I have taken Shadow to the vet twice. She is a Jack Russell and was born April 12, 2005. Her usual disposition is tail up and perky. The first visit was three days ago, because she was (and still is) having intermittent episodes of vomiting a yellow thick mucus substance, shaking profusely, and whimpering like she is in pain. Her diet was changed to white rice and chicken immediately.

The vet did an examination and a Total Body Function test, then prescribed Reglan. The bloodwork all came back within normal ranges. Yesterday she was still no better, so I took her back to the vet and he performed two radiographs that showed two small areas of gas and some stool near the end of her digestive tract. He gave her a shot of dexamethasone and a prescription for Baytril. Only one day has passed, but her night was long with the same symptoms. I would appreciate your professional recommendations or comments.

Pamela (in California)

I’ll cut straight to the chase: I am worried about Shadow, and I think it is important to find out what is causing her to vomit.

Let’s review your story. Your dog developed sudden but intermittent onset of vomiting bile (a type of stomach juice produced by the liver, which is the thick yellow fluid you describe). The shaking and whimpering may be signs of intestinal or abdominal pain, or of nausea. You responded appropriately by switching her diet to something easily digestible, but the symptoms persisted. The “Total Body Function” is a panel of blood tests offered by a major veterinary reference lab; those tests (which check, among other things, major organ function, blood cell levels, and electrolytes) were all normal. The vet then prescribed a potent antinausea drug (Reglan), which failed to control the symptoms.

Two days later, X-rays showed irregular gas patterns, which can be consistent with an obstruction in the intestines — and can mean nothing at all. The vet then administered a steroid injection (most likely to treat either a serious glandular problem called Addison’s disease or inflammatory bowel disease, aka IBD) and antibiotics (most likely to cover against the possibility of an intestinal infection).

Here is my concern: Nothing has worked. Shadow is still sick. There has to be a reason.

Many problems can cause vomiting in dogs. They range from mild issues such as dietary indiscretion that leads to transient vomiting similar to food poisoning to much more serious issues such as pancreatitis, organ failure, Addison’s, and tumors or foreign objects causing gastrointestinal obstruction. In the middle of the spectrum are problems such as IBD. Shadow’s blood tests have essentially ruled out most types of organ failure, and the failure of steroids to improve her health has reduced the likelihood of IBD and Addison’s disease. But the door is wide open to pancreatitis, tumors, and intestinal obstruction.

After three days of vomiting, Shadow must be dehydrated and miserable. My recommendation is that you pick a vet who will work diligently to get to the bottom of this problem. Check her into the hospital for IV fluids, painkillers, and gastrointestinal-protecting medications. I’d recommend repeating X-rays, since the last ones were equivocal, and repeating at least some of the blood tests, such as the electrolytes. And unless something has changed that allows the vet to make a definitive diagnosis based on the new X-rays and blood tests, I’d recommend an ultrasound.

Ultrasound is a very powerful diagnostic tool. However, since its usefulness is dependent upon the skill of the practitioner and the quality of the device, I recommend contacting a specialist in veterinary radiology or internal medicine. In California, most vets can arrange this.

When symptomatic therapy fails in cases like Shadow’s, the best bet by far is to obtain a true diagnosis. Your dog can get the best treatment only when her problem has been correctly identified. Getting to the bottom of the problem is what needs to be done.