diagnostic help needed

[Emily]

My hound has an acute gastroenteritis that the vets haven't been able to pin down. He hasn't been able to keep any food down for 3 weeks, and is beginning to starve--down from 75 to 62 lbs already. Any thoughts or experience that might shed light on the problem would be appreciated.

my otherwise very robust healthy redbone bear dog, seven years old, has come down with a very hard-to-diagnose acute gastroenteritits. He began vomiting 3 weeks ago. Can't keep any food down. He went to my vet 3X and is now in for tests at Cornell's veterinary hospital.
Any thoughts or suggestions as to what we can look into would be appreciated. He is scheduled for the equivalent of a colonnoscopy and the same (camera through mouth) from the other end tomorrow, with biopsies. We have already ruled out obstruction (x-rays and ultrasound); parasites (fecal float test), Addison's disease, gall bladder issues. All blood work looks normal.
History: Clamour is seven years old, was in robust good health, and an athletic competitor--very fast in field trials, happily runs 20 miles on bear hunts and stays treed.
One day about 3 weeks ago, he broke out in hives on the top of his head, then began vomiting that night quite violently. A piece of a sponge rubber dog toy came up with the first round of vomit. However, this was not unusual. He often steals dog toys from other dogs at the dog run and chews them up and swallows. He usually regurgitates them with no ill effects. That night he vomited repeatedly.
The next day, we fed him some rice and steamed chicken, which he ate, and ate again for his next several meals. His bowel movements were normal, but scant. Two days later, he vomited up everything he had eaten for the last two days. He continued to drink and pass water normally, but would no longer eat chicken and rice. The vet suggeted pepto bismol, which we administered. That seemed to help and he ate barley and chicken the next day, then rejected food. Two days after the meal, he vomited that up almost undigested.
He then went to the vet who put him on amoxicillin and flagyl (for parasites)and encouraged us to continue the pepto bismol. Two days later, after a meal of turkey and sweet potatoes on thanksgiving, he had a full day of very bloody diarrhea, very liquid. By that time he had lost a good 10-12 lbs starting out at around 75, The next day he went to the vet again and was put on famotidine (pepcid), sucralfate, and one other--an antispasmodic. By Saturday he was neither eating, vomiting nor having diarhea. He was still drinking and passing water adequately.
We went to Cornell for further diagnosis Monday). They've ruled out a lot of things but don't have a lot of ideas about what else it could be. He is going to starve to death if we can't diagnose him. The vets are suggesting possible cancer, and possible irritable bowel syndrome, which is not really a diagnosis, but rather a catch-all.
Anyone with thoughts or experience like this?
Emily

[a_olly]

Hello Em
My name is Doc Neal! I've been practicing for about 7 years and I wanted to offer some time/advice to see if I can help.
First of all cases like this can be frustrating so continue to be patient, you sound like a great owner! Cornell is a great school so you are in good hands now!!!
A couple of questions? I know he is 7 years old:
1)Neutered?
2) Up to date on vaccines? Wormings?
3)Any history of previous illnesses?
4)copies of bloodwork(just abnormalities)
5)If the x-rays are digital can you send me a pm(ask for a COPY as they are the vets property)
Answers to these questions will help us get started
My thoughts and prayers are with you
Good luck,
Doc Neal

[cobalt]

Have they done a barium study? Has the dog been given any steriods? Why haven't any of these vets opened the dog up for an exploratory and biopsy? If your dog ate a foreign body that has the same mass as the body wall it will not show up on any xray.
Please update on his condition.

[a_olly]

Good point Cobalt, i just hope the dog was stable enough for surgery. I agree if the foriegn body is the same DENSITY then regular x rays may not show anything but a good vet can abnormal gas patterns and positioning that will help determine/find one of those sneaky forieng bodies. I agree I would have done a barium by now but hopefully cornell has figured something out. I sure hope I can get a look at those rads and bloodwork and I hope everything is ok.
BTW-Are you a vet Cobalt?

[Emily]

thanks a_olly
unfortunately, the x-rays are not digital. The Cornell surgeons were pretty confident that it was not an obstruction, as was his regular vet based on gas patterns etc in the x-ray. .They seemed to think a barium study was old-fashioned. He was stable enough for surgery and they would have done that had there been any indication of an obstruction.
Everything on the standard bloodwork was absolutely normal. I don't know how to read bloodwork myself, but every item was smack in the midrange of indicated normal. Don't know if the Cornell vets ordered any special bloodwork, but they did another round of basic bloodwork and saw nothing unusual.
They scoped him today after washing his gut out, and saw nothing beyond extremely inflamed tissue in several places, which they biopsied. Biopsy results will take five to seven days.
He's in pretty good spirits despite being skinny, and they can't believe how well he walks on lead even though he's pretty weak. They also say he's smarter than most dogs and cannot be easily tricked, pulls his iv out in clever ways, etc. Nothing wrong with his mental capacities and he was ready to hunt a housecat in the Cornell waiting room.
He has had ticks on him recently, but they all appeared to be standard dog ticks. I don't keep him on flea and tick preventive, and the heart worm meds were last given in October--too cold for winter mosquitoes here. There were recent floods in our area (end of August) and he does drink from a spring-fed frog pond in our yard that could have been tainted, but so does the other hound and he's fine and usually has a more sensitive stomach. The frogs are still going fine too if you stir up the mud. The day this all started he had a different brand of dog food than usual, but I didn't save the bag and it had no ill effects on the other hound. I often switch feeds depending on whats a good deal and its never bothered him before. He is allowed to lick the human plates (prewash--we don't have a dishwasher), although we stopped that the second he started vomiting. But he is used to a varied diet and it doesn't ordinarily bother him.
I'm fairly confident that the Cornell vets think he'll make it through, but I doubt he'll be the same if his gut remains hypersensitive. Can't send a hound out of sight for hours or days if anything he eats could wipe him out... He may be strictly a stike dog from here on in.

[cobalt]

I hope the biopsy will answer the questions and produce a diagnosis. If not, I hope the dog remains stable enough to open him up and see what the problem is. Barium is old school, but is definitely a commonly used, helpful tool. I'm not going to question your vet or Cornell's practicing protocol, this problem could be from a number of possible causes, but in my experience and knowledge there is too much non-invasive diagnosis speculation at a high cost to the owner these days. Qiut shaking the box and guessing at the contents. There's only one way to find out what's inside. Good luck.

[a_olly]

Sounds like either a pancreatitis or IBD.
Did they place him on a bland diet?
Again, I agree with Cobalt, barium may be old school but sometimes old school is just what's needed. We don't even own a scope in our hospital. Therefore, we do barium's all the time. Good luck,
Doc Neal

[Emily]

He's home, with a hypoallergenic feed that looks like Kiks (if you're old enough to remember that). He's scarfing it down. Doesn't have anywhere near the protein a hunting dog should be getting, but hopefully its temporary. Waiting for biopsy results. The Cornell vet thought they could see everything in his digestive tract with the cameras and there were no obstructions. He still has diarrhea, but it is less severe. I can't imagine what could trigger IBD in a seven year old dog in good health. He's pathetically thin and has lost quite a bit of fur, which is making him cold outdoors. He's in the house for the most part. He definitely has a good apetite, so we may be able to put a few puounds on him. He's belching and farting a lot. Part of me thinks that what helped the most was the enema, but maybe that's just my old-fashioned way of looking at things. He does have enough energy to chase the other hound around the ryard and to bark at a passing jogger. He went nuts when a neighbor hung up a bear he'd gotten. The hunting instincts are very much active still.

[cobalt]

Glad to hear he's doing better.

[a_olly]

That's good news!

[Spokerider]

Has volvulus been ruled out?
http://emedicine.medscape.com/article/930576-overview

This should be page one-grade one for any vet to rule out.

[Emily]

Yes, they've ruled out volvulus. The biopsies came back non-cancerous indicating IBD. He's eating the hypo-allergenic food (Purina HA), but desperate to eat his old food--keeps leading me to the barrel I keep it in. Begs at the human food. Tries to eat grass if let off lead. Still has diarrhea, although that comes and goes. He seems to be eating more than is coming out. I hate the thought that I may never be able to let him hunt again. He's smart, fast, and a good bear dog. One win short of grand champ on the bench, too. The Cornell vets are meeting to devise a long-term plan next week. Had to punch a smaller hole in his collar yesterday. Very sad, and very unexpected.
I talked to the vet about a barium series and they were fairly confident there were no obstructions based on their readings of gas patterns in the x-rays and ultrasound.. I wish I were as confident. There are parts they can't see with the scope. He's stable, properly hydrated but down from an athletic 75 lbs to skin-and-bones 61=62. Lots of muscle loss in his haunches. He's still on pepcid, flagyl, and sucralate. Gotten pretty compliant about swallowing pills!

[Spokerider]

A few more thoughts......

Diabetes?
Some other endocrine disorder? Cushings disease?
Poisoning..........mushroom? Other toxins?
Recall that there was melamine contamination in the grain from China that pet food manufactures were using about 2007 ish? Many dogs died from this.

Have you thought about a BARF diet, consisiting of ground whole chicken, duck or turkey carcasses, green tripe from sheep, chickens feet, fresh minced vegetables like kale, yams, apples, broccoli, carrot, eggs, peanut butter, alfalfa meal, kelp meal, ground flax seed, apple cider vinegar, etc? Might be just what he needs........

[Emily]

Thank-you everybody for all the suggestions. He's doing ok on the hypoallergenic food and stomach meds. He's put a pound or two back on and stopped vomiting and no more diarrhea. We'll start trying him on more foods soon. He's ravenously hungry and keeps trying to get into the food for the other hound, which worked just fine for him for seven years.
All his organs other than the GI tract are functioning normally--no compromises to liver or kidney function, etc. His heart and lungs are fine. He did lose some fur when he was sickest, and is very skinny, so he's having some trouble with the winter weather.
It has occurred to me that one of those additives in the commercial food may have been compromised, or not mixed properly, and he had a reaction to that. Hard to guess which, though.
Definitely not mushrooms--I know my mushrooms and its well past mushroom season here--nothing toxic growing at this time of year, and no liver symptoms as there would be with mushroom poisoning.
I am hoping to put a coat on him and get him to the woods to chase a few coon soon--when there's enough snow cover to limit his access to grass, etc. Chewing a little fur would probably do him more good than anything else.

I've never been a big fan of store-bought kibble. The manufacturers put all sorts of chemicals in it, and they change the formulas constantly depending on whats cheap. Its easy, but I've always supplemented that with table scraps, etc. If his gut can take it, both hounds will be on a well-balanced homemade diet heavy on local protein in the future. I don't want to spend my life cooking for the hounds, but its really not much trouble to chop up some meat and mix in a few reliable supplements. Don't even really have to chop the meat! Nonetheless, most hounds have tough guts and can eat just about anything you give them. Its tough to see a hound in his prime get sick like this with no real explanation. He is recovering. I just hope I don't have to constantly watch him for the rest of his life to keep him out of gut piles or whatever in the woods, and pizza crusts and bagels on sidewalks. Walked him in Brooklyn yesterday and he managed to nab a slice of carrot. Doesn't seem to have upset his stomach.