Hi Dr. Steve,
I was hoping you could take a look at the attached ultrasound and labwork and tell me what you think. A recent UA showed bilirubin, blood and protein (each at 2+). UPC of 1.14. I realize the protein is likely, in part, due to the blood, but she's had mild idiopathic proteinurea (<0.5 UPC) since last year. Her CBC/Chem Panel are pretty unremarkable except for high Na and slightly low Retic-HGB
The back story: My Australian Shepherd has been struggling with severe dysbiosis for the last couple of years. I am on my 3rd round of FMT pills from AnimalBiome; Nutriscan shows many food intolerances except for beef and bison. Texas A&M panel found SIBO and low normal B12 (she gets weekly injections).
GERD and GI issues started 4 years ago after a a dental for removal of an abscess. She was on antibiotics pre and post extraction and she hasn't been right since. She's also fairly itchy, does a lot of paw and vulva/anal gland licking, has thinning dull hair, and occasionally has a bright pink belly and ears.
She is currently on a home-cooked limited ingredient diet (grass fed bison, bison liver, organic buckwheat and pumpkin + eggshell calcium, KAL bone meal, Vit E and D, Adored Beast digestive enzymes, psyllium, Rx Clay, milk thistle, S. Boulardi and FMT pills). This combination is actually working for her as her stools are firming up for the first time in months. I am slowly trying to balance this diet with whole foods (add more veggies/reduce the buckwheat) using Animal Diet Formulator but I have to take it very slowly as she reacts badly to many things (diarrhea and GERD are typical reactions to any changes).
She also has MVD, stage B2 which is stable. She is on Pimobendan. On top of that, she's a very anxious girl who has GI setbacks every time we have a vet appointment. Since the age of about 4 years, she's been raw fed, titered/not vaxed, not on flea/tick/heartworm preventatives, clean water, no lawn chemicals, exercise daily.
I just can't seem to get her gut healed no matter what nutraceuticals I've tried (slippery elm, DGL, marshmallow root, aloe vera, L Glutamine, berberine, etc.
I will say that since we've been on the bison/buckwheat diet, the itching, GERD and GI symptoms have improved dramatically and she actually has an appetite for the first time in over a year so I feel like this diet is the right one for now.
This latest ultrasound and UA threw me for a loop though given how much better she was doing. I am waiting for an appointment with her Internal Med vet (who is not holistic and doesn't buy into anything unconventional) to discuss these results but she's booked out a couple of weeks.
The one thing I have not tried is TCM for her and I'm wondering if Cessorex or Halscion might be good options to help with her stress/immune system and gut inflammation. Also wondering if there are other herbs you would recommend after reviewing her ultrasound and labs.
Dr. Steve's Advice - You've been through a lot but you have clearly done an excellent job looking after your girl.
The splenic and hepatic nodules, suggestion of renal inflammation, and the success you've finally seen on a real-food-plus-probiotics regment makes me think your idea of Cessorex is a good one. It also has the potential to seal the gut wall, so that your dog is not as reliant on B12 injections.
Check the urine again in about two to three weeks after starting Cessorex to ensure the UPC ratio is about the same or lower again. Meanwhile, watch for further reductions in itch and a sustained improvement in the stools and GERDs tendencies.
Cessorex may help with the stress experienced at the vet clinic, too, but if it's not quite enough, you can roll in Halscion
Please let us know how things go. I have lots of other ideas besides, but this seems likely to work
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