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RM Clemmons, DVM, PhD, CVA, CVFT Gainesville, FL.

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Presentation on theme: "RM Clemmons, DVM, PhD, CVA, CVFT Gainesville, FL."— Presentation transcript:

1 RM Clemmons, DVM, PhD, CVA, CVFT Gainesville, FL

2

3  Anomalous  Hydrocephalus  COMS  Intracranial arachnoid cyst  Dandy-Walker Syndrome

4 Copyright 1999 University of Florida  Congenital  Outflow obstruction  De Novo  Brain disappears

5 Copyright 1999 University of Florida DVLAT

6 Copyright 1999 University of Florida T2-horizontalT1-coronal

7 Copyright 1999 University of Florida T1-sagittal (lateral)T1-sagittal (midline)

8 Copyright 1999 University of Florida  Medical Management  Antioxidants and Steroids  VentriculoPerotoneal Shunt  Helpful when progressive changes in neurologic status  TCVM treatment

9 Copyright 1999 University of Florida  Cranial end of shunt is placed through bur hole

10 Copyright 1999 University of Florida  Tunnel is made to bring shunt tubing to the abdomen

11 Copyright 1999 University of Florida  Abdominal end is pushed into abdomen using Kelly hemostats  Extra is left for growth or movement

12  Kidney jing deficiency  Fails to support the development of marrow  Does not nourish the child (liver)  Does not control the grandchild (heart)  Insults the grandparent (spleen)

13  Kidney & Spleen Qi Deficiency  Younger animals with congenital hydrocephalus  Kidney & Liver Yin/Blood Deficiency  Older animals with Canine Cognitive Disease  Liver Qi Stagnation  Secondary to CNS inflammatory disease or cancer

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15  Problem List  Shen Disturbance  Hydrocephalus  Confirmed ultrasound  Hepatoencephalopathy  Confirmed BW  Overall poor development  TCVM  Tongue  thin-red  Pulses  Deep, weak fast particularly on right side  Diagnosis  Jing Deficiency  Yin deficient  Treatment  Hydrocephalus formula  Liu Wei Di Huang  Epimedium powder

16 Bai ZhiAngelicaDispel Wind-Cold, relieve pain Bai ZhuAtractylodesStrengthen Spleen Qi Ban XiaPinelliaTransform Damp and stops vomiting Bo HeMenthaDispel Wind-Heat Cang ZhuAtractylodesDry up Dampness, strengthen Spleen Qi Chan TuiCicadaDispel Wind, move Qi to the head Dang ShenCodonopsisTonify Qi Deng Xin CaoJuncusClear Heat, Drain Damp-Heat Fu LingPoriaBenefit the urination Huang QiAstragalusTonify Spleen Qi and dissipate swelling Jie GengPlatycodonOpen to the Upper Jiao, transform phlegm Jin Yin HuaLoniceraClear Heat, detoxify Ju HuaChrysanthemumClear Heat, detoxify Shan YaoDioscoreaTonify Spleen Qi Sheng MaCimcifugaClear Wind-Heat, move Qi to the head Ze XieAlismaBenefit the urination Zhi Ban Xia PinelliaTransform Damp and stops vomiting Zhu LingPolyporousBenefit the urination

17 Epimedium Yin Yang Huo Tonify Kid Yang/Jing, Promote Sexual Desire Cuscuta Tu Si Zi Tonify Kid Yang, Jing & Yin Cistache Rou Cong RongTonify Kid Yang & Yin Paeonia Bai Shao Yao Nourish Liver Yin & Blood Polygonum He Shou Wu Nourish Blood & Jing, Benefit Hair Actinolite Yang Qi Shi Tonify Kid Yang Cynomorium Suo Yang Tonify Kid Yang Psoralea Bu Gu Zhi Tonify Kid Yang & Strengthen Bones Dipsacus Xu Duan Tonify Kid Yang & Promote Fracture Healing Lycium Gou Qi Zi Nourish Liver Yin, Benefit Eyes Condonopsis Dang Shen Tonify Qi Astragalus Huang Qi Tonify Qi Rehmannia Shu Di Huang Nourish Kid Yin & Jing Angelica Dang Gui Nourish Blood Ophiopogon Mai Men Dong Moisten & Nourish Yin Scrophularia Xuan Shen Cool Blood & Clear Heat Citrus Chen Pi Move Qi & Relieve Pain

18 Copyright 1999 University of Florida

19 Copyright 1999 University of Florida

20  15 yr old M poodle  Owner went on vacation  Boarded at facility  Upon return ataxia that progressed to coma in 8 hours

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22  Problem List  Shen Disturbance  Hydrocephalus  Confirmed MRI/CT scan  TCVM  Tongue  thin-red  Pulses  Deep, weak fast particularly on right side  Diagnosis  Liver & Kidney yin deficiency  Treatment  ½ Dose Hydrocephalus formula  Liu Wei Di Huang  ½ Dose Epimedium powder

23 Today’s Frontier

24  Common Types  Meningioma  Astocytoma  Oligodendroglioma  Choroid plexus papilloma  Lymphoma  Neuroectodermal tumors  Metastatic tumor

25  Dog has 1-18 months average survival time  1-3 with nothing  6-9 with surgery  with radiation treatment  All tumors are invasive (malignant)

26  Most common is meningioma  Usually extra-axial and benign  Seen in aged cats  Present with depression and dementia

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28  MRI revealed mass in the cerebral cortex

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30  Prednisolone ( mg/kg q12h)  Treats secondary effects  Cover with gastroprotectants  Chemotherapy  Radiation therapy

31  Lomustine  60 mg/M 2 given  Monitor CBC weekly  If WBC and platelets okay in 5 weeks, then give 80 mg/M 2  Repeat every 5-8 weeks  Procarbazine  2-4 mg/kg/day for 1 week, then 4-6 mg/kg/day  Monitor CBC  Continue as long as WBC levels are > 4000/µl & platelet count is > 100,000/µl

32  5-hydroxyurea  Meningiomas  50 mg/M 2 given  Monitor CBC weekly  Repeat every 3-4 weeks  Melatonin  Gliomas  mg/kg once a day in the evening  Reduces growth of many tumors by 50%

33  Diet  Low carbohydrate  Supplements  Antioxidants & membrane stabilizers  Herbal medications  Western- - Canine Cancer formula  Traditional Chinese medicine- - Stasis in the Mansion of the Mind

34  Hz:  Acute Seizures  Head Injury  Tongue  red & greasy  Pulse  Fast, wiry & slippery  Rx Principle  expel phlegm, extinguish the wind, open the orifice, stabilize the seizures and invigorate blood  AP  CV-15, ST-40, PC-5, HT-7, LI-11, LIV-3, An Shen, Da Feng Men  TCM Herbal  Ding Xian Wan  TCVM Cancer Treatment

35 Angelica Bai Zhi Warm the Channel, relieve pain Pinellia Ban Xia Transform phlegm Ligusticum Chuan Xiong Move Blood Salvia Dan Shen Move Blood Lumbricus Di Long Clear Wind, invigorate Channel Ligusticum Gao Ben Relieve pain Pueraria Ge Gen Bring Qi upward Carthamus Hong Hua Break down Blood Stasis Bombyx Jiang Can Transform phlegm, resolve nodule Scorpion Quan Xie Break down Blood Stasis Cimicifuga Sheng Ma Ascend Qi Fritillary Zhe Bei Mu Transform phlegm, resolve nodules Scolopendra Wu Gong Detoxify, resolve nodules

36 Bai ZhiAngelicaClear Wind-Cold and relieve pain Da HuangRheumClear stagnation/stasis and clear Heat Jie GengPlatycodonOpen the Upper Jiao and transform phlegm Mu Li(Shu)OstreaSoften hardness and clear mass Tian Hua FenTrichosanthesClear Heat and promote body fluids Xia Ku CaoPrunellaClear Liver Heat and resolve nodules Xuan ShenScrophulariaClear Heat and cool Blood Zhe Bei MuFritillariaSoften hardness and clear nodules

37 Bai Hua She She CaoOldenlandiaInhibit cell mutation and tumor growth Ban Zhi LianScutellariaInhibit cell mutation, inhibit tumor growth Chen PiCitrusMove Qi and transform phlegm Dang GuiAngelicaTonifies Blood Dang ShenCodonopsisTonify Qi and boost Wei Qi Huang QiAstragalusTonifies Qi in whole body and Wei Qi Wu YaoLinderaMove Qi and clear stagnation Xuan ShenScrophulariaCool Blood and nourish Yi

38 Bai Hua She She CaoOldenlandiaInhibit cell mutation and tumor growth Ban Zhi LianScutellariaClear Heat-toxin, inhibit cell mutation, inhibit tumor growth E ZhuZedoariaPurge the interior, break Blood stasis and clear mass Mu Li(Shu)OstreaSoften hardness and clear mass San LengSparganiumPurge the interior, break stasis and clear mass Zhe Bei MuFritillariaSoften harness and clear nodules

39  5 year old, German Shorthair Pointer  History of seizures starting 1 month prior  Responsive to phenobarbital  Tongue: purple  Pulse: fast & wiry

40  Neurologic Exam  Mild dementia  CP deficits in both hind legs  Babinski’s sign on left side of the body  Localization  Cerebrum affecting both side (>right)

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42  Di Tan Tang  Stasis in Mansion of Mind  Wei Qi Booster  Western herbs

43  10 year old, Mx  Progressive loss of coordination and head tilt  Personality change  Tongue: purple  Pulse: fast & wiry

44  Neurologic Exam  Left head tilt  Positional, vertical nystagmus  Mild CP deficits in rear L>R  Xextensor R -> L in rear  Localization  L Cerebellar pontine angle with cerebral signs

45  TCM Dx:  Liver Blood Stagnation  TCM Rx:  Stasis in Mansion of Mind  Wie Chi Booster

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47  McKnight Brain Institute at UF  High, single dose radiotherapy  5 arcs of radiation provide sphere of death  Based upon the focal size and tissue treated

48  Treatment is applied with LINAC unit at UFBI  Cost of radiosurgery  procedure is around $  plus workup & conventional surgery

49  Overall ED50 is around 13 months  Some patients survive much longer  Prognosis for meningiomas is better than others

50 1. Low-Carbohydrate food (home prepared is best or use Pedigree Weight Loss Formula) 2. Canine basic antioxidant formula (Westlab Pharmacy WESTLA) 3. Canine arthritis formula (Westlab) 4. Canine cancer formula (Westlab)- -use at 2 times prevention dose 5. COX-2 inhibitor (daily- -particularly for carcinomas) 6. Melatonin at night ( mg/kg)

51  Max Formula  Stasis in Mansion of Mind  Wei Qi Booster  Western herbs or and and Transports to Head

52  Acute or chronic progressive quadriparesis  Usually has neck pain  Often in older animals

53

54

55 A Perspective on History

56

57  A chronic, progressive neurodegenerative disease  Initial signs are due to TL spinal cord disease  Represents an autoimmune disorder

58  Breeds  German Shepherd dogs  Belgium Shepherds  Old English Sheepdogs  Rhodesian Ridgebacks  Weimaraner  Probably Great Pyrenes  Age  > 5 years old (usually 8- 9)  Sex  Equal  Onset  1 month to 1 year  Clinical Course  Paralysis within 3 to 6 month without treatment

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60  Axon and myelin loss  Swollen axons  Patchy demyelination  Astrocyte proliferation  Increase in vasculature

61  Physical and Neurologic Examination  Electrodiagnostic Examination  Neuroimaging  CSF tap & analysis

62  Exercise  minutes twice a week  1 hour once a week  sustained aerobic exercise is needed   CNS O 2 delivery

63  Dietary Considerations  Tofu  Fresh vegetables  carrots  greens  peppers  broccoli  Ginger, garlic & mustard

64  Supplements  Antioxidants  Membrane stabilizers  Tonics  Anti-inflammatory

65  Medication  Aminocaproic acid (500 mg TID)  n-Acetylcysteine (25 mg/kg TID QD for 2 weeks, then TID QOD)

66  Signalment  8 yr F/S GSD  Weakness  Posterior Paresis S

67  History  Seemed to be slower over last 6 months  Trouble getting up  Vet checked for HD  Minimal response to NSAIDs  Worse over last 30 days S

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69  Neurologic Examination  Head- -NAF  CN- -NAF  Mild Neck Pain (C6)  Forelegs- -NAF (slight dysmetria)  Rear Legs-  Slight hyperflexia L>R  CP deficits Bilaterally  Babinski L  Hypermetria  Mild Back Pain (TL) O

70  Localization of Lesion DDAAMMNNNNIIIIIITTTTVVDDAAMMNNNNIIIIIITTTTVV O T3-L3 Spinal Cord IVDD, GSDM Myelitis GME Spinal Tumor

71 P Problem List  Differential Dx  ?  Diagnostic Approach  ?  Treatment  ? 1.Posterior Paresis 2.Foreleg Hypermetria 3.Neck & Back Pain 1.GSDM 2.IVDD 3.Infect/Inflamm 4.Neoplasia

72  MDB  CBC  Chemistry Profile  UA  Chest & Abdominal Radiographs  Abdominal Ultrasound  Neurologic Tests  EMG  CSF Analysis  Cisternal  Lumbar  MRI (Whole Spine)  Client Education P

73  May expect gradual return to function expecting 80% of recovery in 3 months  May continue to progress over months  Need to monitor spleen and blood work every 6 months  Reassess as needed, changing medications when appropriate P

74  Tongue  Pale  Wet  Pulse  Weak bilaterally  Sensitivity  GB 21  BL 18  BL 23  TCVM Diagnosis  Combined Qi/Yin Deficiency with Stagnation

75  AP  Cervical points  BL10  GB 21  Lumbar points  GV 14  Bai Hui (EA & Moxa)  BL40  BL62  Other points  ST 36  SP 6  LI 10  LIV 3  Herbal  Hu Qian Tang  Walking Tiger Formula  Jing Tang  Di Huang Yin Zi  Rehmannia Formula for Paralysis  Jing Tang

76 Bai Shao YaoPaeoniaNourish Blood Chen PiCitrusMove Qi and Relieve Pain Gan JiangZingiberisStrengthen Stomach and Promote Appetite Gui BanChinemys Nigricans, PlastrumNourish Yin, anchors Yang, tonify Blood, Nourish Heart Huang BaiPhellodendronClear Heat, Nourish Yin Niu XiAchyranthesStrengthens the Kidney and benefit the knees Shu Di HuangRehmanniaNourish Yin, Blood and Jing Suo YangCynomoriumTonify Kidney Yang, Nourish Blood, Tonify Essence, Strengthen Sinews Zhi MuAnemarrhenaNourish Yin, Clear Heat

77 Ba Ji TianMorindaTonify kidney, strengthen yang Fan Shi HuDescurainiae HerbaNourish Yin, clear deficient heat, nourish stomach Yin Fu LingPoriaDrain Damp, Strengthen Spleen Fu ZiAconiteWarm Spleen Mai Men DongOphiopogonNourish Yin Rou Cong RongCistanche Salsa CaulisTonify kidney, strengthen yang Rou GuiCinnamomumTonify Kidney Yang Shan Zhu YuCornusNourish Yin Shi Chang PuAcorusOpen orifices, vaporize phlegm, quiet spirit,harmonize middle burner Shu Di HuangRehmanniaNourish Blood and Yin Wu Wei ZiSchisandraConsolidate and Nourish Lung Yin Yuan ZhiPolygalaCalm spirit, quiet heart, clears orifices


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