Stories of Hope: Franklin

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When Franklin, an approximately 10-year old male castrated Labrador retriever mix, presented to Dr. Jennifer Bagshaw, HVS‘s internist, his owners were at a loss. For more than a year, Franklin had been vomiting at nearly the same time, 3:30 am, two to three times a week. During the day, Franklin was his usual (or, in Frank’s case, unusual!) self, aside from a retching cough several times a day that often ended in a full-blown gag. He had no diarrhea, no loss of appetite, no lethargy.

Over the past year, Franklin had visited his primary care veterinarian, who tried various medications, none of which helped; he was referred for a cardiology consult, from which he emerged a nearly perfect specimen of cardiac health. At one point, someone suggested his radiographs showed a mass in his lung; a second and third opinion with radiologists wholeheartedly discredited this. Franklin next saw an internist at another facility who suggested he eat nothing but a hypoallergenic food and so he began to, and, after months of waking up to the all-too-familiar sounds of Franklin vomiting, his owners were thrilled to sleep through the night and perhaps have gotten to the bottom of the problem: a food allergy! Or was it? Four months after eating nothing but his hypoallergenic food (snack time equaled this same food in his Kong toy), the 3:30 am vomiting began again and with increased frequency, up to four times a week. It was at this point that Franklin came to HVS to meet Dr. Bagshaw.

After ordering and then reviewing blood work, more radiographs, and an abdominal ultrasound, all of which were normal, and after speaking at length with his owners about Franklin’s behaviors (vomit- and otherwise), Dr. Bagshaw suggested an (upper gastrointestinal tract) endoscopy, which would allow visualization of his esophagus and parts of his stomach.

The endoscopy was performed a couple weeks later under general anesthesia, and the scope showed that Franklin had a very red, very inflamed stomach, likely indicative of inflammatory bowel disease (IBD), but only biopsy results, from samples retrieved during the scope, could confirm the diagnosis, which they did just a few days later.

It’s been about six months since Franklin’s endoscopy, which means it’s been six months since his strict regimen of IBD medications began: In his case, metoclopramide, sucralfate, and prednisone. There’s been a lot of trial and error in regard to these medications and their dosages and frequency; for example, for Franklin, one sucralfate a day is not enough, and because his vomit was almost always his undigested dinner, he gets the metoclopramide, a gastric motility drug.

And, it’s been six months since Franklin last vomited.  (Ok, well, that’s not entirely true: Our friend Franklin got into the trash about a month ago and then visited our emergency team to induce vomiting to prevent any negative repercussions of that adventure. Thankfully, we were successful.) Franklin and his family thank Dr. Bagshaw and the internal medicine team for their help, and Franklin vows to do his best to stay out of the trash can…

Stories of Hope: Rudy

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Rudy, an 11-year-old male neutered Dachshund, saw his primary veterinarian in mid-April of 2009 because of vomiting and diarrhea. At that time, he was diagnosed with gastroenteritis and prescribed medications for his gastrointestinal system. It is important to note that at that visit, Rudy’s skin was completely normal.

A week later, Rudy started to have some crusting on his ears; the following week, he developed much more severe crusting on his ears, foot pads, and abdomen–and he was still vomiting. Antibiotic therapy had no effect.

So, on April 28, 2009, Rudy visited the Emergency Services department at HVS and was referred immediately to our Dermatology department. The dermatology team did skin biopsies, which revealed an immune-mediated disease known as Pemphigus foliaceus (PF). Also during Rudy’s visit, the team learned that Rudy had been on Promeris, a topical flea/tick medication.

Rudy was prescribed prednisone (a steroid) and azathioprine an immune-system suppressant), and by the end of May of 2009, he showed dramatic improvement. By September of that year, Rudy was able to be weaned off the azathioprine and maintained on the prednisone. Rudy last visited the Dermatology department at HVS in May of 2011, and he is still doing great!

Promeris, the topical flea/tick medication Rudy was on, was removed from the market in 2011 because it had been linked to causing PF in multiple dogs. Rudy is extra special in that he was the Dermatology department’s first case of Promeris-related PF, and, clearly, he counts as one of their most successful cases!

Thank you, Derm team!