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Dr. Kara
Dr. Kara, Board Certified Veterinarian
Category: Vet
Satisfied Customers: 27525
Experience:  Over 20 years of experience as a veterinarian.
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My 8 and a half old leonberger has been bringing up bile

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My 8 and a half old leonberger has been bringing up bile everyday for 4 weeks. Stopped eating and drinking. Has had x Ray's bloods done been on rehydrating drip. No obvious cause. Now on steroids and antibiotics. He now drinks ok and shows an interest in food but seems unable to eat. He has not eaten properly for 7 days. Has had very small amount for 2 days but today again not interested. Due to long standing untreatable behaviourable problems it would be too traumatic at his age to undergo exploratory surgery and hospitalisation. He is still alert and interested in life. What can I do.

Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

I am sorry to hear about your fellow's repeated bile vomiting, lack of appetite and decrease in drinking despite therapy with fluids, steroids and antibiotics and I understand your concern.

If his blood tests and radiographs are normal and not diagnostic the next step would be an abdominal ultrasound and/or endoscopy with biopsies. But I understand given his personality that may be difficult.

It sounds like your veterinarian is treating him presumptively as a primary intestinal disease case.

Were his cobamalin and folate levels checked?

If he isn't responding to the medications he is taking we can add an antinausea drug including Cerenia (prescription from his veterinarian), an acid reducer medication such as Prilosec (omeprazole) or Pepcid (famotidine) which are over the counter drugs you can purchase at the drug store, and a prescription appetite stimulant called mirtazapine.

Today if you would like you can try either:
1) Pepcid-ac (famotidine) at a dose of one 10mg tablet per 20 to 40 pounds of body weight every 12 hours.
2) Prilosec (omeprazole) at a dose of one 20mg tablet per 40 to 80 pounds of body weight every 24 hours.
These will reduce stomach acid and should help decrease symptoms related to reflux, so they may help him. These medications are quite safe and can be used long term if need be.

Ideally he should be eating a prescription hypoallergenic food, but these aren't highly palatable and we want him to eat so instead you might try feeding him a higher calorie prescription food called Hills a/d or Iams Maximum Calorie from your veterinarian and make sure he has access to plenty of fresh, clean water.

Rarely a parasite called a stomach worm (Physaloptera) can lead to persistent, intermittent vomiting. These are difficult to diagnose because they rarely shed eggs, so we can try simply worming him with a gentle wormer called Pyrantel and see if that helps. This is easy to do and inexpensive so well worth trying.

Please let me know if you have any further questions.

Customer: replied 5 years ago.
Thank you. We are unable to get the omeprazole capsules into him. Big dog and reluctance to swallow. Is there a liquid we could use. Don't know about cobalamin and foliage levels. I'll check tomorrow. What would these show.

If they were abnormal these levels will show that the disease process is likely at least in part caused by a poorly functioning small intestine.

Omeprazole does come in a liquid formula, but I believe it is prescription only and the amount he may need depending upon concentration may be quite a bit given he's a big fellow.

Another option is to mix the pill contents with meat baby food or a little canned prescription a/d or chicken broth and use a dosing syringe to syringe it into him. That may be easier.

Depending upon whether cobamalin or folate is high or low will help too in pinpointing which part of his intestinal tract is affected.

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