Tuesday, June 24, 2014

Management of Kidney and Bladder Disorders with a Combination of Western Medicine, Acupuncture and Chinese Herbs

Disorders of the kidneys and bladder are very common in veterinary medicine. Urinary tract infections, chronic kidney disease, urinary incontinence and feline lower urinary tract disease are often the reason our pets are taken to the veterinarian. In Western medicine, these problems are often divided into acute and chronic conditions. Traditional Chinese Veterinary Medicine (TCVM) describes them as either Excess or Deficiency Conditions. In the following article, I’ll discuss acute kidney and bladder conditions, chronic kidney conditions, urinary incontinence, and FLUTD (Feline Lower Urinary Tract Disease).

Kidney and bladder disorders are perfect examples of the synergism of Western and Eastern medicine.

The most common acute problem we see in veterinary medicine is bacterial infection of the kidneys and/or bladder. Similar to people, we often see dogs with bladder infections with a bacteria called E. Coli. This infection is more common in female dogs because their shorter urethra makes it easier for bacteria to get into the bladder than in male dogs. In dogs, kidney infections are also sometimes seen due to a bacteria called Leptospirosis. Acute urinary tract infections are best treated with conventional Western medicine such as antibiotics, pain relief medication and increasing fluid intake. If the infection recurs, or seems resistant to therapy, other tests may need to be done. These can include urine cultures to identify resistant or multiple infections, X-ray and/or ultrasound exams to identify bladder stones or tumors or assessment of the prostate in intact male dogs for prostatitis (inflammation of the prostate). If any underlying problems are found, the appropriate medical or surgical procedures will need to be performed before the urinary tract infection will resolve.

The most common non-infectious acute problem is accidental poisoning to due ingestion of human medications or automobile antifreeze products. Both of these will cause severe acute kidney failure. Treatment involves hospitalization for three to five days on high rates of intravenous fluid administration and medications to protect the kidneys while the toxin is being eliminated from the body. In rare circumstances, referral to the veterinary school for dialysis is necessary.

Chronic kidney disease, formally known as chronic kidney failure, occurs when damage to the kidney results in an insufficient amount of healthy tissue remaining to remove waste products of normal metabolism from the blood. As these waste products build up in the body, animals and people feel nauseous, lose their appetite, become lethargic and get dehydrated. The loss of kidney tissue can result from chronic infection, congenital birth defects, physical damage, toxins as described above and aging changes, especially in older cats. Conventional treatment includes long-term fluid administration (including giving fluids under the skin at home), anti-nausea drugs, medications to control phosphorus levels and high blood pressure and special “kidney preserving” diets. These treatments often need to be given for the remainder of the pet’s life.

In Traditional Chinese Veterinary Medicine (TCVM), chronic kidney disease can be due to either Kidney Yin or Kidney Yang Deficiency. Yang is the warming “energy” of the body, so pets with Yang-Deficient kidney failure are often cold, have low energy, and since the Kidney System in TCVM controls the hind end of the body, these pets are often weak in their back legs. TCVM treatment includes acupuncture points to stimulate Yang, nourish the Kidneys, strengthen the back end, warm the body and promote appetite. Warming, Yang-nourishing herbs are used, as is a warming, Yang-nourishing diet.

Yin is the cooling “substance” of the body, so pets with Yin-Deficient kidney disease “run too hot”. Seen more frequently in dogs than in cats, these are the pets that pant a lot, tend to be up frequently at night needing to urinate, and often seem agitated and uncomfortable. Treatment includes the same Western methods as described above, but this time with the addition of acupuncture and herbs to help cool the body, stimulate Yin, nourish the Kidneys, and reduce anxiety. A cooling, Yin-nourishing diet is also used.

Urinary incontinence, most often seen in older female dogs, results from a weakening of the neck of the bladder, allowing the outflow “valve” of the bladder to remain slightly open, especially when at rest. This allows urine to leak out, and these dogs often wake up with a puddle of urine in their beds. This is often treated with a drug called Proin quite successfully. For those dogs which suffer side-effects, or in which Proin is no longer effective, or for male dogs, acupuncture and herbs can be very effective at resolving the incontinence. In TCVM, urinary incontinence is due to Kidney and Bladder Qi Deficiency. Like Yang, Qi is energy, the force behind bodily processes. When Kidney or Bladder Qi is deficient, the body lacks the energy to hold the urine in the bladder. Acupuncture points for Qi stimulation, nourishing the Kidneys and strengthening the bladder are used. There are also Traditional Chinese herbs and foods that help strengthen Kidney and Bladder Qi.

Feline Lower Urinary Tract Disease (FLUTD) is a chronic inflammation of the bladder in cats resulting in irritation, pain, urgency to urinate, crystal formation in the urine, and in males, urethral obstruction. It is similar to Interstitial Cystits (IC) in people. There is no one specific cause, and genetics, diet, infection, stress level and lifestyle all seem to play a role. Western treatments include increasing fluid intake, special diets, antibiotics only if there is infection present and medications for bladder pain. Of the five Primary Chinese Pathogens, an Excess of two, Dampness and Heat, are present in the bladder with chronic inflammation. There are very specific acupuncture points for draining Dampness and releasing Heat, as well as points for strengthening the bladder and relieving pain. Traditional Chinese herbs are also used. A cooling diet is fed to help further release Heat, and Damp foods are avoided.

Many of these conditions are never going to be completely cured as a simple acute urinary tract infection may be. For these chronic conditions, incorporating both conventional and Chinese Medicine into the treatment plan can provide relief of symptoms, increased comfort and an improved quality of life for many years.

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