January 16, 2018: Initial presentation
Skin an ongoing issue last 2 years - had resolved completely with medicated shampoo and Apoquel. Second bout nothing worked. Was vaccinated for Rabies, DA2PP, KC in June 2017 while skin an ongoing issue!!! Geriatric Vestibular disease occurred in August 2017, presently ongoing and getting worse - very unsteady, sneeze will have her falling down.. Won't eat kibble on it's own, need to add gravy, chicken, etc. Hungry for family food. Has been nauseous all Fall, would vomit q 2-3 days. May have coincided with GVS and meds (Ketoconazole). Hasn't vomited in awhile. Used to be very itchy but not anymore. Skin issues started on her back and tail, forehead. Had thyroid tested and neg. Last set of meds reduced oiliness and odour to skin. BMs consistently normal. Drooling a lot lately.
Diet: Gravy packets, Orijen duck
Supplements: Fish oil
Medications: None since 10 days (had been on Cephalexin, Ketoconazole, Pred)
Examination:BAR, SWEET girl!!; BCS 3.5/9, thin; Hydration adequate; T =38.9C ; P =96bpm ; R =panting ; mm = pink; CRT < 2 sec; lung auscultation WNL; no cardiac murmurs/arrhythmias noted on cardiac auscultation; eyes - bilateral nystagmus, fast phase left, normal PLR direct & consensual; ears, nose, throat NSF; teeth - moderate calculus, all upper premolars and molars; integument - generalized yeasty odour, oily coat, dorsal patchy hairloss, flakey yellow dander, generalized pruritus over dorsum; peripheral lymph nodes palpate normally; abdominal palpation - soft, nonpainful; pulses weak, slightly rapid and choppy; tongue is lavendar pink, red underside, flabby; left sided head tilt, weak and easily stumbles, hindend weakness
Assessment: Ddx: Dermatitis, Geriatric Vestibular Syndrome TCVM: Internal Wind
Treatment plan: DN AP: GV20, GV14, GB20, BL22, BL21, LI4, LI11; Laser (C): PC6, LI10, Tian-men: AnShen (4.0ml B12 +1.0ml NaCl), 2.5 ml both sides. Rx: Ban Xia Bai ZHu Tian Ma Tang trial BID, HMF probiotics, cooked food. If Bai Zhu not helping, can try CHJLGMLT next.
January 24/18: Patient returned for recheck - her appetite was off again, standing over food and drooling. Drooling has progressed to foaming at the mouth. Falling over more, more uneasy.
On exam: she was tachycardic (but hates car rides),P =120bpm, heart was loud/bounding on cardiac auscultation; integument - dorsal coat still scaley, white-yellow flakey dander, pruritic; pulses choppy, rapid, and weak; tongue is ruddy pink-purple, flabby, wet; left head tilt, weak, easily falls to left side
TCVM now = Shaoyang disharmony
PLAN: DN AP: GV14, GV 18, GV20, BL21, ST36, GB34; laser (C): PC6, LI4, LI11, GB29/30; Vit B12 2.0ml SQ; rec Chai Hu Jia Long Gu Mu Li Tang trial now as no true improvement with GVS on the present herb. Focusing for now on GVS and not skin because GVS interfering more with QOL.
Recent update: Skin improving dramatically but GVS about the same. I know this condition has lasted for several months and I may be expecting too much from myself and Alley but she is so strong! She is such a character! With all of this going on there is not one mean bone in her body - definitely EARTH personality! I really want to help these folks more = young family with limited income. Any advice?
Thanks in advance,