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Bucket Polyuria

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Dear Steve,
I have two patients who are excessively polyuric, or incontinent, or perhaps both. I have having minimal success, so here I am back to pick your brain.
The first is a 12 year FS Golden X whom Ihave recently dxed with PDH. Adrenomegaly, abn ACTH stim, elevated liver enzymes, mild hypertension, III/VI heart murmur, severe hepatomegaly with pot-bellied appearance and thin cottony hair coat. The tongue is consistently red, with phlegm lines. Pulses are deep, thin.There are no active GB points. I have introduced whole foods, CoQ10, fish oil small amount, silymarin. The owner declined Trilostane therapy due to costs of meds and monitoring. Since the owner changed to canned and dry Wellness, the dog is SEVERELY incontinent. She is saturated whenever she sleeps-mopworthy. I tried San Ren Tang to consolidate the urination, along with 25 mg PPA TID, and there was a slight improvement for 2 days and now it' bad again. I changed SRT to Si Miao San due to the appearance of the tongue and only a partial transient change with SRT. I also added 1 gm BID of Sang Piao Xiao Tang for Heart-Kidney disconnect. Any other ideas? Mine are Heart-Kidney disconnect, Damp Heat, Liver Yin deficiency.
The second is a 16 year pug who has severe cervical spondylosis, thoracolumbar kyphosis, facial nerve paralysis on the right, enucleated left eye, end stage KCS on the right. Also extensive history of fecal incontinence, bloating, food/GIT stagnation, Bi syndrome. I have actually managed to keep all of this fairly stable, but he has recently tarted vocalizing for no reaon and standing over the water dish, then drinks a bucket and pees all over (he now wears diapers). I tried alfalfa and Ba Wei Di Huang Wan-minimal to no change. Metacam has helped the restlessness, but he is still polyuric. No UTI, no proteinuria, no active GB points. I have him currently on Yu Mi Xu, Ji Ni Jin, had to add in Bao He Wan as he was starting to "fill up" again and have loose stools. He also ha a hitory of oxalate crytalluria, which is not there now but there is irreglarity to the bladder wall suggestive of blood clots or neoplasia. I started him on Pang Guan Xue Yu Tang, and Chamomile and Dioscorea for the poor colonic motility. I know this is not organized-I am between appts. Ideas? mine are Shen disturbance, Kidney Qi deficiency, Spleen Qi deficiency, Qi and Blood stagnation. BTW, tongue looks fairly close to "normal"-pink, moist, no coat, no cracks, sl lav tongue to the center.
Sorry this is so disorganized. It's actually more like my brain thinks rather than nicely organized like yours!!!!

by naturevet

August 3, 2009

Wow.

We both know that with your certification in Chinese herbal medicine now complete, we're approaching the day when the only way I would have an idea how to treat your cases differently would be if I saw them myself. Today might be that day.

For your first case:
I would have thought SMS plus a home-cooked grain-free or raw diet would be enough, given sufficient time. How long has the dog been on this? Did the diet get changed? If not, it must, in order for the herbs to work. I also wonder if there is a Blood deficiency on top of the Damp Heat, aggravating the poor coat and reducing cognition. The latter would result in incontinence during sleep. I would consider adding 20g of Dang Gui to the SMS to increase cognition, provide some phytoestrogens, and help the SMS have a dispersing effect, such that the pulse moves outwards, the liver decongests, and the skin gets more nourishment. Hopefully that will help.

For the second case:
Homeopathic Causticum fits much of the picture including the incontinence, facial nerve paralysis, spinal issues, and lameness. Think that over.

Meanwhile, have chiropractic issues been addressed? They can create significant nerve root compression of the sacral plexus and associated sphincter weakness.

Lastly, for this dog, a poor descent of Qi in the body can result in the impaired descent of water to the bladder. The result is urine that is prepared in small quantities - so called 'dribbling urination'. Chinese medicine uses Damp drainers to promote better descent of fluids, allowing the bladder to prepare and void urine all in one go. So if this appears a continuous dribbling kind of urination, then Damp drainers may help. Given the peristaltic issues, my choice would be Wei Ling Tang if the dog is voerall chilly, and San Ren Tang if the dog is overall hot. Both can help with oxalates. San Ren Tang can help with Wind invasion tendencies.

That's all I've got for you. Hopefully you get somewhere with that.

Steve

by

August 3, 2009

Thank you.
Just a couple more thoughts on your thoughts-
As the first dog also has a heart murmur, would there be any advantage to using Dan Shen rather than Dang Gui? Could it improve cognition/Shen from it's more moving properties, as it also has hepatoprotective effects. Or do you really want Dang Gui since it is more tonifying? I have also wondered about He Shou Wu, as it also tonifies Kidney Jing, but it is not invigorating? I am hoping the Si Miao San at least makes a dent this next week. If so I will add Dang Gui and whole foods. The owner is so overwhelmed cleaning up pee he has no time to cook right now.
For the second dog, I have suggested chiropractic, but I have not found a chiropractor (veterinary) that the owner wants to use. I like the idea of Causticum. I will recommend that. I know very little about homeopathy-so that's great. I had him on San Ren Tang a while ago, but not for long. He is a little chilly, and pretty dry with flabby muscles. I had him on Wei Ling Tang for the last two weeks actually, but then I saw the Bladder and discontinued that formula and replaced with PGXYT from concern about neoplasia. Guess I could do a BTA test. Guess I could not change around so much and stick with one thing and give it a chance to work.....

by naturevet

August 4, 2009

I was after tonification here, which Dan Shen does not accomplish.

Dang Gui is an antioxidant for the liver as well.

Lastly, when modifying a formula, it's always wise to pick a herb that 'weaves into' the rest of the formula to make a herb pair that acts as a sub-formula. Either that, or the added herb should have a historical precedent backing it up. Dang Gui has historically been added to SMS, so it's the logical choice, given its wide range of therapeutic effects.

S

by

August 4, 2009

Got it. Thanks, Jodi

by

September 18, 2009

Dear Steve,
An update on the first case, the HAC dog withurinary leakage. I have been working on this case since 6/30. Since the start, the owner has been feeding a 1" section GrandDad's raw beef organ blend with cooked lean ground turkey, mixed with leafy greens, spincah, lettuce, celery, apples, blueberries and carrots. No beans or broccoli due to historical problems with flatulence. It has been givem CoQ10 for a heart murmur, Standard Process Whole Body support, and silymarin/antioxidants. One month ago, the owner elected to bite the bullet and use Trilostane, as none of the herbal formulas I have given have resolved the urinary leakage for a consistent period of time. The dog, when laying down, awake or asleep, pours out urine until she is soaked, but can void normally on walks and no accidents in the house. Originally the owner thought it might be worse after walks (Qi deficciency), but then determined that is not the case all the time.
She is currently r4eceiving 1.5 mg/kg Trilostane SID, along with Jin Suo Gu Jiang Wan, Bao Ho Ju Jiang Wam and Four Marvels. The owner was elated as the liver enzymes are the lowest they have been in a year, the ACTH stim is perfect, PU/PD is gone, and there has been no urinary leakage until 3 days ago, when it resumed as if it had never stopped. PPA has had no effect.
The dogs tongue used to be dark red and wet with deep slippery pulses, and a thin hair coat. Si Miao San, SMS+Dang Gui and San Ren Tang alllessened or stopped the leakage but it was transient. ( I was actually a little glad the leaking started with the Trilostane as it meant that the herbs did work and had a similar effect to Trilostane, i.e. I was close).
Currently the tongue is moist, not dry or wet, a lighter red (less Heat) with purplish center (Blood deficiency, Qi stagnation. Pulses are deep, hard to find as the dog is fat. The hair coat has improved. I am wondering if the muscle weakness (Spleen Qi deficiency) is the cause of the leakage, or Kidney Qi deficiency failing to hold. The Jin Suo Gu Jiang Wan at 2 gm BID is not enough, and I'm thinking a Kidney tonic instead, e.g. Reh-6, or Yuo Gui Wan + Zuo Gi Wan, might be the ticket, combined with SMS+Dang Gui, and since the lever enzymes are down just support the liver nutritionally. My concern is adding cloying Kidney tonifying herbs when I know there is still Damp Heat in there. Your ideas?
Thanks,
Jodi

by naturevet

September 20, 2009

Sometimes we'll see Bu Zhong Yi Qi Tang bring down liver enzymes, stop incontinence, and have a centrally decongesting effect. It's also a little less tonifying than the Kidney herbs, and therefore less likely to cause serious Damp. I'd try it and see if it works, as well as recheck the liver enzymes in a few more weeks to make sure you haven't lost any ground there.

Good luck,

Steve

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