Hemorrhagic Gastroenteritis or HGE: A Dangerous Canine Intestinal Disease
The Night of the HGE Diagnosis
In mid-July, 2013, my eight-year-old Miniature Schnauzer suddenly became very ill and was diagnosed with hemorrhagic gastroenteritis (HGE). This intestinal disease can be quickly fatal to dogs unless it is promptly and aggressively treated. Yet, most people with dogs have never heard of the disease. Its exact cause has not been proven, and there is no preventive. Recognizing the symptoms and getting fast emergency vet care in the event of HGE may save your dog's life. That is why I am sharing this story.
My dog, fondly called Puppy Girl, had recently lost her vision and was awaiting an appointment with a veterinary ophthalmologist. Meanwhile, I was studying the book, Living With a Blind Dog, by Caroline D. Levin, RN, so I could help her adjust to her sightless condition. She had the symptoms of canine depression, and my own state of mind was a bit shaky because of the situation.
Symptoms and Behavior That Indicated HGE
On the evening of July 13, I tried to relax on the den sofa watching a movie. Puppy Girl lay in the nearby recliner. By the time the movie ended at 10:30 p.m., she’d moved off the chair, walked around, gotten back in the chair, jumped down and back up several times. I put her restlessness down to nervousness because she couldn’t see. At that point, I was blaming everything she did on her blindness.
By 11:00 p.m., the real reason for her unease became clear. She walked quickly toward the back door and barked twice, her “potty” signal. I grabbed a flashlight and a couple of baby wipes, attached her leash and took her outdoors. I made a mental note to have the patio motion light reset so it would remain on longer.
Her Stool Changed Consistency
When she pooped, it was looser than is normal for her. We’d barely negotiated the back steps—so daunting to her now that she couldn’t see them—when she turned around and practically threw herself headlong down them onto the patio. She rushed to the grass where she passed another loose stool. I was puzzled because I feed her high-quality homemade food made with organic ingredients, including thoroughly washed vegetables. I also add powdered probiotics and enzymes to each serving. This was the first tummy upset she’d experienced in the two-plus years she'd been on this regimen, and there seemed no reason for it.
Her Diet and Health Is Closely Regulated
Time out while I explain that I’m a bit OCD about Puppy Girl’s care. I monitor every bite she puts in her mouth and always take her outdoors on leash. Since her loss of vision, she stayed near me more than ever and was rarely out of my sight for more than a few minutes inside the house. There simply was no way she’d eaten anything I hadn’t fed her or watched her eat. What could be affecting her digestion?
Signs of Incontinence and Restlessness
By 1:15 a.m., we were going outside every few minutes, and she’d had an “accident” inside the house when she couldn't find the back door. Her behavior was extremely restless and erratic. Was she in pain? The problem by then had changed to diarrhea with watery stools. I’d clean her up and take her indoors, then—a few minutes later—we were back outside. I was now worried that she would become dehydrated from losing fluids.
Since her food is wet rather than dry, she doesn’t drink a lot of water and won't drink from her water bowl on command. For that reason, I thoroughly washed and rinsed my hands, dipped my finger in water over and over and put drops on her tongue. She swallowed a few times before turning her head away.
After five or six more trips outside between 1:30 and 3:00 a.m., she made a groaning noise as she evacuated and—fortunately, the motion light was still on. I saw the bright red that gushed out and realized it was blood. My dog appeared to be pooping pure blood. I was horrified!
Bloody Poop and Managing the Mess
I found a half pack of large puppy pee pads on a shelf and cut some of them in half. Grabbing a roll of paper tape, I laid her on her back (she didn’t struggle, but just lay there) and taped a makeshift diaper on her. We couldn’t keep running back and forth from the house to the back yard. The next time she started to walk away from me, I told her, “Poop in the diaper.” And she did just that.
Several years previously her anal glands had to be surgically removed due to chronic inflammation and impaction. After the surgery, the vet gave her a stool softener, so she wore diapers for a week. At that time, I used Huggies for human infants, not the overly expensive diapers made for dogs. Her tail is cropped very short, so the baby diapers fit her just fine. It had taken only a couple of times back then for her to respond to my command, "Just use the diaper. Poop in the diaper.”
Her memory of the previous stint in diapers now served her (and me) well. I tried to get her to lie down and rest, but she couldn’t stay still longer than a minute. I instinctively knew she was in pain, nauseated or both.
When I Realized I Needed to Take Her to Emergency
Looking back, I should have taken her straight to the Animal ER and Referral Center, only 15 minutes away, when I saw that blood. Instead, I waited until daylight—shortly before 6:00 a.m.—before leaving home. Just before I put her in the car, she vomited for the first time. It was pink and foamy. Her breed is predisposed to pancreatitis, and she'd had it before. That's the reason I feed her an organic and very low-fat diet. The vet said she might get it again, no matter how careful I was with her food. When I saw the foam, I assumed she had a reoccurrence of pancreatitis.
Transporting My Dog to Emergency
Placing Puppy Girl on an old towel in the backseat of the car (wearing one of her DIY diapers), I quickly drove to the animal ER hospital, terrified she might die. Fortunately, there was almost no traffic so early on a Saturday morning, including cars equipped with blue lights. We arrived within fifteen minutes, but it seemed longer because I was so worried.
It wasn’t easy carrying her from the parking lot into the hospital. I had trouble holding her in my arms while simultaneously trying to open the non-automatic hospital door. Fortunately, someone rushed forward to open and hold it for me.
I hurried to the desk and told the receptionist it was an emergency—my dog needed to be seen by a vet immediately. I'm sure I looked as distraught as I felt. Fortunately, the on-duty vet appeared very soon. I described the previous night’s events and my dog’s history of pancreatitis. While we were talking, she threw up again, more pink foam. He would see evidence of the bloody diarrhea in her “diaper." As a veterinary tech gathered up my dog and took her to an exam room, the vet told me they would take good care of her. I should try not to worry.
Ruling Out Causes of Bloody Diarrhea
Don’t worry? He may as well have told me not to think. I am a natural-born worrier at the best of times, and emergencies make me frantic. During a crisis, my normal level of worry morphs into full-blown anxiety, shallow breathing and, at times, hyperventilation. Don’t bother telling a major worrier not to worry—just hand her or him a paper bag.
Within an hour, another vet (actually the hospital’s chief of staff and—I later learned—an adjunct professor at Mississippi State College of Veterinary Medicine, with which the hospital is affiliated) came out to the waiting room to tell me my dog had been examined and was already being given IV fluids, plus meds for nausea, pain, diarrhea and intestinal inflammation. Tests had ruled out pancreatitis and the contagious canine disease, parvo, leaving a tentative diagnosis of Hemorrhagic Gastroenteritis, or HGE.
He asked me what I fed her, and when I told him, he laughed and remarked, “She eats better than I do.” Then he asked, “Did she get into the garbage yesterday?” The answer to that was an unqualified “no.” I have a tall, covered kitchen trash bin, and she’s never attempted to turn it over, not even as a puppy. After she pilfered a used tissue from an open bathroom wastebasket two years ago (the subject of another article), I replaced all the bathroom bins with covered ones. She's never bothered them, either.
He explained that it’s impossible to pinpoint what causes canine HGE. Although there are numerous theories—retail food or people food scraps (especially when scrounged from a trashcan), a bacterial infection, virus, reaction to an intestinal parasite, etc., none of these is proven. The vet told me stress may even play a role in HGE development, but, with no causal evidence, this is a “mystery disease.”
How Is HGE Diagnosed?
HGE is diagnosed primarily by ruling out other possible causes of the symptoms. When a previously healthy dog suddenly sickens with bloody diarrhea and a high packed cell volume (PCV), a vet usually suspects HGE.
Puppy Girl stayed in ICU for two days, where she was aggressively treated for HGE. Back home alone, I searched the Internet to learn what I could about this disease. The information I found was not encouraging.
What Causes HGE?
Smaller dogs (toys and miniatures, such as schnauzers and poodles) are more likely to contract HGE, but it can affect any breed or either gender. Deadly complications may develop quickly without prompt treatment, including dehydration, low blood pressure, an elevated red blood count, shock, kidney failure and disseminated intravascular coagulation (DIC). DIC is a potentially fatal clotting disorder that occurs when the blood thickens or slows. Once it begins, it is often irreversible. This is why it is crucial to get a dog to an emergency vet right after seeing the bloody diarrhea and/or vomitus.
How Is It Treated?
Fluids are administered intravenously with medications added to treat diarrhea, nausea, pain, and intestinal ulcers. Sadly, even with treatment, some dogs don’t survive HGE. Among those that recover, the disorder reoccurs in 30%—a frightening statistic, especially since there is no method of prevention. (When scientists don't know what causes a disease, a vaccine can't be developed to immunize against it.)
Although HGE is not contagious, there are records of widely-scattered geographical outbreaks. I later learned the animal ER hospital in my area had eight cases of HGE that weekend! This fact lent credence to the viral or bacterial theories of HGE's source.
I tried not to phone the animal hospital too frequently to check on Puppy Girl, but I was undoubtedly a nuisance to the receptionist. However, she was always courteous, as were the vets and techs. My girl’s condition was stable and began to improve.
How I Cared for Puppy Girl After Recovery
When she was released from the hospital, Puppy Girl still had a very slight amount of diarrhea, but it was expected to end very soon. The vet instructed me to reintroduce food slowly with small amounts of bland ingredients, such as boiled low-fat chicken and rice. Pumpkin, which is good for dogs with tummy problems, was also recommended. She could resume her regular diet a week after there were no further symptoms.
What Medications Are Used to Treat HGE?
There was a “take-home” bag containing three prescription meds—Metronidazole, Sucralfate, and Sulfasalazine. Over-the-counter children’s Imodium was advised until the diarrhea completely stopped. Only one dose of the latter was needed.
I’d bought a package of Huggies diapers to keep on hand “just in case," so I put one on her when we got home. She didn’t seem to mind wearing a diaper, but I added a strip of tape to the front tabs for extra security. That was before I learned that putting the diaper on backward and taping it in the back worked better.
HGE Is a Dangerous Canine Disease
To say I was nervous about a relapse of the HGE is an understatement. I watched Puppy Girl almost continuously, barely letting her out of my sight. She was lethargic for a couple of days before her appetite and strength returned, so she didn’t follow me every time I left the room. Giving her multiple medicines was a challenge, but I managed to get her to swallow every dose.
For a full week, her blindness took second place to a deadly disease that could have claimed her life. I’m so grateful to the vets and staff of Animal Emergency and Referral Hospital for their excellent care of her. One thing I know for certain. If I ever see that bloody signal of HGE, we’ll head straight to the pet ER hospital right then.
I caution all dog owners reading this to be aware of the urgency if your pet develops bloody diarrhea and/or vomiting. These symptoms could mean HGE, which requires fast emergency veterinary care. Don’t delay, or it might be too late to save your dog's life.
This article is accurate and true to the best of the author’s knowledge. It is not meant to substitute for diagnosis, prognosis, treatment, prescription, or formal and individualized advice from a veterinary medical professional. Animals exhibiting signs and symptoms of distress should be seen by a veterinarian immediately.
© 2013 Jaye Denman