Gastroenterology Case Report

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

History

Pet "P" is a 10 M Labrador Retriever cross that was presented for chronic weight loss, vomiting, and lethargy. The dog was a Galveston rescue from Hurricane Ike in 2008. Previous medical history is unknown since the previous owners were going to ground tie the dog in the backyard while they evacuated the island. The current owners took the dog with them when they evacuated and relocated to Montgomery, TX while the hurricane devastated Galveston Island. The current owner has not had the pet to the veterinarian since being rescued due to the owner’s financial problems as a result of the hurricane. Pet "P" has never been on heartworm prevention according to the current owner. The dog started to become hyporexic followed by vomiting a few months prior to initial presentation in late November. The pet’s disposition and willingness to please the owner disguised the fact that this dog has lost 10 pounds within a month.

Western Exam:

Abdominal palpation did not elicit any pain nor reveal any other abnormalities. Diagnostics included a centrifugal fecal parasite exam, heartworm test (both Knott’s and occult), complete blood count, serum chemistry profile, electrolytes, prostate exam and chest and abdominal radiographs. Surprisingly, the fecal exam, the prostate exam, and the bloodwork , including the heartworm tests, were normal. However, the abdominal and chest films were not normal. There was a right atrial mass present, a large abdominal mass at the area of the pylorus and multiple small abdominal masses throughout the abdominal cavity.

Eastern Exam:

The patient’s tongue was lavender and dry from stagnation and heat and the pulses were superficial and bounding due to heat. No obvious warm or cold preference was noted by the owners. The patient’s previous diet was a commercial dry dog food that was drying. Currently the owners were cooking for the pet that included eggs, a variety of fruits and vegetables, and occasionally yogurt or cottage cheese. The dog did not have an appetite for the majority of the foods presented. When the pet did eat, he immediately vomited the food as a result of phlegm and rebellious ST Qi. The fur coat, ears, and skin were normal and did not have any abnormalities noted.

Diagnosis

Western: Neoplasia-primary or secondary GI involvement that is most likely adenocarcinoma, lymphosarcoma or hemangiosarcoma

Eastern: Qi Def/Exhaustion from the fatigue, Phlegm accumulation from the chronic vomiting, SP Qi Def/Inefficiency from the chronic weight loss and vomiting, Triple Burner Obstruction of the Middle Jiao that will account for the SP Qi Def and chronic vomiting

Treatment Plan

Western:

I recommended an echocardiogram and an abdominal ultrasound, with biopsies and histopathoogy, to determine the type of cancer and appropriate treatment. Recommended starting on prednisone to determine if this will increase the pet’s appetite and energy level.

Eastern:

Since the pet was displaying an array of a Triple Burner (TB) Obstruction of the Middle Jiao, Xiao Chai Hu Tang (Minor Bupleurum Combination) was recommended to start to relieve the TB obstruction since it is indicated for this particular problem. The main ingredients that will alleviate the problems that this patient is experiencing is: Chai Hu (Bupleurum) to relieve the TB obstruction, Huang Qin (Skullcap root) to clear the heat, Ban Xia (Pinellia tuber) to dissolve the phlegm and dissipate nodules, resolve rebellious ST Qi, and disperse stagnation, Ren Shen (Ginseng root) for Qi exhaustion, Da Zao (Jujube) to tonify SP, ST and Qi and Sheng Jiang (Fresh Ginger) for the vomiting.

Outcome

Due to the extent of the disease, the expense and the poor prognosis, the owners elected euthanasia.

Ophthalmology Case Report

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

 

History and Exam

Pet "P" is a MN, 15 yr old, Shih Tzu weighing 13.7lbs (6.22kg).  He presented for ear problems.  Upon examination and evaluation, it was discovered that the pet had crusty eyes and had been previously diagnosed with KCS but currently was not on ocular medication.  A STT revealed no tear production and fluroscene stain revealed superficial, bilateral, geographic corneal ulcerations.  Gentamicin Ophthalmic 0.3% Ointment was dispensed for the ulcerations and was to be applied every 8 hours for 7 days.  The ears were cleaned and medications dispensed.   On recheck examination, the pet had a ruptured anal gland.  A fluroscene stained revealed complete healing of the superficial corneal ulceration.  The Gentamicin eye ointment was discontinued at this time.  Pet "P" was sedated, and the ruptured anal gland was clipped and cleaned.  The pet was sent home with oral Clavamox and a tapering dose of Prednisolone for the ruptured anal gland.  It was discussed with the owner to restart the Cylosporine eye ointment even though in the past the medications did not seem to work well according to the owner.   At this time a  TCM examination was performed.  The skin coat was dry and flakey, the tongue was small and pale, and the pulses were normal.

Western and TCM Diagnosis

A western diagnosis of KCS; corneal ulcerations; chronic, intermittent otitis externa that gets worse during humid times; and a ruptured anal gland were made.  A TCM diagnosis of blood deficiency leading to heat and dampness was made based upon the dry, flakey skin; his advanced age; tongue evaluation; chronic otitis externa that worsens during high humidity; and a ruptured, abscessed anal gland.  His pulses were not deep, as expected with a deficiency problem, since he had an active infection occurring from the ruptured anal gland causing heat and a more superficial pulse, thus causing the pulses to feel normal.  Pet "P" has several Western diagnoses that seem to be unrelated; however, he has only one Eastern diagnosis of blood deficiency that connects all of his seemingly unrelated problems together. 

Herbal Formula Recommendation

According to the owner, the cyclosporine ocular ointment does not seem to be working well since the eyes are still cloudy and slightly crusty regardless of the consistency of medicating the animal.  Additionally, the ear problem that the pet was experiencing returned during a week of hot, humid weather.  Another problem the pet is having is that the pet is getting confused and occasionally running into walls.  This behavior could be a result of the chronic KCS or mental confusion.  Regardless if the pet is blind, the pet should be able to memorize the house plan.  Even though he cannot see well, no furniture has been changed nor a move to a new house been made.  As a result, Pet "P" has even more evidence of blood deficiency.   I started the pet on Si Wu Tang:  0.2cc PO q 12 hours.  Since KCS is most commonly a Liver Blood and Yin Deficiency problem and the animal was exhibiting blood deficient problems and minor yin deficiency from age, skin, ear, mental confusion/not remembering, and anal gland problems, I thought that Si Wu Tang would be the best way of treating all of his symptoms.   Si Wu Tang nourishes the Blood (from the Angelica Root and Cooked Rehmannia), moves Qi and Blood (from the Ligusticum, Red Peony, Carthamus, and Persica), tonifies the Kidneys (from the Cooked Rehmannia), tonifies the Liver and regulates the Liver (from the Cooked Rehmannia and Carthamus), all of which Pet "P" can benefit from according to his symptoms.