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Ataxia/Paresis And Chronic UTIs In Frenchie

by CarolineJ - July 20, 2023

Hi Dr Steve,

I'd like to pick your brain to help this new patient of mine. She is a 7 year old spayed female Frechie with skeletal deformities (congenital). I don't have any X-Rays for her.

Owner decided to seek holistic care because patient developed chronic UTIs in the last year and mobility in the hind limbs has declined. She had hematuria, small accidents in the house and mild crystals in urine.

Numerous cultures in the past few months and MRStaph.Pseuintermedius was cultured the past couple times. She was, of course, on many different courses of ATB, with the last course being Zeniquin a couple weeks ago.

PE abnormalities:
Slightly PU/PD per O
Abdomen: Soft and comfortable abdominal palpation. Pot-bellied appearance.
Integumentary: Lichenification both outer pinnas. Rest of skin is quiet, mild dander. Hyperkeratosis on rostrum.
Musculoskeletal: Moderate muscle atrophy, especially epaxial muscles. Limb and spinal deformities (congenital). Deep pain present and sensation on KID1 palpation. CP deficits both hind limbs. Cool/cold hind limbs and feet.
Neurological: Deep pain present w/ both hind limbs.
P doesn't appear to be painful anywhere in particular, very stoic and doesn't give the impression of being uncomfortable on palpation for joints and spine.

Pulse: Deficient. Improved after AP: thin, not very strong, palpable on all levels.
Tongue: Purple/Lavender
Sensitive on the following pts when palpating: none
Sensitive on the following pts when needling: L LI11
Body temperature: Cool ears and cool back feet
Trigger pts: none

My acupuncture treatment involved BH, GV14, L ST36, LI 11, L BL60 to KID3, BL17/18/23/28/40, R LI4, L GB25, GV4, L BL62, LIV3.

O reported that accidents in the house have been more frequent after AP and the amount of urine seems to be larger. She also seems to be having those ''accidents'' while resting and laying around which is new for P. I'm wondering why that might be ? Could it be a relaxation component?
O also reports she is starting to see blood tinged urine again in the house (she was just on a 2 weeks course of Zeniquin).

I was thinking about San Ren Tang at first to see if it might help her ataxia, restore some nerve damage and therefore help her UTIs (overflow bladder ?).

There also seems to be a pre-Cushings component her perhaps w/ PU/PD, pot-bellied appearance, lichenification of pinnas and muscle atrophy? Bloodwork in Nov 2022 was unremarkable.

Should I be looking at a different herbal for this patient?

Thank you in advance and I appreciate your guidance!!
Caroline

by CarolineJ

July 25, 2023

UPDATE:
This patient went for bloodwork this week and this revealed elevated triglycerides (322, upper normal is 291), elevated cholesterol (641, upper normal is 324) and slightly increased platelets (475, upper normal is 400). ALP was WNL along with liver and kidney values.
Owner also started the SRT and patient was tolerating it well at 1 tab SID. Then developed diarrhea at 1 tab BID.
Pulse was still deep, thin and a little weak today, tongue is purplish and hind limbs are cool.
I'm a little confused because I sense a blood deficiency with a Damp Heat on top of it ? Not quite sure.

Her accidents in the house and still fecal and urinary. Got more information out of owner today with the urinary accidents : it seems like she often dribbles small amounts when walking around the house, but will also have larger amounts accidents when laying down/ resting.
Thanks for your insight!

by CorinneC

July 25, 2023

This seems like a ShaoYang disharmony to me now that you've added the elevated cholesterol and platelets. Its a hot above, cool below disharmony so it fits her weak and cool hindend. But I always worry about giving XCHT to these patients when their pulses are so deficient! It may be that she needs Blood tonics and XCHT to balance out? I'm just chiming in so I can have this explained to me too!! Interesting care Caroline. I see too many Frenchies with this same presentation as of late, poor things.

by CarolineJ

July 25, 2023

Would you use Bu Gan Tang for a Blood Tonic or another formula in particular ?
Also curious to know what you make of the diarrhea response to SRT.
What about the Bladder Damp Heat in the lower Jiao ? I apologize, more questions after your answer!

by naturevet

July 25, 2023

Hi all!

The reaction to SRT is curious. We know the formula dries, downbears and mobilizes. One of those attributes is aggravating the dog, so we need a formula that counters that effect (if we can figure out which one it is) or we can counter all three of them. To counteract the SRT effect, we need a formula that lifts, nourishes Yin or Blood, and astringes. When I look at those criteria, what leaps to mind for me is Bu Zhong Yi Qi Tang.

Looking at this case another way, we can get an idea what the Tai Ji symbol looks like for the dog by asking whether the dog is Hot or Cold? Excess or Deficient? I would say Cold (given the extremities) and Deficient, given the weak pulse and frailty, muscle atrophy, etc. To create a Cold Deficient Tai Ji symbol, you have to take away the Yang half. So the dog would be Qi or Yang deficient.

What about the pot belly? A toneless abdomen is actually common in Qi deficiency. Chronic UTIs that don't respond to antibiotics is very typical of Wei Qi deficiency in particular. So is the refractory hematuria (since Wei Qi is too deficient to hold the blood in the vessels).

How about the hind limb weakness? It can be reflective of chiropractic fixations, so an exam by a chiropractor is a great idea. It can also indicate Kidney Qi deficiency as can the back muscle atrophy. A differential for epaxial muscle atrophy is a blocked Shao Yang layer. GB 25 regulates flow of Yang Qi to the dorsum, and with it the arrival of Blood and nourishment. The high platelet count supports a role of the Shao Yang in the pathophysiology, but I wouldn't want to use Minor Bupleurum alone, as the pulse is too weak. It could be paired with Bu Zhong Yi Qi Tang, though, to address the incontinence and recurrent UTI. The two herbs together are actually quite powerful in that regard.

The discharge of urine while lying down tells us she has poor sphincter tone, so some phytoestrogens (such as in Dang Gui) would not go amiss. They are in BZYQT

Based on all of this, I can see a plan A and plan B. Plan A might be Minor Bupleurum paired with Bu Zhong Yi Qi Tang. Plan B might be You Gui Wan. The latter doesn't have as much of a reputation in addressing cystitis, though.

If you tried plan A, and got rid of the UTI, then you could pair Minor Bupleurum with Du Huo Ji Sheng Tang to address the poor mobility and the epaxial musculature later, capturing both Shao Yang and Kidneys

Hopefully this gives you some guidance. It's a tough case!

Steve

by naturevet

July 26, 2023

I have one other thought, here, Caroline. A company called Gold Standard Herbs makes a version of Du Huo Ji Sheng Tang called Lumbrex, and a product called Cessorex that includes Minor Bupleurum and Si Wu Tang. Your client could try both formulas simultaneously to see if you can hit all three targets: incontinence, ataxia and itch.

The two formulas are somewhat synergistic as Cessorex addresses the Shao Yang while Lumbrex addresses the Tai Yang. Both address Blood deficiency. The only thing missing is Bu Zhong Yi Qi Tang, which you could add later if you wished. Just a thought.

Since these formulas are sold directly to consumers, you wouldn't have to carry them, but many vets do, so that owners can try them out even before they get to their first holistic exam, to see if they offer a quick solution to their problems. If you'd like to stock them, just email the company at info@goldstandardherbs.com

Hope that helps! There is a solution in there somewhere!

Steve

by CarolineJ

August 15, 2023

Hi Steve, thanks so much for your input! I am seeing some improvement in mobility with the acupuncture treatments and patient is still on SRT. Pulse has improved some and patient is much more mobile and energetic.

The urinary complaint went from the patient not being able to urinate much (bladder would remain somewhat full all the time) to dribbles of urine throughout the day.
Her urine continues to be blood tinged (even on atb therapy) and mucus was present today.
I am going to try her on BZYQY in the next couple weeks and report back!

by naturevet

August 18, 2023

Sounds great! Thanks

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