Gastric Disorders Cases

This is my dog Ruby she’s a 9 & 1/2 year old female spayed pit bull and  I’m a veterinary technician at an integrative practice. Ruby has been struggling with acid reflux as you can see in this first video. She has episodes of swallowing and licking. She gets so scared and swallows air and struggles to breathe when this happens. I’ve tried a series of GI foods and she’s currently eating Dr. Harvey’s canine health and then I cook the protein. Either turkey or chicken. I’ve done several bloodwork panels , barium study, ultrasound , and even an endoscopy. We can not get down to the cause. On endoscopy her stomach lining was very irritated, biopsy came back inconclusive. The barium study revealed that her gi tract was moving slower than it should so they recommended Reglan for a little while. All this started after Ruby was prescribed an antibiotic , Clarithromycin ( recommended by my human GI specialist when I was sick with H pylori, and then she and my other dog tested positive as well ) I think it really damaged her gut. before that she was completely healthy and was even my clinics donor for fecal transplants ! We have been dealing with this for almost 2 years. I currently give her visbiome probiotic and she takes omeprazole and Dasaquin advanced. I discontinued her galliprant just in case but no difference. Whether she’s on the omeprazole or not she has episodes so I don’t think it’s helping. I tried kefir but she breaks out in rashes. I did a food allergy test and she’s allergic to milk and a few other things. I’m convinced she has leaky gut. How would you recommend I approach this? I am open to any and all recommendations you have. Eastern and Western. Thank you!!

P.S - she never has diarrhea and she also doesn’t vomit. Just these weird episodes .

Dr. Steve's Advice - the good news is that there are many things that may help. The bad news is that there might be some trial and error, but since you're a trained professional, you're in a good position to go through that process. Hopefully the first choice will be the right one. 

The more that the one thing we try captures all salient features of Ruby, the more likely it will work. I think Halscion  (https://goldstandardherbs.com/products/Original-Halscion-85g-p647327436)   by Gold Standard Herbs does that for her. Here's why:
- I agree that Ruby must have a leaky gut, given the allergy to keffir. Leaky gut and associated allergic tendencies are addressed well by Minor Bupleuurm, which is at the core of Halscion
- The slow peristalsis is also likely to be improved by Minor Bupleurum, since evidence suggests it is commonly due to low-grade IBD (e.g., from the leaky gut). In worst case scenarios, that peristaltic disruption appears able to provoke GDV
- The worsening from antibiotics for Helicobacter suggests the leaky gut is due to dysbiosis, which normally could be remedied by a probiotic, but in practice appears to need a local immune stimulant given at the same time for the probiotic to be reliably effective. Halscion has that effect through its content of Minor Bupleurum. Note that long term use of omeprazole, although I see why you felt it was necessary, fosters continued both dysbiosis and Helicobacter infection. Specifically, it promotes stomach and small intestinal bacterial overgrowth (SIBO) since stomach acid is one of the key ways that the GI protects itself from bacterial pathogens
- Helicobacter is an opportunist, taking advantage of not just low stomach acid but poor stomach mucosal circulation. The same condition can cause chronic unresolved gastritis, which can occasionally be reflected in the very pink muzzle that you're seeing in Ruby. My favourite formula to address this condition is Yi Guan Jian (Glenhia and Rehmannia), which is a component of Halscion

All things considered then, Halscion is what I'd start with. 

As well, if you can find a local vet acupuncturist, have them test whether your dog's pulse softens in response to acupuncture at GB 34. If it does, it pretty much proves the Halscion will work, but in the meantime, will help improve gastric emptying and reduce the tendency to what is essentially the equivalent of GERDs. If you see that change, you may be able to start weaning off the omeprazole. If it never helped to begin with, perhaps just discontinue it, but then watch to ensure the condition doesn't worsen. If it does, try something like TUMS or Zantac, which is not quite so wholly suppressive of stomach acid production as to foster SIBO and Helicobacter infection.

Hope that helps!

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I have many of your suppliments already. What would you advise for a dog who burps a bunch after eating and a little bit of food comes up every time with every single meal. It is damaging his teeth which are brushed daily!  He is a quite rare Russian toy (779 registered in the United States) he’s also a registered therapy dog. He is 3 years old and 3 lbs. He eats raw food and it appears chicken beef and Turkey all Still cause the burping. Here’s a recent X-ray of his stomach. It doesn’t show hernia they say. He was hospitalized for an episode in which he aspirated and got pnemonia after we believe he was going to vomit from pain in his abdomen. They did many X-ray and a scope and found nothing in the stomach. Blood work was normal. On the third day in the hospital his stomach filled with fluid 3x the size it should be.  Our vet believed he would die.

The vet waited to long to scope him that day and he sugar crashed to a 25 and almost died.  The video is of him jumping in pain after an odd episode that almost looked like a seizure. That’s why he aspirated.

Dr. Steve's Advice - if he was a larger dog, I'd almost say he has gastric issues reminiscent of GDV, which always makes me reach for Minor Bupleurum derivatives like Adoptrex      (https://goldstandardherbs.com/products/Original-Adoptrex-85g-p647327433) from Gold Standard Herbs. If that's one of the ones you have on hand, I'd give it a try.

Adoptrex pairs well with Glehnia and Rehmannia to heal stomach ulcers as well. I know they saw no ulcers, suggesting it is more of a motility disorder, which makes Adoptrex my top pick. Still, to hedge your bets and ensure acid production is truly normal, you could use it with Kan Essentials' Glehnia and Rehmannia

Hope that helps!

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Hello Dr Steve my Dog (3 yrs old on raw) went into emergency operation for bloat Sunday night and was released today. They recommended a bland chicken and rice diet for the next 3 day and transition to regular diet (raw) on day 4. My question is do you think i should be feeding him rice or can Imyou suggest something else? He was also prescribed Gabapentin for pain and Clavamox for nasal discharge I know sometimes pain meds are necessary put should I give him the Clavamox? I want to avoid any further damage to his microbiome which I’m sure I’m gonna have to look into. Thank you for your time

Dr. Steve's Advice - GDV or bloat pretty much exclusively happens in so-called Shao Yang disharmony animals - that is, in animals who benefit from Minor Bupleurum. These animals also need more soluble fiber and fermentable carbs in their diet for normal GI function. The rice, therefore, seems fine for now as a source of simple carbs. Make sure your dog takes a Lactobacillus and/or Bacteroides probiotics from now on. 

I have also never seen a dog bloat when given Minor Bupleurum. Minor Bupleurum is a main component of Adoptrex by Gold Standard Herbs   (https://goldstandardherbs.com/products/Original-Adoptrex-85g-p647327433) The other component is a formula called Wei Ling Tang which helps to regulate peristalsis. If this were my dog, I would make Adoptrex a standard dietary inclusion, unless the veterinarian is sure there is no risk of GDV in the future. If they did a gastropexy, abdominal discomfort can still occur, which Adoptrex will eliminate.

As for the Clavamox, I can't really comment, since I don't know how bad the nasal discharge was. If your dog had major abdominal surgery, then a few days of antibiotics is probably not a bad idea, especially if they couldn't keep the operating field as sterile as they wanted it.

Hope that helps!

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We would really appreciate your help.
We have a 6 yr old cocker spaniel. He is suffering from what we have been told is GERD. He has been diagnosed with dysmotility of the esophagus after barium swallow. 

After 2 years of trying many medications, supplements, medical tests, food trials, changes to routine and elimination processes we cannot find something to help him. What could we try to help him please? 

He possibly has IBD.
He has had 6 seizures in 2 years.
Only abnormal blood test findings - low folate June 2021, back to normal Feb 2022
He had 3 deep ulcers in his duodenum in Oct 2021, healed now. 

Thank you

Dr. Steve's Advice - I don't know what supplements you've tried, so I can't promise this won't be a retread of advice someone else gave you. There are three basic Chinese medical diagnoses that can give rise to the licking symptoms you're seeing there: Shao Yang disharmony, Dampness, and Stomach Yin deficiency. Shao Yang can be associated with either of the other two, but the other two are somewhat mutually exclusive. So it probably will boil down to a process of elimination. The first thing I would try (since it is usually what works) is Yi Guan Jian (One Linking Combination), sold by Kan Essentials as Glehnia and Rehammnia Combination. It is probably the world's oldest treatment for GERDs and the tendency to gastric ulceration. I've cured my own dog with it, and many human patients, too. You should be able to find the Kan version easily on Amazon. Dose according to the table at https://nphc.ca/using/dosage

If the GERDs gets worse on the formula, even that is good news, because it at least tells us your dog is Damp. I don't think that will happen, though. I would give it a try.

Click here to read the whole thread. 

We’ve been working with Rodney Habib for about 3 months now for our dogs excessive swallowing issues.
Tonight he suggested I reach out to you for help.

Hazel has been excessively swallowing before and after waking up from sleeping for about 4 months.
It’s to the point where when she wakes up from her sleep it seems although she has an excessive amount of saliva in her mouth.
It’s typically when she lays down before her nap/sleep and worse when she wakes.
Her nose is also super congested so we thought it may be some sort of post nasal drip issue, we’ve tried allergy relief options and have had no relief 

We’ve done the GERD protocol by Rodney and we’ve tried a million natural supplements, herbs, etc. None have made a difference at all over the past 4 months.

She’s been on raw and now we do the honest kitchen and add our cooked protein which she loves and seems to be great. 

She’s had chiropractic work done once since because she did run into me when she was off leash pretty hard and the symptoms happened shortly after, but the chiro didn’t seem to help at all. 

We are unsure what steps to take next, if we should get an X-ray or try to find another chiropractor etc.
any help would be great

Thanks!

Dr. Steve's Advice - there are a lot of options that can help your dog. I guess the first thing is to check out the carb content on a DM basis of the Honest Kitchen. If it is above 30%, that may be the problem (unless this was happening on raw - was it?). If so, you could try to source Three Seeds Combination from Kan Essentials (e.g., from Aamzon in the US). It can decongest the nose and help reduce or resolve the GERDs.

If it was happening on low carb raw, then get a hold of some Adoptrex      (https://goldstandardherbs.com/products/Original-Adoptrex-85g-p647327433)  by Gold Standard Herbs and give it a try.

Lastly, it's possible that a Kan Essentials formula called Glehnia and Rehmannia might help, but use it only after you've tried the above.

One rule out is megaesophagus with a secondary nasopharyngeal infection. X-rays may help disclose that. Note that Three Seeds and Adoptrex are two good treatments for megaesophagus, so trying them first might be a good idea. They can even be used together if you want to hedge your bets.

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I'd like to start by saying that Gaby is being actively managed by a veterinarian but so far we haven't been able to find a clear answer to what is happening so I am praying you have seen this before. 

Gaby is a distemper survivor (neutered male) of unknown age. He was already an adult (at least 3 or 4) when i rescued him and he was a former street dog who was actively battling distemper so to say his teeth were bad would be an understatement. He and I both fought like hell for months and he finally beat distemper roughly 4 years ago and has lived a really cushy life in Southern California ever since. 

He does have tics (his head bobs) and had a few seizures early on but those have been managed well with a very low dose of phenobarb. It has now been 1+ years since his last breakthrough seizure and his tics have actually softened so much that they are almost gone now. 

In the last month or two, his health has started deteriorating and no one can figure out why. He has always been a picky eater but he has recently grown so much worse. He acts like he is hungry (runs up to the food bowl eagerly) but as soon as he sees/tries to eat the food, he smacks his mouth and walks away. Two different vets have checked his mouth and seen no reason there, so thought maybe nausea and put him on cerenia but that hasn't helped. His appetite has waned to the point that we are about to put a feeding tube in so he can get adequate nutrition while we look for answers. 

He has also started displaying weird behavior: pacing endlessly in circles, making weird/random vocalizations (sometimes grumbling, sometimes crying). His bloodwork has been great: kidneys/liver/WBC/RBC/etc. with the exception of somewhat low cortisol. His cortisol is .9. We ran the Addisons test and it was negative. We have also done an abdominal ultrasound and it looked normal except some inflammation in his small intestine and a small nodule that the vet believes he was born with on his pancreas. Next we ran a micronutrient panel and it showed he had low B12 so we are now supplementing that and awaiting a low dose steroid to take care of the inflammation.

Tomorrow he is being sedated and will have a more thorough exam (to include x rays) of his head/mouth/neck. If that comes back normal, the next step will be a CT scan of his head/neck. 

I am at a complete loss here and, in spite of the measures we are taking to help him, he doesn't seem to be improving. I can't justify giving up on him because we don't know what is causing his issues and, without that answer, we don't know if this is fixable or not. 

My fear is that he is entering the early (or advanced) stages of dementia and that it may be happening earlier in life because of the neurological damage from distemper. But that wouldn't explain his low b12 and cortisol so there has to be SOMETHING else....

Thank you for reading this far and for any advice you can give on additional tests, protocols, etc. This little boy brings so much joy to the lives of myself and others and I am terrified that I am losing him. Please help.

Dr. Steve's Advice - you may need a trained chiropractor to palpate his neck or jaw, to be sure there are no fixations there that could be contributing to jaw pain and refusal to eat despite hunger. If they don't find anything on his exam today, keep that in mind.

My suspicion, though, is that he might have a mild ulcer. He gets hungry, but then as soon as gastric juices start flowing at the sight of food, he experiences abdominal pain and backs away. Gastric ulcers are hard to detect with routine X-rays and lab work, unless they are quite severe.

The cognitive issues would appear to be separate from a conventional perspective, but in Chinese medicine commonly arise from one of the most common causes of ulcers, namely Shao Yang disharmony. 

Chinese medicine understands the body as made up of Yin and Yang. These two substances - matter and energy - move around the body over the course of a day, powering different organs as they go. If they don't move smoothly, problems arise, particularly if it is Yang that is getting stuck somewhere. It is the job of the Shao Yang to prevent that from happening.

Yang is supposed to internalize at night. If it doesn't, all that energy in the brain creates insomnia, pacing and vocalizing. Seizure tendencies are common as well. If, during the day, the same Shao Yang dysfunction has Yang trapped in the interior, then it concentrates in the Stomach producing problems like ulcers and GI inflammation (which can lead to low B12 levels). 

If that analysis is correct, your dog should respond pretty promptly to Halscion      (https://goldstandardherbs.com/products/Original-Halscion-85g-p647327436) by Gold Standard Herbs. It contains two sub-formulas. One of them, called Chai Hu Jia Long Gu Mu Li Tang, has been used for two thousand years to deal with those cognitive issues. Another one, Yi Guan Jian, is the top formula for healing gastric ulcers. If this were my dog, I would be giving it a try right away

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 I am writing in regard to my 5 lb, 11 year old chihuahua rescue who suffers from acid reflux. Symptoms include either random spitting up a bit of fluid (not bile) hours after a meal or having days where she doesn’t want to eat which results in greater discomfort and a squeaking stomach.

She eats lightly cooked Small Batch chicken/turkey along with GastroElm, Bao He Wan, Optagest, and GutSoothe. The Bao He Wan hasn’t made a noticeable difference and the GastroElm seems to really prevent the spitting up but she still has a day every 1-2 weeks where she doesn’t want to eat. 

I am considering putting her on a fish-based diet and would truly appreciate any further advice you might give as I’m not sure if she has too much or too little stomach acid.

Dr. Steve's Advice -  if the Slippery Elm product clearly helps, then something to improve circulation to your dog's stomach to replenish the natural mucous coating of the stomach lining is called for. I would suggest Glehnia and Rehmannia made by Kan Essentials, and often available online at Amazon in the US. Dose according to the table at https://nphc.ca/using/dosage

Hope that helps!

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 My pup, Peanut was diagnosed with an un-named upper intestinal disease while being tested for EPI. Prescribed B-12 injections once a wk & Folic Acid 1mg once a day. Provesec for acid reflux which made reflux worse, so now pepcid which didn't help so we are back on Gastro Elm. I heard antacids can block absorption of some vitimins. Also Tylon which is going to mess her gut flora even more & I don't want to give it to her. Is there something natural or food-wise, I can give her for healing overgrowth of bad bacteria? And what is a quality kibble? Can't afford raw or homemade. 

Dr. Steve's Advice -  it sounds like your dog could have a bacterial overgrowth, like of Helicobacter, if it got worse on antacid therapies. If so, they should be stopped, so you're not fighting against them. Meanwhile, we need to boost your dog's defenses in their GI, which usually means stimulating mucosal blood flow. In the case of the stomach, that will BOOST acid production, which allows complete digestion of food, resolution of GERDS, and the conquering of bacterial overgrowth.

My favorite formula for that in dogs is Glehnia and Rehmannia by Kan Essentials. If it was not the stomach that was involved, then Adoptrex   (https://goldstandardherbs.com/products/Original-Adoptrex-85g-p647327433) by Gold Standard Herbs is another option.

Note that the main cause of poor GI mucosal blood flow is likely kibble. It promotes a condition known as endothelial dysfunction, that can interfere with normal circulation in a host of locations, allowing chronic inflammation and infection to persist. If you can't feed real food, then freeze dried is about as processed as you can get yet still hope to maybe not experience a relapse of the condition at some future date

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 Hi Dr.Steve ! I am very happy to have found this page !!!
I have a 10.5 y neutered terrier 12.2 pounds . Thankfully , Bonji has not had any health issues until this past October,he was given amoxicillin and clavulanate for upper respiratory congestion which I don’t believe was necessary but I had to learn the hard way . The antibiotics most likely caused a dysbosis in his gut ( I have included microbiome results ) and gut restore fecal pills were  recommended by animal biome to restore the gut unless you see a different problem here ? I believe its acid reflux unless it’s Phelgm accumulation . I believe it does get worse once he eats so I’m assuming there’s quite a bit of inflammation in the body along with high Streptococcus bacteria in the gut per animal biome results . 

Symptoms : gulping after eating
Eating more but not gaining weight . He has lost .6 ounces since October 16th 2023 .
Does not want to drink water as often
Clampy mouth
Elevated liver enzymes ( not out of range however enzymes are elevating each month )
Minimal air licking
Paw licking
Yawning
Jaw snapping ( mouth  sounds like it’s dry but it’s not )
I can hear saliva/ liquid  circulating in his mouth and toys are super super wet after he is done playing  ( sticky saliva ). Washback ? 

Currently on:
Beta thym -half every 24 hours  and 1/2 of XIAO CHAI HU TANG every 12 hours . ( recommended by intergrative vet specializing in Chinese medicine  ) . 

Omprezapole was suggested for 2 weeks by a specialist but it did not help after 3 days in fact I believe it made the symptoms worse and I stopped . Pepcid does help I’m guessing since the effects are immediate . We did start acupuncture today and he seems “ happier “ . 

No vomiting
No diarrhea
No blood in stool 

Acid reflux/ washback is the main concern right now along with the liver enzymes going up every month and as mentioned  he is eating more but not able to put on the weight. I am afraid to do more of a work up since it does require anesthesia for an endoscopy. 

I do have the fos + sboulardi from animal biome along with the fecal pills but hesitant to start them just yet . I’m afraid of doing too much at once or doing the wrong thing . 

Has never eaten kibble . Used to eat different variations of “just food for dogs “ up until 2 months ago however he did develop stomach spasms and I was advised to switch the food and he is currently on small batch lightly cooked turkey and does not have any spasms nor stomach gurgling sounds  . Recent Ultra sound and past 3  X-rays show “normal “. I’ve done an X-ray every month since October 2023.  I would also like to note that I did have him on vet cbd for the past 1.5 months which I recently read can cause elevated liver enzymes and I have stopped that since I also have not seen any improvement with the vet cbd  . Have you seen a dysbosis in the gut cause acid reflux , weight loss or should I have this looked into further and if so what would you do if this was your dog ? I took him to two holistic vets one which did suspect he might have sebo ? Not sure how to go about the possibility of “ sebo “ since that specific vet did suggest digestive enzymes which had Lactobacillus and Bifidobacterium strains and I read these specific strains can make sebo worse which she didn’t seem to be aware of . 

Note : i believe CL levels are showing higher ranges due to less water intake  ? I would appreciate your opinion on 1)what you think might be going on as well as 2)which type of diet have you seen the best results for these type of issues and 3)if there is a herb you like for inflammation /That heals the gut,  soothe the esophageal tract ?
And 4) if the beta thym and XIAO CHAI HU TANG are the right herbs you would give your dog ?
Thank you for taking the time to read this !! Happy holidays

Dr. Steve's Advice -  there are many possible things that might help here, but my first thought for this nausea is to try Glehnia and Rehmannia from Kan Essentials. It is a Stomach and Liver Yin tonic. Yin deficiency is suggested when we have animals with inexplicable weight loss, given that they have normal to increased appetites and normal stools, with no change in diet to explain the body weight change.

The Liver in Chinese medicine is responsible for the orderly movement of Qi, which includes the normal descent of ingesta through the Stomach. If the Liver is lacking Blood or Yin, then it 'goes off the clock' to produce symptoms of Qi Stagnation, which commonly results in nausea. Qi Stagnation is more likely to occur in the fall and winter months, producing the yawning and gulping symptoms you're seeing as well as the "Food Stasis" producing reflux.

Xiao Chai Hu Tang in theory can have an overarching effect at restoring normal GI motility, but it doesn't work as well if Yin deficiency is the cause. It can even be aggravating in that instance. Glehnia and Rehmannia pairs well with XCHT. Your vet probably has it as Yi Guan Jian by Natural Path, but if not, you can source it from Aleksandra Topic, a Kan distributor who is in our group. Follow here instructions here: https://www.facebook.com/groups/1158575954706282/posts/1420037418560133/

If it doesn't help, there are many other things we can try but it fits everything you've mentioned, including the worsening on omeprazole. G&R actually helps in part because it bolsters proper acid production, which helps the body empty the stomach faster (because the rate of digestion is increased); and also because the higher acid kills bacteria in the upper GI and stomach, counteracting tendencies to SIBO and dysbiosis.

Maybe give it a try, then, and see if it helps you out. If it does, you should see overt improvements over the next week or two. Start with the label dose for a day or two if you're using the Kan product, then ease up to two or three times that dose at least so you can be more sure of an effect. If it doesn't help, there are plenty of other things to try

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 Hi Dr.Steve I want to thank you for all that you do. 

My girl Ziggye 5yr Rottweiler has always been itchy. Apoquel  shots about 3-4 times a year.All 4 of our Rottweilers are raw fed. Premade raw. They are on a probiotic and get Green JuJu just greens.She’s my ball crazy girl. Constantly on the go. She runs hot. More so than the rest. She also has crazy reflux. Do you have any advice on her itching and reflux? Is her running hot part of it?

Thanks 

Mandye and the ZigZag

Dr. Steve's Advice -  if you read the posts at #skindiseasedogs and #cessorex, you'll see my knee jerk starting advice for itchy raw fed dogs is:

- ensure adequate carbs in the food

- add a Lactobacillus probiotic of some type like Gussys Gut (https://gussysgut.pxf.io/c/4643206/1738316/19832)

- add Cessorex and see what happens over a few weeks

Cessorex could help reflux at the same time, but to hedge your bets, I would use Adoptrex    (https://goldstandardherbs.com/products/Original-Adoptrex-85g-p647327433) at the same time as the Cessorex, while reducing Cessorex to half doses

The two formulas together should address the likely dysbiosis, immune system excess, and compromised gut wall circulation leading to reflux and to leaky gut

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 Hi Dr. Steve, thank you for your help here. I’ve taken the time to go through related posts and, currently, I’m eagerly awaiting the shipment of bupleurum and kudzu.

Rhodes, my 1-year-old toy Aussie, was diagnosed with SRMA in March  (at ~5 months of age) due to noticing her constantly being hunched and walking a bit stiff. The MRI indicated slightly indistinct SAS/CSF on T2myelo, suggestive of inflammatory meningitis. Despite a CSF sample with a slight neutrophil elevation and contamination, we proceeded with prednisone treatment. She also deals with low-grade luxating patellas, contributing to persistent back pain according to her vets. This sensitivity bever goes away and she gets slightly hunched after a few steps most of the time despite medication, chiropractic care, acupuncture, and laser therapy. Anyway, She was taking only prednisone but I felt I noticed a relapse (probably immature) so now she has been on prednisone (1.25mg every second day) and cyclosporine twice daily for about 6 weeks so far and due to taper again. 

My questions:
Post-cyclosporine initiation, she encountered chronic UTIs, recurring about 3 times now despite a 3-week course of clavamox and the use of bladder treats each time. Any advice on managing this issue would be greatly appreciated.

The primary concern revolves around her sensitive stomach. Despite administering cyclosporine 1.5-2 hours post-meals (she’s on just food for dogs -joint and skin formula with slippery elm), her tummy gurgles, tear ducts overflow, and she experiences nausea/vomiting. She also is always itching like crazy but does so less with the fish formula and this skin one from JFFD. Our routine involves meals at 7:30-8 am with her prednisone every second day, and cyclosporine at 9:30 am and pm every day. 

I’m also attaching her initial findings here for your reference. Any additional thoughts you might have would be invaluable, especially considering her fluctuating symptoms of more unexplainable back sensitivity some days than others and this stomach difficulty. Thank you sincerely for your time and expertise.

Dr. Steve's Advice -  it's alarming to have a diagnosis of meningitis in a dog of such young years (or rather, months!). I understand the basis for the diagnosis, but at least half of me is questioning it, since both findings supporting it (i.e., the MRI and the CSF analysis) are pretty subtle. It's probably wise to seek out local holistic help to see what might really be going on.

Meanwhile, I'd start with the skin symptoms. If we can get them to improve, then we know we are regulating your dog's immune system sufficiently that you will have probably undermined the tendency to SRMA. For that, I'd recommend adding:

- Cessorex (https://goldstandardherbs.com/products/Original-Cessorex-85g-p647327434) from Gold Standard Herbs

- a Lactobacillus or Bacteroides probiotic, such as Gussys Gut (https://gussysgut.pxf.io/c/4643206/1738316/19832)

Meanwhile, continue whatever fresh food diet seems best tolerated.

These two items will start to remove the tendency toward immune mediated disease of any cause in your dog's body, in part by sealing the leaky gut.

It's fine to use this with the Bupleurum and Kudzu, if it has arrived and you've already started it. If all signs of SRMA had been wiped out by the drugs, back off on the cyclosporine to allow some minor recurrence. Then wait until the herbal formulas 'catches up', causing that uptick in symptoms to disappear. You're then ready to lower the dose of cyclosporine (and/or prednisone) again. Once your dog is symptom-free and off drugs, you're clear to start reducing the B&K

If the B&K has arrived, but you haven't started it, and the drugs are resolving all evidence of the SRMA, then proceed with just the Cessorex for now, but add Lift the Qi by Kan Essentials (available through the same place as the Bupleurum and Kudzu) can help the GI symptoms and tendency to recurrent UTIs, by rescuing local immunity in the gut and bladder. As skin/bladder/GI symptoms improve, start reducing the cyclosporine in the step-wise fashion mentioned above, waiting with each reduction until the herbs have caught up.

I can think of a couple of differentials for the hunching, if the immune suppressants aren't doing that good a job of getting rid of SRMA symptoms. One is a 'Wind invasion' where the real problem is poor circulation to your pup's back, causing back spasm and hunching. Candidate treatments include Lumbrex (https://goldstandardherbs.com/products/Original-Lumbrex-85g-647327437) Another, given the GI weakness being revealed, is Free the Sinews by Kan Essentials.

The second possibility, though, is a tendency to gastric ulcer which might not show on any test and would be perhaps the most conceivable of all the diagnoses to exist in a young dog. For that, I would use Glehnia and Rehmannia Combination from Kan Essentials. It is safe to use with Cessorex and Lift the Qi (and B&K, if it's already in use).

Given the complexity of the answer, you can see why it's almost wiser to have a skilled local practitioner guide you through this, but maybe there is enough help here to get you through it, so your dog isn't chained to such hard-hitting drugs at such a delicate age

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 Good day Dr. Steve.
Thanks for all you are doing. Your advise is greatly appreciated.
I have 3 Boston terriers with 2 if them with GI issues. Your advice for my youngest was helpful.
I am having issues with my eldest now. He is 5 yrs old and has a history if a bleeding stomach ulcer 3 years ago. 2 weeks ago he went from eating 3 meals a day, down to 2 to being very fussy and eating little. He then started to get diarrhea that became very dark and greenish. I did consult my vet who thinks it's an ulcer again and he was started on sucralate and antibiotics. He checked the stool and said there was blood.
I asked for blood work when I found he was not improving fast enough. He is still having very dark brown diarrhea. I am attaching a picture of his lab work. Not sure if something else is going on. No vomiting and us still playful. Any suggestions?

Dr. Steve's Advice -  if you saw an incremental improvement when you added the sucralfate and antibiotics, then there may have been an ulcer present. In that case, the Glehnia and Rehmannia that I recommended for your other dog may work here, too. I used it to heal a bleeding gastric ulcer in our own dog.

If you didn't see a jump in appetite and energy in response to the sucralfate and antibotics, then there may be no ulcer there at all. Blood in the stool is commmon and has a number of causes. Only if the stool was dark and black and shiny would we know it's coming from a gastric ulcer. Your dog looks almost hemoconcentrated - that is, the opposite of the anemia we would expect if an ulcer was present. Hemoconcentration can occur if an ulcer is suddenly healed, but if the meds you're using didn't produce an obvious boost in appetite and energy, that's probably unlikely

In that case, apart from the real food diet I always recommend, I'd recommend Happy Wanderer from Kan Essentials. It helps to harmonize and normalize digestion and appetite when liver enzymes are slightly elevated (like the ALT in your labwork) or too low (like the ALP in your labwork). I'd give it a try if the drugs you're using haven't made a huge impact.

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