Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Arlo Guthrie — Wed, 09 Aug 2023 08:03:34 GMT

[quote userid="9632" url="~/f/clinical-questions/30736/can-you-shed-light-on-weird-gastric-dilation-hypomotility-ulceration-paresis-and-urethral-prostatic-calcification-in-my-8-week-old-puppy-loki/242097#242097"]Unfortunately Loki continued to deteriorate on all directions and was euthanasia yesterday.[/quote]

So sorry to read that.

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Ayesha Kyari — Wed, 09 Aug 2023 06:58:53 GMT

Hi Hilary , good to hear from you! Unfortunately Loki continued to deteriorate on all directions and was euthanasia yesterday.

No conclusive diagnosis but, but in the absence of any known toxins it was thought he could have had one or more of:

Leiomyositis - gi signs

Poly neuropathy - paresis

Sensory neuropathy - bladder

Cervical myelopathy - paresis

Hyperparathyroidism - ST mineralisation

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

hilary warner — Tue, 08 Aug 2023 21:57:45 GMT

Hi,

Only just come to this and wondering if Loki is still hanging on in there, hoping he is. Has this been reported to the drug company as a possible adverse reaction and have they had any similar reports? Just wondering if there was some sort of inflammatory response to the drug causing an ileus. Other thoughts; the urea is likely high due to the GIT bleed, the Ca and Phos are both high has there been exposure to excessive Vit D3 could it be associated with diet, is anyone on a psoriasis cream? do you know if other pups have similar high Ca and Phos? Could the calcification of the urethra and prostate cause abdominal pain and secondary ileus? Feel I have given more questions than answers.

Ref managing the ileus/dilated stomach. Only experience is as you have done, maropitant metoclopramide gastric protectants and cisaprid keeping check of K+ levels.

Hoping there is positive news. : - |

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Ayesha Kyari — Mon, 07 Aug 2023 18:30:01 GMT

HI Joyce,

Thanks for looking at this - I appreciate it. As the first incidence of collapse occurred a few hours after his Nexgard, that was my first thought. However, he hadn't had an excessive dose and had been fine with milbemax 2 weeks previously. In this case I would have thought it would have been self-limiting, or respond to symptomatic care - but I can't help being suspicious.

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Joyce Whitehead — Mon, 07 Aug 2023 16:48:19 GMT

Please feel free to ignore/put me right on this as I’ve never seen an affected dog. But with it being a collie type having had milbemycin in the nexguard could it be a MDR1 gene issue? As I say I know it causes neuro issues but haven’t ever seen one. So probably unlikely.

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Ayesha Kyari — Sun, 06 Aug 2023 22:38:41 GMT

Thanks again David, That's really helpful especially as neuro is a weakness of mine.

I know different specialists were looking at him, but not sure if the neurologist has specifically - I will ask tomorrow, and about the ACH test. Apart from my still poor-ish French, the problem is most of France is on holiday for August so most places, including vets, just have a skeleton staff.

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

David Mills — Sun, 06 Aug 2023 19:00:19 GMT

No problem.

Just a few more thoughts based on your reply (I'm a first opinion person with a particular interest in neuro, cardio/resp/ortho just for transparency).

- I wouldn't rule out MG based on absence of megaoesophagus given an x-ray/imaging is a discrete time point. The chest rads you posted do show a relatively widened mediastinum to me though no obvious megaoesophagus. An ACH receptor Ab test is relatively easy to run, even cheaper is the edrophonium test.

- toxin wouldn't fit with the time frame in terms of weakness - toxins tend to be acute then decrease in terms of severity with time, not worsen (with some very few exceptions in dogs). Botulism would be one of the exceptions (which means amoxLA wasn't unknowingly a bad choice from initial vet :) )

- if its something like polyradiculoneuropathy then there is little treatment other than nursing (and I'm not totally up to date but I don't think there's a definitive diagnostic test for it) and it's a long and sometimes painful recovery period (at least 6m in most cases)

- Toxo and neospora are often mentioned but their prevalence is very low and you would expect littermates to be affected to some degree. They are also normally progressive and generalised weakness in the absence of neuro signs wouldn't be compatible.

- Has a neurologist assessed the pup?

You may have mentioned some of the above already - apologies if so.

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Ayesha Kyari — Sun, 06 Aug 2023 12:27:14 GMT

Thanks David,

I discussed with the vets and MG was ruled out on the basis of no megaoesophagus on xray, but I think NMJD is def a possibility. His bloods, apart from the mod uraemia have remained stable, but he's not fit to have a GA for any nerve conduction tests and I understand most blood tests are done in the US.

I also thought about toxo or neospora even though his litter mates are okay and I've never seen it present like this?

Apparently he's a little better today, keeping food down and will have a repeat u/s tomorrow to asses his GIT ... and then unless he continues to improve we'll have to make a decision :(

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

David Mills — Sun, 06 Aug 2023 09:45:33 GMT

MG or some form of NMJD? They could explain the smooth muscle dysfunction (dilatation, regurgitation, heavy breathing, incontinence).

The increasing weakness is concerning and it doesn't necessarily fit with toxin unless botulism is a possibility.

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Arlo Guthrie — Sun, 06 Aug 2023 07:43:54 GMT

[quote userid="9632" url="~/f/clinical-questions/30736/can-you-shed-light-on-weird-gastric-dilation-hypomotility-ulceration-paresis-and-urethral-prostatic-calcification-in-my-8-week-old-puppy-loki/242064#242064"]I did try to reset my display name but the alias box is greyed out ... It was set up years ago![/quote]

Ayesha Kyari Ah yes, I see, but it's not your alias that needs changing - that is/was just used when people didn't tick the box to 'display real name'.

To display your real name, you need to go to settings: https://www.vetsurgeon.org/user/settings, then click the tab marked 'post settings' and then tick the first box labelled 'Display real name', and then save!

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Ayesha Kyari — Sat, 05 Aug 2023 21:15:49 GMT

I did try to reset my display name but the alias box is greyed out ... It was set up years ago!

RE: Can you shed light on weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki?

Arlo Guthrie — Sat, 05 Aug 2023 18:20:24 GMT

To say I'm excited by discussions like these would be one of the great understatements of the century. Could I ask for a better illustration of what I see as the future of this community? I think not! Lovely to see new posters Dervla Lim and ayesha Ayesha Kyari - a very warm welcome to you both!

Couple of things. Have you both subscribed to the email digest of questions, either daily or weekly, here: https://www.vetsurgeon.org/p/questions so you can keep an eye out for answers to your own questions, plus others you may be interested in?

Also, Ayesha, would you mind setting your account to display your real name, here: https://www.vetsurgeon.org/user/settings

If you ever want to ask a sensitive question, you can always use the anonymous login. But otherwise, as we rebuild this community around the central theme of helping one another, I think it is nice for people to know who is asking questions, and essential to know who has answered them (I think transparency is important when answering).

RE: Weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki

Ayesha Kyari — Sat, 05 Aug 2023 12:11:45 GMT

Thank you - I will ask them to check for that too!

RE: Weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki

Dervla Lim — Sat, 05 Aug 2023 11:57:08 GMT

Lepto doesn't always affect the liver from what I have read so wouldn't rule it out purely based on that...if I think of any other DDx I will post again!

RE: Weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki

Ayesha Kyari — Sat, 05 Aug 2023 11:53:10 GMT

Thank you for looking into this Dinu - I really appreciate it. The specialist was happy with the kidneys except for an area of mineralisation, and obviously had more views to look at than I posted.

RE: Weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki

Dinu Catilina — Sat, 05 Aug 2023 11:39:09 GMT

Was renal dysplasia ruled out? To me the corticomedullar ratio is abnormal on the renal ultrasound but of course it could also be just an oblique view.

RE: Weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki

Ayesha Kyari — Sat, 05 Aug 2023 10:44:38 GMT

Thanks Dervla, the pups were left at the Mayors office at 2 weeks old and were hand reared, away from the shelter by a very experienced fosterer. So parents unknown, but good care after that. I thought of Lepto too, but wouldn't that have affected his liver too? And he's always been with one or more of his litter mates and they're find. So sad

RE: Weird gastric dilation / hypomotility, ulceration, paresis and urethral / prostatic calcification in my 8 week old puppy, Loki

Dervla Lim — Sat, 05 Aug 2023 10:00:47 GMT

Hi Ayesha, sorry to read you have such a poorly puppy. Have they tested him for leptospirosis? Do you know his history prior to adoption/arriving at the rescue centre?

Good luck! -Dervla