I’ll get to that answer at the end of this story.
My husband informed me that I need to post about happy things and not just rant on this blog, so I’ve specifically waited to see if this story has a happy ending so I can write about it. The lab results came in today, and it’s looking happy so here we go…
I met Duke this August, he was a sweet, 1year old yellow lab; but skinny as a rail and looked kind of scruffy (that’s the scientific term 😉 Anyhow, he had a 6 week history of intermittent vomiting, which started when he switched from puppy food to adult food.
The number one cause for intermittent vomiting in a young dog is dietary indiscretion. This is a fancy term that refers to the young dogs predilection for consuming anything and everything imaginable. It’s sort of their way of “exploring the world withtheir mouth”. Particularly young Labradors, they are the poster child for dietary indiscretion, particularly of the “foreign body” fashion. Off the top of my head, some of the objects I’ve seen or heard of being removed from dogs include: cat toys, panties,pantyhose, whole rolls of toilet paper, a beanie baby, acorns and pecans, garden hose, fish hooks, rocks, staples, sewing needles, an entire Christmas wreath, a little toy hippo, socks (I once heard of a lab who ate the socks off the babies feet when he was in the car on the way home from having had surgery to remove some other socks he ate). My dog had surgery July 4th about 4 years ago because she ate all the fringe off one of my rugs, not a month later, I had to make her vomit because she ate a rubber mat. Most of these dogs live, I’ve seen a couple that died. Duke looked bad enough to be of the dying variety.
We took X-rays, Duke was not a fan of this, so we had to sedate him to get our pictures. They were suspicious for a foreign body. Unfortunately, unless the dog ate something metal, or a rock, most foreign objects don’t show up on radiographs. We have to do additional testing like barium series to show the blockage. In this case, since Duke looked so terrible, and was already sedated, we suggested that maybe we should go ahead and go to surgery and look around. We did some pre surgical bloodwork to make sure his internal organs were in good shape, which was pretty normal.
I’d just like to mention, that this isn’t generally how we like to meet new clients: “Hello, nice to meet you, I’d like you to spend thousands of dollars doing surgery on your dog”. We’d prefer to develop a rapport with them, and get to know them before going into major stuff. However, in this case, time was critical. So with much trepidation, but hopeful to find something, we dove in, scalpels blazing.
Exploratory surgeries for us are like little treasure hunts. What are we going to find! There’s a sense of excitement that comes withthem, because when we find the offending object, we take it out and (usually) the patient lives happily ever after…a “quick” (albeit expensive, and uncomfortable, and stressful, but pretty straightforward) cure. However, for every few positive exploratories where we take out the, say, Lego Princess Leia (ok, I’ve not seen one of these taken out, but I’m using artistic license), there’s the occasional negative exploratory where we find nothing. This is quite a letdown for us (as, obviously it is for the client). Xrays can lie, I once saw a cat who’s radiographs totally looked like the cat ate a string of beads, that subsequently just turned out to be intestinal segments. Anyhow, we didn’t find anything on Duke’s exploratory, so we took biopsies of his intestines, stomach, liver and pancreas.
When you hear hoof beats, think horses not zebras. This is used a lot in the medical profession to refer to the fact that when faced with a sick patient, look for the obvious stuff first. In this case, the obvious diagnosis failed us, so it’s time begin the zebra hunt. Eventually, this case resulted in a rare, Tibetan Mountain Zebra…(I made that up, there’s no Tibetan Mountain Zebra)
When I saw Duke, I was reminded of another young yellow lab named Bailey. He looked and felt like Duke, his case started when he ate a garden hose. We did the exploratory, took out the hose, and he didn’t live happily ever after. He kept getting worse, his blood protein levels dropped, and he kept losing weight and he never got better. Despite a monumental effort on our and the owners part, ultimately resulting in multiple exploratories, every blood test on the planet, staff members taking him home for hospitalization because the owners ran out of money, we worked SO hard on that case as a group. Unfortunately we never figured it out and he died after his third exploratory. That case was and is to this day still a great mystery to all of us. The best we could figure was he developed severe inflammatory bowel disease as a result of the garden hose which decimated his GI tract, and we couldn’t ever control it.
Bailey was in the back of my mind throughout this case with Duke, and I didn’t want a repeat of all that sadness and heartache. But history started to repeat itself when Duke’s blood protein plummeted after his surgery, and he didn’t do well at all. After a couple of plasma transfusions to bring the levels up, and over a week in the hospital, he finally started to get better.
The biopsy came back: Mild Inflammatory Bowel Disease. I talked to some specialists, I did some research, and it seemed like he got worse whenever he ate chicken. So we decided to make sure he didn’t eat any more chicken and to treat him for inflammatory bowel disease (IBD). Rather than go into a lengthy discussion, I’ll just tell ya that IBD is basically a weird reaction to food, resulting in varying degrees of inflammation in the gut and the resultant vomiting and diarrhea. Usually happens to older to middle aged dogs, but not unheard of in younger ones.
I spoke to our local trusty internal med specialist, Dr. Nitsche (who is awesome), who said to go ahead and treat for IBD, but maybe I should test for Addison’s disease (I’ll explain this in a bit). I opted to just start treatment for IBD because: a). Addison’s disease is the supreme Zebra of Zebras (especially in a dog this young and this breed…ooooh foreshadowing…wink wink)l, Dr. Nitsche specializes in zebras, and I specialize in horses (not literally) so I’m still thinking horses which in this case are IBD horses and b). one of the treatments for Addisons is prednisone, which is also the treatment for IBD, and I REALLY wanted to get this dog eating and feeling better ASAP, so I decided to take my chances and treat for the treatable. Oh and C). Addison’s disease causes a very characteristic change in elecrolytes (high potassium and low sodium) which definitely SHOULD have happened post op and did not happen, which in my opinion did NOT support a diagnosis of Addisons disease…..(unless it was ATYPICAL Addisons…hmmmm, more foreshadowing)
Well, Duke Did GREAT, his protein levels skyrocketed, the vomiting and diarrhea stopped, he was eating like a pig. I was pretty happy.
Then the owners went on vacation, leaving him with a pet sitter. He got a little depressed after that, stopped etaing for a while, but quickly got better. We figured he just ate something that upset his tummy. Then the owner went out of town again, and he got sick again, only this time much worse….
OK, this has gotten really long and I’m facing an afternoon full of appointments, SO…we’ll just build a little suspense!
To Be Continued…