Question Details
Diarrhea/inappetance/occasional Vomiting
by ajerger - October 19, 2023
2.5 yr old Shih tzu mix FS 10lbs.

Christy has a 1.5 year history of decreased appetite, frequent loose stools, burping often throughout the day and intermittent vomiting.

These signs/symptoms seem to be much more pronounced after her spay and 1st Lyme vaccine at the post op recheck in March 2022.

She progressively got more picky with food, especially in the morning. If she ate at all it would be later in the afternoon. The owner resorted to chasing her around offering her different foods.
On the upside she has always eaten fresh with home made or freeze dried foods.

The vomiting got so bad the owner was advised to see a specialist 8/22 where endoscopy was recommended and turned down by owner, so they elected to use gastroprotectants and steroids.

The steroids made the patient worse, more lethargy, and would not eat or drink per the owner.
(Another thing that made her really worse was the Parvo vaccine early this year, she was vomiting and having diarrhea the next day post vaccine.)

Once she was weaned off over time she got back to her usual picky eating habits and normal energy levels.

She was dewormed as well due to history of Giardi which she has tested negative for a few times recently.

Historically her BUN and ALT are up and down, currently they are up. Recently her lymphocytes elevated, so I am tracking those.

Her stools are dark and soft and she has been having more bouts of diarrhea. No PU/PD, seems alert but not overly excited.

She initially responded to metro and then not, same with amoxicillin. Sucralfate helps a little.

8 parameters:
Cold? ( will not drink, soft stools)

Spleen Qi deficient
Qi deficient ( reluctant to eat in the am)
Liver blood deficient ?

I originally tried Si Mao San, owner said she got worse, so to me that confirmed she was cold or at least not hot, so I stopped that and tried Wei Ling Tang , owner said she wasn’t worse but not any better.
Then I used Happy Wanderer tincture and the owner thinks it may have helped her slightly with appetite in the morning, but not much else.

Not sure what the next steps should be?

Thank you in advance...
by ajerger
October 19, 2023
Forgot to add
Pulse: Mid depth, toned, resists compression, normal diameter
Tongue: Light pink/lavender
Thank you!
by naturevet
October 20, 2023
Hi there! It seems you've at least ruled out Damp, paving the way for use of tonics. Even better than Happy Wanderer might be Yi Guan Jian (Glehnia and Rehmannia if using Kan). It fits a few findings:
- the slight improvement on sucralfate
- the slight improvement on Happy Wanderer
- the worsening on SMS, which is both cooling and drying (with YGJ being a Yin tonic)
- being worse in the morning (when Liver Blood deficiency is strongest)
- worsening on pred, which would damage mucosal blood supply through prostaglandin inhibition
- vomiting, regurgitation and (yes, even) diarrhea (which can very occasionally be due to Blood or Yin deficiency in the Yang Ming, causing it to overheat and produce inflammation or colitis)
If you're nervous about trying it, you could use a low dose first, or try the western herb Slippery Elm. If it similarly soothed the dog at least partly, then YGJ is likely going to help a lot.

The only other thing that springs to mind given the association with vaccines is Bu Zhong Yi Qi Tang (Lift the Qi) since it bolsters the immune response, which can become weakened during the initial immune suppressive effect of almost all vaccines. It may be that you'll need to add it later to get a full resolution of all symptoms.

As for the 8 parameters, you could add Hot, since it responded at least at first to metronidazole. Overall, the use of WLT and SMS were good ideas and important to try. So was XYS (Happy Wanderer) a good idea to test. You did well

Reply to this question.
You must be logged in to reply