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My dog has been lethargic and losing weight for 2 months ...

My dog has been lethargic...
My dog has been lethargic and losing weight for 2 months now, and has been treated for pancreatitis 2 times. This last episode started 4 weeks ago. Labwork revealed high WBC, and low hemoglobin and hematocrit levels. Kidney and liver function were reportedly normal. Radiographs revealed inflammation in her intestines. She was given sub-q fluids yesterday, along with a "pain shot". She improved markedly, but by this morning, urine was dark (cola color) again, and she is lethargic. My vet refused to treat further with antibiotics or fluids today, because it is his afternoon off. She was put on Endosorb and Metacam. She is obviously in pain, refusing to eat or drink today. What should I do?
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Answered in 2 hours by:
3/26/2008
Dr. K
Dr. K, Veterinarian
Category: Dog
Satisfied Customers: 7,544
Experience: 13 years experience as Veterinarian
Verified
Hi,
I am so sorry to hear that your dog is so unwell.

How much weight has she lost?
Is she lethargic every day?
Does she have diarrhea or vomiting?
Has the vet done tests on her blood and urine? If so, would you happen to have those test results? (I would be able to give you a much more specific answer if I could see the results).
When was the last time that she ate?
Has her appetite always been bad, or just today?

Dr. K
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Customer reply replied 9 years ago
Her last normal healthy weight was 18 lbs, she is now at 14 lbs. She is lethargic pretty much all the time, but does get excited about going riding in the car. We have been riding her around in everyday to try and keep her spirits up. She has not vomitted, and when she has a bowel movement, it is normal in consistency, but is dark in color since last week. The vet did a CBC, which showed WBCs had increased from 27,000 to 29,000 in 2 weeks. I don't remember the exact values of her hematocrit or hemoglobin, but they were flagged as low. Her liver and kidney functions were elevated 2 weeks ago, and she was treated with amoxicillin. There was no real improvement with that treatment. She was also on Endosorb and Albon 3 times a day along with the antibiotic. The liver and kidney function were supposedly normal yesterday. But her radiograph showed inflamed intestines with very thick walls. She has not had dry dog food (Pedigree small crunchy bites) in about 2 months. I have been feeding her either baby food(Chicken and rice) or cooking chicken breast and rice here at home. She doesn't get "people food", no table scraps, etc. She does get milkbone treats when she goes outside, about 3-4 times per day. She has never had a problem with appetite before, in fact she was considered a little overweight. She had a hernia repair toward the end of December last year and has not been herself since then. The first round of this mysterious illness did present like pancreatitis, with yellow frothy vomit, and responded to Endosorb/Albon. This time, she is not vomitting, and has not had diarrhea. She has had dark cola colored urine since Saturday. She received sub-q fluids yesterday, along with Metacam and Azimycin. Her urine cleared up yesterday, but was dark again today by lunchtime. She has a guarded abdomen, but it is not hard. I don't see why she is not on an antibiotic and IV fluids since she responded so well yesterday. Within hours of coming home, she ate, drank, and even showed some interest in her toys last night. But today has been a complete reversal, and my vet is being a little evasive when I ask questions. I would love to take her to another vet, but have spent my entire savings account on her in the last 3 months. I had to pawn some things to pay for yesterday's visit. I want her to have what she needs and will sacrifice whatever I have to, but I am worried that my vet isn't telling me the truth. I appreciate your time, and any advice will be welcomed. I feel like I am at the end of my rope and don't know where else to turn.
I am so sorry that your vet is making you feel this way. It is not right that he just refused you service because it was his afternoon off. He most certainly should have recommended taking your very sick dog to a specialty critical care/referral center for an internal medicine specialist to look at. It is interesting that your vet said that your dog's intestinal walls are thickened based on X-rays, as you cannot tell this from an X-ray. You would most certainly need an abdominal ultrasound to know that this was the case. I strongly recommend that you see a different veterinarian, preferable a specialist, if you want to have this problem resolved.
There are a number of different things that can cause chronic inability to gain weight in a dog. The most common of them is chronic endoparasitism. Endoparasites can include, hookworms, roundworms, tapeworms, whipworms, coccidia, giardia, etc... Therefore, I recommend that you submit a sample of your dog's stool for fecal analysis and a Giardia ELISA.
Other reasons that this could be happening include malabsorptive/maldigestive disorders such as exocrine pancreatic insufficiency, small intestinal bacterial overgrowth (SIBO), and certain forms of inflammatory bowel disease (IBD) like lymphangiectasia. The first step in diagnosing these disorders is to have blood and urine laboratory testing to look for changes that may be consistent with one or more of the things on this list.
Exocrine Pancreatic Insufficiency (EPI) is a disorder in which the pancreas is not appropriately producing the enzymes that are responsible for breaking down food into the molecules that can be digested by the intestine. These dogs keep eating, but do not gain weight because they cannot get the nutrients from the food. This can be diagnosed with a blood test called a TLI assay. If your dog has this disease, it is easily treated with an enzyme supplement called Viokase, which is put on the dogs food about 30 minutes before they eat it to predigest it.
SIBO is a condition in which there is an overgrowth of certain bacteria that normally live in the gut. This can result in chronic diarrhea, and altered malabsorption and maldigestion and gut motility. It is diagnosed with a serum blood test called folate and cobalamine. Treatment involves lifelong administration of metronidazole or Tylan powder to help control the overgrowth. Most dogs do well with gaining weight, once they are being appropriately treated.
Inflammatory bowel disease is diagnosed with biopsies of the inside of the intestinal tract, usually obtained using an endoscope. The treatment is specific to the type of IBD the dog has, but often involves a change to a special prescription diet and a low-dose of corticosteroids to control the inflammation.
I am attaching a client information handout that I use in my practice on weight loss. I hope that you find it useful.

Click Here

Reddish/brown urine can be caused by blood or hemoglobin in the urine. Brown urine is usually caused by bilirubin in the urine (can be a sign of hemolytic anemia or of liver disease). This is a serious sign, and really needs to be dealt with as soon as possible.

If finances are of major concern, there are many organizations that exist to help with this. I am listing some of them here for you to contact and see how they might assist you.

American Animal Hospital Association _http://www.aahahelpingpets.org/home _" Through the AAHA Helping Pets Fund, veterinary care is possible for sick or injured pets even if they have been abandoned or if their owner is experiencing financial hardship."

__Angels 4 Animals _http://www.angels4animals.org/ _"Our services range from financial aid to complete treatment _to those pets and pet owners in need."

__Care Credit _http://www.carecredit.com/ _A credit card company for health care, including veterinary care. _"With a comprehensive range of plan options, for treatment or procedure fees from $1 to over $25,000, we offer a plan and a low monthly payment to fit comfortably into almost every budget."

__God's Creatures Ministry _http://www.all-creatures.org/gcm/help-cf.html "This fund helps pay for veterinarian bills for those who need help."

__Help-A-Pet _http://www.help-a-pet.org/home.html "Our efforts focus on serving the elderly, the disabled, and the working poor."

__IMOM _http://www.imom.org/ "We are dedicated to insure that no companion animal has to be euthanized simply because their caretaker is financially challenged."

__The Pet Fund _http://thepetfund.com/ "The Pet Fund is a registered 501(c)3 nonprofit association that provides financial assistance to owners of domestic animals who need urgent veterinary care."



I hope that this information is of help to you, and I wish you the best of luck with your dog. Please let me know if I can be of further assistance.

Dr. K

Dr. K
Dr. K, Veterinarian
Category: Dog
Satisfied Customers: 7,544
Experience: 13 years experience as Veterinarian
Verified
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Customer reply replied 9 years ago
Thank you so much for the helpful websites regarding the monetary aspect of this issue.
I do have a couple more questions though....he looked at a fecal sample 2 weeks ago, and said that it was "normal". She has not at any point had diarrhea. Since she didn't have problems prior to the hernia repair surgery, could the surgery itself, or complications from it have caused this? He also told me that it could be IBD, but there was no way to know for certain in a dog. Obviously, from your answer, this isn't true either. Where can I find more information on IBD?
Again, thank you so much for your time.
What type of hernia did she have repaired?
How soon after the hernia repair did she start having her symptoms?

I will attach another information sheet on IBD, so that you can have some more information on this.

IBD
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Customer reply replied 9 years ago
She had a hernia that developed after her puppies were delivered by emergency c-section. It continued to grow larger, and had a fatty deposit around it. It was in the center of her belly, and got so large that it almost dragged the ground when she walked. She developed pancreatitis within a week of the surgery, got better for about 2 weeks, and then this last bout started.
What is Azimycin? On my receipt from yesterday, it says she was given this and Metacam. This was given in one syringe, was a yellowish color, and was only about 1cc or less.   I have read online that Metacam is an NSAID, and is not a good thing to give dogs when they are having IBD? What are your thoughts on this?
Azimycin is an antihistamine. I am not exactly sure why your vet would have given this. Metacam is an NSAID and is contraindicated in patients with gastrointestinal problems.
It sounds to me like you really should seed a second opinion, preferably from a specialist in veterinary internal medicine.
As for the hernia repair, because these problems started so soon after this repair was done, they certainly could be related. Perhaps some loops of bowel that were involved in the hernia were damaged either before or during the repair, and this is what is causing your dog's signs.
Really without a consult from a specialist, and an abdominal ultrasound (to start), I think that it is going to be hard to speculate on exactly what is causing this problem. Your best bet may be to take your dog to a college of veterinary medicine (if you are located within a few hours of one), since you can get a full work-up with the best specialists at these institutions, for much lower prices.
I hope that this helps,
Dr. K
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Customer reply replied 9 years ago
THANK YOU SO MUCH FOR ALL OF YOUR HELP!!!! I am within an hour's drive of NC State University, which has a vet school. I will call them first thing in the morning to see how to get her seen there.
I felt so helpless prior to your helpful advice, thank you, XXXXX XXXXX thank you!!! I feel much better about the situation and know what to do now....get a new vet!!
I am glad that I could be of help. I really hope that your dog feels better soon. Please let me know how you make out at NC State.

Dr. K

P.S.-- Sometimes it can be awhile before you can get an appointment for your dog on the internal medicine service. If they don't have anything available right away, you can just bring your dog in on the emergency service. This will get your dog into the hosptial right away, and then once your dog is stabilized, she will be transferred over to internal medicine.
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Customer reply replied 9 years ago
Hi again.
I tried to get her in at State, and they won't take her without a referral from my vet. She is still being seen by my vet, has been treated with IV fluids all day on Thursday and Friday. She is still not eating. I posted her latest labs in a new question on Saturday, but no one has answered it yet. My vet has supposedly called a specialist, and will repeat her labs tomorrow and speak with him again. I am so worried about this dog, and can't stand to see her like this!!
Thanks again for all your help!
Mandy
Hi,
I responded on your other question...so, I will continue the conversation there.

Dr. K
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Dr. K
Dr. K
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Category: Dog
Satisfied Customers: 7,544
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