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Vomiting and diarrhea.

Species: Dog
Breed: American Staff mix
Age: 1-2 years
Dear Dr. Marie,
I adopted a shelter dog from the southern US last September. He is up to date on all vaccinations and heartworm negative. Until recently, he seemed in good health.
He started vomiting yellow bile in the morning towards the end of June. Local vet suggested giving a late night snack, but the bile vomiting continued and then also progressed to vomiting his meals.
On July 12th, CBC, General Health profile, and Thyroid blood analysis was done. Everything was normal except for an elevated eosinophil level, which she said was suggestive of either allergy or parasites. Where he has no previous history of allergy or symptoms, we did a fecal analysis, which showed parasitic infection of hookworms and whipworms. He was treated with Panacur (fenbendazole) on July 14th, 15th, and 16th. The vomiting stopped at the time, but he became listless, lethargic and lost all interest in walks and toys. He would eat reluctantly, but then would be frantic to get outside and eat dirt. The vet felt he was dealing with a heavy worm burden, and that things would resolve over time. His feces was re-tested on July 23 and found negative for parasites. The vet started him on FortiFlora (a probiotic for dogs) on July 25th, for one week. But on the 4th day, July 28th, he developed severe, explosive diarrhea. (We stopped FortiFlora. He had the diarrhea through the night and into Friday (the 29th). It seemed to have resolved by that evening, but vet advised bland diet through the weekend. He was given boiled rice and chicken on Saturday (the 30th) and began vomiting within a half-hour of eating. He vomited a copious amount of food, followed by two episodes of bile vomiting, one large, the other a smaller amount. He seemed to be feeling better following that, and was rattling his food bowl and bumming around the kitchen wanting to eat some more. We waited a few hours, then tried him with a small amount of boiled hamburger at 5pm. At 7pm, he vomited a large amount of bile and hamburger bits. We called the vet and she advised withholding all food for 24 hours, just make sure he was drinking. On Sunday the 31st, he went outdoors and tried to eat a large amount of grass, after which he vomited a large amount of yellow bile, followed shortly after by 3TBsp size of blood-tinged bile. I called the Emergency vet service, but they said not to get too concerned about the bloody vomit, as he probably "burst a small blood vessel" with his frequent retching and to take him to see my regular vet on Monday (today) unless things got radically worse. However, it is Natal Day here in Nova Scotia, so my vet is closed for the day. He is more energetic today and seems hungry, but he did have some mucous-bloody diarrhea this morning. Since then, he has eaten two small meals of rice and boiled hamburger, and he has not vomited yet and it is now 8:30pm.
My question: do you think this vomiting and diarrhea since being dewormed is related to the original vomiting that brought us to the vet in the first place? Or could there be something else going on IN ADDITION to the already treated parasite infection? If so, do you have any advice as to what it could be, and what testing should I pursue next? I am sorry for the length, but I wanted to be thorough. I thank you for your time and help. Best Regards, Myrna


Online vet, Dr. Marie

Dr. Marie replied:

Sorry to hear that your boy is having such a hard time!

It's hard to know how to advise you here. As I can't give a diagnosis over the internet, what I'm going to do is just give you my thoughts on what you have written.

I don't like the fact that Dalis has had some vomiting and diarrhea for several days now. To me it seems like there is something else going on. But, it's going to be hard to know what that could be.

One thing you may want to do is ask your vet about deworming him again. I know you said his latest fecal exam was negative. However, whipworms can often go through stages where they don't lay eggs. And whipworms sometimes need several treatments in order to be cured. I will often do a three day course of fenbendazole and then repeat it 3 weeks later and again 3 months later.

It is also possible that there is something else going on though. I can think of several possibilities. He could have a foreign object in his stomach or intestines. He could have a bacterial infection in his stomach called helicobacter. He could have inflammatory bowel disease. Or, he could have small intestinal bacterial overgrowth.

I'm pleased to hear that he is improving today. If he was still vomiting and still had diarrhea I would likely be suggesting having an emergency vet see him to administer some intravenous fluids.

It's a good idea to see your vet again when they open. If this were my case, here are some of the things I would be suggesting. I would likely repeat the dewormer. I'd also suggest some xrays to look for signs of a foreign object. I may consider doing a DNA diarrhea panel. This test is controversial, but sometimes we can uncover strange parasites or bacterial infections by doing this test.

I'd likely also be suggesting a prescription hypoallergenic diet for him in case he has food sensitivities.

If none of these things were working then I'd probably be talking about doing some intestinal biopsies. This may seem invasive and expensive, but in the long run, often this is the best way to get a diagnosis and know what treatment he needs.

I just had one other thought...it's not common, but you could ask your vet about Addison's disease. This is a problem with the adrenal glands that can cause a dog to have gastrointestinal issues. If it goes untreated it can be very serious.

It sounds like you are doing all of the right things with him. I really hope he continues to improve.

Dr. Marie



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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. AskAVetQuestion.com 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:

Thank you for your prompt reply and advice, Dr. Marie.

Dalis is scheduled for the 3 week repeat of fenbendazole on August 5th, 6th, and 7th.
His current diet is Acana Pacifica, prior to that he ate Fromm's Duck and Sweet Potato and alternated with Fromm's Salmon ala Veg. We switched to Acana as a single source low-allergen food just in case it was food related, and cut out all treats containing any wheat, corn, soy, chicken. But he still is having struggles.
I am concerned about the possibility of IBD, but wonder if a prophylactic antibiotic course would be worthwhile before doing a more invasive biopsy or endoscopy?
I am waiting for my vet to open to take him over later this morning.
Today he is trying to eat grass or dirt outdoors, so I know he is not feeling well.
I will let you know how he makes out, and again, thank you so much.
Myrna


Online vet, Dr. Marie

Dr. Marie replied:

I am not a fan of the high end foods that you mentioned. I don't have scientific proof of this but I am definitely seeing a lot of animals that have vomiting and diarrhea issues when they are on high end foods. The two foods that I see this the most on are Fromm and Orijen.

I am seeing this enough that I am actually starting to do a study at my office where I ask people what brand of food they are on and marking down whether there is any history of chronic diarrhea or vomiting. Hopefully soon I will have enough data to publish.

A lot of my clients whose dogs have had chronic digestive problems on these foods did great when they switched to something like Royal Canin, Science Diet or Iams. I personally don't buy into the whole "corn and chicken are evil" philosophy that is predominant these days. I can't tell by reading a food label whether a food is good or not. What I go on is the quality of a dog's coat and stools. And, I find that these diets consistently produce good quality coats and stools.

Regarding the antibiotics, I will often prescribe a course of metronidazole when an animal has intestinal upset. This antibiotic is effective against a number of gastrointestinal bacterial infections and also against giardia (which is a parasite that is sometimes hard to pick up on fecal exam.)

I hope things go well at your visit today!

Dr. Marie.



Customer reply:

Hi Dr. Marie.

I just came back from seeing the vet, and she has decided to do the ACTH Stim test to check for Addison's Disease. Even though his sodium and potassium levels were normal, she said he could still have Atypical Addison's, where an electrolyte imbalance may not be detected. We have to go back for the second blood draw in a short while, but the sample itself is being sent to Atlantic Veterinary College on Prince Edward Island for analysis. We should have the results of that by tomorrow.
Should that test prove negative, she wants to try him on a course of prednisone at the high end of the anti-inflammatory dose, and if he responds to this, she said it might indicate inflammatory bowel. Once he tapers off, if symptoms recur, we will look at food allergy possibilities.
She doesn't advise an abdominal x-ray at this time because she doesn't think he has tumors due to his young age. However, I will insist upon it if his situation does not improve in the next week.
She tested the feces again and still says it's negative for parasites, but is reluctant to order DNA testing until after we find out about ACTH, and I guess that makes sense. No point in spending all my money on the same day! :)
Interesting point about the high end food. I never considered that, but there's so much conflicting information about grains and chicken and corn and soy. What if I switched him to something like Prairie's Chicken and Rice or Lamb and Oatmeal? My only condition about food is that it not have BHA, BHT or ethyoxiquin(?)
Again, thank you so much for your advice and I will let you know the results.
Myrna


Online vet, Dr. Marie

Dr. Marie replied:

It sounds like you have a great vet! I like the plan...it's exactly what I would do.

I really can't answer you on the food choice. I'm not too familiar with Prairie's food. I usually just stick with the well known foods that I know dogs tend to do well on!



Customer reply:

Hi. Dalis was negative for Addison's Disease. Starting a prednisone trial for possible inflammatory bowel issues. Follow-up in 2 weeks with our vet to see how he is responding.
Thanks again Dr. Marie!


Online vet, Dr. Marie

Dr. Marie replied:

Thanks for the update!



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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.