Looking for some advice on a thymoma patient who came to me with many complications. Here goes:
11yo FS Shih Tzu diagnosed elsewhere in Jan 09 with thymoma (dyspnea, pleural effusion, mass). Also mature lymphocytosis at that time (28,000; normal 690-4500) presumed chronic lymphocytic leukemia or severe antigenic stimulation due to cancer. Underwent full course Radiation resulting in ~50% tumor shrinkage. Post-radiation thoracotomy for resection resulted in severing left phrenic nerve. Resection was aborted after apparently 3 arrests. She, remarkably, lived and acts relatively normal. Post-op very poor appetite, intermittent diarrhea (cowpie, slight mucus, no tenesmus) and occasional vomiting, bradycardia/ severely pronounced sinus pauses presumably due to increased vagal tone and severed phrenic nerve, "exaggerated"/somewhat erratic breathing pattern (both inspiratory and expiratory but more pronounced irregularity on inspiration). No real improvement in appetite with mirtazapine. On gabapentin for post-op pain. Extreme lethargy and inappetance with tiny dose of tramadol. She has always been a picky eater but no other previous health problems. Pulse thin, deep and weak. Tongue pale and small. Active points BL 20, 21 +/- ST 36 and BL 15. Went berzerk when I needled PC 6 so I didn't. Dx: Qi deficiency (SP--> LU +/- HT) +/- blood deficiency. Prescribed Liu Jun Zi Tang to tonify SP and ST Qi (major complaint was poor appetite/V/D with mucus). Response: only mild improvement in appetite. Vomiting and diarrhea resolved. New problem: episodic ataxia and collapse. Echo normal, ECG shows severely prolonged sinus pauses most pronounced in left lateral recumbency (side of phrenic nerve damage). She is basically fainting sporadically and not necessarily with exertion - at the clinic she was just wandering calmly around the exam room. She continues to be lethargic and her appetite poor. The owner was having trouble giving the powder so I had her switch to tincture. No improvement. While I was gone she got started on prednisone which has helped a little with appetite but her breathing is now very labored.
I am still thinking underlying SP Qi def --> LU Qi def, maybe blood loss during sx-->HT Qi/Yang def. The thymoma is stable. Major complaints now are respiratory difficulty, poor appetite and fainting episodes. Vomiting and diarrhea have resolved. She is still a little chilly (trembles).
I can't really find a formula that seems to fit all these things great. What do you think of Bu Zhong Yi Qi Tang at this juncture? Can I think of this hemiparesis of the diaphragm as a kind of organ prolapse? Is there something better to tonify the Qi and Blood in this patient? Something to better address the fainting and respiratory signs that also addresses appetite?
Thanks a million!
Erin