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Primary GI Disease Of Unknown Etiology In A Dog

by Lewter - March 20, 2016 View Case Report

Submitted by Lauren Robinson, Senior Veterinary Student, on external rotation with Dr. Lewter.

Clyde was presented to the teaching hospital at Virginia Tech on Feb 4th, 2016 for mixed bowel diarrhea with hematochezia, vomiting, weight loss, and a soft cough.

Extensive tests were run on Clyde, including routine blood work, abdominal ultrasound, endoscopy, FNA of stomach and lymph nodes, etc.

Notes from his SOAP recorded at VT indicated:

CBC:
-anemia (moderate, regenerative, normocytic, hypochromic);
PCV: 28.1%
-mildly decreased plasma protein
-otherwise unremarkable

Chemistry Profile:
-hypoalbuminemia (1.4)
-hyperglobulinemia (3.9)--suspect falsely lowered if blood loss is present
-hypocholesterolemia (115)
-hyponatremia (137)
-otherwise unremarkable

Urinalysis:
-largely unremarkable (USG 1.024)

Thoracic Radiographs:
-normal

Abdominal Ultrasound:
-markedly thickened stomach wall and intestinal walls with occasional loss of layering
-moderate abdominal lymphadnenomegaly
-mild peritoneal effusion

Fecal Flotation (ZnSO4):
-negative
-negative

Fecal Cytology:
-normal; multiple inflammatory cells noted

Fine Needle Aspirates:
-stomach: pyogranulomatous inflammation vs. neoplasia; final results pending
-abdominal lymph nodes: pyogranulomatous inflammation vs. neoplasia; final results pending

Giardia SNAP: negative

Clyde was started on Vitamin B and Iron supplements, as well as a number of herbal treatments including Slippery Elm, Xue Fu Zhu Yu Tang, Bu Zhong - central Qi Tea pills, electrolyte solution, probiotics, and coconut oil.

Owner has been giving him EnzymeDiane brand Pancreatin Enzyme powder supplement which comes in 6X and 8X strengths. I believe the owner is giving the 6X strength, with composition of:

Food Grade Pancreatin 6x Digestive Enzyme Powder
Example of Potency: Reevaluate August, 2017
Protease: 456,400 USP/2.8 grams
Amylase: 462,000 USP/2.8 grams
Lipase: 64,120 USP/2.8 grams

Clyde has begun to gain some weight - 2 pounds gained from the beginning of March to 3/17/16.

Question: Have you all had patients with such severe weight loss and muscle wasting, with protein-losing enteropathy that you've treated successfully? Clyde is a fairly young dog, and diagnostic tests were inconclusive as to the etiology of his GI issues. Even though there appears to be some improvement with the addition of enzymes, how likely is continued progress if there is a malabsorptive component?

Also, have you treated dogs with similar condition with additional or different herbal treatments and acupuncture (I will include points stimulated shortly) than we have used?

Thank you all, and feel free to contact me if I can provide any more details.
Lauren R.

by Lewter

March 20, 2016

I'm also perplexed at the addition of the Pancreatin product (http://www.enzymediane.com/) because his TLI reported normal exocrine pancreatic function (9.0ug/L with reference range 5-35ug/L, and TLI values less than 2.5ug/L support a diagnosis of EPI). Although I'm aware that the inflammation present, or possible neoplasia, could be elevating the TLI results, has anyone seen it elevate into normal? I'm glad it seems to be helping him in conjunction with the herbal treatments and acupuncture, but is this likely to solve the problem without a diagnosis of EPI? Thanks!

by Lewter

March 20, 2016

The major therapy for this [patient has been acupuncture, Bu Zhong Yi Qi tang, and two treatments of Microbiome Restorative therapy, which resulted in stopping the diarrhea and vomiting. He became ravenous for food and has started gaining weight. i will see him this week and add an update. Owner is inquiring about Tylan therapy which seems like it would counter the success of the MBRT so I am resisting going down the tylan road.
Dr Lewter

by naturevet

March 22, 2016

Hi there,

Looks like a tough case you have there, but you're making good headway it would seem.

The pancreatic enzymes, as proteases, may be helping by being anti-inflammatory. The inflammatory cytokine cascade makes liberal use of proteins in its operation. Proteolytic substances (e.g. Papain, Bromelain) have long been used to interfere with the cascade, and the proteases in the supplement may be acting similarly. I would wonder, then, if your success thus far implies the gastric lesion is inflammatory, rather than neoplastic.

Tylan may mess the case up, if this is a Spleen Qi deficiency case. So I would hold off on it for now. The benefits of BZYQT and the thickening of the gastric wall do give me another idea, however. Liu Jun Zi Tang (Six Gentlemen) seems relatively specific for gastric adenocarcinoma, and can support the Spleen (and GI) in general. So I'd be curious to see if he would be better still on that formula. It also drains Damp, and so might address that effusion.

Two other ideas if we're pretty certain that the lesion is not cancer, and that we've seen work in lymphedema with PLE:

Wei Ling Tang

Du Huo Ji Sheng Tang (surprisingly!)

Hope some of that advice helps you. I think you could go far with this dog. Best of luck!

Steve

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