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Urge Incontinence?

by marneemadsen - November 2, 2009

HI Steve,
Our Dalmation is going to be 14 this month. . I met him when he was 11..just in time for the golden years. It took about 1.5 yrs to get him to be able to digest any whole foods because of long-term Sp Qi Def, but is doing better now. I can do about half skeletal meat lightly cooked with half grain free dry without the stools being too soft. Organs meats too much.

His tongue is most usually lavendar and pulses deep - sometimes soft and harder to find, other times wiry. He started with some incontinence about same time as rear end weakness. He never leaks or dribbles at rest, but sometimes will start urinating before he realizes what is going on, or tries to get out and doesn't make it, like the sensation that his bladder is full is really diminished. We will take him the rest of the way out and he still has a lot of urine left. Would you consider that urge incontinence?

He drinks a pees a lot for quite a while now. Hearing down, sleeping more. His gait is sloppy and weak, but he doesn't seem overtly painful. His coat is oily and he loves heat. He has had some stasis heat at times and anxiety esp at PC/TH time (better with XCHT).

He has responded best to XCHT and BZYQT based on pts, etc. If I try to add anything to drain damp, he gets worse. Is that because the BZYQT is lifting/raising Qi, and Dampness-draining formulas all are descending to some degree? Should I try something like Wu Wei Zi, or other suggestions as I know he has Dampness?

Thanks a bunch,
Marnee

by naturevet

November 2, 2009

Hi Marnee,

A deep pulse and a lavender tongue in a dog with Damp issues suggests one of two formulas to me - either San Ren Tang or Ba Wei Di Huang Wan. Since Damp formulas make things worse, I'd bet the right formula is BWDHW (Rehmannia Eight). BZYQT and XCHT both contain herbs that increase cognition (cerebral blood flow). BWDHW does the same with its content of Rehmannia. I'd be tempted to combine it with either one of these previously two effective formulas. I would also assume that if you tonified BL 40 or KI 3, you'd see the pulse improve. Lastly, don't forget to have the dog's lumbosacral region evaluated for chiropractic fixations.

Hope that advise proves useful!

Steve

by marneemadsen

November 3, 2009

Steve,
I thought BWDHW would be great for him and it seemed to make things worse...soft stools and weaker. I should probably try again just to make sure that it was not something else going on. His pulse sometimes is better with BL40 T, and sometimes with S.

In a response to a post by Kevin, you were talking about BWDHW, ZBDHW and BZYQT and their ascedinding and descending properties, but I can't find it.

What happened to the feature that you could add discussions to your own list?

Is what I described considered urge incontinence? I am not sure I understand that completely.

Thanks again.

By the way, did you know that your recorded voice sounds like Matthew Broderick?

by naturevet

November 3, 2009

Hi there,

To find all posts by one person, including yourself, just search for their username from the main forum page. If that's not the answer, I'm not sure what else you're looking for. We haven't removed any features.

As for whether it's urge incontinence, that's a toss up. If it was, I would have assumed it would respond to a Damp draining formula.

I guess the other possibility is very chronic cystitis (you don't mention having done a UA). In that case, a blood mover like Shao Fu Zhu Yu Tang might help.

You also didn't mention whether you'd done chiropractic. That's imperative in my book.

Incontinence is due to inappropriate descent of Bladder Qi, which propels the urine outwards. That can be due to an excess of Water, due to a lack of moderating Yang influence (i.e. a Heart Kidney disconnect; Kidney Qi deficiency); a local excess of Bladder Qi (Qi stagnation); and an excess of pathological Water (Damp) that simply must be voided.

For the Heart Kidney disconnect, think of Sang Piao Xiao San (did you try it?). For Qi stagnation in the lower burner, think of BZYQT and Wu Yao Tang. If Qi stagnation has progressed to Blood stasis, think of SFZYT.

As for properties:
BZYQT raises, ZBDHW descends, and BWDHW should be somewhat neutral.

Hope that's more clear. Going for a beer with Matthew. He's my stunt double when I'm lecturing.

Steve

by marneemadsen

November 4, 2009

Hi again,
Thanks for the follow up - He has had lots of good osteopathic care and urine is quiet. He has had bladder stones, but I stopped radiographing because they never changed and he never had symptoms (unless that has changed now...this really came on with his rear end weakness, but I could check again).

I will work through these differentials again and see if I can get improvement. I like the SRT the best right now...

Tell Matthew hi and loved him in that musical with Nathan Lane

by naturevet

November 4, 2009

One more thought springs to mind:
From a TCM perspective, if there are stones, the dog is Damp. If signs of this Damp (Heat) are very subdued, then it's a 'deficiency' cystitis. The main deficiency that creates it (and stones) is Blood deficiency. The dynamic basically goes Liver->Spleen->Damp->Stasis, with the Spleen feeding back to the Liver (by continuing to deprive it of Blood through its ongoing weakness). The formula to address this is Dang Gui Shao Yao San. So it fits the deficient pulse and stagnant tongue as well. Does this dog look Blood deficient to you at all? If so, I'd give it a try.

Steve

by marneemadsen

November 7, 2009

Thanks for the additional thoughts. He does run low normal on HCT and I do think he may be Blood Deficient. I thought Dalmation stones were different origin than Dampness? I have had him on DGSYS at some pt..SRT has not gone so well this week, so maybe that is next or SPXS.

Marnee

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