Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs
Dog "P" is a male, neutered Chihuahua that was born on 2004. When "P" was 5 years old in March 25, 2009, he presented for weight loss, polyuria, polydipsia, polyphagia, stick chewing and storm phobia. On physical exam, tartar was noted but no other significant findings were noted, and no obvious abdominal masses were palpated, no murmurs auscultated, good intestinal slip and normal liver margins were palpated. However, the pet weighed 4.63 lbs. A complete work up was performed and included a CBC, chemistry panel, whole body radiographs and a tick panel. Radiographs of the abdomen and chest were within normal limits. The CBC revealed a slight elevation in HGB 23.3 (12-18) and a slight elevation in the MCH 32.41 (18.5-30). However, the blood machine that was used commonly reveals an elevated HGB and MCH in most animals tested regardless of their health status. The chemistry panel revealed a low amylase 323 (500-1500) and an elevated ALT 126 (10-100). The tick panel tested for Ehrlichia Canis Antibody, Rocky Mountain Spotted Fever, Anaplasma and Lymes disease which were all negative. Five days later on the 30th of March, the owner called and needed medication for diarrhea presumed to have started after a recent thunderstorm. Metronidazole at a dose of 10mg/kg PO every 12 hours was prescribed. On April 2, 2009, the owner called and stated that the pet was more lethargic, continued to have diarrhea and continued to lose weight. A double cavity ultrasound was planned for the end of the week. On April 8, 2009, "P" weighed 4.56 lbs and had a double cavity ultrasound performed. The heart parameters were within all normal limits. The abdomen ultrasound only revealed diffuse edematous intestinal loops measuring 3.9mm. A presumptive diagnosis of IBD was made. Unfortunately, no endoscopy nor biopsies were performed to confirm a lymphocytic-plasmacytic etiology. A grain free, preservative free diet was prescribed and ENOVA was chosen. Prednisilone was prescribed at a dose of 0.5m/kg PO every 12 hours for 4 days, then every 24 hours for 10 days, then every other day indefinitely. Metronidazole was continued at the same dose and frequency. The pet was to be reweighed in one month. A plan to always weigh on the same scale was put in the record to decrease error.
Dog "P" is a male, neutered Chihuahua that was born on 2004. When "P" was 5 years old in March 25, 2009, he presented for weight loss, polyuria, polydipsia, polyphagia, stick chewing and storm phobia. On physical exam, tartar was noted but no other significant findings were noted, and no obvious abdominal masses were palpated, no murmurs auscultated, good intestinal slip and normal liver margins were palpated. However, the pet weighed 4.63 lbs. A complete work up was performed and included a CBC, chemistry panel, whole body radiographs and a tick panel. Radiographs of the abdomen and chest were within normal limits. The CBC revealed a slight elevation in HGB 23.3 (12-18) and a slight elevation in the MCH 32.41 (18.5-30). However, the blood machine that was used commonly reveals an elevated HGB and MCH in most animals tested regardless of their health status. The chemistry panel revealed a low amylase 323 (500-1500) and an elevated ALT 126 (10-100). The tick panel tested for Ehrlichia Canis Antibody, Rocky Mountain Spotted Fever, Anaplasma and Lymes disease which were all negative. Five days later on the 30th of March, the owner called and needed medication for diarrhea presumed to have started after a recent thunderstorm. Metronidazole at a dose of 10mg/kg PO every 12 hours was prescribed. On April 2, 2009, the owner called and stated that the pet was more lethargic, continued to have diarrhea and continued to lose weight. A double cavity ultrasound was planned for the end of the week. On April 8, 2009, "P" weighed 4.56 lbs and had a double cavity ultrasound performed. The heart parameters were within all normal limits. The abdomen ultrasound only revealed diffuse edematous intestinal loops measuring 3.9mm. A presumptive diagnosis of IBD was made. Unfortunately, no endoscopy nor biopsies were performed to confirm a lymphocytic-plasmacytic etiology. A grain free, preservative free diet was prescribed and ENOVA was chosen. Prednisilone was prescribed at a dose of 0.5m/kg PO every 12 hours for 4 days, then every 24 hours for 10 days, then every other day indefinitely. Metronidazole was continued at the same dose and frequency. The pet was to be reweighed in one month. A plan to always weigh on the same scale was put in the record to decrease error.
One month later on May 13, 2009, "P" weighed 4.75 lbs. Medications of Prednisilone every other day and Metronidazole every 12 hours was continued. At this time the pet received annual vaccinations of Da2PP, Rabies, heartworm test, fecal parasite test and monthly Interceptor was prescribed. Fortunately, the pet did not have any adverse reaction to the vaccinations given. Two weeks later on May 27, 2009, "P" weighed 5.2 lbs. The Prednisilone was decreased to every 72 hours and the Metronidazole was to continue at every 12 hours. On July 15, 2009, three months after being diagnosed with IBD, the pet weighed 5.44 lbs. Prednisilone was continued every 72 hours and the Metronidazole was decreased to every 24 hours at the same dose. Five months after the IBD diagnosis, the owner stated that the pet ate and defecated more than the other dogs in the household but was doing well otherwise. Seven months after the IBD diagnosis in April 2009 on November 17, 2009, "P" was evaluated and was changed to a traditional, canned, high fiber diet (Purina OM) and the ENOVA was discontinued since high fiber foods produce fatty acids that act as a natural anti-inflammatory for IBD and ENOVA was not considered to be a high fiber diet. Metronidazole and Prednisilone was continued as previously prescribed. On January 1, 2010, 9 months after the IBD diagnosis, the Prednisilone was discontinued and the Metronidazole was continued at the every 24 hour frequency. Two weeks later on January 12, 2010, the pet weighed 5 lbs. On January 21, 2010, all medications were stopped. The canned high fiber diet was continued. Eleven months after the IBD diagnosis on March 16, 2010, the pet weighed 4.6 lbs. Prednisilone and Metronidazole were not restarted, but Nutrical was prescribed to be given daily as a high calorie supplement in order to help the pet maintain and gain weight. The canned, high fiber diet was continued. The weight loss was regarded as a result of the high fiber diet and not a relapse in the IBD. One year later on April 14, 2010, the pet weighed 4.7 lbs. The last weight on May 18, 2010 was 4.8 lbs. No other weights have been noted in the record, and the pet continues to receive only Nutrical and Purina OM as the principle way of controlling the IBD.
This pet's Eastern exam revealed a diagnosis of damp heat in March 2009 on the basis of the thirst, hunger, pica and diarrhea. The pulses were slippery, rapid and superficial as a result of the damp heat diagnosis, and the tongue was pinkish, red with a thick, mucoid coat. Huang Lian Su Pian (Coptis Tea Pill) was recommended. Additionally, liver treats was prescribed to help with the liver stagnation that was causing the storm phobia and the elevated ALT. "P" needed Guar Gum for the addition of the short chain fatty acids that the ENOVA diet did not provide. Even after the pet was on Prednisilone, which is cold in nature, for 5 months, "P" still exhibited damp heat signs since the owner noticed that the pet ate and defecated more than the other dogs in the household.
The reason that Huang Lian Su Pian prescription is that the formula’s herb is Huang Lian, or coptis root. Coptis root has a very strong heat clearing and dampness drying effect on the intestines and stomach, and "P's" IBD is manifesting as a damp-heat in the lower jiao. It also sedates liver and heart fire that could be contributing to storm phobia that the pet is displaying as a result of the liver stagnation. Huang Lian has a broad spectrum antibiotic effect against many bacteria, especially since berberine is most effective against gastrointestinal infections which could be contributing to some of the clinical signs. Additionally, coptis root has an anti-inflammatory effect as a result of the berberine that is present. Since this herb has the infinity to clear fire, drain damp, exhibits anti-inflammatory effects and antibiotic effects against gastrointestinal bacteria from the berberine, coptis root is an excellent choice for this patient's IBD.
IBD is considered to be an auto-immune disease, and life-long treatment is usually needed. Even though the pet was given two medications that are considered cold, "P" still exhibited damp heat signs after 5 months of treatment. The damp heat can be eliminated by Huang Lian. Additionally, since the pet seemed to have gained weight on the higher calorie diet, ENOVA can be restarted as long as Guar Gum is added to supply the anti-inflammatory properties of the short chain fatty acids.
