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Lab With Issues

by rmtran - September 29, 2009

Hi Steve,

I am seeing 5.5 years old MC Lab with OCD/DJD lesions on right shoulder and hip dysplasia.

The main concern was that this patient cannot be on NSAID for its lameness due to hx of anemia after being on one.

rDVM did ultrasound that showed abnormal kidney, and small liver. He has hx of borderline high crea/BUN (1.9, 27, respectively).
His urine SpGr NEVER been isosthenuric (always around 1.030), but contains protein. Urine prot/crea is 0.1.

He also is low grade anemia (28-33%). The most recent lab work shows mild hypoalbuminemia as well. A brief consult with internist: she suggests atypical Addisonian's.

This patient is doing well with my treatment (acupuncture) and he is on Bluegreen Algae as a part of food therapy. He has been on joint supplement and Tramadol by rDVM.

His tongue was pale and pulse was deep at first, but they improved. His tongue was pink and his pulse was in good quality at the last follow up visit (I am seeing this patient three times so far, 1 months apart).

My question: Now I have these lab work results from rDVM, and is there anything that I can help this patient herbally? He is feeling better clinically and moving around better.

I see stasis here, probably due to Blood Deficiency. Would Dang Gui be good for him along with Bluegreen Algae?

FYI: He had loose stool with modified XFZY, and he is off of it.

Thank you for your advise.

Rieko

by naturevet

September 29, 2009

Hi Rieko,

It was probably the Dang Gui in the XFZYT that gave him the loose stool, so if you were to use it, you'd need to offer Spleen support as well. Dang Gui Shao Yao San and Xiao Yao San are both options.

The other possibility is to use a Kidney tonic like Ba Wei Di Huang Wan. Remember that Rehmannia tonifies the Blood and stimulates the bone marrow. So if you've been using Kidney points to get him better, it's a good choice as well.

Given the presence of hind end weakness and both liver and kidney pathology on ultrasound, I'm thinking of Yi Guan Jian or Rehmannia Eight to tonify his Blood, since they both tonify the Liver and Kidney Blood and Yin, respectively. A Kidney formula also may help with the hind end weakness. Both formulas would quite literally increase the circulation through his liver and kidneys. YGJ has Dang Gui as well, however, so it may also be too much for his colon. Rehmannia Six and Eight both drain Damp, so would be less likely to cause loose stools.

Steve

by rmtran

September 29, 2009

Thanks, Steve.
It makes sense. I have been using a lots of kidney points, so I will go with Ba Wei Di Huang first.

Rieko

by rmtran

June 5, 2010

Hi Steve,

I saw this patient today for recheck; it has been 5 months.

The client reported that the patient started to leak urine while asleep on occasion. Also, he dribbles urine when he is getting up at times. At that time, the patient was Ba Wei Di Huang Wan, so the client thought that it was causing his urinary issue and discontinued (he was on it for more than a few months before urinary issue developed).

He had work up at rDVM, no signs of UTI. No obvious mass in bladder with a brief ultrasound, according to the client. But he is now isosthenuric.

He was placed on PPA, then urinary issue got worse. They used unknown supplement which did not help.

His tongue was pale lavender, and his pulse was slightly deep.
I treated with acupuncture; his pulse improved with SP-9 (tonifying).
This patient prefers cool, but no excess panting. He's always drunk a good amount of water, but his water consumption has increased a bit around the time that the urinary issue started.

I placed him on Jin Suo Gu Jing to see if it helps. I am also thinking about putting him back on Ba Wei Di Huang, and add Sang Piao Xiao San if JSGJ does not help him.

Any comments?

Thank you,

Rieko

by naturevet

June 6, 2010

Hi Rieko,

Urination in sleep is a cognition problem, as much as anything. Sleep is too deep, and is supported by a reduced cortical blood flow. That, in turn, is reflective of a degree of stasis, or at least internalized circulation, which shows itself also in the purple tongue, deep pulse, and hypoperfused joints that lead to chronic lameness. Liver Blood deficiency is at least a partial cause, given the small liver and anemia the dog has shown in the past. Putting that all together, there seems to be a Liver Blood deficiency with secondary stasis problem present.

The worsening on PPA is surprising, but also slots into this picture fairly well. We can tell from the adverse effects of PPA (aggression, cardiac problems) that it must increase Liver or Heart fire, both of which is often caused, in turn, by Liver Qi stagnation.

Putting that all together, we need a Blood tonifying and Qi moving formula that reduces urinary incontinence and has a reputation for increasing peripheral circulation and patient alertness. Bu Zhong Yi Qi Tang springs to mind when I summarize it like this. You could even try Xiao Yao San first, but it doesn’t do a lot for incontinence. Also, if the lab is mellow and Earthy, then a Spleen centered formula like BZYQT may be a better call.

Hope that makes sense. Tough case!

Steve

by rmtran

June 7, 2010

Thanks, Steve.

I could not get out of the thought that urinary leakage is from KID Qi Deficiency...

So, if PPA works for the patient, can one tell that the patient is NOT blood deficient (at least not LIV Blood Def) and has a smooth LIV Qi flow?

rieko

by naturevet

June 7, 2010

Yes, we'd think more of Yang deficiency, the better the PPA works.

S

by rmtran

June 7, 2010

Hi Steve,

Then, Suo Quan Wan should work better for the dog that responds PPA.

Do you use the formula a lot?

Rieko

by naturevet

June 7, 2010

Hi Rieko,

I use it in the powdered form with Sang Piao Xiao San.

S

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