Many dogs and cats are very sensitive to household changes. Visitors and houseguests, an active, loud “terrible twos” toddler or construction can all have an impact on your pet’s health. With this post and the next, I would like to share some cases to show the variety of environmental stressors that can affect pets.
Case #1: "Sibling" Stress
A 10-year-old doxie was brought to me for intermittent vomiting of a month’s duration. The vomit never contained food, just white foam and occasional bile. The owner indicated that the episodes could occur any time of the day, but generally clustered around the early morning hours. He had a history of dental problems and the owner was concerned that his mouth might be the cause of the vomiting. Although he did need some dental work, there was little evidence that his mouth was the culprit.
Physically the dog was in great shape and his blood and urine work-up were normal. His radiographic and ultrasound studies were also normal. With nothing to go on, I sent the dog home on antibiotics and antihistamines thinking that I might be wrong about the teeth. The dog might have a sinus infection from the teeth that was causing post nasal drip and throat sensitivity that triggered a vomit response. I asked to re-check the dog in a week.
For the re-check visit, the owner was not alone. It was his turn for watching his two-year-old son so he brought him along for the re-check visit. After causing quite a stir in the exam room, the child made it very difficult to query his father about the treatment response. Between the loud random questions and events that two year olds like to share, the child was constantly in the doxie’s face. Eventually I was able to determine that my treatment program did not work as I watched the dog cower in the corner.
I was actually glad the owner brought his son. After the initial visit I was still entertaining the possibility of some sort of inflammatory condition of the stomach and/or intestines. I was ready for that possibility if the re-check was not positive. But this visit gave me a very different diagnostic path. Early morning vomiting is often associated with gastric ulcers.
I shared my diagnostic thoughts with the owner. He definitely agreed with my assessment of the household dynamics and the possibility that his dog had a gastric ulcer. Gastric ulcers can only be positively diagnosed by endoscopy (small camera in a tube inserted in the stomach under anesthesia) or exploratory surgery. A less drastic approach is a treatment trial with medication. I had the owner pick up some generic Pepcid at the grocery store to give before bed.
After suffering through this office call I could certainly sympathize with this elderly doxie. We veterinarians often forget that the diseases we chase do not happen in a vacuum. It also made me realize the difficulty of getting a thorough history from clients when trying to unravel their cases. The limitations of the information we are given is even more confounding. Certainly this father was unable to share an accurate assessment of his dog’s household environment because I had asked him about possible stressors on the first visit. I needed to see it first-hand.
The treatment trial worked and the vomiting episodes stopped. Such a specific treatment trial is probably a good indication that the doxie did indeed have a gastric ulcer. More invasive diagnostics are probably unnecessary unless the vomiting recurs. The dog may still not be happy with his rambunctious two-legged brother, but at least it is no longer tearing his stomach apart.
Dr. Ken Tudor