Welcome to Acu in Practice! This week I am featuring the 3rd and final phase of Coors the cat’s journey with chronic renal insufficiency and the aging process. This last phase was just under one year and while it was the toughest for both Coors and his owner, it was also filled with many special final moments. He was able to maintain a quiet, comfortable quality of life until he began experiencing severe mentation changes.
Phase 3 symptoms/signs included:
Progression from Phase 2, but without symptoms of pancreatitis. Increased vocalization, wandering, acting hungry but not eating the food! Dry skin and brittle coat. Noticeably heat seeking. Stiff, slow gate with general muscle atrophy and continued weight loss. Sleeping even more than usual.
Pulse: scattered (a progression from weak that indicates source Qi and Essence are in decline)
Tongue: pale, dry
Western Diagnosis: IRIS end stage renal insufficiency, anorexia/cachexia, arthritis
TCM Diagnoses: This phase is broadly characterized as Source Qi/Essence Deficiency/Global Yin deficiency, Heart –Kidney Disconnect with Shen Disturbance. How do you treat all of that??? I find it helpful to break down the signs into their organ/substance specific patterns in order to form a workable treatment plan. When treating Coors focused on the following patterns: Kidney Yang and Yin deficiency, Spleen Qi Deficiency, Heart and Liver Blood Deficiency, Shen disturbance, Stagnation in the Channels (Bi and Wei).
TCM treatment principles: Nourish Kidney, Nourish Qi and Yin, Tonify Spleen, Nourish Heart and Liver Blood, Calm the Shen (Spirit), Clear Stagnation in Channels.
Acupuncture plan:
*as the aging patient becomes deficient in Source Qi and Essence, they will become deficient in all substances and functions of the body. In this phase I choose a few points and use the points I feel will make the patient most comfortable.
BL 23, GV 4, Lumbar BH – Tonify Kidney and relieve stiffness/soreness in hind end due to arthritis.
ST 36, SP 6 – Tonify Qi and Blood, Harmonize Digestion, (SP 6 – Yin)
BL 18 – nourish Liver Blood and relieve stagnation in the Channel
PC 6 – Calm the Shen, provide relief if nauseated, Harmonize Digestion
Herbs: Declined
Food Therapy: Whatever we can get him to eat, always warming the food.
Western Treatment: Azodyl®, aluminum hydroxide/Epakatin when eating, Subcutaneous Fluids – every other day to daily.
Coors lived a long, happy life and survived renal disease for longer than the average cat that presents in IRIS stage 2b by over a year. More importantly, he lived a high-quality life for the 4 years of treatment. He had a strong bond with his humans and when he was no longer able to live comfortably, they chose to euthanize him humanely and peacefully. In each patient’s life there comes a time when they are depleted in the substances that make life an enjoyable, sustainable process. For some patients, letting go comes naturally and with others the decision to help them along is the final, compassionate treatment that can be provided.
This post is created by Nell Ostermeier, DVM, CVA, FAAVA and is intended for informational use, not to replace medical advice.
