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Sick puppy.

Species: Dog
Breed: Westie
Age: Less than 3 mon
Our Westie puppy, Minnie, is 12 weeks old today. We got her 23 days ago. From Day 1 to Day 6, she was mostly a "normal" puppy except for diarrhea. On Day 7, she had what I would describe as a hypoglycemic episode. She vomited and then fell into the vomit and was unable to walk for about 20 minutes. I immediately knew what was going on and remedied the situation. Her playfulness started to decline after that. On Day 11, she had her first vet appointment. She weighed 1.7 pounds. She was dehydrated and was diagnosed with giardia and an upper respiratory infection (she had a clicking sound while breathing). Her CBC showed extremely low red blood cell and platelet counts. The vet noticed "flea dirt" on her back and wondered if fleas caused the anemia. On Day 13, she had a blood transfusion and seemed a bit more perky after that. The diarrhea still persisted. On Day 15, her counts had improved but not yet to normal. On this day, she was also diagnosed with coccidia and most likely had some type of worms (a cough/gag thing), so we did a three-day dewormer. On Day 17, the upper respiratory infection was better and she had gained one ounce. On Day 19, I left her for approximately three hours. When I returned she hadn't moved at all and was very weak. Back at the vet that afternoon. She now weighs 2.1 pounds and all parasites are gone. Told to stop meds. Day 20, she gets up to walk towards my daughter and collapses in what appeared to be a hypoglycemic episode, but I feed her every two to three hours. I even set my alarm at night. After she collapsed, her leg was so twisted it appeared broken, but it was fine. She again was unable to walk for 20 minutes. After her first vet visit, she has only been on Prescription Diet AD. Her appetite comes and goes, but has been good for two to three days. When she won't eat, I use the syringe. Now, Day 23, the clicking is back and every once in awhile the cough/gag. She has been eating well. I mix a bit of pumpkin in with the AD and her poop is now formed and not so often. (Yay!). What's extremely concerning now is she NEVER plays. She would sleep 99 percent of the time if you let her. Five days ago the vet said that her little body needed the rest to repair itself, but now seems super concerned she's not playing. She's almost depressed. Apparently, her liver enzymes were LOW (everything I've researched only refernces high liver enzymes) on whatever the last blood test was.... RBC count had some improved or fallen. X-rays normal. Barium swallow showed no blockages. Ultrasound normal. I have contacted breeder several times and they know of no genetic issues, other pups are also small but otherwise "fine". The vet is sort of scratching her head. Can you think of anything to explore further? She can't fast for bile test. To summarize, for past two days, stool formed, click and cough/gag is back, more alert but never plays. I am so worried we're going to lose her! We are no closer to answers. :(

Online vet, Dr. Marie

Dr. Marie replied:

Oh the poor little darling. Thank you for your detailed description of her problems. Let me give you my thoughts on Minnie's situation.

My first concern is the possibility of a liver shunt. Sometimes this can be hard to diagnose. Sometimes a shunt is visible on ultrasound but in a dog this small it could easily be impossible to see. I have a theory that some dogs with liver shunts have low liver enzymes. You won't read that in a textbook anywhere, but I had another case in which this was the case. My thought was that there was less liver mass to produce enzymes and therefore the enzymes, especially ALT can be low. But, again, you can't diagnose a liver shunt based on that hunch.

You mentioned that she is unable to have a bile acids test because she can't be fasted (which I can totally understand). However, if not already done, your vet can do a resting bile acids test. This means just running bile acid levels on a regular blood sample without fasting. If the level is slightly high it will be hard to interpret, but if it is REALLY high then this would make me even more suspicious of a liver shunt.

Does the vet have any concerns about Minnie's heart? A congenital heart condition could cause many of these symptoms. Most dogs with this type of problem would have an obvious heart murmur that the vet could hear with a stethoscope, so I'm thinking this is probably not what is going on.

You could talk to your vet about having you measure her blood glucose level at home if she has another episode. I often have my owners of diabetic animals measure their pet's glucose at home by using a glucometer that a human diabetic would use. There are many resources online to help you learn how to get the sample, but check with your vet first before doing that. If she has another collapsing episode it really would be good to be able to tell if her blood sugar is low at that time. If so, then this might help us get a diagnosis.

One thing that could cause low blood sugar is sepsis - meaning that she could have a systemic infection somewhere. In most cases we will see an increase in White Blood Cells on the CBC but not always, especially if bloodwork was done early in the disease. You could ask your vet about running a blood culture or possibly putting her on antibiotics.

It is definitely true that she has been through a lot. The poor little kid has had a rough start in life! It may help her to stay in the hospital for a few days on IV fluids to just help support her while she recovers from all of these things.

I really hope she improves!

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. 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:

Thanks so much, Dr. Marie. I am going to ask about the resting bile acids test. As far as I know, that hasn't been done yet, but my husband did take her the one time, so I don't feel like I have as good of a grasp on what went on that visit.

I did forget to mention one thing. When she went to the vet this last time, one of the reasons we took her was because her belly was hard and big. She did eat some of our other Westie's hard dog food, and the vet said that may have been the cause. It resolved by the next time. But now it's like that again!! It's been like that for about a day, and she has definitely not eaten any hard food or anything she shouldn't have. She is very interested in eating our other Westie's hard dog food, so we have to make sure she doesn't get near it, but I am certain she hasn't had any.

Thanks again.

Online vet, Dr. Marie

Dr. Marie replied:

A hard belly can mean a few things. It's something we commonly see with a roundworm infestation, but that shouldn't come and go like this.

Another possibility is if there is fluid in the abdomen. This can be the case with liver disease or with heart disease.

Another test you could ask your vet about would be to do an aspirate where they put a small needle into the belly and see if there is fluid there. If so, sometimes analyzing the fluid can give us some ideas about what the diagnosis is.

Customer reply:

Update: She just woke up from one of her 2,000 naps, and her stomach does feel better. She has been eating what I would consider a lot, about one can of Prescription Diet per day (I think today will be a little more than that), which seems like a lot for a small dog.

The vet hasn't mentioned anything about heart conditions, but she listens to her each visit. She has mentioned the liver, kidneys, pyrovate kines (sp?).

Online vet, Dr. Marie

Dr. Marie replied:

I have seen some pups that just get a hard belly after eating too, so perhaps it is nothing serious.

I'm trying to figure out what pyrovate kines could be. How would you pronounce that?

Customer reply:

Here is the correct spelling: pyruvate kinase.

Online vet, Dr. Marie

Dr. Marie replied:

Ah, I had to look that up. It's not something I have ever treated. Pyruvate kinase deficiency is a genetic condition that can affect red blood cells, cause liver damage and is very serious. Westies are one of the breeds that can be affected. While it's possible that she has this, this wouldn't cause all of the parasite issues (including fleas). I'm guessing that she has probably had a rough start and just needs help and time to get over it.

Customer reply:

I pray you are right that she just needs some time to get over it. I get optimistic and then get discouraged, optimistic, discouraged. Her next appointment is Saturday. I'll let you know how it goes. Thanks again for all of your help!

Customer reply:

Hi, Dr. Marie. Still having an extremeley rough road... What can you tell me about antibiotics aggravating IMHA? Specifically metranidazole and clavamox. Also, I've read that vaccinations can trigger IMHA. How soon do the symptoms show up post vaccination if this is the case? Thanks in advance!

Online vet, Dr. Marie

Dr. Marie replied:

I'm sorry to hear that she is still not doing well. Has she been diagnosed with IMHA? IMHA is a different thing than just anemia. Anemia means low red blood cells, but IMHA means that the immune system is destroying the red blood cells. It would be really uncommon in a dog this young.

Usually the way we test for IMHA is something called a Coomb's test. A positive Coomb's test is very suggestive for IMHA.

If she does have IMHA I may have to have you open a new question for me to fully answer these questions as it will take some time.

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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.