Pet "P" is a 9yr, intact male Miniature Schnauzer that presented for vomiting and anorexia for the past three days. Upon presentation the patient was very icteric and lethargic. The tongue was yellow and dry and the pulses were bounding. Abdominal palpation revealed a soft, fluid-filled abdomen and an enlarged liver. A severe heart murmur was ausculted at a grade V/VI holosystolic murmur with synchronous pulses. Blood work was performed and revealed the following
Anemia: HCT 17.2% (N=37-55%) RBC 2.21 (N=5.5-8.5)
Leukocytosis: WBC 29.11 (N=5.5-16.9) Monocytes 2.75 (N=0.3-2) Neutrophils 19.88 (N=2-12) Basophils 0.11 (N=0-0.1);
Hypoalbuminemia: 1.6 (N=2.2-3.9)
Increased liver enzymes: ALT 701 (N=10-100) GGT 11 (N=0-7) Total bilirubin 17.6 (N=0-0.9)
Azotemia: BUN 54 (N=7-27) Creatinine 1.9 (N=0.5-1.8)
Hypercholesterolemia: 354 (N=110-320)
A Western Diagnosis of Liver Failure was made. An Eastern Diagnosis of Liver Blood and Qi Deficiency, Qi and Blood stasis, and Damp Heat was made. This patient was exhibiting classic liver blood deficiency due to the anemia, dry tongue, and bounding pulses, Qi and Blood stasis due to the cholesterol elevation and marked liver enzyme elevations, Damp Heat due to the profound icteric state, bounding pulses, and leukocytosis, and Qi Deficiency due to the pet’s inability to walk due to weakness. At this point any Qi tonic, Blood tonic or Damp Heat clearing herb might help but doubtful. Unfortunately, the pet died shortly after presentation.
The interesting aspect of this case is that the pet presented previously for vomiting and diarrhea after the pet received a human NSAID. At that point blood work was performed and revealed the following
Slight anemia: HCT 36% (N=37-55%), RBC 4.64 (N=5.5-8.5)
High normal BUN: 27 (N=7-27)
High normal Creatinine: 1.6 (N=0.5-1.8)
It was assumed that the patient had the beginning of renal insufficiency due to the ingestation of the NSAID and vomiting and diarrhea. Intravenous fluid therapy with antibiotics and anti-emetics corrected the problems but made the anemia more pronounce HCT 24.4 % (N=37-55) RBC 3.14 (N=5.5-8.5) HGB 9.9 (N=12-18). Conventional thinking dictated that the patient was in renal insufficiency and an appropriate kidney plan was put in place that included a low protein diet and phosphorous binders. Over the course of the next few months, the pet became more hyporexic by refusing to eat the kidney diet and take the medications, thus revealing a progressive Spleen deficiency instead of a worsening of the kidney disease.
Retrospect evaluation of the pet's condition both Eastern and Westerrn perspective reveals a different possible outcome. Since the pet had anemia, this would indicate Liver Blood Deficiency. Also, since the pet was having vomiting and diarrhea, a Spleen Deficiency would have been made. Since Blood Deficiency can lead to heat and possible dampness, it would have been interesting to see if an appropriate Blood Tonic and Spleen Tonic, such as Xiao Yao San, could have prevented the severe stasis and heat that caused the jaundice, liver failure, suppurative hepatitis, and anemia. No doubt the pet would have succumbed to jaundice and liver failure, but I wonder how much more quality of life the pet would have if started on Xiao Yao San. Xiao Yao San would have been an appropriate choice in the beginning of the disease because it contains Bupleurum that moves stagnant Liver Qi, Angelica and White Peony that tonifies Liver Blood and Yin, Mint that clears heat, and most of the herbs in Four Gentlemen, White Atractylodes, Poria and Licorice, that supports the Spleen and Stomach.
