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Chronic Small Bowel Diarrhea

by ericahawker - May 18, 2009

4 yr old MN German Shepherd with chronic loose stools since puppy--Small bowel diarrhea. No weight loss. Great appetite, normal thirst.

Hot animals--prefers cold floors, won't lie in the sun, restless at night.

Recently changed performed GI panel from Texas A & M and found low cobalamin and folate. On cobalamin injections every 2 weeks. Was having more formed stools until recent flare-up. Responds to metronidazole but recurs once off of it. He is also on iFlora probiotic.

Very healthy dog otherwise with no other med probs except panosteitis as puppy that responded to Standard Process Musculoskeletal support. Currently eating Solid Gold Bison. Would raw be a better choice for him or home-cooked?

I think he is yin deficient and am considering Zhi Bai Di Huang Wan.

Just wanted to let you know that I love having this forum! The information is invaluable to me and my clients and really helping to advance my TCM practice. Steve, thanks so much for all of your time and expertise.

Erica

by naturevet

May 18, 2009

Hi Erica,

I'm glad you like the Forum. Soon I'll expect you to be answering questions, not asking them!

The dog certainly sounds like a Damp Heat case. We'd expect a classic Yin deficient dog to be both hungry AND thirsty, and to be losing weight. With Damp Heat animals, we commonly see, of thirst and appetite, only one of them increased and the other normal or even decreased.

Certainly the response to metronidazole suggests the need to clear Heat. I guess if nothing works out herbally, there's always Tylosin!

Si Miao San and San Ren Tang are somewhat interchangeable here. I take it fecals are negative. SRT might be a bit better for small bowel involvement.

The only other major option is Huo Xiang Zheng Qi San. This is especially helpful if you suspect a chronic bacterial enteritis (e.g. Clostridia etc.). If the dog was going to benefit from that, it might actually do a little worse on SMS, as mentioned in the last module of the herb course. The reason why is that SMS has an anti-inflammatory effect on the mucosa and pulls blood away from it. In the event of an infection, you actually want better perfusion, especially to combat anaerobes. HXZQS provides that better perfusion.

Remember that to find out of the latter is indicated, you can 'sedate' BL 40 and see if the pulse moderates. Normally, with an enteric pathogen like that calling for HXZQS, it would be deep and wiry. San Ren Tang is sort of a happy medium between the two. It is aromatic and improves gut perfusion, but also anti-inflammatory. So it maybe the safest choice to start with.

Good luck!

by ericahawker

May 18, 2009

I thought the chronic diarrhea is damp heat, but overall his body condition, behavior, etc does not seem like damp heat to me. So good lesson learned.

Yes, floats have been negative. Fecal directs and cytologies have shown flagellates most recently, but clostridium has been present before.

I will try the San Ren Tang.

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