Thanks for your help.
Wendy
Question Details
Resistant Bladder Infection
by
ROBINSON
-
May 29, 2009
Thanks for your help.
Wendy
Replies
by
bannink
May 29, 2009
Hi Wendy,
My thought would be Long Dan Xie Gan Tang if you are seeing lots of excess heat signs. It drains Damp heat in the lower burner and the Gentian Root and Scutellaria in the formula have shown activity against Pseudomonas. For Damp Heat, Si Miao San would also come to mind but from what I understand the Cang Zhu and Huang Bai have more action against Staph aureus and strep infections based on lab studies of the individual herbs so it seems like LDZGT might be a better fit as long as there is a forceful pulse, and signs of excess heat (dysuria, turbid urine).
That's my two cents :)
Erin
My thought would be Long Dan Xie Gan Tang if you are seeing lots of excess heat signs. It drains Damp heat in the lower burner and the Gentian Root and Scutellaria in the formula have shown activity against Pseudomonas. For Damp Heat, Si Miao San would also come to mind but from what I understand the Cang Zhu and Huang Bai have more action against Staph aureus and strep infections based on lab studies of the individual herbs so it seems like LDZGT might be a better fit as long as there is a forceful pulse, and signs of excess heat (dysuria, turbid urine).
That's my two cents :)
Erin
by
naturevet
May 30, 2009
Hi Wendy,
I agree with Erin that certainly if the dog is Damp, almost any Damp Heat formula should be tried. Candidates are Si Miao San, San Ren Tang and Long Dan Xie Gan Tang. Si Miao San is generally a safe place to start, although as Erin said, we don't know if it has the right spectrum for you. Part of the action of these herbs, however, is to stop the inflammatory process from actually interfering with an effective immune response. So to some extent, just by improving circulation and immune surveiallance in the bladder, almost any of them stand a chance of helping.
For very long standing bladder infections, or cases where ultrasound detects mass lesions (polyps, tumors, fibrosis etc.), then Blood moving formulas are required. The main considerations are Ge Xia Zhu Yu Tang or Pang Guang Zhu Yu Tang (K'an Herbs) for hot animals; and Shao Fu Zhu Yu Tang for chilly animals. Si Miao San can be used with any of these.
Hope this is enough to get you started. Let us know what the work ups show.
Steve
I agree with Erin that certainly if the dog is Damp, almost any Damp Heat formula should be tried. Candidates are Si Miao San, San Ren Tang and Long Dan Xie Gan Tang. Si Miao San is generally a safe place to start, although as Erin said, we don't know if it has the right spectrum for you. Part of the action of these herbs, however, is to stop the inflammatory process from actually interfering with an effective immune response. So to some extent, just by improving circulation and immune surveiallance in the bladder, almost any of them stand a chance of helping.
For very long standing bladder infections, or cases where ultrasound detects mass lesions (polyps, tumors, fibrosis etc.), then Blood moving formulas are required. The main considerations are Ge Xia Zhu Yu Tang or Pang Guang Zhu Yu Tang (K'an Herbs) for hot animals; and Shao Fu Zhu Yu Tang for chilly animals. Si Miao San can be used with any of these.
Hope this is enough to get you started. Let us know what the work ups show.
Steve
by
bannink
May 30, 2009
Hi Steve,
Do you have any hints on when you would decide that Blood moving formulas would be a better choice than heat clearing ones? I am assuming that the reason you would switch to that is that the heat would eventually lead to stasis. It is often hard for me to differentiate a heat pulse from a stasis pulse in my patients, I guess maybe because they usually have components of both. Maybe a better question might what do you consider longstanding? I might be confused but it seems like the clinical signs would be similar for both pathologies. In the absence of masses or blood clots, would you tend to still go right to these moving formulas (with chronic UTIs) like the ones you mentioned and just add in a more damp heat draining formula for patients with more severe heat or damp signs?
Sorry for all the question but, as you can imagine, I see a lot of UTIs and I am always looking for a better way to avoid so much recurrent antibiotic therapy. There is still that nagging part of me that wants to see demonstrated antibiotic activity. I do understand that the antibiotic activity, such as with Bu Zhong Yi Qi Tang, can be very powerful just by way of immune stimulation and inducing IL-2 and macrophage activity, even if out of the body there is no apparent direct antibiotic action. That is the beauty of TCM!
Anyway, thanks a million as always! And thanks for giving us the opportunity to learn from each other's cases. It's great!
Erin
Do you have any hints on when you would decide that Blood moving formulas would be a better choice than heat clearing ones? I am assuming that the reason you would switch to that is that the heat would eventually lead to stasis. It is often hard for me to differentiate a heat pulse from a stasis pulse in my patients, I guess maybe because they usually have components of both. Maybe a better question might what do you consider longstanding? I might be confused but it seems like the clinical signs would be similar for both pathologies. In the absence of masses or blood clots, would you tend to still go right to these moving formulas (with chronic UTIs) like the ones you mentioned and just add in a more damp heat draining formula for patients with more severe heat or damp signs?
Sorry for all the question but, as you can imagine, I see a lot of UTIs and I am always looking for a better way to avoid so much recurrent antibiotic therapy. There is still that nagging part of me that wants to see demonstrated antibiotic activity. I do understand that the antibiotic activity, such as with Bu Zhong Yi Qi Tang, can be very powerful just by way of immune stimulation and inducing IL-2 and macrophage activity, even if out of the body there is no apparent direct antibiotic action. That is the beauty of TCM!
Anyway, thanks a million as always! And thanks for giving us the opportunity to learn from each other's cases. It's great!
Erin
by
naturevet
May 30, 2009
Hi Erin,
As always, you ask great questions. Often, I only think of a Blood stasis formula once the Damp formulas fail. That is, unless the physical appearance of the bladder during surgery or ultrasound clearly demonstrates stagnant circulation. Sometimes, too, the pulse will tell you. It'll start to feel weaker and more choppy; that is, the pulse feels weaker and less consistent from one beat to another. Another change could be the passage of clots or tissue fragments. Pain is common in all Blood and Damp Heat cases, so it doesn't necessarily help us.
Very, very chronic cases probably have a good chance of having a Stasis element, making time itself a potential indicator. The exception is recurrent infections that resolve between bouts. These could still be Damp Heat every time they crop up. So that does throw a wrench into the works regarding prescribing on the basis of chronicity.
So what about using both simultaneously in any chronic case - a Damp Heat clearing and a Blood moving formula? You could probably get away with that and not wind up in trouble. So it's not a bad option.
Thanks as always for your input, Erin!
Steve
As always, you ask great questions. Often, I only think of a Blood stasis formula once the Damp formulas fail. That is, unless the physical appearance of the bladder during surgery or ultrasound clearly demonstrates stagnant circulation. Sometimes, too, the pulse will tell you. It'll start to feel weaker and more choppy; that is, the pulse feels weaker and less consistent from one beat to another. Another change could be the passage of clots or tissue fragments. Pain is common in all Blood and Damp Heat cases, so it doesn't necessarily help us.
Very, very chronic cases probably have a good chance of having a Stasis element, making time itself a potential indicator. The exception is recurrent infections that resolve between bouts. These could still be Damp Heat every time they crop up. So that does throw a wrench into the works regarding prescribing on the basis of chronicity.
So what about using both simultaneously in any chronic case - a Damp Heat clearing and a Blood moving formula? You could probably get away with that and not wind up in trouble. So it's not a bad option.
Thanks as always for your input, Erin!
Steve
by
bannink
May 31, 2009
Thanks Steve!
by
ROBINSON
May 31, 2009
Thank you both ( steve and erin) for your input. I will probably start with some damp heat clearing formulas and maybe pursue the long dan xie gan tang if the pending culture returns with pseudomonas still present. I think I am going to pursue ultrasound still just to r/o pathology in bladder. Would continue antibiotics in addition to herbal formulas, even if it seems the antibiotics are not working or clearing infection.??
Thanks again for all your help and I am really enjoying the forum you put together.
wendy
Thanks again for all your help and I am really enjoying the forum you put together.
wendy
by
bannink
May 31, 2009
Wendy,
If it were me, I would also use antibiotics if the culture shows any sensitivity. I would expect to get synnergistic action with the herbs and the antibiotics together, and antibiotics are cooling so if you have Damp Heat they should be beneficial from a TCM perspective. The only reason I might not do that is if I were worried that we would cool the dog off too much and cause vomiting or diarrhea (deficiency and cold in the Stomach and Spleen --> V/D). LDXGT is strongly cooling. If the GI is strong I think you would be fine. Don't know if Steve has any other precautions about that.
Erin
If it were me, I would also use antibiotics if the culture shows any sensitivity. I would expect to get synnergistic action with the herbs and the antibiotics together, and antibiotics are cooling so if you have Damp Heat they should be beneficial from a TCM perspective. The only reason I might not do that is if I were worried that we would cool the dog off too much and cause vomiting or diarrhea (deficiency and cold in the Stomach and Spleen --> V/D). LDXGT is strongly cooling. If the GI is strong I think you would be fine. Don't know if Steve has any other precautions about that.
Erin
by
naturevet
May 31, 2009
Makes sense to me!
S
S
by
ROBINSON
May 31, 2009
Hi, Erin and Steve,
Thanks. I just got the culture results back and there is no growth but the dog still seems to be having issues. She was on a 2 week course of cypro about 1 week ago. I guess I may try the herbs and keep an eye on the urine.
wendy
Thanks. I just got the culture results back and there is no growth but the dog still seems to be having issues. She was on a 2 week course of cypro about 1 week ago. I guess I may try the herbs and keep an eye on the urine.
wendy
by
naturevet
June 1, 2009
Hi Wendy,
If the dog is symptomatic, continue the plan of going with a Damp Heat formula of some kind. If there is no response within, say, ten days, then I'd try a Blood mover as well, or use the Damp Heat and Blood Stasis formula together.
Good luck! With luck you'll prevent reinfection.
Steve
If the dog is symptomatic, continue the plan of going with a Damp Heat formula of some kind. If there is no response within, say, ten days, then I'd try a Blood mover as well, or use the Damp Heat and Blood Stasis formula together.
Good luck! With luck you'll prevent reinfection.
Steve
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