This 7 year old M(N) Sheltie developed lameness and a bone mass on the Left proximal cranial radius in May/17 ( a month after Rabies vaccine not given near that leg) A year before dog had minor trauma to the leg when crossing a railway bridge and the leg slipped down between the ties. Mass did not appear on x-ray to be invading the radial cortex and rDVM wondered about bone cyst. Lameness improved with meloxicam. Mass continued to enlarge to about 4-5 cm diameter, and in Aug/17 lameness recurred, with >50% reduction in range of motion of L elbow, x rays not showing invasion of radial cortex. Biopsy showed new bone/ cartilage consistent with reactive bone and no evidence of neoplasia, though pathologist remarked similar may be found on margins of bone tumor and repeat deeper biopsy advised. They recommended referral to surgeon for possible amputation. Owners will have dog euthanized if can't keep him comfortable.as referral for surgery is not really an option for them. Dog seen by rDVM early Nov. as unable to use leg, and referral for surgery was again advised, Since then dog has been doing well on Meloxicam. Owners would just like to keep him comfortable as long as possible. Mass is about 7cm x6cm, slightly warm to the touch, non painful on palpation, restricting elbow ROM. Dog is bright and alert, very slight limp detectable on LF, eating well (kibble with a few added veggies that keep him from getting constipated - have discussed diet changes) Ears and anal glands good. Skin a bit dry with small flake dandruff. no history of skin issues. Slightly overweight with a few lipomas. Tongue sl. pale pink with lavender tinge and thin white coat. Pulse hard to find, weak, deep, sl thin, sl, wiry. A bit sensitive on palpation of BL-18,19,22,23,25,27 may partly reflect gait compensation with front end lameness, though owners say his hind end has been stiff prior. He is not a thirsty dog, and while a bit heat intolerant not excessively hot. Hoxsey and Boneset don't seem to fit the pulse. Considered XFHMY but concerned alone the increased circulation will stimulate the bone mass, although it is anti-inflammatory. Considered topical essential oil of Frankinscence. Pulse not really responsive to GB points for XCHT. With the lipomas I see some Damp, responsive to meloxicam indicative of Blood Stasis, and evidence of some Blood deficiency.Any thoughts you might have on helping keep this very kind, good natured dog comfortable as long as possible would be appreciated. Thanks again, Llewanda
Question Details
Bone Mass Left Foreleg In A Dog
by
LJH
-
November 30, 2017 View Case Report
This 7 year old M(N) Sheltie developed lameness and a bone mass on the Left proximal cranial radius in May/17 ( a month after Rabies vaccine not given near that leg) A year before dog had minor trauma to the leg when crossing a railway bridge and the leg slipped down between the ties. Mass did not appear on x-ray to be invading the radial cortex and rDVM wondered about bone cyst. Lameness improved with meloxicam. Mass continued to enlarge to about 4-5 cm diameter, and in Aug/17 lameness recurred, with >50% reduction in range of motion of L elbow, x rays not showing invasion of radial cortex. Biopsy showed new bone/ cartilage consistent with reactive bone and no evidence of neoplasia, though pathologist remarked similar may be found on margins of bone tumor and repeat deeper biopsy advised. They recommended referral to surgeon for possible amputation. Owners will have dog euthanized if can't keep him comfortable.as referral for surgery is not really an option for them. Dog seen by rDVM early Nov. as unable to use leg, and referral for surgery was again advised, Since then dog has been doing well on Meloxicam. Owners would just like to keep him comfortable as long as possible. Mass is about 7cm x6cm, slightly warm to the touch, non painful on palpation, restricting elbow ROM. Dog is bright and alert, very slight limp detectable on LF, eating well (kibble with a few added veggies that keep him from getting constipated - have discussed diet changes) Ears and anal glands good. Skin a bit dry with small flake dandruff. no history of skin issues. Slightly overweight with a few lipomas. Tongue sl. pale pink with lavender tinge and thin white coat. Pulse hard to find, weak, deep, sl thin, sl, wiry. A bit sensitive on palpation of BL-18,19,22,23,25,27 may partly reflect gait compensation with front end lameness, though owners say his hind end has been stiff prior. He is not a thirsty dog, and while a bit heat intolerant not excessively hot. Hoxsey and Boneset don't seem to fit the pulse. Considered XFHMY but concerned alone the increased circulation will stimulate the bone mass, although it is anti-inflammatory. Considered topical essential oil of Frankinscence. Pulse not really responsive to GB points for XCHT. With the lipomas I see some Damp, responsive to meloxicam indicative of Blood Stasis, and evidence of some Blood deficiency.Any thoughts you might have on helping keep this very kind, good natured dog comfortable as long as possible would be appreciated. Thanks again, Llewanda
Replies
by
naturevet
December 2, 2017
Hi Llewanda,
I agree with your thoughts. From a biomedical perspective, the goal is to actively resolve the inflammation, which is otherwise continuing to foster reactivity and bone growth. Chronic inflammation is always associated with endothelial dysfunction, and that is always due to a processed diet in most species. So diet change is essential to saving this dog's life. Metacam will hinder the metabolic and immunological pathways needed to resolve the inflammation, so as needed use is required - they should always test the waters, once you get something else in play for the dog to fall back on instead.
A Blood mover of some sort is needed to increase circulation to the area to actively resolve inflammation. Resolution of inflammation always needs an increased blood supply. If you use a turmeric-based formula, you can help counter your concerns about fanning the flames of a tumor, while at the same time introducing an anti-inflammatory that reduces the need for Metacam.
The two options that spring to mind are Modified Xue Fu Zhu Yu Tang, and Xiao Huo Lou Dan. The latter is more analgesic and anti-inflammatory; the former is more tonifying. You can use them together to cover all your bases.
One last thing you can introduce: Boneset (Eupatorium perfoliatum) alone, without the Hoxsey attached. We can send you some if you want. The single best treatment for resolving inflammation within bone.
I think that's what I would try. I'm pretty sure it will work, especially if they change the diet. Timeline for resolution has to be a month or two, though
Steve
I agree with your thoughts. From a biomedical perspective, the goal is to actively resolve the inflammation, which is otherwise continuing to foster reactivity and bone growth. Chronic inflammation is always associated with endothelial dysfunction, and that is always due to a processed diet in most species. So diet change is essential to saving this dog's life. Metacam will hinder the metabolic and immunological pathways needed to resolve the inflammation, so as needed use is required - they should always test the waters, once you get something else in play for the dog to fall back on instead.
A Blood mover of some sort is needed to increase circulation to the area to actively resolve inflammation. Resolution of inflammation always needs an increased blood supply. If you use a turmeric-based formula, you can help counter your concerns about fanning the flames of a tumor, while at the same time introducing an anti-inflammatory that reduces the need for Metacam.
The two options that spring to mind are Modified Xue Fu Zhu Yu Tang, and Xiao Huo Lou Dan. The latter is more analgesic and anti-inflammatory; the former is more tonifying. You can use them together to cover all your bases.
One last thing you can introduce: Boneset (Eupatorium perfoliatum) alone, without the Hoxsey attached. We can send you some if you want. The single best treatment for resolving inflammation within bone.
I think that's what I would try. I'm pretty sure it will work, especially if they change the diet. Timeline for resolution has to be a month or two, though
Steve
by
LJH
December 2, 2017
Thanks Steve.As the dog tends toward the warm side, any suggestions if the XHLD proves too warming? Can the Boneset be used along with the XHLD and ModifiedXFZYT ? Will call and order it. As usual your suggestions are greatly appreciated, Llewanda
by
naturevet
December 2, 2017
Yes, you can use all three together. If the dog gets hot on XHLD, reduce the dose. But given the dependency on Metacam, you should probably start with it, given its analgesic and anti-inflammatory potential
S
S
by
LJH
December 2, 2017
Thanks so much.
by
LJH
December 20, 2017
Hi Steve,
The dog is getting XHLD and Modified XFZYT and we’ve received the Boneset. The dose I have for Boneset by itself is 0.1 ml per 5 lbs body weight divided BID. Is that what you would use in this situation? Any concerns of hepatotoxicity at that dose, when used with Metacam . Will be trying to discontinue the Metacam or at least go intermittent. Thanks again. Llewanda
The dog is getting XHLD and Modified XFZYT and we’ve received the Boneset. The dose I have for Boneset by itself is 0.1 ml per 5 lbs body weight divided BID. Is that what you would use in this situation? Any concerns of hepatotoxicity at that dose, when used with Metacam . Will be trying to discontinue the Metacam or at least go intermittent. Thanks again. Llewanda
by
naturevet
December 21, 2017
That dose should be fine, and there should be no risk of hepatotoxicity
If any lingering pain the dog is currently experiencing starts to improve, they should move toward prn Metacam use. If the dog is pain-free, they can try reducing the Metacam to prn use in, say, a week to ten days
S
If any lingering pain the dog is currently experiencing starts to improve, they should move toward prn Metacam use. If the dog is pain-free, they can try reducing the Metacam to prn use in, say, a week to ten days
S
by
LJH
January 4, 2018
Hi Steve,
Spoke with the owner and she reports since starting on the Boneset the dog has been much sorer and has also started getting them up early in the morning to urinate. They have had to increase the Metacam dose. Prior to starting the Boneset he seemed to be doing better on XHLD and Modified XFZYT. I’ve asked them to stop the Boneset and see if things improve again. I’ve also asked them again to monitor if he is feeling warmer on the current herbs and drinking more as a consequence. Can’t recheck pulse for a week or so as owners going to be away. I did find the last time I checked his pulse that it was a bit stronger than initially but overall still weak, less deep, a bit thin and slightly wiry on the XHLD and Mod. XFZYT. Any thoughts regarding the Boneset and where to go from here, as surgery is still not really an option for them. Thanks, Llewanda
Spoke with the owner and she reports since starting on the Boneset the dog has been much sorer and has also started getting them up early in the morning to urinate. They have had to increase the Metacam dose. Prior to starting the Boneset he seemed to be doing better on XHLD and Modified XFZYT. I’ve asked them to stop the Boneset and see if things improve again. I’ve also asked them again to monitor if he is feeling warmer on the current herbs and drinking more as a consequence. Can’t recheck pulse for a week or so as owners going to be away. I did find the last time I checked his pulse that it was a bit stronger than initially but overall still weak, less deep, a bit thin and slightly wiry on the XHLD and Mod. XFZYT. Any thoughts regarding the Boneset and where to go from here, as surgery is still not really an option for them. Thanks, Llewanda
by
naturevet
January 4, 2018
Hi Llewanda,
I can't think why Boneset would be an issue, but naturally you should stop it. If the pulse is becoming progressively thinner and more toned, then maybe just the Modified XFZYT is best for now. It is the sole tonifier of the bunch. It may be that the primary problem is Blood deficiency, and the other formulas and herbs, by being drying, are aggravating that. If so, then MXFZYT should be both well tolerated and effective. They can give a larger dose if they want of that formula. If the above theory is correct, the dog should start to improve quickly
Steve
I can't think why Boneset would be an issue, but naturally you should stop it. If the pulse is becoming progressively thinner and more toned, then maybe just the Modified XFZYT is best for now. It is the sole tonifier of the bunch. It may be that the primary problem is Blood deficiency, and the other formulas and herbs, by being drying, are aggravating that. If so, then MXFZYT should be both well tolerated and effective. They can give a larger dose if they want of that formula. If the above theory is correct, the dog should start to improve quickly
Steve
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