Case Studies

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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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Winston is a five year old male neutered Border Collie owned by a local harbor master in Chicago, USA. 

History and PE 

Winston was being fed a half cup of a dry kibble food twice a day and was significantly overweight. His owners considered the dry kibble food to be a "high-quality'' food. He was also given baked treats and occasionally raw bones to chew on, but not recently. He was given plenty of exercise and was able to go to work with his owner. He has a history of a hypothyroid condition managed by 0.8mg Levothyroxine with food, his levels had been tested three months prior to presentation. Overall, he was described as having decreased energy at home, decreased appetite and not playing anymore.

On presentation he weighed 92 pounds, his coat was dry with significant dandruff and his body condition score was 8/9. He had difficulty and was slow to get up from lying down and slow to go up and down stairs. He had 0-2/4 dental tartar and mild gingivitis and halitosis, a heart rate of 80 bpm and deep, slippery pulses. 

After His Integrative Veterinary Consultation

Winston’s diet was changed to a high quality fresh raw food. It was recommended that he be fed once a day but his owner wanted to wait a few weeks before starting once a day feeding. They transitioned him over ten days to 8 ounces of fresh complete and balanced raw food twice a day. The raw food was low carbohydrate, with fat and protein percentages almost equal. Fresh raw bones to chew on were again provided. His dose of Levothyroxine was decreased to 0.4mg and given on an empty stomach twice daily. He was also given a quarter cup of fermented goat milk three times a week to improve his gut biome, sustainably sourced fish oil from pelagic fish (mackerel, sardines, anchovy) for omega 3 and a half teaspoon of sunflower oil twice a week for linolenic acid.

At a three week physical examination he had already lost 10 pounds. The owners commented that his energy, appetite, cheerfulness and interaction had improved dramatically, and he was "a different dog." His heart rate was 96 bpm, he was energetic, engaged, not slow to get up or down and he moved with alacrity in the room. His coat was shiny and lustrous with no dandruff. His eyes were bright, his teeth and gum condition had already improved significantly. The owners and many people at the harbor club commented that he seemed like a much older dog before the dietary changes. After his transition they stated that he seemed to be younger and more engaged. He is overwhelmingly excited by his food, eating enthusiastically. In addition, his stools and intestinal gas were significantly improved as well – smaller, firmer and easier to pick up faeces, and less frequent defecation (once a day, normal for a canine) and much less flatulence.

The short turnaround in his condition was noted by all who know Winston and his improvements continue at the time of this writing (four weeks after initial consult) and are impressive. His thyroid regulation will be checked in two weeks. It is anticipated that it all will be well as his physical condition is so good.

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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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Piper is a six year old Mastiff cross who was rescued from an abusive situation as a puppy. She presented with severe anxiety disorder which manifest as antisocial behaviours, phobias and a highly reactive personality. Her owners are committed to a non-pharmaceutical approach to her rehabilitation. Some progress was made with the introduction of a homemade diet, including Chamomile tea, whole oats and probiotics, as well as Adaptil collars (canine appeasing pheromone), environmental enrichment and behaviour management strategies. However most progress was made after the introduction of Rescue Remedy bushflower essences and a western herbal tincture of Passionflower, Chamomile, Lemonbalm, Bacopa and Withania. The owners report a significantly calmer and less reactive demeanour and visitors to their house are amazed at her transformation!

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Louie, an approximately 7 year old male neurtered Yorkshire terrier mix, 4.8kg, presented for help managing liver failure. He was adopted 4 years previously by a Veterinarian and at that time was in liver failure of unknown origin. He initially responded to allopathic medical management but when his condition deteriorated, a surgical exploratory was performed. Grossly his liver appeared contracted, small, firm, and nodular with irregular texture in all lobes and a fibrotic capsule. His liver biopsy revealed evidence of prior injury with fibrosis between portal tracks, infiltrate of large lymphocytes and the presence of necrotic hepatocytes. This was thought to be indicative of a secondary immunopathology suggestive of immune injury to the liver and not cirrhosis. He was initially treated with prednisone but that was discontinued due to worsening of lab work and clinical signs. He had been maintained on lactulose, metronidazole, ursodiol, intermittent antibiotics, and cyclosporine for the past 2.5 years. He was experiencing more frequent episodes of hepatitis marked by nausea, vomiting, inappetence, weight loss, and lethargy, that have were lasting longer and recoverywas slow and incomplete. Louie was anxious and the owner noticed that stressful events often preceded his flare ups. Abdominal ultrasound revealed that his liver appeared small with hypoechoic heterogeneous parenchyma, with chronic active hepatitis being the primary consideration. Louie’s dedicated owner had kept a spreadsheet that included more than 50 entries over the past several years with CBC, chemistry profile, treatments and treatment responses. Treatment goals included normalizing his immune system function, supporting his liver function, reducing scarring and fibrosis of the liver, improving the tone and function of his liver, and reducing his stress and anxiety.

Louie was started on a western herbal formula containing angelica sinensis, scutellaria baicalensis, bupleurum, astragalus membranceus, silybum marianum and glycyrrhiza glabra. Additionally he was started on a mushroom complex, curcumin extract and a liquid herbal calming formula containing l-theanine, l-tryptophan, valerian and ashwagandha. His diet was changed to Dr Jean Dodd’s Liver Cleansing Diet. Louie responded quickly and dramatically with not only improvements in his clinic signs, but also complete normalization of all his liver values within 6 weeks. His owner reported that he was thriving clinically, was energetic with no discomfort or nausea and the blood work results were the best he had ever had. Louie’s owner knew he was thriving when he started doing a happy dance before meals as his enthusiasm for eating returned. Louie was maintained on his integrative approach for 10 months with a wonderful quality of life for the whole family! 

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Signalment: 8-year-old German Shepherd with 6-month history of gradual hind limb weakness/ ataxia.

The dog had a history of gradual rear limb weakness and ataxia over a 6 month period which was unresponsive to both corticosteroids and non-steroidal medications. Neurologic examination revealed weakness, loss of muscle mass, conscious proprioceptive deficits, and normal reflexes in the rear limbs. A localization of T3-L3 was made, with a presumptive diagnosis of chronic intervertebral disc disease or Degenerative Myelopathy. No further diagnostic testing was desired.  
Body acupuncture points were used in addition to scalp acupuncture. Three needlesb (#32 x 1 “) were placed in relay fashion in the upper 1/5 of each motor zone, a single needle was placed in the most cranial aspect of both Balance Areas as well as the most dorsal aspect of the Foot and Motor Sensory Areas. Needles were left in place for 15 minutes, with 10 Hz of alternating cycle stimulation applied to the Motor Area needles. Because of travel limitations, treatments were performed weekly for 6 weeks, then every 2 weeks for 4 more treatments, then monthly for the next 19 months. The patient’s strength stabilized for a period of 19 months at which time the animal was euthanized for progressive rear limb lameness and urinary incontinence.

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Bunty, a 12-year-old, spayed female Staffordshire bull terrier, presented due to an ongoing weight-bearing lameness of the right hind leg. Non-steroidal pain treatment provided relief, but the pain returned if the medications were discontinued. The owner's request was to try and reduce the use of non-steroid pain relief and maintain joint comfort. On physical examination, Bunty exhibited pain on manipulation of her neck, right hip and stifle (knee joint). There was also sensitivity over the spine. Radiographs and blood were undertaken. Gastrointestinal sensitivity was evident with intermittent diarrhoea and intolerance to raw food and bones. Her coat was dull and dry. Radiographs diagnosed bilateral hip dysplasia, with the right hip showing more advanced signs of deterioration and osteoarthritis.

Treatment goals:

• Improve the lameness and generalised stiffness and discomfort by reducing pain and inflammation
• Improve nutrition, digestion and gastrointestinal function
• Enhance detoxification
• Optimise energy by increasing vitality, tonify
• Improve the quality of the coat 

A herbal tincture was prepared to address the above treatment goals. This was combined with nutraceutical and dietary support.

In Summary:  Bunty has now been on the formula for 18 months. Her general demeanour, coat quality and vitality have improved significantly. She only requires non-steroidal pain relief on very few occasions with the herbs and nutraceuticals controlling most of the pain. She will be maintained on this formula at this stage indefinitely as the owners feel it has significantly improved her quality of life.  

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Ludo is a 7 year old, castrated male cat who presented with difficult to control asthma, obesity and constipation.
History: Requiring ongoing steroid injections to control the asthma. Intermittent antibiotics to control secondary chest infections. Laxatives and occasional enemas to aid the constipation.
Diet: Weight reducing dried food.
Therapeutic Goals:
• Increase stool bulk and frequency
• Relieve asthmatic symptoms and ease breathing, ultimately reducing/stopping steroid injections and associated side effects
• Eradicate any infection, parasites (eg lungworm)
• Reduce inflammation and address gastrointestinal tract disorders
• Reduce allergic response and immune reactivity
The herbal tincture included herbs which addressed the above treatment goals.
His diet was changed to a raw food diet, plus vitamin supplements and flaxseed were introduced. Weight loss and increased exercise was advised. Asthma triggers were also identified.
In Summary: There has been a significant improvement in Ludo’s general wellbeing, he has lost a couple of kilograms and is eating the raw foods with relish. His asthma symptoms are being managed without steroid injections (these were slowly withdrawn over a 6 month period). He has not required a course of antibiotics in the last 10 months. The constipation is now resolved.

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George, a 5 year old blind Schnauzer presented with chronic RHL lameness and was diagnosed with IVDD (lumbosacral). Physical rehabilitation, acupuncture and laser therapy were performed weekly together with a daily home exercise program, that was performed vigilantly by his owners. George presented with challenges being completely blind, which limited the ability to perform some rehabilitation exercises and progression of the rehab program at times. The combination of regular treatments, monitoring and persistence and dedication of his owner, enabled George to improve, build up his core strength, muscles and use of his RHL.

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Paco is a 9 year old neutered male terrier mix, 13.6 kg, with a long history of seizures.  Paco began having full motor seizures at about 4 years old.  The frequency was stable at about 2-3 per month until Paco’s veterinarian began phenobarbital at 34 mg BID.  The seizure frequency declined to approximately one monthly.  Paco presented to Holistic Veterinary Care after having been on phenobarbital for four years.  The reason the owners brought him in was a desire to reduce or eliminate the phenobarbital dosage.  Recent bloodwork showed his levels to be in the therapeutic range but his ALP was 450 IU/L and Paco’s veterinarian stated this may be due to the phenobarbital.  The owner expressed interest in trying cannabis as a therapy to help with his seizures.

I discussed this at length with the owner with regards to the current research indicating CBD can be helpful in reducing seizure frequency but there isn’t much literature out there regarding cannabis and seizures in dogs.  I have had professional experience with dogs using cannabis for seizures and I have found it to be helpful in some cases. 

The owner decided to begin cannabis therapy using a broad spectrum hemp-based CBD formula at a dose of 20 mg CBD BID.  My instructions to the owner were to maintain the current dose of phenobarbital and begin the CBD and then contact me in 2 weeks to discuss their impressions. 

I heard back from the owner about 10 weeks later and they let me know they had cut the phenobarbital dose by ½ one month after starting the hemp formula and then discontinued the phenobarbital one month after that.  At the time they called, Paco had been off phenobarbital for 2 weeks with no recurrence of seizures.  They also reported he had more energy and seemed to be much happier.  

While the owner did not follow my treatment instructions, the results of the CBD formula are impressive.  At two weeks post phenobarbital, it was too soon to know for sure if the dog would remain seizure free without the medication and I instructed the owner to monitor closely.  At present, Paco is 6 weeks post discontinuing phenobarbital and has not had a seizure.  The owner will continue to administer the CBD product and monitor closely.

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The adorable Sir Theodorable is a 14-year-old male neutered Burmese diagnosed clinically and radiographically with severe osteoarthritis in both elbows in March 2019. He is currently well managed with an integrative approach including monthly acupuncture treatments, cartrophen injections, nutritional supplements and conventional medications, as well as an environmental modification at home. He has excellent quality of life thanks to his committed human servants and is very receptive to his acupuncture treatments, stretching out on the acupuncture bed and regally receiving the fawning of his staff.

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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!!

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A 5-year-old spayed female Doberman had a history of wobbler’s disease, rapidly progressing to the point where she had severe ataxia in the hind legs with extreme difficulty walking. A board certified veterinary surgeon had performed surgery to relieve pressure on the affected section of the spinal cord. She was unable to rise or walk post-surgery. The owner was advised that this was not unusual in a case of that severity, but he expected a gradual recovery, and she should make enough progress that by one month she should be able to walk better than she had before surgery. Corticosteroids were prescribed post-operatively to decrease inflammation and swelling of the spinal cord.

The owner returned to the surgeon in two weeks and again four weeks post-surgery. There was no change in the dog’s condition. The surgeon recommended euthanasia. The owner refused and came to me after reading about the helpfulness of acupuncture in cases involving injuries to the spinal cord.

After two treatments 3 days apart the dog was able to stand. After 4 weeks of biweekly acupuncture treatments, the dog was running.

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George' is a 7 year old intact male Golden Retriever.  He was presented for TCM (Traditional Chinese Medicine) assessment and treatment with a right hind lameness that was first noticed two months previously.  After three acupuncture treatments George’s lameness was resolved.

George was referred for acupuncture treatment by his regular veterinarian, who was also his rehabilitation veterinarian.  George’s hind limb lameness was first noticed by the owner when George returned from a walk with his dog-walker – George had slipped off the curb when he was with two other dogs.  On examination there was mild discomfort on extension and internal rotation of the right stifle and he was standing off the leg.  X-rays of both stifles, V/D hips and caudal spine showed no changes.  George was started on NSAIDS and laser therapy but after one month was showing no improvement and was referred to the surgical specialist for assessment.  A CT scan and joint tap revealed only non-inflammatory joint fluid in the right stifle joint. 

On presentation for TCM assessment George was grade II/VI lame on the right hind at a walk and trot.  He had been receiving Gabapentin for neuropathic pain for the last 3 weeks with no change.  On standing,  the right foot was rotated outward and held forward and lateral to the normal standing position.  There was moderate to marked discomfort with gentle manipulation of the right stifle.  There was moderate discomfort on gentle downward palpation of the left paravertebral muscles at the level of thoracic 11 to lumbar 2 vertebrae.  George’s TCM Pulse showed a weak , superficial and wiry Pulse.  His Tongue was brick-red coloured, with purple discolouration on the underside of the Tongue.  These signs, along with his history and other physical examination signs, let to a TCM diagnosis that showed there was poor blood circulation in George’s joints and muscles, and his body in general.

Three treatments of acupuncture were performed, focusing on the stifle and lower thoracic/upper lumbar spine, and improving George’s blood circulation.  These treatments were done one week apart.  The owner noticed improvement in the lameness after the first acupuncture treatment.  When she returned to her regular veterinarian two weeks after the last treatment, George was given the “all clear” and did not need further rehabilitation work.  He is being weaned off of the Gabapentin and will return for a TCM re-check in one month’s time.