Hello, I am looking for some advice on a current patient of mine. He is a 2 yr old chocolate lab. He presented to me a few months ago after having been diagnosed (based on blood work and ultrasound - no intestinal biopsies) with protein losing enteropathy. He was given a grave prognosis and estimated about 1-2 yrs to live if he stayed on high dose prednisone. He then developed a stomach ulcer on prednisone and came to see me shortly after. I have made these clients no promises - Coco was in very rough shape when I first saw him - but said I would try my best to help them. Coco initially presented to me with inappetance, muscle loss/wasting, lethargy, ascites (big round belly) and pleural effusion, liquid projectile diarrhea, pacing at night, not sleeping well, increased water intake. All of this came on fairly quickly over about 1-2 weeks after chewing and ingesting some foam from a slipper - GI obstruction was never an issue. I treated him with ozone therapy, sulcrate liquid, fecal transplant capsules, another dog specific supplement to kill off E coli (phage), S boulardii, Xiao Chai Hu Tang and San Ren Tang. He responded well to the treatments, started eating well, got energy back, fluid in the abdomen and chest resolved, his poops turned to more of a sour cream texture than liquid. We added in some digestive enzymes, fibre, L glutamine at different stages along the way in hope that he would put on some weight. I stopped the San Ren Tan and switched him to Bu Zhong Yi Qi Tang, continued the Xiao Chai Hu Tang - after about 2 weeks on this he finally gained some weight. Repeat blood work showed normal CBC, still low albumin, low calcium (likely related to low albumin), some electrolyte imbalance (Addison's ruled out with normal cortisol testing). Essentially this was unchanged from before he same to see me. Urine test was normal. Fecal PCR testing negative for parasites. So things were going better but clearly not resolved. Then this week at his recheck, his weight has stayed the same but fluid is returning in his chest and abdomen - so he may have even lost weight. Obviously the return of the fluid is very concerning. I have stopped the BZYQT and XCHT and put him back on SRT for herbs after consultation with my mentor. Coco currently takes -sulcrate 1-2 hrs before meals - digestive enzymes with each meal - meals are garnished with fresh grated ginger - L glutamine - pre-biotic (psyllium and inulin fibre) -probiotic - post biotic - combination B vitamin supplement - was previously on B 12 injections - San Ren Tang I have been working with my mentor who has been practicing holistic vet med for much longer than me - she uses mainly acupuncture and chinese herbs to treat so I have been using the formulas under her guidance. We are hoping that with him back on the SRT that we will see some resolution of the fluid but I still need to figure out how to help his gut heal. I would appreciate any input you might have on what else I can do to help this guy. The owners are reaching the end of their rope financially so I am trying my best to keep costs down. They don't have any finances to repeat an ultrasound or really any further diagnostics unfortunately. I am thinking of adding one or a combination of: Atractylodes, Poria, Pinellia, Ginseng, Citrus Peel, Licorice (6 gentlemen), trikatu, black seed oil, Amla I would love to get your thoughts on this case. Thank you in advance. Dana

Here are the products that I have been using - from Natural Path Herb Company Xiao Chai Hu Tang - Chai Hu Bupleurum root Huang Qin Scutellaria root Ban Xia Pinellia rhizome Gan Cao Licorice root Sheng Jiang Ginger rhizome Da Zao Jujube Ren Shen Ginseng root San Ren Tang - Xing Ren Apricot seed Yi Yi Ren Coix seed Hua Shi Talc Ban Xia Pinellia rhizome Bai Dou Kou Round Cardamon Dan Zhu Ye Lophatherum Hou Po Magnolia bark Tong Cao Rice Paper pith Bu Zhong Yi Qi Tang - Ren Shen Ginseng root Dang Gui Shen Chinese Angelica root Huang Qi Astragalus root Bai Zhu White Atractylodes rhizome Chai Hu Bupleurum root Chen Pi Citrus peel Gan Cao Licorice root Sheng Ma Cimicifuga rhizome

I would still be interested in your opinion here but I'm pretty sure this guy has lymphosarcoma. Prognosis is grave and we are focusing on palliation. Dana

I see in another post that case histories like this are not ideal for this format. Sorry about that. I will keep questions more general in the future!