Question Details
Chronic Diarrhea An A Guinea Pig
by j_decubellis - February 8, 2019
The patient is a 3 year old intact male guinea pig who before presenting to me for a second opinion had had a history of chronic soft stool and a cystotomy to remove a large single calculi within his bladder.
Peter has always had and continues to have a very good appetite (which the owner has modified to decrease the incidence of urinary calculi - ie. no alfalfa or veggies rich in calcium). He does receive a Vit C supplement on a daily basis.
Following the initial PE which had overall no significant findings except for the soft, unformed stool (not diarrhea) performed a fecal direct/float and a fecal gram stain.
The fecal float was unremarkable, but Campylobactor (2-5/Hpf) and round budding yeast were noted. He was treated with metronidazole and his soft stool resolved. The soft stool reoccurred the following month and a repeat gram stain showed clostridia (only 5 on whole slide and could be normal commensal so did not treat, but focused on diet as was recommended by the consultants on Veterinary Information Network (VIN) and took off all vegetables only giving hay/pellets for 2 weeks. The soft stool intermittently resolved and then a month later, a repeat fecal gram stain showed campylobactor again. I treated as before and recommended to have a fecal culture performed following this treatment if it did not work. The signs again subsided and then returned.
Unfortunately, in preparing to collect for a fecal culture, Peter again developed a urinary stone and was taken to surgery. The culture was not submitted due to financial concerns.
Peter recovered well from surgery and continues to have a good activity level, normal appetite (veggies introduced again) with persistent soft stool.
He had been on a probiotic before he was initially presented to me and continues to be on one still. I feel his GI flora is very unstable and am hoping you have a recommendation for not only soft stool, but prevention of possible future urinary calculi.
Thank you for your advice in advance (it has always been extremely helpful).
Sincerely,
Julie
Diet is largely raw
Replies
by naturevet
February 10, 2019
Hi Julie,

For a dysbiosis that includes occasional Clostridia being cultured, we use Huo Xiang Zheng Qi San. It is quite an aromatic 'anti-Damp Heat' formula that seems to normalize flora when the appropriate diet is in place. It seems to work quickly, say within a couple of weeks.

It may also have an anti-inflammatory effect that could help reduce nidus formation in the urinary tract, although a shift in the biome itself may also conceivably help with that, particularly if calcium oxalate crystals are involved, at least in providing a nidus.

Supplementation with citrate (e.g. potassium citrate) seems a good idea, too, if these stones have a significant calcium contribution. Finally, feeding dandelion greens and roots has been shown to promote calci-uresis, and can often be found at organic grocers and even Save-On foods.

Hopefully these ideas help. If the stones continue even when the gut is stable, there are other formula options, like Dang Gui Shao Yao San, but I think the calcium citrate supplement and dandelion greens may help a lot

Steve
by j_decubellis
February 13, 2019
Thank you so much Steve! I'll contact the owner, start the treatments recommended and keep you posted.
by mnewk
February 23, 2019
Feed him night pellets from a healthy pig. ala fecal transplant!
by naturevet
February 24, 2019
Great idea!

S
by j_decubellis
February 24, 2019
Transfaunation is a great idea and we have been doing that right along. I obviously forgot to mention that, but we started with cecotropes from her normal pigs on a regular basis (twice a week) since the beginning.
I do have good news! After speaking with the owner, we decided to implement one supplement at a time. Because of the history of stones and the chronicity of the diarrhea, we decided to start the potassium citrate first. Within a few treatments, the feces have been perfectly normal now for the past 5 days. I have not started the Huo Xiang Zheng Qi San yet and figured I should see how long this continues before adding another variable. I've used potassium citrate before for recurrent stones, but didn't think it would effect the diarrhea. Would you hold off on the Huo Xiang Zheng Qi San as well at this point? I'll keep you posted.
by naturevet
February 24, 2019
I think taking it step by step is just fine. If the transplants stop working as well, then several days of the herb may prime the digestion to be more receptive to the next transplant. But there's no sign of that currently, so it's steady as she goes!

Steve
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