Endocrine Case Report

Case Description, History and Exam

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 13 yr F/S DSH weighing 7.7lbs (3.5kg) that presented for an annual exam in October 2010.  The previous year’s exam revealed a cat that weighed 7.8 lbs (3.55kg) and no other complaints, or none that was presented by the owner as being significant.  The abnormalities on the 2009 exam were mild tartar and gingivitis and a dull and matted fur coat.  This year the owner claimed that the pet developed polydipsia and polyphagia sometime within the last calendar year.  Upon further questioning the owner disclaimed that the cat’s activity level did not coincide with the pet’s age of 13.  However, the owners felt that the cat slept an adequate amount and was not overtly hyperactive.  This year’s examination revealed a slight weight loss despite an increased appetite, tartar and mild gingivitis that was unchanged from the previous year’s examination, a fur coat that was unkempt and slightly oily, a body condition score of 2/5 and an audible heart murmur that was not ausculted earlier.  No thyroid nodule was evident.  Upon resting, the pet had a loud pur.      

An Eastern examination revealed that the pet’s tongue was red and the pulses were superficial and rapid indicating heat, as well as the gingivitis present.  Phelegm was present due to the oily fur coat, loud purring and heart murmur.

Various diagnostic options were discussed with the owner as well as treatment plans for differing diseases.  The owner declined all diagnostics as well as empirical treatments:  both Eastern and Western.

Diagnosis:  Western and TCM

A Western diagnosis of undiagnosed hyperthyroidism was presumed even though no diagnostic tests were performed.  The presumption was based upon the polydipsia, polyphagia coupled with weight loss, an audible heart murmur, the abnormal activity level of the pet, and the age of the cat. 

An Eastern Diagnosis of Phlegm and Heat were diagnosed.  The Heat signs that were clinically evident were the continued gingivitis, increased thirst, increased hunger, rapid and superficial pulses and red tongue.  The Phlegm signs were the oily fur coat, loud purring and heart murmur.  Coupled with the Western diagnosis of hyperthyroidism, Amber would be classified as a Phase II hyperthyroid cat in which there is accumulation of phlegm and heat in the triple burner

Herbal Prescription

Regardless of the herbal formula chosen, Pet "P"  was in need of a diet change that does not continue to dampen the overtaxed Spleen and Stomach.  A switch from a manufactured kibble that is high in carbohydrates, which are dampening by nature, to a home-made diet low carbohydrate and high protein is essential to the successful treatment of hyperthyroidism in Eastern medicine.   The appropriate herbal formula for this patient is Wen Dan Tang or the Modified Wen Dan Tang in hopes of ceasing the progression of the disease.  The necessity of clearing Heat, moving Blood, dissolving Phlegm and draining Damp are important in Phase II hyperthyroidism.  These objectives are achieved with Wen Dan Tang or the Modified Wen Dan Tang as the following illustrates.  Zhu Ru (Bamboo) clears Heat arising from Phlegm accumulation, Huang Lian (Coptis) and Zhi Zi (Gardenia) cools Heart Fire, thus slowing down tachycardia and the subsequent  murmur, Tao Ren (Persica) and Hong Hua (Carthamus) moves stagnant Blood that has arisen secondary to Phlegm accumulation, Gua Lou (Trichosanthes) and Jiang Can (Bombyx) transforms Phlegm accumulation, Mu Li (Oyster shell) contains iodine that can be used for either hypo or hyperthyroidism, Gan Cao (Licourice root) reduces any harmful side effects of the other herbs, Sheng Jiang (Ginger root) warms the middle jiao and helps in digestion and proper functioning of the Spleen and Stomach, and Chen Pi (Citrus peel) and Zhi Ke (Citrus) eliminates Phlegm accumulations.  Therefore, these herbal formulas are appropriate for Pet "P's"  case of undiagnosed Phase II hyperthyroidism. 

Conclusion

It is unclear from the previous yearly examinations when the pet started to exhibit the Phase I hyperthyroid signs of dampness manifested as abdominal distension, vomiting after meals with a slimy consistency to the vomitus, changes in thirst and appetite, weight gain, lethargy, mucus in the stool, and watery urine.  The environment in which the cat lives in is mainly damp and humid year round, so this benchmark cannot be included in clinical signs and observations.   The undiagnosed Phase I hyperthyroidism misdiagnosis is most likely a consequence of inappropriate questions asked during previous examinations and nondisclosure of perceived “normal” behavior for a geriatric cat from the owner.  Pet "P" is now a Phase II hyperthyroid, geriatric feline that could be helped with a diet change and an herbal formula. 

Respiratory Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a seven-year-old male neutered Labrador retriever weighing 75 lbs (34 kg).  Pet "P"  presented in August for a 36 hour hacking, nonproductive cough.  The previous week Pet "P"  was in play-care at a local facility.  No other abnormalities were noted by the owner.  Physical examination revealed a normal, rectal temperature of 101.2 F, neither crackles nor wheezes upon lung auscultation were noted, no murmurs were ausculted, and upper respiratory stridor was present.  The Western diagnosis was an infectious tracheobronchitis due to the fact that Kennel Cough and the Canine Flu are prevalent in this area.  Additionally, laryngeal paralysis was diagnosed.  The treatment of choice for any  upper respiratory infections is a three week course of 10mg/kg of oral Doxycycline once daily.  This will ensure that a respiratory infection is cleared, and if any residual cough lasts longer than the three week antibiotic treatment, a cardiovascular problem is considered and explored.  Additionally, a tapering dose of Temaril-P was prescribed. Temaril-P is a dual anti-histamine and steroid medication that can be given to pets suffering from bronchitis of any origin and associated coughing.  Since the pet was prescribed a three week course of oral antibiotics, Purina’s pro-biotic, Fortiflora, was dispensed to prevent antibiotic induced diarrhea.  A three week recheck was scheduled but was not followed through by the owner.  

A TCM exam was performed alongside the Western examination.    Pet "P's"  personality has always been a very loving and happy dog that tends to be a little overweight.  Pet "P"  is the typical Earth personality.  Pulses on Bob were bounding and the tongue was a dry, red-lavender/purple color.  Pet "P" also had a dull, flaky fur coat.  Pet "P"  suffered from Blood Stagnation and heat from the bronchitis, Qi Stagnation from the laryngeal paralysis, and Blood Deficiency resulting in a dull fur coat.  The bounding pulses can be explained by the infectious tracheobronchitis that was producing heat.  The dry, red-lavender/purple tongue can be attributed to the bronchitis producing heat that resulted in the red color, the stagnation causing the stridor that resulted in the lavender/purple color and the pet’s diet of dry food that caused heat and dryness.  Dry food kibble weakens the SP Qi, and since Bob is an Earth dog, his SP Qi is easily damaged.   Subsequently, Pet "P"  exhibited signs of Blood Deficiency due to his dull, flaky fur coat.  As a result of Blood Deficiency, Pet "P's"  propensity to develop heat from Blood Stasis is amplified.  The infectious tracheobronchitis that Pet "P"  easily contracted was a result of a Yang Ming and Shao Yang invasion as a consequence of the life-long poor diet that damaged the spleen’s ability to produce blood and Qi to protect the Tai yang level. 

The herbal treatment of choice was Xue Fu Zhu Yu Tang (ZFZYT) since the pet had blood deficiency and blood stasis in the upper burner.    XFZYT not only eliminates stagnation in the upper burner but also nourishes blood which is one of the reasons why this patient contracted the infection.  The SP Qi damage was off-set by a home-cooked diet rich in blood tonics, such as liver, and easily digestible fruits and vegetables that prevented damp and phlegm accumulation.