Vomiting problems in dogs

Video: Canine & Feline Diseases : Dog Vomiting Causes

Vomiting in the morning (mostly)

Question: Dear Dr. Richards..... We rescued a 3 year old rat terrier from the Humane Society... Truly God`s gift. She is so sweet. I am concerned about one problem she has though. In the morning and not every morning....she will vomit.....sometimes a yellow bile and sometimes a white frothy liquid. She also does this sometimes late in the day when it has been awhile since she has eaten. After she retches she is fine. Her vet thought perhaps if we gave her food before she went to bed. Another vet asked if she was excited in the AM and YES she can get very excited. So we have tired to limited her excitability. Both helps sometimes...but she continues to have the problem more than I would like. We have been feeding her Nutro lamb and rice...and Mrs Hubbard treats along with Nutro dental biquits. Perhaps we should change her food. Also we had her teeth cleaned as soon as we got her and within a matter of weeks she had a brown scum on her teeth and now she has plaque. I try brushing her teeth...she hates it soooo much and to use a dental rinse which she really hates. So my questions are..... what do you think is causes her vomiting? Should we be concerned and have have some tests run???? Change her food? Give Pecid AC or similar product??? and ????her teeth? Any information or your thoughts on the subject would be appreciated. THANK YOU AGAIN SO VERY MUCH for your kindness regarding Our Beloved Zedty. Nancy

Answer: Nancy-

I have researched this question in the past without finding a really good answer for what causes vomiting in the morning (mostly) in some dogs or for what to do about it.

The prevailing opinion is that many of the dogs that exhibit this clinical sign have inflammatory bowel disease (IBD) or some other condition that causes a decrease in gastric mobility. This may lead to gastric reflux when the dog first gets up or when there is excitement, as your vets have suggested. The gastric reflux causes some dogs to vomit. It is highly likely that there are a number of causes of this behavior but this theory does account for a big portion of the affected dogs, I suspect.

When possible, confirming or ruling our a diagnosis of IBD through food trials, intestinal biopsy, ultrasonagraphy or other means can be helpful in pointing out a direction for treatment efforts. In many instances, it is not possible for clients to pursue the diagnostic testing right at the time of the visit to their vet, though. Because of this, there is a tendency to try treatment to see if it is possible to aid the pet without having a specific diagnosis. The most common treatments are histamine (H2) blockers like cimetidine (Tagamet Rx) or famotidine (Pepcid AC tm), feeding small meals just before bed and using motility modifying medications like metoclopramide (Reglan Rx). These things sometimes work to control the problem and if no futher signs develop it is reasonable to continue treatment prophylactically without a firm diagnosis, at least in my opinion.

If these things don`t help, or are only partially effective, it would be better to continue to work towards a diagnosis using one or more of the tests mentioned above.

Good luck with this.

Mike Richards, DVM
7/20/2001

Vomiting in Schnauzers

Question: It`s me again. We continue to have vomiting problems with our min. schnauzer, Duffy. He`s been on Hill`s ID dry and canned for at least four months. We have given him Metoclopramide, 1/4-10mg. tablet periodically for his vomiting. He presented with a slight fever on 3-14-01 and dr. put him on 125 mg. Clavamox twice per day for 10 days and we continued the Metoclopramide for four of those days, 1/4 tablet, three times per day. Labs done 3-14-01 were as follows:

1. ALKP-46 U/L
2. ALT-51 U/L
3. BUN-7.5 mg/dl
4. CREAT-1.19 mg/dl
5. GLUCOSE - 107.0 mg/dl
6. LIPASE-1212 U/L
7. TP-7.49 g/dl
8. HCT-49.6%
9. HGB-17.2 g/dl
10. MCHC-34.7 g/dl
11. WBC -9.6 x10/9/L
12. GRANS-7.7 x10/9/L
13. %GRANS-80%
14. L/M-1.9X10/9/L
15. %L/M- 20%
16. PLT-370X10/9/L
17. RETICS-0.5%

No vomiting while he was on the Clavamox except for final day and then he vomited undigested food seven hours after consuming. Most generally the vomit consists of frothy white to yellow to greenish matter. We tried feeding him a small amount at bedtime in the event his stomach rebelled at being empty. That did not work. We now have him on 100mg. cimetidine at bedtime. His eye membranes are reddened. He also seems to expel gas periodically, even on the ID food. What are your thoughts on the possibility of his not producing adequate digestive enzymes and also would you advocate giving him baby aspirin (81mg) for discomfort he may be having? We already suffered the loss of one schnauzer to pancreatitis and are anxious to get this one well. We are really concerned....he is our baby. Thanking you in advance,
Vicki

Answer: Vicki-

In schnauzers, it is helpful to know the cholesterol and triglyceride levels when chronic vomiting is a problem. Hyperlipidemia, which occurs in this breed, can predispose patient with this problem to pancreatitis. This results in chronic pancreatitis or frequent attacks of acute pancreatitis, which can be a cause of the frequent vomiting seen. If the cholesterol and/or trigylceride levels are very high it might be helpful to switch to w/d (tm) diet from Hill`s, which can help reduce the lipid levels in the blood stream.

There is a very good test for deficiencies in digestive enzymes, the typsin-like immunoreactivity test (TLI test). It measures the levels of digestive enzymes in the blood stream and if these are abnormally low pancreatic enzyme deficiency is very likely. This test is often combined with serum folate and cyanocobalamin (Vitamin B12) testing since these can help determine how severe the defiency is and also help sort our other inflammatory bowel diseases that might be present.

If you don`t find a problem with pancreatic insufficiency and if there doesn`t seem to be a problem with hyperlipidemia it will be necessary to think about other possible problems. I will be glad to try to help if that turns out to be the case.

Aspirin is pretty safe in dogs but I would be hesitant to use it until I was pretty sure of the cause of the vomiting, since it can be irritating to the stomach lining in some dogs.

Mike Richards, DVM
5/5/2001

Chronic vomiting in Rottie

Question: I am a new subscriber to your service. I live in Mexico and your site literally saved my dogs life last year. I have a 5 year old Rottweiler who has been vomiting daily for the last 2 month. The vomit is usually has lots of mucus and not much food. The vet here said to give her liquid Malox before each meal and to feed her 3 small meals a day. That seems to work, but when I stop the Malox the vomiting starts again. Other than this she is very healthy and full of energy. Thinking back to when this first started, it seems I had given her a raw hide treat right before this started happening. She has never had any trouble with rawhide before, but also does not get them very often. Could I be looking at a form of IBD? I feed her Nutro`s Natural Choice Lamb Meal and Rice. My options for dietary changes are slim.Thank you for your help.

Answer: Kristi-

It is definitely possible that you might be seeing a form of inflammatory bowel disease (IBD) when daily vomiting is a problem. It would also be a good idea to rule out parasites (worms and protozoans like giardia). Food allergies cause some cases of chronic vomiting but not too many. If the Maalox (tm) is helping it seems possible that there could be a problem with gastric irritation or even a gastric ulcer, although this would be pretty uncommon for a dog. In some dogs, esophageal problems such as hypomotility associated with myasthenia gravis or other problems can lead to regurgitation that resembles vomiting but usually happens just after eating. When motility problems of the esophagus become very severe megaesophagus usually results and in this case the vomiting may not be easy to correlate with feeding or other events.

There are lots of ways to approach the diagnosis of IBD. To try to make a diagnosis, it is a good idea to check fecal samples for parasites on several occasions, run a general blood panel to identify systemic problems that might be causing vomiting, to try a diet that is not likely to cause food allergies (one that contains ingredients your dog has never eaten before) and then to consider surgical or endoscopic biopsy of the gastrointestinal tract.

For many of our patients, there are limits to the amount of diagnostic work due to monetary constraints. In these cases we mix the most essential parts of the lab work with a sort of trial and error approach to gaining control of the vomiting. We usually try deworming the patient and using a medication that can kill protozoans. We favor metronidazole since it also seems to have some anti-inflammatory effect, but fenbendazole can kill giardia when given as directed and also kills roundworms, hookworms and whipworms, so we sometimes start with it. If there is not a good response almost immediately to these treatments we try to get the blood work done. If it is OK, we try for a food trial using protein ingredients like duck, venison or rabbit to try to find a protein source the dog has not eaten before. The carbohydrate is usually potatoes or rice, for the same reasons. Once we get to this point and we have not had much success we will try to use medications such as sulfasalazine (Azulfidine Rx) or tylosin (Tylan Rx) to try to rule out bacterial imbalances as possible causes of the digestive problems. Gastrointestinal protectants, like famotidine (Pepcid AC tm), cimetidine (Tagamet Rx), sucralfate (Carafate Rx) or the Maalox you are having success with sometimes are helpful. We usually try prednisone when everything else fails.

If it is possible to obtain biopsy samples from the digestive tract it is
possible to shorten the trial and error process in many cases and treat for a specific condition. This is especially helpful when there is a condition that will require the use of immunosuppressive medications like prednisone, since we hold off until the end to use these when we are trying to arrive at a solution to the problem by trial and error.

I would be really surprised if the rawhide was causing problems except that salmonellosis has been associated with rawhide treats in Canada and if there is an infection with Salmonella that came from the rawhide, it might explain a long term problem.

I hope that this helps some.

Mike Richards, DVM
4/3/2001




Yellow bile vomit

Question: Dear Mike

Yesterday one of the girls (we are not sure which one) threw up some vivid yellow liquid. They both seem absolutely fine, but should I be concerned?

The colour is alarmingly bright.

Thanks.
Kindest
Raymond

Answer: Raymond-

The yellow fluid is probably bile. Once in a while it is a really bright yellow or golden/yellow color. By itself throwing up bile doesn`t mean much except that the pet probably threw up on an empty stomach.

When vomiting occurs and there are no clinical signs of illness it is always hard to figure out how seriously to take it. If there is no repeat of the episode it is probably safe just to ignore it. If there are more episodes of vomiting in the future then it would be a good idea to discuss this with your vet and consider doing some simple testing, like fecal exams, to make sure there isn`t an easy problem that can be corrected.

Hopefully, there won`t be a future episode to worry about.

Mike Richards, DVM
6/14/2000


Vomiting

Question: Dear Dr. Richards,

I am asking for some guidance on a vomiting problem we are having with our newly-adopted 6 month old Beagle mix puppy from a local humane society. We have only had her 9 days now and the society only had her 10, but in her time with us, she has vomited frequently. At first, we thought it was from her being spayed (the day we got her) but it has continued off and on for 7 days. We fed her the same kibble the humane society used--Pedigree Puppy--but she threw up anything over a sixth of a cup. We took her to 2 different vets and one put her on Reglan 10 mg half an hour before her am meal and I have been feeding her 6-8 small meals a day of Eukanuba low residue kibble which the vet prescribed. She threw up the first few days on that once or twice but has not vomited at all for the last 2 days. The vomiting comes anywhere from half an hour to almost 3 hours after eating. She even wants to eat the vomit, which I think is the reason they didn`t notice this problem at the shelter. She has an appetite immediately after eating and seems fine in every other way--playing, perky, etc. We did notice in one batch of vomit a very tiny little white squiggly thing and although she was declared free of worms twice, the vet gave us another deworming pill and since then, there has been no vomit. I am concerned, however, that the Reglan and special food may be masking the possibility that she has pyloric stenosis. The one vet thinks that is a real possibility and the other one thinks it doubtful. Her weight is fine now--12.7 lbs--and she appears to be in good health (she is small, but not thin).

When we wean her off the medicine and food and if her vomiting resumes, what tests do you suggest we do? I hate putting a puppy through surgery (our past beagle mix had pyloric stenosis too and the surgery was very hard on her) and the one vet said there was a chance she could outgrow it. When do we stop waiting and do something? Should we wait until she is past the puppy stage? As I said, she seems fine otherwise and is on an antibiotic just as a safeguard against any infection although she showed no signs of any. I am just worried about how to proceed if her vomiting starts up after she goes off the Reglan and low residue food or if I start feeding her 3 bigger meals a day. If the vomiting starts up, isn`t that a good indication of the stenosis or could it be something else?

Thanking you for your help, Linda

Answer: Linda-

Vomiting occurs for very many reasons. For this reason, it is necessary to work through a diagnostic process in order to reach a conclusion about the cause. Pyloric hypertrophy (stenosis) is definitely a cause of vomiting but it is not among the most common causes.

In puppies, parasites are the most likely cause of vomiting. Hookworms and roundworms usually show up in fecal samples pretty well. Whipworms are difficult to detect, sometimes. Tapeworms do not generally show up in fecal examinations unless there happens to be a tapeworm segment in the stool (these are egg packets that break off from the worm, but they move, so most people assume they are the tapeworm itself). Coccidia, giardia and other parasites show up intermittently when infections are present. So it is often necessary to choose to use dewormers several times during a puppy`s growth or to check multiple stool samples for parasites --- or in a case like yours, probably both.

Once it seems reasonable to assume that parasites have been eliminated as a possible cause, then it is necessary to move on to other possible problems.

First, it is important to try to determine if the problem is originating in the digestive system or is the result of a problem elsewhere in the body. Liver disease and kidney disease are both possible causes of vomiting, although problems with these organs also may affect growth or produce other clinical signs. Just to be sure that there is not a systemic problem, running a general blood panel is a good idea.

When it seems reasonable that the problem is likely to be in the gastrointestinal system, there is still a lot of work to do in figuring out the exact cause of the problem. Gastric ulcers, intestinal ulcers, inflammatory bowel disease, pancreatic insufficiency, pancreatitis, gastroesophageal reflux, megaesophagus, esophageal constrictions, colitis, hypermotility syndromes, food allergies, small intestinal bacterial overgrowth, maldigestion syndromes and many other digestive problems can cause vomiting.

At this point, it seems possible that the problem has been resolved through the repeated deworming and perhaps the dietary change. It is possible that the changes in diet from the previous owner to the shelter to your home may have induced the vomiting, so be cautious when you do decide to change to another diet, mixing food for several days, at least, prior to making a total switch.

Should the problems return when (if) the diet and metoclopramide (Reglan Rx) are discontinued, there are many possible ways to work through the rest of the diagnostic process, but I think I`d be tempted to try a food trial with foods to help rule out a food allergy or food sensitivity first, as long as your puppy continues to grow normally and have a normal appetite. X-rays may help, especially if some type of barium contrast is used, to help judge motility and eliminate partial obstructions. Examination of the digestive tract with an endoscope and to perhaps take biopsy samples would be a good idea if nothing has shown up to this point in the diagnostic process.

I hope this helps some. Right now, it seems reasonable to just be patient and see what happens. Hopefully, no further diagnostic work will be necessary.

Mike Richards, DVM
5/24/2000



Vomiting with loss of balance

Question: Dr. Mike -

Please bear with this long intro - we`ve been going through a lot and there`s a lot to tell - but we are getting frustrated with our current vet staff and would like some help.

Amber is a 3 to 4 year old Akita/chow mix. She was adopted thanksgiving weekend from the humane society so her age is a guess. All was well, she is a sweet and loving dog and easily trained and adapted well into the new household. Mid December she was at home with me - we took a walk she ate grass, which I didn`t really worry about. When we came in - she made strange heaving noises, tipped over, and vomited, mostly grass and bile. We were concerned then and talked to the vet - and took her in - (I`m not sure what tests they ran) but they were concerned about the fat in her diet and recommended that we take her off treats - especially pig`s ears and any type of chewy bones , they thought she could be having a hard time digesting the fat, and pieces of treats could be causing her trouble as well. She has continued to have incidents such as described.

Our vet was worried more about the tipping over aspect - and we have been to a heart specialist. They did blood work , EKG, ultrasound and x-rays - they didn`t find anything - thought that her tipping over could be that when she is trying to vomit she is pinching a nerve and that is why she loses her balance and we were given pills to give her when we feel an attack is approaching (hard to tell) He also saw some indicators of worms in her blood work and recommended that we have her stool tested - we`ve done this at least 3 times without worms being present. She was dewormed again at that time - and seemed to really perk up - and be more frisky than we`ve seen her in awhile. But the incidents have returned. And we`re a little at a loss.

Could she need to be dewormed again? And would a general medicine designed to get most worms catch everything? She has had dog/cat feces in her mouth since the deworming - seems to be a hard habit to break - she wants to eat it and/or roll in it. With her sensitive stomach we try to keep her away from anything strange during her walks - but can`t always catch her.

Could it be food allergies? She is also a sneezer - had her on allergy medicine but didn`t notice any difference - she didn`t like one brand of food and she has been on rice and lamb IAMS - we just switched to something else - also lamb and rice with the thought that maybe pesticides could be causing her problems.

Do dogs get something like acid reflux, like humans? She very much likes her routine and is very upset when someone in the household is gone for days at a time. Which is understandable - her other family moved and left her at the humane society. Sooo we`ve also thought maybe she could just have nervous stomach and need a way to get rid of her excess stomach acid.

Do you have recommendations on what to have the vet look for? They seemed to be more worried about the tipping over and said "all dogs throw up" but the incidents are coming closer together (or so it seems to us - she had one on Monday when I got home from work and again tonight, Wednesday) And they didn`t seem to be worried about the vomiting, but it just doesn`t seem to be normal.It`s almost as if she`s dry-heaving, or retching - she typically eats grass - although she has vomited without that once or twice, then seems to slow down, sit down and then her stomach makes these rumbling noises and her chest heaves as she`s trying to work something up - she will tip over at this stage and then finally get something up. She seems to seize up - but not really have a seizure - not as we`ve read other places on your web page. She has lost bladder control - once or twice - but only when she was due to go out for a walk.

It`s getting frustrating not knowing where to turn - and any advice you can give us would be very much appreciated! In spite of this long letter, Amber is a wonderful and sweet natured dog! We want to help her have a long life! Thanks for your help!!

:-) Megan/Jim

Answer: Megan and Jim-

I definitely think that it is important to try to find the source of vomiting severe enough to cause a dog to have episodes of fainting or loss of balance (whatever is occurring there). I think that going to the cardiologist was a good first step. It would probably be a good idea to ask for referral to an internal medicine specialist as the next step in the process of getting to a diagnosis.

If it is not possible to go to an internal medicine specialist and no one in your area does endoscopic examinations or ultrasound examinations of the digestive tract, an alternative that most vets can help with would be barium or BIPS (tm) pellet administration and X-rays to evaluate transit of the dye (or dye capsules, in BIPS, case) through the digestive tract. This can help to determine if there is a problem with food retention somewhere in the digestive tract or other abnormalities.

A recent article on inflammatory bowel disease (IBD) stated that ultrasound examination of the intestines was actually a more sensitive test for IBD than endoscopic exam. However, it isn`t possible to get biopsy samples using ultrasound alone and other lesions, such as ulcers, esophageal strictures and pyloric valve stenosis might not show up on ultrasound exam. This makes it a little hard to decide which test is most useful. I am fortunate, in that the specialist we refer to can do both types of exams and makes these choices with the client, so I don`t have to.

I do think that it is reasonable to try deworming, since it seemed to help before, just to see if it will help again. If a dewormer such as febantel (Pancur Rx) is used to kill hookworms, roundworms and whipworms and then a tapeworm medication is also used, this pretty much eliminates the most likely worm problems. If there was an increase in eosinophils (a white blood cell that increases in the presence of parasites) that prompted the thoughts about parasites it is also necessary to consider heartworm infestation, allergies (not just food allergies) and eosinophilic gastroenteritis as possible problems.

We have a few dogs in our practice who appear to have unquestionable stress related vomiting and/or diarrhea. So I believe this occurs. If you really can relate the incidents to similar incidents (like boarding a dog, visits from friends or relatives, absences) then it may be worthwhile to consider therapy during those times with medications that help with stress related gastrointestinal problems.

There are times when it is reasonable to try to treat the symptoms of a disorder and see what happens. Using a medication like metoclopramide (Reglan Rx) to help control vomiting and/or ranitidine (Zantac Rx) to provide some GI protection and also some help with motility disorders may be worth trying, too. It is better to know what the exact cause of the problem is, when possible, but if there isn`t a way for you to see an internal medicine specialist or if testing has to be delayed due to cost, it may be reasonable to treat symptomatically for a while. You can ask your vet about the best approach to this decision.

Good luck with this. If you need more information as the diagnostic process proceeds, please feel free to write again.

Mike Richards, DVM
5/22/2000



Severe Vomiting

Question: Dear Dr. Mike,

We have a 9.5 years old cocker spaniel. He got occasional vomiting (1-2 times a week) a few months ago. It was after he got teeth cleaning and extraction of two of them at vet clinic (may be unrelated). Previously it happend to him only when he has eaten something bad (like e.g. he likes eating paper napcking for some reason), but now it was happenning on a more regular basis. Otherwise he felt well.

Two weeks ago he got severe vomiting (1-2 times every day) and diarrhea (a few times a day). Vomiting often is yellow, sometimes clear, often has food pieces. Diarrhea is often yellow. After a few days we went to a vet, showed two fresh samples of vomiting and diarrhea (nothing was found in them), blood sample was taken (normal, a bit lower protein), urine sample (normal), X-ray (normal, a bit bigger prostate), pulpation did not show anything. We got a few cans of lite dogs diete. After one day of no food, and a few days on a diete he seems to become better. We gave him two days ago a bit of raw meat and on the same days the rest of the dog diete from a can. This seemed to trigger another (even stronger) iteration of vomiting/diarrhea. The current status (after one more day of almost no food) he refuses to eat dog`s food (Science diete dry, Science Diete from cans), eats some people dry crackers and would probably except other people food, but we are afraid to give it at this point. Still has a few loose stools per day.

Our vet does not have a constructive program of how to fight with this. I read all your replies on vomiting/diarrhea cases and would like to fight with possible causes of the disease one-by-one.

Should we start with metronidazole as a possible treatment of Giardia? How long/how much for 22-24 pounds cocker? Should we also use Immodium, or better one treatment at a time. What would be the right order of treating possible reasons (Giardia, Coccidia, inflammatory bowel desease?). Should we do more stool samples?

Also we are afraid that he is loosing weight (since he was not fed normally for two weeks) and he does not like dog`s food (when he was a puppy we fed him with a home diete, and since then he eats dog`s food only with some small addition of some people food - a few small pieces of bread or 1-2 spoons of veg. soup), so may be we should try home diet. Where can I find Hill`s or any other reasonable diet for cockers and what should be the diet for the first days (e.g. is cooked rice a good idea?).

Thanks a lot for you help!
-Mike


Answer: Mike-

The first thing to do is to rule out intestinal parasites to the greatest degree possible. Checking a couple of stool samples for giardia, coccidia and intestinal worms is a good start to this. Giardia can be hard to find on a stool sample and it is reasonable to treat for it with metronidazole or fenbendazole even if it is not found in a stool sample.

It is also important to try to determine if the diarrhea seems like it is a small intestinal or large intestinal disorder. As a general rule of thumb, large intestinal diarrhea tends to have frequent bowel movements, often with straining, and small amounts of diarrhea at a time. Small intestinal diarrhea tends to have a regular number of bowel movements per day, or perhaps a small increase in number and the quantity of diarrhea expelled at one time tends to be a larger amount.

Causes of small intestinal diarrhea include parasites (roundworms, hookworms, whipworms, giardia, coccidia, tapeworms), bacterial infections, viruses, malabsorption disorders, inflammatory bowel disorders, ulcers, fungal infections and systemic illnesses that make it difficult for the intestines to function properly.

Causes of large intestinal diarrhea include parasites ( coccidia and whipworms), bacterial infections (more likely in the large intestine than the small), inflammatory bowel disorders, cancers, fungal illnesses and sometimes protozoans.

If it is possible to decide if the diarrhea and vomiting are occurring due to a large bowel or small bowel problem, it can help with deciding which test to run and which treatments to try.

In older dogs with a new problem of diarrhea and vomiting checking a general blood panel is a very good idea, so having normal test results in blood work is good. It is worthwhile to consider running some specialized tests that are not included in a standard blood panel, too. There is a test for pancreatic insufficiency (which is one of the malabsorption syndromes) called a trypsin like immunoreactivity (TLI) test, that is helpful in determining if pancreatic function is normal. It is often combined with cobalamin and folate serum level tests to try to sort out other malabsorption problems. Checking amylase and lipase levels to try to rule out pancreatitis is a good idea, too. These tests are sometimes included in general panels but more often are not.

After ruling out parasites as much as that is possible to do and after checking general blood panels and perhaps checking the more specialized lab values (depending on the signs seen), the next step, if necessary, is usually to consider intestinal biopsy by endoscopy. Since this is an invasive procedure requiring general anesthesia, many veterinarians feel that taking a short break from diagnostic testing and just treating for logical possible problems, such as bacterial overgrowth or inflammatory bowel diseases is reasonable. That is a judgment call that you and your vet have to make. Some vets and clients prefer to try a dietary food trial to be sure a food sensitivity isn`t present before doing endoscopy. This is not a bad idea but a new food sensitivity in an older dog is not a common event so it may be better to skip that step.

I am really hoping that this information isn`t necessary anymore. If the problem is still going on it would be possible to help more with the lab results of tests run so far and with an updated history of what has happened.

Mike Richards, DVM
2/26/2000



Vomiting after getting into garbage

Question: Dear Dr Mike,

Blue, our two year old border collie is sick.

Yesterday evening he vomited up his dinner. Amongst the vomitus was about one and a half square inches of paper that is used as a base of a commercial chocolate cake. He had been rummaging in the waste bin. This commercial chocolate cake has a paper or paper like base, about the thickness of two sheets of typing paper. When you cut the cake you do not cut the paper. The paper looks pretty harmless to swallow. Of course we do not know what else he might have found in the bin.

He vomited up his dinner in two episodes of vomiting. Then he vomited twice again late in the evening bringing up a couple of tablespoons of yellow vomitus. Then he vomited again about 6am this morning, bringing up a little clear fluid. I think he has opened his bowels only once today passing a couple of tablespoons full of pale brown liquid feces. I saw no paper and nothing unusual in the feces.

There have been no more episodes of vomiting. I think he has been drinking and urinating normally.

He had no appetite this morning and we gave him nothing. However he looked interested in food this evening so we gave him a little chicken and rice which he ate fairly enthusiastically.

He looked unwell during the day and he still looks quite tired now. It is the first time I have seen him where he is not running around full of energy. I am a bit worried about the tiredness. He has had diarrhea and vomiting before but it never affected his energy level.

Presumably we can wait another 24 hours before calling the vet, particularly as the vomiting has stopped and he has some appetite. From past experience I would expect the diarrhea to stop quite quickly.

I am quite worried however, particularly by his tiredness and lethargy. I guess the most likely explanation is a bacterial or viral infection. Is an intestinal obstruction likely? Am I doing the right thing? John

Answer: John-

I suspect that Blue is OK now. We see both diarrhea and vomiting when dogs eat baker`s chocolate, although it sounds like he would have gotten only a small amount. In addition, there is a condition that is sometimes referred to as "garbage can enteritis", which occurs when dogs rummage in the garbage and eat foods and things they aren`t used to ingesting. It will usually clear up if food is withheld for 36 to 48 hours, so you have taken the right steps.

The major worry I would have is the possibility of pancreatitis. The initial treatment for this is the same, so there isn`t a problem with what you did so far if pancreatitis is present. But treatment with intravenous fluids and pain relievers can help dogs recover from this more quickly. I`m sure you have seen your veterinarian if the problem has persisted, but just in case, it would be a good idea to do so now if the problem is still present.

Mike Richards, DVM
2/23/2000



Chronic vomiting

Question: In my household are three pets: Jolly, one of those "grow-a-frogs" which my son received as gift twelve years ago... amphibious- Zipper, our abbysinian/alley cat from Takoma Park, age 10, was run over by a truck a year and a half ago.... he had broken pelvis, forty stitches, etc... he healed in a cage with lots of tlc and catnip and healing tapes and his own Reikian guide, a neighbor who loves him- and most dramatically, Magic, a 19 month old yellow lab, my first dog. Zipper is grumpy and copes which his reduced mobility, although he still climbs trees and fences but is now content with my backyard rather than competing with the other cats in the neighborhood anymore. He has been the dominant animal in the house, and the cat and the gentle dog sit side by side anywhere near me they can.

My problems center on Magic, the lab, and his tender gut- him regular vomiting is getting tiresome..

He`s shy of many other dogs, [since several old lady dogs in the neighborhood have chased him angrily as a puppy]. He doesn`t get enough exercise. I walk him anywhere from .5 to 2 miles a day, generally about a mile - once a day. [my teenage son just grooms, hugs, roughhouses, and sleeps with the dog -- too much homework to walk him tonight he moans daily!] He was crate trained, and we retain the crate for his retreat or when there is company who can`t cope with big dogs: he willingly goes in on voice command. He cut his tendon in his front right paw last winter while walking with a friend and her lab in the woods. He had to have quite a few stitches, having severed it nearly all the way through. He was sequestered from Oct til Jan with no walking....he got fat. He`s always had a picky stomach: he was on purina puppy chow when we acquired him at 10 weeks- we switched him to science diet which didn`t agree with him: load of bouts of diarrhea as a puppy and several ear infections. I put him on nutro lamb and rice ultimately after eating that canned science diet k/d i think -- when he was getting fat, transitioned him to diet nutro, which agrees pretty well. now that he can walk again, he`s trimming down a bit... im about to transition him to a more "normal diet" of Nutro, I guess since it works. Open to suggestions.? His vomiting is often in the morning, occasionally other times, always yellow bile, only once or twice has there been food in it. Sometimes grass however. When we walk, I have to discourage constantly his stopping to sniff where other dogs have left something interesting.... sometimes it seems like he gets a cold or a virus and his stomach is bad. He groans, sighs, looks miserable, it lasts a day or so and passes.... loose stools or vomiting, Other times, he wakes up groaning, wake me up with "dog talk" that I`ve learned to recognize as "Get up, take me out now, or i puke on your bedroom rug" This morning he went outside with me at 7 am, ate grass when i didn`t see him, and puked... then came in the house happily, begging to be fed. I did about 15 minutes later: 1 cup. He gets 2 cups in evening. one or two biscuits during the day. After the vomiting episodes in the morning, he`s nearly always fine -- and hungry and ready to go out or play ball, whatever..

He`s been to emergency room once when my son and I saw a protuberance we judged to be a stick in his gut and he d had diarrhea- x-rays at good local hospital showed nothing. He`s also had another emergency run to the vet about his gut... their view was that he`s not really sick... and that some dogs vomit. He is doing this now 2 or 3 times a week. No evidence of worms although i haven`t had a sample done lately.... it gets expensive having test for nothing. Im willing to spend money on my animal`s health but Im an anthropologist/free lance/independent scholar/not affluent person- Magic costs more to maintain than I do!

I work most days at home, so i could move to three small meals, what do you think.... I feel sorry for dogs having to wait to go to relieve themselves and so dependent on us to feed them... Zipper has access to food all day, and of course has two boxes and outside to choose from... Dogs don`t have it so hot, especially if you have a bad gut. Any advice?

Sorry to be so longwinded, I won`t ever be again if I have to write about another problem. Thanks.. Your website has reassured me on many a topic. It`s really a wonderful service...

patsy


Answer: Patsy-

I really don`t think that it is normal for a dog to vomit this often. Unfortunately, though, I can think of an awful lot of possible causes for this behavior. It will take some time and effort to sort through them and it will probably cost a fair amount along the way, unless you luck out and discover the cause early in the search.

This is the list of things that come to mind:

1. hypoadrenocorticism
2. congenital megaesophagus
3. intestinal parasites
4. liver disease
5. kidney disease
6. hiatal hernia
7. pyloric stenosis
8. gastric ulcers
9. pancreatitis
10. chronic gastritis
11. stress
12. bilous vomiting syndrome
13. malabsorption and maldigestion disorders
14. food allergy
15. eosinophilic enteritis
16. lymphocytic-plasmacytic enteritis
17. cancer
18. colitis (usually diarrhea is a more prevalent sign but vomiting is sometimes the main symptom)

There are probably more causes than this.

With a list this long, the best idea is look for diagnostic testing that can help with several of the possible problems at one time and to eliminate the least expensive things to test for, first, if possible.

A good general blood chemistry panel with electrolyte analysis and complete blood count can be helpful in eliminating a big chunk of the possibilities. If the chemistry tests associated with kidney and liver are OK, that is a good start. If there are no signs of electrolyte disturbances and no increase in esosinophil counts it is less likely that Addison`s disease (hypoadrenocorticism) is present -- but this does not rule out entirely.

More specialized blood tests would include an ACTH response test to rule in or rule out hypoadrenocorticism and possibly folate, cobalamin and trypsin-like immunoreactivity serum levels to try to rule out maldigestion/malabsorption syndromes.

Fecal exams are inexpensive and rule out most intestinal parasistes after two or three negative results.

Feeding a limited antigen diet (a food trial) to rule out food allergies and food sensitivities is a good idea. It is relatively inexpensive but very hard to manage in a multiple pet household with kids because it is imperative that the dog being tested be fed ONLY the diet that will help to determine if a food allergy is present. Your vet can help you choose an appropriate diet and explain further how to be sure that food allergies are not present or to figure out that they are a problem.

X-rays can help to rule out megaesophagus and help in evaluating the liver and kidneys and possibly show other problems, like hiatal hernias, if special contrast media (dyes) are used.

From this point on the testing gets a little more invasive. The next best thing to do, if nothing shows up so far, is probably an endoscopic exam of the esophagus, stomach and small intestine and biopsy of the stomach and small intestine, if it seems appropriate during the exam.

By the time you get this far a diagnosis is usually possible. If not, a trip to a big referral center or veterinary teaching hospital is a good idea. Hopefully, you won`t get this far without some idea about what is going on.

I`d really worry about hypoadrenocorticism and would probably want to test for this immediately after obtaining negative fecal exams and normal lab work for other systemic illnesses. I think I`d try to eliminate congenital megaesophagus early on, too.

The main thing I`m trying to get across is that I believe that something is wrong, too. I think it is a good idea to try to figure out what it is since some of these conditions are life threatening (especially hypoadrenocorticism and megaesophagus). I`d want to at least rule out these conditions before resigning myself to living with the situation and personally, I`d push for a diagnosis.

Feeding smaller meals does help with many of the GI problems so that isn`t a bad interim measure.

Hope this helps some.

Mike Richards, DVM
3/15/2000



Vomiting in morning - Shitzu

Q: I am looking for some information on shitzu dogs. We have a approx. eight month old shitzu who we had adopted from the pound. She was abandond out in the country. We had her vet checked and is very healthy. She seems to like to eat grass if you don`t keep a close eye on her. In the mornings, lately she has been vommitting yellow liquid. Aftershe is done , she wants to play. We feed her technical dry and technicallow fat treats. She seems very happy and gets excited easliy and not bothered about being sick. Any ideas or suggestion? Please respond.


A: Scot-

Sometimes the small breed dogs will stop vomiting in the morning if you feed them a small meal right before bedtime. I am not sure why this helps. If it doesn`t help it would be a good idea to have your vet examine your puppy and make sure there isn`t a problem like intestinal parasites, food allergy or pyloric hypertrophy leading to the morning vomiting. It is not too unusual for dogs to eat grass. Since it can be a normal behavior it is hard to decide if it means much when it occurs in conjunction with other signs.

Mike Richards, DVM



Occasional Vomiting

Q: I have a 20 month old chow. He has been vomiting about once a week mostly at night or early morning. It is nothing but green and once in awhile clear. I have also notice its more after he takes his heartworm prev. treats. He is normal and playful after.

A: Lori- The most common causes of occasional vomiting are probably the inflammatory bowel diseases and functional obstructions of the pylorus (the muscular valve between the stomach and the intestines). Intestinal parasites, ulcers, liver and kidney disease and other diseases can lead to occasional vomiting. Indiscreet eating habits such as eating foods that may be spoiled, eating to much at once, eating objects not meant to be eaten like rocks and other eating habits that can irritate the digestive tract probably account for a number of cases of occasional vomiting as well.

As you can see, this is quite a list. It is necessary to work with your vet to resolve the problem. It is frustrating to attempt to diagnose vomiting episodes that occur infrequently but it can be worth the effort. Some of the causes of this respond much better to early treatment. This is particularly true of the organ system diseases (liver, kidney) so at least doing enough lab work to rule out those problems would be a good idea.

Mike Richards, DVM



Vomiting

Q: Dear Dr. Mike, We have an 8 year old female Dachshund that started throwing up 4 days ago. We took her to the vet 3 days ago and he had us remove all food and water for 12 hours, then give her a small amount of water and a very small amount of cooked rice. She vomited that up too. We took here back to the vet yesterday and he did barium xrays and some blood tests and found nothing. He said her temperature was only very slightly elevated and her white cell count was OK. We kept her off all food until this morning when we tried a little boiled rice again. She vomited it up after an hour. The vet said to give her a Gelusil so we tried that and a teaspoon of turkey and rice baby food. One hour later she vomited that up. She did not seem to feel bad (other than she thought we were starving her to death!)but now she seems to be getting depressed. It is always almost exactly an hour after she tries to eat that she vomits. How long can this go on? Is there something else the vet can check for? We`re getting worried. Carole

A: Carole, Your vet has started on the necessary testing to determine what is going on with a chronic vomiting problem. Hopefully it has resolved in the time since you sent your note but if not it would be a good idea to recheck a general chemistry panel to be sure there is no underlying organ failure and to do several fecal exams to make certain that no parasites are present. Since barium X-rays did not show an obstruction it makes it much less likely that there is one but it might even be worth retaking the X-rays to see if anything has changed that might indicate a problem. The new BIPS (tm) barium impregnated pellets may help to delineate a problem with gastric emptying that liquid barium doesn`t show very well. Trying a hypoallergenic diet is helpful but rice and turkey baby food would be hypoallergenic in most dogs so you are already doing that, too. In some cases endoscopic or surgical exam of the intestinal tract may be necessary to discover the cause of a difficult vomiting problem. A long time ago I saw a dachshund that had eaten several h`ourderves at a party, complete with toothpicks. We had to do surgery to discover the toothpicks because they weren`t totally obstructing the intestinal tract and did not show up on X-rays since wood doesn`t show up well. It can take several tries and some expense to get to the bottom of these sorts of problems.


Mike Richards, DVM




Chronic vomiting

Q: Dear Dr. Mike, We have a 9 year old male Lhasa/Terrier/Basset mix (Kirby) vomits at least once a week (primarily bile) up to daily. Kirby has seen two vets and has been given prednisone, amforal and digestive enyzmes to no avail. Kirby has been on several special diets such as Science Diet-ID and WD. There have been times when the situation requires we feed him only boiled hamburger and rice. As for Kirby`s behavior-when he feels ok he is a pleasure to be around. If he starts snapping at us or our other dog we know a vomiting episode is imminent. This has been going on for four years and is getting progressively worse. Blood tests indicate no problems. We are at are wits end and close to putting him to sleep. Any suggestion?.

A: Mary- It would be a good idea to consider having an endoscopic examination with biopsy of the stomach and intestine (if it seems necessary during the exam). This is the most accurate way of assessing several situations involving vomiting, such as plasmacytic/lymphocytic enteritis, Helicobacter infection, lymphangectasia and other digestive tract disorders.

Your vet will probably have to refer you to a specialist in order to have this testing done. I know you have already done a lot for Kirby but it may be possible to make him comfortable and pleasant more often than he is now. Ask your vet about this.

Mike Richards, DVM



Vomiting - how serious?

Q: Dr. Richards, I`ve got a 2-year-old Yorkie who over the past seven days has thrown up about four times. With only one exception, the vomiting has occurred late (midnight-2AM) in the evening. And with only one exception, the vomit has been simply yellow liquid. The other time, it was as if she had thrown up food.

She has no other symptoms of having a problem. I`m a bit strapped for cash, and can`t afford a $100 vet visit which usually results in, "We don`t know what`s wrong. Just give her a few days."

Any information would be greatly appreciated. Thank you.

A: If your Yorkie is acting normally in every other way (still interested in eating, playing, etc.) then it is pretty likely that the vomiting is not an emergency situation. It is sometimes helpful to feed a small amount of food prior to bedtime to small dogs with a tendency to vomit during the night.

If the vomiting continues or if other signs of illness develop, it is more important to schedule an examination as soon as possible. Vomiting can be a sign of a number of severe problems. Sometimes hearing that your vet can`t tell what is wrong is worth the reassurance that it isn`t something obvious and deadly!

Mike Richards, DVM




Vomiting after eating - puppy

Q: My son was given a boxer and lab mixed puppy for Christmas. He has joined the Army and left the pup with me. Every time the puppy eats it vomits over and over. It is making me sick. Can you give me some idea of what is wrong with it. It eats like a little pig. If I try to feed it from my fingers, it will take my fingers off. It looks healthy and is very lively.

I will appreciate any help that you can give me. Thank You.

A: There are several conditions that could lead to the regurgitation behavior that you are seeing.

If the regurgitation occurs immediately, esophageal problems seem likely. Megaesophagus is one possibility. We have information on that in our dog medical information pages . Other possible problems include persistent aortic arches (though most puppies with this condition don`t grow well), hiatal hernias, esophageal diverticulums and gastroesophageal reflux. Vomiting should occur immediately upon eating any solid food with persistent aortic arches and starts as soon as the puppy begins to eat solid food. Gastroesophageal reflux is caused by a number of conditions and it usually is associated with weight loss or slow weigh gain as well.

If the regurgitation is delayed a little after eating, stomach problems may be more likely. In this case, pyloric stenosis and gastritis may be more likely. Testing for these conditions usually involves using barium or other contrast X-rays and possibly endoscopy.

If you think that the vomiting may just be related to eating too much too fast (this really does seem to be the problem in some dogs) it can help to feed multiple smaller meals. Sometimes overly greedy dogs will eventually get the idea that the food is available and slow down in their eating habits.

Please have your vet check on this puppy. It is important to treat esophageal problems as early as possible for best long term results.

Mike Richards, DVM

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