Question Details
Lung Digit Syndrome
by KarenG - December 4, 2017
I am helping a patient- by phone consultation- a 9 yo DSH cat recently Dx with Lung Digit Syndrome.
Past hx:
Had kittens as young cat and desexed at caesarian surgery
Developed DM 4 yrs ago and currently managed on Glargine 5.5IU BID. Has always been on raw diet- DM seems to have been triggered by acute stress of boarding and overweight
3 months ago infected nail bed digit painful some improvement on antibiotics
2 weeks ago thoracic radiography confirmed pulmonary mass
Current Symptoms:
pyrexia
painful limb ( only one digit affected)
reduced appetite and occasional vomiting- only in last 3 weeks

I had originally considered starting her on LJZT for Spleen Qi support to help with appetite and vomiting, and Chai Hu Jia Long Gu Mu Li Tang to address the lung tumour ( more cooling than XCHT).

On reflection- I've thought she may be better with WLT to address tendency to Damp (wt gain, Vomiting, inappetence- minimal impact on insulin sensitization because I don't want to interfere with current DM control) - and the formula Erin Bannick has discussed used for "Steaming bone pain"- modified : Qing Gu San- to address her Heat ( pyrexia) and bone pain/tumour. Erin has described its use for OSC in dogs.

Unfortunately I can't see her for TCM assessment. I'm worried that the rhubarb in CHJLGMLT may lead to diarrhea with the current tendencey to Sp Qi deficiency.

I also have her on antioxidants ADE. She was been prescribed Meloxicam by her treating vet but it gives her diarrhea with blood.

Thankyou Steve in advance

Karen G
Replies
by naturevet
December 7, 2017
Hi Karen,

Diet change is probably critical here. A species-appropriate diet can help reduce tumor growth at any stage, and would reduce the need for diabetes medication, too.

As to worrying about a need for changing diabetes medication dose, there's no reason the owner can't follow up on the diabetes locally, given the obvious access she has to veterinary care. If it's within you power to reverse the diabetes, there's no compelling reason not to, given the likely positive changes that will occur everywhere in the body in response to that.

I would thus strongly urge her to change the cat's diet, and then check blood glucose at the presumed nadir of the the drug's effect, beginning in a couple of weeks (if she's not already doing it herself).

As to herbs, the meloxicam adverse event tells us we need a Blood dispersing effect. Given the physical presentation, I'd suggest either Xian Fang Huo Ming Yin, or perhaps Modified Xue Fu Zhu Yu Tang (given the primary tumor type). You can also use each simultaneously, but with fever and inflammation, XFHMY is probably the better choice.

That's where I'd start. Hope that helps!

Steve
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