6/22/25 presented to emergency for transfer of care for melena and anemia. He had been exhibiting increased panting for a few weeks, and was having softer stools and accidents in the house. Went on a camping trip and was pacing non-stop. Presented at that time for hematochezia. He would only eat if hand fed his regular diet of commercial raw dog food. He has a history of being Anaplasma positive which reverted to negative. Medications at that time were pimobendan for a IV/VI heart murmur, metronidazole, gabapentin, sucralfate. He had been receiving carprofen historically for cervical, elbow and shoulder arthritis, which was discontinued with the onset of melena.
Radiographs showed cardiomegaly, mild diffuse splenomegaly. Abdominal ultrasound showed slightly hypoechoic spleen, evidence of mild pancreatitis and gastroenteritis. CBC showed a normocytic, normochromic, non-regenerative anemia with a hematocrit of 29.8% (37.3-61.7). SDMA elevated at 28, presumed to be pre-renal. He developed ecchymotic hemorrhage in the skin of the ventral abdomen just prior to discharge with unknown cause.
Owners returned him to rDVM for drooling and vomiting 6/24/25. He was weak and dehydrated. Clotting times were normal. He was given low dose of corticosteroid as he showed a resting cortisol of 1.2. The prednisone was tapered after an ACTH stimulation test ruled out hyoadrenocorticism, Thyroid levels were in reference range. He was treated on an outpatient basis with IV fluids, ondansetron, maropitant, sucralfate and a prescripti0on canned bland diet. His HCT remained low at 34.5, and remains normocytic (low normal MCV), hypochromic and non-regenerative. After consultation with an internist, he was dewormed, and given an iron dextran and weekly B12 injections. Differential Western diagnoses were chronic GI bleed or bone marrow dyscrasia.
7/4/25 He was doing well at home, still only eating if hand fed, and then developed collapsing episodes. He would cough, fall over, urinate and defecate. It did not have a definite correlation with activity: it happened on a walk, after playing with another dog, or laying on the couch. Western differentials for the collapsing episodes included seizures or cardiac syncope. A later echocardiogram did not show significant cardiac pathology that would support heart-related syncopal events. The anemia was unchanged except a new finding of ovalocytes.
Repeat bloodwork showed minimal response to the iron and B12 supplementation. Stool consistency intermittently soft but not dark. A specialty referral for bone marrow biopsy was recommended, but owner declined. The owner was offered a choice between trial of glucocorticoids or Chinese Herbal Medicine. The owner elected the latter.
Patient is friendly with dull Shen and seems fatigued. Fur is dry. Tongue is pale lavender and dry. Pulse have only mild tone and are very deep and weak. Abdominal palpation is unremarkable.
TCM Dx: Heart Blood deficiency (murmur, dull Shen), Spleen Qi deficiency (poor appetite,diarrhea-), TBO Yin and Yang not intermingling to create Qi creating Qi collapse episodes.
Started on Gui Pi Tang Golden Flower (Ginseng and Longan 500 mg PO BID) and Xiao Chai Hu Tang (K’an herbs 1000 mg PO BID). Conventional medications continued oral Petinic (iron, B12, B6, B complex, copper).
The dog continues to only eat if hand fed. There has been no weight loss or muscle wasting. The owner feels it is behavioral. The collapsing episodes have decreased in frequency from 2-3/week to the last one the end of July (4 weeks ago). The HCT is increased 1% to 36.3. MCV still in the low normal range. MCH still low at 19.2. Basically unchanged. nRBC 9 interpreted as a response, but still low reticulocytes. Platelet count is in the reference range.
My original plan was to add Si Wu Tang to the XCHT to more strongly tonify Blood, but after the webinar, I am looking at XFZYT as a better option for Blood Stasis in the Upper Jiao and still tonify Blood. I liked the idea of Gui Pi Tang to tonify Spleen with the diarrhea, poor appetite with Heart Blood deficiency, but it does not seem to have made a huge difference. If I substitute Liu Jun Zi Tang for the Gui Pi Tang and add XFZYT?