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.
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