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brisadog
brisadog,
Category: Dog Veterinary
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I hav a 10 year old pug who's is currently being treated UTI

Customer Question

HI,
I hav a 10 year old pug who's is currently being treated for a UTI (E.Coli) with Cefoperaxzone+Sulbactam 300mg x Inj x BD (Started on the 19th). His TLC was 17470 cells/cu.mm on the 18th; Hemoglobin had fallen to 12.9g/dL and SGPT 93.30 U/L. Urine had Nitrites, Leucocytes, Protein, Pus Cells, RBC and bacteria were all present prior to treatment, and have pretty much resolved in today's urinalysis. Blood test will be repeated on the 25th, after a 5-day course of the antibiotic.
He is also a suspected case of Megaaesophagus, hence we hold him upright for about 15 minutes after his meals. Also he has occult blood showing up in his stool since November 2nd, 2015. The RBC count in the stool also suddenly picked up to 8-12/HPF and Pus Cells 4-5/HPF since the 16th and continues to be the same. We have also noticed that there has been some blood spotting in his regurgitated vomit for the last three days.
What I would most like help with today is:
a) He has started shaking/trembling uncontrollably after eating his food and this lasts for 30-45 minutes. This was first observed around the 17th. His appetite is however quite strong despite this.
b) If you could help shed some light on the occult blood/ gastric bleeding...
Submitted: 11 months ago.
Category: Dog Veterinary
Expert:  brisadog replied 11 months ago.

Hi, I can help you with your question today.

Expert:  brisadog replied 11 months ago.

Since you have seen blood in his regurgitation, it is no surprise that we are seeing fecal occult blood.

Expert:  brisadog replied 11 months ago.

Since he has presumed megaesophagus, I am suspicious that he may have esophagitis due to the repeated episodes of regurgitation. This can cause the shaking after eating, which is due to pain.

Expert:  brisadog replied 11 months ago.

I highly recommend that he be evaluated using either a barium study and regular x-rays, or endoscopy at a referral center.

Expert:  brisadog replied 11 months ago.

These could help us confirm if there are erosions in his esophagus from acid reflux. If so, we can begin treatment with protective medications like sucralfate, omeprazole and famotidine, as well as a prokinetic drug like metoclopramide.

Expert:  brisadog replied 11 months ago.

He would be fed small meals of a low fat easily digestible food like Hills I/D or Purina EN (both are prescription diets).

Expert:  brisadog replied 11 months ago.

We would also start pain medication such as tramadol. I would avoid NSAIDs in a patient that has GI bleeding.

Expert:  brisadog replied 11 months ago.

Please let me know if you have further questions. I am happy to continue until I provide the service that you seek. Here is my website if you need to reach me again: http://www.justanswer.com/veterinary/expert-drsusanfriend/

Customer: replied 11 months ago.
HI. Thanks for your reply. The shaking has just started on 16th/17th December just as the UTI developed. And the spotting has also just started over the weekend (19th). I can definitely get non-invasive tests such as X-Rays and USG's done but I do not want to put him through invasive procedures or those that require GA as he has had an episode of Acute Renal Failure in 2012, and I want to keep his exposure to medication to a minimum. His Vet has just today prescribed omeprazole x 4mg x BD and famotidine x 20mg x BD pre-Breakfast and pre-Dinner to see if it helps (He is 8.4 kg). We feed him a diet of Red Cabbage (ulcer/stomach healing properties) and carrot soup with white rice, olive oil, and 1 boiled egg white/day (1/4 yolk x Thrice per week). He was on renal food for a very long time (Hills K/D) following which we decided to shift him to fresh food and his K.F.T and electrolyte values are actually even better and completely normal.Please advise how else we might take the investigation forward and help him. He is also completely blind, hence gets anxious very quickly, which is another reason I do not want to expose him to too much testing. Also the cold weather is not helping!Hope to hear from you soon,Warmly,Nyla.
Expert:  brisadog replied 11 months ago.

No problem! If you do not want to do general anesthesia for endoscopy, then I would move forward with a barium x-ray. Beyond that I strongly recommend the sucralfate along with his omeprazole and famotidine. He should get the sucralfate 1 hour before food or other medications. If the shaking continues on these medications, he needs pain medication additionally.