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by Allyson - March 12, 2010

I have a client with a 12 yr german shepherd cross dog. Rocky is confident dog, not fearful or aggressive but perfers not to be touched or hugged and goes crazy if confined. Dog has an off and on neck pain for 5 years, no radiographic changes, has declined AP for this. We do blood every 6 months on this dog has off and on mild elevations in liver enzymes, has been on milk thistle for 4 years. Never any signs of liver disease, problem noted on routine blood work. Dog is active walks 4-6 miles a day, good appetite. Has a very full looking belly. In Sept dx an abdominal mass, removed a 6" diam lipoma and it was noted dog had profuse abdominal fat. After surgery severe suture reaction, drained fluid for 4 weeks and I eventually had to go back in because it was breaking down. Healed well the second time but suddenly 2 months latter whole linea just melted. Repeat surgery with overlap and double suture layer. This time healed well and held for 3 months then suddenly dehisced again. Owner took to Guelph for surgery and they redid with no implant. At Guelph dog became very anxious and hyperventilating ( we always send dog home the same day as sx as can't stand to be confined in cage ). Panting at Guelph led to Pu/PD and they diagnosed cushings and confirm with ACTH test. I don't believe this test was correct. Dog has no history of PU/PD at home and owner is are retired nurse who lives for this dog, she notices every burp and hiccup. Guelph was very hard on her insisting she had missed the symptoms. So TCM DX? Herb TX? Sorry for long story. Allyson

by naturevet

March 15, 2010

Hi Allyson,

Maybe repeat the ACTH stim test to confirm Guelph's findings. Impaired wound healing, increased abdominal fat deposition, and a rounded abdomen in general are all consistent with the diagnosis, of course, and I know you're aware of that. So I get that there's something about the dog that doesn't ring true with Cushings, but the only way to be sure now is to repeat the test when the dog is considerably less stressed.

I had a case like this early in my career. I ended up having to get a surgical silk mesh from the local hospital to put over the linea alba, so that it would finally heal properly. So this kind of problem is common in humans and is not always tied to Cushings.

Up until that point in your story, the liver enzymes, irritability, and adbomdinal distention were all consistent with Liver Blood deficiency, and potentially treatable with Xiao Yao San. XYS addresses atypical Cushings so may form a link between what Guelph and you are seeing. Blood deficiency isn't necessarily associated with a huge abdominal fat supply, but is associated with impaired wound healing and neck pain (wind invasion secondary to Blood deficiency; spasm). So it's the other diagnosis I'd entertain. The pulse and tongue will hopefully clarify which you're dealing with, as well as the response of the pulse to various acupuncture points.

I hope that helps you out a little.

All the best,

Steve

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