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Dr. Z.
Dr. Z., Dog Veterinarian
Category: Dog
Satisfied Customers: 6120
Experience:  Over 25 years of experience in caring for dogs and cats.
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I am writing about a dog (not mine) who has been without an

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I am writing about a dog (not mine) who has been without an appetite for approximately two weeks. Somewhere in the middle of that period, she seemed to recover for three or four days. Now she again has not been eating for several days. This is a blond lab. I'm not sure of the age. I think somewhere between 5 and 8. She has been seen by a vet twice. All bloodwork is normal. The vet says that she seems healthy. But she won't eat. Also, she has diarrhea. They also did a panel for some kind of tick-related disease. It came back negative, but the vet still wants to try that medication. She has been on that since yesterday. Earlier, she was given something for whip worm. She is also on something for the diarrhea and on prednisone for the appetite. She will eat milkbone dog biscuits, but not many of those. They've been trying to tempt her with assorted things. She'll sometimes try something, but just isn't interested in food and is eating very little. Her ribs are sticking out. There are no other signs of illness other than the diarrhea. It does not seem possible that it's something environmental because there are three other dogs and they are all fine. There have been no changes in the household or traumatic events. The vet suggested that the recent fireworks (people start early in Oklahoma) might have something to do with it. This dog is not afraid of those noises. My sister (her dog) is extremely concerned. Do you have any ideas both as to what could be causing this and as to what might be done to encourage the dog to eat? Her behavior otherwise is normal and quite cheery.
Submitted: 1 year ago.
Category: Dog
Expert:  Candy replied 1 year ago.

Hello, My name is XXXXX XXXXX I have been a veterinary nurse for 26 years.Thank you for allowing me to assist you today.

I am sorry to hear your sisters dog is having some trouble I just have a few questions so I can better assist you.

Do you know when she last passed stool and if it was normal?

Has she had any vomiting?

Did the vet do x rays to look at the abdomen?

Was a fecal sample done or did they just try deworming?

 

Is she spayed?

Customer: replied 1 year ago.

Please do not be offended, but I clicked and put payment through for a vet. Also, you do not seem to have read my question carefully. Please make my question available again. Thank you.

Expert:  Candy replied 1 year ago.

I am not offended at all and I will be happy to find a vet for you. I just wanted you to know that I did read your question thoroughly and I know you mentioned the diarrhea but I needed to be sure that this was still a problem which is why I asked about the stool.

Please do not reply back or it will keep a vet from responding to you. I hope she gets better soon.

Expert:  Dr. Z. replied 1 year ago.
Hello and thanks for trusting me to help you with your questions about the dog involved today. I am a veterinarian with over 25 years experience and would be happy work with you but I also have a few questions.

Has any sort of imaging study, like xrays or ultrasound been performed or suggested?

Has there been any vomiting?

Has the prednisone or the medication for the diarrhea helped at all?

Has all of the weight loss occurred over the past two weeks of her decreased/picky appetite or has it been a more gradual thing?

Thanks and I will respond further after you reply. There may be a slight delay while I formulate and type a thorough response.

Customer: replied 1 year ago.

Thanks for responding. I'm checking with my sister about the details. I can tell you that she is not vomiting. Also, I believe this is quite sudden (in the last two weeks) and not a gradual thing. I'm still waiting to hear from my sister, but earlier this evening she wrote the following to me:


"hex wouldn't eat dinner either. But had a total of about 20 milkbones
today (only gave when realized not going to eat so not spoiling meals),
lapped up the rest of my milk and cereal, and there was quite a lot.
Thrust glob of peanut butter with pills down her maw and (ick, but
worried) thrust big glob of dog food the same way. Finally, tossed tiny
chicken chips from can (she didn't get many, so this was hardly
anything) and she lapped some chicken water from can. So got a TINY bit
of protein in her in addition to MBs."


 


I will update you if/when I hear from my sister.

Expert:  Dr. Z. replied 1 year ago.
Sounds good.

I will be online for a good portion of tomorrow. (7/7/13).
Customer: replied 1 year ago.

Hello Dr. Z. Below is what my sister wrote. As you can see, I was way off on the age. (All of my sister's dogs a rescues, I thought this one was older when she came.)

From my sister:

 

She's 2. She's eating 20 milkbones a day, so a lot. Here is progression.

For 2 weeks now, disrrhea, no vomiting.
Monday 6/24. Will not eat. Has diarrhea. No vomiting. Vet comes. Concludes she ate something nasty and will get over it and start eating again.
Weds. Still will not eat meals, though will eat milkbone. Given metronidazole and hydrated by vet.
Thurs-Mon: eats regularly, stools loose.
Mon. 7/1. Stops eating. Call vet and as if metronidazole is upsetting stomach. He says try stopping.
Tues 7/2-Wed7/3 still won't eat. Call vet. We worm her on Weds. Diarrhea. No vomiting. New anti-diarrhea med.
Fri. 7/5. HASN"T EATEN ANYTHING BY WAY OF REGULAR MEAL. ONLY MILKBONES. NOW WILL NOT EVEN EAT MILKBONES. Panic. Drage her in for X-Ray (dog afraid of cars, hideous trauma)


Hex is, according to medical tests, not sick. Blood work is fine. X-Ray is fine. Tick panel is negative. She was wormed weds. in case of whip worm. But she won't eat her regular meals, and she has pretty continual diarrhea when she goes at all.

The vet thinks she could have some tick borne thing that the tick panel doesn't test for, so he'd like her to stay on the tick disease meds (since these have been known to help dogs w/such symptoms who tested negative on the panel). She's also on prednisone to help appetite (fat lot of good it's doing) and 3x a day diarrhea pills.

ALL SHE WILL EAT VOLUNTARILY IS MILKBONES. For all I know these are exacerbating the digestive distress that's making her not eat anything else. Vet unhelpful, except in saying she's pretty much healthy and not in danger.

Here's the icky thing I've started doing when she won't eat regular food. I take a can of the non-lumpy canned food and do with it what I do with the penut butter to get the pills down her. She hides in the kneehole of the desk in the laundry roon. I can usually get the pills down her in one go (this is AFTER she has rejected dinner) and then I get a can of dogfood or so down her glob by glob. Nobody likes this. Only doing it because desperate.

 

 

ADDING CURRENT MEDS:

 

doxycycline (in case has tick thing not caught by tick panel)
loperamide for diarrhea
prednisone for appetite

 

Expert:  Dr. Z. replied 1 year ago.
Thank you for the much more complete overview.

Here are my concerns:

1) Just because blood work is fine and xrays did not reveal anything abnormal, she has to have some, as of yet unidentified, disease condition. Some diseases hide well, especially those confined to the GI tract. It is not uncommon for the tests she had so far to be normal, but the real cause of the problem not yet found. I DO NOT agree with her vet in that she is not appearing healthy to me and if the diarrhea and anorexia/hyporexia is not resolved, she will be in danger. What needs to be established as well is does it appear she is dealing with a large bowel problem or a small bowel problem or both. I suspect her problem is more large bowel, referred to as colitis, since it sounds like she is still feeling pretty well. There is often some crossover between the two and some unlucky dogs will have disease that crosses over both large and small intestine. It becomes more critical to ascertain if we are to the point of discussing biopsy of the intestine, only so we make sure we biopsy the correct area of the gut.

2) To review the blood work, I suspect a basic CBC and chemistry panel was run. Again, not uncommon for all to be normal here. There are specific GI tests (not usually part of a basic panel) that need to be requested. These are more sensitive to identify GI issues and focus on diseases of the pancreas and small intestine. These tests are usually grouped into a GI panel and include the following: TLI (to rule out pancreatic insufficiency), SPEC-cPL (to rule out pancreatitis), cobalamine and folate (to rule out small intestinal malabsorbtion diseases).

3) As far as stools, to be complete, a stool sample should be tested for Giardia (preferably with the ELISA test in a lab). One would expect the other dogs would be showing some signs too, but not always the case. Also depending on what whipworm dewormer was given, that can be used to treat Giardia, but the treatment has to be continued for a longer time period than for treating whipworms. A fecal sample should also be evaluated for fecal bacteria, especially clostridium and others.

4) As far as the tick panel, I am not convinced the doxycycline is needed and may be contributing to the decreased appetite. I am also not aware of any tick-borne diseases leading to these type of signs. Even if it were an "early" infection from a tick bite, such that it wouldn't be showing up on the test yet (not likely), we would not expect there to be any signs of disease yet either. A tick panal could be re-run in a few weeks, but I do not believe they are involved.

As far as the prednisone, it is true that some dogs do eat more when on steroids, but there are better and more effective appetitie stimulants that can be offered. Mirtazapine is one that works very well for many dogs. Steroids are also often used as part of the treatment for colitis or inflammatory bowel disease. This is best prescribed however only after confirmation that these conditions exist, which is best done with a biopsy of the intestine. If steroids are used for their anti-inflammatory properties in the gut, they need to be given at an appropriate dose to be effective and that often is initially fairly high. I believe that more of the effort needs to be placed on finding the cause of the diarrhea and getting that resolved, than to look for a food that she will eat or try to stimulate her appetite. I think when her bowel is better, her appetite will improve. There is nothing wrong with hand feeding as you have been for the short term, but the main focus needs to be the stools and why they are not improving.

Ultrasound may help to add information to the case, but even if a thickened bowel is identified, it will not tell you why it is thickened. If the above tests do not turn up any answers, I would strongly consider an intestinal biopsy to get the answer. In a dog this young, food allergy is a very strong possibility, but a food trial is not going to be too effective if she won't eat. If the biopsy would turn out to be suggestive of an allergy, immunosuppressive doses of steroid along with GI support medications like Vit B12 and probiotics can be helpful to calm the inflammation to the point that her appetite may return some and a limited ingredient diet could then be introduced. Metronidazole often works well here (I am not convinced that it decreased her appetite) or the drug called cerenia which both act to decrease inflammation in the gut and often allow for a decreased dose of steroid to control the signs. Cerenia is labelled as an anti-vomiting medication but has multiple uses.

Hopefully, this gives you some things to explore and discuss with the vet. It sounds as if perhaps a second opinion may be needed, preferably with an internal medicine specialist if there is one nearby. Please let me know if you have any further questions or concerns that I can address.
Customer: replied 1 year ago.

She HAS has the fecal screening and it's normal. She had the bloodwork done twice. She did get a B12 shot. That's where she voluntarily ate the one half meal after it.

Expert:  Dr. Z. replied 1 year ago.
If she has had the fecal tests (not just for worms) done, including looking for clostridium enterotoxin, and she had the bloodwork done, including the specialized GI tests and they were normal, then it is time for an intestinal biopsy. I would also include a gastric biopsy just to make sure we were not missing anything in the stomach.
Customer: replied 1 year ago.

Hello Dr. Z.


This is from the original poster - not the dog owner.


My question is this. If she originally had diarrhea from a nonserious cause, and then had a diet of practically nothing but milkbones for an extended period of time, could this cause digestive problems? I don't know what milkbones consist of. Could eating large amounts of them with little else possibly cause diarrhea?

Expert:  Dr. Z. replied 1 year ago.
No, I do not believe the milkbones would cause this. They are pretty bland as foods or treats go with limited ingredients although should not be thought of as a limited ingredient diet.

It is possible she could have a bacterial overgrowth (usually clostridium). This can occur after a prolonged diarrhea from any cause. Maybe she would accept a low residue diet like Hills i/d or Iams intestinal low residue diet and you could get her on some probiotics. I prefer the Purina brand called Fortiflora as it is more readily accepted by many dogs.
Dr. Z., Dog Veterinarian
Category: Dog
Satisfied Customers: 6120
Experience: Over 25 years of experience in caring for dogs and cats.
Dr. Z. and 2 other Dog Specialists are ready to help you
Expert:  Dr. Z. replied 1 year ago.
Thank you kindly for the positive rating and the bonus. It is truly appreciated.

Please keep me updated as to how things progress for her.

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