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Urine Dribbling And Leg Tremors In A Dog

by Dr. Krisi Erwin - February 19, 2025 View Case Report

I am really having trouble with this case and can use some guidance if at all possible? Eddy is a 4-4.5 yo MN Labrador retriever. The family adopted him when he was 2 years old. He has had Giardia multiple times- treated with metronidazole but not since July of 2024. He has started having tremors in all four legs that come and go at random and they do not impact his ability to walk but the leg will visibly shake when they happen. This happens every day and I asked the owner when they started and it maybe has been as long as they have had him, It is hard for them to remember. He has allergies and has been on Apoquel for 2 years. Cytopoint made no change with his itching. They came to me though because he also has been urinating/incontinent for almost a year or more. He has been to IMED- normal ultrasound and cystoscopy and he did not respond to Flomax or Proin. He has been our patient since 12/4/24 and he has had a comibnation of spinal maninuplation adjustments and acupuncture. Tongue is that lavender center and slightly pale edges. Pulse is weak feeling for such a big rambunctious dog. It seems like the leg tremors are unchanged. Possibly the amount of dribbling has decreased to only being visible on walks in the morning but the owner has been reluctant to use a belly band to see just how much he is leaking. In my initial intake notes, I wrote that he had been leaving very large wet spots on his dog bed but now the owner feels like he has only had large urine spots after his first acupuncture treatment and then after the one 2 weeks ago (I had added CV 3, 4, 5 at that visit). So it is nebulous if there is truly no change in his response - the owners are currently feeling like no change. I asked them to start keeping a diary of his clinical signs starting to 1/22 up until now and it does show dribbling multiple times on the morning walk on the asphalt everyday. It is inconsistent when and how much it happens. They do not feel he urinates much in the house that they can find.

1/22/25 was his 7th treatment. I used:
GV 20, 14, 3, tip of tail
BL 12, 19, 21, 23, 28, 39
LBH and SS points
LI 10
ST 36
LI 4, LIV 3
Open GV 41, Close TH5
and then I added B12 to CV 3, 4, 5 for the first time since he was chill enough to lay on his side for me. AP was a mix of b12 along the trunk and laser AP along the legs

I don't know- at that time, I guess I was initially thinking Wind invasion with possible Jing Def and LU def not supporting the KID?? Several treatments ago, I tried corn silk as a single ingredient to try and help with the urine leakage and he had mucousy stools that were soft and odorous within a few days so they stopped. He is tick disease negative. His diet is Hill's I/D biome (?) and I did get them to add a topdressing of lean ground beef, jasmine rice, chicken livers, and Swiss chard and he is tolerating that well. No known trauma leading to these odd clinical signs.

I probably only have 1-2 more treatments with them before they go back to neurology for an MRI but I'm honestly not sure what they will MRI- it feels to me like the leg tremors and bladder leaking are related. I tried to focus more on blood deficiency for him- adding in SP 6, ST 36, BL 17 and swapped BL 39 for 40 when I saw him today..

Herbally, I am considering Standard Process Symplex M and Ligaplex II to try and help support his muscles/bladder sphincter better and/or Jin Suo Gu Jing as an herb to help with the leaking. I know my write up is rather convoluted so please let me know if I need to clarify anything. Any other advice would be much appreciated!! It is puzzling to me that he had increased incontinence with his first treatment and then also the one before today where I added the CV 3, 4, and 5.

by naturevet

February 23, 2025

Hi Krisi,

One way to make sure acupuncture doesn't inadvertently make a patient worse is to ensure that the pulse post-treatment is better than it was pre-treatment. Of course, if it's not, you don't know which needle or stimulation is the issue. For that reason, I place needles one by one, seeing which type of stimulation at that point helps the pulse, if any. If none, I remove the needle.

This approach results in you ending up only with needles that are helping, leaving you more certain the dog will improve. The other benefit is that a diagnosis is hinted at by the specific points and stimulations that worked, allowing you to then target that diagnosis with herbs. If you've got another couple of visits left with this dog, maybe consider that approach. Though it takes longer, I find it's more precise, effective and satisfying.

As for the current case, multiple diagnoses could fit what you're seeing. In general, though, leg trembling is a deficiency symptom, often of the Kidneys if it is affecting more than one leg. The pulse naturally suggests deficiency as well.

The tendency to dribble more when walking (when Qi is being expended) than at rest suggests Qi deficiency, and the aggravation in the morning suggests either deficiency of the Kidney (which is at low tide then) or Damp (which is worse in the morning). Since Corn Silk essentially drains Damp, the aggravation on it tells us that Damp is less likely. I see that kind of aggravation with Kidney deficiency.

If the above is true, then at your next treatment, I would suggest deliberately tonifying BL 23, BL 40 and KI 3. If the pulse improves with just one of those, your diagnosis of Kidney Qi deficiency is established. I would likely reach for You Gui Wan (Eucommia and Rehmannia; Restore the Right) to help the dog.

Regarding BL 40, if the pulse improves when you sedate the point, then you have a Wind invasion creating back issues that are causing the weakness and poor function of the sacral plexus. If that turns out to be the case, but BL 23 tonification helps, then you need a Kidney Qi tonifying Wind expeller like Du Huo Ji Sheng Tang (Pubescent Angelica and Loranthus Combination).

Otherwise, if BL 23 doesn't help but sedating BL 40 does, then try sedating SP 9. If that moderates the pulse, then the dog is Damp after all. I would then prescribe Yi Yi Ren Tang (Coix Combination).

Hopefully this advice helps you out! My suspicion is that this will be a You Gui Wan case. Good luck and let us know what happens!

by Dr. Krisi Erwin

February 25, 2025

You are amazing! Thank you!! In the beginning he was very much a busy body and so I had only used laser AP. Then when he got more used to me, I had instead tried the B12 to help his nervous system and immune system with the allergies. I think he's used to us now and expects to just hang out and eat so I will definitely try the needle plan. This definitely gives me a much more clear road map on how to proceed as, I am sure you can guess, I was getting lost in the weeds. I will report back!

Cheers,
Krisi

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