Dog ate chocolate?

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Lots of problems.

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

Here's the link to our ongoing consultation:

Here's what has happened so far. (Btw, I'm thoroughly p******d off at the vets who are practising here.
They are hardly bothered and are just shooting in the dark. They are just not understanding the severity of the problem.)

* the full abdominal ultrasound showed everything to be OK

I was thinking of going in for the X-ray as well but few new things have come to light as I constantly research the web while going over his earlier treatment.

* The current vet last week prescribed a combination of two meds for him. Practin (cyproheptadine) syrup and Aristozyme syrup(digestive enzymes for humans containing diastase 50 mg & pepsin 10 mg/5 mL)

Both these syrups were to be combined and given with food (5 ml each - twice a day for five days)

Right after the first dose, Mushka's appetite increased and he started eating food. I was happy to see a sudden improvement but unfortunately once the cyproheptadine syrup was stopped after 5 days, his appetite also suddenly came down. The doctor told me not to give cyproheptadine for more than 5 days as Mushka could become addicted to the drug and become dependent on it but asked me to continue with the digestive enzymes. The digestive enzymes didn't help on their own and I stopped giving it to him after a few days.

* Going over his past medical records, I discovered that whenever Mushka's appetite had increased with antibiotics he was first given antibiotics mixed with some steroids by the earlier vet - who is very secretive about the meds he injects and doesn't clearly tell what concoction he is injecting a dog with. (I recalled a conversation I had with him once when he said he generally gives a mixture of steroids and antibiotics). The cephalexin course (oral) always followed those injections.

So we've been focusing on antibiotics (cephalexin) increasing his appetite when - I'm guessing - it was probably the steroids. Once Mushka was given steroids plus antibiotics injections for four days followed by cephalexin for 5 days - and his appetite remained strong for about a couple of months.

ALSO - Mushka has an ongoing problem with a lot of wax discharge in his ears and dark, smelly gunk regularly collects in his ears. One to two weeks after a vet cleans his ears, the issue is back. I've told the vets that this could be a problem but they have brushed it aside and said his ears just make more wax and the dirt sticks to it. My research today made me realize he could have an ear infection/ or some allergies that could be causing his loss of appetite.

Could that be the case, Dr Marie? And could a combination of steroids and cephalexin be clearing it up until it comes back again?

He also used to have a problem with discharge from his eyes as well which was resolved after medication last year.

The current vet has asked me to give Cephalexin for about 10-15 days just to see if things get better. I started yesterday morning and - after three doses - he is not eating anything at all. He's eaten nothing today except the cephalexin he took in the morning with a little icecream. His stomach is rumbling, he has vomited bile twice today (I think he feeling quite nauseous) and has tried eating grass when I took him out.

Should I stop giving him the cephalexin as it's making the situation worse? It's just been three doses so would it be detrimental to his health if I stopped now? Please advice.


Online vet, Dr. Marie

Dr. Marie replied:

Oh the poor guy...he's been through so much! And how frustrating that you are doing all of the right things and not seeing any improvement.

I think it's interesting that he is improving when he is on steroids. Steroids decrease inflammation, so it's possible that he has inflammatory bowel disease, or an inflammatory process going on with his pancreas. These are things that could only be diagnosed by biopsying his intestines and pancreas. Another possibility is an intestinal cancer. With this we would see some improvement on steroids, but at some point they will stop working.

Cephalexin can cause some nauseau sometimes, so it may not be a bad idea to stop it. However, you really need to get the ok from your vet before doing this as I can't directly advise you on his care without him being my patient.

I would ask if they would consider a higher dose of steroids for a while to see how he does.

Regarding the ears, it certainly does sound like infection. I would usually do a cytology test where I look under the microscope to see if there is yeast/bacteria there. They should be able to prescribe you medication to put in his ears. I think that they are thinking his other issues are more important, so this is likely why the ears are not being taken care of. Any time that wax comes back that quickly, an infection is most likely!

It does actually sound like your vets are doing all of the right things...I have had some cases like this that we just can't figure out. :(

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Dear Dr Marie,

There is no option for a biopsy here. Although a new animal hospital in the next city might have a doctor who does endoscopy. Would endoscopy involve biopsy? or is that another procedure?

How is cyproheptadine increasing his appetite? From what I've read it increases appetite in cats, not dogs. For dogs it's used to treat allergies.

Could an allergy be causing his loss of appetite?

Online vet, Dr. Marie

Dr. Marie replied:

Yes, biopsies can usually be done with endoscopy. This would be wonderful if you can get it done!

You are right about cyproheptadine. It is known to be an appetite stimulant in cats. For dogs, the drug book that I use says, "it's efficacy is questionable". What this means is - it may work and it may not. It sounds like it did have some effect on him. But, perhaps it is that its anti-allergy affects were what were working, as you suggested.

A food allergy really shouldn't cause him to be this sick. But many animals with inflammatory bowel disease have a component of allergy.

I don't really have an answer to you as to why it worked. You may want to ask your vet if they have access to a medication called mirtazipine. It is an appetite stimulant that can be given every 3 days. It may help...but again is not a long term solution.

Customer reply:

Dear Dr Marie,

Just so you can picture Mushka.... :)

(taken some months back)

One more concern: I hope endoscopy/biopsy of dogs is a safe procedure and does not involve too many risks.

- Amit

Online vet, Dr. Marie

Dr. Marie replied:

Oh, he is so cute!

Endoscopy is generally safe. Any minor risks would definitely be outweighed by the potential benefit of getting a diagnosis.

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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.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.