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DJD, Chronic Cystitis, PLN

by tradcliffe - November 25, 2009

Hi Steve, I was just looking at the PLN case, and I think it answers some of my question. My patient is an 8 yo Yorkie, that has had chronic mild health problems since birth. She has had chronic UTIs, which we partly explained by abnormal vulva conformation, which was surgically repaired a few years ago.
Then she was diagnosed (by U/S only) with only 1 functional kidney(left). It was suspected the right kidney has congenital renal dysplasia.
She also has severe hip dysplasia and DJD, with bilateral MLP. The left side had surgery 6 months ago to repair the MLP, and a denervation for the hip DJD. She was doing well up until a couple of weeks ago when she seemed to be painful again.
She has had mild azotemia and elevated UPCR (Stage 2 ISIS CRF)for about 1 year. Not hypertensive. She has always had good appetite and lots of energy. Last week she had a mild heart murmur, anemia, muscle atrophy hind legs, and UPCR has dropped. I have had her on BWDHW when I first diagnosed her, and You Gui Wan a few months ago with no change in the BUN/Creat. Before and after her orthopedic surgery I had her on some Golden Flowers - Nourish Essence (augmented Rehmannina 6)and Bone and Sinew (Zheng Gu X Jin Fang) but the BWDHW seems more appropriate now?
Is this the only formula I should try? Will it possibly provide her with enough pain relief - she is on Tramadol. She is also on dry Mobility support, what should we change that to - raw? Her tongue is pale pink with redder tip - tip used to curl, tongue used to look longer and red - really stick out of mouth when panting, and pulses are thin and weaker than normal. Thanks for your help.

by tradcliffe

November 25, 2009

I guess I forgot to mention AP for pain relief - i have not tried this in a while for her, but certainly will start again.

by naturevet

November 25, 2009

Hi Tracy,

I guess my only other thought is whether Xiao Chai Hu Tang with Qin Jiao would help her. Particularly if the Rehmannia formulas never aided the azotemia, I'd wonder if you need an anti-inflammatory effect. This same anti-inflammatory effect would be rendered at the hip joint, if XCHT was used. You wouldn't have to stop Rehmannia Eight, however, but could try the two together first, to assess impact on pain and azotemia. Based on the result of this little experiment, you'd know what to do for diet.

Hope that helps,

Steve

by tradcliffe

January 7, 2010

I just saw Shadow for a recheck, and although her comfort level is much improved, she is bringing up some thick phlegm intermittently now - I think it is regurgitation. Also, she is drinking lots more than before, and seems to have some cold intolerance. Still has excellent appetite but has lost .2 kg in 6 weeks, and has had diarrhea a couple of times. Her pulse is wiry, tongue lavender/pale with red tip and sides (front of tongue only). She has also urinated a couple of times in her sleep again. However, we had cultured a silent UTI 6 weeks ago and put her on antibiotics, and she was feeling much better for a while. She did not have urine today to repeat the C/S, but will try again next week. I am wondering if this indicates the Benefit Hips and Knees is not an appropriate formula? What should my next step be? I will recheck blood and urine values next week. The dog is energetic and happy - you would not know today she has kidney issues, but I am concerned with her continuing weight loss. Thanks for you help as always.

Tracy

by naturevet

January 8, 2010

Hi Tracy,

I'd feel better knowing the lab results before we passed judgement on the herbs. Let's see what you find out.

That being said, San Ren Tang can help appetite and diarrhea, and is a renal anti-inflammatory. You could roll that into your prescription, rather than stopping the XCTH.

Thanks for the update,

Steve

by tradcliffe

January 13, 2010

Hi Steve

Shadow was in yesterday for bloodwork - had some VERY smelly diarrhea, but she does get stressed in the kennel and try and dig her way out.

Her lab values have changed as follows - WBC have increased from below normal (5.8) to normal (9.2) as have RBC (5.3, now 5.9) Hct was 38%, now 45%. BUN and Creat have also increased - BUN 31.6 to 48.5, Creat 199 to 311. TP and globulin levels have increased slightly - have always been within normal range. Lipase is slightly elevated but has been for a while. Phosphorus in November was normal at 1.4, and now is high at 2.4. Urine protein creatinine ratio has decreased - was 1.3 in November, now is 0.8.

So I see some improvements , but general kidney function seems worse. I do wonder if the XCTH decreased inflammation and decreased protein loss from kidneys - +/or maybe the antibiotics were responsible? What would you suggest I do next? I don't have results of the urine culture yet.

Thanks, Tracy

Tracy

by naturevet

January 13, 2010

Hi Tracy,

As soon as the UPC ratio drops to less than 1, I look at that as a sign the inflammation (and need for XCHT) has substantially resolved, and that now the kidneys need tonification (increased blood flow) to finish their recovery and restore normal urine concentration.

How was the urine SG? Those elevations could also be consistent with dehydration as well, although I'm heartened anyway to hear the RBC is normal. That's a very good prognostic sign.

I would now return to Rehmannia Eight, or even Zhi Bai Di Huang Wan if the diarrhea was large bowel in origin (which it sounds like it may be). Any blood or mucous there?

Thanks for keeping us updated. Continued good luck,

Steve

by tradcliffe

January 18, 2010

USG was 1.018, no UTI cultured. She is presently taking Rehmannia 8, I did not see blood in the stool or mucus that I can remember, but because it was partly formed and so stinky, I would say it was large bowel in origin. Maybe I should switch her to the ZBDHW, or can I give both - ZBDHW at night to clear heat and Rehmannia 8 in am to tonify kidney?

Thanks,
Tracy

by naturevet

January 20, 2010

I think given the chilliness and purplish tongue, Rehmannia Eight is fine to try for now.

S

by tradcliffe

September 2, 2010

Shadow has been doing quite well on the Rehmannia 8. She was still in Stage 2 CRF in March, and her creatinine had decreased to 163 (44-159) and BUN was 34.1 (2.5-9.6), no anemia or increased phosphorus or calcium.

Saturday she vomited 1-2X, and again on Sunday, and so we did some bloodwork this week. She has lost 0.7 kg since June, and has gone to Stage 4 CRF. Creatinine has jumped to 520, and BUN is 72.4, phosphorus has increased to 4.4 (0.8-2.2). There is still no anemia.

She has severe halitosis, some periodontal disease, grade 3 heart murmur. Her pulse is deep, thin and wiry? bounding against finger. Her tongue is pale on top, kind of dry, and red/purple underneath. She has been eating dry dog food - a joint support one and a senior formula. Owner has never really wanted to feed canned food, but I am sure at this stage I can convince her to feed something other than dry. She usually has a very good appetite, and drinks a lot. She still occasionally has some incontinence problems - I tried her on stilbestrol which controlled the incontinence but made her start to hump everything. I did reduce the dose, but she had a couple of incidents of incontinence in the past week (she may be out of meds).

I don't think she is excessively hot or cold, right now she does seem to be cold - will see her shiver.

So, what would you suggest? I have had her on You Gui Wan in the past - should I go back to that, or is there something to add to the Rehmannia 8?

She is in clinic right now on IV fluids, antinausea and antacid meds, and has perked up quite quickly. Western protocol would say to switch her to reduced protein/phosphorus food. I could also put her on a OFA supplement.

Thanks for your help as always,
Tracy

by tradcliffe

September 2, 2010

Sorryy, USG was 1.015, UPCR was 0.6 (was 0.8 in March) and we are still waiting on a urine C/S.

by naturevet

September 3, 2010

Hi Tracy,

I find Rehmannia Eight works a little better than YGW in renal failure, at least in animals.

Right now, with the abrupt rise in creatinine and boundding (I assume that means lifting your finger) pulse, I'd wonder about Minor Bupleurum again. Rehmannia Eight may be continued at the same time.

Temporarily, while creatinine is so high, a low protein diet is probably okay.

If the bounding didn't create a finger lift, I'd wonder if the dog has some Damp from the richness of YGW. I'd wonder about switching back to BWDHW and maybe using a little San Ren Tang to calm things down a little.

I guess the other possibility for the red tongue and bounding pulse is Yin deficiency with Empty Heat. Keep Yi Guan Jian in mind for that, to relieve the vomiting and support the Kidneys, in the event none of the above makes sense when looking at this dog.

S

by tradcliffe

February 5, 2011

So, Shadow's kidney disease is progressing. She has needed IV fluids again in December, and again in January. She responds very well to fluid therapy. The owner has started giving her regular SQ fluids, and her breath has improved immensely, as has the gingivitis. She is cold all the time, pulse is a bit wiry, but empty. she is having some gagging/coughing problems right now, nothing too serious, but it makes me think of Kid Yang not grasping Lung Qi? Her tongue is red/purple underside, top is pale red. Her appetite is good.

Active points are BL19, 20, 23,52. Is there anything in addition to Rehmannia 8 you would give? She had another episode of incontinence - this seems to stop with antibiotics, even though we cannot culture bacteria.

She is maintaining her weight better on SQ fluids as well. Thoughts?

Tracy

by naturevet

February 7, 2011

Hi Tracy,

I've added Wu Wei Zi and Huang Qi to Rehmannia Eight. If there is an infectious component, those two will help. In addition, HQ is shown to be effective in improving renal function in humans.

Lastly, you can try a higher dose of herbs. Continue the fluids, and make sure she has adequate protein in her diet.

If you still don't get anythere, and BL 19 helps a lot, perhaps you need to use both Rehmannia 8 and XCHT + QJ. Or Rehmannia 8 plus SRT if she's Damp. But I'd try the WWZ and HQ first.

Steve

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