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Facial Lump

by landauvet - May 5, 2009

Patient: Arlin 6.5 yr old mc golden retriever
P/C facial growth and skin problems
Skin rash to back and inside of thighs of both Hind limbs. Sometimes moist and hot sometimes dry and scabby. Bilateral ear inflammation which tends to be moist and sl brown in discharge. In last two weeks, Arlin has developed a scab over his left eye that is very superficial but does not heal. An inch below this, we just discovered a 2 mm black raised circular lump.
Other pertinent history:
Arlin is graying around his eyes and mouth, His tongue seems more lavender to me in the last 6 months. He is prone to diarrhea with some herbs in past. He is a frequent belcher after eating. Active dreamer with vocalization, leg movement and rhythmic jaw motion. Arlin likes to have his head rubbed a lot. He startles very easily with noise or when we get too close unexpectedly.
Lyme positive last fall by 3 dx- not treated due to lack of symptoms.
Arlin is a skinny golden with a very gentle disposition.

Tongue: Pale pink, lavender. Red, swollen underside.
Pulse: Sl. Thin but strong and deep. Possibly increased tone.
Active points are very subtle. Possibly Bl-20, BL-18, ST -36.

Sp-6 stimulation and Gb-25/ GB-34 stim did not seem to change his pulse.

Tentative diagnosis:
Blood def and stasis I am considering Si Wu Tang or You Gui Wan

by landauvet

May 5, 2009

Hi Steve and anyone else,
I did not say this post is from Kevin Landau. Sorry and thanks.

by johnk

May 6, 2009

Kevin, as a complete novice, looking at this case I agree that it is Blood Deficient but also seems to be prone to Damp. So prehaps DGSYS may be also worth condsidering?

by naturevet

May 6, 2009

Hi Kevin,

I agree that there appears to be Damp and Blood deficiency here. Both problems have a common origin, namely Spleen deficiency. So DGSYS is a consideration, but I feel that for skin problems, an added Wind expelling influence is called for. From a western point of view, many skin problems benefit from increased cutaneous perfusion, which Wind expellers create. In addition, they improve mucosal blood flow in the GI to improve digestion and absorption, while helping to resolve chronic inflammatory processes.

From this perspective, then, I would wonder about Chu Shi Wei Ling Tang, which is readily available from Mona Boudreaux in the US and ourselves in Canada. It's also in the K'an Veterinary Essentials line. It's Blood tonification effect is very indirect, with the main benefits being cutaneous and digestive support and reduction of inflammation. This improved blood flow may allow that lesion to heal properly. A question, though: are you concerned at all about that non-healing wound and adjacent lump being malignant? The more a lump is benign, the more anti-Damp formulas are appropriate.

Anyway, hope that makes sense to you. Some confirmatory findings would be an animal that is worse from antibiotic therapy (e.g. development of diarrhea); an animal that is innately chilly; and an animal with a tendency to low appetite, low energy or soft stools.

If the formula is inappropriate, the itch might be aggravated, but with a deep pulse, that's not as likely. Still, there's no harm in dispensing a small amount and working your way up to a therapeutic dose. With all those GI signs, food sensitivities and allergies may be playing a role as well.

I'll stop talking now. Good luck!

Steve

by landauvet

May 26, 2009

Arlin has been on the CSWLT for about 2.5 weeks @ 1 tsp bid. Initially up until now his energy an attitude have improved in that he is more playful. His skin has been up and down. He seems to break out in a thigh rash with hot and humid weather still. I originally felt like his head was warm and he loved having his head rubbed. Presently, the whole left side of his forehead and face are very warm. There are a few areas of thinned hair coat and redness (to the skin above and below his eye and on his cheek). The non-healing scab is tiny, but still there. The little facial lump is unchanged. He likes having his face rubbed a lot. He likes to lay in the sun. Paws are cool. His acupoint exam still feels subtle to me. Association points are cool. Warmth around LI 10-11. Tongue definitley lavender. Pulse is easy to feel, hard to compress, and stronger the deeper I go.
He is feed a combination raw and good quality kibble. I did not acupuncture him in the last few weeks. Also, he has ground his teeth while asleep one or two times lately which is beyond his normal active sleeping.

by naturevet

May 26, 2009

Hi Kevin,

If Wei Ling Tang is striking you as a little too warming, we can consider San Ren Tang. With skin problems in dogs, however, it can take a month or two to rack up significant improvements in the skin, so if there are any tangible skin improvements, we may not want to switch just yet. If you're not seeing those, I'd try San Ren Tang, which brings blood to the periphery as well, but is slightly more cooling and an anti-Damp Heat formula for the inner thigh.

Good luck!

Steve

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