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.