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Thursday, November 3, 2011

Case Study for the AHG Professional Application Process Nicole Telkes, Practicing Herbalist Austin Texas



In memory of Juliette De Barclay Levy


This case study is offered not only as an example of successful use of holistic therapeutics for pets with extreme injuries but as a guide for others that need help learning how to care for disabled pets or those with chronic illness.  Note Nov 2011.  Mocha is still doing well!


 Well-loved 7 year old healthy dog named Mocha was hit by car Dec 20, 2007. She sustained major injuries which eventually led to major paralysis.  She was  not only able to heal what was thought to be an incurable secondary infection that led to paralysis but then 6 months after healing she began to regain motor function.  Mocha began walking again in March 2009, a year after she was left completely paralyzed in her hind legs.   This is her story of healing herself with some help from her human friends..



Description of initial trauma
Well loved dog was hit leaving lacerations all over her body, broken jaw, and her front right leg crushed.  Minor fracture in spine missed, leading to spine collapsing and cracking completely and rendering dog paralyzed in hind legs.  Secondary infections followed eventually leading to MRSA inside the spine.  Dog was given a 30% chance of making it thru surgery.
Medical History and explanation of emergency medicine for initial trauma

Well loved dog had prior history of demodectic mange as puppy which cleared.  Dog is spayed.  Flea allergy. 
Following accident, well loved dog was immediately put on heavy medication to ease pain and infection.  Veterinarian strongly recommended antibiotics, pain meds, and steroids.  Initial healing was interrupted by spinal collapse.  Paralysis led to a uti from catheter, and on to which led to MRSA(antibiotic resistant staph) crossing the blood barrier into the spinal column.  In total, the well loved dog went through 3 surgeries.  Well loved dog began to lose weight and long term steroid use led to degeneration of muscles.  Antibiotics that were used had chance of causing aplastic anemia. 

Assessment
Due to extremity of situation, herbs and other holistic protocols were employed in conjunction with western emergency medicine. Holistic strategy was to stabilize dog with specialized diet, additional supplementation, and massage.  Adjunct herbal therapies were given to kill infection, tonify various body systems, and calm.  The key methods in assisting her were to do deep immune building to foster strength to heal, and keep system eliminating well.

Later, herbal therapies moved into rebuilding and strengthening neural pathways and regular bodywork.  One major motivator in her rehab was a cat next door I call “Rehab kitty” she would try to chase.  “Rehab kitty” has since moved on since mocha began walking and no longer comes into the backyard.

Formulation and Protocols used

Please see attached sheet for protocols used. 

Time Line of Recovery
Dec 20: Mocha goes to the emergency room and is stabilized after
              being hit by a car
Dec 21: Mocha is tranferred to surgery and receives 8 pins in her leg, 6 staples
              on her side and her lower law is wired together.
Dec 22 Mocha comes home, but has to be carried out to pee and poo, and is on
              a bunch of pills
Jan 4 Mocha is recovering well and she gets her bandage off her leg. Her jaw surgery
              may not hold so she may still lose her lower canine but the vet
              decides to wait to see if it may still take. She is sore but improving.
              Her pins require daily cleaning and she is still on a pain pill
Jan 10 Mocha looks extra tired and can't get up. She is shivering. We carry her
              out to pee. She curls up in the sun and goes to sleep. The next
              thing we know she is sitting up, panting and feverish. She can't
              move. We take her to the vet immediately. She is diagnosed with
              a back injury.
Jan 11 After a bunch of procedures it is determined that surgery is not the best
              option. She has a subluxation/collapsed disc. She is put under observation
              at the ICU for the weekend.
 Jan 12 Mocha is on morphine and groggy but eats wet food from our hands and whines
              when we leave. She is given a prognosis of an 80% success rate if
              she is kenneled for 10 weeks. We will have to express her urine
              from her kennel for awhile.
MAJOR HERBAL PROTOCOLS AND ADDITIONAL SUPPLEMENTATION BEGAN HERE
 Jan 14 Mocha comes home on horse tranquilizers. It sucks. She is a zombie. We
              wait for them to wear off. She cannot hold her head up.
  Jan 16 The tranquilizers have worn off. She is perking up and eating and drinking. We have
              to pick her up to take her outside. She cannot stand up but she
              is in better spirits. Her ribs are very crunchy
 Jan 17 She put  a little weight on her back legs today. She is also being defiant.
              That is a good sign that she is coming back into herself
 February: Mocha is acting tired, she is in more pain and has a low grade fever.
              We take her in and a urinary tract infection is discovered. She
              also seems to have a lot of pain around her injury at the spine
  Mid-February: Mocha is diagnosed with a potential MRSA infection in her spine
              and urinary tract. Her front leg isn't healing due to the extended
              prednisone use and she is losing sensation in her back leg
  Late Feb, a last ditch effort is made to save mocha with a very risky spinal surgery.
              She is given a 30% prognosis of making it.. She makes it through
              surgery but we aren't sure if the antibiotic we are giving her is
              going to even touch the infection. She comes home looking like Frankenstein
 March Mocha is doing fairly well. She is better but still in a lot of pain and
              paralyzed in the back legs. She requires around the clock care.
              We are pretty exhausted at this point. She is getting a little bit
              of pain sensation in her legs and tail but unable to move them.
April. Mocha is turning around. It turned out a UTI infection was complicating
              the situation. We treated her with more yucky antibiotics and her
              spirits greatly changed. She began to get a little perkier. She
              is now paralyzed but the pain is beginning to subside. She receives
              acupuncture and begins to sleep through the night for the first time in 2 months.
              We find a used wheelchair on craigslist and it comes in the mail.
              She DOES NOT like it.
Late April. Mocha barks at another dog for the first time in 4 months, then for the
              first time in 2 months she wags her tail!!! She starts to wag more
              and more. She walk herself with sling support 1/4 of a mile. She
              begins rehab at the pet rehab department
May Mocha is  now in the midst of 3X a week rehab donated by the surgery department
              of Central Texas Veterinary Specialty Hospital. She is practicing
              on her newly healed front paw, getting strength back in her front
              end. In, fact she scooched herself Eddie Murphy Trading Spaces style
              to her dog Bowl one morning before we were awake to get water.
May 4 Mocha learns  to use her wheelchair thanx to the rehab department. She tools around
              for 20 minutes with her tail wagging. She is off most of her meds
              and supplements.
            Summer: Mocha
              is has her ups and downs. Her leg that was broken in 6 places is
              sore a lot but she is tooling around quite well on her chair. Some
              days are better than others. Overall, her spirit is coming back
              a little more everyday. Its a different life but we are very happy
              to have her with us. 
MAJOR PROTOCOLS SCALED BACK BUT I KEEP HER ON WOOD BETONY (STACHYS SP) TINCTURE 1 DROPPERFUL 2X A DAY AND 1 FISH OIL GEL CAP A DAY


Fall 2008: Mocha is in her wheelchair and we notice her back legs are beginning to move. 

Winter 2008: mocha tried to stand up on her back legs, does so and then falls over.  She feels me pinch her back feet and pulls away from the sensation.  The vet doesn’t believe me.  I go back to the pet acupuncturist and keep up her protocols.  She gets another UTI and takes an antibiotic again.  She is not able to clean herself

Spring 2009: Mocha is now walking a ¼ mile by herself without a wheelchair.  She can walk herself outside to relieve herself and she chases cats again
ALL HERBAL PROTOCOLS END EXCEPT FOR REGULAR FISH OIL SUPPLEMENTATION

Summer 2009 Mocha may have hurt herself.  Her left leg is not responding as well so I change her protocol again and put her on supplements.  Another acupuncture appointment is being scheduled
PROTOCOL #2 SEE SECOND SHEET

Evaluation and Special Notes on Caring for Pets:

Mocha is now happy and healthy.  She has regained about 50% use of her back legs and she can wag her tail.  She goes on a short walk everyday and no longer needs our assistance.  Long term care will be needed to prevent UTI’s and stagnation due less movement.  Rehab continues through walking, swimming, supplementation, and massage. 

Because animals cant tell you when they are in pain or how much pain it makes treatment difficult.  Pets also respond differently to herbs and they must be administered in different fashions.  In this situation it is imperative to begin to really read your pets body language, which most of the time is very subtle any change in behavior of lack of interest in eating can signal something is not right. 



Food is very important.  When mocha was very ill I made her homemade dog food, as I did when she was a puppy and had demodectic mange. 
A simple recipe for homemade food is roughly:
50% cooked grains(rice, barley, quinoa etc…no wheat)
20% veggies raw—shredded or chopped in
30% animal protein—it is supposed to be more but affordability makes this difficult.
I also added nutritional yeast and a tspn of yogurt or probiotic powder
I make a batch that was about 1-2 weeks worth and put it  in the freezer, defrosting 3 days at a time. 
When she was very ill with MRSA I added raw liver.
She is now on a NO GRAIN commercial formula.  Both my dogs poo about ½ as much on the no grain formula and have had no digestive problems.  These foods are more expensive but they eat and poo less.  Homemade is best but can get overwhelming

Pet acupuncture and chiropractic treatments from  Dr Van Winkle, helped a lot.  I took Mocha for just a few sessions and immediately saw changes in her behavior as well as improvement in the movement of her limbs

MRSA Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that causes infections in different parts of the body. It's tougher to treat than most strains of staphylococcus aureus -- or staph -- because it's resistant to some commonly used antibiotics.(definition from WebMD).  MRSA is spreading rapidly in veterinarian clinics, one reason being that humans are taking less precaution than at a regualar health clinic with regards to hygiene and transferring it to the animals.  MRSA is extremely painful and very difficult to treat once it gets into the bloodstream and into deeper layer of tissue.  Barberry is used as an adjunct therapy in many hospitals in Europe(Michael Moore) when treating staph.  I took this idea and ran with it, using our native species, Berberis trifoliolata as an adjunct therapy when Mocha was fighting the bugAs in a regular human hospital, vets will take on no liability for secondary infections caught at the veterinary hospital…….

Handicapped Pets Website is an excellent resource for folks dealing with disabled pets http://handicappedpets.com/
Not only did I find a used wheelchair for mocha for 1/3 the price of a new one, but they also have discussions and forums to help you with everything with expressing the bladder to discussion forums on a wide range of ailments









Unique ways to give herbs to pets:
How do you know whether or not to give something to a pet and in what does?
I always drop test my pets before dosing according to bodyweight.  It works out to around 7 drops per 12 pds of weight of tincture.  Water extractions are around 1.5 tblspn per 12 pds of weight. 
Not everybody’s dog will take supplements well.  A few dog friendly ways to give supplements include:
Making meat broth infusions or decoctions of supplements, and then turning those into ice cubes to add to food.  This is a really good menstruum for pets just out of surgery.  My dog would not drink water when she was going through surgeries but would drink beef broth, which I snuck other things into….
If a pill is necessary, ghee is a good medium, it also nourished the nervous system.
To help with upset bellies, frozen yogurt or a tspn of yogurt in food works well.

Thoughts on pain
I thought a lot about whether or not to give the wide range of pain pills to my dog.  I really had to evaluate whether they helped or not.  I am very much against using steroids.  I used them anyway against my better judgement and now really wish I had insisted on taking her off of them after a week or two.  The longterm use was overkill on the vets part and I think led her depressed immune system getting ravaged and leading to MRSA.  Fear based decisions are always prominent when dealing with emergency medical situations.  Remember to listen to your gut no matter what.   The hard part of pet pain is evaluating the situation when something cant tell you how it feels.  At one point I decided, enough with the meds, I will just do herbs.  After carefully watching her, my partner and I decided to put her back on the pain meds.  We weren’t sure but she seemed to be more responsive ON pain meds and more apathetic off of them.  What I have learned most is that pets will NOT complain.  Some may briefly, but it is VERY difficult to tell how much they are hurting.  I feel that it is better to have them on low dose pain meds with some skullcap(skullcap with pain meds strategy in humans according to Adam Sellers) than on just herbs.  One example of how little pets complain just hit home yesterday when one of my friends next door neighbors was abusing an animal with neglect and it literally laid down and died from the pain rather than complain thru whimpering and crying. 

When do you stop trying
Well, most of us stop because of financial constraints or because the animal is going thru too much trauma.  I wasn’t ever sure until Mocha was declared infection free that we were doing the “RIGHT” thing.  I really wanted to do what was best for her. I also felt like it wasn’t fair to allow a hit and run be her last life memory.   .  At one point I even contacted pet psychic to see if she could offer any insight.  I slept with her and watched her closely.  One of my good friends is disabled, and her advice to me is that if it was time to put her down, I would know.  I never did “know” so I kept trying.  I felt that Mocha kept trying and as long as she did, my partner and I did. Luckily I had an empty credit card and refused to look at the balance as we okd surgeries and vet visits.  I felt like her life was more important than debt, and like one of my friends said “lots of people go into debt for stupid stuff, at least you did it to save something’s life”.  I ended up starting a fund for her and a bunch of friends donated what they could.  I looked all over for funding but will tell you firsthand, don’t count on any organization helping My vet clinic ended up donating all of her rehab and call her super Mocha.  She is the inspiration to many others who aren’t sure about whether or not to keep trying. 
Mocha on her first walk in over a year on a road trip to West Texas March 2009

Resources
Pet Remedies 
YouTube Videos showing recovery http://www.youtube.com/user/stikitheclown
March 2009
mocha 2009
Mocha 2011-sunbathing and wise--she is now 10- turning 11

Dosing: Herbs for Dogs

Dogs metabolize meds faster, so therefore I have started with higher dosing of herbs with my animals and am having better results with symptoms being alleviated.
The standard dosage for humans is 30 drops of tincture for 50 pounds of body weight.  I now dose my dogs with 60 drops of tincture for every 50 pounds of body weight.  I also have upped the broths and powders to higher doses based on their faster metabolisms.
As my dogs age, I add most of their supplements into either oil, butter, or a little raw meat treat---

Make sure their food is grain free.  Raw food is obviously the first choice, and homemade second.
If that is cost prohibitive, then at least get grain free and add supplementation.

Inflammation: LOTS of fish oil supplementation
Kidneys: Cranberry Powder in meat---

It is not worth buying dog food with supplementation added.  Thats like buying a Pepsi products that has herbs and hoping that its therapeutic.