My dog is getting progressively sicker – what should I do?

Question: 

My 9 year old dog has not been eating well for about three weeks. The vet did blood work and found slightly elevated liver enzymes. A week later she still was not eating well and had started to vomit occasionally. Her liver values were a bit higher but not concerning. Now she has a dry heave cough. What should I do?

Answer: 

Whenever you are concerned, the safest bet is to have your dog rechecked. Sometimes, the initial diagnostic tests can be non-specific, so if she has not responded entirely to the first round of therapy, it’s usually time to look deeper. A repeated physical exam is always essential, but it is likely that she will need additional testing such as more specific blood testing for infectious diseases including leptospirosis (depending on your geographic location) as well as imaging in the form of an abdominal ultrasound to look at the appearance of her inner organs, including her liver. With the new cough, x-rays of her lungs might also be needed to look for newly developing pneumonia or other disease. Consult with your primary care veterinarian about a recheck there first or the decision to refer you to an internal medicine specialist who can provide more in-depth testing on the puzzling patients.