Orson is a 2 year old male intact GSD that presented to me Jan 2021 for evaluation of lethargy, weight loss, decreased appetite and diarrhea that had been ongoing for 2-3 months prior to being seen. O had been feeding Instinct Raw chicken mixed with dry kibble. At some point the P stopped eating that so he changed to all dry salmon based dog food. No vomiting. Stools were completely liquid, with intermittent presence of mucus and blood.
On presentation, P had normal TPR and BCS 3/9. Remainder of physical exam was normal. His tongue was difficult to interpret because it is pigmented and his pulses felt deep and toneless at that time. I started him on metronidazole, a home prepared diet and Shen Ling Bai Zhu while we waited for labwork results - there was no improvement in the diarrhea, although his appetite did improve with the home prepared diet.
Fecal was negative and bloodwork showed low albumin, low total protein and elevated SDMA with normal creatinine. Vit B-12 levels were very low, TLI was normal (Vit B-12 injections weekly were initiated and continue). ACTH stim test was normal. O reported some of the diarrhea (with the home prepared diet) was undigested veggies. Low dose prednisone was initiated and the undigested food in the diarrhea resolved, the stools started to take some form for just a few days and then went back to diarrhea. While on the prednisone, albumin levels normalized and liver enzymes (ALT and AST) went up slightly. Cholesterol slightly decreased. SDMA levels continue to remain elevated with normal creatinine (these results are from March - O has not allowed me to recheck them). Abd ultrasound showed mildly enlarged mesenteric lymph nodes, distended stomach and dilated fluid filled intestinal loops (diagnosed as ileus by internist). Bile acids were normal.
I started a commercial hydrolyzed protein diet which pet is eating well. He has gained 5 lbs, is eating well but still has small bowel diarrhea. No blood or mucus at this time. At the recent recheck, his pulses were more middle to superficial and toned. A Diarrhea PCR panel was Salmonella positive and showed high levels of C. perfringes alpha toxin. I have started Visbiome probiotic and am very hesitant to turn to antibiotics if I can avoid them.
In your experience, is Huo Xiang Zhen Qi San a good alternative to antibiotics? Do you have any other thoughts about the root cause of the diarrhea or additional testing that could be pursued or herbals I could incorporate into his treatment (O does not want to pursue biopsy)? This has been a tough GI case.
Thank you so so much!
Veronica