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Help me with this month long mystery.
03-14-2017, 09:54 PM,
#1
Help me with this month long mystery.
I adopted Mysti, a 40lb mix of either Husky, Border Collie or Akita, as an adult in 2015. From then till January of this year she had zero GI issues. Never puked and had normal bowel movements.

She started having nighttime episodes of vomiting, sometimes several times, in the middle of January. We ate first thought it was the food we had started feeding her and the other dogs at the beginning of the month. So we slowly changed back to the old food. She still had nighttime vomiting episodes and would periodically vomit during the day. Her coat remained shiny and she was never really lethargic.

We took her to the vet and the vet palpated her abdomen, took x-rays, tested blood and urine, and took her temperature. Mysti screamed and panicked when her temperature was taken, something she had never done before. She had also gained two pounds even though she hadn't been eating more and was getting exercised twice a day. Vet gives her a 24 hour shot of Cerenia and sends her home with some Cerenia tablets. Blood and urine was normal.

Mysti vomits that night and so we take her back Monday afternoon. Mysti is kept overnight and they do more x-rays, an ultrasound, and an enema after they notice hard stool in her colon. Vet puts her on Metronidazole and more Cerenia. The enema works and Mysti has several loose bowel movements over the course of the day.

Mysti is STILL vomiting and so the Vet does more x-rays, finds nothing but gas in her intestines and fecal matter in her colon and sends her home with Reglan to go along with the Cerenia and Metronidazole.

She is fine for several days before the cycle starts again. Vet has a more experienced ultra sound person come in and they do a more thurough ultrasound because the vet is worried they missed an impaction or something. No impaction, but they can't find a Gallbladder Huh  and they DO find "decreased motility" of the intestinal tract  and "The apex of the bladder is mildly thickened with multiple small to pinpoint size finger-like projections along the lumen". Vet speculates it could be a UTI and that there might be ulcers somewhere. Vet then stops the Reglan and now Mysti is on Cisapride, Cerenia, Amoxicillin, Omeprazole, and Metronidazole.

We still have no clue exactly what is happening here.
She primarily vomits solid undigested kibble, but sometimes it is fully digest. She has vomited bile twice. She skips some days, even before the medicines, then vomits several days in a row. I've attached a pic of her last vomit because it looked so strange, even the vets thinks it looks weird. No liquid or mucus and it was a dark green color.


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03-15-2017, 12:44 AM,
#2
RE: Help me with this month long mystery.
Hi Artzwolf,

Seems like a case of a digestive problem. Have you tried getting second opinions from other doctors? It might help to hear their conclusion as well. I think it's better to keep him in A/D diet for the meantime.
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03-15-2017, 08:55 AM,
#3
RE: Help me with this month long mystery.
(03-15-2017, 12:44 AM)IamLacey Wrote: Hi Artzwolf,

Seems like a case of a digestive problem. Have you tried getting second opinions from other doctors? It might help to hear their conclusion as well. I think it's better to keep him in A/D diet for the meantime.

We can't really afford to at this point, plus I cannot drive and my "driver" is recovering from back surgery she had in January. This vet is talking to other vets in their practice and the state. She is on an A/D diet.
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03-15-2017, 10:25 AM,
#4
RE: Help me with this month long mystery.
(03-14-2017, 09:54 PM)Arztwolf Wrote: I adopted Mysti, a 40lb mix of either Husky, Border Collie or Akita, as an adult in 2015. From then till January of this year she had zero GI issues. Never puked and had normal bowel movements.

She started having nighttime episodes of vomiting, sometimes several times, in the middle of January. We ate first thought it was the food we had started feeding her and the other dogs at the beginning of the month. So we slowly changed back to the old food. She still had nighttime vomiting episodes and would periodically vomit during the day. Her coat remained shiny and she was never really lethargic.

We took her to the vet and the vet palpated her abdomen, took x-rays, tested blood and urine, and took her temperature. Mysti screamed and panicked when her temperature was taken, something she had never done before. She had also gained two pounds even though she hadn't been eating more and was getting exercised twice a day. Vet gives her a 24 hour shot of Cerenia and sends her home with some Cerenia tablets. Blood and urine was normal.

Mysti vomits that night and so we take her back Monday afternoon. Mysti is kept overnight and they do more x-rays, an ultrasound, and an enema after they notice hard stool in her colon. Vet puts her on Metronidazole and more Cerenia. The enema works and Mysti has several loose bowel movements over the course of the day.

Mysti is STILL vomiting and so the Vet does more x-rays, finds nothing but gas in her intestines and fecal matter in her colon and sends her home with Reglan to go along with the Cerenia and Metronidazole.

She is fine for several days before the cycle starts again. Vet has a more experienced ultra sound person come in and they do a more thurough ultrasound because the vet is worried they missed an impaction or something. No impaction, but they can't find a Gallbladder Huh  and they DO find "decreased motility" of the intestinal tract  and "The apex of the bladder is mildly thickened with multiple small to pinpoint size finger-like projections along the lumen". Vet speculates it could be a UTI and that there might be ulcers somewhere. Vet then stops the Reglan and now Mysti is on Cisapride, Cerenia, Amoxicillin, Omeprazole, and Metronidazole.

We still have no clue exactly what is happening here.
She primarily vomits solid undigested kibble, but sometimes it is fully digest. She has vomited bile twice. She skips some days, even before the medicines, then vomits several days in a row. I've attached a pic of her last vomit because it looked so strange, even the vets thinks it looks weird. No liquid or mucus and it was a dark green color.

In reading through the sequence of events, the Vet first concentrated on a potential intestinal blockage, and found none.  Then progressed to "impaction" or the idea the hard stool could not pass.  Thus the enema, and reglan (metoclopromide) to accelerate the intestinal movement.  Treating the vomiting with Cernia, and trying to stabilize any imbalances in the bacteria with Metronidazole.  When that didn't work, a second ultra sound, while altering the diagnosis to potential ulcers, and possible UTI infection. 

Green vomit has a multitude of causes: colon inflammation,  liver or kidney disease,  pancreatitis, septicemia, ulcers, or a combination of several.

Most of the drugs being prescribed should have already addressed ulcer, and infection.  You might ask the Vet if prescribing Sucralfate is appropriate.  Also Endosorb tablets to try to absorb any intestinal toxins.  But this is just treating the current symptoms of an undiagnosed underlying condition.

You should ask for a referral  to a Vet internal medicine specialist, or Vet Specialty Hospital in your area.  There are other possibilities as to what is going on such as:  Metabolic disease such as Addison's Disease, the doggy version of IBS,  undiagnosed cancer, other.  Your Vet can transfer the blood chem panel, and ultrasounds (i.e. presumably the recordings still exist) to the Specialist.  Possibly saving the expense of having to do them over.   You will probably need more detailed tests. The goal is to find the root cause for the symptoms your dog has experienced since Jan.  Treat the root cause, with the idea of getting the symptoms under control.
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03-16-2017, 12:50 PM,
#5
RE: Help me with this month long mystery.
Seems like a lot of "guesswork" has been going on. Your vet suspected several things, gave medications but the problem recurs. I agree, at a point like this, it would be best to see a specialist. Specialists are used to seeing challenging cases. Since your vet suspects decreased motility, has anything been prescribed for that?

Normally, the dog's stomach empties in 2 to 4 hours and food moves into the small intestine where digestion continues at a chemical level. When the stomach is not emptying normally as it should, that's when you start seeing vomiting of partially or non-digested food, that has been sitting in the stomach for some time. There are prescription medications that can help improve motility and one of them is Metoclopramide (Reglan). I would ask your vet if that could help your dog or even better, see a specialist to get this sorted out to find the underlying cause of the reduced motility.
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03-23-2017, 02:17 PM,
#6
RE: Help me with this month long mystery.
I'm curious to know what new information you've received on your dog's digestive issues.
I've been dealing with a very similar issue with my soon-to-be 2 year old terrier mix.  It started out of the blue in the middle of the night at least 5-6 hours after she had last eaten and has continued periodically for the past several weeks now.  She's been to the vet 4 times...had the cerenia shots 3 times , was being given reglan injections 4 times a day, switched food to science diet i/d and k/d.  Has had blood work done which all came back good.  Ultrasound showed weak stomach contractions and the flow in the duodenum (which should be moving the food to the small intestine) is actually sloshing back and forth betweenrather than contracting to move in one direction.  She pees and poops as normal as ever.  Healthy, solid stools every day.  She hasn't lost any weight either.  She's not herself 100% but she doesn't really act sick either.  I think she feels our anxiety and is more mellow because of it?  Since the reglan wasn't helping, she is  now on cisapride.  She's only vomited once in the last 3 days.  I've been scouring the internet to try to find cases like hers but this is the only one I've come across that is similar.  What I've learned about gut motility issues is that they are usually caused by trauma, drug side effect, or a blockage.  Mango was on a course of clavamox several weeks before the vomiting Started and the vet doesn't feel this is a reaction to that, so everyone is baffled.  If there is anyone out there who has had a pet with these issues I'd love to know how it was treated, how long will it last, did it affect the quality of your pet's life, and what has and hasn't worked for you.  I'm very curious to know how the original author's pet is doing and if any diagnosis has been made.  If the cisapride doesn't help dramatically, my girl will be going to the University of Florida Veterinary Hospital in the next couple weeks.
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03-24-2017, 10:34 AM,
#7
RE: Help me with this month long mystery.
(03-23-2017, 02:17 PM)fldawna Wrote: I'm curious to know what new information you've received on your dog's digestive issues.
I've been dealing with a very similar issue with my soon-to-be 2 year old terrier mix.  It started out of the blue in the middle of the night at least 5-6 hours after she had last eaten and has continued periodically for the past several weeks now.  She's been to the vet 4 times...had the cerenia shots 3 times , was being given reglan injections 4 times a day, switched food to science diet i/d and k/d.  Has had blood work done which all came back good.  Ultrasound showed weak stomach contractions and the flow in the duodenum (which should be moving the food to the small intestine) is actually sloshing back and forth betweenrather than contracting to move in one direction.  She pees and poops as normal as ever.  Healthy, solid stools every day.  She hasn't lost any weight either.  She's not herself 100% but she doesn't really act sick either.  I think she feels our anxiety and is more mellow because of it?  Since the reglan wasn't helping, she is  now on cisapride.  She's only vomited once in the last 3 days.  I've been scouring the internet to try to find cases like hers but this is the only one I've come across that is similar.  What I've learned about gut motility issues is that they are usually caused by trauma, drug side effect, or a blockage.  Mango was on a course of clavamox several weeks before the vomiting Started and the vet doesn't feel this is a reaction to that, so everyone is baffled.  If there is anyone out there who has had a pet with these issues I'd love to know how it was treated, how long will it last, did it affect the quality of your pet's life, and what has and hasn't worked for you.  I'm very curious to know how the original author's pet is doing and if any diagnosis has been made.  If the cisapride doesn't help dramatically, my girl will be going to the University of Florida Veterinary Hospital in the next couple weeks.

Your dog may have a syndrome generally referred to as GI dysmotility.  Where as you have already researched can be caused, and traced to a specific cause.  Sometimes there is no underlying cause identified.   The generic treatment is cisapride, in combination with metoclopromide (reglan).  Dosing with rantidine (Zantac) every 12 hrs to prevent stomach acid build up can't hurt.  Ask your Vet for the appropriate dose (e.g. most likely 75mg).   A possible try is to measure out the food you would feed normally in 2 meals, and instead feed smaller amounts using 4-6 feedings.  

Clavamox not likely to be a cause.  It's most frequent effect is diarrhea, due to its effect on intestinal bacteria. Which usually quickly disappears after Clavamox is discontinued.

You have a good plan.  Wait a couple of weeks, and then head to the UF vet school.
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03-24-2017, 11:22 AM,
#8
RE: Help me with this month long mystery.
I've tried the small meals often. It doesn't seem to matter. She vomits up her meals anywhere from 1 1/2 hours to almost 6 hours after. And it's generally very identifiable as to being what she last ate. She's vomited her last 3 meals within 2 hours of eating them. I'm making the call to the university now. Hopefully they can get her in next week. Thanks for the feedback. And I will post updates as they come along in hopes of helping someone else with the same sort of issues.
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03-30-2017, 11:28 PM,
#9
RE: Help me with this month long mystery.
There was a cancelation at the university veterinary hospital so Mango had her appointment yesterday.  After going over her history and records they decided x rays were needed to rule out whatever the ultrasound might have missed.  Long story short...they showed 5 small pieces of WIRE in her abdomen!  They are all about the same size and appear to have already migrated out of the GI tract.  The most likely scenario is that they are bristles from our gas grill brush that were in the catch tray.  When we hosed the thing out in the yard she must have gotten into the charred bits and grease that were rinsed out into the yard.  Anyway, our original thoughts had been that she might have had a piece of rawhide or cow ear stuck somewhere in there and had discussed whether an x ray or ultrasound was more likely to show something like that.  That was why we had the ultrasound done and not the x ray by our regular vet.  The plan now is to give her another 2 weeks of the continued treatment with cisapride and science diet sensitive stomach canned food along with prilosec twice a day.  They didn't feel the bristles were an issue where they were now and said the body should "wall them off" if it hasn't already.  They had to poke holes in her GI tract somewhere in order to migrate out though, so that is what has caused the trauma resulting in motility issues.  Hopefully, that will normalize within a couple of weeks.  If not she will go back for an endoscopy to dig a little deeper.  So for now...we continue with the treatment and hope for improvement.  I feel 90% positive that this is the cause and should resolve itself soon.  We feel terrible for being responsible for what she is going through.  It never occurred to us not to rinse the catch tray in the yard.  It's not something we considered a danger to our dogs, but I can promise you it will never happen again!
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03-31-2017, 10:34 AM,
#10
RE: Help me with this month long mystery.
Incredible what they get into.

My Leukemia puppy apparently got into the kitchen garbage can last Jun. Acted depressed, like he had vomited outside in the dark somewhere. Infection? Laid shivering in pain. Pancreatitis? After returning from the emergency vet with pain meds, he vomited up a pile of Glad wrap. Thereafter, immediately returned to normal. Bought a new trash can with a lid immediately. Cheaper than vet visits.
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