Question Details
Chronic Urinary Tract Infections In A Dog
by tracyb - February 10, 2021    View Case Report
Arnie is a 15 yo mc Akita I am treating with acupuncture for pelvic limb paresis and urinary and fecal incontinence.
he has a history of:

presumptive diabetes insipidus controlled with desmopressin
recurrent uti
cauda equina syndrome
degenerative myelopathy
perianal gland tumor
cecal malignant spindle cell tumor surgically removed
acute hepatitis after trimethorprim-sulfa for uti, liver enzymes almost back to normal
urine scalding caudal pelvic limbs and ventral abdomen

he currently has an enterobacter uti with severe hemorrhagic urine.

his pulse is wiry, his tongue is lavender.

I started him on yunnan bai yao which reduced the severity of blood in the urine.

I also started him on shao fu zhu yu tang which caused severe diarrhea.

I know this herb is not great for heat; despite his being an Akita, the owner feels he does not have a preference for cold and I can’t particularly detect heat or cold on exam.

I thought maybe of san ren tang, but I can’t detect any damp (and it is on backorder.)

Where did I go wrong? where do I go from here?
Replies
by naturevet
February 16, 2021
Hi there!

Tough case! If the DM was 'confirmed' through genetic testing, then this is a Shao Yang disharmony dog. There is a strong suspicion of that, given the peri anal tumor. In that case, we'd have to use Xiao Chai Hu Tang for this dog.

XCHT could help the bladder here, especially if he has a tendency to overflow incontinence (i.e. poor sphincter tone). Improving spinal cord function could restore normal tone and prevent repeat infections.

From a Chinese medical point of view, XCHT could help the bladder as well. Shao Yang disharmony can manifest as a Dai Mai that is too tight (particularly when spinal cord disease is present), trapping Qi, Blood and Yang in the lower burner to create cystitis while also cutting off flow through the channels to the legs to create the paralysis. In this context, then, we need to use a moving and cooling therapy for the Bladder. SFZYT is moving but warming. It sounds like there is too much Heat in the lower burner for it, regardless of the dog's overall temperature preferences.

If the above is correct, then especially given the urine scalding, I'd look at using Si Miao San with Xiao Chai Hu Tang in this dog. Alternatively, look at using Ge Xia Zhu Yu Tang with XCHT, and count on restored continence to resolve the urine scald.

Hopefully one of the two strategies will help you out. I guess given the tumor, the second idea is better

Let us know how it goes!

Steve
by tracyb
January 11, 2022
Initially the client had told me that Shao Fu Zhu Yu Tang had caused diarrhea, but he tried again with no GI side effect and was able to use the herb and it was somewhat effective.
This was a good lesson for me, perhaps I reacted too quickly.
I did add in Xiao Chai Hu Tang as this seemed like a good idea with his hindlimb weakness and very active GB34
The client canceled an acupuncture appointment because Arnie had a diffuse pyoderma and subsequently did not update me.
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