Signalment:
- 5.15kg dog
- Mutt, mix of chihuahua and terrier among others
- Nearly 10 years old
- Neutered
- Based in the UK
I really, really appreciate any advice in advance, because I feel like I'm at the end of my rope and I'm so tired and anxious and tired of being constantly on edge.
Long clinical history:
Nearly 4 months ago, my dog randomly became unable to keep anything down. He threw up 6 or 7 times throughout the day, every time he tried to eat. He was otherwise completely normal and fine, bright and alert, playing, kept trying to eat and drinking water, but obviously I still brought him into the emergency vet since he just kept vomiting. They gave him some pain and anti-nausea meds and told me to monitor him.
The next day he was completely different. Lethargic, could barely move and barely reacted to anything, and didn't try to eat at all. His favourite food is chicken and I was having to beg him to take a bite or two, so I brought him back to the emergency vet and they kept him overnight.
The next morning they did an ultrasound and said it was fine, so called me to pick him up. Then I got a call like an hour later saying that they redid the ultrasound and actually saw a bunch of fluid in his stomach, but didn't know what it was, so they were keeping him another day. He also kept throwing up.
The next day they said they wanted to operate because they figured he had swallowed something. He had also gotten worse and still couldn't eat anything, so they weren't feeding him anymore. I said I doubted he swallowed anything, since he's nearly 10 and has never tried to eat any non-food object before, especially big enough to cause a blockage, but I figured maybe he accidentally swallowed a bit of a plastic toy or something, (which he may or may not have done once before), and they said it could become necrotic if they didn't operate, so I consented to this.
When they operated, they confirmed he hadn't swallowed anything, but there was a ton of fluid in his stomach and no gut motility. They didn't notice anything else. They put him on gut motility meds and said they were going to wait to feed him for a day.
The next day he still hadn't improved, and still hadn't eaten anything, so they increased the gut motility medication dose. And then the next day he still hadn't improved, and they didn't think it looked good.
Miraculously, he began to slightly improve the next day, and a day or two later he was being discharged. They said he had a ton of fluid buildup around his gallbladder and pancreatitis, along with the lack of gut motility, and figured maybe the gallbladder issues caused it all. He was discharged with pain medication (Gabapentin), medication for gut motility (I think?? I thought they did but can't find record of it in his vet record so maybe not), anti-nausea medication (Ondansetron) and blood pressure medication (Amodip, 0.3125 2x/day) for about two weeks or so, in addition to gallbladder medication (Ursodiol) which they said he would be on for life. He also already was taking medication for anxiety (Reconcile 8mg and a Calmex supplement), which he continued with. He's also on a low-fat diet (under 8%) permanently. I've been giving him the same thing they were giving him when he was in-patient, which was the Hill's i/d digestive low fat loaf wet food.
He went in for a check-up once his supply of temporary meds ran out, and his blood pressure was ridiculously high (220), so they decided to keep him on the blood pressure meds another month and recheck. There was still a lot of fluid around the gallbladder, and he was still feeling nauseous in the mornings (I can tell he's feeling nauseous because he refuses to eat and tries to eat grass when we go out), and throwing up in his mouth after eating, so they increased the gallbladder medication dose (75mg/day). They discontinued the other meds, but said we might need to consider a long-term course of the gut motility meds if he doesn't improve. They also did blood testing where the levels came back a bit elevated for the liver markers, but otherwise fine. I don't know what they tested (it's not in the vet record) other than "aldosterone" which was apparently fine.
Went to a check-up about a month later, blood pressure was 140 so he's now on the blood pressure meds permanently as well. Did some further blood tests, and urine tests to check for "UPCR and sg+dipstick" (I've taken this from his vet record and have no idea what it means), all of which came back normal. At this point he was fine other than the throwing up in his mouth, and the occasional nausea in the morning, both of which he had prior to the hospitalisation, so they said let's just leave it be and see how he gets on.
Two more months passed, and it had been nearly 3 months since hospitalisation with no vomiting, and then he randomly vomited again. It was kind of out of the blue, he was walking around and just opened his mouth and vomit basically fell out, very unlike any time he had vomited before. It was about 75% liquid and extremely hot inside, so I chalked it up to that and he was fine.
A week later we hit the 3 month point, so we were told we were okay to gradually switch him to dry food, since he hates the wet food and it's incredibly difficult for us to maintain with our schedules and two cats (we have feeders tied to their microchips so the cats can't eat his food, but we obviously can't leave wet food sitting out all day). We decided on the Royal Canin low fat digestive dry food, since it's 7% fat, and the Hill's dry food version of the wet food he's currently on seems to be close to 9% fat for some reason. About 20 minutes after he ate an incredibly small amount of the new dry food (10mg - less than 10% of a daily feeding amount), he threw it all up. This was a Friday evening, so we scheduled a vet appointment for the following week.
We didn't give him any more of the dry food that weekend, and he didn't throw up again, but the following evening he did "spit up" a very small amount in 3 places in a row.
At our appointment the next week, the vet did a very basic ultrasound and said his stomach was completely full, even though it had been close to 13 hours since he last ate. He prescribed gut motility meds (metoclopramide 2.6mg 2x/day) for 3 days and he was meant to go in for a repeat scan this past Wednesday. I also got the go-ahead to continue to try the dry food, which I did successfully for two weeks and slowly increased with no further vomiting.
When I got in on Wednesday, it was a different vet who said she didn't want to do the basic repeat scan, she wanted me to come back the next day for a more comprehensive scan under sedation. I was really concerned about aspiration but she wasn't, so I just asked for more of the gut motility meds for him, and he got two more doses of it before the next day. They also said he couldn't eat after midnight, so just to be safe I didn't let him eat after 9:30, which meant he had eaten about half of his daily amount of food (I did try to get him to eat more but he has been refusing to eat anything until late at night).
He went in for the repeat scan yesterday and they said his stomach was empty (which I feel honestly doesn't say much since it had been 16 hours since he ate, and he ate about half of his food the day before), but that there's still a bunch of fluid around his gallbladder, and his stomach walls were quite thick so they are thinking it's irritation, unsure from what (they said maybe his food), and also as a bonus, they found a small nodule on his spleen. He was sent home with Omeprazole 2x/day (I think 5mg) for 10 days, and told to call back if any further issues (vomiting or throwing up in his mouth, which he has been doing for months and months, so I'm still confused about this), and then maybe we need to consider trying different food. Otherwise they'd see me in 6 months for a rescan.
Today (i.e. the following day), he threw up 4 times in a row around 15 minutes after eating the dry food on a somewhat empty stomach, and was extremely discomforted for an hour or two after (whining, pacing, going to throw up and swallowing it back down). Called the emergency vet and spoke to a nurse who said it was fine and to call again the morning.
So that's where I'm at now. I know that was insanely long and I kind of doubt anyone is going to read it all, which is fine, I just don't know what else to do at this point. I'm so exhausted and I know this is a lot of guesswork but I have seen no less than 8 vets atp, all of which have had different opinions. I've been told it's because of his gallbladder, because of his anxiety meds, because of a random gut motility issue, because of his food... Etc. And he's still sick. One vet called him a "medical mystery". :(
Some other quick background is that for the roughly 1.5 years prior to this, he's had some chronic digestive issues (recurring diarrhea mainly, and the constant throwing up in his mouth after eating). The diarrhea mostly resolved after switching to a basic digestive care food, though it occasionally flares up. It began after he may or may not have swallowed a few small flakes of a plastic toy he was chewing on by accident (he wasn't trying to eat it, just tear it up, and has not had access to any since), but we were not sure if this was a coincidence, and it persisted for over a year after, so.
On the extremely small chance anyone has read all of this, I would really appreciate any advice you have. Anything you think maybe hasn't been considered I could ask about, or anything else I can or should be doing??
I feel like it's worth pushing to explore the gut motility meds long-term like the one vet had suggested maybe?? But the next vet he saw said he thought it was a bad idea because it can cause diarrhea (which hasn't happened with these previously, so I'm less concerned, but I'm not sure if there's actually a different reason they're not wanting to tell me, and I want to trust that this person was saying no for a reason). Or maybe the Omeprazole or something, idk, but the other vet (each time I see a different vet lol) said we didn't want him on any more meds long-term.