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CASE STUDY

THE
POWER OF
INTEGRATION
Jacqui Snell has been a veterinarian for nearly 30 years and
practises conventional and complementary medicine. She used
tools from both kits to treat Skye.

INTRODUCTION general wellness. This is undertaken within


Integrating complementary medicine the framework of both conventional and
with conventional veterinary practice herbal treatment modalities, addressing
offers clients and their pets additional the potential expected outcomes, expected
ways to improve health and wellbeing. risks and benefits, side effects and costs of
This is especially rewarding when each option. All clients are presented with
conventional medicine has failed to and sign an informed consent.
improve a patient’s quality of life.
Veterinary botanical medicine embraces ABSTRACT AND BACKGROUND
a holistic diagnostic approach that Skye, an eight-year-old speyed female
incorporates the Western diagnosis. (A West Highland White Terrier, presented
herbal medical stance is generally based on with a year-long history of treatment
herbal medicines that have been used in an for granulomatous meningoencephalitis
organised therapeutic approach developed (GME) with prednisone. Additionally, Skye
in the East or in the West. The Western suffered from a number of other ailments,
approach is based on bridging science such as degenerative joint disease (DJD),
with the tradition of herbal medicine.) skin disease and gastro-intestinal disease.
The treatment principles are based on the This case report demonstrates the
concept of improving health by enhancing integration of herbal medicine (and
physiological function – including other complementary therapies) into
supporting organ function – and at the the treatment protocol, which facilitated
same time addressing the underlying the reduction of prednisone, resolution
pathophysiology of the condition. This of clinical signs and improvement of the
can be achieved by appreciating the quality of life of this patient.
multi-constituent composition of herbs. GME is a common idiopathic
Herbal medicines are individualised for autoimmune inflammatory disorder
each patient and formulated by taking of the central nervous system (CNS) in
into account the signs of the patient and canine patients (Dewey, 2008). GME is
appropriate treatment strategies that considered an autoimmune CNS disorder,
address the salient features of the case. and immunosuppression is considered the
The aim of the herbal integrative best management method for patients
approach is to alleviate signs and optimise (Jung et al., 2013). The traditional

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CASE STUDY

IT IS IMPORTANT THAT HERBAL MEDICINE IS PRACTISED BY


QUALIFIED PRACTITIONERS TO PROVIDE MEDICAL OVERSIGHT,
MITIGATE THE RISK OF HERB-DRUG INTERACTIONS AND SIDE
EFFECTS AND PROVIDE A PROFESSIONAL SERVICE TO REPLACE THE
AD HOC USE MANY CLIENTS UNDERTAKE FOR THEIR PETS.

mainstay of therapy has been the use of PHYSICAL EXAMINATION AND DIAGNOSIS
corticosteroids, in particular prednisone BIOCHEMISTRY At Massey University’s Veterinary
used at immunosuppressive doses (2mg/ Skye presented for examination in June Teaching Hospital, a hypothetic
kg/day) tapered over the following months 2017, as the owner was concerned about antemortem diagnosis was made
to achieve the lowest effective dose (Platt, symptom recurrence after an attempt had on assessment of clinical signs
2002). It is uncommon for corticosteroid been made to wean her off prednisone. and cerebrospinal fluid analysis. A
therapy to be terminated (O’Neill et al., The owner observed that Skye was definitive diagnosis would be made on
2005). However, response to therapy depressed and quiet. histopathological examination (Dewey,
with glucocorticoids varies, and relapse Cervical neck pain (C1-C3) and 2008). GME, infectious and fungal
of clinical signs often occurs during hyperaesthesia were present. Skye’s (toxoplasmosis, neospora, cryptococcosis),
the tapering of therapy (Dewey, 2008). pupillary responses were normal and immune-mediated inflammatory
Issues with prednisone therapy concern there was no evidence of ataxia. There was encephalitides or neoplastic causes were
adverse effects that include polyuria/ general discomfort on palpation of the the main differentials.
polydipsia/polyphagia, hepatotoxicity, abdomen, the liver margins were palpable
weight gain, iatrogenic Cushing’s disease beyond the 13th rib and the abdomen WESTERN VETERINARY HERBAL
and depression, which are frequently seen presented with a pot-bellied appearance. MEDICAL PERSPECTIVE
during long-term prednisone therapy Dermatitis, excessive dandruff, excoriation The Western veterinary herbal medical
(Jung et al., 2013). and seborrhea were evident over the skin approach considers predisposing and
Skye presented following 12 months of and coat. Pain was present on palpation of perpetuating factors in order to establish
prednisone management. She had been the right shoulder and elbow supporting treatment goals. It is important to address
diagnosed with GME in March 2016 at the diagnosis of DJD. A biochemistry panel all possible contributing factors, such
Massey University’s Veterinary Teaching performed two days prior to examination as identifying infectious agents (past or
Hospital, where cerebral spinal fluid indicated alkaline phosphatase (ALP) present), heavy metals, adverse reactions
cytology supported an immune-mediated 213U/L (120-150U/L), with no other to chemotherapeutics or chemical toxins.
inflammatory process consistent with significant abnormalities. Other predisposing causes are stress,
GME. Skye’s signs associated with GME inadequate diet, over-supplementation
documented on the report included TREATMENT AND DIET and inability to absorb and assimilate
hyperaesthesia, aggression, ataxia, Treatment prior to presentation in June nutrients. Increased gastrointestinal
apparent blindness (loss of the menace 2017 was prednisone in conjunction permeability and dysbiosis could be
response) and neck pain. Neuroanatomical with neutraceutical support, including considered to be perpetuating the concerns
localisation was multifocal, with cerebrum omega-3 fatty acids, magnesium and regarding digestive function, immunity
and cerebellar involvement given the proanthocyanidins. She had also been and general vitality. The ongoing chronic
high-stepping ataxia and the altered receiving injections of pentosan polysulfate inflammation (inflammatory cascade
mentation with blindness. The response to for her DJD. The owner had been dosing and oxidative stress) is considered a
dexamethasone and prednisone had been with additional supplements, including perpetuating factor for GME, despite
good, and the signs had improved. spirulina, green-lipped mussel extract, prednisone use. An important observation
The history also included DJD of the chondroitin, withania, alpha lipoic acid, was that the signs of GME became
right elbow and shoulder, skin disease, acetyl l-carnitine, licorice and ubiquinol. apparent four weeks post-vaccination,
dietary intolerances and associated Skye’s diet consisted of NUTRIPE, Ziwi indicating that vaccination could
gastrointestinal signs of borborygmus Peak, cooked vegetables, ACANA, raw potentially be considered as a predisposing
and diarrhoea. turkey necks, raw veal and raw chicken. trigger (O’Neill et al., 2005).

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CASE STUDY

TREATMENT GOALS metabolism, and may therefore potentiate immunological supportive action.
Skye’s owner requested the employment the pharmacologic effects of prednisone. SGF1000 was sourced from StemVet
of herbal medicine to alleviate Skye’s (Bone, 2003) NZ in Tauranga.
GME signs, relieve her discomfort from »» Dietary exclusions. The aim is
DJD, eliminate her digestive disturbances, Silybum marianum (milk thistle): to eliminate antigens that can
resolve her dermatitis and potentially Hepatoprotective, hepatorestorative contribute to food sensitivities,
wean her off the prednisone permanently. and antioxidant properties (Bahmani et as they can exacerbate intestinal
Utilising Western veterinary herbal al., 2015; Milić et al., 2013; Wynn and hyperpermeability and disturb the
medical principles, the herbal actions Fougere, 2006). intestinal immunological function
employed aim to address the treatment (Anonymous, 2017).
goals. The following herbs were selected »» In addition to the herbal prescription,
for Skye’s treatment protocol. POTENTIAL CONTRAINDICATIONS it is imperative that an improvement in
OR COMPLICATING FACTORS the diet and other lifestyle factors, such
Astragalus membranaceus Although herbal medicine is generally as exercise and emotional issues, are
(astragalus): Immune-enhancing effects, very safe to use, there are potential taken into consideration. These were
antioxidant, diuretic and cardiotonic contraindications, adverse effects and discussed with Skye’s owner.
properties (Auyeung et al., 2016; Wynn drug reactions. Therefore a sound
and Fougere, 2006). knowledge base and correct application OUTCOME, DISCUSSION AND
are imperative to mitigate these risks. Be CONCLUSION
Bupleurum falcatum (bupleurum): aware of the following: In the subsequent 12 months with
Immune-modulating, anti-inflammatory, »» Bupleurum can cause mild the above treatment protocol, Skye’s
analgesic, antipyretic, hepatoprotective, sedation; care is required if other coat became shiny, and the seborrhea,
mild sedative and eliminative properties CNS depressants are used due to excoriation and dandruff resolved. Skye
(Lin et al., 2016; Park et al., 2015; Wynn synergistic sedative effects (Wynn remained on prednisone for the first 10
and Fougere, 2006 ). and Fougere, 2006). months (the dose alternated between
»» Licorice has been known to cause 1mg eod, 1mg sid and occasional 5mg
Scutellaria baicalensis (Baical hypertension, sodium and water sid, depending on the severity of neck
skullcap): Anti-inflammatory, anti- retention and hypokalaemia, through pain and her general demeanour). The
allergy, antibacterial, mild sedative, anti- the mineralocorticoid effect of borygymus and diarrhoea also resolved,
anxiety (Chen et al., 2017; Orzechowska glycyrrhizin (Bone, 2003). and Skye’s biochemistry levels were within
et al., 2014; ; Wynn and Fougere, 2006; the normal parameters (ALP 128U/L (20-
Zhang et al., 2018). OTHER ADVICE AND MEDICATIONS 150U/L). Pentosan polysulfate injections
GIVEN were discontinued in June 2017 as the
Arctium lappa (burdock): Mild »» Nutraceuticals. Continue with alpha DJD was asymptomatic.
laxative, antioxidant, anti-inflammatory, lipoic acid, lecithin, magnesium and In September 2017 the owner stated
eliminative properties (Kwon et al., 2016; omega-3 fatty acids; add vitamin B that, “Skye is bright and happy. Overall
Li et al., 2016; Wynn and Fougere, 2006 ). complex and discontinue the other I think it’s safe to say she has improved,
supplements. with the combination of herbs, lowering
Harpagophytum procumbens »» SGF1000 was incorporated into the prednisone and the SGF1000, but as
(devil’s claw): Anti-inflammatory, the treatment regime in September always we take GME one day at a time”.
antirheumatic and analgesic properties, 2017. SGF1000 is an intravenous As of June 2018, Skye is no longer on
including the potential for neuropathic preparation containing specific prednisone, her vitality and general
pain; it also supports the gastrointestinal peptides that activate stem cells in the wellbeing have improved and she has had
tract and digestive disorders (Conrozier subject treated. Once activated, the no recurrence of her various ailments. The
et al., 2014; Fiebich et al., 2012; Wynn stem cells move rapidly throughout owner stated, “You wouldn’t know that she
and Fougere, 2006). the body, drawn by a chemotactic was diagnosed with GME.”
response to areas of inflammation One study reported that the median
Glycyrrhiza glabra (licorice): Anti- and tissue damage. This produces survival time of 15 GME dogs with sole
inflammatory, mucoprotective, antitussive a very strong and long-acting anti- prednisone therapy was 41 days (Muñana
and mild laxative support (Al-Dujaili et al., inflammatory action, promotes and Luttgen, 1998). GME generally has
2011; Bone, 2003; Hussain et al., 2018). replacement of damaged tissue with a poor prognosis. Most studies offer the
Licorice increases the half-life of plasma original type tissue and results in generalisations that dogs with multifocal
prednisone concentrations by inhibiting its minimal scar tissue. It also has a potent disease typically have a short survival (eg,

26 – VetScript August 2018


CASE STUDY

“SKYE IS BRIGHT AND HAPPY. OVERALL I THINK IT’S SAFE TO


SAY SHE HAS IMPROVED, WITH THE COMBINATION OF HERBS,
LOWERING THE PREDNISONE AND THE SGF1000, BUT AS ALWAYS
WE TAKE GME ONE DAY AT A TIME.”

up to six weeks after diagnosis), and dogs meningoencephalitis in three dogs. The Journal of
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