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Arthritis In A Cat

by jenmercier - February 15, 2025 View Case Report

Miss Muffin is a 12 1/2 yo FS DSH.
She has multifocal arthritis- right stifle has marked DJD and she also has hip and low back pain. Occasionally her left elbow is painful as well.
She responds to metacam but even with twice weekly ultra low dosing it may be aggravating some vomiting.
She vomits 2-4 times a month, clear to greenish liquid. More often with appropriate low dose of nsaid.
She has been sneezing a bit lately as well.

Her pulse is deep, tight, thin
Tongue is light pink

I think Damp is a problem for her along with Blood stagnation. And probably middle burner obstruction. Given that she has a benefit from nsaid but vomiting occurs or worsens, she probably needs a warming effect that is also anti-inflammatory.

I'm thinking of San Ren Tang. Do you think that will help with her joint pain enough? Is San Ren Tang a good choice but also add something like Voltrex? or is there a single formula to consider?

Jen

by naturevet

February 23, 2025

Hi Jen,

I've had success in Blood stasis Damp cats with Xian Fang Huo Ming Yin (Angelica and Mastic). It has Wind expelling effects that help the low back out as well. I'd maybe give that a try as it is more germane to the arthritic complaints than SRT. The two are compatible, though, if needed to give a complete effect (by tackling the sneezing and the vomiting). If the cat does improve on them, then a real food diet is likely to be very helpful.

Steve

by jenmercier

February 27, 2025

Thank you! I am reading on A Time to Heal's site that the NP formula is not comparable to the Evergreen formula. Would the Kan version be similar to NP? I'm just thinking a tablet form might be easier for this owner/cat.

by naturevet

March 3, 2025

Kan's Sublime Joint Formula matches fairly closely XFHMY

Good luck!

S

by jenmercier

May 2, 2026

Hi Steve,
I am not able to treat this cat in person anymore (I moved out of state) but am helping another vet to manage her case.
Before I moved, Miss Muffin was losing weight, vomiting, not a good appetite, grumpy. She has had a heart murmur for some time. Her pulse was thin, deep, wiry, and fast. Tongue was light pink on top and pink on the sides.
She was taking XFHMY but I did not appreciate an improvement on this.
Her labwork revealed TT4 4.6, slight elevation in ALT. Renal values and cholesterol were normal.

I had her stop the XFHMY and switched to WLT along with starting her on methimazole. I was not able to evaluate her in person again after this. Her symptoms improved briefly but she continued to have increased vomiting. Her weight stabilized but she continued to have a finicky appetite. Heart murmur did not improve with control of her hyperthyroid.

The most recent labwork showed normal TT4 at 1.6 (on methimazole), renal azotemia Cr 1.9 and BUN 33, USG not obtained. Cholesterol has been mildly elevated on several checks now (<300 but more than 200) but she is eating kitten formula canned food and baby food (presumably because she will eat this the best), has lost weight again (down 3/4 pound). Her calcium bumped up to 11.7 (10.8 normal) with a ionized calcium of 1.35 (1.34 normal). She is still taking Wei Ling Tang.

The question posed to me is: could the herb be causing hypercalcemia? My answer, and please correct me if I'm wrong, is NO.

My question is, do I switch to XCHT? Thinking would be we have Triple Burner obstruction. According to western medicine, her thyroid is controlled and presumably she has azotemia that has either been progressing or was unmasked by treating the thyroid. But her vomiting, picky appetite, grumpiness, soreness has not improved. And now she is slightly hypercalcemic. This could be a progression of CKD or neoplasia, or idiopathic.
Reading about the stages of hyperthyroidism, she seems to be progressing to stage 4 despite being controlled with methimazole. I am not sure what to evaluate to determine if she is Shao YIN syndrome vs Shao Yang.
Unfortunately, I can't examine her to gather more helpful information.

Thanks in advance for your guidance!
Jen

by naturevet

May 4, 2026

Hi Jen,

When azotemia develops as a result of methimazole treatment, it tells us that a Rehmannia-based approach is needed to provide kidney support. If you use Yi Guan Jian, then you will act somewhat opposite to WLT, which did not work (meaning you will cool and moisten instead of warm and dry). Stomach dryness can cause nausea and vomiting. YGJ moistens the Stomach while harmonizing the Liver and Stomach, so as a Wood-Earth formula, it's appropriate for grumpy cats. I've used it in many hyperthyroid cats, and it contains herbs which inhibit T4 to T3 conversion, allowing the methimazole dose to sometimes be reduced.

The hypercalcemia is not caused by herbs but I don't think it's severe enough yet to warrant building your protocol around. Even a little too much vitamin D in the canned catfood can be enough to raise calcium levels. If it is a parathyroid tumor, then XCHT will be appropriate. XCHT is also a good follow up for animals that have responded to YGJ. But, since it reduces renal blood flow, stick with just YGJ for now, so you can reverse some of that azotemia.

Hopefully, this advice helps her out!

Steve

by jenmercier

May 4, 2026

I will give YGJ a try. So helpful, thank you.

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