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Dr. Welton
Dr. Welton, Dog Veterinarian
Category: Dog
Satisfied Customers: 1451
Experience:  Licensed small animal veterinarian since 2002, practice owner since 2004.
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I have an 8.5yr old Neapolitan Mastiff who's been on a long-term

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I have an 8.5yr old Neapolitan Mastiff who's been on a long-term regime of Metacam and Tramadol for back and hip arthritic pain. Two weeks ago he started rejecting Metacam, no matter how craftily delivered and the vet advised moving back on to Previcox (which he'd been on previously and rejected). For a week we tried giving him Previcox to no avail; even if ground in a pestle & mortar and mixed with liver sausage. He then started rejecting Tramadol too and then, little by little, starting rejecting food types. He's always been fed on mixer kibble + fresh heart/liver/kidneys/chicken or fish and he began rejecting ALL of those. We tried him on wet food but he wouldn't eat that at all and we then essentially tried him on anything and everything - different kibble types, cat food, beef steak, tinned tuna etc etc etc. The only thing he would eat was the odd gravy bone and dried chicken breast treats.
Our vet has done urine tests, full blood tests looking at organ function and infections, mouth check and x-rays of chest and abdomin and can't find any reason for him not eating. His organs are all functioning normally, he's pooing normally (just rarely given the lack of food!) and not vomiting, no tumours are evident on X-ray and his teeth, tongue and throat were pronounced as being fine. As I write he hasn't eaten anything at all in 2 days and is even rejecting the gravy bones and dried chicken breast treats he accepted before. The vet thinks the issue may be 'food aversion' - he's come to associate food we're giving him with medication and is rejecting it and thinks that perhaps we swap to daily anti-inflammatory injections in the hope of breaking the association. I'm terribly worried as he looks so woebegone and he drools when presented with food, but rejects it and goes back to his bed. It's absolutely heart-breaking and also frustrating because nobody knows what's wrong with him and I'm worried how long he can go without eating! He is drinking - he'll drink a lot of water right after rejecting the food.
Is there any suggestions for what may be wrong or things to look out for?
Submitted: 1 year ago.
Category: Dog
Expert:  Dr. Welton replied 1 year ago.
Hello,
Thank you for the thorough history. My name is***** and I'm happy to help. With normal blood work, normal x-rays, and no determinable reason to explain the inability to tolerate food, my concern at this point would be either functional or physical obstruction in the gut. Neither would necessarily manifest in the blood work or x-rays.
We commonly see in middle-aged to senior aged large to giant breed dogs, gastric motility disorders. Gastric motility disorder refers to the inability of the stomach to effectively contract its muscular walls to effectively propagate food distally towards the small intestine. The result of this, is that food remains unabsorbed and undigested in the gut and has no place to go and thus will be regurgitated. This would also have an adverse effect on appetite.
We sometimes see a condition known as pyloric stenosis. Pyloric stenosis is a condition where an abnormal proliferation of tissue occurs at the outflow valve between the stomach and upper small intestine called the pylorus. This results in a narrowed passage, subsequent poor appetite, abdominal discomfort and regurgitation. Pyloric stenosis more commonly would present acutely rather than in a chronic manner as your dogs's progression seems to suggest, however, chronic disease of this sort not unheard of and things don't always present as one would expect.
Cancerous masses that grow inside the stomach or other sections of the gut, or other cancers of the gut that do not necessarily presented as a discrete mass but more as abnormal proliferation of tissue along the lining of the gut, can escape x-ray and blood work detection. Thus, this is another important consideration.
I would advise an imaging technique known as an upper GI series. This is also known as a barium study. Barium is a metallic liquid that shows up very brightly on x-rays. A barium study or upper GI series consists of feeding the dog a substantial amount of this liquid and taking serial x-rays over the course of 4 hours to watch the propagation progression of barium as it travels along the gut. As the liquid travels along the gut, regions where it may profoundly slow down or ceases to move along altogether, would be indicative of a region with areas either functional or physical obstruction. Barium may also reveal a region of narrowed gut, as the barium flow would narrow profoundly in such a region.
Visualization of the function and muscular contraction of the gut in this manner may identify either a medical problem or physical obstruction for which your vet can take action. A physical obstruction would likely have to be dealt with surgically. In the case of a mass or region of abnormal proliferative tissue, the mass would need to be excised and the section of gut affected likely removed. Prognosis would depend on what type of mass or abnormal proliferation of tissue you would be dealing with... Biopsy analysis would determine this. In case of pyloric stenosis, a procedure known as a pyloroplasty is typically effective in alleviating this condition restore normal function.
Your best case scenario would be a gastrointestinal motility disorder, as this could be managed medically with a promotility agent typically given by pill once or twice daily.
Barium series does not reveal any issues, and the next step would be to consider endoscopy. With endoscopy, the scope is passed down the mouth through the esophagus into the stomach and small intestine. At the end of the scope was a camera that enables visualization of the inside of the gut looking for masses, polyps, ulcers, or any other gastrointestinal operations. An alligator clip on the end of the scope also enables the ability to take biopsy samples of the lining of the gut to get a definitive diagnosis. There are other less common occurrences that could explain what is going on with her dog, including inflammatory bowel disease or other autoimmune disease conditions of gut. Thus, even if no masses or other visually significant lesions are noted within the gut, getting biopsy samples of the inner lining of the stomach and intestine and subsequent cellular analysis may shed light on what disease process is that hand, and hopefully lend itself to effective treatment.
Since endoscopy requires general anesthesia and likely more significant cost, my starting point would be with a barium series as I discussed. Please feel free to printout this consultation has a discussion point with your veterinarian.
Thank you for choosing this consultation service. It was my pleasure to help you. Please let me know if you any further questions or concerns.
Best regards,
Dr. Roger
Customer: replied 1 year ago.

Hi there

Many thanks for your comprehensive answer. The one query I had was that in both gastric motility and pyloric stenosis it looks as though one of the major symptoms is regurgitation. In case of my dog he's not regurgitated at all and he doesn't appear to be experiencing any abdominal discomfort as the vet has thoroughly palpated that area on each visit with no visible signs of distress from him. He also has canine massage weekly and he's a completely relaxed state when she's working his tummy. We haven't found any particular area of pain other than the arthritic areas in back and legs we already knew about.

As a follow-up, this morning he shunned his breakfast of lamb heart - but oddly went off into the garden and ate some pieces of lamb heart that I'd tried to feed him last night and had thrown out into the garden for the crows. So it's as though, if hunger absolutely forces him to, he'll find something to eat but something 'scavenged' rather than presented in a food bowl or by hand.

Many thanks

Emma

Expert:  Dr. Welton replied 1 year ago.
Thanks for the follow up. I guess by "rejected," my assumption was some form of vomiting or regurgitation. Still though, if you have ruled out metabolic disease with the thorough work-up he has had, something must be making him anorexic. With no metabolic disturbances, I would still be looking for something that may be space filling in the gut - such as a thickening of tissue, a motility disorder, or mass - that is taking his appetite away. It is not necessarily uncommon for GI motility disorders to not present with regurgitation or vomiting.
As such, I would still consider the work-up I recommended with a barium series and endoscopy.
Best regards,
Dr. Roger
Dr. Welton, Dog Veterinarian
Category: Dog
Satisfied Customers: 1451
Experience: Licensed small animal veterinarian since 2002, practice owner since 2004.
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