Looking for herbal options to manage IMPA (immune mediated polyarthritis), and more recent onset of ADR, splenic issues (based on US) and regenerative anemia.
History: Initially diagnosed with a distinct pulmonary mass in April 2009, as an incidental finding on cranial abdominal films taken after the dog at the owner’s (a vet student) anatomy bone set. Owner chose to do nothing further diagnostically for a few months, as the dog had no clinical signs of illness. She then decided to pursue integrative therapies, specifically TCM herbs; the dog was, and still is, on a raw diet. Steve, this is the dog we saw at the fourth module in last year’s basic course.
Initially, in 7/09, the dog was diagnosed as blood deficient with stasis, and put on XFZYT. A good response was noted, with an improvement in hair coat texture, less flatulence, less stasis qualities in the pulse and a pinker tongue; occasional soft stools had re-developed after initially improving. Repeat thoracic rads, in 9/09, taken out of curiosity, revealed an increase in size (~30%) of the initial pulmonary nodule, and 2 additional smaller nodules now visible. Based on what was assumed to be progression of disease (despite no clinical signs still), the dog’s somewhat irritable nature, the tongue/pulse assessment (ongoing stasis in tongue and pulse), active points (SP alarm, LV assoc pt, others?), the dog was continued on XFZYT and XYS was added.
Within 2 months, the dog developed progressive signs of heat and dampness and somewhat aggravated blood deficiency, including increased pulse rate, thinner pulse, redder tongue, ocular discharge, flatulence, intermittent ear issues, rough hair coat with increased shedding and small dander. In 11/09, the dog was changed to SMS + Dang Gui, with a good response and resolution of these signs. The dog was noted to be losing weight (7#) during this time, with no change noted in appetite (always good), stool, activity level or feeding.
In 1/2010, the dog became acutely lame in the RR limb, with no response to proprietary herbal analgesic compounds (composed mostly of blood movers). The owner was hesitant to use NSAIDs, as the dog had experienced GI signs in the past with NSAIDs; PE, joint taps and stifle radiographs supported a diagnosis of immune mediated poly arthritis (IMPA). The dog had a history carpal IMPA in the far past but had not required any therapy in the last several years. The dog was switched to YYRT, based on its tendency to become damp and/or hot, the current lameness, and the good response to SMS with DG (as YYRT and SMS + DG have many similar herbs). After nearly 4 weeks of intermittent lameness, some of it nonweightbearing, the dog’s primary DVM started pred at 1 mg/kg day. A very quick response was noted (80% improvement in lameness), with few side effects (some mild, intermittent hyperactivity; slight increase in urination noted; no increase in appetite noted). Owner weaned him after a few weeks to 1 mg/kg EOD, and is interested in getting him off pred, or to a minimal dose, simply because she prefers for him not to be on pred; so this is Question #1-herbal recommendations for IMPA????
To make matters more complicated, in the last few days, the dog was noted to have a tense abdomen and was ADR; US shows a swiss cheesy looking spleen, no free fluid in abdomen, no melena but a PCV 26%. He isn’t wanting to eat tonight, although he did go on a 2 hour walk with the owner this afternoon (?). I have recommended staying on YYRT, for now, and adding Yunnan Baiyao at a fairly stiff dose of 6 capsules BID for 2 doses, then 3 capsules BID. The primary DVM wants to increase the pred back to 1 mg/kg/day as palliative therapy; he is thinking the masses in the lungs and the odd looking spleen are all related to a cancer of some sort—up to this point, the owner has opted to not do further diagnostics, aspirates, etc, as she is not interested in chemotherapy, etc. Question #2-Any other recommendations????? I am currently out of state, so I can’t give you an up to date tongue and pulse or active points, but we do know, historically, this dog has a tendency to have stasis, and to develop dampness and heat.
Thanks.
Lynelle