OK it seems like I AM supposed to ask case questions here? Sorry, first time... If not, please let me know!
Lame left hind for past year. Some improvement on Adequan, NSAIDs, gabapentin, but not a lot. Severe medial buttress left stifle with significant DJD on rads. Normal hips. Mild left elbow thickening. Worse after exercise/standing a long time.
History of intermittent soft stool and a finnicky appetite depending on what's being fed. She had some unexplained weight loss when I first saw her, although she was still significantly overweight (BCS 7/9).
Was eating royal canin kibble and some chicken tenders and rice plus a small amount of Fresh Pet. Now mainly eating beef or turkey and rice. Trying to get the owner to feed some veggies but they're resistant because she doesn't really like them. I've at least gotten them to add a multivitamin now and we're working on the diet.
She's fearful of storms and anxious in general.
She seems very hot - panting, red dry tongue with a lavender center. But pulse is very deep and weak, barely palpable.
So I initially thought Kid Yin Deficiency and SP Qi Def with Damp and treated her with acupuncture, Jing Tang's Di Gu Pi, and discussed changing to fresh foods. Saw some initial mobility improvements with acupuncture.
When mom tried to adjust her diet by giving more Fresh Pet and less kibble, she broke with watery diarrhea that was very responsive to Si Miao San. Mom stopped SMS and diarrhea resumed but mom didn't restart it. I had her start it back up and diarrhea resolved again. At this point, mom still hadn't actually started the Di Gu Pi (there's definitely a compliance issue here, but some of it was because of the GI upset), so I had her start it.
We continued to make some progress on the mobility side with the Di Gu Pi on board, but then she'd play too hard and start hurting again. Her gut stabilized- her appetite was great and bowel movements were normal and she was now off of Si Miao San.
She developed UTI signs in mid-October and I treated her with amoxicillin + probiotics based on a urinalysis. She improved significantly but still needed to go out to the bathroom once overnight most nights. Then in mid-Nov, she developed stranguria and was taken to the ER where bladder stones were found. Underwent cystotomy for about 30 struvite stones. Blood work at that time was ok (mildly decreased Phos and potatssium).
This dog is clearly very Damp and also pretty hot, but it seems more like a deficient heat based on age, chronicity, and pulse. Now with the history of stones, I really want to address her Damp while still tonifiying her. I'm not sure she's Excess enough for Long Dan Xie Gan Tang. Zhi Bai Di Huang Wan seems like it might be a good choice, but I see that it has some overlap with Di Gu Pi. Can they be used together to address her arthritis, or would you use a different combo? Her pulse is totally throwing me off. I'm also not sure if ZBWDHW would be a good choice with struvite stones. I'm assuming I don't need Alisma since they're not calcium stones.