Mystery Weight Loss Traced to a Toy
Every once in a while a patient breaks the rules.
Dolly was a small, 2-year-old long hair little cross between a dachshund and maybe a chihuahua or a third tiny cocker spaniel, maybe. She had flappy little ears, a long fringed tail, and feathery fur on her legs and belly.
Her dad had taken her to 6 doctors with no answer. His friends in police Canine told him to come see me.
Dolly was squirmy and wagging her tail, but her ribs, hips, and shoulders stuck out at jarring angles. She ate, her stools were firm and medium brown, and she never once vomited. Her normal laboratory tests offered no clues, save one.
A tiny protein called albumin was low in her blood. The liver can fail to produce Albumin. A liver bile acids test showed Dolly made enough albumin. So I knew she had to be loosing it somehow.
The two main places a body can loose albumin is out through the kidney filters, called glomeruli. Comparison of her urine filtering capacity with the protein in her urine, called a urine protein-creatinine ratio, came up normal (<1). The other albumin leaking culprit could be the intestinal lining.
Usually, if a dog vomits or has diarrhea, albumin could be lost through the walls of the fine network of blood vessels feeding the lining of the gut. Dolly never had diarrhea! We ran the test anyway. Over 3 days, her dad collected 3 separate stool samples, which we froze and shipped to the gastroenterology laboratory at Texas A&M Veterinary College. The test revealed massive intestinal protein leakage!
An abdominal radiograph study (x-Ray series) was normal. Finally, Dolly underwent abdominal ultrasound. A small section of small intestine looked lumpy. It looked like a mass, maybe cancer.
As we went over the upsetting news, Dolly reached out her front legs and stretched her belly, with her rump high in the air.
“Does she do that at home?”
“Yeah, a couple times a day, why?”
“She’s in ‘prayer position.’ It’s a sure sign of abdominal pain.”
Dolly probably felt abdominal discomfort for 6 months!
I performed surgery at 10 the following morning, expecting the worst and hoping for a miracle.
Dolly lay on her back under a surgical drape. I incised along her ventral midline (middle of her belly). In a dog, the strong connective tissue in the middle of the right and left abdomen cuts easily and heals quickly. I exposed her peritoneum, the clear layer over the abdominal contents. I was through that in seconds and on to the culprit region.
I felt Dolly’s small intestine until I found the lump. I gently exposed it outside of the abdomen and made a small incision just behind the lump. I swept my gloved finger into the lumen, or insides, of the small intestine. Something firm and rounded pushed back!
5 minutes later, I was the proud possessor of one green slime-covered squeaker!
I biopsied the sore spot, sealed the intestine and checked everything else in case multiple abnormalities lurked. Dolly was clean, so I closed her up. She recovered quickly!
Two weeks later, she’d already gained 2 pounds. That one little squeaker stayed stuck in Dolly’s mid small intestine for 6 months. The albumin protein leakage caused her body to steal protein from her muscles until she’d lost half of her body weight. All without ever experiencing any vomiting or diarrhea.
Dolly is the reason doctors run tests. She’s the reason I do not give up. She just celebrated her 8th birthday, fat and happy!
P.S. (March 2010): to read another, very in-depth case of nebulous indistinct symptoms that turns out similar to this case read Titus’ the Canine Narcotics Officers story.