I am seeing a 12 yr FS yellow lab with a history of vaginal strictures, pollakiuria and incontinence. 7/2000, 4/2004, 3/2008, 3/2009 urinary frequency increased, and the stricture was digitally reduced and signs resolved. In 1/2009 I referred to a surgeon, who visualized the stricture as mild, cranial to the urethral papilla, and did not think in that location it should be causing these clinical signs. He reduced it with a mucosal incision and signs resolved. The dog was seen at a local veterinary university by a DVM specializing on repro, who identified isothenuria, negative culture, and prescribed DES for TDx for estrogen-responsive vaginitis. DES has had no effect according to the owner. Additional history includes a cutaneous MCT excised from the left hock and irradiated, and recent development of mild mitral and tricuspid myxomatous valve degeneration. The dog has eaten raw/home-prepared food for many years, balanced and supplemented. Herbs for the last 2 months: Marsden's magical MCT formula, Si Miao San and Tian Wan Bu Xin Dan.
The dog leaks urine approx 2x/week, and urinates up to 5x in a 20 min walk. The owner feels the abdomen is "drooping"-normal abdominal palpation and muscle tone on exam. Tongue has a red underside, is swollen but retracted in the mouth, dark lavender center, very wet. Pulses are a normal rate, depth and rhythm, Spleen sl deep, slightly wiry. I did not appreciate any active acupoints.
MY TCVM dx-Spleen Qi deficiency (retracted tongue, weak pulse, poss weak muscle tone/urethral function) with Damp (wet tongue), Heart Yin-Blood deficiency (red tongue,murmur), with stagnation (tongue color, hx of tumors, stricture). Now has Kidney Yin (Qi) deficiency-isothenuria, incontinence, pollakiuria, Spleen not replacing Jing, Heart Yang not descending, aged).
I would like to know if you think replacing Si Miao San with San Ren Tang, or the K'an formula combining Suo Quan Wan/Sang Piao Xian Wan would help the urine leaking and frequency. Also, would you please comment if my dx is off?
Thanks,
Jodi