Neurologic 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 9yr, FS English Bulldog.  She has a long medical history which includes recurrent otitis externa that resolves with SMZ TMP oral tablets and topical medications; uncontrolled hypothyroidism even on levothyroxine; urinary urgency with hematuria that revealed a sterile cystitis via a C&S in October 2010 and which is alleviated with intermittent Meloxicam; seasonal pruritis that is controlled with Hydroxyzine; seizures that are controlled with Phenobarbital; and a tendency to gain weight despite being on controlled feedings.   The pet is heartworm and fecal negative and eats a commercial dry dog food. 

On physical exam, the dog is very friendly, has upper respiratory stridor and has flatulence.  The ears at this time are fairly controlled with the current medications.  The pet’s allergies have recently flared with slight control with Hydroxyzine.  The urinary urgency and hematuria has not recurred in two months, thus the dog has not needed Meloxicam.    The pet has gained three pounds since the last visit and remains obese.  The owner was instructed to give the levothyroxine on an empty stomach one hour prior to meals to help increase absorption and hopefully eliminate more weight gains.  Due to the pet’s obesity, the pulses were difficult to palpate but seems to be slippery.  The tongue was a purplish color with tenacious saliva. 

The Western diagnosis is otitis externa, hypothyroidism, sterile cystitis, allergies, seizures, and obesity.  Eastern diagnosis is: 1) phlegm/damp disguised as seizures, recurrent otitis externa,  weight gains, upper respiratory stridor, slippery pulses, and the tenacious saliva; 2) heat disguised as otitis externa that is alleviated with oral antibiotics, flatulence, and sterile cystitis with hematuria that is alleviated by NSAIDs; 3) wind that is disguised as seizures,  seasonal pruritis that worsens during windy times of the year; and 4) blood deficiency with stagnation that is expressed as a purplish tongue and hypothyroidism.

The majority of this dog’s symptoms could be explained by a SP/ST being overwhelmed with an inappropriate diet, thus causing heat symptoms, blood deficiency and stagnation, and phlegm symptoms.  Therefore, a change to a low grain-high protein diet would benefit this pet tremendously.  The wind and phlegm seen in this pet as seizures and allergies can be alleviated by Ban Xia Bai Zhu Tian Ma Tang since it is indicated in dogs that have a history of weight gains, cystitis, and otitis externa.  It will also strengthen the stomach and spleen to prevent further damp and phlegm accumulation. Secondarily, the formula will drain damp and clear heat.  The main ingredients in the formula that will help pet "P" are Er Chen Tang that helps eliminate phlegm, gastrodia that extinguishes wind, alisma that drains damp, phellodendron that clears heat, and atractylodes that supports the spleen. 

Case Report: Equine Infertility

Equine Infertility

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


History

Mare “P” is a 14-year-old Quarter horse that has failed to cycle and become pregnant four out of the five years.  2009 was the first time the mare foaled.  The owner disclosed that the mare always has had a long winter coat during the spring and is under lights.  She is not housed around cycling mares and a teaser stallion is not available for estrus testing.  The mare conceived her only pregnancy after an acupuncture treatment.

Western Examination, Diagnosis, and Treatment

The mare is presumed to have “Cushing’s” or pituitary pars intermedia disorder (PPID).  This condition prevents the mare from cycling as a result of an abnormal.  This condition is recognized as the mare having a long hair coat, not cycling, and infertility.   As a result, the mare’s body is not in sync with the natural cycle of fertility that coincides with the increased spring daylight hours.  The increased daylight hours signals the pituitary to produce increasing amounts of lutenizing hormone (LH) and follicle stimulating hormone (FSH) that leads to a normal cycle and ovulation allowing a successful pregnancy to occur.   The Western treatment for this mare’s disorder is to be placed “under lights” to mimic the increased daylight hours observed during the spring and summer, be placed around other cycling mare and a teaser stallion, and be given Altrenogest (Regu-mate).  Altrenogest is a synthetic progesterone that will suppress release of stored LH and FSH in the pituitary.   Although it suppresses the release of luteinizing hormone (LH) and follicle stimulating hormone (FSH), it does not suppress the production of the two.  After discontinuing the medication, these increased hormone levels will be released and mares will cycle shortly after discontinuation. This time frame is the most fertile time frame for the mare to conceive. 

Eastern Examination, Diagnosis, and Treatment

Since the owner’s only success with this mare’s fertility concurred with acupuncture, the owner elected to treat this mare with conventional and nonconventional medicine.  The use of acupuncture in reproduction has been documented as an adjunct to help an aging mare to cycle and become pregnant.  The Chinese view conception as a result of pre-heaven, post-heaven, and kidney-essence.  Pre-heaven essence is equivalent to the sperm and ovaries successfully uniting.  Post-heaven essence is equivalent to the nutrition consumed.  Kidney-essence is equivalent to an individual’s constitution.  The goal of acupuncture for this mare is to nurture and strengthen the pre-heaven essence and improve the kidney-essence.  As a result, the mare most likely will become pregnant. 

The best way of strengthening the two essences is to perform acupuncture on the meridians that passes through the reproductive organs and unique acupuncture points that are known to strengthen the uterus and help with conception.  Most of these points lie on the Bladder (BL), Liver (LIV), Kidney (KI), and Spleen (SP) channels.  There are a few extra-ordinary points known to strengthen the reproductive system in general such as Stomach (ST), Small Intestine (SI) and Heart (HT) points.  The following points in the table below were used.  Most of these points were injected with vitamin B12 complex to stimulate the acupuncture points long-term because the mare was being shipped and most likely not able to return for follow-up treatments.  The asterisks (**) indicates the points that were stimulated at each of the three sessions.  The nonasterisks indicate that the point was used once during the three sessions.

Acupuncture Point	Point Function
LI 10	Qi deficiency
LI 11	Tonification point
ST 36  (**)	Xue tonification point
ST 44	Mammary gland tonification
ST 45	Clears heat
SP 1 (**)	Regulates blood
SP 6	Master point for the lower abdomen and urogenital system
SP 9	Drains damp
SP 10 (**)	Regulates estrus
HT 9	Tonification
SI 1	Lactation
BL 10	Tonification of the bladder meridian
BL 16 (**)	Invigorates blood
BL 18 (**)	Regulates liver blood
BL 20 (**)	Dispels and transforms damp
BL 21	Dispels and transforms damp
BL 23 (**)	Nourishes essence
BL 67	Labor
KI 1 (**)	Tonifies yin
KI 3	Infertility
GB 41 (**)	Urogenital disorders
LIV 1 (**)	Urogenital problems
LIV 3 (**)	Promotes LIV Qi flow
LIV 4 (**)	Urogenital problems
LIV 8 (**)	Nourishes liver blood
Bai-Hui (**)	Any rear  end problems
Da-Feng-Men	Sedation
Xue Fu (**)	Ovary point

Pain 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 14 yr old FS Jack Russell Terrier weighing a lean 15 lbs.  The patient has a history of a partial RACL of the right rear limb that occurred when the pet was three years old.  As the pet ages, the pain during cold weather worsens and is almost nonexistent during warm weather.  NSAIDs occasionally alleviate the pain but not consistently.  The pet is known to sleep deeply and dream excessively to the point of waking up self and seeks cool places after lying next to the owner after marked panting.  The tongue is red and dry and the pulses are very deep and wiry.  Previous radiographs do not reveal any bone cancer but does reveal effusion and arthritis in the stifle joint.  Recent blood work abnormalities reveal a slightly elevated ALKP 330 (3-131 Normal) and microabluminuria > 30 (< 2.5 Normal).  Active points are located at BL 20, 21, 23 and GB 34. 

A Western diagnosis is arthritis due to a partial RACL at the age of three.  An Eastern Diagnosis is a Triple Heater (TH) obstruction and Cold Bi.  The TH obstruction is evident by the mixed hot and cold symptoms of a red tongue, cool seeker and cold aggravating the pain in the rear limb.  Additionally, blood deficiency is evident by the deep sleep and dreaming which can be caused by continual heat and a TH obstruction.  The appropriate formula for this patient is Xiao Chai Hu Tang (Minor Bupleurum Combination) twice daily.  This herb will harmonize the patient with the mixed hot and cold symptoms and will relieve the obstruction of the TH.  Bupleurum expels pathogens from the GB and TH channels by forcing upward and outward.  Scutellaria descends Yang from the upper burner to reintegrate with the lower burner to generate Qi to give more limb strength and stamina.  Ginseng, Jujube and Licourice relieves Qi deficiency from the failure of Yang and Yin to merge as a result of the TH obstruction.  Pinellia removes Phlegm from the GB channel.  Ginger harmonzies the middle burner.   After the patient was on the herb for two weeks, the pet no longer needed NSAIDs for the Cold Bi symptoms, even during a severe cold front.  Additionally, the pet no longer has excessive dreaming.  The pulses are becoming stonger but still have a wiry feel to them, and the tongue is still red.  These symptoms indicate that the formula is appropriate, but the 9 year deep seated TH obstruction followed by Cold Bi will take more than two weeks to completely resolve. 

Nutritional 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 13yr old, MN, tall and lean, broken-coated, Jack Russell Terrier that weighs 22lbs (10kg).  His chief complaint is intermittent loose, cow-pile stools found in the morning by the owner.  His disposition has always been very docile and attention seeking.  When he was 5 years old he injured his right rear limb and has a partial ACL tear that is now causing constant nightly lameness.  His tongue is red with no coating and no excessive moisture, and his pulses are so deep they are difficult to palpate.  Upon deep palpation, the pulses are wiry.   The pet will seek out the owner to lay next to her, but then quickly starts panting and then lays on the cold wood floor.  After cooling down, the pet will then move to the dog cushion.  Occasionally, the pet will have a deep, dry, hacking, cough that worsens if the leash is pulled. Active points palpated are at BL 20, 21, 23 and GB 34.  The pet’s diet consists of Purina ProPlan Small Breed Formula.  The ingredients are listed below.

Chicken, brewers rice, corn gluten meal, poultry by-product meal (natural source of glucosamine), whole grain corn, animal fat preserved with mixed-tocopherols (form of Vitamin E), corn bran, fish meal (natural source of glucosamine), animal digest, dried egg product, potassium chloride, calcium phosphate, salt, L-Lysine monohydrochloride, Vitamin E supplement, taurine, choline chloride, zinc sulfate, ferrous sulfate, L-ascorbyl-2-polyphosphate (source of Vitamin C), manganese sulfate, niacin, calcium carbonate, Vitamin A supplement, calcium pantothenate, thiamine mononitrate, copper sulfate, riboflavin supplement, Vitamin B-12 supplement, pyridoxine hydrochloride, garlic oil, folic acid, Vitamin D-3 supplement, calcium iodate, biotin, menadione sodium bisulfite complex (source of Vitamin K activity), sodium selenite.
D-4450

Pet "P" has a Western diagnosis of a partial right rear ACL tear, arthritis, and intermittent gastritis.  An Eastern diagnosis of Liver Blood Deficiency causing blood stagnation, heat and lameness; Liver overacting on the Spleen and Stomach causing loose intermittent stools; and Lung  Qi not descending to assist the Large Intestine properly  is appropriate.  The following recipe is recommended to correct the Liver Blood Deficiency, cool the patient by tonifying Yin, tonify the Lung and Large Intestine, and tonify the Spleen and Stomach.  It should be added all together and cooked in a crock pot until the potatoes are soft.  A half of an adult multi-vitamin should be given daily.

Protein source:  Beef Liver (tonifies the Liver, nourishes the Blood, source of Vitamins and Minerals)

Carb source:  Sweet potatoes (Spleen tonic, Liver tonifying)

Vegetable source:  Kidney beans pre-soaked at least 8 hours prior to cooking to ensure easy digestion and palatability (drains and dries Damp, high fiber source, tonifies Yin).  Kidney beans are recommended over Barley due to availability.

Fruit source:  Strawberry (helps with indigestion, strengthens Spleen). This should be added at the end of cooking.

Fat source:  Almonds (for coughing, strengthens Stomach and Spleen)

Supplements:  Nettle (tonifies Yin and clears heat) and a small amount of honey (tonifies Yin and strengthens Spleen and Stomach)

Liver Failure 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 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. 

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.