Gastroenterology Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

History

Pet "P" is a 10 M Labrador Retriever cross that was presented for chronic weight loss, vomiting, and lethargy. The dog was a Galveston rescue from Hurricane Ike in 2008. Previous medical history is unknown since the previous owners were going to ground tie the dog in the backyard while they evacuated the island. The current owners took the dog with them when they evacuated and relocated to Montgomery, TX while the hurricane devastated Galveston Island. The current owner has not had the pet to the veterinarian since being rescued due to the owner’s financial problems as a result of the hurricane. Pet "P" has never been on heartworm prevention according to the current owner. The dog started to become hyporexic followed by vomiting a few months prior to initial presentation in late November. The pet’s disposition and willingness to please the owner disguised the fact that this dog has lost 10 pounds within a month.

Western Exam:

Abdominal palpation did not elicit any pain nor reveal any other abnormalities. Diagnostics included a centrifugal fecal parasite exam, heartworm test (both Knott’s and occult), complete blood count, serum chemistry profile, electrolytes, prostate exam and chest and abdominal radiographs. Surprisingly, the fecal exam, the prostate exam, and the bloodwork , including the heartworm tests, were normal. However, the abdominal and chest films were not normal. There was a right atrial mass present, a large abdominal mass at the area of the pylorus and multiple small abdominal masses throughout the abdominal cavity.

Eastern Exam:

The patient’s tongue was lavender and dry from stagnation and heat and the pulses were superficial and bounding due to heat. No obvious warm or cold preference was noted by the owners. The patient’s previous diet was a commercial dry dog food that was drying. Currently the owners were cooking for the pet that included eggs, a variety of fruits and vegetables, and occasionally yogurt or cottage cheese. The dog did not have an appetite for the majority of the foods presented. When the pet did eat, he immediately vomited the food as a result of phlegm and rebellious ST Qi. The fur coat, ears, and skin were normal and did not have any abnormalities noted.

Diagnosis

Western: Neoplasia-primary or secondary GI involvement that is most likely adenocarcinoma, lymphosarcoma or hemangiosarcoma

Eastern: Qi Def/Exhaustion from the fatigue, Phlegm accumulation from the chronic vomiting, SP Qi Def/Inefficiency from the chronic weight loss and vomiting, Triple Burner Obstruction of the Middle Jiao that will account for the SP Qi Def and chronic vomiting

Treatment Plan

Western:

I recommended an echocardiogram and an abdominal ultrasound, with biopsies and histopathoogy, to determine the type of cancer and appropriate treatment. Recommended starting on prednisone to determine if this will increase the pet’s appetite and energy level.

Eastern:

Since the pet was displaying an array of a Triple Burner (TB) Obstruction of the Middle Jiao, Xiao Chai Hu Tang (Minor Bupleurum Combination) was recommended to start to relieve the TB obstruction since it is indicated for this particular problem. The main ingredients that will alleviate the problems that this patient is experiencing is: Chai Hu (Bupleurum) to relieve the TB obstruction, Huang Qin (Skullcap root) to clear the heat, Ban Xia (Pinellia tuber) to dissolve the phlegm and dissipate nodules, resolve rebellious ST Qi, and disperse stagnation, Ren Shen (Ginseng root) for Qi exhaustion, Da Zao (Jujube) to tonify SP, ST and Qi and Sheng Jiang (Fresh Ginger) for the vomiting.

Outcome

Due to the extent of the disease, the expense and the poor prognosis, the owners elected euthanasia.

Ophthalmology Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

 

History and Exam

Pet "P" is a MN, 15 yr old, Shih Tzu weighing 13.7lbs (6.22kg).  He presented for ear problems.  Upon examination and evaluation, it was discovered that the pet had crusty eyes and had been previously diagnosed with KCS but currently was not on ocular medication.  A STT revealed no tear production and fluroscene stain revealed superficial, bilateral, geographic corneal ulcerations.  Gentamicin Ophthalmic 0.3% Ointment was dispensed for the ulcerations and was to be applied every 8 hours for 7 days.  The ears were cleaned and medications dispensed.   On recheck examination, the pet had a ruptured anal gland.  A fluroscene stained revealed complete healing of the superficial corneal ulceration.  The Gentamicin eye ointment was discontinued at this time.  Pet "P" was sedated, and the ruptured anal gland was clipped and cleaned.  The pet was sent home with oral Clavamox and a tapering dose of Prednisolone for the ruptured anal gland.  It was discussed with the owner to restart the Cylosporine eye ointment even though in the past the medications did not seem to work well according to the owner.   At this time a  TCM examination was performed.  The skin coat was dry and flakey, the tongue was small and pale, and the pulses were normal.

Western and TCM Diagnosis

A western diagnosis of KCS; corneal ulcerations; chronic, intermittent otitis externa that gets worse during humid times; and a ruptured anal gland were made.  A TCM diagnosis of blood deficiency leading to heat and dampness was made based upon the dry, flakey skin; his advanced age; tongue evaluation; chronic otitis externa that worsens during high humidity; and a ruptured, abscessed anal gland.  His pulses were not deep, as expected with a deficiency problem, since he had an active infection occurring from the ruptured anal gland causing heat and a more superficial pulse, thus causing the pulses to feel normal.  Pet "P" has several Western diagnoses that seem to be unrelated; however, he has only one Eastern diagnosis of blood deficiency that connects all of his seemingly unrelated problems together. 

Herbal Formula Recommendation

According to the owner, the cyclosporine ocular ointment does not seem to be working well since the eyes are still cloudy and slightly crusty regardless of the consistency of medicating the animal.  Additionally, the ear problem that the pet was experiencing returned during a week of hot, humid weather.  Another problem the pet is having is that the pet is getting confused and occasionally running into walls.  This behavior could be a result of the chronic KCS or mental confusion.  Regardless if the pet is blind, the pet should be able to memorize the house plan.  Even though he cannot see well, no furniture has been changed nor a move to a new house been made.  As a result, Pet "P" has even more evidence of blood deficiency.   I started the pet on Si Wu Tang:  0.2cc PO q 12 hours.  Since KCS is most commonly a Liver Blood and Yin Deficiency problem and the animal was exhibiting blood deficient problems and minor yin deficiency from age, skin, ear, mental confusion/not remembering, and anal gland problems, I thought that Si Wu Tang would be the best way of treating all of his symptoms.   Si Wu Tang nourishes the Blood (from the Angelica Root and Cooked Rehmannia), moves Qi and Blood (from the Ligusticum, Red Peony, Carthamus, and Persica), tonifies the Kidneys (from the Cooked Rehmannia), tonifies the Liver and regulates the Liver (from the Cooked Rehmannia and Carthamus), all of which Pet "P" can benefit from according to his symptoms. 

Endocrine Case Report

Case Description, History and Exam

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a 13 yr F/S DSH weighing 7.7lbs (3.5kg) that presented for an annual exam in October 2010.  The previous year’s exam revealed a cat that weighed 7.8 lbs (3.55kg) and no other complaints, or none that was presented by the owner as being significant.  The abnormalities on the 2009 exam were mild tartar and gingivitis and a dull and matted fur coat.  This year the owner claimed that the pet developed polydipsia and polyphagia sometime within the last calendar year.  Upon further questioning the owner disclaimed that the cat’s activity level did not coincide with the pet’s age of 13.  However, the owners felt that the cat slept an adequate amount and was not overtly hyperactive.  This year’s examination revealed a slight weight loss despite an increased appetite, tartar and mild gingivitis that was unchanged from the previous year’s examination, a fur coat that was unkempt and slightly oily, a body condition score of 2/5 and an audible heart murmur that was not ausculted earlier.  No thyroid nodule was evident.  Upon resting, the pet had a loud pur.      

An Eastern examination revealed that the pet’s tongue was red and the pulses were superficial and rapid indicating heat, as well as the gingivitis present.  Phelegm was present due to the oily fur coat, loud purring and heart murmur.

Various diagnostic options were discussed with the owner as well as treatment plans for differing diseases.  The owner declined all diagnostics as well as empirical treatments:  both Eastern and Western.

Diagnosis:  Western and TCM

A Western diagnosis of undiagnosed hyperthyroidism was presumed even though no diagnostic tests were performed.  The presumption was based upon the polydipsia, polyphagia coupled with weight loss, an audible heart murmur, the abnormal activity level of the pet, and the age of the cat. 

An Eastern Diagnosis of Phlegm and Heat were diagnosed.  The Heat signs that were clinically evident were the continued gingivitis, increased thirst, increased hunger, rapid and superficial pulses and red tongue.  The Phlegm signs were the oily fur coat, loud purring and heart murmur.  Coupled with the Western diagnosis of hyperthyroidism, Amber would be classified as a Phase II hyperthyroid cat in which there is accumulation of phlegm and heat in the triple burner

Herbal Prescription

Regardless of the herbal formula chosen, Pet "P"  was in need of a diet change that does not continue to dampen the overtaxed Spleen and Stomach.  A switch from a manufactured kibble that is high in carbohydrates, which are dampening by nature, to a home-made diet low carbohydrate and high protein is essential to the successful treatment of hyperthyroidism in Eastern medicine.   The appropriate herbal formula for this patient is Wen Dan Tang or the Modified Wen Dan Tang in hopes of ceasing the progression of the disease.  The necessity of clearing Heat, moving Blood, dissolving Phlegm and draining Damp are important in Phase II hyperthyroidism.  These objectives are achieved with Wen Dan Tang or the Modified Wen Dan Tang as the following illustrates.  Zhu Ru (Bamboo) clears Heat arising from Phlegm accumulation, Huang Lian (Coptis) and Zhi Zi (Gardenia) cools Heart Fire, thus slowing down tachycardia and the subsequent  murmur, Tao Ren (Persica) and Hong Hua (Carthamus) moves stagnant Blood that has arisen secondary to Phlegm accumulation, Gua Lou (Trichosanthes) and Jiang Can (Bombyx) transforms Phlegm accumulation, Mu Li (Oyster shell) contains iodine that can be used for either hypo or hyperthyroidism, Gan Cao (Licourice root) reduces any harmful side effects of the other herbs, Sheng Jiang (Ginger root) warms the middle jiao and helps in digestion and proper functioning of the Spleen and Stomach, and Chen Pi (Citrus peel) and Zhi Ke (Citrus) eliminates Phlegm accumulations.  Therefore, these herbal formulas are appropriate for Pet "P's"  case of undiagnosed Phase II hyperthyroidism. 

Conclusion

It is unclear from the previous yearly examinations when the pet started to exhibit the Phase I hyperthyroid signs of dampness manifested as abdominal distension, vomiting after meals with a slimy consistency to the vomitus, changes in thirst and appetite, weight gain, lethargy, mucus in the stool, and watery urine.  The environment in which the cat lives in is mainly damp and humid year round, so this benchmark cannot be included in clinical signs and observations.   The undiagnosed Phase I hyperthyroidism misdiagnosis is most likely a consequence of inappropriate questions asked during previous examinations and nondisclosure of perceived “normal” behavior for a geriatric cat from the owner.  Pet "P" is now a Phase II hyperthyroid, geriatric feline that could be helped with a diet change and an herbal formula. 

Respiratory Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs

Pet "P" is a seven-year-old male neutered Labrador retriever weighing 75 lbs (34 kg).  Pet "P"  presented in August for a 36 hour hacking, nonproductive cough.  The previous week Pet "P"  was in play-care at a local facility.  No other abnormalities were noted by the owner.  Physical examination revealed a normal, rectal temperature of 101.2 F, neither crackles nor wheezes upon lung auscultation were noted, no murmurs were ausculted, and upper respiratory stridor was present.  The Western diagnosis was an infectious tracheobronchitis due to the fact that Kennel Cough and the Canine Flu are prevalent in this area.  Additionally, laryngeal paralysis was diagnosed.  The treatment of choice for any  upper respiratory infections is a three week course of 10mg/kg of oral Doxycycline once daily.  This will ensure that a respiratory infection is cleared, and if any residual cough lasts longer than the three week antibiotic treatment, a cardiovascular problem is considered and explored.  Additionally, a tapering dose of Temaril-P was prescribed. Temaril-P is a dual anti-histamine and steroid medication that can be given to pets suffering from bronchitis of any origin and associated coughing.  Since the pet was prescribed a three week course of oral antibiotics, Purina’s pro-biotic, Fortiflora, was dispensed to prevent antibiotic induced diarrhea.  A three week recheck was scheduled but was not followed through by the owner.  

A TCM exam was performed alongside the Western examination.    Pet "P's"  personality has always been a very loving and happy dog that tends to be a little overweight.  Pet "P"  is the typical Earth personality.  Pulses on Bob were bounding and the tongue was a dry, red-lavender/purple color.  Pet "P" also had a dull, flaky fur coat.  Pet "P"  suffered from Blood Stagnation and heat from the bronchitis, Qi Stagnation from the laryngeal paralysis, and Blood Deficiency resulting in a dull fur coat.  The bounding pulses can be explained by the infectious tracheobronchitis that was producing heat.  The dry, red-lavender/purple tongue can be attributed to the bronchitis producing heat that resulted in the red color, the stagnation causing the stridor that resulted in the lavender/purple color and the pet’s diet of dry food that caused heat and dryness.  Dry food kibble weakens the SP Qi, and since Bob is an Earth dog, his SP Qi is easily damaged.   Subsequently, Pet "P"  exhibited signs of Blood Deficiency due to his dull, flaky fur coat.  As a result of Blood Deficiency, Pet "P's"  propensity to develop heat from Blood Stasis is amplified.  The infectious tracheobronchitis that Pet "P"  easily contracted was a result of a Yang Ming and Shao Yang invasion as a consequence of the life-long poor diet that damaged the spleen’s ability to produce blood and Qi to protect the Tai yang level. 

The herbal treatment of choice was Xue Fu Zhu Yu Tang (ZFZYT) since the pet had blood deficiency and blood stasis in the upper burner.    XFZYT not only eliminates stagnation in the upper burner but also nourishes blood which is one of the reasons why this patient contracted the infection.  The SP Qi damage was off-set by a home-cooked diet rich in blood tonics, such as liver, and easily digestible fruits and vegetables that prevented damp and phlegm accumulation. 

The Five Elements

Dr. Shana Buchanan, MBA,

Certified Veterinary Acupuncturist, Certified in Veterinary Chiropractic, Certified in Veterinary Chinese Herbal Medicine, Veterinary Food Therapist

The five elements that we will be discussing are:  Fire, Earth, Metal, Water, and Wood.  Each of these elements has a season, a climate, a direction, a color, a flavor, a sound, an emotion, growth, an orifice, a sense, a tissue, a function, a body action, a body odor, a weakness, and certain personality aspects that make up their characteristics.  We will explore each element’s uniqueness in our pets.  Pets and people can exhibit more then one type of constitution.  Additionally, if there is a mixture of elements that make up the constitution of a pet, the element that is usually expresses is during its season.

The Fire element’s season is summer, the color is red, the climate is hot, the emotion is joy and fright, the tissue is vascular system, the function is circulation, the organ is the heart, and the weakness is walking.  The Fire personality is easily excited, extroverted, tends to be the center of the party, loves to be loved, mischievous and is proficient in competition.  The Fire’s physical characteristics include a strong body, small head, prominent blood vessels, runs fast but easily fatigued, and is excellent for short-distance racing.  The Fire’s disease predispositions include strokes, separation anxiety, and restlessness.  A small animal that has a Fire constitution is friendly, greets strangers warmly, is noisy and barks, is excitable and is difficult to keep still.  A horse that has a Fire constitution is friendly, noisy and vociferous, loves to be touched or petted, is excitable, is difficult to keep still and is very sensitive. 

The Earth’s season is late summer, the climate is damp, the color is yellow, the emotion is preoccupation and worry, the tissue is muscles, the function is digestion, the organs are stomach and spleen and the weakness is sitting.  An Earth’s personal characteristics include honesty and kindness, is a good care taker, is laid back, is humble, is easily satisfied, is slow to response to a stimulus, is a good worker that is a little slow and is generous and modest.  The Earth’s physical characteristics include a short and sturdy body, a prominent musculature, a big head, and thick lips.  Disease predispositions include chronic gastrointestinal problems like diarrhea and colic, edema and obesity.  A small animal with an Earth constitution is friendly, is eager to please, is a slow walker, enjoys sleeping and relaxing, and is laid back.  A horse with an Earth constitution is friendly, enjoys relaxing, is easy going and mellow, is eager to please and moves slow. 

The Metal’s season is fall, the climate is dryness, the color is white, the emotion is weeping, the organs are the lung and large intestine, the tissue is the skin and hair coat, the function is respiration, the body action is coughing and wheezing, and the weakness is lying down.  The Metal’s personal characteristic are a good organizer, a leader in a group, a rule follower and likes routines, is confident and consistent.  The Metal’s physical characteristics include a broad forehead, a broad chest, and good hair coat.  The disease predispositions are respiratory problems, including cough, asthma, and nasal congestion, diabetes, and constipation.  A small animal with a Metal constitution is quiet and confident, disciplined, follows the owner’s commands, organized and knows what to do next or what is expected, and has a clean hair coat.  A horse with a Metal constitution is quiet and organized, confident, disciplined, follows the rules, prepared for what happens next, and has a clean hair coat. 

The Water’s season is winter, the climate is cold, the color is gray/black, the emotion is fear/terror, the organs are kidney and bladder, the tissue is the bones, the function is elimination, and the weakness is standing.  The Water’s personal characteristics includes being introverted, terrified and fearful about everything, quiet, willing to live along, very consistent but slow when doing something, and a fear biter.  The Water’s physical characteristics are a thin, middle sized body, cold intolerance, and have deep, big eyes and ears.  The disease predispositions are edema, infertility, back pain, urinary infections, and depression.  A small animal with a Water constitution hides behind the owner, is not confident, is a fear biter, and leaks urine because of fear.  A horse with a Water constitution hides or runs away, kicks when afraid, is not confident, may present rear-end and threatens to kick when approached. 

The Wood’s season is spring, the climate is wind, the color is green, the emotion is anger and irritation, the organs are liver and gall bladder, the tissues are tendons and ligaments, the function is purification, and the weakness is looking.  The Wood’s personal characteristic includes a dominant behavior or attitude, quick and fast movements, skilled with running or moving, impatient, easily becomes angry, alert and responds quickly to stimuli and is good at adapting to changing conditions.  The Wood’s physical characteristics have a thin body, big eyes, good but variable performance, runs quickly and has nimble movements.  The disease predispositions include hypertension, stroke, allergy, depression, hysteria and neurosis.  A small animal Wood constitution is confident, irritable/”crabby,” active, energetic, athletic, aggressive, angry, bites with little provocation and is impatient.  A horse with a Wood constitution is confident, irritable/”crabby,” active, energetic, athletic, aggressive, angry, kicks, stomps or strikes, impatient and bites. 

As you can see there are several breeds that come to mind when describing the various elements.  For example, a typical horse with a Wood personality is a racehorse.  A typical dog with an Earth personality is a Labrador Retriever.  A Water dog is any small breed that is scared, particularly Chihuahuas.  A Metal horse example is a horse that does well in weekly competitions such as Dressage.  A Fire animal example is a Jack Russell Terrier, especially when it is a puppy.  However, like previously stated, most animals and people are a mixture of the elements, and the current season can influence an animal’s disposition.  Now that you know a little about the various elements what do you think your pet’s dominant element is?

References

Xie, H & Preast, V. (2002).  Traditional Chinese Veterinary Medicine:  Volume 1 Fundamental                             Principles.  Florida:  Jing Tang.

Neoplasia Case Report

Dr. Shana Buchanan, MBA, Certified in Veterinary Acupuncture, Certified in Veterinary Chiropractic, Veterinary Food Therapist, Certified in Chinese Veterinary Herbs
"P", a 9.8 lbs (4.45 kg), 17.5 year old, MN DSH that lives inside and outside with several other cats that compete for food out of the same food bowl, was presented to a previous veterinary clinic in April 2010 for weight loss and decreased appetite.  Blood work, thyroid panel and blood pressure values were within normal limits.  Due to the past history of urinary tract infections (UTI), it was presumed that the pet could have an occult UTI or pyelonephritis.  A 14 week treatment of daily 12.5mg oral Zeniquin was dispensed. 

In August 2010, "P" weighed 8.6 lbs (3.9 kg) and presented for continuing weight loss, blood in stools and hyporexia.  A diagnosis of gastritis and severe dental disease was made and a recommendation to have a dental as soon as possible to rule out dental problems causing the weight loss and hyporexia.  Twice daily of 25mg Clindamycin was dispensed to begin a few days prior to the dental and to continue 7 days after the dental.  Pre-anesthetic blood work revealed slight anemia and hypoalbuminemia.  The dental was successful with only one tooth extraction and an uneventful recovery.  In September 2010, "P" weighed 8.1 lbs (3.68 kg) and presented for a hyporexia, continued weight loss and hematochezia.  Giardia was diagnosed and twice daily dose of 80mg of Metronidazole, daily dose of 200mg of Fenbendazole and pro-biotics were dispensed for the bloody diarrhea.  A few days later, "P" boarded at the clinic and an appetite stimulant of twice daily 2mg Cyproheptadine was dispensed.  During the stay at the clinic, "P" ate Hill’s Science Diet a/d and did not exhibit any further diarrhea. 

At the end of September, "P" weighed 7.7 lbs (3.5kg) and presented again for continued weight loss and anorexia.  Abdominal palpation did not reveal any tenderness and the intestinal loops were easily palpated.  Anemia was the only abnormality on repeated blood work.  Radiographs of the chest and abdomen were performed.  The thoracic radiographs showed microcardia presumably due to dehydration and anemia.  Abdominal radiographs revealed a mass in the upper right quadrant of the abdomen under the rib cage and a lot of gas in the small intestines.  A diagnosis of abdominal cancer was made.  The mass was presumed to be partially obstructing the pylorus, thus causing the gas in the intestines and the decrease in the pet’s appetite. 

A TCM exam was performed and revealed a thin cat with a red tongue and forceful pulses.  With the past history of hematochezia, UTI, gingivitis and an abdominal mass, Blood Stasis causing Damp-Heat was diagnosed in addition to Qi deficiency.  Treatment options were discussed and the recommendation of Ge Xia Zhu Yu Tang (Drive Stasis from Below the Diaphragm Decoction) since this formula not only moves Blood and Qi but also tonifies the blood and cools the patient.  Liu Jun Zi Tang (Six Gentlemen Decoction) was recommended to help tonify the Qi in this geriatric patient and to help replenish SP Qi.  Additionally, high doses of fish oils and arginine were discussed, as well as a diet change.  Due to the ongoing problem and the late diagnosis of cancer in the patient, the owner elected euthanasia. 

Auto-Immune Case Report

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 30^th 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.