Concern about worsening GI upset with antibiotic use
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My 14-year-old spayed female mini dachshund was initially taken to the vet March 22nd for suspected idiopathic vestibular syndrome (head wobble/nystagmus after shaking head, balance issues). Bloodwork showed markedly elevated ALT/ALP, dehydration, and mild RBC abnormality. Abdominal ultrasound findings included diffuse hepatopathy with multiple small liver nodules (possible vacuolar hepatopathy/hepatitis/nodular hyperplasia vs metastatic disease not ruled out), gallbladder sludge/cholestasis, mildly mottled/heterogenous pancreas consistent with possible chronic pancreatitis, mild left adrenal enlargement, and mild chronic kidney changes. No obvious active pancreatitis or obstruction. No elevated WBC count or confirmed infection.
Initially she improved significantly on liver support supplements alone (Zentonil + Liver Hepato, and a custom herbal blend): better energy, more alert, eating better, acting more like herself. Vestibular symptoms resolved during this time (I believe the vet thinks this was incidental). This was after the bloodwork, prior to the ultrasound. Then the vet started:
* Clavaseptin for 30 days
* Zeniquin for 30 days
* Ursodiol
* probiotics (I added these myself as I know antibiotics can be hard on the gut. At first just Adored Beast Healthy Gut I already had on hand, about a week ago changed to Proviable Forte)
After starting antibiotics she progressively developed:
* reduced appetite
* food aversion/selective eating
* reluctance to eat regular dog food
* occasional trembling around meals
* vomiting yellow foamy bile once
* nausea suspected (improved somewhat with Cerenia after the vomiting episode)
* mild diarrhea once (could be from the ham that was given yesterday as she refused the chicken, rice and pumpkin and thats all I could get her to eat
* reduced stool frequency/volume
* increasing suspicion of medicated foods/treats
The pattern seems strongly associated with Zeniquin timing — she often eats best farther away from the previous dose (within a few hours the next is due).
She is currently on day 23/30 of antibiotics. Still somewhat willing to eat homemade bland food (chicken/rice/pumpkin, some ham, cod/salmon, broth), treats intermittently, and hand-fed meals, but appetite is clearly declining overall. Refusing breakfast the last couple of days, refused broth today. No repeated vomiting, severe lethargy, fever, or jaundice. We had a visit yesterday with our regular vet to repeat bloodwork (still waiting on results), and she expressed surprise at the 30-day dual-antibiotic course given lack of confirmed infection and normal WBC count, but did not want to directly override the prescribing vet before follow-up. (Prescribing vet has been away the last two weeks, should return Monday as far as I'm aware. Two former vet friends of mine also expressed surprise and some concern with 30 day duration and the progression of symptoms.
Question:
How concerning does this sound for progression of underlying liver/pancreatic disease vs antibiotic intolerance/GI side effects? In a case like this, how concerning is it to consider stopping or shortening Zeniquin given the worsening appetite/food aversion and lack of confirmed infection?