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I present to you Molly, female, spayed, 9 years. Her current issues are anorexia, & vomiting. We have suspected diagnosis of IBD and/or lymphoma.

Summary:

Molly has always had issues with a sensitive gut, and picky eating, adult onset epilepsy (very well controlled) and Borellia positive (Lyme). Molly would go through vomiting episodes that were generally short lived. All tests we had done on her were normal / negative. We have fed her for the last 5 years on Royal Canin H/E Gastro kibble and mixing gastro canned food +/- chicken, lean burger/moose, salmon, etc. Bland no spices. She is quite neurotic/sensitive, fireworks will cause her to shake uncontrollably for hours on end (we’ve used valium a couple times, it was that bad). Loud noises will send her off to a room or couch away somewhere in the house. Two years ago, we brought a baby home and Molly became kind of depressed (we tried Prozac), her vomiting episodes became more pronounced in intensity and duration. At 6 months old, our kid was throwing food on the floor and we’d sternly say no and this had a huge impact on Molly who developed a food aversion, she would shake when food was offered to her. We had to coax Molly from this point on to eat sitting on the floor hand feeding her 2 meals a day with varying results, we’d have to change it up between my wife and I and her mother. Molly would most reliably eat with my mother in law.

Three months ago, we brought home another daughter (I know we are selfish). Molly’s food aversion got worse. We spend more time coaxing her to eat than feeding our 2 children. “Luckily” I was unemployed for some of this and was able to spend the time needed to feed her. Once I began working (out of province) my wife could not devote as much effort with 2 young children in the mix.

Molly began to lose weight from a stable 58lbs to 56lbs. In the last two weeks she lost a further 8lbs and is now 48lbs. My wife called me the other night when I was at work, I had to rush home as Molly had an episode of non-productive retching. My wife suspected something was seriously wrong. Vet did an Xray and she was bloated! I got home just as that happened and we drove Molly to Atlantic Veterinary College in PEI. They stabilized her and performed a series of tests (all normal, go figure) and we did an ultrasound that showed inflamed intestines. After much consulting and deliberation we came up with the suspected diagnosis above. We did not want to open her up for biopsy so we opted to treat with steroids.

Molly began to show a drastic improvement, we transferred her to a vet hospital closer to home and we visited her often. She was like our old girl again. Exposing her belly for rubs (she hadn’t done this for a couple years when we thought of it). Molly would eat readily for the hospital staff (but not us). Molly did so well in hospital, they discharged her to us after two nights (3 nights in total since emergency). We took her home and she showed the food aversion again, shaking when we attempted to feed her broth, chicken and her recovery food. We have always tried different areas of the house instead of the kitchen floor and same results.

We’ve taken Molly back to the vet hospital this morning hoping that she would eat and begin to put some weight back on. Last update, still not eating, and shaking and hypersalivating when the staff are even discussing food.

Anyone dealt with something like this before? We love our girl and its too early to say goodbye….close friends of ours offered to look after her at their home with their two dogs to hopefully teach her how they should eat. It’s a lot of ask of them…

Molly – Medical History

September 2009 - Dec 2013 - Nothing significant, spayed at 6 months old.

Dec 2013 - MOLLY had a confirmed case of pancreatitis, which was severe and did require 24 hour hospitalization and care for 4 days. She recovered well. This developed 1 week after a sewage line rupture in our backyard.

Dec 2014 - She began to develop seizure activity - partial at first with trembling and shaking of the hind end and then more generalized and grand mal. Full blood including T4/TSH unremarkable except for very mild increase in ALT. Her seizures slowly became progressively more intense. Shannon took MOLLY for TCM consult at this time and tried a supplement with no change. She was seen at AVC in September 2015 and had a work-up and CT and MRI. Diagnosed with idiopathic epilepsy. Started on Zonisamide, and she has done well on this with only a handful of seizures in total since starting treatment.

Started with episodes of anorexia as part of her post-ictal phases, but this progressed to many repeat episodes of vomiting/anorexia/+ or - diarrhea in the Winter of 2015. There used to only be a couple of episodes a year, but as time has gone on this has become a monthly struggle. Full blood work has been run MANY times, and mainly a mild persistent elevation in ALT has been the only abnormality. An ACTH stimulation test was run in May 2015 to assess for atypical Addison's disease and was normal. She had an U/S in September 2017, which showed no abnormalities.

MOLLY has been treated with many medications to try to help her GI symptoms:
Ranitidine, Famotidine, Sucralfate, Cerenia, Metoclopramide, Metrodidazole, Mirtazapine, Omeprazole, Cerenia, Fortiflora, Tramadol and Cisapride (Paige states we’ve tried Cisapride in her history – I don’t remember ever trying this). She often vomits food long after eating it and has been suspected of having underlying IBD and a possible gastric outflow restriction.

Summary prior to presenting to AVC on Dec 13, 2018:
MOLLY has now eaten little in 3 days and has lost 2kg in 3 weeks. She had blood work run today which showed a stress leukogram as well as her persistent increased ALT. A lateral abdominal view was obtained for peace of mind and showed a dilated stomach containing gas and the start of possible compartmentalization. A large amount of gas was noted throughout the intestines as well. MOLLY was actively passing gas both as flatulence and burping during the exam. She had vomited a small amount of bile twice before coming in as well.

Summary of Medications over the years:
- Mirtazapine
- Sucralfate
- Metronidazole
- Ranitidine
- Famotidine
- Omeprazole
- Cerenia
- Vit B12 inj (x1 at AVC)
- Dexamethasone inj
- Fortiflora
- Prozac
- L Theanine (Anxitane)
- Bio-calm
- Valium PRN
- Zonisamide
- Tramadol
- Holistic Meds (June 2015):
o Ban Xia Bai Zhu Tian Ma Tang
o Three seeds combination tabs
o Wei Ling Tang (spleen support)

** We have NOT tried CBD oil, it’s on order to arrive Dec 27, 2018 **

Summary of Diagnotic Testing over the years:
- Cortisols/ACTH Stim
- T4/TSH
- Full bloods – multiple times (elevated ALT only, and only slightly elevated)
- Urinalysis
- Urine culture – awaiting results from AVC
- Multiple CPLs – only one positive
- 4Dx – positive for borellia
- Lyme Quant6 – ran x2 … results always in the 70 range with no elevation (2016 and 2017)
- Fecals
- Fecal culture in 2013
- TLI, PLI, Cobalamin, folate – Awaiting results from AVC (sent to the states)
- Urine Protein:Creatinine (UPC) – Mar 31, 2016 = normal

Summary of Imaging over the years:
- Ultrasounds x 3
o Only the last taken at AVC showed inflammation of the bowels, etc. See report.
- X-rays (too many to count)
o Only one that has been abnormal is most recent –showing bloat
- CT/MRI
o Diagnostic of idiopathic epilepsy
 
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