My newly pregnant cousin Marlene (who says women with child don’t glow?) has the most beautiful specimen of a French bulldog you’ve ever seen. While he’s currently the perfect vision of Frenchie masculinity, he’s in desperate need of a snip-snip (but that’s another post). I’m writing about Hugo today as a result of his recent round of visits to my office.

Hugo, it seems, turned his nose up at his food on Wednesday. This being a previously unobserved phenomenon in the Hugolicious dog we discussed a no-food, just water and Pepcid AC regimen for the next 24 hours. When vomiting ensued, we elected to investigate with a round of blood tests and X-rays.

Poor Hugo—while normally a tractable beast, he was having no part of the whole X-ray thing. Perhaps, vain as he is, he felt we were photographing his less attractive side. Too bad, Hugo. (Have you ever heard a French bulldog scream? It’s blood curdling!)

Bloodwork was normal, no fever, belly pain or apparent dehydration—Hugo looked and acted his normal, bouncy self. But his X-rays told another story—lots of gas and intestinal swelling. Onto the next step: the barium study.

And here’s where I must pause to explain my reasoning: A young, active dog with no obvious signs and symptoms beyond simple vomiting is more than likely a dog suffering from what we call gastroenteritis (a broad term for infection or inflammation of the stomach and intestines). While this is usually a self-limiting condition in most cases (it will pass on its own) a few require supportive care (antibiotics as a result of heavy bacterial overgrowth and fluid therapy for the resulting dehydration).

A subset of these cases will require more dramatic intervention. These are the dogs that are suffering from more serious infectious diseases (like Parvovirus) or whose GI inflammation has either caused severe problems (like twisting or telescoping of the intestines) or where it is the result of an offending foreign body (almost always something the dog ingested).

Because Hugo is a young, toy-driven dog, his risk-factor for this final option was considered high. Moreover, the pattern of gas in his intestines was very suspicious for an obstruction. So what’s the best way to find out whether there’s an offending foreign body in there causing an obstruction? Barium—that nasty white pasty stuff you must swallow so your intestines light up like a Christmas tree on X-rays.

Now this poor Hugo dog (who you will recall has no great love for the X-ray experience) must undergo a daylong photo shoot to determine whether he consumed something sufficiently indigestible to cause him potentially surgical harm. Indeed, the upshot of this adventure is often to find something we can cure by surgically removing it.

Should you ever be unlucky enough to go through this experience with your own dog, please be prepared for all the veterinary hemming and hawing that happens as a necessary part of the imaging process. You say you can’t understand why your vet seems to have acutely undergone a metamorphosis into someone less sure of himself and his patient? That’s because while we’re willing to put you and your dog through this trial-by-barium, we know that half the time we’ll not be any more informed than we were when we started the process.

Either…

1-We won’t see anything that looks like an obstruction, in which case we’ll send you home with your vomiting dog with admonitions of possible further testing. Because a negative test doesn’t mean there wasn’t ever anything stuck in there it just means that there’s nothing stuck there right now.

or...

2-It looks like something’s in there but we’re not sure what and unless we have a clear history for your dog having eaten something indigestible we’ll vacillate wildly and second-guess ourselves mercilessly until we finally decide to cut into your dog to explore or repeat the process the next day, potentially risking the well being of your dog’s intestines in the delay. Incidentally, this is when a specialist (a vet surgeon) or having multiple vets in one practice is extremely useful—more eyeballs generally translates into better results in equivocal cases like these.

Sometimes we get lucky (you might not see it this way) and there’s something really obvious in there so that we know exactly what we must do to fix your dog. Sometimes we get unlucky and we perform surgery only to find an innocuous bit of reddened bowel. I had a professor once say that if this doesn’t happen to you 20% of the time you’re potentially doing harm by not investigating aggressively enough. That’s a tough spot to be in, though.

So what about Mr. Hugo? His dice came up snake-eyes (#2 above). It looked like a cloth-like substance was causing inflammation but things were still moving along just fine in spite of it. No obstruction now but what about tomorrow? Because the deemed-to-be-foreign stuff in there was getting close to the large intestine, it seemed a safe bet to let him off the hook and go home for the weekend.

Meanwhile, my cousin spent more than $500 (with my family discount) for a qualified, looks-like-he’ll-be-fine diagnosis. Sometimes, as my second-grade teacher used to say, that’s the way the cookie crumbles. And, as I like to say, dogs are not cars. Their bodies are as deeply mysterious as the methods we use measure them are limited. There’s only so much we can do before our methods enter the realm of the doing-harm thing. Still, it’s a good thing Hugo’s mom has me on speed-dial.