. Seizure like activity results as well, sometimes.

That's my next take. Thanks so much for following up, and hang in there!

Steve

by Pamela Page

November 24, 2011

Hi Steve,
Sargeant is still around, still having his issues, has been on chai hu jia long gu mu li tang which helps some, especialy with the tremors. He still has the seasonal skin problems in summer and fall which periodically requires cephalexin and/or prednisone, recurrent otitis and ananl gland issues. His current struggle is related to his only having one hind leg.
The other was amputated several years ago after a car accident. Overuse of his remaining hind leg has resulted in injury to his achilles tendon insertion, the lateral gastrocnemius origin, and "chronic disease in this entire area of the extensors of the left hock", according to the surgeon who evaluated him. He decided it was non-surgical and Sargeant is recovering use of his leg pretty quickly, but I'm wondering if you have any new suggestions for herbal support for muscle/tendon support with this new addition to his constellation of troubles.

Thanks!
Pam

by naturevet

November 27, 2011

Hi Pam,

You could roll Qing Ying Tang into your protocol. That has a tendon nourishing and Blood moving effect while also being helpful for itch in late summer.

I'm glad he's still around and that the owner is still committed to him.

Steve

by Pamela Page

November 30, 2011

Thanks Steve,

We'll try it. Continue the Chai hu jia long gu mu li tang as well? How would you recommend dosing them together?

Best,
Pam

by naturevet

December 4, 2011

Hi Pamela,

The two formulas are entirely compatible and can be used together. Just use a full dose of both formulas on a BID basis to start with, while we're trying QYT out.

Good luck!

Steve

by Pamela Page

October 2, 2012

Hi Steve,

Yet another update on Sargent. He re-injured his achilles apparatus, and his sole hind leg has become so weak in the ankle area that they have decided to try arthrodesis of his ankle joint. He is currently still on the above two herbal formulas. Is it Ok to keep him on them for the surgery? Also, the owner ran into a large animal vet who recommended considering an herbal formula from Jing Tang herbals called Jie Gu San, which is specific for bone healing. Have you any opinion on this?

Thanks for your thoughts!

Pam

by naturevet

October 7, 2012

Hi Pamela,

Sorry that you were unsuccessful in healing his achilles. Or had there been improvement?

As for surgery, I can't see it posing a contraindication to the formulas, if they seem to be helping.

Regarding bone healing, I've yet to see anything work better than plain old Symphytum, which can be sourced in homeopathic form from any Whole Foods or equivalent.

How is his skin doing?

Steve

by Pamela Page

October 7, 2012

Hi Steve,

Yes, I had been thinking of comfrey too. I am not a homeopath. What strength would you recommend - 30c? Twice daily? for how long? The achilles did heal and he did well for quite awhile, but then re-injured it. He is just too big and heavy for that one leg I guess. His skin problems are seasonal (summer), and maintaining without too many bad crises, but he does sometimes still need Cephalexin and sometimes low dose prednisone in addition to his herbs, which does not help his weight. I am frustrated that we can't resolve it for him. We have tested him for thyroid several times, always comes back normal, but I wonder if he is one of the 25% I heard about that are hypothyroid but have normal test results? normal. Thanks for all your ideas, and I'd appreciate it if you can advise me on the dosing of the symphytum.

Thanks!
Pam

by naturevet

October 7, 2012

I'd go with 30C strength BID.

It should work well.

Steve

by Pamela Page

May 26, 2015

Hello,

Another question for you on Sargeant. He had tarsal joint arthrodesis of his left hind leg late 2012. Recovery was a long struggle, and he has struggled with mobility ever since. His moderate overweight condition contributes to it. He is a big dog, around 98 lbs, and it is a big load for that one leg (if you remember the other one was amputated). Over the winter he started showing greater reluctance to get up and walk. A few months ago he developed a soft cough. Also soft stools. His conventional vet took x-rays and apparently found no abnormalities (I haven't seen them) It got to the point where Sargeant really developed heavy breathing with any walking and would sit down frequently for rest. Her conventional veterinarian finally put Sargent on a course of fenbendazole for a presumed diagnosis of lungworm (not confirmed, and I question how he would have acquired it with his limited activity and mobility) Also he is on his second course of metronidazole for diarrhea. He also decided to update his DAP vaccine (I had been doing titers). While I had concerns with these treatments for an already weak dog, the owner feels his breathing is 50% improved now. Soft stools are unchanged. His tongue is pale pink, pulses are soft, he seems depressed and with low energy, I thought I heard a soft heart murmur, he is overweight. Excellent appetite remains the same. Breathes hard with walking, sits to rest, lays down immediately in the exam room. He is currently not on any herbs. Skin is doing well, Not having any of the partial seizures either. Would love your herb suggestion for him.

Thank you,

Pam

by naturevet

June 1, 2015

Hi Pam,

Seems like you have a real mixed bag presentation there, with evidence of Qi, Yang or Blood deficiency (tongue, pulse, poor stamina); Blood stasis (problems with former surgical site); and Damp (overweight, colitis).

My first thought when I see these mixed presentation in a big dog with weak pulses is Yi Yi Ren Tang (Coix Combination). I think I'd start with that and see what transpires.

Also, if this dog is not on a home-cooked low-starch OR commercial raw diet, I think I would recommend it. At the very least, have the owners try freeze-dried foods. Moving dogs off kibble and canned food can make a profound difference in chronic weight gains, lethargy and chronic pain and inflammation.

Hope that helps,

Steve

by Pamela Page

June 1, 2015

Thanks Steve,
Further diagnostics are indicating possible Cushing's disease, with mild elevated Alk Phos. and bilateral enlarged adrenal glands on abdominal ultrasound. He doesn't show the typical PU/PD, but has had some unexplained hair loss on his tail, and I guess the weakness and breathing changes can also fit that diagnosis. Low dose dexamethasone suppression test results are still pending. Would your herb recommendation be the same if he is diagnosed with Cushing's? Over his life he has off and on been on a home-prepared grain free diet when the owner can afford it. But he only gained more weight on it. Currently he is on a reduced calorie dry food on the request of her conventional vet.

Thanks!
Pam

by naturevet

June 2, 2015

Looks like you need an insulin-sensitizing treatment. YYRT fits that, but Si Miao San even more so.

I think I'd go ahead and give it a try.

As to the cost of the healthier diets, I always explain to the owners, "You're going to spend the money either on vet bills or pet food. Pet food seems the wiser choice"

Good luck!

Steve

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