Elderly dog is sometimes not well

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Ash
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Elderly dog is sometimes not well

Post by Ash »

Hi Traci and all!

I would be glad if you could give me some advice on my female dog, Shida. She is minimum 12 years old, maybe older, we don't know that exactly.

For the past 5 weeks she has been having 'episodes' where she is not so well. They are characterised by

- not eating or drinking anything
- being restless and panting
- wanting to go out (sitting in front of the door), and when out
- she eats grass, which she then sometimes vomits out, sometimes not

The 'episodes' never last long, usually half a day, in the evening she usually is totally normal, eats and drinks, rests etc. They also don't happen every day, but once or twice a week.

First (in July) we thought it might be a stomach bug (once she had diarrhea as well, but that stopped after two days). The vet gave her Norfloxacin for three days.

When the episodes reoccurred we did a blood test on the 6th of August: full blood count and liver + kidney values. That time he also palpated her abdomen and found nothing unusual, and she didn't have any pain while he pressed her belly.

The blood count was normal apart from an elevated WBC count at 23,000 (normal is given at max 12,000). Neutrophils are elevated at 74% (normal is max 70%) and it says "WBC abnormality: neutrophilia".

The kidney values are totally normal, but one liver value is high, it says SGPT (ALT) 65 iu/l (normal is given at max 50 iu/l). The SGOT (AST) is normal.

So the vet diagnosed bacterial liver infection and she was on ciprofloxacin 500mg twice a day for 5 days. She was then ok, no more episodes until today.

Today she is again restless, wants to go out and when outside she only wants to eat grass, and she has not eaten or drunk anything today.

So, what can this be? Does this sound like something you recognize? She has no fever and is not lethargic, but sometimes her stomach makes sounds and she has gas. On her good days she behaves very normal.

Vet is on holidays for two weeks so I can't call him. He said before leaving if there are more episodes we can investigate further, but because she's elderly he doesn't want to tranquilize her so the tests we can do are limited.

Thanks for any ideas!
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Traci
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Re: Elderly dog is sometimes not well

Post by Traci »

Did he do a urinalysis?

Did he take an xray to check vital organ function, inflammatory evidence, bone problems, masses or neoplasia? (size, shape, to detect abnormalities, effusion, etc) Was heart function evaluated?

These are really very limited symptoms, and without urinalysis and at least an xray, impossible to guess. One thought would be heat, is it unusually hot for her? Does she have arthritis? What are you feeding her? Are her urination/defecation habits normal? Does she seem weak, slow to rise, etc? Is she anemic, pale mucous membranes, etc?

The CBC should be repeated in a week or two from the first one to rule out stress neutrophilia or inflammatory conditions and to keep an eye out for anemic conditions. I don't know how your vet determined a liver infection, since the ALT was not significantly high and I assume all other liver enzymes were within normal range. There could be a bacterial infection going on somewhere that is exacerbating a hidden illness, like GI tract, inflammatory condition, etc. Also, rule out tick disease if she is anemic.
..........Traci
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Ash
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Re: Elderly dog is sometimes not well

Post by Ash »

Hi Traci! :)

Did he do a urinalysis?

No because she doesn't seem to have any problems with urination and kidney values are normal.

Did he take an xray to check vital organ function, inflammatory evidence, bone problems, masses or neoplasia? (size, shape, to detect abnormalities, effusion, etc)

No, because that would with her only be possible with tranquilizers, and he doesn't want to do that because we don't know her age.

Was heart function evaluated?

Again, no, because there are no facilities for animals here to test heart function. Listening to her heart with a stetoscop is also not telling because she's so hyper and scared when the vet comes.

One thought would be heat, is it unusually hot for her?

No, it's monsoon and not hot at all, but sometimes very humid.

Does she have arthritis?

No.

What are you feeding her?

She gets 'Pedigree' dry food and about every other day I cook meat (either chicken or beef, no bones) with rice and veggies for dinner. The odd doggie treat, chewy sticks, sometimes a little yogurt ... And brewers yeast + vitamin tablets (imported from Germany) which the vet recommended. But I have been given them only for a couple of days and her problems started much earlier.

Are her urination/defecation habits normal?

At the moment yes. In July she had diarrhea a couple of times, but after the first course of antibiotics it stopped.

Does she seem weak, slow to rise, etc?

No.

Is she anemic, pale mucous membranes, etc?

No.

He wanted to wait with a second CBC till a couple of weeks after the course of second antibiotics was completed. Now he's away, so we will do another one when he comes back, beginning of September.

She doesn't have any ticks.

So, what should I do with her in the meantime (until vet comes back)? Should I avoid certain foods? I have cut down on the chewy bones, she loves them but I thought they might be too heavy?

Vet was also thinking she might have acidity and simply feel nauseous sometimes which is why she wants grass then. Possible?

I could do a urinalysis now because here you can simply collect the urine and bring it to the lab (I even have the sterile container here), no vet needed for it. Should I do that? And if yes, what should I tell them to test for? Sugar, whole analysis?
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k9Karen
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Re: Elderly dog is sometimes not well

Post by k9Karen »

Traci is very much more experienced and qualified to answer your question, but urinalysis hit me immediately. My Angel has recurrent urinary tract infections, and she almost never has any symptoms with them, but she does sometimes present with some of the things you've described. If it were me, I'd want to rule-out a UTI. A routine urninalysis will also help assess overall health and kidney function. Since antibiotics have already been given without success, it might be a good idea to get a urine culture done to be sure.

High WBCs are caused by inflammation (they are a normal body response to inflammatory conditions). Infection is only one possible cause of inflammation. Dogs hide pain extremely well. When they refuse to eat, in my experience, pain is often the cause. Every elderly dog I've had developed arthritis, and it eventually became pretty severe in all of them. Allie is only 9, and is already starting to show signs of arthritis in one shoulder. Arthritis would be one thing to rule-out that could be the cause of both pain and inflammation. To me, not eating and high WBCs spell pain and inflammation somewhere - the problem is to figure out where.

One question? Has she been spayed? A uterine infection is a possibility if she hasn't been.

Hope you figure it out!
"A dog is the only thing on earth that loves you more than he loves himself." ~ Josh Billings.
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Traci
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Re: Elderly dog is sometimes not well

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Yes, again, get a complete urinalysis done, which includes checking volume, color, turbidity, checks for hematuria, WBC, glucose, ketones, pH, and also specific gravity, and checking for sediment or crystals (assuming he has the equipment to do this). A culture might be indicated if there is evidence of infection, that may not have responded to the first antibiotic (the antibiotic has to be specific for the infection type).

Does this vet frequently recommend tranquilizing prior to xrays in alot of pets? If so, that may be an indicator he is either too lazy to learn proper handling techniques or is scared of some of the animals. Xrays are a critical part of practice, and where there is a will, there is a way to xray an excited or hyper pet. An assistant, I presume, is available?

So, an xray can determine alot. Yes, I recommend it.

You can't detect inflammtory problems without additional diagnostics. CBC's are useful diagnostics, but cannot detect the actual location of an inflammatory process. This is where an xray for example, is quite useful. An xray can also detect organ size/shape/abnormalities/effusion in body cavities, enlarged organs, masses, sometimes neoplasia, etc. Just palpating the abdomen does NOT rule out various health issues.

A fecal could be done to help rule out GI tract infection or bacteria. Might be worth a shot to get that done.

Good call on the chew sticks, as I was about to recommend ceasing feeding them. Diet should be fine, providing she is not vomiting, developing skin lesions, avoiding her food, etc. I would however, try to limit cooked foods, particularly the meat, at least temporarily in the event she may be developing a sensitivity to a food type, or even bacterial infection (are you cooking it thoroughly?) Lastly, check the bag of dry food to ensure it isn't expired, rancid due to moisture, etc. The brewer's yeast and vitamin tabs may not be necessary, and if she's developing a food sensitivity, you also have to take into account either of these could also be causing a reaction.

One can do a CBC within days after a course of antibiotics, one does NOT have to wait two weeks after antibiotic administration to repeat a CBC.

What is occuring in the day when she is so restless, and panting? You said not really hot, but humidity is high. Did vet listen well to heart and lung sounds? Perhaps developing asthma or panting due to a heart condition, lung condition. Xrays helpful for determining those.
..........Traci
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Ash
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Re: Elderly dog is sometimes not well

Post by Ash »

Thank you Traci, and K9Karen.

I will get a urinalysis done.

X rays - no, the vet does not routinely tranquilize animals who need an x ray. It's pretty obvious that it won't be possible to do one without tranquilizing Shida.

Nobody would even be able to lift her onto the table, she weighs more than 30 kg and struggles like mad.

You don't know the circumstances here - there are no x ray facilities for animals here! It's done in a facility for humans and no one there will help lifting the animal or keeping it still. (And I can't lift her anyway - disc problems.)

But even if we would get her onto a table somehow she won't lie still. So how to x ray without giving her something?

Just fyi: there is no vet here who has experience with x ray machines, sonograms or heart diagnostic machines etc.

Maybe in Delhi or Mumbai are vets who do that but not here.

would however, try to limit cooked foods, particularly the meat, at least temporarily in the event she may be developing a sensitivity to a food type, or even bacterial infection

Actually I had the feeling that she might not take the dry food as well, and the cooked food is easier for her.

Yes, I cook it thouroughly, we get it minced.

Like I said, the brewer's yeast tab she has been getting only for the past few days so I don't think it's giving her the problems.

The days she is so restless it always starts in the mornings around 9 or 10. The only thing before that is her morning walk but I can't detect anything unusual.

Husband thinks she might eat something she finds on the road (roads are always full of rubbish, it's not always possible to stop her in time, especially when they are on the stretch where they can run off leash). He thinks that might sometimes happen and make her sick. But then - she's always had the habit of eating scraps she finds on the road, she had been a street dog and the habit is hard to stop. And if she has always done that why should she now suddenly become ill from it? (Not that I approve of this nasty habit, but as I said, we are sometimes too late in stopping her).

By 6pm she's always fine. Today as well. Ate again, drank, sleeps now.

Re arthritis: she does sometimes limp a little with her one front leg. But it's rare (like once in a month or so?) and not very prolonged, i.e. only for like 10 sec after sleeping. I don't think that could be arthritis, could it?
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Ash
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Post by Ash »

Forgot: yes, k9aren, she is spayed!

I'm thinking about how to possibly x ray her. If it was my male dog it wouldn't be a problem. For one, he's much lighter, and second he doesn't struggle, he's scared, yes, but he will kind of freeze and you can do what has to be done. Not so Shida. She becomes a cat when examined :shock: When the vet took the blood, husband and I were almost lying on top of her to keep her from struggling.

But you can't lie on top of her when taking an x ray ...

And then I also think: well what if an x ray shows a growth? We won't operate on her anyway so why stress her out to see what it is ... You know what I mean? If she does have something malicous, an x ray won't help her anyway.
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Traci
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Re: Elderly dog is sometimes not well

Post by Traci »

If a dog has a fracture, how does the vet identify it, does he ever use an xray machine, even at the human clinic?

If a pet has a heart condition, how does the vet identify it?

If a pet has pleural effusion in the chest, how does the vet identify it?

I'm sorry, I'm really confused. He doesn't have an xray machine, wouldn't know how to use it anyway, human clinic won't lift heavy animals on the table, and no one to assist in keeping animal restrained? In essence, he rarely ever does an xray for pets?

If that's the case, then I don't know what else to tell you.

I know how different this must be for you. I've lifted dogs who weigh more than I do, (normally with assistance), and if you do it right, a heavy, nervous dog can be restrained on the table long enough to snap the xray. The key is measuring the dog first, setting the machine, setting up the film, all BEFORE actually getting the dog on the table. Once the dog is on the table, position correctly (and quickly, calming the dog at the same time), snap xray, done! (then of course, getting the dog off the table correctly and gently)

I guess if no xray possible, then at least a urinalysis, repeat on bloodwork/CBC to note any changes.

Arthritis isn't always obvious, it is a slowly progressive condition, sometimes taking months or years to show obvious signs, arthritis can also be exacerbated by a previous fracture/sprain, injury etc and can occur sooner in dogs who've had prior injuries. Slow to rise after napping, taking slower and more limited walks, hunched spines, stepping gingerly, wincing in pain if touched, etc can all signal signs of pain and discomfort due to arthritic conditions. (an xray can help detect inflammation)

Something is more pronounced in the earlier part of the day. What is it? Is she simply nervous about something, is she overheated, does it seem she is not digesting her food normally after eating? (does she lay down directly after meals or does she resume normal activity -- the former may indicate poor digestion, this of course can occur with age/diet, etc). Can you determine if she's in pain upon waking from a nap (i.e, slow to rise, get around, etc)
..........Traci
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Ash
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Re: Elderly dog is sometimes not well

Post by Ash »

Traci, I know it is hard to imagine for you and we have discussed the workings of Indian vets here many times ... believe me, I'm always as frustrated as you.

My male dog had a fractured leg (many years ago). The vet diagnosed it by touch and sent us to the human x ray clinic. Like I said, with my male dog it's not a problem, we had him x rayed without too much stress. I guess that's how it's done in most cases. But if you happen to have a very large dog, yes, there is nobody to help. And if the large dog is doing her best to struggle they will sedate it but as I said we don't want to do that with Shida.

And without sedation I fear she would manage to fall from the table .... if we would get her up on it at all. She does not want to be lifted!

I don't know how they identify heart conditions. Probably pure guess work.

I recently found a relatively new animal shelter here, it's outside the city, I hadn't been there before. It is run by a woman who is herself a (human) doctor and has lived in the UK for many years. She is doing her best to keep it up to Western standards, I was very impressed! This shelter is pure luxury by Indian standards, I have never seen anything like it here before but yet their clinic is by Western standards simple, to say the least.

Image

Image

Putting the pictures I took there last week so you get an idea ... this is a clean, modern Indian vet clinic (only one room), the cleanest and best I’ve ever seen here (as is the whole shelter).

They are now saving for an x ray machine, sonography and other diagnostic equipment. It will make them the first veterinary clinic in the vicinity with such facilities.

Back to Shida: she never had any fracture.

Slower to rise after napping

yes, sometimes she does that. Usually in the winter when the nights are cooler. But I have not seen her doing it for months now. Sometimes a little limp as I have described above, but not for long - couple of steps.

Hunched spines, stepping gingerly, wincing in pain if touched

this she doesn't have/do.

Something is more pronounced in the earlier part of the day. What is it? Is she simply nervous about something, is she overheated, does it seem she is not digesting her food normally after eating?

My husband walks the dogs in the early mornings. I get up later, after he brought them back, which is when I sometimes find her not feeling well. But she was ok while walking and when he brought her back, he says.

I can only describe her as looking very uncomfortable, just like she does when she has a full bladder and urgently needs to go out, but now she doesn't need to pee, she simply wants to eat grass. After eating grass she calms down somewhat and lies down to rest, but still doesn’t eat nor drink until the night.

This always starts before they get their morning meal, so I don't think it has to do with proper digestion of food? Could it be acidity as my vet thought?
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Traci
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Re: Elderly dog is sometimes not well

Post by Traci »

How long are the walks and does hubby walk slow or fast? What is the terrain of the walks? It could be she tires easily during the walks. Doesn't she eliminate during the walks? If confined in the house at night, I'd think she'd have to urinate/defecate first thing in the morning. I hope she's not developing a heart condition, as this could tire her quite easily.

Maybe try feeding her a small meal before the walk, let her rest a bit, then go for a short walk. She will probably want to eliminate during the walk. After the walk, let her drink small amounts of water and let her rest. Later, let her out to urinate. Try feeding another small meal in the afternoon. In the evening, another small meal and let her out again to urinate/defecate.

It could be she may be alittle hyper or hypoglycemic, in which a small meal fed early morning will give her more energy for her walks and help her metabolism/digestion during the day. Maybe three small meals as opposed to two large meals a day would be more appropriate for her. Just a suggestion. Do NOT feed a large meal and/or let her drink large amounts of water then let her walk or exercise directly afterwards, this can cause bloat problems. A urinalysis done will also determine if there is excess glucose in the urine (which can exacerbate an infection as well). Although, blood and urine glucose should be tested together.
..........Traci
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