canine anorexia

Question
QUESTION: Our 8 year old male Husky/Shepherd mix has stopped eating (and drinking, for the most part) and was hospitalized this weekend for IV hydration, but despite extensive evaluation, the vet specialist in internal medicine can't find a cause. He is usually very active and joyful and goes to playgroup with 10 or so other dogs 5 afternoons/week and did well til this August. He occasionally would refuse to eat for a day or so (we thought maybe he would get a mouse), but would drink. In August, this extended for 3 or 4 days and he looked like he was in pain. At that time, his CBC and chemistries including liver tests and pancreatic tests were normal. He had an abdominal ultrasound that was normal. We put him on Prilosec, and he got better, regaining the 5# he had lost. However, over the past 3 weeks it has happened again. We tried scrambled eggs, cheese (his favorite), boiled chicken, rice, even chicken broth and he just turns his head and won't eat. Last week we took him back to our local vet for the 3rd time and repeat blood tests were normal except for a mild anemia and he was started on Reglan without help. He was referred to a veterinary specialty hospital where he had more labs and was found to be a bit more anemic, but had no blood in his stool. He had an ACTH stimulation test that does not show Addison's. He had another abdominal ultrasound that was normal. He was put on an appetite stimulant that didn't work. This weekend he became lethargic and we took him back when he got admitted for IV hydration. Yesterday he had upper endoscopy that did not show an ulcer or anything else, but they took biopsies. Blood tests were drawn for thyroid tests and a special pancreatic series and have been sent to Texas A & M. The vet says he has "anemia of chronic disease" but doesn't know what disease. They sent him home with us yesterday with instructions to give him a bland diet and keep up with the Prilosec, Reglan, and mirtazepine. He still has not had anything to eat or drink. What do we do? How do we get him to eat?

ANSWER: Hi Julie,

First of all let me say how sorry I am that your dog is going through all of this. It's bad enough when we have a veterinary diagnosis to work with, but in the absence of one, it can be hard to know exactly what to do. I am somewhat concerned about cancer, has this been discussed with you at all? ANother possibility that occurs to me is immune mediated hemolytic anemia; I'm guessing yor vte ahs ruled this out, but in case not:
http://autoimmunedisease.suite101.com/article.cfm/canine_hemolytic_anemia



In my work with seriously ill dogs, inappetance is someihtng I deal with all the time. However, ion those cases I also have a confirmed idea as to what is going on. In this case, I am worried about making suggestions when I'm not clear on the rpoblem. In addition, cases of serious health problems really do suggest a consultation. I would love to help more, but I need more information. If you would like to pursue a consult, please see my homepage www.thepossiblecanine.com under Services for an idea of what I can offer you.

One thing that could help in the immediate is, what had you been feeidng? Are you using a raw diet by any chance, any raw bones?  I'm assuming kidney values were normal too? No one feeding him onions or garlic? Are you using any supplements such as fish oils or Vitamin E?

The more information you can give me the more I can try to help. With advanced cancer cases (as an example) we often use a whole smorgasbord of foods, because what appeals one day will disgust them the next. I use babyfood, tripe, lightly cooked beef heart(cant hurt to increase iron right now anyway) sometimes NutriCal (available from your vet) - you need to experiment. When my dog was  in her last days with advanced abdominal cancer, she would prefer strong flavours one day (cooked lamb, beef heart, liver) and the next day want blander foods like chicken or  cottage cheese. Please try anything you can and rotate. I can be contacted at catlane@thepossiblecanine.com for more indepth help. Of course, you are most welcome to contact me here. I would like to hear what is happening.

Catherine

---------- FOLLOW-UP ----------

QUESTION: Hi Catherine,

Thank you so much for your rapid reply. Yes, this as confusing to us and to the vets as it is to you. My spouse and I are both human doctors, so we've asked all these questions, too. No solid tumor found was found anywhere in his body by 2 abdominal ultrasounds. He does not appear to have a hemolytic anemia (autoimmune or otherwise)because his reticulocyte count is low (i.e., he is not making new red blood cells). His white blood cell and platelet counts are normal, so they don't think he has leukemia or other blood disorder. His kidney and liver tests were normal. We're waiting for the intestinal biopsy results and thyroid tests to come back.

Last night, for the first time, he had a little diarrhea, so the vet's best guess is that he must be having some prolonged virus. Before this started, he was getting dry food (I can't remember the brand, but it was an organic food for sensitive stomachs and had venison, I believe) and wet Eukanuba alternating with Science Diet or Nutro Max adult dog food. We would alternate because he would get tired of one and refuse to eat it, then eat heartily when we switched back and forth. A few weeks ago, the vet switched him to prescription Eukanuba low residue, which must not taste good, because he wouldn't touch it.

Last night, he refused boiled rice alone, chicken broth, and scrambled egg, but ate a little poached salmon and rice that was underneath the salmon. This morning he refused scrambled egg, but ate some leftover medium rare prime rib beef. Seems like he prefers the protein. The organ meats (liver and heart and tripe) you describe above sound interesting. I would have had no idea that dogs might like them. How do we make sure he gets complete nutrition?

Answer
Hi Again Julie,

Reading over your account of your dog's issues I again feel much sympathy for the frstration of   a lack of diagnosis. In my line of work it's critical to maintain a line between what I do and what the vet does, so I will refrain from further speculation as to cause. I will make a comment or so on the diet, as this falls within my area of expertise.


NOTE: you can always check the Merck Veterinary Manual online; since you have medical training a lot of what's contained in the Merck will be more useful for you than for the average layperson.
http://www.merckvetmanual.com/mvm/index.jsp

Now: the diet. The foods you have been using, while supported by research in terms of nutrient content, utilize such poor quality ingredients as to be notorious in the world of the enlightened dog lover. I'm not blamning these diets for the anemia, but with the ingredients they contain I'm not surprised your dog finds them unpalatable. Step one, in my opinion, would be to purchase some small bags and cans of premium quality foods and see if your dog finds them more tolerable. Foods I use and recommend include Innova, Orijen, Fromm Four Start Merricks (the canned is almost always a hit) and Wellness. Liver and heart are rich in iron and copper as well as many other nutrients, but with an anemic dog minerals need to be attended carfeully to. No reason not to try a little lightly cooked heart and liver...tripe is like doggie-pizza, they all love it. Try a little, the canned green products are the most readily available. I have issues with longterm use of canned foods but in a situation like yours, it will only prove helpful to have him eat something. Check in a natural petfood store in your area for canned EVO or Evanger's meats (rabbit, venison, duck) and try mixing a  litte with cooked brown rice, sweet potato, a little low sodium beef or chicken stock.

It's difficult to think about complete nutrition when he will barely eat at all. That is of course a goal for down the road, but this is triage and you need to supply his first requirement: energy/glucose. Beyond this I would say getting to the bottom of the issue is the next step, but you're well aware of that. If your dog is totally inappetant it constitutes a veterinary emergency and you will need to have him seen.  

I hope tonight goes well and you find some answers soon.  I'm here as you need me.
Catherine