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Dr. Amanda
Dr. Amanda, Dog Veterinarian
Category: Dog Veterinary
Satisfied Customers: 799
Experience:  Associate Veterinarian
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I have a 4 year old female who had been sick couple weeks

Customer Question

I have a 4 year old female ***** ***** who had been sick for a couple weeks and nobody can figure out what's wrong with her. Symptoms started as vomiting and diarrhea. She appears to be in distress after eating. She refuses to drink although she'll eat. X-rays come back fine. Ultrasound didn't show anything unusual and her labs looks ok. Addison's test came back negative too.
Submitted: 2 years ago.
Category: Dog Veterinary
Expert:  Dr. Amanda replied 2 years ago.

Hi,

My name is***** and I am very sorry to hear that Mabel is sick. I have a few more questions for you:

1) Did your vet run a "GI Profile?" This is a blood profile that evaluates pancreas function and inflammation and tests for markers that suggest inflammatory bowel disease?

2) Have you considered deworming her with 5 days of Panacur (fenbendazole) even with a negative fecal? There are several parasites that are very difficult to find on fecals such as esophageal worms that are common in the south where you live.

3) Have you tried a hydrolyzed protein diet in case of food allergy? This type of food has the protein already predigested so that the immune system cannot see it and not react to it.

These are the places that I would start. Let me know if you have tried these things and we can brainstorm together some other options.

I hope this answer helps you.

Dr. Amanda

Kansas State University

College of Veterinary Medicine Class of 2001

Customer: replied 2 years ago.
we've done all that. Her pancreas also did not show any abnormalities on ultrasound as I know occasionally pancreatitis can present with normal pancreatic enzymes. She's just finished her course of Panacur which we did even though she takes monthly Triphexis.
Expert:  Dr. Amanda replied 2 years ago.

Hmmm....

Have you tried the Royal Canin Diet- Ultamino (check my spelling on that). This diet is super pre-digested and can be helpful for pancreatic insufficiency as well as food allergy.

Have you tried supplementing pancreas enzymes even though the bloodwork came back normal?

Have you tried a steroid trial for inflammatory bowel disease? Buspar? Tylosin?

Have you considered an abdominal exploratory and collection of biopsies?

Expert:  Dr. Amanda replied 2 years ago.

I got your request for a phone call, but I am sorry, I cannot take it. My license restricts my phone calls to patients that I have examined with my two hands. I will be happy to continue this conversation in this forum for as long as you need to have your questions answered. Dr. A

Expert:  Dr. Amanda replied 2 years ago.

I am getting ready to log off for the night. I will check in with you tomorrow morning to see if you have any more questions. Dr. A

Expert:  Dr. Amanda replied 2 years ago.

Hi, How is Mabel this evening? Were you able to speak with your vet about the other options I suggested?

Do you have any more questions for me?

Also, if you would consider rating our conversation, I would greatly appreciate it.

Best regards,

Dr. Amanda

Customer: replied 2 years ago.
She's had so much imaging done in addition to bloodwork, several vets have said they don't think the pancreas is the problem. My regular DVM is out of town until Monday, however I have a colleague who had given me a trial Rx of prednisone I could give her to see if that possibly helped with IBD. I've been doing research too - what are your thoughts on a liver shunt? Her AST and ALT are wnl but her BUN is at the very low end of normal.
Expert:  Dr. Amanda replied 2 years ago.

A shunt is possible- the best blood work test for that is a fasting and post-prandial (after eating) bile acids. It doesn't usually cause nausea, though, so that doesn't perfectly fit. Bile acids is an easy test to run, though, if that is a possible diagnosis.

Low end of normal BUN can be many things- low protein intake, poor protein absorption, starvation, poor liver function (but to blame it all on the liver you also need a low albumin, cholesterol and glucose as well). Poor absorption and starvation can fit with severe IBD.

I think a prednisone trial is a great idea. Dosing would be 1mg/kg (0.6mg/pound) twice daily to start.

Expert:  Dr. Amanda replied 2 years ago.

Hi! How is Mabel this evening? Any updates on her intestinal issues?

Do you have any more questions for me?

Also, if you would consider rating our conversation, I would greatly appreciate it.

Best regards,

Dr. Amanda

Expert:  Dr. Amanda replied 2 years ago.

If you are satisfied with my assistance, please take a moment to use the stars at the top of the page to rate my answer so that I will be compensated for answering your question. For future questions, you can find me here: http://www.justanswer.com/profile.aspx?PF=88695179&FID=0

Best regards,

Dr. Amanda

Expert:  Dr. Amanda replied 2 years ago.

Hi,

I haven’t hear back from you in a while. How is your pet this evening? Do you have any more question for me? If you are satisfied with my assistance, please take a moment to use the stars at the top of the page to rate my answer so that I will be compensated for answering your question. For future questions, you can find me here: http://www.justanswer.com/profile.aspx?PF=88695179&FID=0

Best regards,

Dr. Amanda