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Cavalier With Stiffness

by rmtran - December 22, 2009

Hi Steve,

I am seeing this dog since the beginning of December.

She is a 8 years old FS, and her initial signs were stiffness, lethargy and anorexia about 2 months ago.

Internists run numbers of tests, and all came back negative; tick titers, ANA, Coom's, etc.
The patient was placed on doxy for trial, but it did not help her. Deramaxx seems to help but not Tramadol because she gets too sleepy.

Her pulse is deep, thin and wiry, her tongue is pink but dry. She likes to be in cool place. Her submandibular nodes have been slightly enlarged. Dry and crusty nose and pads.

I placed on this dog on Yi Yi Ren, and her appetite improved and she acted better. At that time.

She came in yesterday and the client reported that her stool is looser and smelly, and her appetite decreased again. Her popliteal lymph nodes were slightly enlarged, her tongue pale pink and dry, and the pulse was
I did acupuncture again, and told the client to continue Yi Yi Ren, and add Bu Zhong Yi Qi Tang. Although I do not see much heat signs here except that the dog prefers cool and her stool has smell, I was hoping that BZYQ will take care of her appetite and loose stool. It is likely that the client might have given too much freezed dried liver treats that caused loose stool, but I thought that helping Spleen will help this patient's Blood deficiency that is causing stasis.

Am I in the right direction?

Thanks,

Rieko

by naturevet

December 22, 2009

Hi Rieko,

You should definitely see what happens with the two formulas. I associate the return of symptoms and stool order with Spleen Damp. Now are you using just Yi Yi Ren, or are you using Yi Yi Ren Tang, which has built in Spleen support? If using Yi Yi Ren Tang, and the stool has odor, then the formula, despite its anti-Damp herbs, may be too rich for it (assuming changing the diet away from those treats doesn't help). So the type of Spleen support the dog needs would theoretically be of the dry and aromatic variety, which is not necessarily BZYQT's forte. San Ren Tang, or Wei Ling Tang (if the dog is chilly) might be better choices. But I'd try using BZYQT since you've started it, and see how it turns out first.

Steve

by rmtran

December 23, 2009

Hi Steve,

As for the formula; I used modified Yi Yi Ren Tang with Cang Zhi, Chuan Wu, Dang Gui, Du Huo, Fang Feng, Fu Ling, Gui Zhi, Mu Gua, Qiang Huo, Xin Xian Cao, Yi Yi Ren.

This dog always prefer the coolness, but I see more deficient signs than Excess. I told the clients to contact me with any change; I have not heard from them yet.

Thanks, and I will try SRT for this patient if they do.

Rieko

by rmtran

December 29, 2009

Hi Steve,

This patient improved its appetite and her stool got better with BZYQT.

However, her popliteal lymph node remains slightly enlarged, and now prescapular nodes are up. The client does not appear to go forward with more invasive procedure with internal medicine.
If those are from due to blood stasis, will this condition imporve with some blood mover?

This patient also is blood deficient; very dry and cracked pads with hyperkeratosis on nasal planum and its discoloration.

Do you think that using Blood tonifying, Qi moving formula like Gui Pi Tang helps this patient?

Thank you for your imput.

Rieko

by naturevet

December 30, 2009

Hi Rieko,

Generally, I associate lymphadenopathy with a Yin deficiency in the outer layers of the body, resulting in a build up of Yang and Heat in those same layers. This, in turn, congeals any Phlegm in those layers, resulting in lymphadenopathy appearing relatively suddenly.

If lymphadenopathy is not endogenous in cause, then it can be due to Wind Heat invasion of these outer layers, causing the same congealing of Phlegm.

Either cause of Heat can create the cracking and hyperkeratosis you're seeing.

The fact that the lymphadenopathy is slightly worse on BZYQT suggests more of an infectious (Wind Heat) cause, since the Astragalus in the formula is a potent immune stimulant. It most likely heightened the patient's immune response, which may not be a bad thing. But we should try to help. The herbs that work for this type of scenario are things like Ban Lan Gen, Niu Bang Zi, and other antimicrobials and antivirals. Tan Yu Tang has a bit of this design, is intended for use in lymphadenopathy, and has some Blood movers.

If you want to pursue the Yin deficiency theory, Blood and Yin tonics are fine, as well as herbs like Xuan Shen. Qing Ying Tang has some of that structure and is a Blood mover. It is also a pathogen expeller.

I know you have other formulas you like to use as well, so I've stayed general here so that you can choose from what you might have on hand.

Continued good luck with your case.

Steve

by rmtran

December 30, 2009

Hi Steve,

I have both Qing Yin Tang (NP) and Tan Yu Tang (NP) on hand.

If I were to continue helping this patient with its appetite, would you keep BZYQT on board while treating with one of above formulas?

If this case is due to pathogen invasion such as Wind Heat, I suppose that I see its pulse change with BL-40 draining, correct?

I will try that at the next visit.

Thanks,

Rieko

by naturevet

December 30, 2009

Hi Rieko,

Yes, I'd continue the BZYQT regardless. And yes, sedating BL 40 should help, both to draw out the pathogen and cool the patient.

Happy new year,

Steve

by rmtran

March 28, 2010

Hi Steve,

I saw this patient and there is a change.

Her tongue is pale lavender and dry, and her pulse is weak. I have kept her on Bu Zhong Yi Qi Tang and Tan Yu Tang and she was doing better until recently.

Her lymph node remains increased in size (not bigger at popliteal and prescapular, but her appetite has been very good. She started to lame on right front leg for no obvious reasons, and her hock drops when she is standing. The client states that she is weaker on rear.

BL-23 improves pulse some.

Tonifying formula such as Liu Wei Di Huang or Ba Wei Di Huang came across my thought, but I do not mix too many formula in one patient and I was not sure if tonifying formula actually make her lymphadenopathy worse.

I recommended to increase the dosage of TYT to 1/2 tsp BID (BW=17.5 lbs) to see if it is going to help.

I appreciate your imput!

Rieko

by rmtran

April 5, 2010

Hi Steve,

I got a mail from my client that the patient started to have mucous around her stool. Clinically, the patient is doing better (eats better and moving better), but the lymphadenopathy continues.

Her nose is less dry, and her pads are much better than it used to be when I saw her last time.

I do feel that there is heat (mucous around stool).

Interestingly, the patient had watery diarrhea when the client home cooked 100% usng bland food such as turkey, beef and chicken not so long ago.

Any how, I am going to use Qing Yin Tang for current condition (loose stool); it has Huang Lien, which would help mucousy stool, and it would also tonify Yin (that was shown as improved pulse with BL-23).

Is my thought process sound?

Thank you for your assuarance,

Rieko

by rmtran

April 5, 2010

I meant your reassurance...

by rmtran

April 7, 2010

Hi Steve,

I put this dog on QYT; within two doses, she started to pant a lot, lethargic and did not walk any longer. The client discontinued it, then started TYT again. The patient is back to where she was.

How I can explain this reaction?

Thank you,

Rieko

by naturevet

April 7, 2010

Hi Rieko,

Since the formula is cooling and moistening, if the QYT was responsible for the downturn, it would be because the dog was Cold or Damp. An improvement again on TYT suggests that at least Damp is present. QYT also moves blood peripherally, so we might wonder if an anti-Damp formula that pulls inwards is a better call (e.g. Si Miao San). SMS doesn't fit that well the original picture, however.

I guess for now, if the lymph nodes are stable and the stool is formed again, just keep going. On the other hand, if the lameness persists and the mucous is back in the stool, and the dog is Damp, then San Ren Tang might be a good choice. If the dog has a L-S disk protrusion, SRT is a good formula for that. Even Huo Xiang Zheng Qi San has been helpful. Both are supportive of Tan Yu Tang and so should be good fits. We also thought of using SRT from the beginning, so it isn't as likely to cause side effects.

Hope that's somewhat helpful. Don't forget to check the dog out chiropractically, if you can.

Steve

by rmtran

April 8, 2010

Hi Steve,

It is strange to me to see that kind of reaction in this patient; she always prefers cooler place, and she did not appear Damp when I start seeing her (dry cracked nose and pads). I suppose that it was not obvious to me due to her mixed pattern.

Thank you for your advise, and I will continue TYT and BZYQT for now.

Rieko

by rmtran

April 23, 2010

Hi Steve,

The patient is gradually deteriorating.

Her appetite has been okay, but her mobility is not. She now walks almost on her hocks, and she gets tired quickly.

She recently had a joint tap which suggested immune-mediated cause.

I have not started her on SRT since I do not see much of Damp signs now.

I do not do chiropractic work; could chiropractic issue cause plantigrade?
The client is very sad and she does not know what to do. The internist is planning to place this patient on immunosuppressant. Once that starts, I would support the patient as I see each time.

Thanks for your help!

Rieko

by naturevet

April 23, 2010

Hi Rieko,

Chiropractic is always a good idea, and never a bad one, except in neoplasia metastatic to the spinal column; and acutely ruptured painful disks. I would seek it out in this instance.

It sounds like the dog is increasingly deficient, making a tonic formula progressively more likely to help. Is the dog still on BZYQT? Is there still lymphadenopathy?

It's time to reassess pulse and points, and forget the dog's past complaints for a moment. If you were seeing it for the first time just today, what would you do?

Does Du Huo Ji Sheng Tang look at all appropriate?

Steve

by rmtran

April 23, 2010

Thanks, Steve.

Yes, the patient is still on BZYQT as well as TYT. Her lymphadenopathy still persists, but not worse. I will be seeing the patient on Monday for follow up. I will reassess her condition then.

Rieko

by rmtran

April 25, 2010

Hi Steve,

I saw this patient today and looks really bad. She had joint tap and they found immune-mediated process going on.
Her plantaigrade got worse; she was having trouble on carpal joints when she saw our internists last week. They found that her tarsus and carpal joints are braking down its connective tissue, and she is not able to support her weight.

She was not like this when I saw her last time. I feel awful.

Any how, her pulse today was fast, strong, and bouncy. Her tongue was reddish. Her feet/ears were warmer, and her joints were swollen (it started when she got off of Deramaxx 3 days ago according to the instruction from internist).

She started immuno-suppressive dosage of pred today. I dispensed Si Miao San. She is off of TYT, but she is continuing BZYQT for appetite.

Now she does not have much option except for having arthrodesis on carpal and tarsal joints; the client won't pursue the option.

Is there any herbal/homeopathic formula that would help her connective tissue?

Thanks for your help.

Rieko

by naturevet

April 25, 2010

I'd stop the BZYQT. It's a deficiency formula and so is not contraindicated in this excess condition.

Si Miao San is a good choice. Consider teaming Hoxsey with it.

Steve

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