Felix, a 950 pound, gelded Appaloosa horse, 16 years old
Initial Exam January 13, 2019
Felix had been stabled at a barn the prior year, 2017, that had exceptionally poor-quality hay with large amounts of dust and mold. As an additional worry, the barn is located in an area that had been used for the original nuclear work in the 1940’s. The local “joke” is the wildlife in the area glows in the dark. Since the summer of 2018, Felix’s exercise tolerance had been decreasing and he was becoming increasingly lethargic. He started a gradual weight loss in August of 2018. During the fall, he was in a run-in shed and started to have an even more dramatic weight loss. His owner moved him on January 2, 2019, when his body condition was deteriorating so rapidly, she feared he was dying. On physical exam on 1/13/19; Felix was thin, (he weight taped at 720 pounds, he should weigh at least 1,000); with his ribs protruding even through a heavy winter coat with a relatively distended abdomen (body condition-3/10). His gums were pale, tongue was pale and swollen with a few petechial hemorrhages; he was very lethargic, and while not neurologic was slow to place his legs when moving. His heart rate was slightly elevated; 54 beats per minute, respiration seemed slightly labored, with a slightly flared nostril when breathing. With any even mild exertion, his respiratory rate would increase dramatically. Although no abnormal lung sounds where heard, there was a hoarse quality to the bronchial sounds. His parotid, lateral retropharyngeal, medial retropharyngeal lymph nodes where painfully enlarged. They were warm to touch and he resented any pressure on these lymph nodes.
His initial TCM diagnosis was Spleen Qi deficiency with some type of Heat toxin with a secondary heart qi weakness; he was placed on Wei Qi Booster initially, 2 tablespoons twice a day; a Spleen tonic with Two Blood heat clearing herbs. It contains Astragalus, Huang Qi; Angelica, Dang Gui; Codonopsis, Dang Shen; Lindera, Wu Yao; Citrus, Chen Pi; Scutellaria, Ban Zhi Lian; Oldenlandia, Bai Hua She She Cao; and Scrophularia, Xuan Shen. Overall, this formula is immune modulating, immune supportive, alterative, and an anti-microbial tonic.
In western terms, Felix appeared to be anemic with evidence of a thrombocytopenia, which is “Bad Blood”. Blood was drawn for a CBC and Chemistry panel; and Lyme and Ehrlichia equi titers. Titers were both negative; blood work was normal except for a low segmented neutrophil count 2.3 (2.7-6.6 thou/uL), AST was high at 539 (199-374 U/L) and total and indirect bilirubin was low (total 0.3 (0.5-2.5 mg/dL; indirect Bilirubin was 0.2 (0.3-2.3 mg/dl). With these results, his liver function seemed weak with potential cellular damage suspected in the heart, as all the other liver function tests and kidney function tests were normal. With the segmented Neutrophils low, it was feared that there was a cellular migration into the peripheral tissue, that is evidence of a possible retained pathogen. With these results, it was concluded that he had some type of retained pathogen which was irritating and destroying cardiac tissue. He was started additionally on Cinchona bark, 1 tsp per day, and Xue Fu Zhu Yu Tang, one tablespoon once a day. Cinchona has an anti-microbial, antipyretic effect with a cardiac tonic, alterative, adaptogen influence. A “Blood moving” effects was satisfied with the Chinese formula, Xue Fu Zhu Yu Tang: Persica, Tao Ren; Carthamus, Hong Hua; Ligusticum, Chuan Xiong; Cyathula, Chuan Niu Xi; Paeonia, Chi Shao Yao; Angelica, Dang Gui Tou; Bupleurum, Chai Hu; Platycodon, Jie Geng; Rehmannia, Sheng Di Huang; Aurantium, Zhi Ke; and Licorice, Gan Cao.
On February 7, 2019, he was rechecked. His energy seemed to be better, he was gaining weight, Color was better, no petechial hemorrhage; plan – continue treatment. 3/7/19- Felix has good color, except for a slightly purple tongue, pulse was taut. His attitude was good but Felix was acting very painful in the GB meridian. I felt that the disease process was moving out of the Blood level into the Shao Yang level; his primary herb was changed to Xiao Chai Hu Tang with Cinchona bark. Xiao Chai Hu Tang is the Chinese Herbal formula to clear retained pathogens in the Shao Yang level. This level refers to the endocrine system and potential source of an auto-immune antigen. The formula contains Bupleurum root, Chai Hu; Chinese Skullcap, Huang Qin; Chinese ginseng, Ren Shen; Pinellia rhizome, Ban Xie; Licorice, Gan Cao; and red jujube, Hong Zao.
April 8, 2019 Felix was seemingly doing well, his owner was very happy saying he was looking good, his weight was up to 950 pounds; exercise tolerance was better; but he would still tire; his heart rate was 30 bpm, respiration rate was normal but his lymph nodes were still very painfully swollen; now there were distended veins seen on the surface of the lymph nodes. His tongue color was looking murky. Basically, he just was not better enough. There still seemed to be a deeper pathogen that was still causing “Bad Blood”. While the plan was to continue his herbs, I felt I was missing something vital in the case. When I was expressing my concern to his owner she reported her concern that he had stopped his mischievous mannerisms.
Felix had done well with his Chinese herbs but we seemed to have reached a plateau. His tongue color was brown and was still slightly swollen; capillary refill time was less than one second. Body condition was normal. His parotid, lateral retropharyngeal, medial retropharyngeal lymph nodes where still painfully enlarged. There seemed to be a multitude of engorged, stagnant blood vessels in the entire region over his painful lymph nodes. He was still slightly depressed and “tired”, in previous years he was always very mischievous, now he would stand quietly when being worked on. Initially I thought he was finally growing up and behaving but it was more and more apparent that his quietness was a sign of his chronic disease. His owner was more aware of his quiet behavior, that he used to play with her other horse for hours and now he would just stand with no interest in any interaction with the other horses. Heart and Lung sounds were normal but there was a harsh quality to the lung sounds on the right dorsal area. Chronic active inflammatory process in the parotid, lateral retropharyngeal, medial retropharyngeal lymph nodes with immune deficiency with the potential of an opportunistic organism ( for example: Pneumocystis type organism) with a need to improve his mitochondrial function.
The general treatment goals were to increase health and vitality, to restore his prior performance level; to improve his lymphatics; and to treat the symptoms of chronic immune weakness, chronic lymphatic congestion and stagnation and infection/inflammation; to clear his body of opportunistic pathogens; treat the symptom of his lethargy; improve the quality of his “blood” and the stagnate venous congestion, and modulate his immune system.
To Increase health and vitality; herbs are needed with an immunoregulatory, alterative, tonic, and adaptogen qualities. To improve the quality of Blood; an immunoregulatory with alternative qualities will be needed. To treat the symptom of inflamed lymph nodes anti-inflammatory, anti-microbial, alterative, and astringent, immunoregulator, anti-catarrhal, lymphatic herbs are needed. To treat the implied Pneumocystis infection, an herb with an anti-microbial, anti-inflammatory, anti-fungal, anti-protozoan effects are needed. To improve the venous congestion in the Lymph nodes, an alterative and circulatory stimulant/blood tonic is needed.
PRESCRIPTION-Echinacea (Echinacea angustifolia) 30%; Cleavers (Galium aparine) 25%; Gotu Kola (Centella asiatica) 15%; Nettle leaf (Urtica urens) 15%; Thyme leaves and flowers (Thymus vulgaris) 15%. This formula was a tincture; volume of 4 tablespoons twice a day. The historical dose in horses for these herbs would be 15-30 ml a day. The combined dose is 60 ml twice a day. It was felt that the synergy of the herbs would allow for a decreased individual dose.
- Echinacea was the primary herb, 60% of the formula. Echinacea is an antimicrobial, anti-inflammatory, alternative immunoregulator and tonic herb known to be important to treat recurring respiratory infection in weakened individuals. Felter and Lloyd considered it to be an important herb in toxic states that have septicemia, tonsillitis with a dirty brown tongue and catarrhal states of the nasopharyngeal or bronchial system. It is also an herb that is characteristic for a high level of exhaustion: overwork, long hours, when the veins are full and dark. The tongue was so characteristic of Echinacea; it was the primary sign that made me change to western herbs.
- Cleavers is an alterative, anti-inflammatory astringent that is specific for the lymphatics. Culpeper used for hard swelling and to cleanse the blood, BHP-specifically for enlarged lymph nodes. It was the assisting herb to help treat the symptom of enlarged lymph nodes and the primary lymphatic herb.
- Gotu kola is an adaptogen, with a strong regenerative effect on the connective tissue; it is a mild diuretic, alterative, with and antipyretic, antimicrobial, antiviral effect. It is indicated in the treatment of Lymphoma, and alterative for sore throats, tonsillitis, and traditionally used for swellings in the respiratory tract; improves venous stagnation. It was felt that this herb could improve the health of the connective tissue to encourage the removal of any opportunistic pathogens, like a Pneumocystis organism.
- Nettle leaf is an anticatarrhal, anti-inflammatory blood tonic. It helps with the removal of proteinaceous waste products. Nettle was used for its nutritive blood tonic effects and its ability to help clear wastes from connective tissue and to decrease the chronic inflammation.
- Thyme is an antimicrobial, antiviral, antifungal alterative, immunoregulatory antioxidant. Thymus is such an incredible respiratory antimicrobial herb; it was thought to be a likely choice to clear the presumed Pneumocystis infection. Cinchona had made significant progress with this case, but it was felt to try a different anti-septic herb.
5/24/2019: Felix was much better. The Lymph nodes were no longer hot to the touch, but still enlarged; the venous congestion had lessened. His tongue was actually pink. Exercise tolerance was better. He stole my stethoscope when I examined him; he was much more himself. Plan-continue treatment.
7/18/2019 Much better, lymph nodes were half the size, exercise level back; tongue color was pink, attitude was great; owner was riding daily, no complaints. His dose was slightly decreased to 1 tablespoon twice a day.
9/13/2019 Owner riding back at normal level; he was back at his old tricks. His lymph nodes may be a tad swollen, but not hot or painful. I would consider him just about cured but his dose currently is 1 tsp daily for continued immune support.
2/20/2020 Phone update: Owner had stopped herbs at Christmas time as she felt he was back to 100%.