Notes:  At this recheck, Bandera's growths seemed to have stabilized and no apparent continued growth. Her cough/gag is slightly less, and she did not have any reactive points and was not fidgety with hind limb palpation or seem as painful as last visit. The owner is now feeding Honest Kitchen Turkey and HK Limited ingredient Fish with fewer treats. The owner does report that she is not eating with her usual gusto, is eating, just not as enthusiastically unless treats, and she is still having fluctuating energy levels. One day she is energetic, wanting to play and go for a walk, and the next day she needs to be coaxed to go for a walk and then will only go a short way, and lays around more. We did find a loose upper premolar so maybe that is an issue for her but owner is very reluctant to have her undergo any anesthesia with the suspected lar par issue.

She is currently getting:
NP TYT 3/4 tsp BID and SMS 1/2 tsp BID, Kan Essentials Three Seeds 1 BID, and HTQ 3BID, Evergreen Si Wu Tang 1/8-1/4tsp BID. (I refilled her SMS and added 25gm of the Evergreen Dang Gui to 100gms of the NP SMS to replace the SWT).

Bandera had a purple, slightly pale tongue and her pulses were weak, deep and thin. We ran labs and her Valley Fever was negative, everything normal except mild increase to SDMA 15 (0-14), but this is decreased from 17 in 12/20. Her urine sp gravity was 1.011, no UPC run as rest was normal, inactive sediment no protein. She is on Vit D and we rechecked her level along with the neoplasia index at VDI lab: Vit D sufficient at 114 and neoplasia index was negative as TK1 and CRP were normal (low).

Wondering if maybe I need to cut her SMS down a bit more with the weaker thin pulse, lethargy, and decreasing appetite? Or other suggestions? Thanks, Peg

Notes: None submitted

Notes:  Hi Steve,

An update on this very lumpy, stiff girl (63#2oz). She is still getting more lumps, but our concern now is her renal disease (diagnosed Stage 2 IRIS in 12/21) and more recent Yin/Blood Deficient signs: has more dried out hair and skin, with flakiness, has much more weakened left pulses this visit than her last check in March, has brittle dry nails with almost a separation of some as with lupoid onychodystrophy but not as painful, some mild weight loss with terrific appetite, smallish lavender tongue.

Her renal function is stable, slightly improved with UPC that has gone from 0.4 in March to 0.3 now. Her SDMA stays around 23-27, BUN 40s, creatinine started at 2.7 in 12/21 and now 2.4. Her BP is great 115mmHg.

She moves like she has stiff and dry tendons, has muscle atrophy of her hind legs, sore hips and low back, does not like to be touched, massaged other than her head. Still has Lar-Par but has remained stable even now with the hot weather (Phoenix).

Current herbs:
KE Harmonize the Qi 3 tabs TID (for the lar par)
NP BWDHW 3/4 tsp BID (renal)
NP SRT 1/2 tsp BID (lumps, renal?)
NP TYT 1/2 tsp BID (lumps)

My initial thought was I need more Yin/blood tonics for her and thought about switching the BWDHW to Yi Guan Jian but she still seems to fit more overall with the BWDHW (she does not have the GI/liv/pancreas issues or KCS, eye issues). She is more restless and panting at night which I am not sure is Yin defic. or pain related? Is otherwise not anxious or fearful, seems pretty happy. She also needs something more for her arthritis/stiffness, so was thinking maybe the HA granules, but do not think she needs all these formulas (or will take them!)

I am looking for help in herb selection/modification--should I add ophiopogon or something like that to the BWDHW? I think I am just confusing myself going round and round so need some guidance:)

Thanks very much! Peg