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Mix Breed With KID/SP Issues

by rmtran - February 1, 2010

Hi Steve,

I have been treating a 11 year old, MC Mix breed dog (90 lbs) for his hind limb weakness.

He has been treated by our internists for possible Cushing's disease; the patient was (still is) PU/PD, but the lab work was not supportive. Lysdren was used to control the symptom; which did not work. Then the patient became anorexic and weight loss started (6 months ago), so Lysodren was discontinued.
The patient developed a pronounced hind limb weakness for the past 2 months.

When the patient came in, his pulse was thin and choppy. His tongue was lavender in color.
I performed acupuncture and dispensed Liu Wei Di Huang for his Kidney Yin and Qi deficiency; which he tolerated for a few days and started to have loose stool.

At the second visit, his pusle was fast, wiry and thin. His tongue was pale pink with redness at tip. I dispensed Si Miao San, based on his responce to Liu Wei Di Huang (to protect SP, yet have some anti-inflammatory and moving effect); he tolerated for almost 1 week, then watery stool developed.

At third visit, his pulse was still thin and wiry, but not as bad as it was week before. This time, I was to tonify his SP and dispensed Liu Jun Zhi Tang (Plum Flower teapills); he did not developed diarrhea, but he started to drink a lot more water in a few days.

I am a little confused by the reaction of this patient to each herbal formula, and I feel like I am shooting in the dark.

I see SP Qi Deficiency, Kidney Qi Deficiency; his PU/PD was thought to be coming from Yin Deficiency. His hind weakness seems to be a result from adrenal damage due to Lysodren tx; would Gan Cao containing product helps his cortisole regulation?

He is low dosge of pred, Mirtazepin (appt stimulant) and Gabapentin. According to the client, he does not eat without Mitazepin and his hind weakness was improved with Gabapentin (still weak, but can get up).

What am I missing on this picture?
I tried point stimulation, but this patient is very scared and shakes like a leaf everytime he comes in, and it is almost difficult to check pulse.
I also noticed that this patient gets weak with my acupuncture treatment for a few days; I reduced the numbers of needles to less than 10, then he was okay. I think that he is significantly Qi Deficient. Although this might be too warming for him, Si Jun Zhi Tan might work??

Thanks for your advise,

Rieko

by naturevet

February 1, 2010

Hi Rieko,

I agree the dog is deficient. Deficient patients can’t handle too many needles or too long a treatment. The Mirtazepin acts as a Qi tonic to support appetite. The fear is very typical of deficiency. So the question is which type.

I feel the dog is probably hot above and cold below. This creates PU/PD, as well as the red-tipped tongue and lower limb weakness. A Yin tonic (Rehmannia Six) was not helpful as the main problem is too little Yang in the lower burner, resulting in a failure to steam up Yin, and therefore a persistent entrapment of Heart Yang in the upper burner. With Yang and Yin not commingling, Source Qi is not generated, and there is no fire under the pot. He can’t handle Yin tonics alone, and herbs like Si Miao San are too cold. Both thus create loose stool. LJZT tonifies Heart Qi, which he sort of has too much of, given the trapped Yang in the upper burner. So he is more thirsty as a result. Ultimately, the only Qi tonic that will work, if this is the situation, is a formula that warms the Yang of the lower burner to steam up Yin and allow Heart Yang to descend. Such a formula is Rehmannia Eight, and that is the first formula I’d try.

The response to gabapentin would make me want to rule out nerve root entrapment from lower back fixations, which would aggravate lower limb weakness. Is there someone you can refer the dog to for chiropractic?

Hope this was helpful.

Steve

by rmtran

February 1, 2010

Thank you, Steve.

It totally makes sense.
I have aready implicated the possibility of referral to a choro tx at the last visit. The patient is coming back in 1.5 weeks, so I will be sure to dispese LWDHW. I wish I can do choro myself...too little time for anything else right now; so much to learn about TCM!

Thanks again,

Rieko

by rmtran

April 6, 2010

Hi Steve,

The client pursued chiropractic, and there was no improvement.

So the client went to see a neurologist and had MRI; there was an incidental lung tumor suspected as carcinoma.

The lesions on his spine was chronic and multiple, so the neurologist did not recommend surgery.

Now I am wondering if I can help this dog with my treatment, knowing that there is a tumor in his lung.

Would Xue Fu Zhu Yu Tang helpful in addition to Rehmannia Eight combo that he is taking?

I have not seen him lately, so I cannot provide recent findings of tongue and pulse.

Thank you for your imput!

Rieko

by naturevet

April 6, 2010

Hi Rieko,

There should be no problem to try XFZYT as well. Has there been any improvement on the Rehmannia? If not, you can dc it, although it's anti-Dampening effects may help the XFZYT be maximally tolerated.

The other thing to think of when there is a Yin Yang separation, spinal cord disease, and a pulmonary tumor, is Xiao Chai Hu Tang. Ideally, the pulse would be deep and wiry for this to be the best approach, but if it was superficial and slippery that would fit too, in which case Chai Hu Jia Long Gu Mu Li Tang would be a better pick.

So a recheck of the pulses and to make up your own mind is always a good idea.

Hope these ideas help,

Steve

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