Primary complaint is PLN with elevated blood pressure. For the last 2 weeks, he has been ADR, occasional vomiting and in the last 48 hours chronic vomiting and lethargy.
He also has a history of seizures (no meds, resolved w/ acup), skin allergies and itch (hot spots, ear infections, pododermatitis, yeast; tx: Apoquel), anaplasmosis (+) and elevated amylase.
Current diet is formulated by a veterinary nutritionist at Missouri - 75% white potato, 25% chicken, duck fat, hemp seed oil and a multi-vitamin/mineral supplement from Balance It.
I started seeing this case on 2/21/18, a little over a month ago.
I have lots of history and can fill in but thought I'd cut to the chase. Based on his 2/10/18 lab results (bp, UP:UC, BUN, Cr, P) I started him on XCHT (1500mg BID) and SRT (1500mg BID). His BUN, Cr have gone up and after about 2 weeks on XCHT/SRT, he started to get worse clinically.
Blood work 3/22:
Cr 3.6 (range 0.5-1.5)(hx: 2.8 - 2/10, 3.2 - 12/6)
SDMA 21 (range 0-14) (hx: 22 - 2/10, NA - 12/6)
BUN 52 (range 9-31) (hx: 40-2/10, 38 - 12/6)
Amylase 1891 (range 337-1469) (hx: 1527 - 2/10, NA 12/6)
BP sys 142, dia 103, MAP 111 on 3/21
(FYI, TT4 is 1.8, range 1-4)
While on a raw diet in July 2016 is UP:UC was 2.2, which was the beginning of his PLN diagnosis and treatment. 1/31/18 his UP:UC was 4.1
Enalapril 10 mg
Amlodipine 5 mg
Apoquel 16 mg
Had been on Si Miao San until 2/21 when I switched him to Xiao Chai Hu Tang and San Ren Tang.
Of course, it seems he's gotten worse when I switched him from SMS to XCHT/SRT. Is this simply a matter of going back to SMS and rechecking blood work? At this point, I've d/c'd the XCHT/SRT. Looking for any insights, comments, suggestions, things I should pursue.