Underweight dog.

Dear Dr. Marie,

I have three dogs, one of whom, Mushka (mixed breed), has been chronically underweight since he was about 1 year old. When I say underweight, its because one could always clearly see his ribs unlike his litter mate and mother. And he's always eaten less food than his shorter litter mate.

He's going to be 3 years old in May this year.

He's been examined by the best vets in Delhi, India and his complete blood work carried out but they can't find anything wrong with him.

The strange thing is that the last 3-4 times he has been on broad spectrum antibiotics (as a result of minor injuries), his appetite has grown tremendously. He wants to eat even out of the bowls of other dogs, finishes his food quickly without any fuss, and gains weight so that he looks like a healthy dog and not an under-nourished one.

But once his antibiotics course is over, slowly his appetite starts decreasing until it reaches pre-antibiotic levels.
The last time this happened was about two weeks ago but this time instead of reaching earlier levels, his appetite has decreased so much that he is hardly eating these days.

We've tried changing his diet, removed grain (boiled rice) from his diet, tried feeding him just meat for a few days, but still he hardly eats. I can see he is hungry because he will come for the food but then turn his face away from the food (even his favorites - liver & kidney). He is eating - but just enough to get by.

Last year - as well as this year - we've got his Kidney function & Liver function tests done but everything came out normal. The vets have no answers. And they don't know why antibiotics (cephalexin) suddenly increase his appetite to a healthy level until the effect peters off.

I'm wondering if there could be an issue with his GI tract. An endoscopy is out of the question as no vet has the facility in India. But could a stool/saliva test throw more light on this?

I'm really, really confused. His stool is normal although he quite frequently vomits bile first thing in the morning unless we've given him something small as a treat. Sometimes when he refuses the treat, he goes ahead and vomites. This sort of vomiting stops completely while he's on antibiotics.

I'm giving the link to the latest blood report for your reference (its a PDF file)

http://goo.gl/2aQud

Thanks.

Have a great day!

Dear Dr. Marie,

The lab that did the tests usually does blood reports for people and not dogs. So they recommended ultrasound based on the reference values for people, not dogs. My vet confirmed that the values are perfectly normal for a dog.

He has never had a heartworm test. I wanted to vaccinate all my dogs against heartworm when they were pups but the vet at the time told me that since heartworm wasn't found in India, he didn't vaccinate for that.

Today, I did some research after you mentioned heartworm and found that heartworm is found in India. It's very rare in my part of the country but it is present.

I will take Mushka for a heartworm test next week. I'm hoping it's not heartworm as he doesn't have most of the symptoms of heartworm other than loss of appetite. No wheezing or coughing, no runny stools plus he's generally quite active with the other dogs except these days as it's pretty hot here right now. But still, I'll get the tests done - the more things are ruled out, the more closer we'll get to the real issue.

As to your questions:

•What type of antibiotics was he on before, and for how long?
ANS. Cephaxin (cephalexin), dispersible tablets. In the last one year, he's twice been on that, both times for 5 days duration, 2 tablets twice a day. Starting 14/10/2010 & then starting 17/3/2011.
Note: We used to mix the cephaxin tablet in a spoonful of vanilla icecream and give him to make it palatable, otherwise he just wouldn't have it.(Got on OK from the vet on that) Could either the sugar or fat in the icecream be responsible for the increased appetite instead of the antibiotic?

•Is he neutered? NO


•Does your vet have any concern about his teeth? A dental infection could easily explain these symptoms.
ANS. The vet never checked his teeth. He's having his calcium bones with great gusto as well as his chew sticks so I don't know if there is an infection there. I can get his teeth checked.


•Does he have diarrhea? NO. A bit constipated lately because he's not eating much but otherwise he's been fine.


•Has he been dewormed and if so, with what?
ANS. He was last dewormed about a year back. The tablets given were Eazypet (Praziquantel, Pyrantel Pamoate and Fenbendazole)

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A few more things: Since the past two weeks, he's stopped having chicken. He used to have it daily with rice and other stuff like mutton (goat meat), liver and sometimes kidneys. He doesn't want rice anymore as well. Sometimes he will eat just the goat meat and liver but sometimes not that as well. We ordered some canned beef from the US (Wellness 95% Beef) and he had some meals when we mixed that in his food. But as he gets more used to the beef taste, he is reducing that as well.

One thing that he has with gusto is his calcium bones. (ingredients are: Milk powder, sodium caseinate, calcium carbonate, cereal cellulose, gelatin, Yucca, Rosemary extract and natural flavors)

We don't give him raw bones as the quality of meat I get here is a bit suspect (we get the best available). But the soft cartilage and soft chicken bones are still had with relish.

I am well and truly flummoxed. Since he was a year old, his appetite was never great but these past few weeks it's been a real struggle to feed him anything.

I hope we can get to the root of the problem soon.

Thanks for helping me out here.

Amit

Dr. Marie, forgot to add a few more things:

Along with the test for heartworm, should I also get a GI panel done? I found out through the web that perhaps it might be good to do a GI panel to look for some of the other GI diseases- EPI (exocrine pancreatic insufficiency), IBD (inflammatory bowel disease) and SIBO (small intestinal bacterial overgrowth). Could any of these be the cause of his low appetite?

Also should I get his stool tested? And any other blood tests that you'd want to get done? I'll be taking him to a lab that only does pet screening so while they are checking for heartworm, they can do other tests as well.

Also, I had mentioned earlier that he frequently vomits bile first thing in the morning (almost never regurgitates)unless he has something to eat. These days - and even previously - when he's hardly eating anything, the vomiting stops. I don't know if that indicates anything.

Dr. Marie:

His vomiting in the morning(along with dry heaves) - not happening currently but otherwise a regular occurence - does that indicate regular bouts of nausea? And does that in turn point to some thing that might be wrong?

Dr. Marie:

I got some tests done.

The tests for Heartworm and Brucellosis came back negative.

There does not appear to be a tooth infection.

In other blood chemistry tests (I got these done as they were not done earlier), all the values are within normal range except AMYLASE, which is 2983.4 U/L (normal range:269-1462) -- Quite HIGH

And in Lipid profile, VLDL is 22.1 mg/dl (normal range: 7-18)

I've uploaded the new blood chemistry tests at:

http://goo.gl/ls4mb

Am awaiting tests for his thyroid & will also be getting his stool tested.

Hope this sheds more light on his condition.

Thanks

Amit

Dr. Marie:

Biopsy is not an option here and neither is endoscopy. And no exploratory surgery. (Not till I move to the West :) )

The pet lab has x-ray options as well as ultrasonography. Would ultrasonography be a better option? I have discovered (online) that ultrasonography can help diagnose problems in the GI tract specially in cases involving chronic vomiting.

And should I be telling the lab for any specific stuff when getting the ultrasound done (haven't done it before)?

Also, the thyroid tests came back today and here are the results:

T3 0.667 ng/ml Normal: 0.45-1.5

T4 0.85 μg/dl Normal: 1-4

TSH 0.05 μU/ml Normal: >0.45


Only the T4 is a little low. Is that significant?

Thanks for persevering with me on this.

Amit