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My dog has been very sick for a week. she started out with…

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My dog has been...

My dog has been very sick for a week. she started out with declining appetite, I had blood work done, the vet thought it was pancreatitis due to increased lipaise levels, she was in the hospital for a day then came home, she was no better the next day so we went to emergency. They did more blood work and did 2 ultrasounds and determined it was not pancreatitis. They found no sign of any tumors or blockages, she eat a bit at the emerg. they kept her overnight and she came home last Saturday. She had developed diarrhea, she has been on Metronidozole since Saturday and also taking Mirtazapine to try to stimulate her appetite. By Tuesday her feces had some form to it (before it was just liquid) and while she was still not wanting to eat she was perky and even trying to play with one of my other dogs. I should say she is a 16 year old basset hound. I have been trying to feed her anything she will eat, as of yesterday she would eat a little tiny bit of cooked chicken but nothing else. Today she won't eat at all. I also tried Pepcid and Sulcrate in case her tummy was acidy. That was no help either. I have a call into the emergency clinic internist again to ask about the possibility of an endoscopy to try to get more answers. Within the last 24 hours she also has started stumbling a bit (she did not seem weak in any other way). I don't know what to do.

Veterinarian's Assistant: I'll do all I can to help. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else important you think the Veterinarian should know about your dog?

She also has had low thyroid for the past few years. She was .5mg Thyro, all of a sudden last week when we did the blood tests her thyroid level was very high, so the vet reduced her thyroid med to .2mg. Also her ultrasound showed she has some nodules on her liver, the vet biopsied them and they are benign he thinks just consistent with age related liver regeneration. She also has one of her adrenal glands that is enlarged, but the others are not. he suspects that perhaps she has cushings, but suggested we not test her until she is feeling better. I understand that Cushings hides infections in a sense since it reduces immune response.

Submitted: 4 months ago.Category: Dog Veterinary
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Customer reply replied 4 months ago
Are you still there?
Answered in 2 hours by:
3/22/2018
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago
Chelsea Schwarb
Category: Dog Veterinary
Satisfied Customers: 114
Experience: Associate veterinarian at Towne and Country Animal Hospital
Verified

Hello. My name is ***** ***** I am a licensed veterinarian. I apologize for the delay in response to your question. The website has automatic questions it will ask when a customer has posted a question. Then, a professional has to be logged in to respond. The professions (i.e. veterinarians in this case) are not always online especially during the day as most of us have full time jobs. I just wanted to clarify why sometimes there is a delay in a response once you have posted a questions on Just Answer.

But, I would be happy to talk with you regarding your 16 year old Bassett Hound. You typed out a lot of helpful information and I feel I have a good idea of what has been happening with her and all of the diagnostic tests that have already been performed. Please let me know when you are back online so we can discuss further. I will be signed into the website for the next little bit. Thank you.

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Customer reply replied 4 months ago
I am here now
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Great, hello.

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Customer reply replied 4 months ago
any thoughts about what else could be going on for my dog
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

I want to make sure that I am helping you as best as possible. So you mentioned that you are just not sure what to do next with your Bassett's care?

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Customer reply replied 4 months ago
I don't know what is the best course of action. she won't eat
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

I am concerned that there could be cancer in her abdomen, more specifically her liver. I read that there were biopsies taken of the liver nodules and they did not come back as cancer. It is still possible that there is cancer in her liver though.
Did the specialist or your regular vet also take x-rays of her chest to look for signs of a mass/cancer in her chest?

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

She is currently taking the Mirtazapine pill. There are varying dosages for this medication. Usually a 15 mg concentration tablet is sent home with instructions of anywhere from 1/4 to 1/2 tablet administered by mouth every 24 to 72 hours. Depending on where her dosage is on that spectrum I would recommend increasing it. For example if your vet dosed it as 1/4 tablet by mouth every 3 days. I would try 1/4 tablet by mouth every 24 hours.

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Customer reply replied 4 months ago
they ruled out cancer. It is an internist with a veterinary emerg clinic
Customer reply replied 4 months ago
She is currently taking 1, 15mg tablet every 24 hours. do you think that dose can be doubled?
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Okay. That is good her chest x-rays were unremarkable.

Alright - that sounds like the max dose for the Mirtazpine so now I would not increase it any further. Another thing is that the Mirtazapine does not work for every patient. Another medication that can be used in combination with the Mirtazapine is a drug called Cerenia (Maropitant). She possibly was administered an injection under the skin of this if she was hospitalized recently for suspected pancreatitis. But, the Cerenia also comes in an oral tablet form too. So you could administer this every 24 hours at home for her. The Cerenia is very safe.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

*no I would not increase

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Customer reply replied 4 months ago
Ok I will ask about that drug. What about other issues that may not show up on ultrasound can you think of any?
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Yes. There are a lot of things that may not show up on ultrasound. It is a wonderful diagnostic tool, but not perfect. If she had something wrong at the level of her bone marrow and has not spread elsewhere yet then that is a possibility. I once had a patient who stopped eating and we kept ultra sounding her every 2 months and did not find anything until we did a bone marrow biopsy and found cancer at the level of her bone marrow.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

In a 16 year old dog you are going to worry less about infectious diseases and less about immune mediated diseases. Cushings disease is an endocrine disease which it sounds like you have done your research on already. It could make her not want to eat, but she should have changes on her blood work in theory if she is a Cushinoid dog.

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Customer reply replied 4 months ago
I will pursue that with him. Might we learn anything from endoscopy?
Customer reply replied 4 months ago
Oh one more thing. she seems interested in eating but when she smells the food she seems nauseated by it. She is also wants to go for walks and is very engaged when we are out, so my feeling is that she is not necessarily feeling a lot of discomfort but rather she is just nauseated by food all of a sudden
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

I'm very sorry. My internet froze and I had to restart my computer.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

The endoscopy procedure I feel is not the best next step for her. If she was having excessive vomiting and/or diarrhea or if her bowel wall thickness was too thick when measured via ultrasound then yes GI endoscopy could be helpful. But, it doesn't sound like that is the case for her. I would talk to your regular vet and/or internal medicine specialist about a bone marrow aspirate followed by a CT scan. The CT scan would likely cost about the same as GI endoscopy as both procedures are performed under general anesthesia. The CT scan would give us a 3D image of her chest and abdomen so if there is something hiding that ultrasound missed the CT scan would hopefully pick up on it.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

If she was my dog I would have the CT scan done first. If the radiologist did not see anything on the images I would have her bone marrow biopsy done before she was woken up from anesthesia. So that would prevent her from having to go under anesthesia twice because a bone marrow aspirate has to be done under very heavy sedation or general anesthesia. In a 16 year old dog it isn't really safe to sedate them heavily and anesthesia is the safer of the two options.

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Customer reply replied 4 months ago
OK that is helpful thank you. I have now booked an appointment for tomorrow, and he asked me not to feed her anything in the morning (that shouldn't be a problem) in case they want to put her under for more testing.
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

The drug I mentioned before, the Cerenia, is actually a very potent anti-nausea and anti-vomiting drug. It has a lot of properties that are still exploring. For example, we are recently realizing Cerenia even is helpful for pain. So we are still researching it in a few ways, but we use it for dogs we thing are nauseas, which she sounds like she is if she seems eager to eat but won't actually eat.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

*think are nauseas

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Lastly, for the appetite there is a very new drug called Entyce that I would ask the internist about. This is the website for it:

http://entyce.aratana.com

I have not used it in any patients as it just came out on the market. But, if your internist has access to the drug then I say it is worth trying.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

And it is FDA approved so that tells us it is heavily researched and safe.

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Customer reply replied 4 months ago
Ok, are you in the USA? I am in Canada, I am not sure if the same drugs are available here.
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Oh that is a good point. I am in the States. I really do not know if it is in Canada or not. If not, then maybe it could be ordered through an online pharmacy? It is worth discussing though with the specialist.

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Customer reply replied 4 months ago
Will do thanks
Customer reply replied 4 months ago
One more question. If it were bone marrow cancer, what would I be able to expect. Is it painful? If so I guess euthanasia may be the best options. I guess I just want an idea of how it progresses
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Cancer in general we do not think is very painful in dogs. Some cancers like a bone tumor (osteosarcoma) we know is really painful bc it is growing into and out of the bone. But, generally cancer in pets is more of a wasting away disease so they will stop eating, act lethargic, have GI upset (vomiting/diarrhea), and lose weight. The patients I have had with bone marrow it is usually a very frustrating progression of having a pet that is obviously sick and running a lot of diagnostics that come back with wishy washy results until we commit to the bone marrow biopsy and find cancer cells there. If the biopsy finds cancer then it would be able to tell us what type of cancer it is and from there we would know if that type of cancer is responsive to chemotherapy. Not every cancer in dogs has a good success with chemo, but some definitely do.

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Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

I would say that most cancers progress by the pet becoming more anorexic, lethargic, losing weight and just generally not feeling well. Most of my patients with known cancer are eventually euthanized vs passing away at home from the cancer. But, every family choosing what they feel is best for them and their pet. It sounds like she is very much still wanting to fight whatever is making her sick.

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Customer reply replied 4 months ago
I don't see putting a very elderly dog on chemo. I don't care about cost, but I don't want her last bit of time to be more illness.
Thanks for all your help. I will start with the CT Scan and bone marrow biopsy and see where we end up.
Dog Veterinarian: Chelsea Schwarb,
 replied 4 months ago

Yes, I understand that completely. You are welcome. I'm very happy we were able to talk. I am very fond of Bassett Hounds and I will be keeping her in my thoughts. Please keep me updated on her if you are able.

I would greatly appreciate if you would hit accept at the top right of your screen and leave me a review. Thank you and good luck with her.

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Customer reply replied 4 months ago
Will do
Dog Veterinarian: Chelsea Schwarb,
 replied 3 months ago

Hello. I wanted to follow up to see if you had any additional questions? I saw that you did not accept my answer and I wanted to make sure you didn't have any concerns for me? Thank you very much.

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