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Why is This Dog Vomiting? aka Barium Series in a Maltese

July 10, 2011

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Vomiting and no Bowel Movements in a 10-Year-Old Maltese

“Angel has not been able to hold anything down for 5 days.  At first, we thought he was eating and just vomiting a little.  Then we realized he really had not held down a meal for days,” said a distraught Maltese mommy.

“He’s probably been vomiting on and off for weeks, but we just realized how bad it’s gotten.”

“How do his bowel movements look?” said Doc Truli.

“They were a little soft, but then, come to think of it, he has not pooped in about 4 days,” said Angel’s mom.

Uh-oh, thought Doc, nothing in or out for at least 4 days equals obstruction.

“If a dog or cat does not eat and does not poop for  days, especially a younger pet, a veterinarian will immediately think the pet might have an obstruction,” says Doc Truli.

Reasons for Intestinal Tract Obstruction

  • Foreign Object
  • Tumor or growth
  • Intessusception (like a Chinese finger trap in the intestines)
  • Torsion (twisted intestine/stomach)
  • Functional obstruction (ileus-no movement of the muscles for many reasons)

Tests a Veterinarian Needs to Determine Why a Pet Can’t Eat

Bloodwork in Angels’ case showed slightly low blood protein called albumin (probably from loss in the stomach and intestines).  His urinalysis was normal. He showed slightly low chloride from vomiting hydrochloric acid stomach juices. We ran a pancreatitis test to see if his pancreas was angry and inflamed and causing the vomiting.  It was slightly elevated, showing some pancreatitis.  (Not surprising, the organ that makes your digestive enzymes would be upset by your not eating situation.)

We started Angel on intravenous fluids to rehydrate him and help provide his little 7 pound body with the electrolytes and fluids he needs to balance his blood and heal.

The Radiograph study (X-Rays) were eagerly anticipated.  His history of vomiting, not eating, and not pooping meant that x-rays were likely to show the problem.

Angel’s X-Ray Study

The first radiographs are called the abdominal study.  At least two pictures are needed to characterize the abdomen in 3-dimensional space.  Angel’s X-Rays looked, basically, normal.

Some round, white lumps in the stomach

Round white lumps near the bottom of the stomach in a Maltese

Close up of empty air-filled stomach. Air looks black on an X-Ray because there's nothing to bounce the X-Ray beam off of.

Close up of first X-ray. Stomach appears empty.

Now, here’s a dilemma!

The survey x-ray study looks normal.  Yet the little guy had abdominal pain.  He had a history pointing to an obstruction, which is life-threatening.  What can we do?

We can feed him barium, as long as he can hold it down without vomiting it up.  Barium is a liquid metal that lights up as white on x-rays.  It also generally coats and soothes the lining of the stomach and intestines.

Sounds like a no-brainer, right?

If a Dog Were a Human, They Would Get Whatever Tests They Needed

Costs of a Barium Series

If Angel were a child, we would not be having a conversation about money at this point.  You see, Angel was very sick.  He had already required $700-$900 for the tests, treatments (medications, fluids) and a barium study is not cheap.

A barium series means feeding the barium (which takes 2-3 people to syringe-feed or tube-feed it to most dogs) and taking radiographs throughout the day to chart the course of the barium as it moves through the intestinal tract.

Timing a Barium Study

We know scientifically, that the barium should leave the stomach in 30-120 minutes.  We know it should be into the colon in 3-12 hours or so (dogs poop twice daily in general).  Sometimes the gastrointestinal tract will be hypermotile (hyper=high) and the barium will seem to fly through in only a few hours.  Sometimes it will linger in areas of hypomotility (hypo=low).  Sometimes it will not move at all, as with ileum or obstruction. The result, financially, is the barium series can cost anywhere from $300-$900.  It can cost as much as a surgery to cure the problem!

Also, there’s a time problem with the barium series.  If a dog is metabolically unstable, or suffering very much pain, then the 6-12 or 24 hours needed to perform the barium study may delay surgery or a cure.  It may not be a perfect choice to perform a barium study.

Alternatives to a Barium Series

Endoscopy or Ultrasound Can Help

For Angel, we discussed ultrasound and endoscopy.  Ultrasound uses sound waves to see inside the body while a computer processes the data and gives us pictures on a screen.  The sound waves do not travel through air in the body, like an air-filled stomach.  Since the stomach is near the body wall and large, it effectively blocks the ultrasound from seeing about half of the abdomen that lies behind the stomach.  Not a good option for Angel.

Because Angel was vomiting and his pain was in the front of his abdomen when Doc Truli felt his belly, endoscopy was considered.  With endoscopy, Angel would undergo anesthesia and have a scope with a camera on the end snaked into his stomach, and it could reach the first part of his small intestine.  If he had a foreign object in his stomach, if it was rounded and small enough, with no pointy edges, then the scope could be used to pass a grabber-instrument and pull the object(s) up his throat and out hs mouth.  Clearly, a less invasive, more comfortable option than surgery.

There are down-sides to scoping.  Surgery would still need to be done if the scoping did not find the problem, and scoping cannot be down right after a barium study because the white liquid barium blocks the camera scope, so you delay days for the barium to clean out.

Plus, honestly, endoscopy is high-tech and expensive.  It generally costs more 25-50% more than surgery.  While Doc Truli performs endoscopy, it often is beyond the financial abilities of most families.  It’s just as real and practical as that!

Angel Eats Barium

We decided Angel needed more testing before we would consider surgery (we had no proof anything was in there to fix).  He ate his barium like a champ and the X-ray series in the slideshow at the beginning of this article was the result.

Close up of barium sticking to rounded objects in the stomach

Close up of rounded objects in the stomach highlighted by barium

Round objects clumped in the center of the stomach were out of place in a vomiting dog who had not eaten in days.  Frankly, they looked like dog food to Doc Truli.  But why hadn’t the stomach acids eaten away at the kibbles?  They were supposedly in there for days.  Other doctors disagreed with Doc Truli.  They felt the pattern looked like stomach carcinoma, a nasty cancer you do not want to wish on anyone.

Just because of the idea of cancer, Angel’s parents almost decided to take him home with medication and no further treatment.

“It’s my obligation to let a pet parent know every viable option.  Yet, I know that as soon as I mention cancer out loud, verbally, then the conversation and emotions shift.  The word itself could end up killing a dog.  It almost killed Angel.  Yet, I know in my gut, if I truly think that cancer is a real possibility, I have to let the parents know that medically, scientifically, in my professional opinion, cancer is possible,” Says Doc Truli.  “I hate to think I brought up the possibility of  cancer  and caused someone to euthanize a pet because of the word.”

Doc Truli called Angel’s parents with the results of the barium series.

“There are rounded objects in the stomach which I think look like food, but I can’t for the life of Angel tell you why they are there so many days after eating.  I must mention that in the opinion of other doctors here, it could be a cancer of the stomach lining.  We cannot be sure without surgery.”

Angel’s dad opted for a “wait and see” approach.  “Let’s try some anti-nausea medicine and see how he does,” he said to Doc Truli, “He’s ten years old, and if it’s cancer, I don’t want him to suffer.”

“If it’s not cancer, he might lose his life way before his time. Can you take time from work and come in a see the X-Rays?  We can talk more about it then,” offered Doc Truli.

“I’d love to,” said Angels’ dad.

That offer to show Angel’s dad the x-rays, so he could get a feel for the situation for himself,  saved Angel’s life.

Read more next week…

2 Comments leave one →
  1. Beatriz permalink
    July 7, 2013 5:32 am

    So what was it? My dog has been vomiting and the exrays are very similar😦

    • July 7, 2013 5:13 pm

      Read the story to find out!

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