View Question

Chronic Regurgitation In A Dog

by lrf9187 - February 18, 2025 View Case Report

~4yr FS Frenchie, rescued from a puppy mill after a number of litters in June 2024. Immediately began regurgitating on pick-up & continued throughout, worse after exercise or drinking water. Strong appetite but often unable to keep food down, constantly looking for food. Lots of gas, both belching and flatulence. Diarrhea or soft stool frequently, sometimes w/ mucous. Had become polyuric w/ incontinence when I first saw her in December. Weight loss over time.

Thorough conventional work-up showed normal barium swallow, inflammation on upper GI scope. (I don't have any access to the x-rays or to the doctor's notes on the x-rays, so I'm flying a bit blind here and assuming that there's no megaesophagus).
Gastric biopsy: mild Lymphoplasmacytic gastritis with mild fibrosis, suggesting IBD. No spirochetes are seen.
Blood work in July showed high HCT (78), low Cl (106), Na:K 41 (normal), Cholesterol 77 (low), remainder wnl.
rDVM treated with lots of GI meds (flagyl 3x, panacur, cerenia, reglan, sucralfate, pepcid, omeprazole, prednisone, Visbiome, Hills I/D, Vit B12, you name it) with no significant improvement. Pred may have made her worse. She was already off pred when the polyuria started.

Holistic pet store owner put her on Vital essentials freeze dried raw rabbit and some supplements (flora4 sprouted seeds, herbsmith microflora plus, Slippery Elm, Animal essentials Daily Digest), which quickly resolved the diarrhea and improved but regurgitation a bit but didn't resolve it. Adding Tinkle tonic did not change the polyuria. Pet store owner sent her to me.

PE in December: BCS 3/9, Pale tongue. Pulse mid-depth, toneless, weak. A little dental tartar. Remainder normal. Acupuncture and Vit B12 started.
UA/UCS: usg= 1.006, ph 6.0, inactive sediment, neg C&S.
CBC/Chem/T4: HCT 58 (high-norm), Glob 2.2 (low normal), rem wnl.

At recheck 2 weeks later, her tongue was more red and her pulse was more toned, mid-depth, and a little fast.

Working diagnosis is ST yin def, SP Qi Def w/ rebellious ST Qi & Wei Syndrome, Shao Yang disharmony. Western Problem list below:

Regurgitation
Hx Diarrhea - resolved
- Never blood, has had mucous in D+
Lymphocytic gastritis +/- IBD
Low cholesterol (r/o GI, liver, other)
HX giardia
Urinary incontinence (night & day)--> improved
R Medial Patellar Luxation
Mild dental tartar

I started Kan Open the Liver Canals first (because Harmonize the Qi was out of stock) and she was to start Yi Guan Jian the following week. Open the Liver Canals seemed to increase regurgitation. I had her stop it, wait a bit, start YGJ, then restart open the liver canals. Stopping open the liver canals reduced her regurgitation. Starting YGJ seemed to reduce it further, but that response seems to have faded again (or it's increased again after restarting Open the liver canals).

At most recent recheck:
T: red w/ thick white coating, tacky mucus membranes
P: thin, toned, deep

Any suggestions for my next move?

by lrf9187

February 19, 2025

Quick clarification- Mom just let me know that she did NOT re-try Open the Liver Canals yet, so she's only on Yi Guan Jian (and a few supplements/western herbs). We're going to try re-adding it now that she's got some more moisture in her system.

by naturevet

February 23, 2025

Hi there,

A response to YGJ and Xiao Chai Hu Tang should tell us if Shao Yang disharmony is present or not. That is one of the differentials, given the improvement on the pet store diet and supplements. The lack of response to conventional treatment and the observation of lymphocytic plasmacytic inflammation indicate a need for a tonic +/or dispersing treatment, of which XCHT + YGJ is one. Note that the Turmeric in XCHT can be irritating to dogs with Stomach Yin deficiency. XCHT alone may work better if you decide to persist with that angle.

If not, here are a couple of other ideas:
- the response to the pet store approach must indicate Dampness, instead. If that's the case, continued real food (or at the most freeze dried) plus Three Seeds Combination may help. The latter descends Qi, dries Damp, expels Wind, and clears Heat. Regurgitation of water is considered a potential Dampness sign in Chinese medicine, as are the mucousy stools and polyuria. San Ren Tang is one of my favourites for megaesophagus, too, if that's not off the table. The pulse of SRT is often toned and deep.
- if that doesn't help, I'd at least try Liu Jun Zi Tang. It addresses Damp, too, but is more tonifying yet also cooling, fitting the history of pale tongue turned red

Hopefully one of those approaches (pure XCHT + YGJ, SRT, or LJZT) bears some fruit. If there is some substantial improvement with one of them, we at least have an understanding of the key issue, and can then try other formulas depending on what symptoms are still lingering.

Hopefully this helps you out!

S

by lrf9187

February 26, 2025

Thank you! I've been wondering if the turmeric is an issue. My materia medica has conflicting information that leans towards it being beneficial for most GI issues. The online pharmacy I use has been out of stock of Harmonize the Qi, otherwise I would have pulled for it instead.
Would Benefit Hips & Knees be a better alternative if regular XCHT is still out of stock (I think they anticipate a March replenishment).

by naturevet

March 3, 2025

Sorry for the delayed reply. Yes, Benefit Hips and Knees can help Shao Yang disharmonies and be used with the Yi Guan Jian

Good luck!

S

by lrf9187

March 21, 2025

A small update- We had a long pause where mom didn't start the XCHT (in addition to YGJ), but it doesn't seem like it's doing the trick anyway. I trialed sildenafil in case this was an overactive esophageal sphincter but it made her worse immediately. Now I feel pretty solid in my theory is that it's delayed gastric emptying and I threw together a Western herbal with lots of pro-motility + moisturizing herbs (Marshmallow / Globe Artichoke / Slippery Elm / Chamomile / Licorice / Sweet Annie / a touch of Ginger). Would SRT also fit this bill with its Qi descending properties, or LJZT with the orange peel? I'm just worried about it being too drying. I'm having a hard time deciphering dryness vs Damp with her.
Do you worry about aromatics reducing esophageal sphincter closure and allowing reflux? I initially took her off an herbal containing mint for this reason.

by naturevet

March 25, 2025

Hi there!

Delayed gastric emptying can be a pure motility issue, which Wei Ling Tang or San Ren Tang can help with, in addition to the western herbs you're considering. It can also happen in 'dry' dogs, where the Stomach Dryness and Yin deficiency correlates to reduced gastric acid ph. A watery acid is produced that refluxes because of it's sheer volume. In that case, YGJ is my go-to, so if she has it on hand, maybe give it a try in tandem with what you're contemplating.

Hopefully this helps! Reflux is an amazingly common challenge in dogs!

Steve

by lrf9187

April 3, 2025

So far no long on my Western herb. She started San Ren Tang about 5 days ago with on change yet. Fingers crossed some more time on it and/or a change to WLT or adding YGJ back in will work.

by lrf9187

April 3, 2025

So far no long on my Western herb. She started San Ren Tang about 5 days ago with on change yet. Fingers crossed some more time on it and/or a change to WLT or adding YGJ back in will work.

You must be logged in to reply

CuredCases.com