Question Details
Coughing In A Dog
by mszyrmer - November 11, 2022    View Case Report
Hello Dr. Steve! I have a difficult and interesting case that I would love help with:15 year old MN Pomeranian. He is a large pom (both very tall for his breed and a little overweight - 25 lbs).

Diet: Raw Primal since a puppy. Switched to Just Food for Dogs cooked renal diet last year when diagnosed with kidney disease and bladder stones.

Previous history: Mild azotemia for one year. Has always drank a lot of water but possibly increasing with worsening azotemia. Pants at night. Had some mild IVDD that responded well to acupuncture in July.

Current history: Went into acute kidney failure last month in October. Creatinine: 13 and BUN> 180. At same time, developed a cough. Taken into ER given aggressive IV fluid therapy. Responded somewhat to IV fluids - Creat went down to 8 and BUN went down to 97 when he was released from the hospital. While hospitalized, PCV dropped to 16%. Was given a blood transfusion and this bumped the PCV up to 22% when he was released from the hospital.

Was started on Darbopoetin injections and owners given SQ fluids to continue at home.He wasn't doing great when owners took him home - up all night coughing, panting, restless, not wanting to eat.

Owners brought him to me the day after hospitalization: I gave him 1 tsp Chai hu jia long gu mu li tang rectally. Pulse was superficial and bounding - responded to BL 22/ BL 25 and GB 34. We did laser settings for acute kidney disease and sympathetic overdrive.

He responded quickly, slept through the night. We continued the Chau hu orally once he started eating and did 2 more laser/acu sessions.

Went to the nephrology specialist at UC Davis last Friday who called him a "miracle dog" when he found that his BUN and creatinine have continued to come down - currently creat is down to 5.7, BUN is 67.

HCt went up initially but now back to 26.

So thank you for teaching us about this pattern and for figuring out how to treat these dogs!!! However, I don't know exactly what to do next. My thought was to keep him on the Chai hu until the kidney values go low enough and then switch him to Rehmannia.

One new problem: Liver values are climbing even with the Chai hu jia long gu mu li tang. ALT is now 307, Alk phos 486.The other new problem, is that his cough has gotten much worse and I am not sure how to treat it...

Owner reports the following:

-Cough worse at night (worse at 3am)
-On and off throughout the day
-Better with humidifier
-Cough was initially dry, now sounds slightly wet
-Better with movement (walks) and mid-day
-Coughs less in the afternoon
-No response (so far) to Doxycycline
-Xrays were clear
-So some kind of a yin-deficient with qi stagnation cough + the climbing liver enzymes. Maybe add in XFZYT? Or something to help with yin deficiency? However, is it ok to start a yin-deficiency formula while we are still trying to pull blood away from the kidneys? I don't want to tonify the kidneys too much at this stage...Sorry for the long post but looking forward to any insight or thoughts!!!!
Replies
by naturevet
November 14, 2022
Hi Magda!

Great job so far on a challenging case!

XFZYT is definitely a consideration for the cough given the improvement mid-day. It doesn't quite fit the current moisture level, though. One other idea, though, is just to tonify the Kidneys first with something basic like Rehmannia Eight. This formula helps the Kidney grasp descending Lung Qi. As Lung Qi completes its descent, it pulls fluids out through the Kidneys and should get rid of that wet cough. Note that as Shao Yin organs, the Kidneys gain strength in the early to late afternoon, which fits with when the cough is most improved.

I'd use the CHJLGMLT along with the Rehmannia Eight for now, since they somewhat work together, given both are trying to facilitate the descent of Qi and fluids. Keep an eye on the azotemia. As long as it continues to improve and the cough begins to resolve, you're on the right track. If that happens, you can gradually reduce CHJLGMLT, testing as you go, until the transition to a Kidney formula is complete.

Regarding the liver enzymes, they are probably going up as a function of the 'ice pack' effect of a Bupleurum derivative (i.e., CHJLGMLT) on the liver. Once we transition fully to a Kidney formula (such as Yi Guan Jian), the liver will see a return in blood flow that resolves the liver enzyme elevation.

Hope that helps. I saw you removed your post from Ask Dr. Steve to lighten my load. I appreciate that!

Steve
by mszyrmer
November 14, 2022
Haha yes, I felt bad about the deluge you were dealing with on facebook!

Thank you so much for the response - will try the Rehmannia 8 later this week and hopefully that continues to help him!
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