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IBD And Recurrent Cystitis

by Kathleen - September 25, 2014 View Case Report

I would appreciate your help with a F/S, English Bulldog, Poe, born 2002. She was diagnosed with IBD in 2009 and has been maintained quite well on Natural Path Xiao Yao San and Xiao Chai Hu Tang. Initial signs were off and on loose stool with occasional mucous, Food BARF, lots of dark brown ear wax and redness of the chin. Had been hospitalized with rDVM for diarrhea with prednisone and Tylosin dispensed. Tongue medium red, lavender middle. Pulse thing, wiry. Restless and pacing on prednisone.

We have weaned her off all meds and has maintained on herbs for years. Owner lives far from me and also travels to Vancouver Island so sees two other veterinarians. Had the start of recurrent cystits with crystals this past spring, 2014. Originally responded to Si Miao San but owner discontinued and has had several rounds of antibiotics to deal with infection. Urinary incontinence a year ago treated successfully with stilbestrol by rDVM and owner has since discontinued it. Still occasional incontinence but owner concerned about drugs. Occasionally throws up with antibiotics.

Urinalysis Feb/14: SG l.043, ph 7.68, Protein trace, WBC 10 – 20 hpf, RBC 0-31 hpf, Epith l-3 hpf, Struvite crystals 3-7 hpf, Cocci 2+, occasional granular cast.
Urinalysis Sept 16/14: SG l.021, ph 6.5, Blood positive 1+, No bacteria, RBC 10-20 HPF, Squamous epithelial 1-5/hpf, WBC 0-3 HPF, no crystals, Protein trace. Urine Protein: 20, Urine Creatinine: 11135, Urine Pr/Creat Ratio 0.2.
Idexx geriatric panel July 28, 2014 NAF

I had tried her Zhi Bai Du Huang Wan but owner did not notice much change. Her male dog will start to sniff at her if she is brewing an infection.

Saw her in March, 2014 for a sore back (acupuncture and cold laser) and recent x-rays show varying degrees of bridging spondylosis from L2 to L7. Ultrasound of abdomen NAF. No pain over bladder area.

Last seen for acupuncture Sept 19, 2014.
Ears contain wax; tongue med red
Hot pts: BL18, BL20, BL23
Pulse: can compress, minimum tone, thin
Paws and ears warm.
Skin: chin red and will rub her face on the rug.

I was wondering if there is a better choice for the recurrent cystits that would also address her spondylosis. She has responded to Si Miao San but she has not been consistent with it. Also, because she has maintained so well on Xiao Yao San and Xiao Chai Hu Tang, we have kept those on board for her.

by naturevet

September 25, 2014

Hi there,

Tough case. I take it the cystitis and diarrhea is relatively asymptomatic at this point, and the goal is to prevent recurrence. If so, you may want to amend the visit outcomes you recorded on this case, if the dog was clinical and now is not.

The thin compressible pulse in late summer suggests Blood deficiency. You're already addressing that with XYS, but you may be dispersing the Blood too much with continued XCHT; and drying as much as you tonify with XCHT and SMS.

I know you don't want to stop those formulas because of their perceived benefits, but we can test the theory by coming at the cystitis from that angle. I'd probably suggest trying a little known formula called Dao Chi San (Guide Out the Red Combination). It's perfect for refractory hematuria with or without cystitis. It's content of Rehmannia may help out the chronic skin rash, too, while it's content of Mu Tong (Akebia) works quite well for bladder infections.

Mu Tong is not readily available everywhere, but you're in Canada so we can certainly make this formula up for you and send it. Just email Jo if you want it and I'll let her know the ratios. Or you can make it up yourself if you have a formula book to use as a reference.

Let me know how that goes!

Steve

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