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GBTH Obstruction , GB Mucoceal

by swaneysue - February 7, 2010

PATIENT Levi 15 year old male neuter terrier mix, 21#

DATE INITIAL PRESENTATION 2 /2/2010

HISTORY I began treating Levi for cervical pain and ataxia in sept 2009. He had been doing great and was stable. The owner had declined herbal support due to a history or being very sensitive to medications and diet changes. She was on W/d Diet to control epeisodes of vomting/pancreatitis. In January she had an episode of acting confused stumbling and falling over she was also drinking more and her hair was falling out.. Her regular vet ran blood work , U/A, and thyroid . Alkpho and ALT were elevated along with mild proteinuria. Denosyl 1daily and Same 200 mg sid were started . She continued to have episodes of confusion , stumbling and falling over. She recovers within a 5 to 20 minute period and is back to normal.

TONGUE Red Lavender

PULSE middle rolling strong

SIGNS/SYMPTOMS Episodes of acting confused , stumbling and falling over . Increase in drinking and restless periods. No obvious temp preference noted. Appetie is normal to increased. Stools are ok . Between episodes she acts normal. Active points BL 22, BL 18, 19 , 20 , GB34 . Pulse softened with sedation of BL 22, GB34 and BL 18 and BL 19

WESTERN DIAGNOSIS open , possible seizures-hepatoencephalopathy, brain tumor , inflammatory, cushings, liver disease , hypertension.

TCM DIAGNOSIS Damp heat in the Liver Gallbladder , Liver yang rising with internal wind , GB/TH obstruction

PRESCRIPTION Started Damp Heat Dermal relief 1 twice daily and open the liver channel at ½ twice daily. Acupuncture

ADVICE GIVEN recommend ultrasound of liver , cushings test and Blood pressure check.

FOLLOW UP The night after appointment she had 3 epiodes in 1 hour period . She went to the internal medicine specialist – Ultrasound revealed Gb mucoceal . Alkphos increased to 1,291 from 831 (10-150) , Alt increase from108 to 177 ((5-107), cholesterol mild increase of 367 (112-325). U/A 3+ proteinuria , SG 1.010. Cushing test pending , they are recommending surgery to remove mucoceal and they feel there is still possibility of brain pathology also.

Question : do you think I should stay with Damp heat dermal relief and open liver channel or change open liver channel to Chai Hu Jia Long Gu Mu Li Tang ? Also would you go full dose on both or start slower with open liver or chai hu jia ? or any other thought thanks a lot Sue

by naturevet

February 8, 2010

Hi Sue,

Interesting case. I hope you have the chance to remain involved. If the dog is somewhat stable, I'd evaluate for Cushing's. If the dog is Cushing's positive, then a LDXGT plus SMS derivative like the one you're using is still appropriate. I'd try it, if you have the luxury, for a couple of weeks, since it will also have a general anti-inflammatory effect that may speed healing following any surgery.

Remember as well that GB mucocoeles are as much a symptom as a problem. So surgical removal may not accomplish much if there is an associated biliary tree spasm or other pathology that is currently functional and thus unrecognized. Indeed, mucocoeles are just an excess build up of mucous, and we would expect that in an animal with severe inflammatory problems. So even with a mucocoele, I would expect the anti-inflammatory approach you've embarked upon to be helpful. In addition, the SMS component of the formula greatly helps bile metabolism and biliary tract pathology in particular, and is thus well indicated in mucocoeles.

What I would not expect, whether with Cushing's or mucocoele, is any meaningful improvement in the animal's well being on the diet it is on. A diet change to raw or home-cooked is mandatory, because of its strong anti-inflammatory, insulin-sensitizing and anti-Cushings effects. If the owner is not willing to pursue that, the case is not likely to be rewarding regardless who treats it.

Is CHJLGMLT okay to try? Sure. There's some interchangeability here, but I think the formula you've started with is fine. The aggravation post-treatment may have been due to excitement as much as anything, and doesn't likely represent a reaction to the herbs or your acupuncture. It just means they hadn't taken effect yet.

I hope this advice is useful and that you have a chance to participate further. All the best,

Steve

by swaneysue

February 8, 2010

Steve , I saw the dog today. Her Cushing test is positive as expected, bile acids normal. She is now having episodes of real leg ataxia , weakness and collapse just the rear legs worse on one side , she does not act confused or lost or spaced out at all, she keeps walking and within a few minutes is normal. Episodes last few minutes and can be in groups. She just walks out of it. The internist feels they are seizures from the cushings and pituitary tumor but they don’t look like a seizure and I am not convinced –what do you think? Could they be coming from some sort of spinal inflammation ? she has ongoing cervical and T_L sensitivities we treat with acupuncture. There is no sig pain . that we can find. I adjusted her today and we are going to acupuncture thur. She has started the herbs. She will not do raw, but maybe homecook-what would you recommend cooking? would high protein be too hard on the liver ? I appreciate you help and will keep you posted. Best Sue

by naturevet

February 8, 2010

Hi again,

I think their pituitary tumor theory is a possibility, actually. If it is correct, the herbs should shrink it. I'd give SMS in addition, for good measure.

Home-cooked is fine. Roughly a 50:50 split of meat to veggies with no grains should be very well tolerated by the liver. Remember to add calcium.

Good luck to you. It could be a really rewarding case.

Steve

by swaneysue

February 25, 2010

Update, grest news, Owner is home cooking , and giving the herbs, no episodes of weakness/seizure like behavior !!! and acting very calm and happy . looked like a whole new dog. We did the happy dance. Sue

by naturevet

February 26, 2010

Congratulations to you, Sue. Take some time to bask in your glory!

S

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