The owners main concern is weight loss followed by rhinitis. He is thin with low muscle mass. Despite this, he is active and inquisitive with no signs of joint pain or mobility issues.
He also has chronic rhinitis. He is not audibly congested but did sneeze a few times in the exam and had thick mucopurulent discharge. owner reports his congestion worsens with stress. His history suggests he had calici virus 5 years ago and could be an underlying cause but he doesn't present like an active calici virus kitty.
He also has bouts of blood in the stool. Not diarrhea, no constipation, but short bouts of blood in the stool that appear to be brought on by stress as well.
Other things related to GI: his appetite isn't consistent. He will have days of eating good and other days with little interest but no sign of nausea and minimal vomiting.
Recent labwork raises concern for CKD and hyperthyroid. His Cr was 2.3 (which I think is extra concerning given his low muscling) but USG 1.050. His TT4 was 3.0. He is not an overt renal failure cat nor a hyperthyroid cat. He might produce more urine than is normal- 2-4 pee clumps per day. owner doesn't notice him to be PU.
Tongue is light pink to lavendar (owner says it looks white to her when he yawns) and pulse is deep, thin, wiry. Not fast.
His coat is maybe the slightest bit greasy.
He is laid back and a confident cat. He goes on camping trips and walks on a leash.
He did ok with most of the acupuncture needles but did react with BL20 (not sure if that was just my placement or it was actual "active").
Pattern DX:
Qi deficiency (SP, KID)- low motivation for food, azotemia, weight loss.
Blood/Yin deficiency given the weight loss.
Not much in the way of Heat signs except for when he has the bouts of blood in stool which I think is likely LIV overacting on the weakened Spleen.
The rhinitis could be entrenched Damp Heat but also secondary to lack of support from the middle and lower burners?
Because there is so much going on I think there must be some separation of Yin/Yang. TBO or perhaps Damp injured the Spleen to begin with?
Plan:
We are trying out home cooked food. Do you have a simple recipe suggestion? I've pulled some out from the TCVM Food Therapy text that I thought would fit.
Herbs: I have many thoughts but feel like I need a minor bupleurum formula and either a spleen qi tonic or Kidney Qi tonic
Maybe start with Dang Gui Shao Yao San to address Blood deficiency but also open the triple burner and support the spleen
and either Six Gentlemen or Rehmannia Eight (the KPC formula?). Six Gentlemen may be preferrable to start for appetite.
Cats are so tricky! This owner is very committed so I am hopeful to be able to make a difference.
Thanks,
jen