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Posted on 04-11-2017

While most of our clients see the benefits of Homeopathy, few see all the "behind the scenes" work that goes into picking the remedy that will make your pet better.  Many hours of pouring over books, computer programs, charts, and emails lead us to the ONE and the ONLY remedy that will work for your dog or cat.  Then the doctor has to pick the right potency, or strength to treat your dog.  While picking a lower, "safe" potency is the preferred slow approach, sometimes a stronger 1M or a daily LM are a better fit for the case.


We thought it might benefit of our clients to see what goes into one straight forward case work up.  Miss Leah had been treated server times by other doctors for a reoccurring skin issue that mostly affected the sebaceous gland at the base of her tail.  While different treatments had lessened the severity of it, none had completely alleviated the issue.  It was to the point that this treat loving kissing girl would because very agitated and unhappy if anyone even touched her back end.  Treating the tail topically was becoming a nightmare for Leah.  We turned to homeopathy to offer her, and her mama, some relief!

Here are the notes and case work up for Miss Leah's case:

Case Report

Chronic

Leah

Female Spayed

Belgian Malinois

DOB 8/1/2010

  1. Current complaint May 23,2016
    1. Recurrent condition of the tail, and sensitivity in the rectal area.   The area of the tail gland approximately 1/3 of the way down the tail on the dorsal surface is pruritic with scabs, generalized dermal swelling, and is moist. Leah becomes anxious when the areas are cleaned or touched.  This complaint has waxed and waned depending on therapy for the past 4 months.   The condition always returns, however, and no treatment has been curative.  The owner has not treated the patient today and reports that previous treatments are only temporary.

  1. Leah has had itching of the overall body for the past 2 years, which seems to worsen in the wintertime.  The itching gets better in the spring. The itching does not produce any lesions over her body.

  1. Leah’s scratching and overall well being seems to be aggravated by the heat, and she enjoys the cold.  Warmer conditions seem to aggravate her overall scratching and agitation.  She loves the snow in the wintertime and pants in the evening in a warm house.  There is not a particular time of day when the licking seems to be better or worse.  Her thirst, appetite, stool, urine appear to be normal.  She is spayed.

        

  1. Historical Complaints/Past Medical History
    1. Leah was seen in January 2015 at her previous veterinarian for generalized pruritus.  She was given dewormer 2 weeks previous to this visit which seemed to quell the itching for a couple of days.  At that visit she received a Lyme Vaccine and was found to be negative for Heartworm, Lyme, Ehrlichia, and Anaplasmosis.   

  1. Her last DHPP was in September 2014.  Rabies was given in July 2013.  Bordetella vaccine was given June 2014. 

  1. Leah was seen again in March 2015 for constant licking and itching of her legs, abdomen and paws with a report from the owner that it had been going on for a couple of months.  This was treated with Benadryl, Dermal-Soothe Shampoo, and Cream rinse. 

  1. January 29, 2016 Leah presented to our clinic for a tail gland infection.  See photo below.  Treatment at this time included cephalexin and chlorhexidine scrubs.

  1. In February 2016 she presented with ear inflammation.  The owner noticed that her right ear was lying flat and that the other dog was sniffing at the ear.  She had copious light tan gooey discharge, and the right ear was painful.  Ear cytology was performed and noted that she had +4 yeast and epithelial cells on the slide.   This was treated with Dermalone (Ointment for skin and ears – contains:  Nystatin, Neomycin sulfate, Thiostreptone, Triamcinolone).  At that time it was noted that she had a tail gland infection which had cleared some with the antibiotics given in January.  On this day a photo of her tail was taken. 

  1. On April 6, 2016 she presented again with alopecia, pruritus, and crusts on her dorsal tail – in the same location that the skin infection was present in January.  The Grady Medical Laser was used to treat the affected area on this day. It was recommended to use black tea and spray the area 3-4 times per day. 

  1.  She presented again on April 21, 2016.   She was less excited about to eating her food than normal.  The owner reported that she licks and bites at her tail sometimes.  She did this in the exam room also. The dorsal surface of the tail is inflamed - the caudal portion is red with a scab - about 3 cm long and cranial portion is black - as it has healed.  Alopecia in these areas is about 50%.  We used the medical laser on the tail and the owner will continue to use black tea applications.  These therapies did not seem to give Leah relief and she returned on May 23, 2016 at which time we decided to work up a remedy for her.

  1. Diet/Food

Food

Amount to feed per day

Turkey ground

1 lb

Rice white rinsed and cooked

¾ Cup measured before cooking

Broccoli

1 Cup

Celery

1 Cup

Pear or bananna

½ fruit

This diet was created for Leah based on her food allergy requirements.

Supplement:  Seaweed Calcium

Step 2:  Physical Exam:

Approximately 1/3 of the way down the tail, there is alopecia, redness, and moist discharge.  Leah bites this area and it is sensitive to the touch.  She seems agitated when the tail is handled and quickly moves out of the way.  The affected area is approximately 4 cm in length and 2 cm in diameter with some areas of black pigmentation.   The owner also reports that she turns quickly and licks her anal gland area.

Step 3: 

  1. Master Problem List
    1. Itching of tail – 1/3 of the way down.
    2. Scabs dorsal tail
    3. Licking – itching rectum
    4. Generalized pruritus
    5. Decreased appetite when tail becomes inflamed
    6. Worse in the wintertime
    7. Overall she does not like the heat, and desires cold

  1. Homeopathic Work Up
  1.  The details of this case have increased over time, given the number of times the dog has been seen in this clinic and others.   Symptoms have increased in number and changed in severity over time.
  2.  Obstacles to cure?  Leah’s owner has tried several different medications topical and otherwise to cure this condition.  Most of these cause temporary alleviation of symptoms but do not cause complete cure or suppression of symptoms.  Given that few of her previous medications have suppressed her symptoms for a significant period of time, it is likely she is still curable with homeopathy.

  1. Methodology:
    1.  This case is an acute flare-up of a chronic disease.  Leah is pruritic most of the time, with symptom intensification during the winter months.  Her ear inflammation, which was seen in February 2016, was also an acute flare-up of her chronic condition.  This was suppressed with Dermalone and has not yet resurfaced. 
    2. Vitality:  As a 6 year old FS Malinois, Leah has had only symptoms on the surface of her body.  She has had no internal symptoms in her life.  This is indicative that she has a strong life force.
    3. Seat of illness/Organ Affinity:  Skin, glands, and rectum
    4. Causation:  Leah has had a rather standard lifestyle for a dog in Virginia.  Her vaccines given in September 2015 may have caused the pruritis which started in January.  She seems to have a sensitivity to different food types which has also been associated with over vaccination in some cases in this clinic.
    5. Never well since:  January 2015 – note that this is just 3 months after a multivalent vaccine.  No other outstanding life changes occurred for this patient in the months previous to her first symptoms.

  1. Keynote symptoms:

There are no keynote symptoms

  1. Homeopathic symptom List:
    1. SRP: Tail gland pruritis
    2. General Symptoms:  Itchy all over
    3. Symptoms with severity:  Tail gland pruritis which results in swelling of the itched skin, scabs and discharge of blood and purulent material.
    4. Modalities:  Pruritis is ameliorated by cold, and aggravated by heat.  Skin symptoms are worse in the winter, and become worse by scratching.  As she lives in the house, the dry heat may be contributing to the worsening in the winter.
    5. Concomitants:  When Leah’s tail and rectum become bothersome to her she often has less desire for food, and is more lethargic.
    6. Behavioral changes from normal:  Sometimes her appetite wanes, and she becomes agitated when the pruritis around the anal area is worsened.
    7. Particulars:  Glands Itching, inflamed, rectum itching
    8. Common symptoms:  Itching in general – generalized pruritis, decreased appetite and lethargy

  1. Homeopathic Repertorization

  1. Homeopathic Discussion/Differentials

  1. Sulphur, Mercurius, Lycopodium, and phosphorus were the top remedies in the reperitorization.  Sulphur was given as the first remedy.

The most prominent symptom that made me consider Sulphur as the top remedy is the location of the symptoms – the anus or rectum is often a primary location for symptoms requiring Sulphur (Vermeulen, 1499).Also for Sulphur: Pruritis especially from warmth in evening.Sulphur patients have eruptions that are scratched and tend to ulcerate and exude offensive discharge (Vermeulen 1504).Sulphur patients tend to be lean persons and persons of nervous temperament, quick motioned, quick tempered, plethoric, skin excessively sensitive to atmospheric changes (Vermeulen 1505).

Mercurius patients may also have symptoms involving the rectum as is apparent on the repertorization.When reading about these symptoms in Vermeulen – none of these rectal symptoms match those of Leah (1050).Mercurius symptoms of the rectum include constriction, tenesmus, burning and itching of anus and adjacent parts after stool.Leah’s itching seemed to occur regardless of the passage of stool.Leah also has no mind symptoms of Mercurius which could include a slow weak memory, mistrustfulness, restless at night, violent impulses, and changing place continually.The skin of Mercurius patient is almost constantly moist and has vesicular and pustular eruptions.Itching is worsened by warmth of bed.While Leah’s tail gland is moist, the remaining skin is normal. The resulting scabs and inflammation are not vesicular or pustular in nature, just swollen and moist (1053), with mild ulceration.

Lycopodium patients are often afraid to be alone, and extremely sensitive with an aversion to undertake new things.They become headstrong and haughty when sick and have a loss of self confidence (Vermeulen 974).Anxiety, angry and sad are all emotions of lycopodium, but are not shared by Leah.

Digestive symptoms are common in the lycopodium patient.The rectal symptoms often include constipation.Anal itching is often related to excoriations which bleed easily and are itching and moist.This is not the case in Leah whose anus had no physical abnormalities, just pruritis.

Phosphorus patients are often fearful, and sensitive or hyposensitive, excitable and easily irritated (Vermeulen 1227).Leah is none of these when considering her emotional symptoms.Phosphorus patients are tall slender patients with narrow chests and thin skin.They are weakened by loss of fluids with nervous debility and emaciation (Vermeulen 1238).Phosphorus does have smarting of the rectum and needlelike stitches when not at stool, rectal polyps, and proctitis Vermeulen 1233).

Step 4:  PLAN

Rx Sulphur 200c, prescribed May 23, 2017. 

Supportive care:  Tail kept clean with dilute lavender spray used daily with caution. 

Owner reported on May 24, 2016: I gave Leah 10 pellets last night.  She seems a little more lazy this morning, not wanting to go out to potty as early as she usually does.  She was outside in the yard from about 9:00 to 2:00 laying in the shade.  When my husband let her in around 2:00 she slept a lot which isn’t unusual after she has been outside.  She wasn’t licking her behind, but I noticed her doing that when I got home.  She really seemed to be acting pretty much the same except for licking herself less. 

Follow Up Evaluation:

August 10, 2016

S:  In the past couple of weeks she has started to lick her rectal area.  Previous remedy helped in 3 days tail is completely healed. 

O:  This area is very sensitive to the touch when the temperature is taken or anal glands expressed.  Anal gland discharge was tan in color, and of a normal amount and consistency.   During this visit it was noted that her tail was no longer alopecic and she was not itching this area.   No new symptoms were noted.  Her overall pruritus was improved but not completely gone.  Note this was in August – a time of year that in general the pruritus is improved.

A:  Problem LIST:

Rectal pruritus – Improved for the past 2 months but recently worsened.

Skin itching – Improved

Tail gland pruritus and inflammation – healed

Overall wellness – excellent

B. Homeopathic Work up:

  1.  Movement towards cure.  The owner observed a possible counteraction.  After remedy was given she was less interested in food and more lethargic the next day.
  2. Homeopathic Symptom List:
    1. Rectal pruritus
    2. Overall pruritus – with no lesions noted
    3. Aggravated by touch

Most of Leah’s symptoms have subsided and she is emotionally well.  Given the length of time it has been since she had a remedy, it was reasonable to repeat the remedy and potentize the remedy slightly.

P:  Rx:  Sulphur 200c 10 pellets dissolved in ¼ C water, succussed 24 times and 3cc was given to the patient.

Owner update November 2016

Leah is doing GREAT! I used the sulphur pellets on her for the second time after I brought her to see you last time.  She responded in just a couple days after just that one dose. I also used the wipes with Lavender Essential oil on her hinny for a couple weeks. 

Couldn’t be BETTER! 

January 30, 2017.  Presented for uncomfortable anal area.  Owner gave one dose Sulphur 200c at home before appointment with no instruction.  Tail continues to be completely healed.  Anal glands examined and did not need to be expressed, no discharge present in gland. 

Call to owner one week later – she reported that she was feeling fine.

Reference

Vermeulen, Frans 2000. Concordant Materia Medica

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