Chronic Progressive Weight Loss in a West Highland White Terrier
A 12 month old male neutered West Highland White Terrier named Riley presented to myself for chronic, progressive, unexplained weight loss of 4 months duration. West Highland White Terriers originate from the Western Highlands of Scotland and they are usually feisty dogs from 15-18 pounds of body weight. Upon presentation Riley was subdued and an emaciated-looking 8.5 pounds. To understand his body condition, try to imagine yourself at 1/3 to ˝ your normal adult body weight!
Riley had been examined and given a large variety of modern western diagnostic tests at his regular veterinarian’s office. When the veterinarian found no discernible dysfunction with Riley, he referred the dog to the University of Florida College of Veterinary Medicine’s Small Animal Hospital. After more extensive and expensive tests were done at the veterinary hospital in the Internal Medicine department, the chief clinician was still at a loss to explain Riley’s continued weight loss. At that point Riley’s caretaker sought me for a third opinion.
Upon presentation I found a calm, albeit ravenous, very thin dog with all major bony prominences protruding. His western biomedical exam was unremarkable except for the severe emaciation. There were some subtle changes that will be delineated below in his TCVM examination.
The Traditional Chinese Veterinary Medical (TCVM) examination results were as follows: Riley had normal eyes with a somewhat subdued Shen. His nose was cold and moist and had recently begun to change from dark black to a light grey and slightly pink pigmentation. His tongue was pale and slightly moist. Riley’s ears were cool, even to the base where they were continuous with his scalp. He was so thin that most of his back Shu (UB association) points had too little underlying muscle mass to determine Excess or Deficiency. Nevertheless the Weishu (UB21) point at the T13-L1 junction and Shen-shu (UB23) at L2-L3 seemed as if they were the most Deficient. His dorsal thoracolumbar, lumbar and sacral areas were cool to the touch. Riley’s pulse taken at the femoral artery was slow, deep, and weak. His Kidney Yang (TH/PC) pulse was the weakest followed by his Spleen pulse. His footpads had recently changed from deep black in colour to a grey to pink colour and they were cool to cold. Riley’s hair coat was relatively normal. Riley defecated 4-6 times each day and commonly had somewhat loose stools with undigested material sometimes apparent to the caretaker.
Riley had begun life as a seemingly normal puppy and had a history of mild gastrointestinal issues such as mild, occasional diarrhoea and slow weight gain. Besides the relatively slow weight gain for his breed, Riley had seemed in good health and had been routinely vaccinated (which probably means over-vaccinated) and dewormed. His primary complaint of chronic progressive weight loss began at 8 months of age immediately following neutering. Veterinarians commonly neuter (orchiectomy) male dogs to reduce excessive aggression, perceived increased incidence of prostatic cancer, wandering to find and inseminate fertile females, and reduce unwanted population growth (Spain et al, 2004). From 4-6 million unwanted dogs are euthanatized in the USA each year (Scarlett et al, 2002). However, recent data suggest that un-neutered male dogs have an increased risk of prostatic hyperplasia, not neoplasias, and suffer fewer mental age-related deficits compared to their neutered cohorts (Hart 2001).
Riley’s presumptive TCVM Bian Zheng or Pattern Differentiation was Spleen Yang Deficiency, Kidney Yang Deficiency, and Kidney Blood Deficiency. Spleen Yang Deficiency was the pattern linked to the pale, moist tongue, cool thoracolumbar junction (Pishu (UB20) and Weishu (UB21), loose stools with undigested food particles and deep, slow Spleen pulse. Kidney Yang Deficiency was the pattern seen with a cool lumbosacral area, cool feet and ears, pale moist tongue and deep, weak and slow Kidney Yang (or TH/PC) pulse on the right. Kidney Blood Deficiency was seen with his depigmented nose and paw pads.
Riley’s initial treatment principles were to Tonify Spleen Yang, Tonify Kidney Yang and dispel interior Cold, and Tonify Kidney Blood. Because Blood Tonics are commonly cloying and poorly digested, especially in Spleen Qi/Yang Deficient animals, the Spleen Yang disharmony was the first to be addressed (Bensky and Bartolet, 1990). Kidney Yang tonification was undertaken as a primary treatment strategy and also to benefit Spleen Yang (Maciocia, 1994).
Riley’s treatment plan with acupuncture, moxibustion and herbs was as follows. Acupuncture points chosen included (CV12), Zusanli (ST36), Qihai (CV6), Pishu (UB20), Weishu (UB21), Shenshu (UB23), Mingmen (DU4), and canine Baihui (DU20 - dorsal midline at the lumbosacral junction, human Shiqizhuixia) (Flaws, 1998; Xie and Preast, 2002). The caretaker was instructed to use indirect moxabustion at Mingmen (DU4), and canine Baihui (DU20) (every 48 hours) at home. The herbal formula Li Zhong Wan (Regulate the Middle Pill) was prescribed (1g every 12 hours) to warm the middle burner and strengthen the Spleen and Stomach (Bensky and Bartolet 1990). Li Zhong Wan is a simple yet elegant variation of Si Jun Zi Tang (Four Gentlemen Decoction) with Gan Jiang (dried Ginger Rhizome) substituted for Fu Ling (Poria). Riley was also given a prescription for TCVM Food Therapy that warmed the Spleen/Stomach and Kidney while tonifying the middle Jiao.
Three months have passed since Riley first presented and he has gained 2 pounds or 24% of his initial body weight and has more normal Shen and bowel movements. His nose and paw pads are beginning to have dark to black pigmentation again. His TCVM Food Therapy was changed to include the principle of Dang Gui Bu Xue Tang (Angelica Tonify the Blood Decoction) by cooking Dang Gui (Radix Angelicae Sinensis) and Huang Qi (Radix Astragali Membranacei), (1:6 ratio) in his home-cooked food and removing the root pieces before serving.
The gonads are a source of Jing, particularly the Yang Jing associated with thermogenesis and sexual development. Early removal of gonads leads to a host of western biomedical disease processes such as increased rate of cystitis and decreasing age at gonadectomy was associated with increased rate of urinary incontinence among female dogs. Among male and female dogs, hip dysplasia and noise phobias were increased (Spain et al, 2004). From a TCVM perspective, gonad removal leads to Kidney Yang Deficiency and may exacerbate Spleen Yang Deficiency as well (Xie and Preast 2002). Perhaps veterinary medical practitioners should be a bit more cautious when they consider performing what has, unfortunately, become such a routine veterinary surgery.
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Flaws, B. (1998). Sticking to the Point: Volume II. Boulder: Blue Poppy Press.
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Spain, C.V., Scarlett, M. & Houpt, K.A. (2004). Long-term risks and benefits of early-age gonadectomy in dogs, J Am Vet Med Assoc; 224:380–387.
Xie, H., Preast, V. (2002). Traditional Chinese Veterinary Medicine, Volume I. Beijing: Beijing University of Aeronautics and Astronautics Printing House..
Zhang, K. (2005). New Patterns of Disharmony. 2nd Annual TCVM International Conference, Guangzhao, China.