Case Studies

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Amadeus is a four-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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Cassie is a 6 year old, recently spayed Chocolate brown Labrador, with a lovely docile nature. She was rehomed from a breeder and has been with her current owner for approximately six months. Cassie had weighed 37kg/82lbs when she was adopted, but over the six months prior to her presentation, her weight had increased to 41.2kg/91lbs in March 2021.

Cassie’s owners tried a range of diets including home-prepared raw food, raw food with more vegetables added, a popular commercial Labrador dry food and finally a prescription weight loss formula. On the most recent diet, Cassie had stopped gaining further weight, but had reached a plateau, and was currently being fed the ration for a 36kg/80lb dog.

Cassie’s general examination was unremarkable. Her BCS was 7/9, she was calm and well behaved. Moderate back pain was identified, and it was acknowledged that Cassie had a degree of separation anxiety when away from her owner.

Cassie’s owner was reluctant to change her diet away from the weight loss dry food, because her weight had stabilised on this diet.

Assessment of Cassie’s diet indicated that she was eating an appropriate balanced diet based on her required kcal, but there was a block to Cassie losing further weight. Cassie was consuming ~1028kcal/day, the calculated RER for a 36kg/80lbs dog. We decided to remove 1/8 of her kcal (128) and replace this with the following foods:

1 tablespoon of full fat yogurt (15kcal)

½ cup green leafy vegetables (22kcal)

12 pumps PAW Fish Oil (3000mg combined EPA + DHA) (54kcal)

20g food-based micronutrient supplement (93kcal)

Total added kcal = 184kcal/day

This was a net ADDITION of 56kcal/day

Cassie was re-weighed fortnightly for the following eight months without any further change to her diet and she steadily reduced her body weight to 33.4kg/74lbs in December 2021. Since that day, Cassie has varied only slightly in her fortnightly weight checks and currently sits at a comfortable 32.3kg/71lbs in May of 2024.

This case highlights how we can encourage a dog to reach their potential lean body weight by ADDING to their nutrient and caloric intake, once we understand what might be lacking in an individual dog’s diet from a thorough nutritional assessment. Once all of a dog’s nutrient requirements are being met, weight can be released. When experiencing any form of malnourishment, the body aims to preserve energy stores and metabolic rate slows, making weight loss more difficult.

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Grover was a 12 year old neutered male black Labrador Retriever when he came to me for his cancer diagnosis of hemangiosarcoma. In March of 2022, on a routine visit for vaccinations, it was noted to the vet that Grover had been observed to have episodic periods of weakness and lethargy. Blood tests at that Banfield Veterinary Hospital indicated elevated liver enzymes, but a normal hematocrit.  10 days later, he collapsed, and a dual cavity ultrasound was performed at this same facility. The ultrasound found in the abdomen a cavitated mass on the spleen suggestive of splenic hemangiosarcoma; no lesions were observed in the thorax. At that time a splenectomy was recommended, but the owner was reluctant to pursue.

Grover’s parents reached out to me for an integrative approach in April of 2022, and I recommended an immediate splenectomy, which the owner declined, not wanting to subject Grover to the stress and recovery of surgery when his survival time was questionable. Statistics suggested he might not live longer than 30-60 days. I agreed with their reasoning, but felt that if integrative care was to be successful, the presence of the diseased spleen and hemoabdomen would be a liability to the potential for better longevity. I also suggested they consider euthanasia versus treatment given that the diseased spleen was a “ticking time bomb” that might defeat our efforts.

I agreed to work with Grover’s parents without him being splenectomized, although I was very uncomfortable doing that, as I had never had a patient before that was not splenectomized prior to initiating integrative therapeutics. I explained this to Grover’s parents but they remained steadfast in not allowing the splenectomy. Grover’s plan follows, which his parents followed religiously.

GROVER’s PLAN: 12 yo;27 kg; NM

• Yunnan Bai Yao for hemorrhage and to reduce growth of cancer (3 caps BID)
• Xue Fu Zue Yu Tang (XFZYT) modified with E zhu and Sang leng (1 tsp BID)
• Highly bioavailable curcumin (10 mg/kg BID)
• Turkey Tail (Trametes versicolor) mushroom extract powder (1 tsp BID)
• Vitamin D3 after testing for D3 levels (500 IU/d)
• Stasis Breaker and Wei Qi Booster from Jing Tang herbals (3 caps each BID)
• Cannabinoids (1:1:0.5 THC:CBD:CBG) (to effect)
• EPA/DHA (30 mg/kg/d) of DHA
• Ketogenic diet
• Controlled activity

Grover thrived on this program for 8 months, and during that time, maintained his appetite and activity, although his parents were cautioned to avoid any uncontrolled activity. Following excessive activity he would be observed to be a bit lethargic, indicating that the activity had precipitated a bleed from the still-present splenic mass.  Finally, after 8 months of this success, Grover’s excessive activity caused a significant hemoabdomen, and the decision was made to euthanize him at home.

Medicinal mushrooms have been in use for centuries if not millenia by humans to address their cancer diagnoses. The use of medicinal mushrooms in veterinary species is relatively new. A study published in 2012, when Grover was 2 years old, looked at establishing an effective dosage of a liquid mycelial extract from Turkey Tail (PSP) in dogs with hemangiosarcoma.

This was a Phase 1 study exploring dosages and proof of concept that this extract could impact the course of the disease. The study groups were small, only 5 dogs in the three different tiers, and the results were remarkable, in that the highest dosing tier of 100 mg/kg BID of PSP provided median survival times for the dogs in this group that exceeded historical survival times for dogs that were splenectomized and who received concurrent chemotherapy. Those results got everyone’s attention and many pet parents and veterinarians started using this very expensive patented extract from the liquid culture of turkey tail mycelium.

10 years later, a clinical trial with 101 dogs was published in 2022 that produced different results, due to the larger sample size that produced more accurate results. This trial included chemotherapy with a placebo PSP, PSP alone, and chemotherapy with PSP. They were unable to find statistically significant results showing that PSP was able to match or exceed the anti-neoplastic effect of chemotherapy. It also found that outcomes were different for males (better) versus females (worse), and that the hematocrit, if it was greater than 30% was a positive prognosticator, as was the staging of the progression of the hemangiosarcoma metastasis. So males, presenting with hematocrits of 30% or greater, and in the early stages of the disease had better survival times. 240 day median survival time for this cohort, for dogs who just received the PSP and did not receive chemotherapy.

Grover presented with a hematocrit of 35%, he was male, and although staging was not performed, catching this problem relatively early in its progression, means he was of a lower stage, probably stage 1. His survival time  equaled the median survival time of dogs who were splenectomized and who received the PSP patented extract, although he was NOT splenectomized, and he did NOT receive the PSP extract but instead received the full-spectrum hot water extracted turkey tail mushroom extract.

Grover’s case supports the use of integrative therapeutics combined with the Turkey Tail mushroom extract at substantially higher doses.

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Jelly Bean, a German Shepherd Dog, was adopted byBrad when she was six months of age. She had severe hip dysplasia, and he was told to expect shorter than average life with lots of medication required. She went along reasonably well for the first few years, Brad noted she had a few quirks, such as moaning a lot when she slept, but thought that was just her unique way. At around five years of age Brad noticed she was becoming grumpy and aggressive, he took her to a behaviourist who suggested she be checked out by a therapist. The therapist revealed Jelly Bean was in severe pain and recommended acupuncture, hydrotherapy and home exercises be commenced immediately. Results were rapid, and, when Jelly Bean started to sleep quietly, Brad realised just how much pain she had been in previously. Jelly Bean’s therapy continued and she went from strength to strength - she lost weight, her medications were reduced and she started running around happily again. She started to slow down at around ten years of age, but lived very comfortably for a couple more years; much longer than expected. Brad commented that the difference the pain management therapy made to her life and theirs was immeasurable. 

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Kiara, a 17 year old female neutered Burmese cat, suffered from osteoarthritis and chronic pain, she struggled to move around her home, was on occasion noticeably wobbly on her hind legs and could not go up the stairs anymore. She had also been diagnosed with chronic renal disease so her primary veterinary surgeon avoided the use of NSAID and had trialled her on tramadol, but this had not helped her. 

Kiara was seen by our pain clinic and was started on acupuncture and laser therapy. This was initially performed weekly but after four sessions we extended this to every other week. Kiara is generally a little grumpy at the vets but she was always good for her treatment and sat calmly in her carrier for her sessions.Her owner noticed after a couple of acupuncture and laser treatments that she was brighter and moving around her home better, she was even jumping over the stair gate that her owner had used to prevent her from going up and down the stairs. We had also introduced Kiara onto a daily capsule containing Reishi, Devil’s claw, Boswellia and Turmeric which her owner sprinkled onto her food. 

It is now six months since Kiara fist came to see us and we are now treating her with acupuncture and laser therapy monthly along with continued use of her capsule supplement. She is moving around her house much more freely; her owner is very happy with her progress and she is certainly less grumpy when seen for her general vet visits.

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Luna, an eight year old rescue Great Dane, was suddenly unable to lie down one morning. The local vet took emergency X-rays, that revealed she had severe spondylosis and spondylitis in several places along her spine. Luna began rehabilitation exercises including physiotherapy and underwater treadmill, which helped build her strength. Unfortunately she became incontinent, at times the urine would just stream out of her, to her great discomfort and embarrassment. Her owner felt somewhat desperate, with little hope for what could be done.

It was recommended that regular acupressure might help, but the owner was concerned that she might do harm, as she knew nothing about acupuncture or acupressure, and worried that if she pressed on the wrong spot, it might make things worse. It was suggested she start with Bladder 23 and Kidney 3 points that are easy to find. Descriptions and diagrams were provided, and the owner started putting some pressure on Luna’s Kidney 3 spots, at first very tentatively, and discovered it seemed to help. That gave her the courage to try Bladder 23. To the owner’s astonishment, Luna’s urinary incontinence became less, and then actually stopped. Every now and then, when Luna twists her spine or over-exerts herself, she wets her bed again, but the owner applies pressure on the Kidney 3 and Bladder 23 points, and she regains control of her bladder. The owner is greatly relieved and commented that it’s so effective, it’s almost too good to be true.

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Coco is a five year old female spayed Yorkshire Terrier, who became paralyzed after jumping/falling off the sofa. She was weak with difficulty walking using the left front and back legs. She went to her local veterinarian who diagnosed her with Intervertebral Disc Disease and prescribed treatment. Coco was gradually improving until she jumped off the sofa a second time and was subsequently unable to walk and could not feel pain in her hind legs, indicating more severe spinal cord damage. Coco presented for acupuncture to see whether that would help.

After only two biweekly treatments using electroacupuncture, Coco was able to feel pain in her feet again and was able to walk unassisted. The owners were diligent at home keeping Coco confined and preventing her from getting on or off the furniture.  In fact, she was moving so well, she was not able to hold still enough for electroacupuncture anymore. Treatments changed to dry needle acupuncture combined with photo biomodulation (cold laser) treatments alternating biweekly. Two weeks later you would never know anything had happened to Coco, she is playing and walking normally, and will be working on her luxating patellas in her knees next.

Acupuncture is an extremely effective treatment modality for pain, neurological problems, as well as gastrointestinal, liver, skin and behavior concerns.

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Hendrix is a three year old, male neutered Groodle. Nine months ago, Hendrix became painful and pruritic in both ears.  His conventional vet diagnosed Malassezia otitis externa bilaterally and prescribed topical ear medication and a tapering dose of oral steroids.  Clinical signs seemed to resolve, however three weeks later, after going swimming in the lake, Hendrix became acutely painful and pruritic in both ears again. 

Hendrix’s owner sought integrative advice.  He had suffered chronic skin and ear infections since he was young, and his owner was interested in addressing the underlying causes of these problems.  Hendrix was treated with acupuncture weekly, with a goal of treating the acute disease in his ears, but also to address the causes underlying his chronic skin disease (i.e. Damp Heat).  To relieve Wind, drain Damp and clear Heat, local points on the Gall Bladder, Triple Heater and Small Intestine meridians which encircle, enter and exit the ear canal were treated, and some distal Spleen points.  A topical ear medication was also prescribed, to be applied by the owner daily.  A diet change was also recommended, avoiding kibble which is high in simple carbohydrates, which maintains the underlying conditions for skin disease.  It was recommended to change to a natural, grain free, balanced diet, containing high quality animal meat, oily fish, organ meat and cooked, sweet root vegetables to support the Spleen.  After his first acupuncture treatment, his ears were less painful and pruritic.  After several weeks of treatment, clinical signs completely resolved, confirmed in cytology.  Nine months since acupuncture and diet therapy commenced, there has been no further pathology, and Hendrix continues to enjoy swimming. 

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History

Olive is a 14 year-old, spayed, 41 lbs, female, Australian Blue Heeler. She presented for an integrative consultation to address a recent diagnosis of an inoperable bladder tumor. Olive had a history of years of chronic leukemia with no treatment. Recently she had been examined at her RDVM for frequent urges to go outside to urinate and had been showing blood spots in her urine. UA revealed a UTI, and Olive had been treated for a UTI with two rounds of antibiotics to no avail. An ultrasound showed a mass in her bladder near her urethra. She was also being treated for arthritis.

On a physical exam Olive was overweight and potbellied, scoring 7/9 BCS, and MCS 3 (moderate muscle loss). She appeared somewhat reactive and also depressed. Her popliteal and inguinal lymph nodes were enlarged. She was in an E-collar because she had been frantically licking, chewing and itching the skin around her vulva and abdomen. She presented with severe odor from her rear end, severe inflammation, ulceration and purulent dermal discharge around her vulva, perivulvar, and inguinal folds. She was painful on light touch to any of the affected areas. She had dental tartar, mild lenticular sclerosis OU. Her pulses were deep, slippery and thin with a weight of 41 lbs.

Olive’s diet consisted of a processed dry extruded kibble. The macronutrient content of the kibble consisted of approximately 50% carbohydrates, 38% protein, and 13% fat. Included high in the ingredient list were chickpeas and whole green lentils along with a large amount of supplemental synthetic minerals and vitamins for balance.

Current Medications 

• Phenylpropanolamine 25mg AM/PM for leaking urine
• Gabapentin 100 mg AM/PM
• Rimadyl 75 mg PM
• ReMatrix 1 soft chew AM/PM for joint support - a glucosamine/chondroitin and other joint support ingredients with Glycerine Molasses (dried) as a base
• Purina FortiFlora Pro Probiotic

Antibiotics for suspected UTI:

• Simplicef 200 mg for 6 days
• Switched to Enroquin 136 mg 1/2 tablet once a day for 10 days

Because of Olive’s diagnosis of cancer and other inflammatory conditions (leukemia, severe perivulvar and abdominal dermatitis,and arthritis) it is essential that we address her diet, supplements and medications to decrease inflammation at all levels. A fully integrative approach to her care will likely help her overall health. We recommended Olive transition to a species and moisture appropriate, fresh, balanced, commercial raw diet. We also suggested Olive change her pill vehicle from peanut butter to organic pasture-raised butter (healthier less inflammatory alternative with CLA). Her treats should be well-sourced, freeze-dried meat-based treats. These diet changes will help decrease inflammatory ingredients and the percentage of carbohydrates in her diet.  We will also limit her exposure to unwanted food additives, preservatives, toxins, and high heat by-product carcinogens. 

Additionally we recommended she be offered fresh raw bones to chew for her oral health - to start after she had fully changed diet, and offer frozen for a few minutes a day initially. 

 Treatment Goals

• To introduce a species appropriate diet, treats and bones
• To reduce inflammation and promote the healing of Olive’s vulva and surrounding areas
• Improve her overall health, immune system, weight and biome to promote Olive’s cancer fighting abilities

Treatments

• Discontinue dry/kibble food and transition to a commercially prepared, balanced, fresh, frozen/raw diet - for weight loss, we will aim for about 9 oz of a nutrient dense food per day
• Start to feed her once a day to allow more time for metabolic mitochondrial clean up while the GI tract is empty. Feed at random times to dissociate time with feeding to avoid anticipatory bile production/bilious vomiting. 
• We will be careful with her caloric intake to help her lose weight and become more comfortable, and improve health.
• SQ fluids with Vit B12 periodically for hydration, electrolytes, and urine flow.
• Skin/vulva care
• Gently clean and use topicals and supplements to help her fight her profoundly uncomfortable vulva/abdominal/tail base dermatitis.
• Cool water and dilute Betadine to help keep skin clean - can use squeeze bottle or curved tip syringe to rinse, and/or dab gently on, do not wipe.
• Apply ointment combo: calendula, arnica, aloe, CBD, copaiba to affected areas to soothe & treat for bacteria/yeast infections on the skin.

 Supplements 

• Mushroom 5 Defenders to help her fight her bladder tumor, provide immune support and healthy fiber for her GI tract
• SAT - Turmeric/Milk Thistle/Artichoke for liver support, GI support, and to help fight cancer
• Cell Forte (Cats Claw, IP6, herbs) herbal/supplement combination to help fight cancer and inflammation
• Astaxanthin antioxidant to help fight cancer
• Vitamin B Complex (Thorne) support to recover from anemia, microbiome and nutritional imbalance
• UT Vibrance to help fight UTIs naturally, and as prevention from urinary tract infections – 
• Ingredients: D-Mannose, Uva-Ursi leaf extract (20% Arbutin), Blueberry whole fruit, Cranberry whole fruit, Dandelion Root, Taraxacum officinale, European Goldenrod (aerial parts), Goldenseal root, Hydrastis canadensis, Parsley (aerial parts)
• Erythropro Herbal to support RBC production in anemia - 
• Ingredients: Iron (naturally occurring) 0.3 mg, Iron EliteTM 656 mg (Pumpkin seed, Organic Oat grass (Avena sativa), Organic Beet root (Beta vulgaris), Blood Advantage 180 mg (Organic Chlorella, whole; broken cell wall, Chlorella sorokiniana), Organic Rice Bran, Organic Tomato fruit, Organic Bilberry fruit (Vaccinium myrtillus), Reishi fruiting body Extract (Ganoderma lucidum). Other Ingredients: Plant-Source Capsules (cellulose, water).
• Yunnan Bai Yao Chinese herbal combination to help decrease bleeding (bladder/infection/cancer)
• NOW GI support 1 tablet daily to help with microbiome/GI health
• Green tea - antioxidant/cancer support.

We may consider additional herbs/supplements

• Vitamin E - helpful for bladder tumors
• Selenium - helpful for bladder tumors
• Additional botanicals as needed

 Urine monitoring

• Check urine with UA for infection every 4-8 weeks
• Also purchase urine strips and dropper to use to check urine at home 1 x week

Discussion 

• Discussed how diet-related issues can develop over time and may be seen as dogs age
• Discussed that we do not know why this cancer occurred, but we will do our best to maximize her overall health to help her fight it
• Discussed inflammatory effects of high carbohydrate, highly processed diets
• Discussed carcinogens as by-products of ultra-processing and also in certain preservatives and medication, pesticides
• Discussed how a fresh raw diet will provide her with the causes of health and is highly unlikely to cause any harm

 Outcome 

Olive’s life improved dramatically by her 2 week recheck. She had lost over 3 pounds, her lymph nodes returned to normal size, her potbelly had decreased, she was less painful on palpation, and was moving better. According to the owner, she seemed happier and better than she had been in a long time with the change to a fresh, balanced raw diet. The perivulvar dermatitis was over 75% healed with the topical medication, and her urgency and urinary signs had disappeared. Ultrasound showed that there was indeed a bladder tumor that was inoperable and was affecting one of her ureters as well. Piroxicam treatment was started and tolerated well. 

At her 6 week recheck exam, Olive’s owners were delighted with her continued body condition improvement, muscle mass improvement, increase in energy, and new interest in play and activity. Her focus and cognitive function had also shown a marked improvement since the addition of integrative treatments and supplements and her transition to a fresh balanced raw diet. Her severe dermatitis was fully healed and she was acting like a healthy dog at home for the first time in a long time. Currently the owners are considering radiation treatment to slow the tumor growth at the ureter. We are excited to keep working with Olive and her family to help manage her bladder tumor while continuing to improve her overall health. 

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Summary

Basil is a seven year old Basenji with a history of itching and skin lesions that have been somewhat managed, but not resolved with conventional medicines. Whilst he remained on several medications he was also prescribed a custom herbal formula comprising Ashwagandha, Astragalus, Licorice and Milk Thistle. The properties of this tonic include anti-inflammatory, antimicrobial, antioxidant, adaptogen, immune modulating, anti-allergic, anti-inflammatory, hepato- and reno-protective. The goal of the tonic was to provide support through the detoxing process of the skin and to improve metabolism of the other drug therapies. Three rechecks over a five week period indicated Basil’s skin was much improved, his coat was filling in, with no visible skin lesions and the owner confirmed he was feeling great. 

Full Report

Signalment: 7 ½ year old NM Basenji weighing 18 pounds

Reason for visit: Ongoing itching and skin lesions

History: Came to a rescue group in June of 2019 from a shelter in Utah.  Had had three homes.  The first was abusive (broken rib) and he was returned to the breeder.  The second home was good, but he fought with the female dog and was again returned to the breeder.  He ended up biting the breeder and was surrendered to the shelter.  Medical records provided show skin issues dating back to 2016.  Treatment included diet trials, Cytopoint, prednisone and antibiotics.  He was first seen at our clinic in September of 2019 and was tested for Fanconis (negative).  He was treated with Nexgard, Suffusion shampoo, and Temaril-P.   He returned six months later with no resolution of the itching.  Cytopoint was started.  He was then seen in September of 2020 and treated with cephalexin and monthly Cytopoint.  This also did not help and daily Apoquel was started in early December 2020. 

After a month, the foster owner noted that there was no change in symptoms, so she brought him in January.  At that time, she noted that he had a yeasty smell and that the medicated baths did seem to help for a day or two.  She was feeding a commercial raw beef diet as he seemed to do the best on that.

An important note in his history is that of his behavior.  On his first visit we were advised to “not look him in the eye” as he will lunge and attack.  Exams are done with a muzzle that the owner places and a rolled towel around the neck to control the head.  Even with these precautions, he will charge staff and snap without warning.  Exams are less than thorough due to his behavior.

Exam findings:

• Yeasty smell
• Thickened pinnae with swollen canals and rough/dry feel to skin. Unable to do otoscopic exam but suspect cone would not fit in canal due to swelling.
• Thin hair coat with erythema over trunk
• Crusting generalized
• Lichenification of inguinal folds and axillae
• Strong femoral pulses that feel full, weak dorsal pedal pulses
• Cool feet
• Calmer than normal behavior (did not snap or charge, allowed more of an exam including auscultation and looking at ears)

Diagnostics:

• Skin scrape and tape prep: Negative for parasites, some yeast and bacteria seen (note, these had not been done previously because of his demeanor)
• Chemistry, CBC and TT4: Slight increase in ALP, high eosinophils, mild decrease in TT4

Treatment and rationale: Given the lack of response to all previous therapies, the low TT4 was considered a possible contributor to his skin issues and he was started on L-thyroxine 0.15mg BID.

Recheck on 02/10/21:  Thyroxine not helping his skin, although he does seem more energetic per owner.  Owner notes skin is worse, now scratching himself until he bleeds.  On exam, he now has multiple excoriations, erythema, and hives.  TT4 now in normal range.

Treatment: Gave Diphenydramine injection 18.5mg SQ for the hives.  Prescribed the following: Prednisone 10mg BID for three days, then 10mg SID until recheck visit; -Cephalexin 150mg BID for 14 days; Ketoconazole 50mg SID indefinitely; Hydroxyzine 12.5mg q 12 hours; Miconahex + Triz Mousse daily.

Western herbal assessment and treatment: In addition to the conventional medical diagnosis of atopy/allergy with secondary bacterial and yeast infection, the Western herbal diagnosis includes excitation/heat, choleric temperament, and negative adaptation to state.

Western herbal treatment principles are:

• decrease inflammation and itching
• enhance physiologic processes by improving the function of the liver, gastrointestinal, integument and immune system
• sedate and tonify the nervous system to control the excessive behavior
• support in adapting to stresses
• slowly cleanse and detox the body

In addition to the conventional treatment above, the following custom herbal formula was dispensed with instructions to give a half dropperful by mouth twice daily:

• Ashwagandha (Withania somnifera) (1:4) 18cc: anti-inflammatory, antimicrobial, antioxidant, adaptogen
• Astragalus (Astragalus membranaceus) (1:5) 18cc: immune modulator, tonic, adaptogen
• Licorice (Glycyrrhiza glabra) (1:2) 12cc: anti-allergic, anti-inflammatory, demulcent, laxative, adaptogenic, gastrointestinal tonic
• Milk thistle (Silybum marianum) (1:1) 12cc: cholagogue, demulcent, hepato- and reno-protective, to provide support through the detoxing process of the skin and to improve metabolism of the other drug therapies

All herbs were checked in Stockley’s for their potential interactions with the conventional drug therapies.  There could be a heightened effect to prednisone with the licorice, but otherwise no major interactions were found.  Our dispensary was out of Echinacea or this would have been added to the formula for immune support, as an antimicrobial, and as an alterative.

The formula was dosed at a half dropperful twice daily, this was measured with a syringe and found to be 0.75cc.

The goal of this first formula was to support the body and to come in behind the conventional drugs to try to correct some of the imbalances in the body.  Mainly the focus was on liver metabolism, adapting to stress, and beginning to tonify with a nod toward symptom relief with the licorice. 

Additional recommendations: Either a raw diet or a limited ingredient cooked diet will be continued.  Probiotics will be added, along with fiber, for GI tract support.  Daily walks are recommended to improve circulation and as an outlet for mental stimulation.  A cage muzzle will be placed for these and the walks will be in areas where there are not many people until his behavior around people improves.  We may also consider the supplement Solliquin (magnolia and phellodendron) or pharmaceutical therapy depending on his progress.

Recheck on 02/17/21: Foster reports decreased itching, skin is less red.  He is eating very well but she is concerned about weight (losing some weight).  On exam, could not examine ears (canals did visibly look more open but snapped when they were touched).  Less erythema, crusting and lichenification on exam.  Continued all therapies and will recheck in one week.

Recheck on 02/24/21: VERY cranky today (in other words, back to his normal personality).  Only a very brief exam, could not even look at ears.  Inguinal lichenification has improved by 70%.  No erythema to skin.  Coat appears to be filling in.  The prednisone was decreased to every other day, the cephalexin was discontinued, and the mousse, ketoconazole and hydroxyzine were all continued at previous levels.  Calculated out the calories he is eating and he is on the low side.  This combined with thyroid function can explain his weight loss.  Recommended increasing his food and if the weight loss continues we will decrease the thyroxine.  It is possible the low TT4 was a euthyroid sick situation, but his mentation, activity levels, and appetite all improved with the thyroxine so we will continue for now.

Phone call on 03/16/21: Skin is great, thickening of the pinnae has resolved, they are no longer rough and look normal.  No visible skin lesions and he feels great.  On every other day Temaril-P and his herbal formula.  Continue every other day Temaril-P for one week, then do two doses the following week, one dose the week after that, then stop.  Owner will call if itching returns.

Case discussion:  Given the chronicity of the condition and the fact that the majority of the symptoms were being managed with the conventional treatments, I chose to put adaptogens and tonics in this first formula.  While licorice technically is also symptom relieving, its role as a GI tonic and mild adaptogen helped it blend well in the formula. 

Overall, I felt this case really started with his abuse, rehoming, and shelter history in that the chronic heightened anxious and aggressive behavior can create excess heat in the body.  The skin’s inability to continually manage and remove that heat, combined with the chronic stress effects elsewhere in the body, ultimately led to the skin condition. 

The next herbal formula, which will be formulated at his next recheck, will shift some of the focus to treating that underlying anxiety by adding a nervine sedative (most likely Passionflower) and a nerve tonic (Ashwagandha can do this, but depending on his symptoms, Eleuthero or Ginkgo may be better).  Licorice will likely be continued as he is weaned off the prednisolone but will ultimately be dropped out of the formula on the following round. 

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Signalment: 12 year old neutered male Terrier mix weighing 12lbs

Reason for visit: Up multiple times in the night without urinating or defecating

Past medical history: Wallie was adopted from a rescue at age 3.  He had both distemper and parvo, although his symptoms were not as severe as typical cases of either disease and he recovered well.  He has always had pica behavior, ingesting various objects and food over the years including makeup, candles, toothbrushes, steak, a full loaf of French bread, gum from the sidewalk, and most recently a full bag of tortillas.  He has been given apomorphine many times in his life for this. 

He also has a history of chronic regurgitation, generally when he eats something he shouldn’t or gets too excited.  This has been reasonably well controlled with oral metoclopramide.

Wallie periodically goes through aggressive episodes, generally around food.  He can be extremely loving to his owners, but he has bitten both owners on more than one occasion (always with food involved).  He also has some separation anxiety and cries when his owner is out of the room at the clinic.  He will cry some when the owners leave the house, but it is less than when they are away from him in a strange environment.

3 ½ years ago, Wallie was diagnosed with severe mitral regurgitation and congestive heart failure.  Medication has stabilized this and his most recent echo last month shows some improvement in heart function and a small decrease in heart size.

History of current problem: Starting about 6 weeks prior to presentation, Wallie started getting the owners up in the middle of the night to go out.  The issue always occurs around 4:30 pm and over the 6 weeks has become more frequent, up to hourly.  He will go outdoors and then just stand there—there is no attempt to urinate or defecate other than at the 4:30am outing.  There is no straining to urinate or defecate and no accidents in the house.  Wallie eats normally and has normal energy levels for him, although the owners note he does sleep a lot.  He will also play with the other dog or with the owners, is still interactive with the family, and still gets “the zoomies” at times.  His water consumption is normal.  The owners are anxious to resolve Wallie’s problem because it is significantly impacting their sleep. 

Current Medications:

• Fluoxetine for aggression
• Pimobendan
• Benazepril
• Rx Hepato Support

Current Diet: Earthborn Holistic Adult Vantage Dry

Exam findings:

• Grade III/VI systolic murmur
• Strong and synchronous femoral pulses that are slightly wiry
• Moderate tartar (has dental scheduled in a few weeks)
• Bilateral mild MLP
• Mildly deceased caudal extension in both hips
• Wiry coat that is mildly dry
• Mentally he seems slightly dull, not quite as bright and interactive as normal

Diagnostics:

• Chemistry and CBC:

-ALP 185 (n 20-150)

-BUN 27  (n 7-25)

-Creatinine 1.4 (n 0.3-1.4)

-Rest WNL

• Urinalysis: WNL

• Repeat Echo: Stable heart disease with slight improvements in CO and heart size

Conventional Medical Diagnosis:

• Historical distemper and parvo infections
• Significant mitral regurgitation and CHF, stable with medication
• Pica behavior
• Aggression (food/resource guarding)
• Anxiety (separation anxiety and noise phobia)
• Cognitive dysfunction
• Possibly IRIS stage 1 renal disease
• Slight hepatopathy

Western Herbal Assessment:

Overall, Wallie seems to have a choleric temperament but recently there is a decrease in his overall vitality that has him tending toward melancholic at times. 

Predisposing causes: Distemper and Parvo, multiple overeating episodes, multiple apomorphine treatments, history prior to age 3 unknown, chronic anxiety/aggression.

His current issue is likely related to his heart problems combined with cognitive dysfunction consistent with age (which is likely also related to his heart problem and diminished circulation to the brain).

Treatment Goals: While Wallie has multiple issues, the primary initial treatment goal of the owners is to get him to sleep at night, so the majority of the focus of his initial formula was on calming and relaxing the mind.

Herbal Formula:  The following formula was dispensed with the directions to give ½ dropperful 1 hour before bedtime.

• Valerian (Valeriana officinalis) 1:1.25, 6cc: Anxiolytic, can help with stomach cramps (potential cause of him being up all night), in cats can increase coronary artery blood flow so could be beneficial to his heart
• Passionflower (Passiflora incarnata) 1:5, 6cc:  Anxiolytic, helps with neuralgia and insomnia in people (useful if Wallie is having pain at night that we aren’t recognizing)
• Lemon Balm (Melissa officinalis) 1:1.5, 3cc: Has shown improved cognition and mood and decreased agitation in Alzheimer’s patients, indicated for Cognitive Dysfunction, which Wallie may have
• Fennel (Foeniculum vulgare) (1:2.5) 3cc: Sweetener, carminative in case he is up at `night from gut discomfort.

All herbs were checked in Stockley’s for potential herb-drug interactions.  The Valerian was noted to increase the sedative effects of TCA’s.  Wallie is on Fluoxetine and while it is an SSRI, it is assumed that both the Passionflower and the Valerian may potentiate the effects of fluoxetine, which is not considered a negative effect in Wallie’s case.  There were no interactions found with his cardiac medications.  No major contraindications were found.

Follow-up:

Recheck at 1 week: Owner notes within 3 days Wallie was sleeping better and getting them up less.

Recheck at 2 weeks: Wallie is sleeping through until 4:30 am every night.  He seems brighter and more interactive on exam.  Recheck bloodwork shows mild decreases in his ALP (183 to 165), BUN (27 to 24) and creatinine (1.4 to 1.0).  We will continue this formula for now and may shift to a longer term formula to manage his chronic issues.

Phone appointment at 4 weeks: Wallie is still doing well, gets up once at 4:30.  He still seems like he wants something.  We are considering adding Saw Palmetto to his regimen to cover urinary tract irritation but the owners are happy with his progress so we are keeping the formula the same for now.

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At five months of age Riley presented with progressive hindlimb weakness and a swaying gait. She was referred to one of the largest specialist veterinary practices in Johannesburg. Riley was Ortolani positive on both hips but not painful. The specialist surgeon asked for an MRI scan which revealed spinal compression from T2 to T8. On 5^th July 2021 Riley underwent left sided hemilaminectomy T2 – T8 extending to dorsal laminectomy T2/T3/T4. Following the surgery, she retained deep pain perception but was non-ambulatory. Her physiotherapy began immediately post-op.

The referral centre has an in-house veterinary physiotherapist who applied ice twice a day in the initial phases. Therapeutic laser and TENS (transcutaneous nerve stimulation) were performed twice daily. Comfortable that Riley’s pain was being managed, therapeutic exercises started a few days after the surgery. These included assisted standing with activation of the abdominal musculature. As she responded, standing bicycles, weight shifting, and rhythmic stabilisation were added. The right hind limb showed some degree of extensor rigidity while the left was flaccid. Passive range of motion helped to overcome the rigidity and allow other exercises. Riley tired very quickly.

After two weeks of intensive therapy Riley was allowed outside in a support sling. When outside the therapist assisted with support, walking and hind limb paw placement. Her family visited twice a week as they did not reside close to the facility. Riley really responded so well to these visits and tried even harder in her sessions that followed the family interactions. By the end of July (3 weeks) Riley was able to push herself up into a standing position and hold this for 3 seconds. Underwater treadmill sessions, with gait training, started soon after this.

One month after the surgery Riley was discharged. Physical rehabilitation sessions continued, and Riley’s family were given home exercises. One of these exercises was to place Riley over a peanut and rock her backwards and forwards. Riley was able to sit properly at this point. Assisted sit to stands were added. She made great progress once she was sent home. The power of love can never be underestimated!

Riley continued to progress until November 2021 where she seemed to have a dip in physical ability. At this point she was still being carried up and down the stairs and helped a great deal at home. It was suspected that the hips may be playing a role as Riley was growing and moving more. The program was adjusted to a twice weekly. The sessions alternated between hydrotherapy and land-based exercises. Riley was still dragging her hind paws. Booties were supplied. Despite her physical shortcomings she was determined to move and very active.

The time spent walking in the underwater treadmill gradually increased. Riley walked inclines and declines and at different water levels depending on her ability and capacity on the day. Riley was constantly challenged with therapeutic exercises. Increasing the difficulty of the exercises enhanced the outcome. She progressed form weight shifting on a solid elevated surface, to an inflatable disc. Riley was walked over foam mattresses, up and down ramps, over cavaletti rails and around obstacles. Many of these exercises were also performed at home.

Riley’s rehabilitation continued until September 2022 – a journey of 15 months. Her recovery was possible because of good surgical interventions, appropriate in hospital care, intervention by trained physical rehabilitation practitioners and a dedicated family. Riley is mobile, pain-free, and happy.

To watch a video of Riley’s amazing rehabilitation progress please click HERE.

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Numbi was driven over in the driveway of his home on 6th December 2019. He was 11 months old. He sustained severe pelvic injuries. After 5 days in hospital he underwent surgery. The ileal fracture on the left hand side was plated. The fracture of the right ischium was not repaired. Fortunately no acetabular fractures were present. Physiotherapy began in hospital and he was soon weight bearing on his right rear leg. The left rear limb remained non-weight bearing and he began to hold this limb beneath his body with rotation of the paw. Numbi was referred to our rehabilitation practice at the end of January 2020. At presentation Numbi was shifting most of his weight onto his forequarters. The left hind limb was non weight bearing and knuckling. Sensation was present.

Therapy began with gentle release of the hip area bilaterally. This was followed by gentle standing and weight shifting onto the rear limbs. The client was most adept and these exercises were also performed at home. Slowly but surely the left hind limb released. Heat, photobiomodulation and massage were the mainstay of early treatment, followed by stabilising exercises and slow deliberate movements. After three weeks, when the soft tissue restrictions were released and the area was more pliable, his therapy moved to the pool. Hip extension remained restricted.

Early in March Numbi started to use the left hind limb. After that there was no going back. In the middle of March the clients went on leave and COVID lockdown happened. We did not see Numbi again. A follow up call after lockdown about 4 months later revealed that Numbi was “full of beans and running around like crazy!”

Click HERE to Watch a Video of Numbi's Amazing Progress!

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Oreo is a seven year old Dalmation, who has faced some unexpected health problems due to his breed. At two and half years of age, Oreo was diagnosed with urate urolithiasis, requiring urgent surgery to remove the stones after he showed signs of blood in his urine and straining to urinate.  Mineral analysis of these stones confirmed the Dalmation-specific difficulty in metabolising purines. After surgery he was put onto a Prescription Dry Food (Hills U/D) that is restricted in protein and purines to prevent this serious problem from recurring.  
 
Oreo has not had any recurrence of bladder stones, however, more recently he has suffered from chronic small intestinal bacterial overgrowth (SIBO) and chronic diarrhoea. He has also been ravenously hungry and scavenging any possible food source, including, to his owner’s horror eating his own and his dog-friend’s poo!! Often as soon as it hits the ground. He lacked energy, was losing muscle tone but putting on weight and generally appeared as an unsettled and anxious little dog.  
 
Oreo's owner sought Dr Kelly Halls out for a second opinion. A thorough nutrition consultation was performed and Oreo was found to be suffering from both protein and micronutrient deficiencies which was responsible for the scavenging and unsettled behaviour. Careful selection of real food ingredients was done and added to Oreo’s dry food ration, replacing 20% of his food intake with fresh foods on rotation.  
 
These foods included egg, zucchini, chicken frames, kefir, smoked oysters, spinach, canola oil, fish oil, psyllium husk, turmeric, spirulina and dried kelp – in careful quantities and on a set rotation over the week. The amounts and rotation of these foods ensured the additives were complete and balanced according to AAFCO guidelines, but necessarily still low in purines. It contained high quality proteins, fats and micronutrients and was fed as only 20% of the total diet with the Hills Prescription U/D dry food the remainder.  
 
A follow up appointment 12 weeks later revealed a very different picture. Repeat urine testing and bladder ultrasound confirmed there is no reappearance of the stones, nor change in the urine pH or concentration and Oreo’s owner described a very much happier little dog. No longer scavenging for food. No longer anxious and unsettled, losing weight around his middle but putting on muscle tone. No more diarrhoea and overall, very much improved. The only down-side – Oreo’s owner now has to pick up much more in the backyard! A further 6-month review showed sustained improvements in his demeanour, behaviour and body condition with no return of urolithiasis. 
 
This is a great example of where the prescription dry food diets can sometimes not quite be right for each individual dog. This dog was being appropriately managed for his urolith problem, but the solution was slowly making him more and more unwell. This combined approach means we will still need to monitor his urine parameters and regularly ultrasound his bladder, but overall, his health and vitality and zest for life are so very much improved. Another example where real foods can heal the gut, the mind and the body and result in better health and vitality all round!  

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History:

Jackson, an 11 year old neutered, 47.2 lb male Labrador mix, presented at 10 months of age with a history of unresolved giardiasis, low Vitamin B12, decreased muscle condition score and body condition score, significant dental tartar, and gastrointestinal disorder including diarrhea, vomiting, and reluctance to eat. Jackson was defecating 4-5 times per day and had chronic diarrhea.  He had been given (Tylosin) Powder for months unsuccessfully to help resolve the diarrhea.

Jackson’s owner had been switching between a variety of dry/kibble food and bland home-cooked diets for months. He was also consuming a variety of treats: lamb jerky, sweet potato and flavored squeezable pastes. Much of his main diet, regardless of the brand, consisted of oatmeal, rice, hydrolyzed soy protein, and meal by-products. The macronutrient content of these pet food formulas averaged 24% protein (mostly derived from non-meat/legume sources), 10% fat, 10% moisture, 8% ash, 2% fiber and 50% carbohydrates.

We encouraged Jackson’s family to transition to a fresh, species appropriate diet: fresh, balanced, low carb and raw. We also suggested supplements to support the GI tract and biome including probiotics, tripe, coconut oil, and vitamin B-12.

Treatment Goals:

• Introduce a species appropriate diet and nutritional supplements to:
  • Improve gastrointestinal absorption of important nutrients
  • Improve muscle mass and body condition
  • Resolve diarrhea
  • Decrease dental tartar

Treatments:

• Discontinue dry/kibble food and bland diet recipes.
• Slow transition over to a commercially prepared, balanced, fresh, well-sourced raw diet
• Provide fresh, raw meaty bones for dental health - weekly
• Supplements/medications
  • Fenbendazole to treat unresolved chronic giardia
  • Tripe to help repopulate the GI tract with beneficial bacteria
  • Coconut oil to help with GI absorption, fats, skin and haircoat
  • Bacillus coagulans to support microbiome and GI health during diet change
  • Clay as needed to help treat diarrhea
  • Vitamin B-12 injections weekly for vitamin support

Discussion:

The kibble foods and bland diet recipes that Jackson was eating were high-heat processed foods (ultra-processed) containing inappropriately high amounts of inflammatory carbohydrates, inadequate protein sources, and inappropriate moisture content. A growing body requires appropriate, nutrient rich foods for energy, functionality, and development. Medical professionals are aware that food – its sourcing, balance, quantity, and freshness – is very important to health.  It makes sense that pet food would be improved if its freshness and balance more closely mimics the needs of the species we are feeding – in dogs, that is a carnivore/scavenger. The kibble foods provided Jackson with basic nutrients, but not nutrients that would make him thrive.  A significant amount of his protein was from non-meat sources, limiting his full profile of amino acids. The high-heat degradation of his food further added to his nutritional deficiencies and could not support his already struggling immune state. 

It seems that Jackson’s chronic giardia severely debilitated him because his meals provided him with a very poor nutritional plane from which to start.  It is difficult to imagine how to properly support body functions at their most efficient and effective manner while feeding food that begins with inappropriate macronutrient balance (high carb, low protein and fat), and has been rendered, extruded and heated multiple times. This high-heat processing is known to create many troublesome by-products (e.g. advanced glycation end products, heterocyclic amines, acrylamides), and to degrade many needed heat-labile nutrients (thiamine (B1), Panthotenic acid (B5), taurine, omega 3 fatty acids, etc.).

Fresh meat-based protein provides a digestible and complete amino acid profile, unlike protein from legumes (e.g. garbanzo beans, lentils or peas) that are deficient in amino acids like taurine or methionine which are important for immune function and antioxidant activity. In addition, appropriate ratios of animal-based fat with plant-based fats provide a more species appropriate fatty acid profile for a dog.  Improving the macronutrient balance of the food with fewer carbohydrates (sugars) decreases insulin produced by the body and decreases inflammation in the body.

Providing foods/supplements that re-florinate the GI tract’s microbiome (probiotics, fiber, fresh foods) can help the body recover from both microbiota-deficient and macronutrient-deficient foods as well, as these help rebound from GI parasite medications that might alter the microbiome, even as they are needed to manage infection. 

Once more sensible nutrient sources/ingredients and supplements can reinvigorate the body, provide appropriate microbial functionality of the GI tract, the animal can properly grow, develop muscle & body condition, and support a healthy immune system.  

Outcome:

In only a few weeks of eating his fresh species appropriate diet, chewing on raw bones and taking his treatments, Jackson’s gastrointestinal signs were fully resolved, and his body condition steadily improved and his dental tartar resolved completely. His owner noted that in addition to resolving his Gi signs, Jackson’s energy levels and activity were significantly improved as well.  As his body condition score returned to normal so did his muscle condition score.  

While Jackson has remained an overall strong and healthy fellow since he was a one-year-old, he is now 11 years old and the exact effects of his troubled development as a puppy are not clear.  His main health concern over the years has related to periodic joint problems. Currently he is being treated post-op for a ruptured anterior cruciate ligament, but with acupuncture, physical rehabilitation, supplements, and excellent diet, he has recovered well and remains very strong. We will take care to maintain his overall health, microbiome, muscle condition and immune health. We have been delighted to watch Jackson develop and maintain his happy healthy body over the years.

*The image shows Jackson as a thin puppy and an 11 year old, his future's so bright he has to wear shades! 

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A case study in progress... Charlie is a beautiful, energetic two year old female spayed German Shepherd. While charging up hardwood stairs, Charlie stumbled and then began limping on her right hindlimb.  Radiographs ruled out a fracture and Charlie was diagnosed with a cranial cruciate rupture.

Following three months of rest and oral anti-inflammatory medication, Charlie was still limping.  On initial presentation, she was still not completely bearing weight on the right hindlimb.  She guarded the limb even with gentle palpation and emitted a soft, low growl for the first time during my examination.

An essential oil blend consisting of basil, ginger, helichrysum, lemongrass and rosemary was started with application to the affected stifle three times daily.

• Basil (Ocimum basilicum) - anti-inflammatory properties, helps relieve swelling and pain
• Ginger (Zingiber officinale) – anti-inflammatory properties, helps relieve swelling and edema
• Helichrysum (Helichrysum italicum) – analgesic and antioxidant properties, helps relieve swelling, and facilitate wound healing
• Lemongrass (Cymbopogon citratus) – analgesic, anti-inflammatory and antioxidant properties, helps support ligament/tendon repair
• Rosemary (Rosmarinus officinalis) – anti-inflammatory and antioxidant properties, helps relieve swelling, pain and stiffness

Charlie is still on exercise restriction (leash-walking).  She received targeted pulsed electromagnetic field therapy (tPEMF) and takes an herbal supplement.

Six weeks later (4 ½ months after her initial injury), Charlie has improved significantly.  Charlie will continue to be monitored and re-evaluated; digital thermal imaging will help evaluate how inflammation and pain are resolving with the use of the essential oil blend.

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Bella’s initial clinical examination took place in September 2018. She was one year old. Bella is a Labrador with bilateral hip dysplasia. 6 months prior to our meeting (March 2018) Bella had undergone a femoral head and neck ostectomy (FHO) on her left side. She had been on a home exercise program after the surgery, but her weight was a consistent problem (37 kgs). The referring veterinarian preferred not to perform an FHO on the contralateral side until Bella had lost 5 kgs. The discussion with the client revolved around using hydrotherapy to assist with weight loss.

At this point, the left hind limb was not fully rehabilitated. There was a 3 cm difference in circumference at the proximal thigh and a 5 cm difference mid-thigh. Both limbs showed a decreased hip extension of 135 degrees on the left hip and 134 degrees on the right. Normal hip extension is between 160 and 165 degrees. Hydrotherapy session finally began in January 2019 after much discussion. At this point Bella’s hind limb circumferences had equalised but measure less than in September 2018.

Bella started in the underwater treadmill. Weekly sessions were advised and she was placed on a commercial weight loss diet. By June 2019 she was performing activities she has not tried in months (like climbing on the bed). Bella was more active, interactive and happier. She lost 3 kgs but also strengthened her hind quarter musculature. NSAIDs were only being administered after hydrotherapy sessions. By June 2019 Bella’s thigh circumferences had increased by 2 cms all round, coupled with weight loss. Her hip extension has increased to 158 degrees on the left-hand side (operated side) and 155 degrees on the right.

After lengthy discussions with all parties it was decided to continue the hydrotherapy and forego the proposed FHO on the right hip. Bella visited our facility every 2 weeks for a hydrotherapy session (except during lockdown). She had ups and downs, and weight fluctuations but she was happy and well-managed until August 2022. Her weight remained at 36 kgs. She was tested for an underactive thyroid. All results were normal. She became less active and started to lick her right hind paw. Bella’s ability to walk in the underwater treadmill decreased. She was doing less and less despite daily NSAIDs and frequent LASER therapy to her hip. Radiographs revealed increased osteoarthritis in the right hip joint. In December 2022 Bella underwent an FHO to her right hip. Our facility performed routine post-op management. Bella was back in the UWT 3 weeks post-FHO and she has not looked back.

We continue to see her twice a month. Her weight is stable at 32.5 kgs. She is happy and healthy. Bella’s human is thrilled with the outcome and delighted to have Bella with her, for longer, and pain free.

Click HERE to watch a brief video of Bella's progress. 

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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.