Difficulty Treating Canine Diabetes Insipidus
Ceasar presented as a 10 year old neutered male white German Shepherd dog with nephrogenic diabetes insipidus. Central diabetes insipidus is caused by reduced secretion of antidiuretic hormone (ADH). When target cells in the kidney lack the biochemical machinery necessary to respond to the secretion of normal of increased circulating levels of ADH, nephrogenic diabetes insipidus results. Affected animals excrete large volumes of hypotonic urine and drink equally large amounts of water (Aiello, 1998).
Ceasar was diagnosed with nephrogenic diabetes insipidus when he presented to his primary veterinarian with increased urinary frequency (polyuria, pollakiuria) and urinary incontinence in his home. Biochemical tests showed no decreased kidney function that would be seen in primary renal failure. Urinalysis revealed urine of extremely low specific gravity with no evidence of inflammatory cells, infectious pathogens, or glucosuria which ruled out inflammatory disease, infectious disease and diabetes mellitus. Unfortunately for Ceasar, treatment with conjunctival desmopressin, a synthetic analog of ADH, yielded no change in polyuria. Not only was the desmopressin treatment a final test to indicate that Ceasar had diabetes insipidus, his lack of response meant that there was no western biomedical treatment available for his disease.
Ceasar presented to me as a calm, handsome, biomechanically normal appearing German Shepherd dog in disposable baby diapers. His caretakerís primary complaint was urinary incontinence and restlessness. Ceasar had a red somewhat dry tongue with little coat. His nose was warm and dry. His ears were very warm adjacent to his scalp and slightly warm on their tips. Ceasar had rapid, somewhat thin and forceful, pulses bilaterally. He had depressed Back Shu points at Gan Shu (UB 18), Wei Shu (UB 21), and Shen Shu (UB 23). Orthopedically, he was completely sound with no reduction in flexion and extension of his joints or joint pain. His caretaker claimed that he was cool-seeking and restless, especially at night. He panted throughout the day and seemed to be uncomfortable or unable to rest for long in one place.
Ceasarís TCVM Bian Zheng or Pattern Differentiation included Kidney Yin Deficiency with False Heat and possible Kidney Qi Deficiency. Kidney Yin Deficiency is seen with the dry, red tongue; warm, dry nose; warm ear tips; rapid and thin pulse and night-time restlessness. Kidney Qi Deficiency is seen with frequent, prolonged urination and urinary incontinence.
Ceasarís treatment plan was formulated to treat both the Biao (branch) of urinary incontinence and the Ben (root) of restlessness due to Kidney Yin Deficiency. He was treated with acupuncture only twice, two months apart due to client financial limitations. The treatments reduced his incontinence approximately 40% and the client claimed that he was perhaps a little less restless.
Ceasar was treated with Suo Quan Wan (Shut the Sluice Pill) to warm the Kidneys, dispel cold, shut off urinary frequency and stop leakage. Suo Quan Wan is commonly used to treat Biao (branch) clinical signs of urinary incontinence in veterinary medicine. Although Suo Quan Wan (Shut the Sluice Pill) reduced urine dripping, it had almost no positive benefit with respect to Ceasarís urinary frequency for two major reasons. First, from the perspective of western biomedicine, Ceasar was urinating frequently due to his bladder filling rapidly with hypotonic urine from kidneys unable to recover filtered fluids back into the bloodstream. This is a simple mechanical truth. From the perspective of TCVM, Ceasar had a predominant pattern of Kidney Yin Deficiency with False Heat and Suo Quan Wan is a warming formula with warm and pungent Yi Zhi Ren (Fructus Alpiniae Oxyphyllae), and pungent, warm Wu Yao (Radix Linderae Strychnifoliae). Warming remedies are mostly, although not always, contraindicated in patterns of Yin Deficiency.
Ceasar was also treated with Zhi Bai Di Huang Wan (Anemarrhena, Phellodendron and Rehmannia Pill) for Kidney Yin Deficiency with vigorous fire. His response to this herbal formula has been about a 50% reduction in restlessness. His caretaker has also been instructed to add Yin-tonifying and Cooling foods to Ceasarís diet for TCVM Food Therapy.
In a final effort to help Ceasar secure his essence, Jin Suo Gu Jing Wan (Metal Lock Pill to Stabilize the Essence) has been prescribed. He has only begun using this formula, so it is too early to report results. However, Jin Suo Gu Jing Wan stabilizes the Kidneys and binds the essence in cases of spermatorrhoea and urinary incontinence. Sha Yuan Ji Li (Semen Astragali Complanati) tonifies the Kidneys, benefits the Jing and stabilizes the gate of essence. With the other cooling herbs in this formula, it is possible the Ceasarís nephrogenic diabetes insipidus clinical signs will be palliated enough to increase his quality of life.
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