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Underweight dog.

Species: Dog
Breed: Mixed
Age: 2-5 years
Dear Dr. Marie,

I have three dogs, one of whom, Mushka (mixed breed), has been chronically underweight since he was about 1 year old. When I say underweight, its because one could always clearly see his ribs unlike his litter mate and mother. And he's always eaten less food than his shorter litter mate.

He's going to be 3 years old in May this year.

He's been examined by the best vets in Delhi, India and his complete blood work carried out but they can't find anything wrong with him.

The strange thing is that the last 3-4 times he has been on broad spectrum antibiotics (as a result of minor injuries), his appetite has grown tremendously. He wants to eat even out of the bowls of other dogs, finishes his food quickly without any fuss, and gains weight so that he looks like a healthy dog and not an under-nourished one.

But once his antibiotics course is over, slowly his appetite starts decreasing until it reaches pre-antibiotic levels.
The last time this happened was about two weeks ago but this time instead of reaching earlier levels, his appetite has decreased so much that he is hardly eating these days.

We've tried changing his diet, removed grain (boiled rice) from his diet, tried feeding him just meat for a few days, but still he hardly eats. I can see he is hungry because he will come for the food but then turn his face away from the food (even his favorites - liver & kidney). He is eating - but just enough to get by.

Last year - as well as this year - we've got his Kidney function & Liver function tests done but everything came out normal. The vets have no answers. And they don't know why antibiotics (cephalexin) suddenly increase his appetite to a healthy level until the effect peters off.

I'm wondering if there could be an issue with his GI tract. An endoscopy is out of the question as no vet has the facility in India. But could a stool/saliva test throw more light on this?

I'm really, really confused. His stool is normal although he quite frequently vomits bile first thing in the morning unless we've given him something small as a treat. Sometimes when he refuses the treat, he goes ahead and vomites. This sort of vomiting stops completely while he's on antibiotics.

I'm giving the link to the latest blood report for your reference (its a PDF file)

http://goo.gl/2aQud

Thanks.

Have a great day!


Online vet, Dr. Marie

Dr. Marie replied:

I'm sorry to hear that Mushka is having problems. I'm trying to think of reasons why a dog's appetite would improve with antibiotics and I have a few thoughts, but no complete answers for you.

I've had a look at the bloodwork and everything is normal. I'm wondering why the report suggests an ultrasound of the liver and pancreas. From what I can see the liver enzymes are normal. (There are no reference values there and the units are different than where I practice in Canada, but it looks like there are all normal). But, there is no test on the panel for the pancreas. We would normally run something called a PLI level which would tell us about pancreatitis. However, pancreatitis would not really improve with antibiotics.

Has he had a heartworm test? It's possible that antibiotics could make a dog with heartworm feel better temporarily. Heartworms need a bacteria called wolbachia in order to thrive. This bacteria is killed by some antibiotics such as doxycycline. Heartworm could definitely cause weight loss and failure to thrive and would eventually get to the point where it makes a dog really sick.

It's also possible that he has a small intestinal overgrowth problem in his intestines. But if this were the case he really should be getting better with antibiotics.

I'm really interested in this case...it's a bit of a puzzle and I'd like to see if I can help you figure it out. Before I list some more possibilities I have some questions for you to answer:


  • What type of antibiotics was he on before, and for how long?

  • Is he neutered?

  • Does your vet have any concern about his teeth? A dental infection could easily explain these symptoms.

  • Does he have diarrhea?

  • Has he been dewormed and if so, with what?



Thanks! I will be heading to bed shortly, but I'll check in on you tomorrow.

Dr. Marie



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Customer reply:

Dear Dr. Marie,

The lab that did the tests usually does blood reports for people and not dogs. So they recommended ultrasound based on the reference values for people, not dogs. My vet confirmed that the values are perfectly normal for a dog.

He has never had a heartworm test. I wanted to vaccinate all my dogs against heartworm when they were pups but the vet at the time told me that since heartworm wasn't found in India, he didn't vaccinate for that.

Today, I did some research after you mentioned heartworm and found that heartworm is found in India. It's very rare in my part of the country but it is present.

I will take Mushka for a heartworm test next week. I'm hoping it's not heartworm as he doesn't have most of the symptoms of heartworm other than loss of appetite. No wheezing or coughing, no runny stools plus he's generally quite active with the other dogs except these days as it's pretty hot here right now. But still, I'll get the tests done - the more things are ruled out, the more closer we'll get to the real issue.

As to your questions:

•What type of antibiotics was he on before, and for how long?
ANS. Cephaxin (cephalexin), dispersible tablets. In the last one year, he's twice been on that, both times for 5 days duration, 2 tablets twice a day. Starting 14/10/2010 & then starting 17/3/2011.
Note: We used to mix the cephaxin tablet in a spoonful of vanilla icecream and give him to make it palatable, otherwise he just wouldn't have it.(Got on OK from the vet on that) Could either the sugar or fat in the icecream be responsible for the increased appetite instead of the antibiotic?

•Is he neutered? NO


•Does your vet have any concern about his teeth? A dental infection could easily explain these symptoms.
ANS. The vet never checked his teeth. He's having his calcium bones with great gusto as well as his chew sticks so I don't know if there is an infection there. I can get his teeth checked.


•Does he have diarrhea? NO. A bit constipated lately because he's not eating much but otherwise he's been fine.


•Has he been dewormed and if so, with what?
ANS. He was last dewormed about a year back. The tablets given were Eazypet (Praziquantel, Pyrantel Pamoate and Fenbendazole)

-------------------------------------

A few more things: Since the past two weeks, he's stopped having chicken. He used to have it daily with rice and other stuff like mutton (goat meat), liver and sometimes kidneys. He doesn't want rice anymore as well. Sometimes he will eat just the goat meat and liver but sometimes not that as well. We ordered some canned beef from the US (Wellness 95% Beef) and he had some meals when we mixed that in his food. But as he gets more used to the beef taste, he is reducing that as well.

One thing that he has with gusto is his calcium bones. (ingredients are: Milk powder, sodium caseinate, calcium carbonate, cereal cellulose, gelatin, Yucca, Rosemary extract and natural flavors)

We don't give him raw bones as the quality of meat I get here is a bit suspect (we get the best available). But the soft cartilage and soft chicken bones are still had with relish.

I am well and truly flummoxed. Since he was a year old, his appetite was never great but these past few weeks it's been a real struggle to feed him anything.

I hope we can get to the root of the problem soon.

Thanks for helping me out here.

Amit




Customer reply:

Dr. Marie, forgot to add a few more things:

Along with the test for heartworm, should I also get a GI panel done? I found out through the web that perhaps it might be good to do a GI panel to look for some of the other GI diseases- EPI (exocrine pancreatic insufficiency), IBD (inflammatory bowel disease) and SIBO (small intestinal bacterial overgrowth). Could any of these be the cause of his low appetite?

Also should I get his stool tested? And any other blood tests that you'd want to get done? I'll be taking him to a lab that only does pet screening so while they are checking for heartworm, they can do other tests as well.

Also, I had mentioned earlier that he frequently vomits bile first thing in the morning (almost never regurgitates)unless he has something to eat. These days - and even previously - when he's hardly eating anything, the vomiting stops. I don't know if that indicates anything.


Online vet, Dr. Marie

Dr. Marie replied:

Thanks for the detailed reply!

So, the antibiotic cephalexin isn't one that I use for intestinal issues so I can't see that it would make things better if this was an intestinal problem. While cephalexin isn't my first choice for a dental problem, it still could cause some improvement. So, I think it's worthwhile to have your vet have a good look at his teeth.

I don't think the ice cream is a factor.

You may want to ask your vet about a condition called Brucellosis. This is a bacterial infection that can infect the testicles. It can linger on for months or years before it gets really bad. Again, it's an infection that is not cured with short courses of Cephalexin but I could buy that a short course of Cephalexin could cause some mild improvement.

It's interesting that you said he is a bit constipated. We don't often see constipation in dogs. Did your vet feel his prostate? This would be done with a rectal exam. A prostate infection could cause these symptoms. However we usually see some difficulty with urination as well.

Regarding the GI panel...these diseases are often not simple ones to test for. I think I would go with other things before I pin this on a GI problem. Dogs with EPI usually have very characteristic grey colored diarrhea. It really doesn't sound like IBD. SIBO is possible but there's no quick blood test for this.

It's never a bad idea to have stool checked for parasites as well.

Your vets will advise you on what to do next, but if this were my case here's what I'd be recommending:

-A good exam of his testicles and prostate
-A good exam of his mouth and teeth
-A good feel of his lymph nodes
-A fecal exam to look for parasites
-I might consider treating him with doxycycline which is an antibiotic which covers brucellosis and a number of other infectious diseases. If he responds well then he may need to stay on it for a few months.
-I may consider a course of metronidazole which is an antibiotic which would help with intestinal issues.

Please let me know how you make out with him!



Customer reply:

Dr. Marie:

His vomiting in the morning(along with dry heaves) - not happening currently but otherwise a regular occurence - does that indicate regular bouts of nausea? And does that in turn point to some thing that might be wrong?




Online vet, Dr. Marie

Dr. Marie replied:

There could be a great number of reasons for vomiting...upset stomach, upset intestines, kidney problems, fever, etc. etc.

If a dog vomits once or twice and still wants to eat then I don't get worried. But, repeated vomiting makes me concerned.



Customer reply:

Dr. Marie:

I got some tests done.

The tests for Heartworm and Brucellosis came back negative.

There does not appear to be a tooth infection.

In other blood chemistry tests (I got these done as they were not done earlier), all the values are within normal range except AMYLASE, which is 2983.4 U/L (normal range:269-1462) -- Quite HIGH

And in Lipid profile, VLDL is 22.1 mg/dl (normal range: 7-18)

I've uploaded the new blood chemistry tests at:

http://goo.gl/ls4mb

Am awaiting tests for his thyroid & will also be getting his stool tested.

Hope this sheds more light on his condition.

Thanks

Amit


Online vet, Dr. Marie

Dr. Marie replied:

Well this is frustrating that we still don't have an answer. The VLDL level really doesn't mean much.

The high amylase level may be significant. Amylase is a pancreatic enzyme. Animals with pancreatitis will often have high Amylase (and usually high Lipase too, but not always.) However, it's not a very accurate test.

You could ask your vet if they have access to doing a PLI test. This test is much more access for diagnosing pancreatitis in dogs.

But, pancreatitis is usually a sudden thing, not something that would be going on over time like this. It is possible to have chronic pancreatitis but I don't think this is what is going on.

Now I'm wondering about the possibility of a foreign object in the stomach. Has he had any xrays yet? Sometimes it is really obvious on xray if there is a foreign object. But not always. I think the next step, if the xray is not conclusive would be to do an exploratory surgery on him. It may sound invasive but at the rate we are going he is just going downhill and we don't have any answers. If there is an object then it will be obvious. If there is no obvious answer then the vet can take biopsies of the stomach, intestines, pancreas and more. This really should give us an answer.



Customer reply:

Dr. Marie:

Biopsy is not an option here and neither is endoscopy. And no exploratory surgery. (Not till I move to the West :) )

The pet lab has x-ray options as well as ultrasonography. Would ultrasonography be a better option? I have discovered (online) that ultrasonography can help diagnose problems in the GI tract specially in cases involving chronic vomiting.

And should I be telling the lab for any specific stuff when getting the ultrasound done (haven't done it before)?

Also, the thyroid tests came back today and here are the results:

T3 0.667 ng/ml Normal: 0.45-1.5

T4 0.85 μg/dl Normal: 1-4

TSH 0.05 μU/ml Normal: >0.45


Only the T4 is a little low. Is that significant?

Thanks for persevering with me on this.

Amit


Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome...I just wish we could figure this out!

I don't know that I'd agree about ultrasonography being a better option for GI issues. Intestines are difficult to see properly on ultrasound. If this were my case I would be doing an xray first. If I couldn't get an answer on xray then I would proceed to ultrasound. However, I really think that your vets will advise you on what they feel will be the most helpful.

The thyroid results don't make me too excited. The T4 is a little low. However, this can often happen when a dog is unwell for some other reason. Mushka doesn't have symptoms of hypothyroidism - these dogs always struggle with being overweight.

Let's hope the xrays/ultrasound give us some answers.




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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

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