This is a 12 year ild beagle mix female spayed . two year history of recurring bouts of panting , restless , ravenous, vomit bile, frequent urination-accidents in house. Two years ago she was worked up- low dose dex negative , liver enzymes elevated-alkphos 256, alt 685, ggt 18, chol and platletr normal, multiple urine cultures negative, ultrasound liver- with biopsy multifocal mild glycogen like hepatocellular vacuolization -compatible with glycogenosis of steroid hepatopathy or idiopathic vacuolar hepatopathy.He was also told the ultrasound of the bladder showed thickening of the urethra, they tryed amitipitlyine and antibiotics but the problem cycles back no matter what they do. The owner changer the diet to an all vegetarian diet and the symptoms imporved significantly for 6- 8 months. He has found that changing food will set off an episode but it can occur with out a diet change. The dog lives betwwen him and his ex wife, they live close but share him.
I started to see him in January end of. Sweet, active with T= lavender , big little dry, pulse + wiry litlle thin ,
GB 34 softens wiryness
storm anixety-shakes and hidesin closet
energy good, appetite ravenous when urine symptoms return, then normal appetite when urine is ok again.
At one point owner thought exercise or increased activity brought on the episodes, but last one not associated with activity
They dont want acup dt $$$ , Blood Alkphos had increased to 719 , alt 359. rest normal I started on XCHT < GEI Xiao ZHu Yu Tang 50:50 mix and cantharis, then he had bad episode over weekend 3 days after starting this and went to the emergency clinic ,they couldnt culture the urine because he went on the floor , so they stated clavamox and he improved in 24 hours I ran a culture 1 week after he was off which was negative.
Added probiotic for diarrhea from antibiotic
While on the antibiotic he had an episode that resolved without any changes to meds.
3 weeks later I changedmix to Si Maio San /Gei xiao Zhu Yu Tang 50:50 mix. repeat urine culture negative , U/A normal sg 1.035
improved urination freq, but still ravenous, vomiting ;added milk thistle 400 mg daily, increased si maio san to 70 % and gei xiao zhu yu to 30 % and increased does to 1/2 bid., off antibitics seemed to do well for a few weeks.
Then he was leaking urine where he slept not staining, still ravenous, added small dose sou Quan wan . Then she stopped urinating , vomited and had a episode of collapse in the yard , down for 30 sec then ok. we stopped all meds for two days , exam normal except lethargis-repeated blood- Liver improved- alkphos 589 from 719 and but alt is 446 was 359. rest normal.
two days recovered well and looked normal changed mix to . Mix: Schisandra compound 10% Sia maio 40% Gei Xia Zhu Yu 30 %, added Hepatrophin pmg and milk thistle for liver . Did great for 10 days , no symtoms at all.
Then started Freq urination vomited blie, ravenous , urine can be small freq orlarger amts. still active alert. not temp preference
pulse has stayed wiry, tonuge lavender little dry. Seems like she cycles no matter what we do. The obvious thought is cushings disease= damp heatI. suspect she has been precushing for a while and this would connect her liver with the urine signs but the signs are so inconsistent ? The alkphos has been reducing so we are making some progress but the alt is up (446). The owners are fed up dont want to run any more tests . I put her on urinary support formula today .
I was thinking an obstruction in the middle jiao with damp heat draining down. I also considered Heart heat leading to bladder signsand considered Dao Chi San .
What do you think any herbs or direction ???