Susie is a tiny dog: at less than 4kg, she’s smaller than most cats. She’s an active animal, full of energy and enthusiasm, which makes it particularly upsetting when she falls ill.
Her problem started a year ago, just before Christmas. Dolores found poor Susie collapsed and foaming at the mouth. She had suffered a severe upset stomach, with blood in her vomit. She was rushed to the vet, where she needed emergency treatment, including intravenous fluids and medication to settle down the irritation to her digestive tract. She ended up spending Christmas in the Pet Emergency Hospital.
Her blood tests had all been normal, which meant that this was thought to be just a one-off gastric irritation, with no sinister underlying cause. Some dogs are prone to this, and they respond to simple treatment including a bland diet and medication to soothe an inflamed digestive tract. We hoped that once Susie had recovered, she’d stay better.
Unfortunately, a few weeks later, the problem recurred. At this stage, further investigations were needed to find out why she kept getting an upset stomach. It’s distressing to see a dog vomiting, and there’s always a worry that there could be some undetected serious underlying illness.
This time, we repeated the blood tests, and they now showed that she had raised liver enzymes, indicating some type of liver disease. We also took x-ray pictures of her abdomen, and these showed that she was suffering from an enlarged liver. Finally, we carried out an ultrasound examination. This showed that she was suffering from a problem that both humans and animals can develop: an inflamed gall bladder, with low grade damage to her liver and pancreas, structures that are adjacent to the gall bladder.
The gall bladder is an important structure, in dogs just as in people. It’s like a small balloon, slotted into a corner of the liver. The gall bladder stores a dark brown liquid produced by the liver, that looks like soya sauce: this is known as “bile”. When a dog eats a fatty meal, the bile empties from the gall bladder through the bile duct into the intestines. Bile helps the digestive system to digest fatty foods, helping to break down and absorb fats and fat soluble vitamins. Bile also acts as a way of helping the body excrete some toxic by-products of the metabolism. So when the gall bladder becomes inflamed, these toxic by-products start to accumulate, the body can no longer digest fat properly. Affected dogs feel nauseous, and they often vomit.
There are a number of causes of gall bladder inflammation, and treatment of dogs usually involves trying to address the most common of these.
First, Susie was given antibiotics. Bacteria sometimes track up from the intestines through the bile duct, settling in the gall bladder and causing inflammation. So a course of antibiotics is needed to solve this issue. Second, Susie was put onto an ultra-bland, low fat diet. High levels of fat cause the gall bladder to become more active as the body tries to deal with digesting the fat. If only low levels of fat are offered, the gall bladder rests and recover.
Third, Susie was given a daily capsule that contained a substance called ursodeoxycholic acid. This chemical is known as a “kind bile acid”. When it’s eaten in a capsule, the body concentrates it into the bile, and it accumulates inside the gall bladder. While some other bile acids can have an irritant effect on the lining of the gall bladder, this chemical has a soothing, anti-inflammatory effect. The idea was that this would take away the inflammation from Susie’s gall bladder, easing her nausea and providing a long term cure for her problem.
Susie’s treatment plan worked well: she stopped feeling nauseous and vomiting for over six months.
Then last week, it started again. She sleeps beside Dolores, and she started to wake up in the middle of the night, getting distressed and agitated, and then bringing up bile. After she’d been sick, she settled down to sleep again. But it was very worrying for Dolores, so she brought her back to see me.
I repeated the blood tests, expecting to find the same signs of gall bladder and liver issues as before. So I was pleased to find that all of her blood tests were normal: the daily capsule had been enough to keep this issue under control.
This time, we’ve been able to keep Susie’s treatment simpler: my suspicion is that we have caught her issue very early, before any serious inflammation has moved in. So we are continuing the daily capsule of “kind bile acids”, we are giving her antibiotics to deal with any recurrence of infection of her gall bladder, and she’s also being given anti-acid medication of the type that humans take if they have heartburn. The idea is to do as much as possible to make her irritated digestive tract calm down.
Susie has responded well, and the vomiting has settled down. Some dogs do need to have their gall bladders surgically removed, just like humans, but it’s very rare. And with luck, little Susie is not going to need anything as dramatic as that to keep her healthy and happy.