Question Details
Colitis With Anemia And Elevated Liver Enzymes In A Dog
by LJH - August 18, 2018    View Case Report
Hi Steve, I’ve started seeing a 4yr M(N) Mastiff that had bloody diarrhea starting in Mar./18 unresponsive to metronidazole, Tylan,salazoprin, Baytril. Improved on high dose prednisone but continued having watery diarrhea. Endoscopy and biopsies diagnosed plasmocytic Colitis. Several diet changes were also tried and diarrhea improved on hypoallergenic dry. Any reduction in Pred dose diarrhea recurred. Dog did not tolerate pred well, severely PU/PD with episodes of incontinence so about 6 weeks ago rDVM reduced pred dose and added Chlorambucil. Over 3 1/2 months dog lost about 30 lbs. When rescued 3 years ago this dog was significantly overweight but owners had gradually got him down to 156lb which he had stayed at for the 2 years prior to the onset of diarrhea. No digestion issues previously. Did have a Hx of hot spots and otitis. When I first saw him he was emaciated, haircoat a bit dry, waxy ears, bilateral mucoid ocular discharge. Ravenous appetite, gets them up at 4:30-5 am for breakfast, sleeps deeply, snores some, dreams some but not a lot. Tends to be a “hot” dog but will go lie in the sun sometimes. Drinking a lot, large vol med yellow urine.Sometimes mucous and undigested food in stool.Tongue sl. pale pink, moist sl. froth. Not a droopy dog. Pulse superficial, sl weak, sl thin, sometimes slippery other times sl wiry.Bloodwork Alk Phos 3454, GGT increased a bit, ALT 458 SDH 62. MCH was sl low but WBC, RBC and HCT normal. With the dependence on pred but poor tolerance of it, Hx of overweight, otitis, hot spots, mucous in stool, mucoid ocular discharge, superficial sometimes slippery pulse, summertime and very high Alk Phos I started him on Si Miao San very gradually, slowly added probiotics intending to introduce digestive enzymes as tolerated and colostrum. Recommended weaning off Chlorambucil and repeating bloodwork and trying to work to a novel protein homemade diet. I wondered if prolonged Damp Heat had damaged Yin and Blood. Dog seemed to do well, no diarrhea, better energy, eating very well but not getting them up as early, haircoat shiny.Started to put back on a bit of weight. Pulse less superficial more moderate still sl slippery / wiry. rDVM gradually reducing pred to 12.5 mg SID Chlorambucil down to 2 mg SID Owners have gone back to Ontario for several weeks. Repeated bloodwork at rDVM this week showed RBC 4.41, ret 0.3% HCT down to 0.29 WBC # normal but lymphocyte sl low. Alk Phos 1988 ALT 343 Alb 30. He is more hungry again, lost 3 precious pounds again but stools and energy good.. Where to go from here? rDVM has dropped pred to 5 mg and Chlorambucil to 2mg EOD.Add Dang Gui to SMS if diarrhea doesn’t recurr?XCHT with SMS+/- DG ? Have recommended milk thistle .Had been thinking steroid hepatopathy and acute inflammation/ congestion but are we now seeing immune mediated issues as the immunosuppressants are reduced. Your thoughts would be very much appreciated. Thanks again, Llewanda
Replies
by naturevet
August 21, 2018
Hi Llewanda,

You could look at using Zhi Bai Di Huang Wan here, along with the SMS or instead of it. It works similarly, clearing Heat from the Yang Ming and lower burner, but has the Blood and Yin tonification you're looking for. Dang Gui is an option as well, but it can be moistening to the intestinal tract, promoting loose stools again. ZBDHW carries less of that risk, and is specifically indicated for colitis in Blood or Yin deficient animals. I'd give it a try

If you find that at some point, the immune suppressive drugs are low enough that the diarrhea comes roaring back, my next suggestion would be Xiao Chai Hu Tang with Si Wu Tang together. It fits the pulse, as it treats a combination of Shao Yang disharmony and Blood deficiency, both of which can naturally worsen in March. Keep it in mind if you hit a wall with your current strategy.

In the meantime, though, since you've made headway with the Damp Heat approach, keep going. ZBDHW is probably the safest next step to getting that anemia addressed.

Dang Gui added to SMS is your runner-up plan, since it can aggravate hepatic congestive disorders, as well as diarrhea, and so isn't the best thing to lead with.

XCHT and Si Wu Tang together fit everything you've mentioned, so don't sweat it if things go south again. Did the dog get vaccinated at all in January or February?

Steve
by LJH
August 21, 2018
Hi Steve, Thank you so much. I’ll add the ZBDHW and see how it goes weaning off the SMS. I was worried adding DG would flare up the diarrhea, which has been doing so well. I do remember you once said ZBDHW would be much like using SMS with LWDHW. The dog wasn’t vaccinated in Jan or Feb but apparently received a Bordatella vaccine in mid April. Have talked about both diet and vaccine issues for this dog. Will keep XCHT and SWT in mind if things worsen as the pred and chlorambucil are reduced.Thanks again! Llewanda
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