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Recurrent Cystitis/mass

by LJH - January 14, 2010

Hi Steve,
I've just seen a 12yr F(S) Cavalier King Charles Spaniel with a many year history of episodes of cystitis that ususally cleared with antibiotics. Bladder stone removed in 2006 and fed Medi Cal Preventive since. Last urinalysis showed a few calcium oxalate crystals . Dog has a Grade 3-4 heart murmer but no cough etc and no meds.On glucosamine for severe hip dysplasia. Lots of signs of Damp/ Damp Heat including recurrent otitis, very full anal glands needing expressing,snoring, reverse sneezing, eructation, flatulence and borborygmus, ropey saliva.Usually great appetite, moderately overweight.Abdomen is quite rounded though NAF on palpation.Haircoat drier, small flake dandruff (more Blood def.). Occassionally goes off food for a couple of days which alerts owner to check for another UTI. Bloody urine a week ago with no straining or increased frequency. Drinking more and larger volume med yellow urine. Generally avoids heat,likes to sleep on tile floor and can't be covered up on the bed.Reg vet started on 6 wk antibiotics and did ultrasound.Showed very small lumen with mixed echogenic thickened bladder walls and tissue extending into lumen. Suspected tumor but no biopsy. Can't ruleout assoc. with chronic inflammation.Tongue a bit pale, slightly flabby, very thin white coat, sl. dry.Pulse weak, a bit thin and sl. slippery. Was considering Si Miao San or even Hydrangea and Eupatorium but with suspected mass wondered about Wu Lin San or Shao Fu Zhu Yu Wan. Bleeding has already stopped on Antibiotic. Any thoughts would be appreciated. Thanks,
Llewanda

by naturevet

January 15, 2009

Hi Llewanda,

I'd probably try two formulas at once here - Ge Xia Zhu Yu Tang for moving and cooling Blood, and San Ren Tang to address the Damp Heat accumulation. Feeble slippery pulses still indicate an overall need to disperse, rather than astringe, at the bladder mucosa (and skin). So SRT is better for that than SMS. It is also quite effective at eradicating CaOx crystals. Meanwhile, GXZYT can get to work on the tumor aspects of things. If the animal were colder and weaker, then SFZYT would be a better call.

Another Blood moving option would be the Dispel Stasis from the Bladder Combination in the Kan Veterinary Essentials Line. It would be what I would use if the animal needed tinctures or pills only (since SRT is also available in that line).

Good luck!

Steve

by marneemadsen

January 18, 2010

Steve,
Does the feeble part of this slippery pulse here indicate deep, and that is why dispersal?

Thanks,
Marnee

by naturevet

January 19, 2010

Hi Marnee,

What I've observed is that a superficial slippery feeble pulse still indicates a need to disperse, and perhaps tonify as well. We can look at it as a compromised peripheral blood flow that isn't as robust as it should be, and is in need of additional prodding by tonics, aromatics, or both.

Steve

by LJH

March 15, 2010

Hi Steve,
This little dog, 1 week after stopping 6 wk antibiotics, had cystocentesis urine culture showing no bacteria. One week later she had hematuria again with tiny clots in it. No straining, increased frequency etc. Regular vet repeated ultrasound. Bladder looked OK, no thickened wall, no apparent mass so they figure was related to chronic inflammation not tumor. On first ultrasound kidneys maybe small but no noted abnormality, on 2nd is dilation of left renal pelvis suggestive of pyelonephritis.She has also had an episode of unilateral facial paresis/paralysis with drooping lower eyelid, lip, dropping food and saliva out side of mouth but no affect to pupil or 3rd eyelid. Apparently has had a couple of these in the months before I started seeing her. Ears seem OK .Regular vet recommends seeing specialist for pyelocentesis but with dog's heart murmer owner reluctant to have sedated, so they have opted for another 6 wk antibiotics.I would like to see how her kidney function looks on a geriatric panel. Urine SpG has been low for a while but BUN/Creat was good when last checked. From a herb point of view should we discontinue the Ge Xia Zhu Yu Tang and just continue with the San Ren Tang for her Damp Heat. Also if continuing SRT how much can a 28lb dog go up to dose wise. I had started her on 1/4 tsp per 10-15lbs divided BID. Any other thoughts would be appreciated. Thanks again,
Llewanda

by naturevet

March 15, 2010

Hi Llewanda,

GXZYT can probably be stopped, if there are no signs of tumors. How are the GI signs? Have they improved on SRT? If so, we should continue it. At that weight, probably a half tsp BID.

As well, we may want to look at BWDHW. It is Damp draining, but helps improve the blood supply through the pelvis, improving immune support. I've had several animals do well on this combination.

Lastly, if the culture shows E. coli, cranberry concentrate can help prevent re-infection if that is a problem. I just use about a third of a human dose for this size dog.

Hope that helps out! If the GI signs are persistent or worse, let me know before starting the BWDHW. Otherwise, it's a go!

Steve

by LJH

March 15, 2010

Hi Steve,
The eructation, flatulence and borborygmus haven't resolved but have improved. Appetite good.Last culture was E. coli sensitive to almost everything so will try the cranberry concentrate. Regarding the BWDHW increasing blood supply of pelvis and improving immune support, when I looked back through her labwork I see last year she had protein in her urine as well as the low SpG,good BUN/Creat. and has never had any casts. Is there any concern of increasing inflammation with the increased renal perfusion. Thanks,
Llewanda

by naturevet

March 15, 2010

No, it should be okay. The only time we expect that kind of aggravation is when the animal has glomerulonephritis. But pyelonephritis cases often respond well to Rehmannia based formulas, even Rehmannia Six or Yi Guan Jian.

S

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