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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 9322
Experience:  Over 20 years of experience treating cats, dogs, guinea pigs, hamsters, rats, mice, and iguanas
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my dog (now 8) has vomited blood every couple of weeks...ALWAYS

Resolved Question:

my dog (now 8) has vomited blood every couple of weeks...ALWAYS in the morning...and his stomach gurgles very loudly.
He has has blood work..all normal...eats low fat gastro food, and is fed three times a day...with the last feeding prior to bed so his stomach acid will be reduced overnight
This condition is not new...but it worries me.
Give me your gut feeling on what this could be
Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Kara replied 1 year ago.

Hello, I'm so sorry to hear about Dugan and I'd like to help.

Vomiting fresh, bright red blood means that this blood is likely from the esophagus or fresh bleeding in the stomach, otherwise the blood would be digested and look more like coffee grounds.

I would be highly suspicious of a stomach or esophageal ulcer or mass. Other possibilities are kidney failure or mast cell tumors that release histamine which can cause ulcer formation. But given his bloodwork was normal and you have not mentioned any skin masses or an enlarged spleen or liver, ulcers or a stomach/esophageal mass seem more likely.

I recommend an endoscopy to gather biopsies and look for ulcers.

 

In the meantime starting treatment for an ulcer would be recommended.

At home you can try either:
1) Pepcid-ac (famotidine) at one 10mg tablet per 20 to 40 pounds of body weight
every 12 hours.
OR
2) Prilosec (omeprazole) at one 10mg tablet per 20 to 40 pounds of body weight
every 24 hours.
These will reduce stomach acid and should help settle his stomach as well as help his irritation heal.

Your veterinarian will likely prescribe sucralfate which is a medication that coats his stomach and cover any ulcers, helping to heal them.

Antibiotic therapy with two antibiotics, often amoxicillin and clarithromycin or metronidazole, is often used as well.

Please let me know if you have any further questions.

Dr. Kara, Board Certified Veterinarian
Category: Veterinary
Satisfied Customers: 9322
Experience: Over 20 years of experience treating cats, dogs, guinea pigs, hamsters, rats, mice, and iguanas
Dr. Kara and 3 other Veterinary Specialists are ready to help you
Customer: replied 1 year ago.


SInce I mentioned that this problem is from birth, its doubtful that its a mass. I also mentioned that I gave the dog zantac, an h2 inhibitor, which is in amerca known as Pepcid...and I also tried prevacid..a proton pump inhibitor.


So I am left with your suggestion of an endoscopy...which I had previously considered...it will most likely show an ulcer..not a new thought in this rodeo and the treatment is the same.


Thanks...

Expert:  Dr. Kara replied 1 year ago.

I can hear your frustration in your response. Having had 2 dogs with inflammatory bowel disease I completely understand it. It sounds like you have tried many of the things that we recommend.

I'm sorry, I re-read your write up and while I see that this is a long term problem I don't see the information that it has been happening since birth.

 

Zantac is ranitidine, and it is a H-2 receptor antagonist and mild prokinetic. I didn't see that he had been given that drug in your write-up either.
Pepcid (famotidine) is a different drug, but its actions are much like Zantac so if Zantac didn't help the Pepcid may not either.

Prilosec (omeprazole) is a little more effective then Prevacid in dogs, so it may be worth a try. If given before bed it will have its maximal effects in the morning.

Finally sucralfate is a pure coating agent. If that hasn't been tried it is absolutely worth trying.

 

In some cases long term ulcers progress into cancerous lesions, so while this may not be a new problem for him it may be changing into something more aggressive. That's the reason that I think endoscopy is best.

 

I also didn't see any mention of combination antibiotic therapy which can be helpful if his ulcer is related to a helicobacter infection.

 

I know he is being fed a low irritant diet. There are several on the market. My own dog did poorly on Hills i/d but very well on Purina Veterinary Diets EN. Some dogs need a hypoallergenic food, such as Royal Canin limited ingredients or Purina Veterinary Diets HA.

Please let me know if you wish to discuss this further or have more questions based upon what I wrote. Chronic illness are wearing on everyone and I've been through it with my pup so I'm more then willing to help if I can.

Customer: replied 1 year ago.

I feed him medical royal canin low fat gastro. As I said, I did try Prilosec otc, and it gave him violent projectile diarrhea....


he was on antibiotics...and after that he didn't vomit for 11 weeks...but now its started again.


I have had him tested for h-pylori...negative.


Endoscopy is my next step I guess...unfortunately we have to travel a great distance for it and Dugan Hates the car...so he will have to be sedated.


I have noticed older blood occasionally in his stool...I suspect the problem is in his small intestine up near the stomach...


 

Expert:  Dr. Kara replied 1 year ago.

Thanks for the further information. I'm sorry to hear Prilosec gave him diarrhea, it happens but that side effect is pretty uncommon for most dogs, he is truly unlucky.

In some cases we need antibiotics on and off chronically. If they were of benefit to him I would try pulse antibiotic therapy along with sucralfate.

Obvious digested blood in his stool simply means that there is enough bleeding now that it is no longer in microscopic amounts so you can see it. There was likely always some present.

I do think endoscopy is best.

I'm sure the car ride upsets his stomach further. It may help to pre-medicate him with Cerenia (maropitant) as well as a light tranquilizer.

Best of luck with your fellow, please let me know how things go for him.

Customer: replied 1 year ago.


What would you use in the pulse therapy...

Expert:  Dr. Kara replied 1 year ago.

Sorry I missed your reply, the site was experiencing some hiccups for about an hour or so.

I would use a combination of two antibiotics, amoxicillin and clarithromycin or amoxicillin and metronidazole for 10 days once every 4 to 6 weeks.

I would also leave him on sucralfate long term.

 

Customer: replied 1 year ago.


Thank you so much...I will consult with my vet and see if he concurs.


I will also let you know how we make out regardless of the course of investigation and treatment.


You must work long hours..I really appreciate your opinion.


I had read that this site was not reliable however, I must say, you have been of great help.


Dugan says thank you too...(**) If you have ever met a bearded collie, you would know that there is no lack of personality!

Expert:  Dr. Kara replied 1 year ago.

Thank you, XXXXX XXXXX the positive feedback.

I would absolutely love to hear how things go for Dugan. I enjoy internal medicine and helping owners and their pets, so the time I spend working on this site is usually a positive for me. The only down side is not knowing what happens after my interaction with the customer, so I appreciate it when people take the time to come back and let me know how things turn out.

Most beardies are a joy to work with and do have plenty of personality so I can imagine how upsetting it must be to see him sick so often. Tell Dugan I will cross my fingers that he finally gets some relief.

Customer: replied 1 year ago.

I have decided to try pulse therapy with flagyl...it has worked so well for him before as a single treatment.

This was one of your suggestions, and I spoke with my vet, Dr Michael Blaney, and he advised me of the risks, but said, even with the endoscopy most likely since this is a problem from puppyhood, the management prob will be what we are trying.

The cost of the endoscopy was a factor...$2000. If this were a new health presentation, I would think the scope would be important...

Will let you know how the pulse goes...thanks again "Kara"

Expert:  Dr. Kara replied 1 year ago.

Thanks for letting me know what you've decided.

Please let me know how things go for him, I hope he is more comfortable with antibiotic pulse therapy, thanks, XXXXX XXXXX

Expert:  Dr. Kara replied 1 year ago.
Hi Carol,

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

Dr. Kara
Customer: replied 1 year ago.

The pulse therapy didn't work...after one week he vomited blood again.

I think the sucralate would work but my vet is hesitant...says its hard on the kidneys.

From what I have read, I don't agree.

But hey...what do I know...I just work in a medical clinic for four family drs..lol

So I joined a group on facebook about sick beardies...and one of the members has a similar situation...sucralfate worked for her....

What do you think?

Expert:  Dr. Kara replied 1 year ago.

Thanks for the reply.

I'm really sorry to hear that pulse antibiotic therapy wasn't helpful, I had big hopes for him.

I cannot see why chronic sucralfate therapy would be a problem for him.

The drug really isn't absorbed, it has a topical effect on the gastrointestinal system. It becomes a paste which clings to raw areas in the gastrointestinal tract and coats the gastrointestinal tract.

It does interfere with absorption of some drugs because it has a coating effect. And it can lower phosphorus levels in the blood because it has some mild binding effects on phosphorus in the gut. But that would actually be a positive for a dog with kidney disease as they often have higher phosphorus blood levels than is desired and we often give them phosphate binders.

The only downside to chronic use of sucralfate is constipation in some patients.

I looked it up in Plumb's Veterinary Drug Handbook, the gold standard in veterinary formularies, to be sure and there is no mention of this drug being nephrotoxic or tough on the kidneys.

It is true that sucralfate has aluminum so if his kidneys were very diseased that might be a small concern as the kidneys excrete excess aluminum. But so little would be absorbed in the first place I would not be worried about this.

I don't like to contradict other veterinarians but frankly I am puzzled.

Customer: replied 1 year ago.

Think I will kick the can one more time with my vet...he seems to want the endoscopy...to the tune of 2000 dollars.

I understand its nice to know what you're dealing with...and appreciate his trepidation but since Dugan has had this for 8 yrs now, I see no problem with trial and error in treatment course.

Thanks again Kara.

Expert:  Dr. Kara replied 1 year ago.
I think it is well worth chatting about again. While all of us love to have a diagnosis and know what we are dealing with, our patient's comfort really should come first. My feeling is that this is a "do no harm" drug that is well worth trying.
Take care and let me know what happens from here.

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