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Orthopedic Pain And Chronic UTI In A Dog

by jenmercier - May 22, 2024 View Case Report

Hi Steve,
I am working my way through the CIVT herbal course but am only on the first module. At the same time, I am treating several tough cases. Each one is an opportunity to try and to learn. I so appreciate your wisdom.

Katie Maki, 16 yo FS Pit bull mix

Chief complaint:
primary concern is orthopedic comfort. Still active and likes to wrestle but her legs give out/slide out. She trips easily.
Appetite is good but is taking baytril and it is making her feel a little off. Not finishing food and sometimes not wanting to start eating her regular food. willing to eat plenty of cookies.
has had chronic UTI's. Has had a few accidents and when she has a UTI she is PU/PD but when UTI controlled she is not PU/PD.
During the day she has to go outside to pee often but can hold it about 8 hours overnight. Gets MP ocular discharge from the left eye at the start of a UTI and at the end as well.
no vomiting/diarrhea
sleeps comfortably but does have vivid dreaming. sleeps good at night.
Energy level is good for her age. walks an hour every day. 30minutes in the morning walking in the yard. Spends time with them outside in the evenings. Does sleep alot.
Pants often- when anxious and sometimes out the blue.
Does have sundowning- panting and pacing in the evenings. Started gabapentin for that and has helped.
Doesn't like it when it's too hot, prefers cooler. Has a fan on her permanently for her naps and she loves it
In the past year she can have some aggression toward one of the cats
loves to be massaged

Pertinent medical history:
chronic UTI's
Cushing's in past- testing negative for it now
OA, neuro signs/ataxia
recent hx of anaplasma positive-tx with course of abx

Medications:
baytril right now
rimadyl 75mg- 1/2 BID
gabapentin 50mg QID
D-mannose with meals
proviable
librela – responded great until 4 weeks ago when it seemed to have caused worsening of neuropathy

Diet:
mix of different kibble with pumpkin, peas, almond milk and some cereal to entice her to eat
started eating salmon for the omega 3

PE:
Tongue pink with light pink lavendar in the body; somewhat thin with fine wrinkles
Pulses: deep and weak, only slight tone, not fast
mild heat over BL20/21/GV4 region and GV20, mild sensitivity around GB25, sensitive to palpation around BL22-23
weak hind limbs and ataxia with all four limbs; CP deficit left hind
paws cool, limbs and body neutral except for heat noted above

mild cholesterol and ALP elevation on last labs
urine is not bloody or malodorous even when has UTI

TCVM
Overall she is deficient- Qi, possibly Blood and Yin but also has signs of Stasis. Given her history I was expecting to see more heat and Damp signs but I did not.
Kidney Qi/Yang deficiency; chronic Lin syndrome
Qi/Blood stagnation, Stasis
mild Shao Yang disharmony and Yin deficiency
Acu points: GV14, BH, Shen shu, BL18, 20, 21, 22, 23, GV4, SP4, ST36 and GB 34R, GB41
B12 1.5cc + 1 cc saline- BL40, ST36 and GB34 on left
- After the session her pulses were almost not palpable at all so not sure if I should have done something else?
- Follow up session two weeks later- owner reports she is weaker and sitting and standing in odd positions, very slow on walks but will play with the other dog. Pulse was not palpable. After acu again (did ST36, LI10, BL40, 54, BL18, 20, 23, BH) pulse was very deep, thin, wiry.
Treatment options:
Xiao Chai Hu Tang to reintegrate Yin/Yang and resolve TBO (assuming I am interpreting things correctly).
Is there a formula that will be best for the ataxia/presumed DJD possible IVDD and neuropathy but also aid in the chronic UTI? The owners came to me to help with the orthopedic concerns and have no idea that I might also be able to help with the chronic UTI’s! I am thinking of Bu Yang Huan Wu to tonify or would Bu Zhong Yi Qi be better?

by naturevet

May 25, 2024

Hi there! Yes, you are definitely getting some tough cases for someone so early in their career. Hopefully you feel like you're seeing some success.

In this case, I suspect the dog is primarily Kidney Qi and Blood deficient, causing secondary circulatory impairments that leave the dog unable to properly thermoregulate itself. In addition, these deficiencies of Blood and Yin create the Sundowner Syndrome and the vivid dreaming.

The bladder condition, as you said is Chronic Lin, calling for Kidney tonification. There is a suggestion of Dampness there, too, though, with the incontinence being worse during the day (when animals are most affected by Dampness) and better at night (when they are less so). A pure Kidney deficiency would have the opposite pattern.

From a biomedical perspective, it would be interesting to see if the dog had myasthenia gravis. You might want to look for that.

With the pulse being so weak, strongly moving and dispersing formulas are not a good idea, so our treatment goals are to tonify Blood and Kidney Yin, without aggravating Dampness. The most basic of these is Rehmannia Eight, and if we are on the right track, you should see some sort of benefit.

Kidney Yin tonics can be considered, but need to be Damp draining, and should not be aggressively cooling (i.e., not directed at Empty Fire) with that weak a pulse. An example is Zuo Gui Yin. Zuo Gui Wan can be considered, too, but doesn't have the Damp draining I think you need. Meanwhile, it seems we need a bit of spark in the Kidneys, not just Yin tonification, to help control the thirst (by steaming Kidney Yin to the upper burner where it can slake thirst). For that reason, pure Yin tonics might not help just yet.

I see you want to come at it from a neurological perspective as well. If so, I'd probably add in Bu Zhong Yi Qi Tang, but to start with, I'd use Rehmannia Eight for the first couple of weeks. If we are on the right track, you should see a benefit. Then, based on what happens next, we can figure out what to add, so keep us posted!

Steve

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