Ongoing GI issues in dog - Final Update: Post 30

[Displaced_Yankee]

My poor Carolina Road Dog is having the full range of GI issues. We are trying to balance caring for our dog and money. Here is the timeline:

ETA: She is about 13 years old, 55 lbs and an easy keeper. Keeps a pretty tight feeding and bathroom schedule normally. No underlying health issues that we have identified. 100% Good Dog.

• Wednesday, 09/28: Dog begins having diarrhea. Like “run-out-the-door-runny” diarrhea. We immediately pull her off of her kibble and feed her 1/4 cup of plain rice and boiled chicken. It doesn’t resolve over the rest of the week and I notice some blood in her stool, so we make a vet appointment.
• Tuesday, 10/04: vet appointment with our regular vet. They suspect ulcers. They prescribe metronidazole, omeprazole, and sucralfate. They do a quick blood draw and red blood cell count is normal.
• Wednesday, 10/05 PM: she starts puking. Seems to be unable to keep her small meals down (still chicken and rice). Generally, about an hour or so after her meal it comes back up.
• Friday, 10/07: we take her to the urgent vet (no appointments available with my reg vet). They do xrays and a pancreatitis test. Xrays show some debris in her large colon, but they were unconcerned (it would pass fine). Pancreatitis test is slightly positive. She gets sub Q fluids and an injectable anti-nausea med that should supress vomiting for 24-48 hours. Suggest a probiotic that we start on Saturday. Continue with small feedings of chicken and rice.
• Saturday-Sunday, 10/8-9: all is good, just no bowel movements. We think this is ok since she hasn’t been getting a lot of food.
• Tuesday, 10/11: good poop! We also add a tablespoon of pureed pumpkin 2x a day.
• Wednesday, 10/12: More good poop!
• Thursday, 10/13: she is vomiting again.

We have not yet started feeding kibble. Just boiled chicken and rice the whole time.
She does not have access to trash. She goes on supervised walks (often leashed) since we don’t have a fenced in yard.
She has been happy, drinking and peeing well.
She was dehydrated while she was vomiting the first time, and I think that brought her energy level down. Otherwise, her energy has been good.
Debris in her colon may have been from an elk antler that we instructed our pet sitter to give her when we were out of town. It began to splinter and break so he took it away from her. But that was the only thing we can think of. That was the weekend of 09/24, so I suspect that it has passed by now?!

I called our regular vet today. They don’t have any appointments for 2 days. They suggested the 24 emergency vet, as the “urgent vet” had no further diagnostics for her.

I am hung up on “can I manage this at home for a day or two” and see if it resolves. Do I bite the bullet and take her to the ER vet? What can they do other than more xrays, fluids or meds? She is poozily, not dying. Generally, I can manage a poozily feeling horse. I know the signs to call the vet. For as long as I have had dogs I haven’t had this much of an ongoing issue.

What say COTH? (probably to suck it up and take her to the vet)

[S1969]

Ugh that’s a tough one.

Is she still on metronidazole? Omeprazole and sucralfate shouldn’t be an issue but some dogs do have issues with antibiotics. I would think she is done with it by now though? Just curious if it could be two issues - first was diarrhea but the vomiting was the antibiotics?

What kind of kibble does she eat, and does she normally do ok with chicken? (We found out our first dog was sensitive to chicken when we put him on a chicken/rice diet after some other issue…ugh. Made him worse but of course we had no idea.) If the kibble is not chicken based, I might suggest switching over to the same base protein and rice if you can.

I personally have switched my dogs back to their kibble rather than protein/rice for extended periods of time- but generally when symptoms were soft stools/diarrhea not vomiting.

If the dog is otherwise not in distress, I might wait for a visit with my regular vet, but I think it depends on your confidence in the vet.

PS never heard the term Poozily so had to look at this thread - but maybe you want to update to “GI distress”…?

[CindyB59]

My standard poodle bloated and then went into pancreatitis. Did all what your doing. Kept throwing up. I started her on tiny amounts of goat milk, like a couple of tablespoons an hour. She kept it down. By the next morning, she ate some chicken, kept it down. We went back on regular dry food.

I swear goats milk can do miracles.

[Displaced_Yankee]

Thanks, I’m glad I’m not crazy for considering riding it out.

No, she finished the metronidazole (Tuesday, 10/11 I think) as prescribed.

I also thought the same thing: vomiting was caused by the meds. “UrgentVet” did not think it was an issue.

She is on Purina Pro Plan Large Breed Chicken and Rice. Two other occasions she has GI upset (due to knowing that she ate something -cough- Bojangles box -cough cough-) we did chicken and rice, mixing in kibble to shift her back to a full kibble meal. Perhaps we need to stay the course. I will add this to my main post, but she is an easy dog. No concerning health issues, usually eats twice a day and pees and poops like clockwork.

RE: Poozily: Sorry about that, I will attempt to edit! I really appreciate your input.

@CindyB59 Thanks! That is a great idea!

[mjwright]

The vomiting is a concern. Just plain diarrhea wouldn’t bother me, unless it had blood in it.

Until you can see the vet, I would add: heaping teaspoon of psyllium (Metamucil) to every meal. This is a great prebiotic for dogs. Every working dog in our kennel gets it every day on the advice of a sporting dog nutritionist.

Also a good probiotic like fortiflora and proviable.

We add water to ALL kibble we feed…helps with digestion/absorption. Also helps with fluid intake.

[BootsAndCoffee]

I would suggest an emergency vet.

Pancreatitis can be a beast to wrangle, and mild cases can snowball rapidly. If there are ongoing GI symptoms, that’s a sign that things are not resolving as they should.

[Displaced_Yankee]

Well, we tried to ride it out and she vomited again. Our regular vet didn’t have any openings and it took 3 calls to 24 hour vet services to find someone who could evaluate her.

ER vet’s first comment: she is in remarkably good shape for a 13 year old dog.

• Blood panel was good. “Mini” chem test was normal (gluclose, potassium, electrolyte and renal values) with the exception of a minor increase in lactate.
• Limited ER ultrasound showed no obvious masses, obstruction, or free fluid.

She got more sub Q fluids, more anti-nausea meds which should get us through until we can get in with our regular vet for a liver enzyme test and advanced abdominal imaging. I was able to get a hold of my reg vet before they left today and we have an appointment for Wednesday.

sigh I do love this pound puppy.

[thatmoody]

I was going to ask if you’d done an ultrasound; that’s good. I’ve wrangled a couple of dogs with chronic pancreatitis (also a bunch with other GI issues such as giardiasis and just plain gastritis). It sucks; I agree with the pro and pre-biopics comment; that’s helped our latest bout of gastroenteritis, along with sucralfate and cerenia for the nausea.

[Displaced_Yankee]

How do you administer the sucralfate? Our girl is not a fan of a water/sucralfate slurry. Applesauce was better, but I know it’s not actually supposed to be fed with food.

[thatmoody]

I put it with a small amount of water in a fairly large syringe, then I “pop” the plunger of the syringe to dissolve the pill (it takes a surprisingly short time versus putting it in a mortar). Then I just squirt it at the back of his throat. He gets most of it, which is more effective than none

[hoopoe]

I think you next step is likely to be contrast / barium radiology.

I am surprised that they are not doing full panel work up on blood, rather that the a la carte panels. If there is left over serum at the lab i would request an add on. Add as much data the serum will yield. A geriatric dog should always have liver and kidney evaluation during blood work , IMO.

[Displaced_Yankee]

I will be happy to see my regular vet on Wednesday. I think part of the problem (re: a la carte panels) is that this is the 3rd vet to have seen her. Not just “different vet within the same practice” but a whole different practice.

My regular vet has been booked since the vomiting started, but preferred that I go get her seen somewhere rather than wait. And even that took several calls to find someone.

In the meantime, she has been great. Good attitude, loves her chicken and rice. Her poops are back to being more regular.

I really appreciate all the recommendations!

[SMF11]

If she’s eating I doubt it’s pancreatitis, thank goodness.

[Mosey_2003]

That sounds super frustrating, I’m sorry you guys haven’t gotten good answers yet.

[Displaced_Yankee]

Not sure that many people are following but I wanted to provide an update.

So while the anti-nausea meds have kept the vomiting at bay, Lily began having diarrhea again on Tuesday and she started turning her nose up at the chicken and rice. ~sigh~

Wednesday AM, was our appointment. Our vet pulled blood for a comprehensive lab work up and performed a physical exam. She is down 2 lbs since her visit 15 days prior, which was expected given the vomiting and limited diet. She was not dehydrated and is in good spirits.

We decided to not give her any additional meds (she has finished all rounds of metronidazole, omeprazole, sucralfate, anti-nausea meds) and allow her system to reset. The vet sent us home with special GI dog food since she was refusing chicken and rice. If for any reason Lily started to vomit or her diarrhea did not resolve we could call and she would prescribe more meds that we could pick up. No need to go to another emergency vet. She has an ultrasound scheduled for next Tuesday, which was the earliest they had the radiologist coming. We need to get a fecal sample, just to rule out a parasite or giardia.

The vet called today to check in and go over her lab work. Her lab work was unremarkable. Everything was within the expected ranges. The vet was happy that Lily was doing well. We agreed that even if Lily seemed fine on Tuesday we would still get the ultrasound. She seems to enjoy her new kibble.

So no good answer yet. I like the idea of “she has had a lot going on…lets see if less is more” approach.

[hut-ho78]

Thanks for the update. Good luck.

[hoopoe]

have you done serial fecal exams? I would and be sure they include a direct swab slide paying attention to the single cell parasites like Giardia. Many times direct swab samples are best done from the rectal thermometer.

I have lost track, were barium contrast bowel films done? These would look for foreign bodies, strictures and pathologic lesions

[Simkie]

Some just don’t respond to PPIs. It might be worth trying a different class of ulcer med. Pepcid is cheap, available OTC, and there’s no real risk in adding it. I’ve run into this myself…PPIs are just really minimally effective for me, but h2 receptor agonists work well.

I’m really surprised you’ve gotten this far without a comprehensive fecal panel, though. Definitely a box to check.

[Displaced_Yankee]

Serial fecal exams: no.

• Giardia or another parasite was brought up, which is why we are getting a fecal done. Her fecal as of 01/25/22 was normal/fine. Just waiting on the to appear!

Barium contrast bowel films: no.

• The only imaging that has been done is an xray that showed some debris in her large intestine (first ER vet). This was not a concern, as if it had made it that far, it would pass. The second ER vet did a limited abdominal ultrasound that showed no obvious masses, free fluids, etc.
• Is this something that would be done on a generic ultrasound?

My hope is that this more comprehensive ultrasound on Tuesday will provide an answer. Again, even if she is doing well, we will get the ultrasound.

I know, I have lost track too. In some ways, I am using this thread to track Lily’s timeline! And my understanding of the ER vets is that they troubleshoot, determine if there is an immediate need and then delegate to the regular vet for non-emergent care.

[Displaced_Yankee]

I know. I contribute it (RE: fecal panel) to being seen by different ER vets. Our first visit with our regular vet was 10/04 and we only got in with her again on 10/19. Thankfully, the ongoing issues have her attention and I have spoken with her on the phone every day this week.

I will keep Pepcid in mind. So far we have no vomiting and no poop. Her next poop will be telling. We do notice that she has drank more in the last 24 than she has in the prior 72 hours.

If I haven’t said it yet, I really appreciate everyone’s comments and ideas.