Jake is a 14 year old MN Golden Retriever mix with a history of IRIS stage 2 chronic renal disease, mild atopy worse in the Fall and Spring (with pruritus of face and ventrum and redness of ventrum), chronic halitosis (that I believe is rooted in Stomach Heat and not periodontal disease), history of regurgitation that resolved after initiating Stomach Happy and chronic intermittent episodes of repeated swallowing behavior (which I believe is from acid reflux). HIs bloodwork has been mostly stable - his creatinine is holding steady at 1.8mg/dL, remainder of bloodwork is normal. He has had 2 ultrasounds in the past year which came back unremarkable. He has been on a home cooked diet which consists of turkey or white fish (on rotation) for the past year. He is currently on Jade Lady for Stomach Heat and Rehmannia 6. He has had hip dysplasia since he was 8 months old. He is cold seeking and pants, although panting has improved with addition of both herbals. We continue to struggle with the Stomach Heat, which I believe has become Stomach Yin Deficiency. He also has mild dry flaking along dorsum and dry paws. He also seems restless to me - like he can't settle in one place/position for a prolonged period of time. The past several months he has also lost considerable muscle mass along his dorsum and pelvic hindlimbs and has the beginning of some pelvic hindlimb weakness. Shen, appetite, urination/defecation are normal.
TCVM diagnosis - Kidney and Stomach Yin Deficiency, Kidney and Spleen Qi Deficiency
Tongue: Red and dry to pale pink and dry with thick phlegm/saliva at kidney tongue position
Pulses: deep, fast and toneless
I feel like I have not been able to get control of his yin deficiency (although his renal values did improve after starting Rehmannia 6). His halitosis has not improved (sour vinegar/rancid smell to his breath) and he continues to have some breakthrough episodes of licking the air with exaggerated swallowing and compulsive licking of his forelimbs (antebrachii and paws) that lasts for several minutes and then resolves. Can you please give me your thoughts on this case and what herbal adjustments I should make? Thank you so so much!