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CriticalCareVet
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My dog is a 1-year old male neutered German Shepherd and Im worried about him.

Resolved Question:

My dog is a 1-year old male neutered German Shepherd and I'm worried about him.

History: He's had all his shots and takes Sentinel heartworm/flea medicine 1x/mo, last dose June 5. Otherwise he takes no meds or supplements

except as noted below.

After experiencing recurring diarrhea and watery stool during his first 8-9 months and somewhat below expected weight gain, he seems to have

responded well to a change in diet to grain-free dry food, with mostly firm stool now, better appetite and resumed weight gain, albeit slowly. For

the past two-three months he's been eating a Costco brand salmon and sweet potato dry food usually made more interesting with non-fatty juices from

whatever meat or fish we're serving.

He's normally very active and lively. Typically on week-days he spends between 5 and 8 hours at a doggy day care and gets an hour walk in the

evening. On weekends, he spends 1-2 hours a day at a dog park playing very actively, gets about a hal
Submitted: 2 years ago via Maybeckvet.
Category: Dog Veterinary
Expert:  CriticalCareVet replied 2 years ago.
Welcome to JustAnswer! I am a licensed veterinarian and specialist and will do my best to assist you today!

Based on the breed, I would consider a process called Exocrine pancreatic insufficiency.

You can read over this link as I think it very much applies to this case:

http://www.petplace.com/dogs/exocrine-pancreatic-insufficiency-in-dogs-epi/page1.aspx

This is something that MANY dogs of this breed have!!!

As often the case, while they can benefit from a hypoallergenic diet, pancreatic enzyme supplementation (LINK HERE) is needed as well.

weight: bold;font-style: normal;font-variant: normal;text-decoration: none;">This is meant to be a running dialogue, and for this reason it is very IMPORTANT that you reply using the REPLY TO EXPERT button if more information is needed at any time BEFORE rating.

Positive RATING (EXCITED FACE or 5 STARS) is appreciated as this is the only way I know you have received the information and I receive credit for my time.

Please remember to ONLY rate my answer when you are 100% satisfied. IF you feel the need to rate "Poor Service" or "Bad Service", please STOP and reply to me via the REPLY TO EXPERT button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek.

With this communication - we are here to guide you in making the best decision for your pet. This is for informational purposes only. We are not allowed to diagnose and prescribe medications - rather provide a course of action to speak to your veterinarian about - and any medical therapy and treatment should only be performed after an in-person examination with your veterinarian as a professional-client relationship has not been established on the site. While information may be discussed, this is not intended as an encouragement for you to self treat your pet, rather information online, and any treatment provided should only be performed after consulting your veterinarian.
Customer: replied 2 years ago.

It does not appear that my entire question made it to you, but only part of the introduction. I asked five specific numbered questions, none of which was answered. The answer you gave was information already known to me and not what I need to know right now. I'm recopying my question below, in case that is the problem.


 


My dog is a 1-year old male neutered German Shepherd and I'm worried about him.


History: He's had all his shots and takes Sentinel heartworm/flea medicine 1x/mo, last dose June 5. Otherwise he takes no meds or supplements


except as noted below.


After experiencing recurring diarrhea and watery stool during his first 8-9 months and somewhat below expected weight gain, he seems to have


responded well to a change in diet to grain-free dry food, with mostly firm stool now, better appetite and resumed weight gain, albeit slowly. For


the past two-three months he's been eating a Costco brand salmon and sweet potato dry food usually made more interesting with non-fatty juices from


whatever meat or fish we're serving.


He's normally very active and lively. Typically on week-days he spends between 5 and 8 hours at a doggy day care and gets an hour walk in the


evening. On weekends, he spends 1-2 hours a day at a dog park playing very actively, gets about a half-hour each day of chase play at home, and


gets a 1/2 hour to an hour walk in the evening. The weekday schedule gets him home nicely tired and well-behaved. The weekend schedule is the bare


minimum to keep him well-behaved.


He had an episode of aspiration pneumonia at about six months, and an episode of acute gastric disturbance in February, when he was having severe


diarrhea and straining on elimination, became extremely lethargic and stopped eating and drinking. He was treated with metronidazole, rehydrated


overnight at a vet hospital, and bounced back quickly. Parasites, giardia and obstructions were ruled out by testing; pancreatitis and IBD were not


ruled out by testing due to expense, but the diet changes seemed to resolve the problem. He has had three episodes of panosteitis for which I give


him Tramadol. These episodes typically last about 7-10 days and the last one ended about a month ago.


Current observations:


Seemed fine Friday morning before going to doggy day care, but on my return home I did notice two mounds of what looked like diarrhea in the yard


(but might have been vomit) with undigested food in it. Very light in color, grainy and not watery in appearance, no blood apparent.


Within 1/2 hour of return home Friday night and without eating anything, he threw up - mucus and bile, no food particles. Afterwards throughout the


evening seemed to experience a few bouts of nausea (a little drooling, a lot of licking his lips) and did not eat anything or drink much. Slept


through the night though with no further episodes of vomiting. Ate nothing and drank very little.


Saturday morning seemed lethargic, still not eating, would occasionally drink some water if I held the bowl for him and didn't give him much choice.


Mostly just slept.


Saturday afternoon, ate about 1-1/2 cups of food and a piece of duck breast jerky, drank a little more water, but now doesn't seem to want to lie


down, just wanders slowly around the room and mostly stands in place for long periods looking dejected. He will sit down for a treat, but he won't


lie down. In fact, he's started to lie down a couple of times but then stops, like he thinks it might hurt, and gets up again. When I palpate his


abdomen he doesn't seem to experience any pain. He's not vocalizing at all, like he does when he's in pain from the pano. He is still


occasionally acting nauseated but hasn't thrown up again.


My regular vet is closed 'til Monday. There is a vet hospital in the area where he was treated for the pneumonia and to get him rehydrated during


the gastric episode, but frankly they are very expensive and I'm sorry to say I don't necessarily trust them the way I do my regular vet.


My questions:


1. Is it better to withhold food or encourage him to eat? He could probably be tempted if I put some tuna juice on his food, but should I?


2. Is there anything OTC I can give him for the nausea? I take peppermint tea or ginger tea or both for mild nausea, but I suspect they work (if


at all) mainly through a placebo effect, which unfortunately dogs don't have the benefit of. I think I have some left-over meclizine from an


episode of vertigo, that's not too far past its expiration date. Or I could pick something up at the drug-store if needed.


3. He's obviously in some discomfort, and something is causing him not to want to lie down. Should I give him a dose of Tramadol? He didn't


experience nausea as a side-effect previously, but I understand it is one possible side effect.


4. If there's something I can do to make him more comfortable until Monday, and he is still drinking water and doesn't seem dehydrated, what are


the risks of not taking him in to the vet hospital now and waiting until Monday, and how would I know if his condition is worsening?


5. What else do I need to know?


Thanks.


 


 

Expert:  CriticalCareVet replied 2 years ago.
Hi there,

Yes - unfortunately only a fraction of your question was initially sent!

1. Is it better to withhold food or encourage him to eat? He could probably be tempted if I put some tuna juice on his food, but should I?

 

Typically in these cases, food is removed for 12-24 hours - from the last vomiting episode. Following that time - I would consider food encouragement. Unless there is severe vomiting, typically we encourage them to eat. Low sodium broth can be considered. Some add water and microwave it as well for the aroma to entice them.


2. Is there anything OTC I can give him for the nausea? I take peppermint tea or ginger tea or both for mild nausea, but I suspect they work (if


Regarding stomach upset, Pepcid A/C (Famotidine) is also a consideration - dosages and usage information here: http://www.petplace.com/drug-library/famotidine-pepcid/page1.aspx

3. He's obviously in some discomfort, and something is causing him not to want to lie down. Should I give him a dose of Tramadol? He didn't

 

Tramadol is a great medication in dogs, and unlikely NSAIDS does not tend to cause stomach upset - and nausea is not that common with this as well..

 

4. If there's something I can do to make him more comfortable until Monday, and he is still drinking water and doesn't seem dehydrated, what are

the risks of not taking him in to the vet hospital now and waiting until Monday, and how would I know if his condition is worsening?

 

The risks of not taking him in would be if there is continued vomiting - dehydration. Sometimes unfortunately severe dehydration - more than anything else.

 

5. What else do I need to know?


If you see worsening diarrhea, blood in the stool, abdominal bloating, cramping, retching, or other signs such as pale gums - those too would be emergencies.

This is meant to be a running dialogue, and for this reason it is very IMPORTANT that you reply using the REPLY TO EXPERT button if more information is needed at any time BEFORE rating.

Positive RATING (EXCITED FACE or 5 STARS) is appreciated as this is the only way I know you have received the information and I receive credit for my time.

Please remember to ONLY rate my answer when you are 100% satisfied. IF you feel the need to rate "Poor Service" or "Bad Service", please STOP and reply to me via the REPLY TO EXPERT button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek.

With this communication - we are here to guide you in making the best decision for your pet. This is for informational purposes only. We are not allowed to diagnose and prescribe medications - rather provide a course of action to speak to your veterinarian about - and any medical therapy and treatment should only be performed after an in-person examination with your veterinarian as a professional-client relationship has not been established on the site. While information may be discussed, this is not intended as an encouragement for you to self treat your pet, rather information online, and any treatment provided should only be performed after consulting your veterinarian.
Customer: replied 2 years ago.

 


So to summarize:


Since it's been nearly 24 hours since he vomited and he didn't eat for at least 12 after, I should encourage eating now, unless he vomits again.


I can give him a Tramadol to see if it will alleviate his discomfort.


I might also give him a Pepcid according to the dosage instruction at the site you referred to.


Follow-up would be the EPI test but that can wait til Monday.


If he appears to be getting dehydrated, I should act more quickly than that.


Correct?

Expert:  CriticalCareVet replied 2 years ago.
Yes - food can be considered and for these cases, famotidine and tramadol are more common than other medications which can have digestive side effectis.

Follow-up would be the EPI test but that can wait til Monday - yes - that would be ideal.


If he appears to be getting dehydrated, I should act more quickly than that. - YES!


This is meant to be a running dialogue, and for this reason it is very IMPORTANT that you reply using the
REPLY TO EXPERT button if more information is needed at any time BEFORE rating.

Positive RATING (EXCITED FACE or 5 STARS) is appreciated as this is the only way I know you have received the information and I receive credit for my time.

Please remember to ONLY rate my answer when you are 100% satisfied. IF you feel the need to rate "Poor Service" or "Bad Service", please STOP and reply to me via the REPLY TO EXPERT button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek.

With this communication - we are here to guide you in making the best decision for your pet. This is for informational purposes only. We are not allowed to diagnose and prescribe medications - rather provide a course of action to speak to your veterinarian about - and any medical therapy and treatment should only be performed after an in-person examination with your veterinarian as a professional-client relationship has not been established on the site. While information may be discussed, this is not intended as an encouragement for you to self treat your pet, rather information online, and any treatment provided should only be performed after consulting your veterinarian.
CriticalCareVet, ER/ICU Specialist
Category: Dog Veterinary
Satisfied Customers: 63981
Experience: Emergency and Critical Care Specialist
CriticalCareVet and 8 other Dog Veterinary Specialists are ready to help you
Expert:  CriticalCareVet replied 2 years ago.
Hi Ann,

I'm just following up on our conversation about Ranger. How is everything going?

CriticalCareVet
Customer: replied 2 years ago.
Thanks for checking. He had X-rays yesterday ruling out obstruction but showing considerable bowel inflammation. He had a blood draw this AM for his EPI test, and a subcutaneous fluids injection to help keep him from getting too dehydrated. He's still eating eating and drinking very little. Basically, he's the poster-boy for the expression "hang-dog." I hope we'll be able to figure out what's bothering him. Thank you for your help this weekend. It helped me sleep a little better.
Customer: replied 2 years ago.

I thought I would give you an update, not as a criticism but as a learning aid.


 


As Ranger was not improving, on my vet's recommendation I took him for an ultrasound early this afternoon, and the diagnosis was an intussesception (sp?), for which he is being operated on as we speak. Apparently because he was so lean, and the condition is hard to see on X-rays, it was not visible to the vet or radiologist who looked at his films on Monday. A biopsy for other possible bowel conditions will be done at the same time.


 

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