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Dr. B.
Dr. B., Veterinarian
Category: Dog
Satisfied Customers: 16163
Experience:  Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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My Doggie's ill again, and like before, he's become

Customer Question

Hi Dr. B,My Doggie's ill again, and like before, he's become very weak. It seems the problem started two weeks ago when he stopped wanting to eat his kibble. I searched online and read that old dogs can sometimes do that for several reasons, so I thought there's nothing wrong with it, just an old dog's whims. I then feed him human food. What I ate, he ate too.Then about four days ago (friday) he stopped eating, so I bought him his favorite meatballs the next day. Then he only ate about half the amount of what he usually eats (usually he eats meatball like eating peanuts), and after that he won't eat at all. He still drank his water, though. Sunday and monday he won't eat. I bought him several of his favorite dishes but he wouldn't touch it. I have to cut them into small pieces and hand-fed him. Even then he'd only eat a little bit. Starting monday evening he just lays around and sleep. He would occasionally (rarely) get up on his own to get some drink and then went back to laying down and sleep.By the way, he's had diarrhea since saturday or sunday, and on sunday I gave him diarrhea medication that contains the following: psidi folium leaf extract 100 mg, curcuma domestica rhizome extract 80 mg, camellia sinensis leaf extract 45 mg, and zingiber rhizoma extract 50 mg, but it doesn't seem to help. So starting monday night I gave him a generic med that contains kaolin and pectin (what KaoPectate used to contain). Half an hour ago I gave him his 2nd dose of it. He hasn't defecated since last night, so I can't really tell if it's working. Although I doubt he has anything to expunge, since he hasn't been eating.Now, time for some data: last night I took his temp, and it's 39.6C. This morning I took it again, it's the same 39.6C. I read that normal body temp for dogs can go up to 39.2C, so his temp is kinda high. His supplements mostly remain the same as before (Drs Foster & Smith's joint care premium plus, Nordic natural omega-3 soft gels, and cetyl m joint action formula, and some Missing Link for senior). I added something for his kidney (Vetri Science renal essentials chews) and heart (Vetri Science Cardio Strength).He hasn't been given any medication. I'm thinking of giving him the same antibiotic as before (cefixime) and some meloxicam, should I? Anything else I should give him? Any idea what's causing the problem this time?Thanks much.
Submitted: 9 months ago.
Category: Dog
Customer: replied 9 months ago.
Here're the links to the web pages for the new supplements:
Cardio Strength: http://www.vetriscience.com/index.php?l=product_detail&p=900631090
Huh. The link for the other product is dead on vetri science's page. Here's the link for info on other store's website: http://www.onlynaturalpet.com/products/Vetri-Science-Renal-Essentials-Dog-Supplement/125028.2.aspx. Hope this helps.By the way, he's really thin now, almost skin and bones (well, to me he is). I weigh him a few days ago and he's only 11.9kg. When I asked my other question last july he was 13.2kg. Unlike last july, he can get up from sleeping to the laying down position on his own. He can even get up and walk to his water bowl, as I mentioned. He just doesn't want to do anything.
Customer: replied 9 months ago.
He just went potty, and his poop was brownish-yellow. Sort of like the color of dijon mustard, not bright yellow like regular mustard. I read that color of poop might indicate problems with liver or pancreas. Any tests/blood work I can do to make sure? Remember, in Indonesia (especially in smaller towns like mine) the quality of vets are very poor and the equipments are lacking. So you'd need to be very thorough on what to check. Thanks.
Expert:  Dr. B. replied 9 months ago.

Good morning,

I have just come online and am handling an emergency; but wanted to let you know I will review everything you have posted and reply shortly.

Dr. B.

Expert:  Dr. B. replied 9 months ago.

Hi again,

First, if his appetite is poor and he had diarrhea, then it may take a few days to see him pass anything with the Kaolin on board. This is just because if we have slowed the diarrhea, but he isn't taking in much, then it takes time for the gut to produce a normal stool to pass. Though I would just note that yellow stools can be related to issues with those organs but can also just be related to the species of bacteria causing diarrhea. So, we could test pancreatic and liver function but with that fever we likely also have a bacterial problem that needs treating.

Otherwise, it sounds like we have a fever and with the appetite loss/diarrhea there is the concern of an infectious process. In regards ***** ***** we do not use Meloxicam with GI issues since it will do more harm than good. As well, antibiotics would be indicated but cefixime isn't one that is ideal for GI issues. Therefore, we'd prefer his vet to use a more GI appropriate broad spectrum like Amoxicillin or Metronidazole. Or ideally, they could culture the diarrhea and choose a drug based on the bacteria' strain's sensitivity.

Finally for the moment, can you tell me if he ever had a blood test for his kidney function. Was that normal? When did he have a blood test last? Do you know what they can specifically check (if limited)? And has he had any gagging, retching, lip licking, gulping or vomiting with this?

Speak to you soon,

Dr. B.

Customer: replied 9 months ago.
Amoxicilin or metronidazole? I think I have those lying around. Or I can get them real quick. How about the dosage? He's 11.9kgs now.About the kidney test, do you remember if I tested for his kidney last July? I don't think so, but I couldn't remember. That was his last blood test, BTW. About the things they can check, well, the blood is checked at a lab for humans, so all the human tests are available.He's been having these dry coughs, maybe 6-8 times, and ended with one retching (I thought those retching and gagging mean the same thing. They're not? Huh). He may had these episodes maybe once every 1-2 weeks, or if his body is overly bent. By that I mean I usually sit on the floor with my legs in an O position and I'd tell him to lay down inside the O like a donut. If I make the O too small, sometimes he coughed. It had happened for many months though. I read it's got something to do with his heart function. As for vomiting, he usually vomits maybe once or twice everytime he had diarrhea, so this time is no exception. As for the rest (lip licking & gulping), I hadn't noticed any of them.So I'll get him started on either amoxicilin or metronidazole (which one would you say fits the situation better?), I'll just wait for the dosage from you. And as for tests, can you maybe list the things that need to be tested, and I'll see which ones are available here.Thanks again.
Expert:  Dr. B. replied 9 months ago.

Hi again,

If you have access to Amoxicillin, that would be our first choice here. You can read more about dosing and its use @ http://www.petplace.com/article/drug-library/library/prescription/amoxicillin--clavulanate-clavamox

Otherwise, I did recall kidney concerns with him but as I speak to so many pet owners, I do admit the finer details were a bit fuzzy for me and I did want to get a message to you before undertaking review of everything we discussed before. Though if his last blood test was in July, it is worth doing a follow up general blood profile to assess any changes especially with that weight loss.

In regards ***** ***** to check on blood profile, we'd want a hematology (red blood cell levels, white blood cell levels) which should be pretty standard no matter the species being tested. For the chemistry, we want to look at the kidney parameters (urea, creatnine, phosphorus), liver parameters (alkaline phosphatase, alanine transferase, bilirubin, +/- GGT), amylase, lipase, protein levels (total protein, albumin, globulin), calcium, and glucose as our main ones. And these should all be things that are tested for in people but of course we will need to just use an alternative reference range for dogs.

Now the cough is a concern. With the retching and vomiting, its likely we have a secondary esophageal inflammation. It will make his throat sore and even less keen to eat for us. But if its been intermittent for longer and tends to be when he is in certain positions then, he may just have a collapsed trachea that deforms when his neck is too kinked. Heart issues are another concern but the coughs tend to be softer and not be associated with posture or retching.

In any case, we could consider adding a gastroprotectant (ie Sucralfate) to coat the throat and stomach to help reduce discomfort and get him eating. As well, since nausea often puts dogs off food, we should speak to his vet about anti-nausea treatments for him (ie Zofran, Metoclopramide, Cerenia) or at least consider an antacid (ie Ranitidine, Famotidine, Cimetidine, etc). That way we can reduce the nausea, allow the throat to heal, and hopefully get him eating better for us. Otherwise, if we cannot, then we'd need to be thinking about whether we use appetite stimulants or feeding tubes.

All the best for Doggie,

Dr. B.

Customer: replied 9 months ago.
amoxicilin it is. Anti nausea might be hard to get here, but I'll try to find their alternative here. Antacids are easier to get, something like mylanta is readily available everywhere. I thought the kaoLin and Pectin can also do some coating? In any case, should I continue giving it to him?And in the meantime, is there any food that I should/shouldn't give to doggie? So far, I've given him fresh milk, honey, royal jelly, albeit in very small quantities using a needle-less syringe. Oh, also some homemade beef broth. Which should I keep feeding him to give him energy so he wouldn't get worse?Thanks Doc.
Expert:  Dr. B. replied 9 months ago.

Hi again,

Kaolin is better at coating the lower gut (since its an anti-diarrhea treatment, which we can keep using here just now) but it will have had some benefit. Still, the antacids are better for GI upset and general coating of the upper GI. Mylanta would be an antacid we can try with her and since it is a liquid it will coat the esophagus/stomach as well. Dose-wise, we can give 0.5ml per kilogram of his weight every 8-12 hours. Remember it has to be given at least an hour before food.

Otherwise, those are all ok to feed but we can also try a bland diet like cooked white rice with boiled chicken, boiled white fish, cottage cheese, or scrambled eggs (made with water and not milk). Or if he won't eat at all, we may need to syringe feed using a calorie rich diet. Usually, we will use Hills A/D, Royal Canin Recovery diet, or use a liquid diet (ie Clinicare, Dogsure). If those aren't available, then puppy food can be watered down to feed or syringe feed to get some nutrition and energy into him.

All the best,

Dr. B.

Customer: replied 9 months ago.
Dr B,I gave him 250mg of amoxicilin about 4-5 hours ago, but it seems he got worse. His fever went up to 39.8C, and he became even lethargic. He would only sleep and sleep, even when he's awake, he seems to be only half there. What's wrong?Ted
Expert:  Dr. B. replied 9 months ago.

Hi again Ted,

First, when any of us feel poorly, we will feel weak and tired all the time. And if he isn't eating, then he will especially. Otherwise, antibiotics are not going to make his fever increase, they don't have the ability to do that. And I would note that it takes more then one dose to stomp out a bacterial infection. Therefore, I would continue them but if the fever is climbing then we may need those bloods checked and then if his kidney parameters are normal we may need to use the Meloxicam in a very low injectable (so its not directly in the stomach) dose as a one-off to get the fever down as we treat this infection.

Dr. B.

Customer: replied 9 months ago.
The earliest I can get a blood work done is tomorrow morning, err, later today, since it's already 3 am here. I do know antibiotics don't cause his fever to climb, I'm just worried something else might be starting. Well, I guess I won't find out until the results came out.So to recap, I'll continue the amoxicilin (the ones sold here doesn't have the clavulanate, as in the link to petplace you gave me earlier), while at the same time give him kaolin and mylanta, correct?Thanks.
Customer: replied 9 months ago.
By the way, his gum is paler than usual. Is this related to the fever? Here's a picture of him posing for the camera.
Expert:  Dr. B. replied 9 months ago.

Hi again,

Those gums are quite pale . Its not related to the fever, but I'd be concerned that we may have an anemia. This can be secondary to kidney disease but also issues like stomach ulcers (though we'd expect black stool and brown coffee ground like vomit with that). So, we do want those bloods and a check tomorrow. Otherwise, I would keep up on all of those (regular Amoxicillin is fine, it just is a little less broad spectrum then the combination) every 12 hours until he is seen.

Dr. B.

Customer: replied 9 months ago.
Is there anything I can do to make him feel better in the meantime? I tried to keep him hydrated using syringe, I gave him about 50-60ml (4-5 syringes) of water, I'll repeat in a few hours. Anything extra I can give him, at least so he won't lose too much of his strength? Honey diluted in water, milk, more broth? Any of those might be too "heavy" for him, that might make his tummy feel worse?Some people that I talked to mention infrared light therapy (you know, those funky red lights that made you warm), would it help in any way?Thanks.
Expert:  Dr. B. replied 9 months ago.

You are doing all you can under the circumstances. If the Mylanta soothes his nausea, you could syringe feed watered down canned puppy food. Otherwise, do know he needs 48ml per kilogram of his body weight as his daily minimum fluid intake. And besides water, you could use unflavored pediatric rehydration fluids (ie Pedialyte) to just get some electrolytes in him too.

Dr. B.

Customer: replied 9 months ago.
about 600ml a day? Okey dokey. I'm getting the pedialyte now.Two final questions before I rest a bit: Do I just replace water altogether with that, or use it in combination with water? And how about the other things I mentioned (honey etc), do I need to give him that to givehim some energy or skip them for now?Thanks much.
Expert:  Dr. B. replied 9 months ago.

It would be ~571ml per day + an amount to match losses in diarrhea.

In regards ***** ***** to use, you can use a combination that is fine. And the honey can added as it does no harm and will give him a bit of a sugar boost.

Have a peaceful evening,

Dr. B.

Customer: replied 9 months ago.
Some of the test results have come back, but I haven't got the hard copy with me, so I'll write it here:
Glucose 52
Creatinine 2.5
BUN 50.6
Birilubin direct 0.1
Birilubin total 0.5
SGPT 55.5
Alcalide phosphate 151.6
Gamma GT 15.3
Albumin 2.47
Globulin 3.48
Amylase 1202.8
Lipase 176.2
Leukocytes 37.6
HGB 9.5
Trombosit 246000
There is 1 more test that hasn't come out yet. The X Ray & USG haven't been done also (I must wait until they open in the morning because I have to drive 300km to get it done).
What'a wrong with Doggie? Do you need more testa done? He's still throwing up yellow vomit & wouldn't eat anything. Is there anything that I can do? Should I continue the meds?Thanks much.
Customer: replied 9 months ago.
Also, around 7 hours ago his local vet gave him an injection of ranitidine. She said the injection is safe for doggie. She also prescribed Metoclopramide HCl 0.5mg twice a day & famotidine 10mg once a day. She also changed the antibiotic to Cefadroxil 250mg twice a day.I've administered both the metoclopramide & famotidine about 2 hours ago, but haven't administered the Cefadroxil yet, because I've already given him amoxicilin. What do you think about this?
Expert:  Dr. B. replied 9 months ago.

Thank you,

Now I do think a scan is worthwhile or at the very least having a urine sample tested. Still, the bloods have given us a lot of answers and we do have some very worrying findings here for Doggie.

To start, that glucose is dangerous low (it should be >70). This could be due to his self-starvation (though less likely with your support), but also raises concerns of bacterial infection in the blood stream causing sepsis which would explain the leukocytes being elevated. As well, another concern for low blood sugars and weakness would be a possible insulinoma (insulin producing tumor of the pancreas).

As well, the amylase and bilirubin are up, which could be hints of pancreatitis brewing but also could just be secondary to his issues eating.

That all said, what is our main problem on the bloods and what is likely the primary issue here is based in the kidney. With his age, this is likely related to kidney failure but since the white cells are elevated, there is a risk that this is a kidney infection (pyelonephritis). In either case, these differentials are raising the BUN + Creatnine. As well, both clinically can cause uremic gastritis which makes them nauseous and will induce vomiting and appetite loss. It can also even cause oral ulcers, ammonia scented breath, and as the kidneys cannot concentrate urine dehydration is a very serious risk.

In this case, to differentiate between those 2 kidney issues, the scan and urine testing would help us do so. Though I have to note that both carry guarded prognoses for him with either. Though if you did wish to treat, while the treatments we were using are correct and most of what your vet is using is fine (though I don't agree with the antibiotic chance since Cefadroxil isn't ideal with kidney disease), we usually have to be more aggressive with both of these conditions.

For pyelonephritis or sepsis, then we tend to need these dogs on IV antibiotics and IV fluids. As well, we’d want to add in injectable anti-vomiting medication (though the oral Metoclopramide is fine if he can keep it down), gastroprotectants, and may need a feeding tube. For kidney failure, we tend to focus on those IV fluids and kidney supportive medication (ie Benazepril) but with elevated white cells IV antibiotics would also be used for that.

Overall, this isn't good news for Doggie. His bloods support kidney compromise and an infection; the two may be intertwined with a kidney infection or we may have 2 separate issues. So, we need to tread with care and be aware that this is very serious. So, if he doesn't respond to her treatments, you would need to consider whether he's hospitalized for the above and whether we scan and test a urine sample.

Please take care,

Dr. B.

Customer: replied 9 months ago.
Thanks for your fast response.
This is a heartbreaking news for me. Doggie'so getting weaker & weaker; I'm so afraid I'm losing him :(So for now, is there anything I can give him at home since there is no vet available at this hour?
For the antibiotic, I should stick with amoxicilin, right?
I'm so tired & my mind doesn't seem to work properly right now, so forgive my redundant questions.I'll get the X Ray & USG in 9 hours. But for the urinalysis, should I collect the sample at home? Is it OK to use any container? How long can I store it before it needs to be submitted?Thanks.
Expert:  Dr. B. replied 9 months ago.

You are very welcome,

I know that these weren't the results we were hoping to see. Still, we now can understand the root of his signs and why he is struggling so. In regards ***** ***** tonight, I would stick to the treatments we started before as well as the ones his vet started (they can all be used together though we can skip their antibiotic just now). Otherwise, we'd want to keep up his fluid intake if he will allow and try to just help him settle over tonight.

In regards ***** ***** diagnostics, xray isn't going to be of use here since we need to see the details of inside the kidney. So, we'd want to stick to ultrasound and you can try catching a sample of urine overnight (it can stay in the fridge overnight that is fine) but since we are trying to determine if the infection is in the kidney we can just have the vet take a sample when they ultrasound. And that is ideal since sterile samples take that way can be cultured for infection if need be.

Best wishes for Doggie,

Dr. B.

Customer: replied 9 months ago.
I forgot to tell you that the local vet said there is a lump in the lower right abdomen. I have also noticed his tummy seems larger over these few months. Do you think I should skip the X Ray?He is coughing a lot more than usual, even when his neck is not overly bent. Is it because I give him liquid using syringe or is there any other problems?Is there anything I can do for his anemia since his gum has gotten paler & paler?Thanks
Customer: replied 9 months ago.
Oh he is now weighing only 10.5 kg, so in a few days he has lost 1.4 kg (more than 10% of his weight).
His temperature is now 38.4C.
Customer: replied 9 months ago.
Oh he is now weighing only 10.5 kg, so in a few days he has lost 1.4 kg (more than 10% of his weight). His temperature is now 38.4C.
Customer: replied 9 months ago.
I attached his x-ray results (we got it done anyway), and now the doctor put him on a NaCl 0.9% iv. I'll send the doc's notes after I translate them, and the results of his ultrasound as well, they're still being prepared. His urine sample has been taken and the results will be ready tonight.From what I read online, for his case regular treatments can't help him much, agressive treatments will be needed. What do you think?
Customer: replied 9 months ago.
Ok, here are the results of the ultrasound, I'll try to translate the best I can.
UU Palpation: thickening
Vesica: a hyperechoid mass can be seen on the walls of the Vesica. Prostate appear more hyperechoid (?)
Ren - dexter: form isn't symmetrical. A hyperechoid mass can be seen on medula & cortex
Ren -sin: enlargement. Level cortex (or is it cortex level?) is even more hyperechoid (whatever that means)
Liver: hyperechoid mass appear fully on level liver (or liver level, whichever one made more sense), vena cava & Porta hyperechoid.
Conclusion:
Suspected renal failure
Hypertrophy prostate
HepatomegaliAnd here are the notes of the x-ray :
Spondilosys VT11-VL3 spotted
High density mass on caudal Castal ventiol (this make any sense to you?)
Lien appears to shrink
Round mass on thorax, the dorsal caudal part with a diameter of about 4 cm
Conclusion :
Spondilosys
Hepatomegali
Thorax tumor
Expert:  Dr. B. replied 9 months ago.

Thank you,

No worries, your translation was good and I was able to decipher the less clear bits. Though caudal Castal ventiol is a tough one; but I do suspect its referencing the caudal vena cava (a large artery) since I can see it on one of the scans with a suspect mass along its bottom edge.

Just to start, hyperechoic is a term we use when tissues are appearing brighter on the scan then it should be. Often this can correlate with inflammation or sometimes diffuse tumors. Now major concerns on the scan and xrays are that we potentially have a mass at the vena cava (this could be a tumor of the adrenal gland as it does lie close to that artery) and that is a worry since these cannot easily be removed and there is always some risk of masses eroding the vessel wall to cause sudden bleeds and death.

That said, that isn’t going to be causing our clinical signs and it may be that that has been there for a long time causing no issue. Instead, what is more of a worry is that we have an enlarged liver (though I suspect the changes are secondary to his current signs) and those kidneys. Im regards ***** ***** kidneys, seeing a mass in the medulla (central region) is a worry as we can see kidney cancers cause kidney failure. As well, if both kidneys are hyperechoic and the scan didn’t show that they were small and fibrotic (scarred), then pyelonephritis is a real concern here though again possibly related to a tumor. So, we’d want that urine sample tested to confirm that (and having it analysed via microscope advisable since we may see tumor cells from the bladder or kidney to help us ID what is there) would be the next step but otherwise those treatments we discussed before would be ideal if we did want to treat this. But again we have to be aware that with this condition, the kidney failure, and a possible mass; this is getting to be a situation we won’t be able to cure but may not even be able to manage and settle for him. So, while it breaks my heart to have to say this, we may need to think about putting him to sleep to prevent him from suffering with this.

Please take care,

Dr. B.

Customer: replied 9 months ago.
Wow, I don't know how to answer that last few sentences. Ahem. So we'll just need to wait the urine results right? The lab said it will be done tomorrow morning. I'll take a quick pic of it and send it to you when I have it.Now, here's a picture of another test the local vet asked for. I don't know if it'll be useful to you in any way, so could you please take a look at it and let me know if it affect the prognosis in any way?Oh, and this: "and having it analysed via microscope advisable since we may see tumor cells from the bladder or kidney to help us ID what is there", do you mean I should tell the lab to ALSO check it with microscope, or ONLY check it with microscope? Or something else?Thanks much Dr B.Ted
Customer: replied 9 months ago.
Say, do you also need a test of his feces?
Expert:  Dr. B. replied 9 months ago.

Hi again,

I know it is a difficult situation but I did need to make you aware that we may have to consider that for him.

In regards ***** ***** microscopy, I am saying check it as well no only. So, a general urinalysis but also examination of the urine. As for the reticulocyte count, that just tells us that there we arent' seeing the marrow release new red blood cells as it should. Though while the mention the marrow, we have to be aware that kidney disease will cause secondary anemia and decline in new red blood cell numbers because the kidney isn't producing the hormone that stimulates the bone marrow to act as it should. So, that is not unexpected with kidney failure.

Please take care,

Dr. B.

PS- there isn't really an indication to test the stool here.

Customer: replied 9 months ago.
Here are the results of the urine test, can you please take a look at it? In regards ***** ***** urine culture, I'll have it done in my hometown, there's a lab there that's pretty big. I'll let you know as soon as I have the results.Thanks.
Expert:  Dr. B. replied 9 months ago.

Good morning,

While it doesn't look like they do as in depth testing (looking for casts as well as cells on the sediment), what they did check does suggest that there is infection in that bladder so quite likely in the kidney as well. Hopefully the culture will tell you what is there, so we can ensure we are treating this as effectively as possible. Though be warned that if we culture when dogs are antibiotics that the bacteria is sensitive to then we may get a false negative that we'd have to interpret as being a sign that the antibiotic is doing its job and needs to be continued.

All the best,

Dr. B.

Customer: replied 9 months ago.
Dr. B,The local vet did say something similar regarding the test, but she recommended I go ahead and do the test anyway. I'll let you know as soon as I have the results.By the way, doggie's temp last night and this morning 38.5, and he seems to have more energy. I hope this is a sign that he is on the road to recovery. I fed him 2 organic eggs, scrambled without any oil/seasoning, 3 times a day. Is this OK?Ted
Expert:  Dr. B. replied 9 months ago.

Hi Ted,

I will keep my eyes peeled for those results. Otherwise, I am glad to hear that his fever has broke and that certainly will make him feel better. As well, the food intake sounds good and that will be helping him some energy into him. So, that is all positive and we want to keep up that good work.

All the best,

Dr. B.

Customer: replied 9 months ago.
Dr. B,Tomorrow morning I'll go to a lab and have the culturing done. In the meantime, I'm feeding him royal canin renal canned food about 2-4 teaspoons (those spoons that holds 5ml liquid) several times a day and am giving him drinks of bottled water mixed with pedialyte or his leftover NaCl IV fluid (50:50 ratio), about 150-200 cc several times a day together with his meal. Is this alright? Anything else I should do?He still vomits yellow liquid (kind of like when his stomach is empty), but much clearer/transparent, and somewhat more syrupy. When he usually vomits (usually because his stomach is empty), it's more watery and more opaque, and yellow (is it due to bile?). Is this OK? I mean the fact that he still vomits, and also the fact that the vomit itself is different than usual. He vomits 0-2 times daily. Oh, and tonight I noticed that there 2 small specks of what seems to be blood in the vomit. Anything I should worry about?)I read about sub-q treatments for dogs with crf, will this need to be done on doggie as well? If so, which IV fluids I should choose, and where can I get them?Thanks.Ted
Expert:  Dr. B. replied 9 months ago.

Hello again,

I am glad to hear that the culture will be done soon.

In regards ***** ***** his IV fluids, those aren’t ideal to give orally, even diluted. That just won’t be properly balanced for oral intake. Instead, stick to the diluted Pedialyte if possible. In regards ***** ***** fluids, these can be given and your vet should be able to dispense a bag of Hartmans or Normasol (which are more balanced then the NaCl). Just so you can see how to administer this, you can watch a video on giving fluids @ https://www.youtube.com/watch?v=mxAAyISHRk8

Otherwise, the yellow is bile and if its when his stomach is empty, we perhaps need to try and keep him on small meals all through the day to reduce that. Otherwise, its good to hear that he may be vomiting less, but if he still is then you may want to work further with his vet to find the right combination of medications to better manage that. Especially if we are seeing a bit of blood since that is telling us that the vomit is traumatizing and hurting his throat. So, we need to see if we can reduce that further.

Please take care and keep up the good work,

Dr. B.

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Customer: replied 9 months ago.
Huh, that's weird. The question I posted last night's gone. Oh well, I'll write it again.Dr. B, I have doggie's blood tested again last Tuesday, and here are the results. Please take a look at them and tell.me what you think. The numbers in parantheses are the old values.
Hb 9.1 (9.5)
WBC 26.9 (37.6)
PCV 25.9 (27.9)
RBC 3.80 (4.17)
CREATININ 1.74 (2.5)
BUN 70.7 (50.6)Now, he started to want to eat on his own yesterday. Still very little, not like his usual amount, but it's a start. Problem is, he doesn't want to drink. He came up to his water bowl, took a few laps of water, then left. He repeated this several times later, but didn't drink at all. I already replenished the water. So what do you think is the problem now? I still force fed him food and water like before.Thanks Dr BTed
Expert:  Dr. B. replied 9 months ago.

Good morning Ted,

If he isn't keen to drink, we can syringe fluids but need to think about giving subcutaneous ones as we discussed.

*Otherwise, can you remind me what drugs he is on just now?

* Has he had any black stool, belly pain, or paling of his gums further?

The reason I ask is the new bloods suggest the red blood cell level has dropped a bit and the BUN is up. These make me concerned alongside the lack of drinking that we may have a secondary stomach ulcer starting because his stomach has been empty so long. So, we may need to check for those signs and speak to his vet about covering bases further for that.

Dr. B.

Customer: replied 9 months ago.
Dr B,He's currently being given antibiotic only. The other meds are just vitamin B and omega 3, and a supplement to increase his red blood count.No black stool so far. His stool has returned to being chocolate brown (that's the first representative that comes to mind). I don't think he has any belly pain, I sometimes stroke his belly rather vigorously but he didn't make any complaints. As for his gums, I'll attach a picture.So what do you think? And what do you think might be causing him not wanting to drink? Well, actually he seems to have the desire to drink, as i wrote before, he sometimes approached his water bowl, but somehow just won't drink...Thanks much.Ted
Customer: replied 9 months ago.
Some more questions, Dr. B,Can I resume his supplements for his joints, kidney, and heart? I stopped them when he was diagnosed with kidney problems because I wouldn't want to add more burden to his kidney. It's been about 10 days since I stopped his supplements, and I can see his hind legs are getting much weaker. I'm attaching a picture of his current standing posture.Seeing from his test results so far, would you say his kidney really is damaged (like the original diagnosis), or is it just an infection that happen to also attack his kidney, or is it something else entirely? What would you say is really wrong with him?I plan to do another blood test tomorrow, just to be sure. Are there any specific areas that you want me to test?Thanks much.
Expert:  Dr. B. replied 9 months ago.

Hi again,

First, as I noted it isn’t that the kidney values look worse, its just seeing that BUN up more while the creatnine is stable makes me concerned we have something else afoot like a stomach ulcer. I am glad that you aren't seeing those signs I asked about, but if he isn't keen to drink and isn't eating as well; then it'd be ideal to have him on gastroprotectants and anti-nausea medication as well.

Though in regards ***** ***** overall kidney situation, if those white cells are climbing then this all does raise worries that the kidneys are fighting infection and that is what is causing the damage. So,I’d be leaning to this being a pyelonephritis but with the scan suggesting a mass that is a consideration here too.

Otherwise, in regards ***** ***** previous treatments, it depends which ones you are using. I would avoid any non-steroidal anti-inflammatories but other supplements should be ok to restart. And hopefully we can get him moving more comfortably and stop his hunching. As well, if his vet hasn’t him on any gut safe pain relief (ie Tramadol, Buprenorphine), these may be an option since the posture does fit with his arthritis but also fits with a tender abdomen from a stomach ulcer (they won't always respond to pressing/palpation since its a burning discomfort as opposed to a bruising one).

In regards ***** ***** those parameters you posted before are our main focus at this stage. If we are getting on top of this, then we should see the white cells go down, the red blood cells go up, and the BUN/creatinine stabilize back into normal range. So, hopefully those will be improved at the next check.

All the best,

Dr. B.

Customer: replied 9 months ago.
Dr. B,Is there anything I can check to confirm whether he has stomach ulcer or something else?I gave you values for these before: Glucose, Creatinine, BUN, Birilubin, SGPT, Alcalide phosphate, Gamma GT, Albumin, Globulin, Amylase, Lipase, Leukocytes, HGB, Trombosit. And the last time I gave you these values: Hb, WBC, PCV, RBC, CREATININ, BUN. Do you want me to test all of them again, or are there anything else to be tested?Doggie loves beef so much, and there have been several times in the last few days where he begged for human food. I didn't give him any because I fear his kidney will get more problems. Should I continue limiting his food to renal diets only, or can I start spoiling him again? Well, certain things will need to be limited, I know, but still...By the way, he's been having these tremor episodes, it's been happening several times already in the span of maybe 2-3 months. Early on, it's only with his legs, and not very noticeable. Just now, he's had another episode, and it was quite bad. His body even shakes. It's on-off, like 10-15 seconds of shaking followed by another 10-15 seconds of calm. This would happen over and over until 15 minutes. What do you think is causing this? A new problem?Thanks much Dr B.Ted
Customer: replied 9 months ago.
Dr. B,I mentioned his hind legs getting weaker due to me stopping his supplements right? Last night he suddenly tripped in the middle of walking, and I noticed that his walk is getting unsteady. Will the supplements (I've begun to give them again last night) get rid of this problem, or is this yet another new problem?And he once or twice would just begin to bark, growl, and lunge. At nothing. He barked at the wall, growled at the air, and lunged at my room's curtain. For no reason whatsoever. I searched online and most of the articles only mentioned boredom, fear, confusion, and excess attention from owners as the reasons. Oh, and "passing ancestral spirits", lots of them. Anyway, none mentioned these symptoms related to pain or illness. So what do you think?Thanks.Ted
Expert:  Dr. B. replied 9 months ago.

Hi Ted,

Apologies for my delay, I’ve had to attend an out of town funeral since we last spoke and am only just home.

In regards ***** ***** concerns, the only way to diagnose an ulcer would be to have your vet scope his stomach or it can sometimes be diagnosed on contrast xrays (where we use barium to line the stomach so we can see where the ulcer lies).

Anyway, for the bloods, we want to recheck the Creatinine, BUN, Leukocytes, HGB, Trombosit. Hb, WBC, and PCV. Those are our main parameters to look at kidney function, the dropping red blood cell level and what the white cells/immune system is doing.

In regards ***** ***** food, while we prefer low protein foods for kidney issues, I would actually feed him the beef if he will eat it. This is because getting food into him is more important just now. He needs to survive, his immune system needs the nutrients to fight the infection, and if we have food in that stomach the stomach acid won’t be able to chew on the stomach wall. So, if he is being fussy, give him his way on the eating front at least for the short term. And if he is sticking to just human foods, then consider a dog vitamin to meet his vitamin/mineral needs.

Finally, in regards ***** ***** tremors, this sounds more likely to be related to his body being under all this stress and that arthritis then anything neurological. Though with the barking and odd behavior, I cannot rule out brain based issues (infection, inflammation, growths, bleeds), blood pressure elevation, or dementia. But we can see odd behavior and even seizures with kidney disease; so it could still be linked to everything else we are seeing. So, hopefully as we address the major issues we are fighting, this will settle too. So, I’d monitor it just now and perhaps video (you can post them on youtube and the paste the link here for me to check) what you are seeing.

Overall, we need to have him eating so some beef is fine. We may also need him back on the supplements for his joints. Though I did ask last time what supplements you were using and cannot see any note of them. Can you remind me of what they are?

Dr. B.

Customer: replied 8 months ago.
Dr. B,Sorry for the long hiatus, I was waiting for the results of his last test (includes culture) to come out. Anyway, for his supplements, he is given Drs Foster & Smith's joint care premium plus, Nordic natural omega-3 soft gels, and cetyl m joint action formula, and some Missing Link for senior). I added something for his kidney (Vetri Science renal essentials chews) and heart (Vetri Science Cardio Strength).And here are the results, I'll try to translate to the best of my knowledge the parts that are completely in indonesian:
- Hemoglobin (HGB): 10,8
- Eritrosit (RBC): 4,12 million
- Hematokrit (HCT): 31,5
- Lekosit (WBC): 20.380
- MCV: 77
- MCH: 26,2
- MCHC: 34,3
- RDW: 15,3
- Trombosit (PLT): 34.000
- type count (this makes sense to you?)
- Lym: 10
- Mono: 8
- Neu: 80
- Eos: 2
- Baso: 0
SGPT: 52,8
G_GT: 18,8
FOSFATASE ALKALI: 43,1
- Total: 0,40
- Direct: 0,10
- Indirect: 0,30
ALBUMIN: 2,5
GLOBULIN: 3,6
BUN/UREA NITROGEN: 35,4
UREUM: 75,7
CREATININ: 1,85
Timed glucose (or glucose at a time?): 83
- Glukosa urine: Negative
CALSIUM TOTAL: 11,2
LIPASE: 167,4
AMYLASE PANCREATIC: 1011
- Germ numbers (I struggled real hard to find the proper translation for "kuman". Other options are organism & bug, you choose): no growth of aerob (?) germs
- culture result: NegativeSo what do these values tell you about doggie's health? By the way he is now willing to seek food on his own, especially human food. I continue to feed him the royal canin renal canned food, though. He's drinking on his own, but very very little. I don't think on his own he can fulfill his 600ml minimum liquid daily intake, so I continue to syringe him water and pedialyte mix (50:50).The only drug he's on now is famotidine (10mg 2x a day), and supplement for anemia. I'm thinking of stopping this supplement, due to the fact that it's local-made (poor quality), so if it's no longer required please let me know. Oh, and of course his regular daily supplements of the things I wrote earlier.So from these results can you pinpoint what is actually wrong with him? I read that dogs that would eat but not drink may have problems with his pancreas and, umm, something else but I forgot. What is the actual problem that caused all these symptoms to appear? If we're only treating the symptoms and not the actual underlying problem (like both local vets here have been doing thus far ), I worry that one day the actual problem would get so bad it is no longer treatable and any symptoms that appear are fatal.Thanks Dr B
Expert:  Dr. B. replied 8 months ago.

No worries about that.

Thank you for telling me more about the supplements, as I did want to make sure we weren’t using anything that work against our ongoing issues (which they don’t). So, those are fine to continue as lng as he tolerates them.

In regards ***** ***** results, first I want to say that your translations have been very good and I have been able to work out everything from them. Just to note, the urine “germs” is just that there were no aerobic bacteria found (which is positive from ruling out infection point of view)

In regards ***** ***** bloods, there are actually a lot of positives here. The red blood cell levels are climbing and nearly normal (the PCV/HCT are the same and 35% is the bottom of normal, so nearly there). The white blood cell levels have dropped quite a bit and that fits with the infection being cleared and the urine culture being bacteria free. So, that is all positive and it was likely the infection that was making him feel so poorly. That said, we need to be aware that while the kidney values are much better than they were, they are still elevated. So, that does mean that we may have some reduced kidney function. So, we’d want to keep him on the kidney supplements and keep an eye on his fluid intake.

Otherwise, its great to hear that he does have an appetite again. Though again we do need to work on his drinking. This won’t be linked to a particular disease and instead just tends to be related to nausea. You are right to syringe fluids if he will allow it. You can also try watering his food down (plus the canned diet is 35% water itself), or flavoring his water (with low salt chicken broth, even a bit of milk). So, those all help. Otherwise he may need subcutaneous (under the skin) fluids given for at least the short term.

With those kidney parameters elevated, we do have the risk of uremic gastritis. Therefore, I’d be inclined to keep him on the famotidine (10mg 2x a day) for the short term at least. For the anemia supplement, I would give it another week before discontinuing since he has really bounced up in his HCT/PCV levels and we’d just want him back into the normal range before stopping anything that is aiding that.

Finally, in regards ***** ***** summation of his situation, he initially appeared to have an ongoing infection that appeared to be targeting the kidney. Based on the bloods, treatment has cleared that and the overall kidney function has improved during that time. That said, at this stage, we have to appreciate that there is am underlying kidney dysfunction (which is common at his age) that needs to be supported to keep him comfortable for as long as possible.

All the best and keep up the good work,

Dr. B.

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