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PLN Wheaten Success And Plateau

by marneemadsen - June 3, 2009

HI All,
Riley is a 10 yr old Wheaton I started seeing a year ago. He was diagnosed 4/07 and UPCR was 8.8. He was put on ZD and enalapril and over the year his UPCR hovered between 6.4 and 4.9.

We started herbs, real food, acupuncture and osteopathy in 4/08. He is hot dog with gobs of sebaceous cysts, needed baths weekly, soft stool with exercise, grass and dirt eater. Noise phobias were bad, lots of skin and GI problems.

His pulse is usually deep, this wiry L and weaker on R. Consistent points BL22, GB25, BL20, BL18 - all improve pulse with sedating. His UPCR dropped to 2 in a few months, and we have stayed at 1.8 now for a few months. He has been on combo of SMS, XCHT + QJ and SRT (though he can only tolerate low dose or diarrhea). We are weaning off enalapril and he is doing fine, numbers still better.

He only needs baths every 3 weeks now but still dry/oily, noise sens is better, but still present, still hot, still progressively loose stool with exercise and mucus occ. Tongue is lavendar top, and purple red underside. Last points were BL18S, BL21S, GB 29/30S, SP4S. Pulses are thin wiry and deep, still weaker on R. It seems like need stronger SP Qi tonic and Blood tonic. I was thinking of BZYQT, but worried about the inflammatory component? Maybe ZBDHW, but too dampening? DGSYS?

Would love some input....

Thanks, and Riley thanks you...couldn't have done so well without all I have learned.

Marnee

by naturevet

June 4, 2009

Hi Marnee,

You've done so well, I hate to rock the boat, but getting off plateaus always requires a little experimentation and an associated amount of courage.

There are a couple of options. One is an anti-Damp Heat formula that I've only ever seen one renal case do well with, but this particular Wheaton is dependent upon it. So that's an option for us if things don't continue to improve.

Meanwhile, when renal inflammatory cases plateau in their improvements, it can be a sign (as you also seem to be thinking) that it's time to let a little more blood come back to the kidneys, instead of spending so much effort pushing it away with hypotensives, XCHT, SMS and SRT. A sign that this might be safe to do is the fact that you've been able to cut back on the hypotensive drugs without destabilizing the dog. This is usually a sign that Rehmannia formulas may now be appropriate. If the dog has colitis tendencies, then Zhi Bai Di Huang Wan is probably your best option. Otherwise, you can test the waters with some anti-dampening, cooling, tonifying to the Kidneys, but overall gentle in its effect. I would wonder about Rehmannia Six for this.

If the dog does well or better on a low dose of Rehmannia Six, the way is clear to increase the dose and start to move the dog toward tonics and away from anti-inflammatories.

If it does worse, we'll need that other formula I mentioned above.

Let us know how it goes!

Steve

by marneemadsen

June 19, 2009

UPDATE:

Riley is now on 5 mg Enalapril AM and 2.5 mg PM (was on 10mg BID for about 1.5 yrs). I have not added in the LWDHW yet as he was scheduled for labwork/BP's with reg vet and wanted to see that first. He is still on herbs as above. His UPCR has now dropped to 1.6, but BUN and creatinine have crept up to 34/2.2 where they were consistently at 19/1.1. USG 1.029 (at >1030 at home consistently).

I am not sure how to interpret...should I go ahead and start the LWDHW and see if kidneys asking for perfusion, or is he still in inflammatory stage?

Thanks,
Marnee

by marneemadsen

June 19, 2009

PS
Albumin has been 1.8-2.2 and now finally at 2.6, BP's were around 160 systolic, but he got very nervous at the clinic I am told and they felt like the rest of the readings were inaccurate.

His eosinophils have been elevated since diagnosis 2 yrs ago, and that number too, now in normal range....I am feeling more confident about the LWDHW.

Marnee

by marneemadsen

June 19, 2009

OOPS
Fasted Cholesterol 238 (112-328), and TG 245 (20-150).

by naturevet

June 19, 2009

Hi Marnee,

I would probably test the waters with Rehmannia.

Hypotensive drugs always lower UPCR's, even in animals where the ratio is already less than one. But in kidney problems where the inflammatory process now needs increased perfusion to remove inflammatory mediators, flush out free radicals, and increase oxygen levels, we've found that hypotensive drugs can worsen azotemia. Rehmannia has been shown in recent studies to produce the same benefits as enalapril, and then some, but seems to benefit azotemia in animals where enalapril worsens it. So Rehmannia Six seems a good choice right now.

Good luck!

Steve

by marneemadsen

June 19, 2009

Thanks Steve,
Do we keep tapering the Enalapril?

What about the SMS....should I add them all together now and then start decreasing the SMS?

by naturevet

June 19, 2009

I'd change one variable at a time to make sure you understand what's going on. SMS should be compatible with Rehmannia Six if you want to start that way. Or you may want to decrease the enalapril. So I'm not clear, here, but did things worsen as you decreased the enalapril, or when you increased it?

S

by marneemadsen

June 19, 2009

Sorry for confusion. Last full blood panel before this was 11/08, and we started tapering enalapril in March 09 from the 10mg bid he had been on for 1.5 yrs. It had helped initially but only down to UPCR of 4.9 (see initial post). His UPCR dropped from 1.8 (where we had been stuck for a few months) to 1.6 since we decreased dose.

The albumin, eos, normalized since 11/08. His Bun/Creat were 24/1.9 in 11/08 while still on full dose enalapril, so were starting to rise already.

BTW, Liver enzymes running low normal.

Hope that helps...

by marneemadsen

June 22, 2009

Hi Steve,
Just wanted to see if you could check this again before you go..tried to clarify lab results above.

Thanks so much,
Marnee

by naturevet

June 22, 2009

Hi Marnee,

I would still try the Rehmannia out and see where it goes.

S

by marneemadsen

November 24, 2009

UPDATE:

Hi Steve,
This guy is holding steady with BUN/Creat normal, UPC 1.6 past few months. The LWDHW was a little too rich during end of summer heat, but on 1/8th tsp BID with the other herbs (SMS AM, SRT PM, XCHT+QJ BID). He has had trace amount blood on dipstick last 2 months on and off - all else quiet. Also very prone to Wind Invasions causing neck pain. Responding well to Valerian, but having to do it every time the barometric pressure drops and it gets windy.

Historically hot dog - wondering about Bup and Kudzu?

Any thoughts about why trace blood in urine?

Thanks,
Marnee

by mikemesley

November 24, 2009

Hi Marnee,

I've only just seen this case for the first time today. I was wondering what it was that made you (and Steve) choose LWDHW rather than ZBDHW. Is there a chance that ZBDHW would be a better fit, esp with blood in urine which I presume must be a sign that Heat not fully controlled?

I don't mean to say it is not the right choice, just that I wasn't sure what it was that made you chose one over the other, from a theoretical point of view.

Thanks
Mike

by naturevet

November 24, 2009

Hi Marnee,

I'm still a little wary of rocking the boat, but if you're looking for a Wind Invasion formula that has renal benefits, you have some options:
1. Combine Gui Zhi and Bai Shao with XCHT. This is probably the least disruptive option and should help the neck issues
2. Consider Fang Ji Huang Qi Tang (Stephania and Astragalus), which expels Wind invasions that lead to renal damage. Particularly if this is reminiscent of how the whole problem started (i.e. the dog had a lot of neck pain before the renal problems began), then I'd consider this as a way of completing the case.
3. Lastly, remember that San Ren Tang expels Wind, too, and is a renal anti-inflammatory, thanks to its content of Yi Yi Ren. So perhaps Yi Yi Ren Tang might help as well.

Hopefully one of those will help. In terms of hemostasis (supporting the Spleen Qi so that there is no passive loss of blood in the urine), FJHQT is a good bet. Dang Gui in YYRT may help with hemostasis as well, so that's another possibility.

Steve

by marneemadsen

November 24, 2009

Hi Mike,
I was thinking he still has Damp Heat and not false Heat from Yin Deficiency, which I think the ZBDHW would be better for. The blood has just only recently started, so maybe Steve is right and from Sp Qi not controlling...

Marnee

by marneemadsen

November 24, 2009

Thanks Steve...
I had thought of some of those things, which makes me happy! He has run so hot in the past, how do we use Yi Yi Ren in animals who run warm if it seems to fit well? That's why the Bup and Kudzu came up for me, but not sure if it's as good for Tai Yang.

I am seeing gobs of Wind, Damp invasions right now. We had such a humid summer here, so maybe everyone is especially Damp. Also learning lots about Wind from my clients who live at the coast!

Marnee

by naturevet

November 25, 2009

Hi Marnee,

YYRT is cooling for two reasons. First, YYR is a cooling herb in general. Second, even though the rest of the formula is warming, in a Damp Heat animal, it is the Damp that is causing the Heat. Drain the Damp, and there is no Heat. Thus, it is the Yi Yi Ren, our Damp drainer in the formula, that adapts the formula to patients with a warm presentation.

As for CGJJT, it is okay for Tai Yang patients, provided they also have Shao Yang and Yang Ming invasion symptoms as well. This ends up making the patient very hot and painful.

Have a great day!

Steve

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