Needing suggestions regarding intermittent vomiting and intermittent lack of appetite for a couple of months. What should my vet be testing for if anything, at this point?

3 days ago,vomited food in middle of night eaten 8-9 hours before and same thing early this AM - vomiting food and now diarrhea.

10+ yr spayed German Shepherd approx 70 lbs. Currenty on DES since Nov 2010. Raw diet for most of her life.
Recent ear infection treated with two "rounds" of drops and steroids. Vet visit 4 days ago-yearly vaccinations, prescribed Deramaxx(No NSAID today), ear swab showed no infection, fecal test normal. Heartworm blood screen normal.

Blood work done in Nov 2011 (for violent vomiting)where kidney and liver functions tested normal.

Appetite and behavior improved with steroids and clearing up the ear infection. Off steroids, appetite decreased as well as energy level. Vomiting started after steroids and before the Dermaaxx.

Sorry for the book and thanks for any suggestions!

More info:

What yearly vax?

Is the DES for incontinence?

What pain was the NSAID for?

Was the material in the ear cultured? Was the ear infection yeast or bacteria or combo?

How bad is the inappetence?

Did this vomiting episode start immediately after the vet visit or immediately before? I'm confused on the time line.

"Vomiting started after steroids, before Deramaxx."

How far apart were the end of the Pred and the beginning of the NSAID? (And what was the NSAID prescribed for?)

"Blood work done in Nov 2011 (for violent vomiting) where kidney and liver functions tested normal."

Did the vet caution you about NSAIDs, what to watch for? Way up there, of course, are vomiting and change in appetite. I see from your time line that the vomiting started before the NSAID, but I'm really curious about starting an NSAID on a vomiting dog. (Vomiting can be caused by steroids, too, of course.)

Lots of questions.

The vaccines were DHLPP and Lymes.

The DES is for incontinence.

Ear infection: I don't know what the ear tested positive for two times. The ears weren't squishy/yeasty. They were red, black crud and blister type sores. 10 days or so of steroids in Jan and Feb about 3 wks in between.

NSAID: Prescribed for arthritis. Along with the ear infection were loss of appetite, extreme gas, very low energy, and movement seemed "clumsy". Vet wanted me to try the NSAID for a week, drop off the med,compare results, and continue if necessary. No Xrays have been taken.

Vomiting: Right after the the last round of steroids. Vomiting food, usually overnight. Diarrhea just started this AM.

2 weeks between steroids and NSAID.

The vet described NSAID as "in the same family as ibuprofin and aspirin". First NSAID Tues AM=vomited overnight. Vet on Wed told me to try a couple more days, but stop NSAID if vomiting continued. NSAID Wed-decreased app, no vomiting. Last NSAID given Thurs AM-decreased appetite,vomit and diarrhea overnight. Friday-no NSAID, no appetite, no food but drinking water.

Appetite: Very sporatic. Of course, the steroids had helped, but dropped off on completion both times. Some days both meals, some days just one meal.

Thank you very much!

There's no way I'd still be doing that vax on a ten-year-old dog. You might want to look at this: http://www.weim.net/emberweims/Vaccine.html

OK, that said, back to the NSAID. Aspirin is indeed an NSAID. Dogs are much more vulnerable to NSAID side effects like ulcers and kidney and liver damage than humans are (and this includes aspirin). No NSAID protocol should be commenced without blood work. I imagine the vet was relying on the November bloodwork for his baseline?

BTW, Deramaxx is one of the two NSAIDs I personally would choose first for any dog of mine who needed an NSAID to provide quality of life. In fact, I have a senior on daily Deramaxx (deracoxib). That doesn't mean that it's any less crucial to do pre-protocol bloodwork (and regular re-testing during the protocol) or that the side effects suggesting GI distress can be ignored. The most common side effects of NSAIDs in dogs are nausea, vomiting or diarrhea, and inappetence. I would want a liver enzyme and renal parameter bloodwork done if my dog experienced these side effects.




These questions are not logically linked; I'm asking questions about various thoughts with no particular order:

I don't understand the extreme gas. I can't think of a connection with the ear infection, since there was no oral med, right? Just Otomax or similar?

Is this dog stiff in the morning? Trouble getting up? Is there bunny-hopping?

Have you seen any blood in the stool?

Is the dog maintaining weight/body condition?

Is she on daily fish oil (and Vitamin E) and one of the GAG (Glycosaminoglycan) supplements? How much fish oil?

When (if ever) were x-rays done to determine the extent of OA changes?

What was going on with the dog when the past vomiting episodes happened? A med? What was the vet's best guess of what caused the violent vomiting?

Is the dog still having diarrhea today?

Did the vet ask for a stool sample to check for blood?

Is the dog still lethargic?







BTW, I'm not a health professional.

How long has the dog been on DES?
This dog is old enough that all sorts of things could be going on.
I think that a call to the veterinarian would be in order, and perhaps a visit in the morning if there is not an improvement.

I was hoping Dr. Betty would see the thread and comment.

"I think that a call to the veterinarian would be in order, and perhaps a visit in the morning if there is not an improvement."

The dog has not responded as hoped to the steroid/NSAID trial, now it's time for some sort of diagnosis rather than symptomatic therapies.
When time and best guesses stop working though, it's time for some diagnostic work.
Here's hoping it won't be TOO expensive.
I am not a fan of vaccines in 10 yr old dogs either -- though I know many veterinarians who still are.

"I am not a fan of vaccines in 10 yr old dogs either -- though I know many veterinarians who still are."


I'm a lot more than "not a fan." I see it as worse than a huge waste of money. I see it as (1) something that even according to the manufacturer is not appropriate for a dog who is not well ("don't vax a sick dog") and (2) a multi-complication added to kind of a wide array of symptoms.

But this vax stuff is after the fact (this time), and despite the fact that they introduced a pile of "feeling worse" in a ten-year-old dog who IMO is unlikely ever to need another so-called booster (besides the three-year mandatory rabies), it's not where the focus belongs right now.

I'd want bloodwork and x-rays.

If cost is a serious factor, I'd probably want at least x-rays* and a check for blood in the poop.

But again, I'm not a health professional, and this is strictly what I would want to do if this were my dog.

I hope you will update us in the morning. I can tell you are a caring owner, and you have happened upon a caring board.


*abdominal for now if $$ is tight, with a plan for a look at the OA joints when possible

PS

Once the acute problems are resolved, and once the OA is ascertained, we can help with some suggestions for alternatives to NSAIDs (if the deracoxib does turn out to be the {or a} problem here).

One immediate thing to help provide some additional sleeping comfort is to get the dog's bed off the floor, perhaps with a heavy blanket folded over three or four times between the floor and the dog-bed.

Also, even if it can't be tonight, a large-breed dog with OA will have less trouble getting into and up out of a bed that's raised even more than that ..... perhaps 8 to 12 inches from the floor.

Thank you all very much!

Saturday-diarrhea, no vomiting. Limited food-maybe 1 cup total of (boiled chicken only) entire day. This AM-vomited (only yellow stuff) immediately after drinking water. No diarrhea yet, but no food either.

Ears: No meds prescribed other than drops and steroids on either visit. I forgot-blood was taken to check cell count during visit for ears in Jan due to high fever.

DES: 1 mg every third day since Nov 2010.

Supplements: 2000 mg fish oil, 1,000 mg glucosime/msm, 1,000 mg Vit C. This hasn't been regular due to her lack of appetite. (Heidi will only take any pill with food.)

Mobility: No bunny hopping, but appears stiff and lethargic, mostly in the AM and of course after a weekend of activity. 80% of time, needs assistance getting into the Jeep and bed. Though no issues with a car and does not refuse to climb stairs. Will growl slightly (assisting with rear legs) into bed. On steriods and couple of days on NSAID, increased mobility and deffinitely more alert.

No Xrays that I can ever remember. My apologies-things get blurred-We've been to the vet alot since June 2010!

Vomiting: November prescribed Sucralfate and Famotidine. Gave Sucralfate but not Famotidine. Good until Dec. when we returned for vomiting. Famotidine prescribed, again issue resolved.

Stool: No blood noticed. Friday's AM stools- very,very "mucousy". No vet requests for samples Wed or Friday.

Weight: Consistent (since incontinence addressed) at around 70 lbs. She is thin, and I am uncomfortable with freind's "skinny" comments. Even with a ravenous appetite on steroids, she did not gain weight. Heidi has always had a thin waist and "hourglass" shape.

NSAID: After Tues PM-Wed AM vomiting, and doing NSAID side effect internet research, and I too became very concerned a blood test was not done immediately prior to giving the med. Wed vet conversation revealed the November's blood panel was to be the NSAID baseline. Even though slightly irritated I was told to "quit reading scary stuff on the internet", I did what she advised-continue the NSAID unless vomiting.
NSIAD conversations started in Jan-and has been discussed 3x before it's use on Tuesday. Never was it's possible dangers or side effects mentioned. Friday's vet conversation was to definitely stop the NSAID-wait and see this weekend. Vet doesn't want to blame the NSAID, but rule out the NSAID as the cause and start from a "clean slate" to identify the vomiting/diarrhea/lack of app. issues.

Looking at her, Heidi is in good shape right now for 10+ yr old dog. Money is somewhat of an issue, but if it's accomplishing something, I will spend it. I would again spend $200 referral fee to see another vet if it would get us somewhere!

Long story and off topic, but my confidence has degraded in my local vet, and not wanting to endure another drawn out diagnonsis (like the 6 month incontinence diagnosis ordeal), I appreciate so much all the information and course of actions suggested here!