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Collapse In A Lab(EIC?)

by jjasek - April 13, 2009

Emmy is a 4 yr old SF Laborador Retriever. She originally presented after an episode of acute collapse at the dog park. According to the owner, she was completely down in the back end, unable to rise, but did not collapse in the front end, or lose consciousness. By the time she arrived at the clinic, Emmy was walking, though her gait on front and back was a bit stilted. Her temp was 104.5, proprioception was normal, and spinal radiographs were normal. The remainder of her physical exam was unremarkable except for some obvious anxiety.

She has a history of being pu/pd and was azotemic on initial bloodwork with a BUN of 55 ( this was done on the day of collapse, so hydration may have contributed). Her UA showed a pH of 7.5, moderate wbc and some crystals. Urine SG was >1.040. On abdominal ultrasound, she had some debris in the bladder, nothing over 1.4mm, everything else was normal.

The owner reports that she has very sweaty paws - will melt the snow where she is standing, as compared to their other laborador. When excited, she leaves 'sweaty footprints' in the house. The owner reports a high level of anxiety, though in the clinic she is quite calm for a lab.
Her pulses are forceful, not easily depressed, but not rapid. Tongue color is lavender.

We tested her for the exercise-induced collapse (EIC) that certain lines of labs are prone to and she is a carrier of the genetic marker. From what I have been able to learn, the condition is not generally expressed without the double recessive marker, but some carriers can have symptoms. In any case, my big concern is that these dogs can get a life-threatening hyperthermia during episodes. The episodes seem to be induced by physical exertion and stress.

Emmy has not had any more episodes since the original collapse. The owner has been keeping her activity moderate, but allowing some exercise, as it also elevates her anxiety to be inactive.

by naturevet

April 14, 2008

Hi Judy,

With tough cases it's sometimes helpful to step back and evaluate from the so-called Eight Parameters: Hot, Cold, Excess, and Deficient in particular. We could add Stasis to the mix.

Definitely Heat is there. You can see Deficiency given the hind end weakness and potential for collapse, but there's an Excess (or severity) there as well, in terms of the forceful pulse, the acuity of onset, the potential severity of the condition, and the high temperature. So Hot, Excess, Deficient. That leads us to general formulas like Si Miao San (a common lab formula), well known for its cooling and anti-inflammatory effects. It is, however, insulin-sensitizing, which means it lowers blood sugar, rather than raises it. So if the concern is mitochondrial function and ATP generation via the Kreb's cycle, something like Long Dan Xie Gan Tang would be more potentially beneficial. It's effective in severe hypoglycemia, and thus stimulates gluconeogenesis and Kreb's cycle activity. So if you subscribe to the ATP synthesis theory, it's more appropriate.

In the end, I would probably suggest starting with something like Xiao Chai Hu Tang and its derivatives, which are especially important in states where there is the potential for collapse . In particular, I'd try Chai Hu Jia Long Gu Mu Li Tang, which re-connects the upper and lower burners like XCHT, but has an added Yang descending and cooling action that relieves anxiety, cools the animal off, and makes sure 'Source Qi' is being generated, resulting in a prevention of collapse. From a western perspective, its sedative properties are effective, enough to augment or replace the need for phenobarbital in some seizure cases, especially meningioma. This has been one of the most consistent risk factors in EIC in labs - the level of excitability going into the exercise period.

Hope that helps. I'd love to hear how it goes!

Steve

by jjasek

June 14, 2009

Update on Emmy. I spoke with Emmy's mom this weekend, and she says she has a 'different dog' since starting on CHJLBMLT. Emmy has always been so high-strung that she could not focus and was difficult to train, plus had horrible separation anxiety. Since beginning treatment, the owner says that Emmy makes eye contact with her for the first time, and actually responds to commands. She has not had any more episodes - mom is trying to keep her anxiety levels down, and the herbs definitley seem to be helping. I have not yet repeated any labwork.
Any other thoughts?

Thanks!

Judy

by naturevet

June 14, 2009

Hi Judy,

Glad to hear of the significant progress. I'm not sure what you'd be checking lab-work wise, since there wasn't much that was compelling there before. A clinical improvement is your biggest indicator of things resolving, and also your goal in the end.

I'd continue the herbs for another couple of months at least, to see if we can get through the summer without incident. If you do, and the dog is great, then you may be able to look at weaning the dog off them. Meanwhile, we should probably try a little exercise challenge to see how she is bearing up, if the owner is okay with that. No rush on that, though.

Anyway, all the best, and continued good luck!

Steve

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