vet and I are at a loss

My almost 9 year old English Springer Spaniel absolutely refuses to eat or drink ANYTHING. He stopped eating two Thursday's ago, so that Saturday morning, we took him to the animal hospital. Six days and several blood and organ function tests later, we still had absolutely no idea. All his organs tests (liver, kidneys, heart) came back as completely normal. No bowel obstruction. Lungs normal. Blood work all normal EXCEPT that both his sodium and potassium levels were VERY low (the potassium was dangerously so). So after a week on IV (normal saline with a potassium supplement) he finally seemed interested in food instead of just turning his nose up at it, and pigged out on maccroni and cheese baby food. We took him home Wednesday night, and he ate the baby food for me at home, and took him back Thursday morning to talk with the vet. He seemed on the mend, so the doc gave me a Rx of amoxicillin and sent him home. Now, he is refusing to eat again. He only ate willingly for me on Thursday evening. I have had to force-feed him watered-down baby food just for him to take the antibiotic (he has to take it with food). I am taking him back to the vets in an hour, but we have both combed the internet and other resources, and can find no reason why he refuses to eat or drink. He has no vomiting, no diarrhea (and didn't before the refusal to eat), he still loves playing catch, but when we're not playing catch, he's lethargic. If ANYONE has ANY ideas, I would LOVE to hear them- thanks so much!

[Arnold L Goldman, D.V.M.]

Dear kashadell,

We are sorry to hear your dog is not well. While it sounds like your doctor has done a fairly thorough initial workup: blood work and presumably abdominal and thoracic x-ray imaging, there is obviously a reason for the cessation of appetite, lethargy and electrolyte abnormalities found. Rare is the well dog who will not eat!

Assuming the remainder of the blood work was completely normal (no anemia, no blood sugar abnormality, no kidney or liver value alterations, etc) It is likely the answer lies in the electrolyte abnormalities. I am also interested to know if a urinalysis was done and if that was normal. Finally, was the lab work done in an "in-house" lab or  a commercial lab? In other words, are the results reliable?

There is at least one condition, often underdiagnosed, which could encompass the findings you have reported and that is Addison's disease, formally known as hypoadrenocorticism. In a 9 year old,  Addison's disease is an acquired adrenal gland dysfunction which may affect  the electrolytes (sodium and potassium)  in somewhat unpredictable and variable ways. The other signs may be quite variable (lethargy, appetite change, bowel changes, etc) or even nonexistent and when present the signs can be subtle and perplexing.

The condition is diagnosed with an "ACTH Stimulation Test", a simple provocative lab test series done after injection of the hormone ACTH. Perhaps suggest that your doctor consider this test, if he/she hasn't. Aternatively, you may need to seek a second opinion. While there may be other possible diagnoses that fit your dog's signs, regardless a diagnosis should be sought. An ACTH stimulation test will rule in or rule out Addison's disease and that should be accomplished. Continuing to be "at a loss" will not make your dog feel better any time soon. Good luck!

Very best regards,

Arnold L. Goldman DVM, MS

[kashadell]

Thank you so much for your quick reply! I'm sorry, I forgot to mention, a urinalysis was done, and the results were normal as well. The vet did say he thought it was presenting as atypical Addison's, but he wanted to rule everything out before performing such an expensive test. He has actually sent the blood work to an internest to see if they have any ideas as well, but I will just ask him to perform the ACTH test- a diagnosis would be very good right now! Again, thanks so much for your response, and I will let you know the findings!

[Justine Lee, D.V.M., DACVECC]

I'd really push for the x-rays and ultrasound instead. Typically with an ACTH test, you're looking for Addison's disease (where the body doesn't make enough steroids) but your potassium should be VERY HIGH (not very low, as in your dog's current situation). Abnormal types of cancer or even liver disease can cause inappropriately fluid in the abdomen and these electrolyte/salt shifts. X-rays, ultrasound, and  other tests are definitely warranted! I'd get your dog worked up sooner than later, as the prognosis and treatment vary on how soon the problem is identified. Good luck with him and keep us posted!

[Aleda M Cheng, D.V.M., C.V.A]

Hello Kashadell,  Dr. Goldman gave you a really great answer.  

I would like to add that until you finally get an answer about whether your dog is Addisonian or not, your dog really must eat, even if force fed.  

Acupuncture and Herbal medicine may help when all else fails.  

There are acupuncture points, and herbal formula’s specifically to stimulate appetite which are quite effective, if a veterinary acupuncturist is available.  If a veterinary acupuncturist/herbalist is unavailable the  following two herbal remedies, (available online) are safe and helpful to stimulate appetite: Eight Gentlemen (Xiang Sha Liu Jun Zi Tang), or Jade Lady (Yu Nu Jian) and worth a try.  

Good Luck, and please give us an update!

[kashadell]

Thank you all so much for your advice! After his visit with the internist and an ultrasound, they found a ball stuck in his intestines... one of those little rubber bouncy balls you get for $0.25 in a gumball machine. It didn't show on the radiograph because of the material. He had surgery this afternoon, and had the ball, along with several small portions of his intestines, removed. He's not out of the woods yet (high risk of infection from the "nasty" in his intestines) but the prognosis is favorable. And my husband and I have gone through the whole house and tossed ANYTHING small enough for him to easily swallow. I will let you all know what happens with him, and thank you so much for caring about my old man!

[Justine Lee, D.V.M., DACVECC]

Yeah! So glad to hear that! Hope he recovers quickly and well! I didn't see that you mention whether or not he was vomiting? Hope he recovers quickly!

[kashadell]

Dr. Lee- no, he wasn't vomiting, he didn't have diarrhea... he basically gave no real indication as to why he was behaving the way he was. He had a bowel movement yesterday morning, and I think that may have been what pushed the ball into an area where it was easily felt... who knows. All I know is that my boy is going to get better!

He was very alert and awake- and ready to go home this morning! Unfortunately, he has to stay until Saturday. :-( I understand the reasons, I just miss my old man. But I did promise him I would play lots of catch with him when he gets home! (with tennis balls lol)Again, I appreciate everyone's concern and information.