Case Studies

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

Treatment:

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

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

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

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Sammy is a handsome 15-year-old, neutered, standard poodle who presented with seizures, mild/moderate ataxia/balance issues, laryngeal paralysis, AU yeast otitis, multiple skin masses and lipomas, generalized muscle weakness and decreased muscle mass, dry haircoat, 4/4 dental tartar, halitosis and gingivitis. He had a history of benign splenic tumors (splenectomy), liver cancer (suspect hepatic carcinoma), neurological issues, decreased stamina, and a “sensitive stomach” with daily diarrhea episodes. His owner was interested in dietary and nutrition recommendations to improve overall health.

Sammy was eating an ultra-processed dry extruded kibble food. The macronutrient content of the kibble food included nearly 50% carbohydrates, 26% protein (much from non-meat legume sources) and 15% fat. Ingredients included garbanzo beans, lentils, beet pulp, pea proteins, and pea flour. We encouraged Sammy’s family to transition Sammy to a species appropriate, fresh, balanced, commercial raw diet. We also recommended well-sourced supplements including anti-inflammatory herbs, probiotic/prebiotic support, and Omega 3 fatty acids. Further, we recommended feeding Sammy once a day and at random times.

Sammy was also diagnosed with significant dental tartar and gingivitis. We recommended offering fresh, raw meaty bones to improve dental health, oral health, and jaw/head/ears/neck musculoskeletal condition.

Treatment Goals

• To introduce a species appropriate diet and nutritional supplements that improve:
  • Overall health, skin/ear condition, biome
  • The oral biome and decrease dental tartar
  • Laryngeal function
  • Neurological function
  • Seizure prevention
  • Neuromuscular function and stability
  • Immune system functions in preventing further tumors/skin growths

Treatments

• Discontinue dry/kibble food and transition over to a commercially prepared, balanced fresh, frozen/raw diet
• Fresh, raw meaty bones
• Acupuncture
• Supplements:
  • CBD Oil for anti-inflammation and seizure control
  • Omega 3 for overall health, inflammation control, seizure support, free radical scavenging
  • Gastrointestinal supplements/probiotics to support overall microbiome health, absorption and improve GI function, decrease diarrhea
  • Anti-inflammatory herbal combination – musculoskeletal support –turmeric, Boswellia, corydalis, marine extract, hyaluronic acid, glucosamine, MSM

Discussion

Geriatric dogs have been shown to need more protein than younger dogs to avoid sarcopenia (muscle loss/atrophy) typically associated with age. They can require up to three times as much protein to maintain proper muscle mass. Providing a nutritious balanced and complete diet with protein and fats as the highest macronutrient percentages rather than carbs can improve muscle mass in a geriatric dog with sarcopenia. The protein from excellent meat sources will provide a digestible and complete amino acid profile, unlike protein from legumes like garbanzo beans, lentils or peas which will be deficient in amino acids like taurine or methionine.

Feeding once a day helps the body maintain condition and health by allowing more time for mitochondrial cleanup mode. While the body processes food, it shuts down its mitochondrial cleanup mode as it needs to instead assimilate nutrients into cells. When digestion is finished, it will then turn to “cleanup mode” and start repairing and healing body areas with inflammation, unusual cells, cancer cells, or damaged cells. This is the idea behind “intermittent fasting” as a helpful tool to improve health and longevity. More time “cleaning up” will mean healthier bodies. Feeding once a day provides this “clean up time.” In addition, a dog’s stomach is 70% of their GI tract (humans’ are 30%) and ancestrally they should really only expect one large meal per day. Feeding them half portions or even feeding smaller amounts more frequently can be unsatisfying to a dog. Once they get used to eating once a day again, their GI functionality improves, overall health improves, and they are very satisfied by their meals.

Feeding at random times prevented Sammy from developing a hyper acidic response from anticipating a meal. Feeding at random times will mean that the dog will not know when mealtime is. We understand that would be unusual for a dog/canine in the wild to know exactly when they might catch and eat a rabbit every day. Being on a schedule is relatively unnatural for them although they get used to it and certainly can tell time. When a dog is used to a fixed schedule of eating, there are other health concerns. They will start anticipatory bile production in the stomach sometimes 30-60 minutes before a meal. A random amount of bile and saliva and enzymes will be produced and is waiting in the stomach for the food. The food amount will not be necessarily what the canine expects (especially if the meals are being split and fed two times a day or more) and the acid may be too much for that meal, creating possible vomiting, diarrhea and at best a strange over-acidic pH for the GI tract to deal with. Sometimes if an animal that expects a meal at a certain time is not fed on time, they will vomit the bile that has been waiting in the stomach for the meal. The best way to avoid this bilious vomiting syndrome is not to feed acid reducing medication, or feed earlier. It is best to simply avoid feeding at a specific time. Then the dog can return to a more natural state of not knowing when mealtime is, not overproducing acids/bile, and the GI tract can function more normally.

Bone Chewing

Fresh, raw bones provide the shearing force on the teeth to remove tartar, and provided him with an additional healthy fat source, mental stimulation and a naturally relaxing activity. While chewing on a bone, animals use muscles meant for this action in the head and neck. Without this satisfying activity, dogs lose those muscles and don’t have the benefit of an activity that is ancestrally practical and beneficial. Most animals in the wild do not require dental tartar removal under anesthesia.

Outcome

Since transitioning to a species appropriate diet and targeted supplements, Sammy is a healthy, happy dog. Sammy’s seizures have subsided, and his stamina has drastically improved as evidenced by daily two plus mile walks (a distance he was previously unable to accomplish – he would barely go around the block). Sammy’s tartar and gingivitis were resolved with fresh raw bones. We have loved watching Sammy rediscover his vitality!

Words from Sammy’s Owner

“It’s unreal. Sometimes we look at him and wonder how he is 15 years old with liver cancer and a history of seizures. His stamina is great. He’s even jumping on the bed again! That was the most notable change when switching to raw food. Feeding him one big meal a day really helped with his digestion; we were able to discontinue medications such as famotidine. The low keto diet helped him neurologically too. Sammy’s absolute best prognosis in October 2021 was that he would get seven months. We’re thrilled and amazed to have such quality of life for him after twice that many months – and counting!”

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Mr Glenny's owner says he now finally tolerates his food better than ever and his energy levels continue to be amazing. He is a lot more active than he was the last couple of years.

History:

Mr Glenny is a very handsome 12 year old male castrated tabby cat who presented with renal/kidney disease and ongoing constipation. He has had a long history of digestive issues (over many years), abdominal cramps, severe difficulty and pain around passing stools (about 2-3 years duration) furballs and in recent months he started developing early renal/kidney disease. His owner had experimented with many different diets with no change in his general well-being.

When I first started working with Glenny his diet was a non-processed raw diet, but he still vomited and had digestive issues including constipation on this. Over time we have worked with a diet that suited Glenny’s needs and he is now on a balanced home-made non-processed diet which he loves eating and supports him well.  

To aid his constipation maintenance CatLax (oral laxative) and lactulose was given as needed, but he did react to these conventional products, presenting with abdominal discomfort. He also had to have enemas to help relieve his constipation problems. 

Treatment Goals:

• To support the gastrointestinal system and avoid constipation
• To prevent furball accumulation, vomiting and abdominal discomfort
• To support the kidneys and try and prevent further kidney disease
• To support the immune system and aid with detoxification

Treatment Protocol:  

He was prescribed a herbal treatment which supported his kidneys, helped to prevent anaemia, constipation and continued disease progression.  A Heel Remedy – utilising a modality known as homo-toxicology was made for him to support the abdominal discomfort, mild osteoarthritis, kidney disease and constipation. Probiotics, Omega 3’s, Vitamins, Fibre and Slippery Elm were introduced. He was also put on a phosphorus binder to help support his kidneys. A prebiotic was also put into his water to help with the gingivitis. Ozone gel was used to support his sore bottom. 

Outcome:

His normal signs of aging have improved, the stomach cramps have resolved and he is now passing his stool regularly and comfortably. He no longer needs laxatives and enemas. His gums are looking healthier and it will be interesting to retest his kidney profiles as his owner feels that his kidney disease appears to have also improved as he is urinating less frequently. Most importantly his vitality and general well-being have returned, he meows and chats to his owner throughout the day, working his magic. 

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

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

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

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

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

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

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

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Jinx is a thirteen year old domestic shorthair who presented with chronic rhinitis non-responsive to conventional medications despite a full diagnostic work-up and interventions over many years. His treatment approach included transitioning to a homemade diet supplemented with EPA/DHA, probiotics, antioxidants and turmeric, steam therapy, medicinal mushrooms and a western herbal formula of tinctures and glycetracts of Marshmallow Root, Elder Flowers, Echinaceae, Eyebright, Goldenseal and Gotu Kola. He has now been weaned off all conventional medications and breathes freely with only occasional minor episodes of nasal discharge and has excellent quality of life.  Several years following the introduction of natural therapies Jinx is still going strong! His owners travel around Queensland with Jinx in their caravan working and periodically phoning with an update and a request for more herbs to be posted to them. 

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Oreo, an anxious six year old male neutered Chihuahua, presented with a long history of recurrent anal gland abscessation and a more recent history of unusual neurologic episodes that appeared to be triggered by stressful events and exposure to certain foods and toxins. Bloodwork and urinalysis were unremarkable. Further diagnostics were declined and the owner sought an integrative medicine consultation. Oreo’s diet was changed from kibble-based to a balanced lightly cooked novel protein homemade diet supplemented with fibre and probiotics, and a western herbal tincture containing Passionflower, Bacopa, Chamomile, Baical skullcap, Burdock and Milk Thistle. This was implemented alongside behavioural modification strategies and a consistent home environment. Oreo’s stool bulk improved and his anal gland disease resolved. Neurologic episodes became very rare and only mild when they did occur, and his anxiety was well managed. He is now a very happy and healthy nine year old and the owners are delighted with his quality of life!

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Kyser, a 7 year old male Rhodesian Ridgeback, presented with a history of reoccurring Mast Cell Tumours, chronic anal gland infections, conjunctivitis, dermatitis and hindleg discomfort. He had received many courses of antibiotics, non-steroidal anti-inflammatories, skin supportive medication, antioxidants and Vitamin C. The aim was to support Kyser’s immune system, reduce the inflammation, detoxify the body, address any food intolerances, possible gut imbalances and possible nutritional deficiencies. He was treated with herbal tinctures, a course of stem cell treatments and his diet was changed from processed foods to a raw diet. Probiotics and further supplements were also introduced. Two years later Kyser’s mast cell tumours have been managed, the anal gland infections, dermatitis and conjunctivitis have resolved and he is maintaining a good quality of life. His owners feel that he is a happier dog, often walking up to one hour a day.

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Mindy, a 9yo Maltese cross, presented with a history of frequent recurrent urinary tract infections and two surgeries for struvite bladder stones. Her dedicated owners were finding it challenging to tablet her, collect repeat urine samples and feed her a prescription diet. They were also highly motivated to implement a more natural preventative strategy. Her treatment approach involved a high moisture containing homemade diet supplemented with probiotics and Cranberry extract, as well as the administration of a twice daily Western herbal tincture based on Crataeva, Astragalus, Marshmallow Root, Withania and Chamomile. She has had no further urinary tract infections since commencement of this regime over a year ago and is a very happy little dog who willingly takes her food and supplements!

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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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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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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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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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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.