Question Details
Bacterial Osteomyelitis In A Dog
by LPinn - November 3, 2017    View Case Report
I will attempt to summarize (owner brought in 100 page "summary" of the dog's problems). Granite first came to me 1 week ago for acupuncture, VSMT, and herbal therapy. Owner is trying to reduce the number of DVMs he sees so for integrative medicine she elected to come to me.

History of hip dysplasia, hypothyroidism, food allergies/intolerance, and atopy.

Feb or March 2016 saw neurologist for head shaking crying out and lifting left arm up. Tentative diagnosis was CVI (Wobbler). Owner started acupuncture and cold laser.

April 2016 right THR at UPenn due to hip dysplasia - worsening condition --> luxated the hip post-op --> surgically replaced and reinforce --> placed in Ehmer sling for 10 days --> day she was going to pick him up it was infected --> surgically explore and culture --> pseudomonas aeriginosa and warned owner may need to remove implant --> 1.5 mos later broke the femur below the implant --> removed all of the hardware and did FHO and plated the femur. Between the surgery and internal medicine department they were debating if they should remove the plate or wait. Currently waiting. Was on meropenem for at least 4-6 mos. Was seeing acupuncturist, herbalist, and rehab.

Developed chronic recurrent UTI's with pseudomonas. Being treated by internal medicine for UTI's. Developed skin lesions and saw a dermatologist who diagnosed pyoderm and culture a different pseudomonas. Rehab will not allow him to come anymore due to skin lesions.

Approximately 1 yr ago diagnosed with DCM through cardio after having arrhythmias at rehab.

TCVM Questions:
Anti-social dog --> only likes to walk when no others
Scared in life --> does not like other dogs or people
No cold or hot preference
Pants when anxious
No vomiting or diarrhea
Food allergies presented as skin --> poultry, lamb, rice, peas
Owner's goal is to find a DVM that can perform AP, VSMT, and Chinese Herbal Therapy

Diet:natural balance duck and pot-food allergies
Heartworm Prevention:Sentinel
Flea and Tick Prevention:none- treats her yard

Medications, Supplements, Herbs:
1. SP Boswellia Complex 2 PO BID
2. Crananidin 2.5 SID
3. VSL #3 Probiotic SID
4. Canna-pet 1 BID
5. Woman's Precious (Ba Zhen Yi Mu Wan) - Nourishes the Blood, supplements the Qi, regulates the Blood, adjusts the menses, supports fertility
6. Symphytum 30C 1 dropper daily
7. Galliprant 60 mg SID
8. Thyro-Tab 1 mg BID
9. Ciprofloxacin 750 mg 2 SID
10. Gabapentin 600 mg BID
11. Sotalol 120 mg 1/2 BID
12. Pimobendan 15 mg SID
13. Exogen bone stimulator

Was on Relaxed Wanderer and helped with anxiety and has been on Women's Precious for 3 mos --> seems more confident


TCVM Exam
[X] Shen: quiet, nervous, shy
[X] Personality: waterish
[X] Heat/Cool: cool paws
[X] Tongue: pale pink
[X] Pulse: deep, weak, thin (right weaker than left)
[X] Active Acupuncture Points: Not Evaluated
[X] Diagnosis: Damp (minimal heat), r/o Wind, r/o Shao Yang Pathogen, Bony Bi Syndrome, Liver Blood Deficiency, Kidney Yang Deficiency, KID Jing Deficiency

I performed VSMT in lateral recumbency on the initial visit because the dog received a CIV vax that day (talked to owner about vax but she insists).

Returned 1 week later for AP. Today's TCVM findings:
[X] Shen: quiet, nervous, shy
[X] Personality: waterish
[X] Heat/Cool: cool paws
[X] Tongue: pale pink
[X] Pulse: deep, weak, thin (right weaker than left)
[X] Active Acupuncture Points: LI11, BL20, BL23, BL26 --> no response with SP9/10, GB34, BL40
[X] Diagnosis: Damp (minimal heat), r/o Wind, r/o Shao Yang Pathogen, Bony Bi Syndrome, Liver Blood Deficiency, Kidney Yang Deficiency, KID Jing Deficiency

I feel like I should address the damp (mild heat) and I suspect a Shao Yang Pathogen (since the infection basically started at the bone --> super close to bone marrow). I was thinking DGSYS but not sure if that was enough. I wondered about stopping the Women's Precious and starting DGSYS. Uncertain if we needed something to move Shao Yang Pathogen (XCHT) and if there maybe a TB obstruction and move Yang and Qi. Could the chronic bone infection lead to phlegm formation? Thought of SRT for lower jiao damp heat but didn't know if it would be too cooling. I'm also wondering if I am over or under thinking this and confusing myself. Any help would be greatly appreciated. I have not been practicing herbal medicine long and want to make sure I do not worsen this pet but think I can do more to help.

Thank you

Lisa
Replies
by naturevet
November 7, 2017
Hi Lisa,

If I'm reading this right, this dog has infections everywhere - bone, skin and bladder - correct?

If that's the case, and the dog doesn't have skin allergies, then it seems there is a broad scale immune deficiency. That, in turn, puts me in mind of Astragalus, the Qi tonic that is our number one immune stimulant. Lots of tonics have been used in this dog, but not that one, and the pulse you describe suggests tonification may still be indicated, just in a different form.

The other reason tonification may not be working is if there is an Excess in the way, that must be stripped. The behaviour suggests a 'Metal Excess', when viewed from the Spiritual Axis perspective, and is corroborated by the partial behavioural response to Xiao Yao San. Rather than working on the Wood side of the Wood - Metal axis, we could try to target the lungs instead.

Those two thought streams together make me think of Yu Ping Feng San (Jade Wind Screen Combination). If you would describe the dog as Deficient and Chilly, it would be the first thing I'd do.

Otherwise, I find myself thinking of Xian Fang Huo Ming Yin, which can be useful in animals with weak pulses; addresses pyoderma (especially if furuncles or abscesses are present); deals with Metal Excess through Wind expelling herbs; and has been used by some vets to resolve chronic osteomyelitis.

Start with one of these two, and let us know how it goes!

Steve
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