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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15577
Experience:  Over 20 years of experience as a veterinarian.
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cavalier king Charles 5 years of age male.dirrhoea,vomiting,eating

Resolved Question:

cavalier king Charles 5 years of age male.dirrhoea,vomiting,eating excessive grass,loss of appetite,lethargic,licks his lips,
Already taken to vets and administered panacur worming tablets,pro-kolin ,metronidazole,and he has had the front bottom teeth removed apparently because they were loose.
This problem has been ongoing since Christmas and he has lost weight from 6.5kg to 5.5kg.
He still licks his lips but the vet assures me his gums and teeth are fine?.
He had a blood test prior to his teeth removal 15th jan .ok.
Submitted: 3 years ago.
Category: Vet
Expert:  Dr. Kara replied 3 years ago.
Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help with your concerns about Buster.

His vomiting, weight loss and diarrhea point toward a disease process that is interfering with Buster's ability to digest and absorb the food that he is eating. Lip licking and eating grass point toward him feeling nauseous. Dogs eat grass as a way to help settle their stomachs, but grass is an irritant and if they eat too much it will cause irritation and lead to more vomiting so you are wise to keep him away from it.

Chronic vomiting can be related to chronic pancreatitis, esophageal reflux, a dietary allergy or sensitivity, inflammatory bowel disease, internal organ failure, Addison's disease, a full or partial gastrointestinal obstruction or even infiltrative cancers such as lymphoma.
Chronic diarrhea can also be secondary to many of the diseases I mentioned above but also can be secondary to pancreatic insufficiency, gastrointestinal parasites and abnormal bacteria overgrowth.

It will be important to describe what sort of loose stools he has to try and localize the problem. Loose stools with mucous or bright red blood without weight loss point more towards large bowel diarrhea or colitis, whereas just watery stools with no mucous and weight loss more toward small bowel disease.
Chronic diarrhea does cause changes in motility of the gut and can lead to reflux and vomiting. It can also lead to bacterial overgrowth in the gut. Probiotics such as Fortiflora or Benebac can help replace appropriate bacteria.

I assume that he has had stool samples checked to make sure that parasites aren't part of his problem. If those were done in the veterinary clinic I recommend having them sent out to the laboratory to look for more unusual parasites, especially protozoal parasites.

Have any other diagnostic tests on his stool been checked?
Has he had a fecal culture to check for abnormal bacteria such as clostridia?

Pancreatic insufficiency is a possibility. These dogs have a pancreas that produces a decreased amount of digestive enzymes, and the amount produced can wax and wane in some cases, especially early in the disease process. Testing is by running a blood test called a TLI which checks for digestive enzymes. Treatment is replacement of digestive enzymes at each meal. An easier to digest food would be expected to create less problems with digestion and as such less diarrhea.

I know that he has had some blood tests done. I assume those were a complete blood count and biochemistry profile, which are great for looking for underlying organ failure, anemia and changes in electrolytes. Ideally he would also have his cobamalin and folate levels checked. If these are low then that signifies that he has a diseased, abnormal, small intestine. He must be tested for pancreatic insufficiency first though as dogs with poor pancreatic function will have low blood levels of folate and cobamalin.

It is quite possible that he has a food allergy/sensitivity or inflammatory bowel disease and that he needs a different low residue, easy to digest food or a hypoallergenic food to be able to properly digest and absorb his food and not have loose stools. I highly recommend a trial of either Hills i/d or Purina Veterinary Diets EN. No treats, table food or edible chewies while he is on his food trial. If he does well he can eat these foods for life as they are balanced. Having had 2 dogs with inflammatory bowel disease I have a personal preference for Purina Veterinary Diets EN. Dogs with food allergies can benefit from Hills z/d or Purina Veterinary Diets HA.
Dogs with inflammatory bowel disease will worsen with stressful situations. There may be times when he will need medications too, such as metronidazole or even steroids if that is his problem, but I have found that a consistent, easy to digest diet is very helpful for long term control.

There are other possibilities too.
Addison's disease, which is a poorly functioning adrenal gland, can lead to chronic diarrhea and vomiting. These dogs cannot handle stress at all because their adrenal gland doesn't produce cortisone when stressed and their electrolytes can be off too if their adrenal gland isn't controlling that normally either. We see vomiting, diarrhea and sometimes physical collapse in severely affected dogs. Testing is an ACTH response test to check adrenal gland function and checking electrolyte levels. Treatment is steroid replacement therapy and electrolyte replacement.

If all of his blood tests (other then folate and cobamalin levels) look good then he may need intestinal biopsies to get a definitive diagnosis. These can be collected via endoscopy or an exploratory surgery.

In short because this has been a problem for months now for Buster then more diagnostics need to be done. They can be as simple as fecal checks and cultures and more blood tests for specific diseases. Or they can be more invasive such as biopsies of his gastrointestinal tract to look for inflammatory bowel disease or infiltrative cancers such as lymphoma.

In the meantime you can try giving him an acid reducer to see if that helps at least settle his stomach. You can try either:
1)Pepcid ac (famotodine) at 1/4 of a 10mg tablet per 5 to 10 pound cat every 12 to 24 hours
OR
2)Prilosec (omeprazole) at 1/4 of a 10mg tablet per 5 to 10 pound cat every 24 hours.
These acid reducers may at least decrease his vomiting and nausea.

I would also try a homemade bland diet mix of 1/3 boiled, minced white, skinless chicken or lean, boiled hamburger and 2/3 boiled white rice mixed with some low salt chicken or beef broth to make it easy to lap up and swallow and get in plenty of fluids. Feed small meals frequently. If he does well on a bland diet then consider a switch to one of the bland diets I mentioned, either Hills i/d or Purina Veterinary Diets EN.

Please let me know if you have any further questions.
Customer: replied 3 years ago.

Hi Dr Kara,


Update on buster.


He passed 3 stools this morning,1st stool normal light brown in colour and normal smell,2nd stool same colour but more moist,3rd stool dirrhoea and slightly reder in colour.


The very first time he had dirrhoea over Christmas was black in colour and very pungent.Today noticed that the licking of lips was due to him swallowing partial vomiting stage.


Two nights ago after not eating for over 48hrs he vomited after 8hrs which was partialy digested food and grass.He has not eaten since.


At this moment I am taking stool samples over the next 3 days for lab tests.


Spoke to vets today and rather than wait for stool samples and tests have requested full blood tests.


Blood test taken prior to his teeth removal was profile 13 for liver kidney and glucose all were fine.


Hope this helps in narrowing down his diagnosis.


yours thankfully daryl baker


 

Expert:  Dr. Kara replied 3 years ago.
Thank you for the further information regarding Buster.
Black, foul smelling stools make me very suspicious of blood in his stools. Your veterinarian can run a test on his stools for occult blood to confirm whether his gastro intestinal tract is still bleeding. His diarrhea sounds like small bowel diarrhea to me.

Regurgitation and vomiting fit with abnormal intestinal motility, and that seems especially true for him given that he vomited food that he had eaten 48 hours earlier. A normal dog's stomach empties within 2 to 3 hours.

I agree that further blood testing now is ideal given how sick he is now. It sounds like his complete blood count and biochemistry profile were normal in January, so that puts things like kidney or liver disease as a less likely cause of his symptoms. I would be looking for a primary intestinal disease (inflammatory bowel disease or cancer) or a mass in his abdomen that is blocking intestinal motility.

It may be helpful to have an ultrasound of his abdomen to look for a mass, thickened intestines or a partial obstruction. If thickened intestines are present we would need to consider inflammatory bowel disease or infiltrative cancers.

Please let me know how his test results come out, thank you, XXXXX XXXXX
Customer: replied 3 years ago.

Hi Dr Kara,


You may have misinterpreted my info regarding my last email.


Buster did not eat for 48hrs and when he ate his last meal he vomited 8hrs later.


On a further note have noticed his stools have on occasions have been mucus based.


Also previously he has vomited up his water which I thought could be colic.


 

Expert:  Dr. Kara replied 3 years ago.
I'm sorry I did misinterpret your write up, but it is still very abnormal that he would vomit food so long after eating. Because normal dogs empty their stomachs in 2 to 3 hours I would not expect to see food in their vomit much after that.
Mucous means that Buster has some colonic irritation as well, so he may have a mix of large and small bowel inflammation/disease. That isn't uncommon with chronic disease.

Vomiting water can be from overdrinking, a poorly functioning gastroesophageal sphincter which allows fluids to reflux easily back into the esophagus, or being too active after drinking. Given his other symptoms I would suspicious of reflux and a poorly functioning gastroesophageal sphincter. Giving an acid reducer (like Pepcid or Prilosec) should help somewhat.
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 15577
Experience: Over 20 years of experience as a veterinarian.
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