Si Miao San - Traditional Chinese Medicine her s

[BrookeR]

We are back on the roller coaster again. We believe Pepper is relapsing again (impa)  and have had to go up in Pred. 😔
I have also just started giving her (very gradually) Si Miao San, Traditional Chinese Herbs. The list of things that it has claims that it helps with is extensive and would be absolutely amazing if it ends up doing even half the things they say it can help with.
With Peppers sensitivity I have always been scared with trying things like this. Although given her age, the chronic steroid use, the worsening of her joints and now this latest relapse I have decided it's worth the risk. So far we have had no problems but I'm still working up to her correct dose.

Has anyone else had any experience with using traditional Chinese medicine? In particular Si Miao San (four marvels powder).

[Jo CIMDA]

Hi Brooke

I am so sorry Pepper is not well again.  I haven't had experience of using Chinese medicine but a lot of the veterinary drug books these days, especially for skin disease, recommend Chinese herbs.

I do hope you see positive results very soon.  Please let us know your opinion.

All the best
Jo

[BrookeR]

Thanks jo, I really hope they work for pep.

[mon67]

Hello Brooke

I have been following Pepper story as my dog started this January with IMPA and just needs someone to relate to.
I see that your Pepper had some very good time in the past few years, so I would love to hear what really worked with her.

Our dog, Ripley, has started on a strong dose of Prednisone (20 mg for 40kg of dog) but we had to reduce that to 20mg  and then 15mg because she had huge quick muscle wasting.

Last month she started to get better with her blood test and her limping, so our vet decided to taper prednisone to 10mg and then 5mg per day and start Cyclosporine (75mg per day). She limped a bit at the beginning but then started to be okay with the 10mg dose of pred. We then reduced to 5mg and now she is really limping and  she is lethargic again.

I was wondering if you can tell me how much Cyclosporine and Pred worked for your dog. I read you had problems in the first few months because the doses were weaned to quickly but then you managed to find a dosage the kept her well for a few months.

Thanks for all you can share
As you know, this condition si very frustrating, and all we want, is for our loved pets to have a good quality of life.

Thanks a lot
Monica

[BrookeR]

Hi Monica,
Good to hear from you. Sorry that you are also going through the same with your girl.
We had to change to cyclosporine early on due to advice from an inexperienced vet which caused an initial incorrect dosage regime wth pred. Ultimately resulting in Peppers liver reaching damaging levels. We had to change to the cyclosporine to try give her liver a break. We managed to get the cyclosporine to work for long enough to give her liver a break. But there was lots of ups and downs. Pepper responds much better to pred. We were having to give her such a large dose of cyclosporine for it to have effect.  Which ended up costing us all of our savings. She has since been able to maintain a much lower dose of pred, until this latest relapse. She seemed to have more side effects from the cyclosporine too. She is a English staffy, so a medium size dog (approx 18kg) and won't suffer the effects of pred quiet as much as a larger dog. But she definitely shows muscle wastage. Although already being such a muscley breed to begin with that may have left her more muscle to make it not so obvious.

I have read & researched everything I can to give Pep the best chance I could. Jean Dodds book canine nutrigenomics is a great start to read. I have eliminated chemicals from our home, she also does not have any worm, heartworm, topical flea treatments or vaccines.  Pepper has lots of allergies and food intolerances & sensitivities so I have worked on her diet a lot. We did nutriscan testing and I had a balanced diet made Dr Remilliard at Pet Diets for her.
I give her probiotics, she has wild liquid salmon oil for omegas, sunflower oil for linoeic acid, Rose hip vitamin c joint supplement, a trace vitamin and mineral supplement to help balance her home cooked diet.
Now I have just started trying the Chinese herbs. I figured to give her the best chance I would try get her body in as best health as possible.

[mon67]

Hi Brooke
thank you so much for you reply.
Ripley is also taking a few non chemical drugs, like Reishi, Arnica and Ribes Nigrum EIE (that is supposed to be the natural corticosteroid). We don't think they really make the difference, but maybe they help.

Do you remember what dosage the cyclosporine was on?

Thanks again
And hope Pepper will make it to this relapse again.

Monica

[BrookeR]

Thanks, I've heard of arnica (I took when I had my second child to recover quicker) but don't know the other two. I'll have to look into them.
I was giving Pepper the Human cyclosporine drug called neoral. She was on 150mg a day. I think 100mg in the morning and 50mg of a night/afternoon.
Its worth trying natural remedies to try lessen the chemical load. They can't be expected to have the same effectiveness as the hard drugs, but I'm all for trying. Every little bit could help.

[BrookeR]

One thing I forgot to mention. Just check the contraindications with cyclosporine when using herbs. I did a very quick google search on Ribes Nigrum EIE & it mentioned something about black currents. I remember checking the contraindications of different drugs/ herbs with cyclosporine before I gave it to Pepper. I thought I remembered reading something about cranberry juice, changing the effectiveness. I can't be sure though, as it was some time ago. Your vet should be able to check their 'plumbs veterinary drug handbook' for you.

[mon67]

Hi Brooker

how is your dog doing?
Hope all is getting better.

Monica

[BrookeR]

Unfortunately Pepper is not doing well. She has been quite somber, slow and not her usual perky self. I took her back to our vet to get bloods done to check what was going on and her liver levels were through the roof! Higher than they have had ever been, even when she was on much higher doses of pred. I have dropped back her dose from 10mg per day to 7.5mg and started her on denosyl. We are going to wait a week and then drop back a further 2.5mg (back to the dose we were originally on). I'm so worried she is going to relapse badly, but also worried about the damage to her liver. I cannot afford to put her back on cyclosporine again so we don't really have any options. She has never got a fever again when she has relapsed. She only got the fever when she was initially diagnosed with impa. So my vet is wanting to get her back to her previous 5mg tablet of pred and if she is still in pain try tramadol. As long as she has no fever. In which case she says we would need to go with an immunosuppressant.
Other symptoms do not seem to be suggesting she now has full blown Cushings or diabetes. We think it's just the increase in pred that has caused the extreme liver levels. But she has been on much higher doses before (even though she has now been on steroids for a long period of time) we didn't expect to see results like this with the pred increase that we made. The only difference this time is she is on the Chinese herbs but I spoke with the specialist vet who prescribed them and they should not have any affect on liver levels or causing inaccurate results. They are supposed to help with liver support.

I don't know what's going to happen. I'm hoping her liver is going to be okay while we taper her. more quickly than we would normally do with Pepper (as she is so sensitive to change). I don't know what we will do if she ends up in pain when we drop back. I don't think the tramadol will work. We have briefly tried things like gabapentin and a non steroidal anti inflammatory before when she relapsed and they didn't work. But that was when she was on no immune suppressants. This time we plan on keeping her on a low dose of pred.
After we do the next taper we will wait a bit and then retest her blood and see what her liver levels are doing. 🤞 fingers crossed we haven't cause irreparable damage 😞

[Jo CIMDA]

H Brooke

I am sorry Pepper isn't too good at the moment. 

I had Chinese medicine prepared for me by a well respected and experience Chinese doctor to address several minor problems, and I persevered with it for 3 months because I wanted it so much for it to work but it caused me dreadful and persistent heartburn and in the end I had to stop it.  I wonder if it might be prudent to stop the Chinese herbs to see if Peppers problems reduce.  You can always restart them at a later date.   This is just a thought.

I hope she improves very soon.

Jo

[BrookeR]

Thanks jo. Yes I had thought about stopping the herbs. But Peppers relapse, lack
of energy and down mood all started before we began the herbs. Ordinarily we would never have started Pepper on something new when she wasn't stable. But condsidering we believe she was relapsing and we were worried about her liver, and having nowhere else to go if her liver levels went up. My vet and I decided it was best to risk trying the herbs in case they helped.
They are supposed be a natural steroid (however the specialist said they don't interfere with blood alp & alt levels?), with potential to be able to lower pred doses. Also they are meant to be good for Cushings, liver support and antii inflammatory.
i keep thinking should we stop them? But then I don't want to because what if they are helping her enough to keep her walking and not in horrible pain and enough to support her liver so we don't have irreparable damage. If we stop they will take time to build up in her system again if we want to start again. That's time we won't have. But the fact that she was already down before we started them is the main reason I haven't stopped giving them to her yet.

She has been slower getting about today. So I am getting concerned that the drop in pred dose is taking affect. She did do some short bits of running chasing birds today so let's hope that's why she seems more uncomfortable

[Jo CIMDA]

It's a tough time Brooke but you know her best and go with your gut instinct.  I do hope she picks up very soon.

Jo

[BrookeR]

We retested peps liver levels 2 weeks after the drop in dose and they had gone from 6500 to 2700. 2700 is still very high but a fair drop from what it was. Her fat levels were very high when we took her bloods.
Pep was down to 5mg per day (her normal dose that she has been stable on for sometime) and any other time we had tried dropping below this she has relapsed. So we decided to stay at this dose, continue denosyl and hope the levels may drop some more with a little more time.
Tuesday morning pep vomited when she got up and then Thursday morning she vomited again when she got up. She has had times before when she has vomited, but I didn't fell like it was the same this time. I felt something was wrong and was worried about an ulcer. Took her to our vet to stay for the day and run some tests. She tested positive for pancreatitis . She was really dehydrated and so had to spend the day on a drip. She had the day without eating and then yesterday was allowed small meals. She has so far kept it all down without anymore vomits. I have had to stop her steroids and only give every second day. I also have had to stop all her supplements, (salmon oil, Rose hip joint supp, sunflower oil for linoeic acid, Chinese herbs) because my vet believes giving the pancreas time to heal is the more important danger at the moment. I am very worried she will relapse. We have tried every second day pred dosing before and she relapsed. I have asked if after today we can go to 2.5mg per day dose. It is such a little dose and shouldn't make a difference but Pepper always likes to do things different from the normal so I'd prefer try this and hope she can remain stable from relapsing drastically. We are not sure what has changed to make her get pancreatitis. She didn't eat anything different or anymore treats then normal. We are still wondering if she could have full blown Cushings now (not steroid induced).

It feels like we are running out of time and all the bads are catching up to us. Options are getting more slim. If we have a relapse there is no where to go. Her liver levels are too high to go up and I cannot afford to go back to cyclosporine or the more expensive drugs. I also don't think she could handle them at this point in her life.
She now has a permanent limp in her front leg which came after falling in a bandicoot hole. Her joints are very grindy when you lift up each individual leg now. You can feel the grinding. We had summarised that her recent drop in mood was because arthritis (normal, not poly arthritis) has caught up with her. We had planned on trialing her on tramadol to see if that made a difference. But then this happened.

We will keep fighting, but I'm just feeling quite worried and out of options at the moment.
Trying to keep positive for Pep though because she feeds off my mood.

[Jo CIMDA]

Hi Brooke

I'm so sorry Pep has pancreatitis.  I do agree with your vet that this is the most important thing to address at this time.   I do hope she continues to improve a little every day.  Get her over the pancreatitis and then think again about what you want to do to optimise her good health.

A very good homoeopathic remedy for pancreatitis is Iris Versicolor. It might be worth keeping them in just in case she gets another bouts in the future.  Also I was going to suggest CBD oil for her joint pain, and the good news is it helps pancreatitis, so perhaps you can check this out too.

https://holistapet.com/using-cbd-for-pancreatitis-in-dogs/



Jo