Barnum’s Bad Breath: The Continuing Quest for a Diagnosis

I know I haven’t been posting much. That’s partly to do with me being sick and overwhelmed with my own health stuff. Things are in flux for me right now, medical-wise, and I’m waiting for them to unflux before I post more about it.

Barnum’s health has also been a source of worry for me. It’s a long, complicated saga that doesn’t yet have a resolution, but if I waited for everything in my life to be settled, I’d never post anything. This is also why I’ve written so little about writing — there’s been major flux and uncertainty on that front for the last several months. More on my big writing project when I’m less fluxed up

Let me fill you in on Barnum’s health. The way it started might sound silly to some people: I was concerned because Barnum had bad breath.

Most people think all dogs have bad breath, and that it’s normal, but that’s not true. “Dog breath” is the result, usually, of poor oral hygiene; it can also be a sign of other disease. When my dogs have had their teeth brushed regularly and have good oral health, their breath does not smell.

Since Barnum started getting his adult teeth (around six months old), I’ve tried every day to either brush his teeth or give him a raw meat meal. (Chewing up a big piece of meat will clean a dog’s teeth.) As a result, Barnum’s teeth and gums look clean and healthy.

Close-up of Barnum's mouth -- Sharon's fingers pulling back hair and lips above and below, with the canine teeth and some of the incisors visible, as well as several premolars on top and one molar on top and bottom. All the teeth are white except for a couple of yellowish stains near the root of the upper canine.

Barnum’s (mostly) pearly whites

His gums look good and they don’t usually bleed when I brush them, which is a sign of gum health for dogs. (If you’ve ever gone a long time without flossing and then started flossing, you probably remember that your gums bled, making the effort seem counterproductive, but that if you kept flossing, after a while your gums did not bleed, and your it didn’t hurt to floss anymore. This is how it is with brushing your dog’s teeth, too.)

In other words, all indicators of oral health pointed to “good” except Barnum’s breath, which should have smelled fine, but it didn’t. It smelled yucky.

I decided to get more rigorous about tooth brushing, trying not to miss any days. I thought maybe he just had more of a tendency toward tartar or plaque than most dogs, or maybe the baked kibble he sometimes got (which does have a tendency to gum up between his back molars and his cheeks, if he eats a lot of it)                                                                                                                                                                                                                                                                                                                     was to blame. So, I brushed more often and more thoroughly. Though his mouth looked great, it still smelled bad.

I decided to take him to the vet, but before we went, I wanted to have an idea of the differential diagnoses that might be on the table so I could prepare whatever data might be most relevant. So I searched VirtuaVet, my favorite veterinary blog. She had many posts on bad breath as well as on dog dentistry. I posted about Barnum’s problem in her comments on a post about a dog who had impacted infected baby teeth (a problem that required dental x-rays to diagnose) and she encouraged me to take Barnum to the vet, listing not just dental issues but liver or kidney disease as possible culprits for bad breath.

Back in February, I was too sick to take Barnum to the vet, so Betsy did. The vet said Barnum’s teeth looked terrific and didn’t see any problems in his mouth. A complete blood count (CBC) and chemistry showed no abnormalities (except for slight elevation in one type of white blood cells). Since he would be due for his spring health check soon anyway, we decided to get his annual SNAP 4Dx (a test for heartworm, Lyme disease, anaplasma, and ehrlichia — diseases carried by mosquitoes and ticks, respectively). Finding no obvious cause for bad breath, the vet looked to Barnum’s history, which included hookworm as a puppy. She said hookworm can cause bad breath, and even though his stool test was clean, it was possible he had it again. Since she considers the treatment (Panacur) very safe, she suggested we try that.

So, we started hookworm treatment that night. The next day, the vet called to tell me that Barnum’s SNAP test was positive for Lyme disease. I have a lot of experience with Lyme, unfortunately, in dogs and people. I have chronic Lyme disease, and my previous SD, Gadget, did, too. However, Barnum was asymptomatic, and it’s certainly best to catch it early. We started him on doxycyline, which he tolerated fine. We also ran a [next link is a PDF] C6 test to try to determine the extent of his infection. Lyme is endemic where I live, and it’s really not a matter of if your dog will get Lyme, but when, how often, and how severely.

A little over a week after Barnum went on doxycyline and about ten days after his first Panacur dose, his breath improved. This led me to believe that either hookworm or Lyme had been the cause of the bad breath, though I leaned more toward Lyme because the vet had said if hookworm was the cause, Barnum’s breath should improve within three or four days of treatment. In other respects Barnum seemed healthy, and I focused on his Lyme treatment and didn’t worry much about his breath anymore.

However, a few weeks later, Barnum’s bad breath returned. Clearly he had not had hookworm — we’d already done two rounds of treatment, and his breath had gotten worse, not better. I redoubled my tooth brushing efforts just in case Barnum had some tartar or plaque I didn’t know about. It made no difference. His breath got worse.

I called the vet again to ask if we should bring Barnum in again, but she suggested I feeding him parsley every day as this is an all-natural breath remedy. I am certainly not opposed to feeding parsley — it’s a very safe herb — but since my concern was not “dog breath” but the underlying health problem causing halitosis, feeding Barnum parsley to cover his bad breath felt a bit like turning up the car radio to disguise a worrisome noise a car is making. I was worried that the vet didn’t understand that my concern was not bad breath in itself, but what hidden problem it might signal, and therefore that she wasn’t taking the issue seriously as a health problem, not as some sort of aesthetic issue. I tried to explain this to her (but more tactfully) and we discussed what bad breath could indicate. She said she had guessed hookworm because it can cause the breath to smelly “bloody.”

“Oh!” I said, surprised. “Did you think his breath smelled bloody?” That was certainly not how I would have characterized it.

“I actually don’t have a good sense of smell,” she said, admitting that she had just taken my word for it that Barnum had bad breath because she hadn’t noticed it. Feeling discouraged, I said I’d give the parsley suggestion a try. Admittedly, I have an extremely fine-tuned sense of smell and can detect and identify smells that most people can’t. I hoped that Barnum simply had a tendency toward bad breath and that he was, in fact, healthy.

I gave the parsley a try — feeding it to him daily (covered in salmon oil and with a side of fresh liver or kidney) for the better part of a month. Nonetheless, Barnum’s breath went from bad to worse. Betsy and my PCAs have commented on it, too. By now, my entire bedroom smells like his bad breath. I look forward to fixing the problem and then washing all my bedding (and his) very thoroughly.

It definitely got worse last weekend, which is also when I got several clue as to what I think is causing the problem. Of course, dogs always get sick or show symptoms on a Friday night or Saturday!

  • When brushing his teeth, I noticed that he was very compliant with me doing the right side of his mouth, but when I switched to the left, he kept pulling his head away. Also, when I brushed the left molars, his gums bled, whereas the rest of his mouth didn’t.
  • Later the same day, he was lying in bed with me and lazily lifted his hind leg to scratch his head. When his foot made contact with the left side of his muzzle, he yelped.
  • The fear reaction he used to have when my feet moved toward his face when he’s lying on my bed has returned — after I thought I’d trained him out of it.
  • I smelled both sides of his mouth, and although it’s hard to be sure, it seems to me that the smell is worse on the left side.

Everything seems to point to some source of pain and/or infection on the left side of his mouth. I wonder now if the reason the smell got better when we treated for Lyme is that whatever caused the smell was also brewing an infection, and while he was on antibiotics, the infection part of the problem was being treated.

I’ve examined the left side of his mouth, and I’m not sure if I see anything suspicious. I thought it was possible that an area of his lip is swollen — it’s pink and a little bulbous — but Bouvier lips are so weird (varying in color from black to pink and with many wrinkles and bumps) that I have trouble determining what’s normal.

Close-up of the left side of Barnum's slightly open mouth, showing most of his upper teeth and a couple of the bottom ones. He has very wet, rubbery mostly black lips, and a lot of drool in his beard.

See? His teeth look good, don’t they? As for the rest, who can tell?

First thing Monday morning I called the veterinarian, saying I wanted Barnum’s mouth looked at again, and that I wanted to get dental x-rays, too. To my surprise, the veterinary assistant told me that they can’t do dental x-rays because they don’t have the right machine for it. I hadn’t known that dental x-rays required a different type of machine from other x-rays. She told me they referred people who wanted veterinary dental x-rays to a clinic in the greater Boston area, which is about a two-hour drive from me. I asked around and discovered a local vet has just acquired a dental x-ray machine. Unfortunately, however, they said I’d need a referral and records from my current vet and that it could take two weeks to get an appointment.

Meanwhile, Barnum is now acting sick. You wouldn’t know it if you didn’t know him, but his energy level is lower. He is slower on walks and eager to get home. When he does get home, he immediately curls up for a nap — instead of trotting around the house saying hello to everyone and everything like he normally does. He also seems to be drinking a little more.

The soonest appointment I could get with his regular vet was Friday morning, which I anxiously anticipated all week. I was able to accompany him this time and meet the vet, who did the exam outside in my van as an accommodation to my multiple chemical sensitivity. I was very grateful for that.

Barnum was well-behaved and really seems to like this vet. That’s saying something, as he usually is nervous around people who smell like veterinary hospitals.

The vet did poke around and think it felt swollen above his third premolar on the upper left side of his mouth. (I hope I’m getting that tooth correct. It’s the last one before the molars.) I also had to hold his mouth open pretty firmly while she mucked around on that side, whereas when she felt around on the right side for comparison, Barnum was very cooperative. And this time she could definitely smell his bad breath! She agreed that he should have dental x-rays and said she’d refer him to the other vet and fax his records over. Now it’s the weekend once again, and since I haven’t heard from the vet who has the dental x-ray machine, I’m planning on calling her Monday morning.

I really hate waiting around for vet care when I know my pup is not well, especially because I know whatever this is has been a problem for a long time. It’s frustrating that it’s taking so long to figure out. I don’t know if he has a retained puppy tooth or an abscess or a broken tooth root or what. I just want to find the source of the problem and treat it!

It’s hard not to be angry with myself and with my vet for my not effectively communicate my concern about the problem earlier. I wonder if I had been able to go to the first appointment in person — and if my voice had been working better so the vet understood me better on the phone — if she would have been more aggressive in seeking out the cause of the problem. But probably most people wouldn’t have noticed the problem so early. This is an issue I run into a lot; service dog partners are very, very tuned in to our dogs’ health and behavior. I don’t think most vets are used to interpreting the subtleties that we present.

Also, dogs often hide their injuries and illnesses, and Bouviers are particularly known for their stoicism. This stoicism can make it hard to convey to veterinarians the seriousness of a problem. For example, I knew Jersey was in bad pain when she had a problem with her eye because she was spending time in the bathroom instead of with me, and when someone accidentally bumped her eye with their knee, she yelped, but because Jersey was eating and working and otherwise acting “normal,” I couldn’t convince any vets of that until she lost her eye to glaucoma. They didn’t get that she always was with me in whatever room I was in, and that she never vocalized (except in her sleep). I always said Jersey would have to be dying not to eat, and that turned out to be true. Gadget, too, only stopped eating within a couple of days of dying.

Barnum is the least stoic of my Bouvs, but that’s not saying much. He is eating and working and playing, etc., but I can tell he is not feeling his best. He does a lot of his work with his mouth (pulling doors open with tug cords, retrieving, pulling off socks), and I want him to be comfortable and happy.

My anxiety is a bit triggered, too, because when something mysterious is wrong with my dog’s health it tends to remind me of Gadget in the days before his lymphoma diagnosis. Even though my rational mind absolutely does not think this is cancer, my emotional/body memory self has been flung right back into that place of worry.

On the bright side, we gave Barnum a bath when we got home from the vet, which he really needed. This was the first time he’s had a bath since I replaced my six-foot shower hose with an eight-foot hose, and it was great! Much easier to reach all parts of the dog. So, at least his coat is all soft and curly and clean.

Barnum, a black brindle Bouvier des Flandres with a very short, curly coat and natural ears, lies on a red comforter on a bed, looking into the camera.

Mr. Barnum, all soft and clean



Barnum’s Bad Breath: The Continuing Quest for a Diagnosis — 4 Comments

  1. Sounds like you are being a great advocate for Barnum. And that you are getting to the bottom of things, even though it may feel like it’s taking too long. Sending you both gold light.

  2. Pingback: Finally! An Answer! Class 2 Malocclusion (Lower Canine Penetrating Roof of Mouth) | Sharon Wachsler

  3. Hi Sharon,
    Were you able to diagnose the problem? My dog is going through exact same condition but no vet is able to figure it out.

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