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Bassett Puppy With Shifting Lameness/inappetance

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Dear Steve,
Here is an update on the Bassett puppy. I originally prescribed Hoxsey & Boneset 1.5 cc TID, Shi Quan Da Bu Wan 1 gm on am (inappetance and pale tongue, weak), Jia Wei Si Wu TAng (move/nourish Blood, Wind suicides, muscle tremors, migrating lameness), Standard Process Adrenal Support. There was a brief episode of diarrhea, so I d/ced SQDBW and halved the JWSWT dose. Diarrhea resolved. The puppy is now eating, lots, and the lameness in the RHL has moved to the LHL, and trainsient lameness LFL. I am not convinced this is pain, so stopped any Tramadol. No pred for 2 weeks and the dog is fine. Sent it to a chiropractor and he felt the problem was sacral, so I did EAP last treatment, and resumed full dose of JWSWT. I also used JWSWT overlapped with H&B as I was thinking that once the excess Damp Heat in the bones was cleared, moving Blood in to cleanse would be good (Module 7).
I am not sure where I am going with this. The tongue is pale lavenderish pink, dry. Pulses are soft and deep. TMJ pops with full extension of mandible but is not painful. I was thinking with the small adrenals, HQ and sacral involvement, dog loves warm, and tongue that this might be a Kidney Yang (Jing) deficiency and my use Ba Wei Di Huang Wan eventually. Any ideas on transitioning from what I'm doing to that? No active GB points right now. I know I don't want to tonify too soon, maybe in combination with XCHT?
I'll post again when I see her next week.

by naturevet

April 27, 2009

Hi Jodi,

You're doing great with this dog. In terms of when to transition and what to transition to, I always let the points and pulse dictate that. For myself, I've learned that if I transition too early, I set the patient back. So for me, I don't get too far ahead, and make sure that any improvements on the current protocol have had a time to completely manifest.

Given your current thrust, and your suspicion of Kidney deficiency, Du Huo Ji Sheng Tang makes sense as your next step. It expels the Wind, tonifies Yang, and has the desired affinity for the back end. Ginseng is in there to support the adrenals.

Hope that helps!

Steve

by

April 27, 2009

Thank you. I never would have thought of that! That's why you are the teacher and I am a grasshopper. Jodi

by

May 5, 2009

I saw Abigail again today. Last week the owner had told me the puppy was having urinary accidents, but I was unable to collect a urine sample as she urinated in the car. So the owner took her to the other DVM Sunday, who measured USG=1.016, 2+ blood, sent out a culture and started her on Clavamox. They said the urine culture would probably not grow as the urine was so dilute. (They don't know about Damp Heat, do they?) They palpated deep bone pain in both femurs and tibias, and she is now limping on the LEFT hind leg.
When I saw her today, she was barely limping at all. She did have heat and sensitivity at BL28, and didn't like me palpating her femoral pulses. Tongue is darker pink, not as pale, still dry with lavender center. Her appetite is great now, and she is more playful at home.
She has been taking Du Huo Ji Sheng Tang, Hoxsey & Boneset, Standard Process Adrenal Support, and am tapering down Jia Wei Si Wu Tang.
I think that she is still Spleen Qi/Kidney Qi and Blood deficient. The Internal Wind-Damp Heat has not moved forward like it did before, and I think that the fact she did not limp much today compared to non-wt bearing in the RHL 2 weeks ago is attributable to the Du Huo Ji Sheng Tang. Although her T&P don't reflect it, I know she still has Damp Heat-Bladder/Bones-both Kidney involvement. I'll have to watch the Spleen with more antibiotics.
Anyway, enough of that. I think this dog is stable right now, and I am keeping everything the same unless the antibiotics make her sick, in which case I may nee a Spleen tonic-change Hoxsey and Boneset to Si Miao San?
It's cool to see TCVM work, when this puppy would be on pred, antibiotics, etc., otherwise.

by naturevet

May 6, 2009

Hi Jodi,

Glad to hear of the continued progress, especially in a complicated case. You always seem to get those, don't you?

S

by

May 19, 2009

I presented this case a t a TCVM group meeting, and while doing so Inoticed a pattern. Started with SPleen Qi deficiency (diet, young dog), then pneumonia (Lung), then bone involvement (Kidney), and then muscle trmors/Wind/Blood deficiency (Liver). The next (and last( in the circle is the Heart. Although I see this dog later today, I like to be prepared. I believe the lameness has improved on Du Huo Ji Sheng Tang. I am trying to get to a pint where I can tonify Kidney/Spleen, which are the roots. But when I tonigy the SPleen, would Gui Pi Tang be an idea to nourish Heart Blood (a preemptive strike?)
I saw the posting for a position in your clinic. What an opportunity!!!!!!!
Thanks, Jodi

by

May 19, 2009

Results of exam today: T is lavender with pink edges, more color (not as pale), still dry. Pulses are slightly wiry but soft, deep SP/HT, L>R. Owner discontinued Clavamox for UTI 1 week ago. Out of Hoxsey & Boneset x 2 days, Adrenal Support x 2 days. No more heat over sacrum. Fully weight bearing all legs. Weight up by 1 lb. I think the Wind has abated, but there is likely still Damp Heat. Kidney-Spleen QI deficiency, Blood deficiency.
I am continuing Du Huo Ji Sheng Tang, and changing H&B to Si Miao San 1/2 gm BID Natural Path (wt=38lb). Sent out a urine culture. Continuing Adrenal Support. Recheck in a month.
I am still curious about the Five Element cycle progression above and would love your ideas.
Thanks, Jodi

by naturevet

May 19, 2009

Hi Jodi,

If the dog tolerates DHJST well, then Heart Blood tonification using Gui Pi Tang may be well tolerated. It all depends on how much the dog needs the SMS. If you get through another few weeks with no problems, try weaning off the SMS. If there are still no problems with the dog still on DHJST, then it should be able to handle Gui Pi Tang.

Be sure to tell your colleagues about the job posting. We need the help!

Cheers!

Steve

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