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Vomiting dog

Species: Dog
Breed: lhasa apso
Age: 5-8 years
Hi Marie,
Our dog is a 5 year old Lhasa male (entire).Which we bought to China with us from Australia last year.
We live in a large provincial city in China - Wuhan - where the standard of veterinary service is questionable and not to the standard we are used to, so difficult to get good advice/ treatment
He has not eaten for 3 days but is drinking water. He is lethargic but still able to walk, when attempting to eat he vomits anything back up. He is regularly wormed and is administered "Frontline' for ticks monthly. Up to date on all his parvo and rabies shots.
His temperature is normal 38C. He does not appear to have abdominal pain when his stomach is massaged. He has not defacated for 3 days.His gum colour is good and eyes clear.
I first thought it could be an obstruction so took him to the vets tonight and got 2 X rays of the abdomen.No obvious obstruction was evident but the x ray machine was old to say the least and mainly used for bone work. They did not have ultrasonics. So still not totally convinced its not an obstruction.
Tonight we gave him some Noroclav antibiotic
which we had from Australia, just in case there was an infection.
If we were in Australia I would have got blood tests done for cell count etc and tomorrow will see if there is anywhere this can be done, but as his temperature is normal its confusing to say the least.

Online vet, Dr. Marie

Dr. Marie replied:

Hi Brian,

I'm sorry to hear that NuNu is not doing well. I'm sure it is frustrating to see him sick and not have an answer as to why he is vomiting.

There are a great number of things that can cause a dog to have the symptoms that he has. I don't like the fact that he is vomiting everything that he eats.

Has he had any blood tests done? I'm wondering if he perhaps has pancreatitis. While most dogs with pancreatitis are sore in their abdomen, some can be really good at hiding this discomfort. If this is pancreatitis most dogs need to be treated with IV fluids and injectable pain medications which both would be given in a veterinary hospital.

Another possibility would be something affecting his kidneys. Dogs with kidney failure will be extremely nauseous and vomit. They often are very thirsty because the kidneys are failing to retain enough fluid in the body. Dogs can get kidney failure from eating something toxic or from exposure to something called leptospirosis which is a bacteria that can be caught from drinking water contaminated with wildlife urine.

There is some suspicion in Canada right now that some dogs are getting Fanconi syndrome because of treats that are made in China. Fanconi causes kidney problems and we usually see glucose in the urine and normal blood glucose levels. Has he had any urine tests done? You can read more about this issue here: Are treats from China causing Fanconi syndrome in dogs?

An obstruction still is possible even with normal xrays. Some types of material don't turn up well on xrays. If this was my case and I was worried about an obstruction then I would be doing a barium series of xrays. This is where we give a white liquid that turns up really well on xrays and then we take multiple xrays over a period of several hours. We can watch and see if the liquid travels through the intestinal tract without a problem. If it doesn't then this is really suspicious for an obstruction. Hopefully that's not it though because if it is, he may need surgery.

This doesn't sound like an infection to me. Plus, Noriclav (called Clavisceptin or Clavamox in Canada and the US) can cause stomach upset, so I'm not sure if it's the best idea here, unless it was suggested by the vet.

I wish I could give you more help here. Is there any way he can get to a vet that is able to do some better testing? I have no idea what vet care is like in China.

Feel free to reply if I can be of any help. I'll be online till about 10 pm EST tonight and I'll check in on your question in the morning as well.

Dr. Marie.

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Customer reply:

Hi Marie,
Thanks for your quick response.
He is still lethargic and rather slow when going for a walk.
Good news is he did a small poo this morning which was normal,so maybe we can rule out the blockage theory.
We're off to another vet right now which have overseas trained vets who can do a blood test so will check for pancreatitus and lepto etc.
We feed him only Pedigree (Mars) brand pet food but who knows in China everything is copied but we only buy from the big supermarket. He does have the chicken and liver treats occasionaly but I bring these up from Australia and they are Australian made with Australian ingredients.
I found this article re Chinese dog food which you may find interesting.
Anyway will let you know more when we have blood tests.
Thanks for your help.

Customer reply:

Hi Marie,
OK back from the vet. Much better than the vet last night but still nobody speaks English which makes things difficult.
Temperature still normal and NuNu seemed better earlier today but has now gone very quiet and lethargic.
Blood tests revealed very high ALT. We did another test for ALT to make sure, and the second reading was even higher.
First one 700 second one 1200. Apparently normal is 1 - 80.
So I'm presuming this could mean liver damage.
All we are giving him is INOSINE which we got from the chemist,he's still not eating but drinking plenty of water.
Oh and my wifes father who is Tibetan has given us some Tibetan traditional medicine (a herb) for liver problems to give to him so I'll try that also.Makes sense for a Lhasa :)
The vet suggested we take him back in 20 days for another blood test. His AST was 47 , I believe within the normal range.

Still no idea where he got the toxicity from - I bought a fresh bag of dry food to try once he starts eating again, but I don't think it was the dry food as he had been eating the other one for many weeks before getting this problem.
About 2 1/2 years ago when we were in Australia he had a similar problem after ingesting some onions. We're thinking that maybe last week we gave him some pre cooked duck that I bought at the local street market may have been coooked using spring onions or something similar.
Any suggestions for any other treatment?
Thanks once again.

Online vet, Dr. Marie

Dr. Marie replied:

Hi Brian. Yes, that is quite a high ALT level.

Do you know what other blood tests were done? Specifically I'd love to know if an ALP level or any of PLI, AMYL or LIPA were done.

ALT can be high because of pancreatitis, but we would expect to see some of the other levels high as well.

If all of the blood tests were done and were normal and just the ALT is elevated then this is really suspicious for a toxin. There can be some parasites that can affect the liver as well. In my area this is really uncommon. I would think that if this is common in your area then one of the vets would have suggested treatment for parasites.

The good news is that if this is a liver toxin then the liver is quite good at repairing itself.

Does NuNu have any access to food with the sweetener xylitol in it? (i.e. sugarfree gum). This ingredient is really toxic to a dog's liver.

It's also possible though that this is something like a liver tumor but he is quite young for this.

I'm not familiar with inosine but I see (from some quick research) that it is a liver protectant so it sounds like a good idea. (I can't see any reference to use in dogs though so I can't say 100% for sure if it is safe.)

To answer your questions about food, a single dose of onions would not cause him to get sick. Chronic use of onions can cause anemia (low red blood cells) but not his current symptoms. Some foods can be contaminated with aflatoxins which could cause liver toxicity so it's possible that his food was contaminated.

I'll let you know what my treatment would be for an animal with suspected liver toxicity but keep in mind that I don't know all of the facts for NuNu's case and this is just a generalization:

  • IV fluids for 2-3 days to flush out toxin from his system.

  • Anti nausea medication

  • A liver protectant such as sam-E (adenosyl)

I hope he continues to improve! Dr. Marie.

Customer reply:

Hi Marie,
Thank you so much.Really appreciate your help.
OK got some more results. Rang the vet and they can't do
ALP level or any of PLI, AMYL or LIPA.
These are the other results they gave me.Which hopefully mean something to you

WBC 5.12 - 10(9)/L
LYMR 49.1%
MIDR 13.7%
GRAN 37.3 %
LYMPH 2.51 10(9)/L
MCC 0.70 10(9)/L
PBC 6.91 10(12)/L
MCHC. CHCM 119 g/L
MCV 66 f/L
HCT.PLV 0.46 L/L
RDW - 20.2%

T-BIL 9.99 PmoL
O-BIL 1.25 PmoL
AMY 719.20 U/L
CREO 71.98 PmoL

Online vet, Dr. Marie

Dr. Marie replied:

Unfortunately the numbers don't mean a lot to me without the reference ranges. Some of the units are different than what I'm used to. If you have normal values along with those values I may be able to see if I can help more, but I don't think it's going to put us too much further ahead.

Customer reply:

Hi Marie,
I think its just rest and recovery now. He's still not eating, we tried a bit of rice but he just vomits it up, he's getting plenty of liquids though.Keeping him off dry foods to try and restrict his protein intake. If he doesn't get any better by the weekend I'll take him down to the vets for I/V. Still going for a small walk twice a day, which he seems OK with but rather lethargic.

I can't thank you enough for your help and advice over the last few days. As I've owned boarding kennels for 10 years and have been a Championship judge for 40 years, I like to think I know a little bit about dogs. Unfortunately when you're living in a foreign country where the standard of pet care is a bit third world and you don't speak the language it gets frustrating to say the least.
Which is why your service is a brilliant concept and a solution for our present predicament. I will highly recommend your web site to other expats in China.
Will let you know how Nunu goes.
Thanks again

Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome. Keep me updated. I wish I could do more to help the little guy!

Customer reply:

Hi Marie,
Just to let you know 100% recovery,now running around the park!
Managed to get a sachet of I/V 10% Glucose a couple of days ago which we administered orally. That with the magic Tibetan liver remedy which he gets twice a day has done the trick. Eating rice and wants dry food and meat but will leave it a couple of more days.
Will get his ALT levels checked in a couple of weeks to make sure no permanent problem.
Once again thanks for your support.

Online vet, Dr. Marie

Dr. Marie replied:

Wow! That's great news!

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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.