Case Studies

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Jazzy is a female 7 ½ year old Labrador. She started urinating without noticing when she laid down. She wasn’t incontinent during the night, or she would ask if she needed to go outside to urinate in the middle of the night. The problem occurred mostly during the day when the owner wasn’t at home or wasn’t paying attention. The owner believed the dog was urinating more lately because she was stressed as there was a new puppy in the house. Urinalysis and blood work were normal. Kidney-Heart Disconnect with Kidney Qi deficiency was suspected, so Jazzy was prescribed Restore Restraint (Kan Herbal version of Sang Piao Xiao Wan) for three weeks. On refill the owner requested a full bottle of 300 tablets as there had been no further leaking. Jazzy has been on Sang Piao Xiao Wan for over a year now with no incontinence issues whatsoever.

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History:

Moses is a 9-year-old, 25 lb, neutered, French bulldog. He presented for an integrative consult in August of 2022 to help address a recent diagnosis of splenic hemangiosarcoma. The history of his case began with a morning walk when Moses’ back legs splayed out, and he refused to walk any further. His other symptoms included continued lethargy, regurgitating large amounts of fluid, and sudden overall weakness and dullness. At the ER, he was anemic and radiographs revealed a large abdominal mass. Moses had an emergency celiotomy, and his severely enlarged and diseased spleen was removed. The histopathology diagnosed splenic hemangiosarcoma.  He was given a poor long-term prognosis of three weeks to three months to live. His integrative consult included a recommendation that Moses start on Yunnan Baiyao to help stop bleeding, support his ability to battle the cancer, and promote healing. Moses was put on a fresh, raw diet. He also had a history of vaccine reactions as well as chronic GI distress that resolved with fresh food. 

Treatment Goals:

• Support Moses through his healing post-surgery
• Decrease anemia and support healthy blood production
• Support healthy vascular function to avoid future bleeding
• Support the immune system
• Encourage and enhance his anti-cancer cellular and metabolic functions to overcome any spread of the splenic hemangiosarcoma

Treatments:

• Offer meals at random times once a day, trying to leave at least 18 to 30 hours between meals, mimicking “fasting” between meals to encourage ketone body production which may stimulate a protective adaptive cellular response (a.k.a. “metabolic cellular cleanup mode”) which typically is not employed while a dog is processing a meal. 
• Chronic supplements:
  • Yunnan Baiyao (YBY) is a Chinese herb used specifically in cases of bleeding tumors 
  • ErythroPro Western herbal combination as a blood builder
  • CBD Oil for anti-inflammatory and anti-cancer properties
  • Agaricus Blazei Mushrooms and other mushrooms in broth for immunity support properties
  • Wheat germ oil along Moses’ incision line to promote healing
  • Dehydrated heart treats as a source of natural taurine and cardiovascular support
  • Levothyroxine to treat his thyroid condition

Discussion:

Hemangiosarcoma is an aggressive form of cancer that develops from blood vessels. Clinical signs of this condition vary with the organs involved, however, a common symptom is the ability to bleed profusely. Tumors are invasive at the primary tissue site but as a hematologic cancer, can also aggressively spread to other parts of the body. Moses was diagnosed with splenic hemangiosarcoma which leads to large, blood-filled tumors within the spleen. Although some patients can be asymptomatic, pet parents most often notice clinical signs secondary to a ruptured splenic tumor such as weakness, pale gums, lethargy, decreased appetite, and a distended abdomen. 

Yunnan Baiyao is currently one of the most famous and widely used combinations in Chinese traditional medicines. Its ingredients include pseudoginseng, chinese yam, yam rhizome, sweet geranium and galangal root. It has been shown to be useful to stop bleeding, improve blood circulation, disperse clots, and support other possibly anti-cancer cellular functions. Its main active ingredient consists of pseudoginseng root (a.k.a. Panax notoginseng, notoginseng, “tien chi,” or “san qi.”) which contains a high concentration of hemostatic constituents that is more than any of the seven major ginseng types. Uses in cancer treatment may be due to a cytotoxic effect of notoginseng, and possibly its capacity to specifically sensitize tumor cells to ionizing radiation. The small round red “rescue pill” at the center of most bubble pack containers of YBY contains an easy to administer small pill with higher concentration of pseudoginseng to be used in critical bleeding emergencies. Yunnan Baiyao works in two seemingly contradictory ways: it stops bleeding and also acts as an anticoagulant to improve blood circulation and disperse clots. It is prescribed to:

• Stop acute bleeding
• Regenerate new tissue by removing accumulated blood
• Relieve swelling by clearing away toxic materials
• Alleviate pain by promoting circulation
• Accelerate healing of contusions, sprains, fractures, purpura, skin and muscle wounds, penetrating wounds, abdominal enlargement due to internal bleeding, and gastrointestinal, postpartum, and brain bleeds
• Assist in management of immune-mediated thrombocytopenia and blood disorders related to tick-borne diseases

Studies have been done in veterinary medicine about the use of Yunnan Baiyao for hemangiosarcoma in dogs. One study concluded that Yunnan Baiyao initiated hemangiosarcoma cell death at the time of administration and thereafter. These studies as well as the many anecdotal cases of successful use have made YBY a commonly prescribed Chinese herb even in conventional practices and emergency rooms. 

Outcome

Moses is doing so well! His integrative combination of supplements and food seem to have made a difference for him. It has been nine months since his ER visit and his splenic hemangiosarcoma diagnosis. His energy, vibrancy and overall health has dramatically improved, proven by his sprinting around the house and up the stairs! We will continue to work as a team to beat the odds Moses was given. 

Dr Royal is thrilled with Moses's progress and provided this celebratory rhyme from the movie Singing in the Rain....

'Moses supposes his toeses are roses, but Moses supposes erroneously.  

Moses he knowses his toeses aren’t roses, as Moses supposes his toeses to be.'

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‘Luci Lectric’ (‘Locki’) is a 16yo warmblood mare. She is a competition horse and was recently diagnosed with severe bilateral acute coffin joint arthritis. 

Treatment:

• Conventional: intraarticular injection of dexamethasone and hyaluronic acid 3 weeks prior to first hirudotherapy session.
• Hirudopuncture: application of one leech on the acupuncture points Pericardium 9 and Triple Heater 1 bilaterally.
• Acupuncture (same session): Four Gates (Liver 3 + Large Intestine 4 bilaterally), Bladder 11 (Influential point for the bones) bilaterally, Spleen 21 bilaterally, Spleen 6, Stomach 36, Bladder 23.
• TCVM herbs: Juan Bi Tang (Selected Formulas) containing: notopterygium, turmeric, tangkuei, red peony, siler, astragalus, prepared licorice, fresh ginger.
• Western herbs: sweet clover (melilotus).
• Orthopedic shoeing.

After 4 weeks on a training regimen starting with 10 minutes walking BID and adding 2 minutes every week, Locki was re-examined and received another leech treatment using the same points. As she was sound in walk and trot she was allowed to be walked for 30 minutes BID for another two weeks. After that the walking time was increased up to 45 minutes BID for another two weeks and then to 60 minutes BID. Also a few minutes of trotting on soft ground was added. Eight weeks after the initial hirudotherapy session Locky had her final lameness exam which was all clear, so she was allowed to gradually return to normal training and going out on the pasture.

From that point on Locki received regular leech treatments twice a year in spring and autumn as a preventative measure using one leech on Pericardium 9 bilaterally. The TCVM herbs were discontinued. She stayed on melilotus and a hyaluronic supplement. She continued her career as a sport horse without any further episodes of lameness until she was retired at the age of 21.

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PoPo is a Japanese Spitz currently aged 10 years and 7 months. Popo first came to see me in November 2017 (at 5 years of age) as her owner had always fed her a home cooked diet and was prompted to seek my advice on ensuring this was complete and balanced for her. After analysing her diet of cooked meat, rice and green vegetables, a nutritional balancer was added to her diet to approach a nutritionally complete recipe. PoPo’s owner was very averse to feeding any commercially prepared diets. Baseline blood and urine testing at the time returned normal results.

In October 2018, PoPo returned to see me as she had been urinating indoors which was very unusual for her. Blood and urine testing was performed and it became evident that PoPo had developed early chronic renal disease. Her diet was again analysed and recalculated to provide a diet with moderate protein, moderate carbohydrates and a reasonable amount of fat.

On a Dry Matter basis, the diet was formulated to provide 30% protein, 25% fat, 35% carbohydrates (7% fibre and 3% ash). Proteins were chosen to be white meat only (chicken, turkey, pork and fish), avoiding the extra DNA breakdown products from lean, red meats. The Ca:P ratio was adjusted to be higher (2:1) and the B group vitamins, and other micronutrients were increased by adding a micronutrient supplement, to help cope with her metabolic stress. A calculated omega 3 fatty acid supplement was added, as was a TCM Rehmannia 8 herbal formula. Silymarin was also later introduced.

During the almost four years since her diagnosis, PoPo has progressed from IRIS Stage 1, normotensive, normo-proteinuric to now being IRIS Stage 2 (SDMA of 34 and Creatinine of 200 in July 2022). Her blood pressure and urine protein remain normal. Ipakitine was introduced in November 2021 as her blood phosphate levels increased but ground eggshells were also introduced to her diet to increase the calcium further and the Ipakitine was later discontinued as PoPo refused her food with this added. Her blood phosphate levels have since remained near the upper end of normal.

Earlier this year CBD oil was introduced to manage back pain related to osteoarthritis and her mobility and general demeanour have improved with this addition. PoPo has required yearly dental treatments under general anaesthesia, sometimes requiring dental extractions. Analgesia during these times were with carefully calculated non-steroidal medications, as well as opioids and paracetamol. A combination Silymarin, SAMe and Vitamin E preparation was used to support PoPo in the peri-anaesthesia period.

Sadly (for us), PoPo’s family will be returning to Korea in early 2023 and PoPo’s ongoing care may be lost to us as she will migrate with her family. Her back pain will be managed with palmitoylethanolamide and a concentrated green lipped mussel extract due to concern over the different prescribing laws for CBD oil in that country. This case is a good example of how a combination of tailored nutrition and herbal supplementation can be used to manage a case of chronic ill health for many years.

PoPo is now four years into her diagnosis and remains a bright and alert and very happy little dog. Whilst many practitioners and owners may baulk at performing general anaesthesia and dental treatments for a dog with a diagnosis of kidney disease, we feel this has enabled PoPo to remain well over the past four years. We are constantly amazed at the care and dedication her owner provides her, her compliance and her gratitude for our care. She has been a darling little dog to know and to care for. We wish both her and her owners the best of luck for their move to another country.

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“Princess”, a 9 year old spayed female Shepherd Cross, presented as a new client. Princess used to leak urine daily after coming in from her walk. She had a history of urinary infections and her previous vet regularly ran urinalysis which were normal. Her only medication was Proin (phenylpropanolamine) 50mg ¼ tablet every other day, due to the owner’s concerns about using the drug. This was controlling the issue just enough for the owner to be able to tolerate the leakage. The owner was willing to try herbal medicine, so Princess was started on Restore Restraint (Kan Herbal version of Sang Piao Xiao Wan) and kept on Proin for one week after which time the Proin was stopped and she was only given the herbs. Two weeks later the owner called wanting to buy 360 tablets to last her a good while because she had not seen any incontinence since started on the herbs and taken off the Proin. She was obviously highly impressed with the result. 

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Pippin, a two-year-old male neutered Chihuahua, presented with a one year history of progressive alopecia, diagnosed by his DVM as Alopecia X.

For review, Alopecia X or Adrenal Hyperplasia-Like Syndrome, is a rare, cosmetic skin condition characterized by areas of alopecia and hyperpigmentation as seen in the images of Pippin. For some unknown reason, the growth phase of the hair follicle is arrested which causes the hair loss. This condition can happen as early as one year of age but can also occur much later in life. There is no known therapy or treatment for this condition in conventional veterinary practice. His TCVM clinical presentation of weak, deep pulses, cold extremities, pale tongue with cracks and diffuse alopecia indicated a Blood Deficiency pattern. 

Following Pippin’s first visit, his treatment plan included implementing a fresh, balanced, species appropriate diet, and a Chinese Herbal formula: Bu Gan Tang. Specifically, we used the Kan Essentials, Liver Support Formula, starting with the normal dosing for his body weight. After three months there was a mild improvement in hair growth, but it is not significant. During this visit, the Chinese herb dose was increased to double the amount daily. During this time, the owner was in email communication and expressing excitement about the results. The second image was taken after six months on the doubled dose of Bu Gan Tang, full hair coat regrowth was eventually achieved shortly after this image was taken. Pippin was slowly weaned off the Chinese herbs completely over the next six months and his owner was absolutely grateful. We think Pippen was also likely thankful for not having to shiver as much! 

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Integrative treatment of hip and stifle pain in a dog with lymphangiectasia.

Samwise is a 7 year old MN German Shepherd dog, who presented for TCM evaluation for treatment of hip and stifle pain. At 10 weeks of age he was surrendered with a dislocated, broken mandible. He additionally suffered from giardiasis and parvovirus. Despite this, he was adopted by the current owner, a veterinarian. At two years of age he was diagnosed with bilateral hip dysplasia, and a cranial cruciate rupture of the left stifle, at which time he underwent a tibial plateau leveling osteotomy (TPLO). With this history, he had been administered chronic pharmaceutical regimens of antibiotics and analgesics.

One year later, he developed a reaction to the TPLO implant which required removal of the implant. Around the same time he was diagnosed with lymphangiectasia and was prescribed steroid therapy. If the steroids are tapered or discontinued, overt severe foul-smelling diarrhea occurs. The diet must be strictly controlled with prescription low-fat kibble, and the only treats he tolerates are carrots and watermelon. The dog can no longer take conventional analgesics without a severe exacerbation of diarrhea and associated abdominal pain.

The owner sought integrative therapy for progressive musculoskeletal pain, with the goal of allowing the dog to comfortably enjoy weekend hiking and camping.A TCM diagnosis of Spleen Qi deficiency with Damp Heat was made based on poor muscle condition, maldigestion and lymphangiectasia with foul-smelling diarrhea. Kidney Jing deficiency was assigned due to the presence of hip dysplasia. Pain that was not severe and migratory between stifles and hips indicated Qi stagnation. Chronic medication with antibiotics and steroids exacerbated the Spleen Qi deficiency and Damp. The TCM treatment principle was to tonify Spleen and Kidney Qi, drain Damp and clear Heat (resolve inflammation), and invigorate Qi to relieve pain.

Biweekly acupuncture was performed, timed around Platelet-Rich Plasma (PRP) treatment of the hips and stifles. The addition of a whole food nutritionally complete diet was prescribed to supplement, if not replace, the processed kibble. The combination of acupuncture and food therapy has successfully allowed the dog to continue to participate on hikes, sometimes many miles in mountainous terrain, comfortably without pharmaceutical intervention for pain.

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Amadeus is a 4-year-old, neutered Cornish Rex, whose owner contacted me for a nutrition consult due to a history of urinary tract and renal disease. 

In our initial consult, I worked on a detailed history of his diet, litter box protocols, and environmental enrichment strategies. Given the owner was a well experienced cat owner, litter box and lifestyle issues did not appear insensitive to Amadeus. His canned food diet seemed appropriate initially, but I was concerned with the limitation. He had been fed one formula of one brand for the last three years. He was fed this as a default because it seemed to reduce his itchy skin and lesions and had been recommended by the breeder. Nonetheless, this limitation gave us an important break: analysis of the formula proved it unfriendly to both the urinary tract and the kidneys.  

Diet changes were implemented to include a rotation of a few well-balanced canned formulas and the addition of some raw meats as a topper to encourage the incorporation of raw food meals over time. An herbal anti-inflammatory urinary formula along with a kidney formula based on Er Xian Tang were introduced, and if he would accept, additional water in his food.

Two months after our initial consult, Amadeus was seen by a feline specialist with significant improvement in his laboratory results. A bonus with the diet change, his skin issues resolved.

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Pogo is a four-year-old male neutered Chihuahua/Jack Russel Terrier cross. He was adopted by an elderly couple as their dog had recently passed away. There was no information available regarding his conditions prior to his arrival at the re-homing facility.

Pogo had been with his new carers for eight weeks, and arrived with itchy skin. He scratched vigorously at his face with his front paws, causing bleeding. He chewed on his front feet and rubbed his back on the sofa. They gave an itch scale of 6/10, but they were concerned his skin would worsen and they didn’t want to use steroids. He had a good appetite and was eating supermarket moist food and supermarket kibble.

Pogo was quite difficult to treat – he seemed agreeable to being handled, but became suddenly aggressive with any noise or sudden movement – lunging and barking at the veterinarian. His Tongue was slightly swollen, with pale edges and a lavender centre. His TCM Pulses were very superficial, deficient and slightly taut. Pogo had moderate erythema and alopecia in both flanks, and under both elbows. His coat was dry and brittle. He had bilateral conjunctivitis, was tender laterally on both sides of his abdomen.

Pogo was sent home with the Chinese herbal formula Si Wu Xiao Feng Yin, also known as Four Materials Eliminate Wind Combination, to Tonify Blood and Expel Wind Heat We discussed leadership for Pogo to give him more confidence and decrease his anxiety . Instructions were given for green tea application to his most itchy areas.

At his two week re-check Pogo’s mom and dad reported that he had stopped pawing at his face , and his paw chewing had greatly reduced. He liked the application of the green tea and would roll over to have it applied. On physical examination his Pulse had moderated, and the erythema had resolved in his axillae and flanks, and the conjunctivitis had resolved. Treatment is ongoing and leadership training is ongoing – Pogo will go to his bed now when asked but is still very reactive when visitors come to the door and doesn’t listen as well at those times!

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Gracie is a 12 year old female spayed Terrier who was diagnosed with megaoesophagus 5 years ago. She presented 4 years ago for acupuncture because she had an increased frequency of regurgitation with phlegm and coughing, with one episode of aspiration pneumonia. She ate in a Baily chair, but that wasn't helping her enough and her owners felt that they felt something in her throat after she ate, even after standing in the chair. Gracie was eating a raw diet made into a gruel, but she was losing weight. Abnormal findings were a BCS of 2/5, and a dental disease of 2/3. Her pulses on the right were weaker than the left and her tongue was light pink. The goals for Gracie were to increase motility and peristalsis, improve absorption, support her back legs and heal potential gastritis. Gracie was treated with the following acupuncture points: ST36, PC6, SP6, CV17, BL54 and ST25. She was prescribed Bu Zhong Yi Qi Tang powder and a tincture that contained chamomile, licorice, angelica archangelica, orange peel, calendula, gotu kola and ashwagnadha. Her regurgitation went from daily to once every 5 weeks, and she comes in for acupuncture every 4-6 weeks. Not only has she gained weight, practically stopped regurgitating, but she has been living a normal healthy life for the past 4 years. Gracie is a happy girl living her best life with the support of acupuncture and herbs.

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'Bitsy' is a three-year-old female spayed terrier mix who became paralyzed in the hind legs after jumping across another dog in the car and taking a tumble. Bitsy's owner was referred for acupuncture treatment after two weeks of conventional treatment with a diagnosis of disc rupture at the T10-T11 intervertebral space. We began integrative therapy which included Chinese Herbal Medicine, photobiomodulation (cold laser) therapy and electroacupuncture. After biweekly acupuncture and laser treatments for one week, Bitsy was already showing strength in her hind legs and was beginning to be able to wag her tail again! Because of a dedicated owner and continued weekly laser and acupuncture treatments, Bitsy is able to move her hind legs and stand for brief periods. Bitsy now is active at home, has a new cart and is entering the rehabilitation phase of her recovery. It is uncertain how Bitsy would have done without integrative therapy but look at her now! Go Bitsy!!