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Small Bowel Diarrhea Dog

by landauvet - September 23, 2009

Hi Steve,

I am working with a 6 1/2 month old German Shepherd, FS. She started with mostly diarrhea and some vomitting at age 2 months. Primary care offered antibiotics which helped intitially then has not been on any abx last few months. She has a lot of undigested food in her poop. Her diarrhea is an orangy color often. She vomits mostly bile not food.
She has a great appetite, but is thin. The owner can only feed her white rice and chicken or else...
Drinking and peeing ok. The dog otherwise has a good appetite and energy. She chews the top of her paws and has a red ear that bothers her. She had a lot of orange diarrhea on the car ride to my office (Yea!)
Part of her history is that she is up and panty at night.
On initial exam
Pulse: wiry, thin and deep
Tongue: lavender an pale

I treated ST-36 Bl-20/21, SP-6, and Liv-13

I put her on a low dose of BZYQT and probiotic

After this initial appointment her owner reported an improvement immediately. Less diarrhea, less paw chewing, less restless at night.

I rechecked her 2 weeks later recently. Tongue and pulse were improved.
In my infinite wisdom, I decided that SLBZ would be better for her and switched the formulas.

I switched back to my original choice after 4 profuse diarrhea days.

Things are back to improving. There are days when things are fine. Other days when there are no poops, and days where there are some soft stools with undigested food.

Her primary wants to do a 3 week course of amoxicillin and B-12 injections based on bloodwork taken last week. I am inclined to stay away from the antibiotics unless the proverbial poop hits the fan. I have never worked on a small bowel diarrhea case before and wondered if you have any suggestions.

Thanks,
Kevin Landau

by naturevet

September 23, 2009

Hi Kevin,

I agree with everything you said. I also suspect the antibiotic trial will go badly, just like you. Unless you've been able to document a bacterial overgrowth, and have culture and sensitivity to back it up, then sticking with your herbal approach (which is essentially the regulation of peristalsis and inflammation) is a more prudent way to go. I would wonder if Xiao Yao San may help, if BZYQT did. Something to keep in mind. But if you're patient, the BZYQT may resolve the whole thing. If the owner wants to go further, B12 is fine. She could also consider digestive enzymes.

You're doing great! Keep it up!

Steve

by landauvet

December 11, 2009

Hi Steve,

An update on this patient. I added XYS to her regimen about three weeks ago. She has continued to improve, however has had problems while in heat in the last 2 weeks. Some diarrhea and lameness that the primary diagnosed as panosteitis. She also has an ear infection which is being treated topically. The owner is looking for some help over the phone until she gets here next week. She is trying to avoid the antiibiotics and NSAIDs being recommended to her.
She is looking for something to help manage pain and inflammation which won't exacerbate the diarrhea, which is a bit tenuous presently.
My instinct (based upon the forum's consult) is to use Hoxsey or Si Miao San. Based on her chronically thin pulses despite all this damp heat, I am leaning towards Hoxsey, but oh the diarrhea!
How will the Hoxsey affect the gi? Too cold?

Help please.
Kevin

by naturevet

December 11, 2009

Hi Kevin,

If XYS, which increases peripheral and mucosal circulation, has been helpful, then using SMS or Hoxsey, which has the opposite effect on blood flow, may aggravate him. I'd wonder more about taking a Wind invasion approach. Is there one that is suited to his pain pattern and location. You need more information to do a proper job of choosing a formula. In general, though, Du Huo Ji Sheng Tang, San Ren Tang and Yi Yi Ren Tang are good Wind expellers. Of these, the most Spleen support comes from YYRT. It also has the most 'appendicular' effect of the three.

If the dog is Blood deficient, which it seems to have been if it has responded well to XYS so far, then that is the main reason this animal woud become painful - Wind invasion.

Hope that is somewhat helpful,

Steve

by landauvet

December 12, 2009

Steve,
I am not sure that the XYS helped matters much. The continued diarrhea and panosteitis commenced after starting XYS. Further, the dog's diarrhea deteriorated to pipe stream profuse and blood tinged on Friday. She stopped all the herbs except a small amount of BZYQT.

I like the wind invasion theory explaining pain to the FLs and YYRT seems to the fit the bill from a metaphoric perspective. I am not sure how to manage the diarhea acutely at this point.

Kevin

by naturevet

December 12, 2009

Hi Kevin,

If the diarrhea is colitis, then a homeopathic that can help both it and panosteitis is Mercurius solubilis, 30C strength, given as needed up to three times daily. Don't go longer than three days if there is no benefit.

Lastly, if a tonic approach didn't help the dog, then SMS or Hoxsey with Boneset may be helpful after all, if it was antibiotics that helped reolve the diarrhea last time. Boneset alone is excellent for panosteitis.

Steve

by landauvet

December 29, 2009

Hi Steve,
more updates on this dog. I saw her 7 days ago. Her pulses were deep and thin, although less sore, still limping on a front leg from panosteitis. She was still in heat. Her diarrhea was still pipestream when she pooped although not pooping more than two times daily.
I put her on WLT which helped with getting the diarrhea back to custard. She had a few episodes of straining.
She did take the homeopathic mercurious as you recommended with no noticable changes. I have had the most dramatic improvements with some of my gi cases, but feel like I am not getting ahead of this case.
With the deep pulses, I stayed away from SMS. Have you seen cases of small bowel diarrhea like this one? The owned is giving me frequent gi reports and I don' t have a lot of options about how to stop the diarrhea.

Thanks for any input.
Kevin

by naturevet

December 29, 2009

Hi Kevin,

One formula that's worked well for us for refractory small bowel diarrhea is Huo Xiang Zheng Qi San. When it does work, I presume it was because the animal's diarrhea was microbial in nature.

Besides the persistent nature of things, another thing that puts me in mind of it is the panosteitis. From a Chinese point of view, bone inflammation constitutes a deep-seated pathogen, so much so that they even used Minor Bupleurum derivatives to treat it (tried that yet, Captain?). Anyway, that's how HXZQS works - to expel pathogens. It doesn't act from as deep a place as XCHT, though, but it is good for aches and pains that are actually musculoskeletal in origin. So if the panosteitis diagnosis isn't firm, then HXZQS may take care of things for you.

Steve

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