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Dog With KIDNEY Issues

by rmtran - March 14, 2010

Hi Steve,

I have a friend's dog (14.5 years old FS Mix) that has an early stage of renal insufficiency.
She also has a severe hip dysplasia that are managed only with Tranadol right now.

Her tongue is reddish at the tip, somewhat dry overall, and paler at the back. Her pulse is deep, surprisingly strong.

Her drinking has increased despite of improved renal values using Purina NF diet and Azodyl. She prefer cool, hard surface. She also is on DES for urinary incontinence. Her right hind shakes constantly when she is standing.

The friend elected not pursuing FHO option due to her age (15 years old soon). She is fairly active for her age, although I feel crepitus from CF joints when she moves.

I see KID Yin Deficiency with false heat, and Stagnation. I also see some Shen disturbance (she became timid).

My first selection is Zhi Bai Di Huang, but it does not have much moving effect like I want. Would you suggest combining it with XCHT (or even XCJLGMLT), since she has deep pulse?

Thanks for the advise as always!

Rieko

by naturevet

March 15, 2010

Hi Rieko,

The heat signs you're seeing all seem to be in the upper burner (Heart), causing the red tip and pale tongue root. The tongue, in other words, suggests a Heart Kidney disconnect, where the Heart Yang is not descending to the Kidney, and is thus preventing a steaming of Yin that, in turn, allows the Heart to get hotter.

Ba Wei Di Huang Wan is a good formula for this scenario, and will cool the Heart while warming Kidney Yang and tonifying Yin.

My only concern in going that route would be the wiry nature of the pulse. Some Kidney Qi or Yang deficient patients have that, associated with coldness in the lower burner, but otherwise I would wonder if there is a Wind invasion on top of the Kidney signs. In that case, I'd wonder about Du Huo Ji Sheng Tang, which nourishes Yin, Qi and Yang, and so covers all our bases. If you put a needle in BL 40 and sedate it, and the pulse improves, I would try DHJST.

Hope that helps!

Steve

by merrimandvm

April 14, 2010

Hey Steve,
Just wanted to give you an update on this case. Rieko did the initial TCVM workup and I have since been managing the case. The patient has been on DHJST for the better part of a week or so. The owners have since noted that the patient is now preferring to be outside at all times(day and night) if possible and that she seems generally restless/unsettled at bedtime. She continues to prefer hard/cool surfaces. I am not sure if the weather change has something to do with her preference for outdoors of late as the beautiful spring weather has arrived in North Carolina. The owners are worried this is a direct relation to the herbs. On our exam yesterday I felt the patient had deep/wiry pulses, they actually were more readily palpable to me than they have been in the past. In regards to her tongue it appeared generally lavender to pink in color with moderately full body and a slight white film mainly in the central region. She continues to demand her nightly walks despite extreme hip dysplasia although the owner states that since starting the herbs she seems to be defacating earlier in the day as opposed to on her nightly walk around 7 or 7:30. Owner states stool consistancy is still formed although she is not eating her food with quite as much zest since the herbs have been added. If you have any input on the matter it would be appreciated.
Thanks,
Matthew

by naturevet

April 14, 2010

Hi Matthew,

It sounds like there may be a Damp Heat element to things that weren't originally apparent. That would create the slight reduction in appetite, earlier stool, and increased Heat in response to the tonics in DHJST.

Given the above, what I would try is cutting back on DHJST (but not stopping it yet) and rolling in San Ren Tang (Three Seeds Combination). It should normalize these various symptoms, as well as potentially improve the animal's strength. If it does, then Yi Yi Ren Tang might be a better choice for the dog when it comes time to refilling.

Good luck with the case!

Steve

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