Tuesday 29 April 2014

Borra Tintas - a refractory epileptic dog

Date of the consultation : 17th March 2012

Description of the patient
Borra Tintas" is a 5 years old (born approx. June 2007) cross-breed medium size, castrated male canine, he was adopted by a couple at the age of two months.

Main Complaint
He suffers from convulsive "fits" and was given a diagnosis of refractory epilepsy due to the fact that even while under two heavy anti-epileptic drugs (phenobarbital + potassium bromide) he still develops epileptic fits.
Origin: It all started a day after hearing some fireworks. A week before there was a fire in his house that burnt part of it. He was the one to notice the fire and gave the alert barking constantly. A few months earlier his owner had passed away due to a fatal car accident and left him with a great grief.
Causative factors: Fireworks, thunderstorms (he anticipates them and fears them), cold weather, veterinary visits, whenever a bitch around the house is on heat (reproductive cycle).
Modalities: Aggravates from fears, stress and cold.
Description: Before the fits he trembles, smells like sewage and his fur starts to glue as if dirty (this also happens when he is anxious or at the vet), walks disoriented, agitated, and starts losing the strength of his back limbs until complete paraplegia. Then comes the fit beginning with a spastic extension of extremities and neck, starting from the tip of extremities (nails) and extending upwards completing the whole body. He also licks himself all over before and after the fits. He does not lose control of his sphincters neither has excessive salivation. Posterior to the fits he suffers from disorientation, ataxia, loss of sight and weakness remaining very sluggish and slow for up to 3 days.
Frequency: In less than one and a half year, since December 2010, he had five fits although strongly medicated.

Other complaints
He had a complicated fracture of the right femur at the age of 6 months (December 2007) due to a fall from a wall (not very high, rather a bad fall). He developed fear of vets because of constant visits which frequently needed heavy sedation in order to change the plasters that constantly made wounds. Finally the owners found another vet that was able to do a good plaster but the aversion to vets and fear of clinics remained since. During this time he received a course of antibiotics for a period of 2 months.
He also suffers from itchy anus, therefore scratches his anus against the floor frequently. 
He likes to be left alone when feeling sad (which is often) and does not like to be consoled. 
He sighs a lot. 
He does not like dark people and there are some persons that he just cannot stand. 
He is afraid of shadows and darkness. 
He barks at noisy things (cars, motorcycle, even when the neighbor cuts the grass with the machine). 
He hates people´s smoke, cannot stand their smell even after they have finished smoking. 
He has changeable moods very often during the day, but is overall more sad than happy and sometimes sits still staring nowhere. 
He is very sensitive with the moods of the owner, tries to console her when she feels sad.

Personal Medical History
Supressive therapy: He had strong long standing supressive therapy with painkillers, sedative and antibiotics during his fracture.
Vaccination: He has annual vaccination protocols against Rabies, core and non core vaccines. 
Acute diseases: The owner cannot recall any acute illness in his life, nor any episode of fever
Chronic ailments: He does not have any chronic ailment 
Personal medical file from referral clinic: This information is available upon request to the author (please send an Email if you are interested).

Familiar medical history
No info on the subject was available.

Physical generals
Reaction to climate: He prefers and seeks heat, but is not specifically chilly. He hates rain, cannot stand to wet himself and will not go out when raining.
Sleeping habits: He likes to sleep covered and always in contact with someone, he sleeps well and snores.
Food modalities: He barely eats in the morning, mostly eats in the afternoon and little by little, he sometimes doesn´t eat at all for a whole day. He used to like eating fruits and now he does not eat at all. When he drinks water, part of the water comes out of his nose and he drinks quite a lot. He also likes sweets and loves ice cream.
Bathing: He likes taking a bath but as soon as he gets out of it he searches for something or somewhere to dirt himself on.

Analysis
Anatomopathological analysis: His main complaint is on the mental sphere and probably due to emotional disturbances.
Depth of the disturbance: It is a very deeply rooted disturbance since all his symptoms are on the mental level and only a few are on the emotional and none on the physical level.
Personal medical history: His fears have developed and have been growing since he had the accident (fracture) then he suffered a few emotionally traumatic experiences one after the other, these shock were probably overwhelming due to them he developed the seizuires.
Familiar medical history: No information.
Conclusion/prognosis: Due to the fact he does not develop acute illness, according to Vithoulkas theory of levels of health, he can either be in a high level of health despite the ailment and therefore might be cured with a single dose of a single remedy or else, most probably, might need more than one remedy  in which case he must be in the higher levels of the 3rd group because he has not developed high fevers or acutes in a long period (owner cannot recall any). Due to the fact his mental level took the whole burden and developed the epileptic fits he might be in a higher level of health but had a great grief.

Selection of symptoms:
Peculiar symptoms: anticipates thunderstorms, watery discharge from nose when drinking water, aversion to certain persons.
Intense symptoms: convulsions, fruit aversion, sighing, ailment from grief and fear.


Repetorization:  Rhododendrum, Natrium Carbonicum, Ignatia and Phosphorus  are the most prominent remedies. The grief that “Borra Tintas” suffers is the essences of his actual ailment so the choice for the first remedy is highly influenced by this fact and therefore must be taken into great consideration and hopefully be the essence of the remedy. That is why Ignatia was chosen as the first remedy.

Potency: One unique dose of Ignatia 200K was given. The reasoning for the chosen potency was decided by the analysis: since Borra Tintas has no chronic disease and does not suffers from acute diseases, he seems to be on a high level of health, therefore we could give him a higher potency. The other reason is that the potency needs to be high enough to be able to touch the mental sphere, that is why it had to be 200K or more. I chose 200K because first I need to be certain that this is the remedy and I do not wish to provoke a greater aggravation by giving a higher potency. Most probably I will have to repeat this dose or according to the reaction even raise the potency.
Other remedies: Continue with current allopathic medicine and slowly lower the dose over a period of months after evaluations of symptomatology. In case of excitement or to calm him I also suggested to have Valerian pills available at home.

Follow Up 1: 22-March-2012
Aggravation: The same day he took the remedy (Saturday 17-03-2012) he had spasm of his left back leg. On the next day, that is Sunday afternoon, as the owners started packing bags to travel back to Lisbon, he developed anxiety and on the next day, that is, on Monday (26th March 2012) he had a fit at 20:00 (they had traveled from Algarve to Lisbon, 300km and arrived at 15:00), the fit was less intense, lasted fewer time, he recovered quickly from it, and he did not lose control of his back legs. I recommended using preventive valerian pills for any stressful moment that might come in future and to start lowering the allopathic drugs slowly in at least a six to nine month period, starting with the phenobarbital and slowly. No homeopathic remedy was given. 
Comments: An aggravation is considered to be a very good reaction, it confirms that the remedy is acting, is probably the right remedy and that the patient might be in a higher level of health, time and the following reactions will determine if this is so.

Follow Up 2: 2012-May-26
No fits since 26th of March. He has changed his spirit, does not isolate himself and always seeks for company. Doesn´t sigh anymore and licks everyone at home, he didn´t use to do that in the past. He recovered his appetite for fruits. Much more sociable with neighbors and he enjoys company of neighbor´s dogs. He is going after trucks or noisy vehicles but only to protect his territory, even with people cutting the grass. No homeopathic remedy.
Comments: This reaction confirms the remedy acted, was the correct remedy, he is a patient in a higher level of health and will probably need less remedies or repetitions that I anticipated

Follow up 3: 2012-December-05
He is doing well but had a spastic episode of his lower limbs while running on the fields, the owner thinks it is due to the fact that it was very early in a cold winter morning and the grass was wet so he might have had a cramp. It has been two months since he does not take any phenobarbital and one month since the last dose of the potassium bromate. No homeopathic remedy.
Comments: He has definitively a very strong vital force and is most probably in group one, level one of the health scale as defined by Vithoulkas theory.

Follow Up 4: 2013-February-21
He came for his Rabies vaccination. The owner tells me he never had any fit since 26th march 2012, and he has been out of anti-epileptic drugs for over 4 months already. No other homeopathic remedy was ever given after the unique initial dose of Ignatia 200K.

Follow Up 5: Phone call on 2013-September-09
It has nearly been 1,5 years since he took the remedy and he is still doing very well. Not taking any remedy at all.


Note:
This case was published as a clinical case in a Portuguese Veterinary Journal as follows;

Caso clínico: “Alterações neurológicas - Duas abordagens complementares”
Veterinária atual Nº54, October 2012, pages 26-28





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