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 Digestive Problems of Dogs
Antibiotic sensitive gastroenteritis, Liver values and IBD
Vomiting and diarrhea, elevated liver values, possible IBD
Eosinophilic Enteritis or Lymphocytic/plasmacytic Enteritis
Gagging problems
Digestive problems
GI Problems
Flatulence in Golden
Clay colored stools
GI problems - IBD or pancreatitis in Fila
Stomach problem
Gastritis
Inability to digest food - German Shepherd
Gas or flatulence
Sugar overload
Clear, gel type diarrhea
Mucous in stools
Gastrointestinal discomfort
Stomach Problems
Dogs ate cooked chicken bones
Chronic vomiting
Chronic Diarrhea
 

also see grass eating
also see IBD
also see Colitis
also see Diarrhea
also see Diet
also see Hemorrhagic Gastroenteritis
also see Inflammatory Bowel Disease -IBD
also see Megaesophagus
also see Pancreatitis
also see Megacolon
also see Liver disease

Antibiotic sensitive gastroenteritis, Liver values and IBD

Question:  Dear Dr. Mike,
 
I have the report from the Internal medicine Vet who did the ultrasound.  It says "recent episodic vomiting may suggest GI inflammation secondary to indiscretion or idiopathic IBD. "  He then recommends "start empiric therapy for chronic gastroenteritis............"  I think the issue is they don't know what it is.  I have had him off the carafate and pepcid and noticed no change in his bowel movements or the occasional vomiting.  It's my understanding that the only way to biopsy the liver is through a surgical biopsy.  I hate to put him through this, without trying a lot of other options first.
 
Thanks for your thoughts.
 
Susan

  Answer: Susan-

In most cases I think that I would want to do several things prior to considering a liver biopsy in a case like this but there may be physical or laboratory findings that are prompting your vet to think of liver disease as the primary problem and it is reasonable to try to understand why there were changes in the liver enzyme levels in the labwork and to try to estimate how serious this might be prior to working through a set of diagnostic procedures and tests to try to rule out various causes of inflammatory bowel disease.

To help with understanding what is happening in the liver you have some choices other than liver biopsy:

1) It is almost always worth rechecking the liver enzyme levels to see what has changed. There are two main liver enzymes that are considered in most cases, alanine transferase (ALT) and alkaline phosphatase ( alk phos,  SAP, several other abbreviations).

ALT rises occur when liver cells die or are ruptured and leak the enzyme. Severe rises in ALT can occur with damage to limited areas of the liver. The half life of this enzyme is relatively short so rechecking lab values in 5 to 7 days can indicate whether there was a one time problem (in which case the level should have fallen significantly) or whether it is staying the same (ongoing damage) or rising ( may indicate more severe liver diseae).

Rises in alkaline phosphatase are less specific. This enzyme level rises when there is a reduction in bile flow for any reason. It also rises when corticosteroids are used in many dogs, when benign nodular hypertrophy of the liver is present, when there is liver swelling for any reason (disease, trauma), in hyperadrenocorticism (Cushing's disease) and less commonly when there is bone cancer (almost always there are significant signs of this before there is a rise in alkaline phosphatase).

In the case of both of the above enzymes it is really important to understand that even very large rises in these enzymes on a single lab test may not indicate life threatening liver damage and that truly serious liver disease an occur without significant rises in these enzymes. It is entirely possible to injure the liver without doing serious damage and it is possible for serious damage to accumulate slowly over time without significant rises in ALT or SAP.  It is also possible for liver disease to be a chronic process and in this case the liver enzyme levels may stay elevated for long periods of time. This inability to tell for sure what the meaning of rises in liver enzyme levels means is the reason that some sort of more specific testing has to be done when the rise in liver enzyme persists over time.

2) Bile acid response testing

One test that can give you a lot of information about how much liver function is affected is a bile acid response test. This is an easy test to run. A blood sample is taken after a 12 hour fast. A small meal is fed. A second blood sample is taken 2 hours later. If there is a large rise in the fasting sample or the sample taken after a meal then the liver is not functioning as well as it should be. There has to be significant damage to the liver before it is unable to process the bile acids properly so this test can really help to determine how severely the liver is affected by whatever condition is causing rises in liver enzyme levels.

3) There is no reason not to repeat the ultrasound examination if you aren't worried about the expense and want to choose a cautious approach rather than an aggressive one. Sometimes changes have occurred that are very helpful in figuring out what is happening. It can also be helpful to have X-rays taken. Most of the time X-rays aren't all that helpful in liver disease but once in a while they help a great deal. It isn't a common practice in veterinary medicine but my understanding is that MRI examination is pretty good for discerning some forms of liver damage, as well.

A biopsy is sometimes the only way to really know what is happening in the liver. There is pretty good evidence that ultrasound guided biopsy is about as good as a biopsy obtained by exploratory surgery.  The tricky thing, though, is that both techniques have advantages and so even though they give similar results overall when the ability to make a diagnosis from the sample is the criteria, they are each better at diagnosing some conditions and worse at others. Ultrasound biopsy works best when the ultrasonagrapher can identify a lesion in the liver that seems worthwhile to biopsy and can guide the biopsy probe right to that spot. Surgical biopsy works better when the ultrasonagrapher can't identify a specific area of interest. The surgeon may be able to see a problem and if not, surgical biopsies are bigger so there is a better chance of finding a problem that isn't confined to a specific area. Your vet and the specialist can help you decide which is the better approach if ultimately it does become necessary to do a biopsy.

If the specialist is really saying that he or she doesn't think that there is visible liver damage and if follow up liver enzyme levels show improvement in the liver values then it would be more reasonable to go on a hunt for a gastrointestinal cause of vomiting and/or diarrhea.

We like to start with administration of a broad spectrum dewormer to rule out intestinal parasites that are hard to find on fecal examinations. Once in a while this works to resolve problems and it is inexpensive. It is far better to do this first than to do a whole workup and later discover that Physelopteran worms or whipworms were the cause of problems. Doing several fecal exams is always a good idea. There seems to be some controversy over what dewormers will kill Physelopteran worms consistently and finding it is reason to try more than one if necessary -- so there is good reason to do the fecal exams and to deworm even if they are negative.

We usually try a low fat diet and if that doesn't produce improvement pretty quickly we try a hypoallergenic diet or an elimination diet ( one protein source, one carbohydrate source, both of which the pet hasn't eaten before, if possible).  When low fat diets work they usually work quickly so we try them first. When food sensitivities are present it can take several weeks to resolve problems (up to 8 weeks or more) but usually there is at least some improvement on the diets within 2 to 3 weeks. If we think that the problem is severe enough that we can't afford to wait long for an answer we move on to the other steps and come back to this one later, if necessary.

I think that is reasonable to try a course of antibiotics to rule out antibiotic sensitive gastroenteritis. I like metronidazole but some vets prefer tylosin, tetracyclines, sulfasalazine or other antibiotics as their first choice. I am willing to try more than one antibiotic prior to moving on to endoscopic examination as long as there aren't factors like rapid weight loss or other signs of a more serious condition.

Testing folate, cobalamin and trypsin-like immunoreactivity (TLI) is reasonable prior to going for more invasive testing. This is done by drawing blood after a 12 hour fast and sending the serum to the appropriate lab.

You have already had serum chemistry testing and blood counts done but there is no reason not to repeat this testing several times to see what changes occur.

If  you get through this much testing and still have a problem then endoscopic examination of the GI tract is a good idea. Biopsies can be taken during the exam as seems necessary based on what things look like. If the results are inconclusive you can consider biopsy by exploratory surgery. In this case another advantage of surgery is that you get biopsies of the liver, intestines, pancreas or whatever else looks like it should be biopsied during the surgery.

Your vet can help you decide which testing or trial and error treatments are reasonable prior to trying to obtain a definite diagnosis through biopsy of the liver or intestines (whichever seems most appropriate as time goes on).  Your vet can also help you decide when the symptoms make it more imperative that you proceed quickly or when you can take your time working through the process.

I hope this helps some.

Mike Richards, DVM
4/19/2005

Vomiting and diarrhea, elevated liver values, possible IBD

Question: Dear Dr. Mike,
 
I am writing about my 11 year old American Eskimo, Gatsby.  Several months ago, he began vomiting in the early am (usually around 4).  As it was about every 10 days, I didn't notice, at first.  Eventually, I took him to the vet.  A senior blood scan showed his liver values were elevated.  He then got an ultrasound, which showed everything was normal, except his bowels looked inflamed.  He was put on a rabbit/potato diet w/ carafate before meals, followed 1/2 hour later by pepcid ac.  After 48 hours on the new diet, the vomiting started again.  It was yellow bile.  The vet recommended going to chicken and rice.  After several days on this, the vomiting started again.  At this point, he had lost 4 pounds in a month.  The vet gave him a centadine shot and tablets.  I was able to put him back on normal dog food and discontinue the tablets.  The vet also recommended an endoscopy.  I took him to a holistic vet for some ideas.  He gave him an herb to balance the digestive system.  This caused vomiting and diarrhea.  He is now back on cottage cheese and boiled ground beef, as his stomach won't settle down.  He has remained happy and energetic through this whole ordeal.  At this point,  do you have any other suggestions than the endoscopy?
 
Thanks for the help!
 
Susan

Answer:  Susan-

I think that I would want to recheck the liver enzyme levels to see if they were getting worse, getting better or staying the same. If they are worse or staying the same I might add bile acid response testing as it gives a better evaluation of how the liver is functioning than chemistry tests run with most profiles, such as ALT, alkaline phosphatase, GGT, etc.

There are a number of other possible approaches to inflammatory bowel disease if your vet suspects that as the primary problem. We often try several things prior to referral for endoscopy, including a broad spectrum deworming. We usually use fenbendazole ( Panacur Rx) and we give it even if fecal exams are negative for parasites. We also often try the use of antibiotics, especially metronidazole, prior to referral for endoscopy because it sometimes provides a cure and other times provides enough relief that we can use it intermittently. Our thinking is that if intermittent antibiotic use controls the problem then we may not need to know what it is, exactly. One thing that does worry me is that it looks like your vet might be treating for a gastric ulcer, since famotidine (Pepcid AC, tm) and Carafate (sucralfate) are often used for ulcers. If this is the case then an endoscopic examination might be more important since it would be best to identify and monitor an ulcer to prevent secondary complications or to catch and treat them early if they do occur (such as severe bleeding).

Mike Richards, DVM
4/16/2005

 

Eosinophilic Enteritis or Lymphocytic/plasmacytic Enteritis

Question:  Hello,

  I need to know what eosinophilic and plasmacytic gastritis are. There are several articles on the Web that discuss it, but from the layperson standpoint I'm really not sure what these problems are all about. Could you perhaps enlighten me as to what these diseases are? Or point me in the right direction?

  thanks,
  Anthony A.

Answer: Anthony-

Eosinophils, lymphocytes and plasmacytes are different types of white blood cells. When a particular type (or types) of these cells invade the digestive tract in unexpectedly high numbers and this causes clinical signs, then the result is "eosinophilic enteritis" or "lymphocytic/plasmacytic" enteritis. Since some white blood cells are normal in the intestinal lining and since white blood cells are supposed to fend off bacteria, parasites and other invaders, it isn't unusual to find these cells in the intestinal tract in high numbers in dogs or cats with chronic diarrhea or vomiting. However, it also seems clear that at least at times there are situations in which these white blood cells are there when they shouldn't be and that they are the cause of the disease rather than part of a normal response to a disease process.

When eosinophils are the predominant cell the most likely causes of the enteritis are parasitic infection, allergies or "idiopathic", which means that there is not an identifiable cause.

When lymphocytes and plasma cells are the predominant cell types the most likely underlying causes are sensitivities to dietary components (wheat gluten is one example), parasites, bacterial toxins, cancers, heritable tendencies (occurs in Basenjis and wheaten terriers), and again a big group of dogs where a specific underlying cause isn't identifiable, or the idiopathic cases.

As you can see there is some overlap in these conditions and there are similar conditions associated with other types of white blood cells.

When it is possible to identify an underlying cause and treat it, these conditions can sometimes be cured. When no underlying cause can be identified an effort is still usually made to eliminate as many of the common causes as possible, by using a wide spectrum dewormer (usually fenbendazole) to try to rule out parasites, dietary food trials to try to identify food sensitivities and allergies, biopsy of the intestines to try to rule out cancers and to aid in identifying other underlying causes and by the use of antibiotics to try to rule out the bacterial overgrowth/toxin issues. If none of these things help then it is usually necessary to use immunosuppressive drugs to try to reduce the immune system component of the disorder. Drugs such as prednisone and azathioprine (Imuran Rx) have been used for this in dogs and chlorambucil is sometimes helpful in cats. Cyclosporine may also help some dogs or cats with these problems.

I hope that this is helpful.

Mike Richards, DVM
10/12/2004

 

Gagging problems

Question: I was just on my way with the dog to the dog chiropractor, when I got
your e-mail. I had been looking up megaesophagus, to see if that might
be what makes my dog gag, but I don't think that is it.

You probably remember Platy, the old dachshund who always seems to have
something mysterious. This time, she has started making sort of "ack,
ack" noises and then acts as if she is going to vomit, but nothing comes
up. She has been doing this on and off for a few months, and the vet
couldn't figure it out and was talking about megaesophagus and a barium
swallow when we all got distracted by her awful neck injury, which is
responding well to chiropractic after not improving with Rimadyl and
steroid injections. She does this gagging thing if she gets overexcited
(like when we come home), if someone picks her up putting pressure under
the rib cage, spontaneously at night in bed, and once in a while just
for no reason we can see. It doesn't seem to bother her and she goes on
about whatever she was doing after she makes the vomiting motion, and
she will readily eat and drink and has no problem swallowing or
retaining food or liquids. I wonder if she has a hiatal hernia and/or
gastroesophageal reflux and so it happens at night when she is lying
down and when something presses on her gut. You may remember she had a
big laparotomy last summer to do the liver biopsy and see what else was
wrong when she got so mysteriously sick (they never figured out what it
was), and I'm wondering if something didn't stay sutured inside and she
now has some herniation or at least weakness around her diaphragm.  I
doubt it is megaesophagus since she never really regurgitates anything
or has difficulty eating, etc., but maybe it is early stage.

Anyway, any ideas would be much appreciated.
Thanks for the latest VetInfo Digest!
Helen

Answer: Helen-

The biggest problem with a symptom like gagging is that it can occur in
conjunction with a wide range of problems. It is also something that some
dogs seem to do as a behavioral habit, or at least they never develop any
discernible disease or disorder even though they continue to gag when
picked up, swallow water or some other triggering event.

These are the general areas in which problems can occur, with some
detailing of possibilities.

1)  Esophageal problems
         a) megaesophagus (can be variable in its presentation)
         b) hiatal hernia -- probably occur more often than they are looked for
         c) esophagitis // esophageal reflux
         d) esophageal strictures and tumors

2) Neuromuscular problems
         a) laryngeal paralysis
         b) myasthenia gravis (mostly because it causes megaesophagus, though)
         c) neurologic swallowing problems

3) Respiratory disorders
         a) tracheal collapse
         b) chronic bronchitis
         c) chronic obstructive pulmonary disorders

4) Cardiovascular disorders
         a) chronic heart failure

5) Gastrointestinal / liver disorders
         a) sometimes gagging is a symptom of inflammatory bowel disease
         b) gastritis and pyloric stenosis can produce retching/gagging
(hard to distinquish)
         c) liver disorders sometimes cause gagging but I think this is
probably nausea

6) Hormonal disorders
         a) Cushing's disease seems to cause some dogs to gag when picked
up, probably by weakening the intercostal muscles, increasing blood
pressure and compromising respiratory function
         b) hypothyroidism is supposed to cause some of the neuromuscular
problems and possibly megaesophagus but there are very only very weakly
proven links.

6) Other stuff
         a) there is always other stuff, or at least patients that don't
have any of the above

The quickest test procedure to pick up most of these problems is endoscopic
examination of the esophagus and upper GI tract. Chest X-rays help in some
gases. Barium swallow X-rays are also helpful. If the GI system seems to be
OK, endoscopic examination of the trachea may also be useful. The larynx
can be examined prior to intubation for anesthesia for these procedures. A
good physical exam should be done preanesthesia, of course.

There is always the option of living with the problem if it isn't severe
but there are advantages to an early diagnosis of several of the above
problems, especially the megaesophagus, myasthenia gravis, hormonal
illnesses and cardiovascular illnesses.

Good luck with this. If Platy continues to me a mystery on this issue, too,
I hope she is as successful in handling it as she was the last problem.

Mike Richards, DVM
5/22/2001
 
 
 

Digestive problems in Shiba Inu

Question: Dear Dr. Richards
I have a very bright and normally highly energetic 3 year old Shiba Inu
named SaSi who has some sort of digestive difficulty.  Our veterinarian is
trying to stabilize her on MediCal Gastro Formula and, if successful, plans
to try to get her back on an adult maintenance diet, and if not, is planning
blood tests and endoscopy.  The lipase amylase test was done and levels were
slightly elevated.
Sasi has always been a finicky eater, self feeding, and enthusiastic about a
new dog food at first.  Her breeder fed the puppies homemade rice and
hamburger mixture.  I have changed SaSi's food regularly as she seemed to
become disinterested over time, but always fed good quality brands and
transitioned slowly.  She has been difficult to train and we used a variety
of treats to reward good behavior.  She also has a habit of picking up all
kinds of ugly stuff on the street.  She has had regular bouts of tummy upset
and diarrhrea and a couple of episodes of bright red blood in the stools.
During these upsets she would be desperate to get outside and eat a lot of
grass.  I started to give her pepto bismal tablets instead and this seemed
to help settle her down in a day and a bit.  I first became concerned that
these upset episodes were increasing in frequency and then she had an
episode over Christmas where she seemed to be in a lot of pain over a couple
of days.
Our veterinarian recommended that we switch her to the Gastro formula and
try to feed three meals a day.  I stopped the pepto bismal and all other
foods and treats, and have been somewhat successful in training her to stop
picking up crap on the street.  Since Christmas I have watched her closely,
and she is still up and down.  Recently she seemed back to normal for about
four days and then relapsed (possibly as a result of something she ate
during an unsupervised play in a neighbor's backyard).
The episodes consist of listless behavior, a characteristic odor,
occasionally vomiting bile in the middle of the night, and formed but very
soft stools.  She still wants to eat, and walk and play, but with less
enthusiasm than normal and occasionally seems quite depressed.  Also
periodically she has extreme flatulence.  Many nights I hear her making
mouth sounds and otherwise restless activity as if she is uncomfortable even
though she does not vomit.  (When she does vomit it almost always bile, or
before, bile and grass.)  During the period over Christmas when she seemed
to be in a lot of pain and not improving, I stopped her food for twelve
hours during which she tried to get me to feed her and after which she
vomited a lot of very yellow bile.  At that point our vet advised trying her
on rice and a bit of honey until we could start the gastro, and she really
liked it.
I would appreciate, as well as your impressions, some help in deciding
whether or not to do the endoscopy.  For this procedure, what are the
tentative diagnoses and resulting treatments.?  What other blood work would
be helpful, and in what order?  How long and under what circumstances is the
wait and watch approach acceptable?  In human medicine I read about bacteria
as a cause of ulcers and irritable bowel syndrome.  Is this a possibility in
dogs also?  My main concerns are to not subject SaSi to unnecessary testing
particularly where it is likely to be stressful.  I am hoping that a detailed
history will help narrow the range of diagnoses and treatments.  I am, of
course, speaking with our veterinarian regularly, but appreciate the
opportunity to consult with you.

Dianne

Answer: Diane-

I think it is hard to decide when it is necessary to really pursue a
diagnosis hard when dogs have digestive problems that don't result in
weight loss or seriously affect their quality of life.     In SaSi's case,
there does seem to be some discomfort based on the periods of being
lethargic or depressed, though.

Inflammatory bowel disease is kind of a catch-all term for a number of
individual conditions that have similar symptoms. These include food
allergies, food sensitivities that are not allergic in origin, small
intestinal bacterial overgrowth, plasmacytic/lymphocytic gastroenteritis,
colitis, eosinophilic gastroenteritis or colitis. Sometimes, problems like
persistent parasitism with whipworms, giardia or some other parasite are
present and are not showing up in fecal testing. This isn't really
inflammatory bowel disease but it does have sometimes have similar effects.
Systemic illnesses such as liver disease, diabetes or kidney
insufficiencies can sometimes produce these effects as secondary problems
but these usually show up in blood chemistry examinations.  Helicobacter
infections, responsible for ulcers in humans, have not been conclusively
demonstrated to cause ulcers in dogs or cats. When these parasites are found
during diagnostic procedures it is hard to decide whether treatment is
necessary but often it is attempted, on a "just to be sure" basis.

Working through the possibilities and getting to a diagnosis is the
frustrating part of dealing with inflammatory bowel disease. This is often
a process of trial and error, especially when it is not possible for
patients to have endoscopic examination and biopsy of the intestinal tract.

The first step is to try to figure out if this is a small intestinal or
large intestinal problem. In general, if diarrhea occurs more than three or
four times a day the problem is large intestinal. Usually, the volume of
stool is lower for large intestinal diarrhea, since there are more frequent
bowel movements. Bright red blood is suggestive of large intestinal disease
and maroon colored or black colored blood is more suggestive of small
intestinal disease.  If it is possible to localize the problem it helps in
choosing where to take biopsy samples and it also can help in eliminating
some of the potential causes of problems.

We do some things for almost all patients with chronic diarrhea, prior to
referring them for endoscopic examination. We usually deworm them with a
dewormer capable of killing whipworms and giardia, fenbendazole (Panacur
Rx), whether we find parasites, or not. We try limited antigen diets if
owners are able to keep their pet from eating other foods and we use these
for six to eight weeks before deciding that they are not helpful. We often
try a course of metronidazole and if dogs respond but the problem returns
on withdrawal of the medication we use sulfasalazine (Azulfidine Rx) for a
while to see if that will resolve the problems. At this point, we usually
want to have intestinal biopsy samples. We refer patients for endoscopy or
take the samples surgically when referral is not possible. Many of our
clients refuse either of these tests and in this case, we continue to try
to figure out what is wrong through trial and error treatments. If we feel
that we have eliminated most other causes, we treat for the
lymphocytic/plasmacytic and/or eosinophilic enteritis diseases, usually
using prednisone or other immunosuppressive medications such as
azathioprin.  I really prefer to have a diagnosis at the time we start
using these medications, whenever possible. There is strong potential for
adverse side effects with immunosuppressive medications and it seems better
to have good reason to use them. Despite this, there are lots of times when
we go ahead in the absence of a diagnosis and usually this works out OK.

Obtaining a diagnosis makes it possible to direct treatment at a specific
condition and it also helps to eliminate the possibility of using a
medication with serious side effects for long periods of time when it might
not be necessary. Those are the advantages.  The disadvantages of pursuing
a diagnosis through endoscopy or surgery are the risks of anesthesia and/or
surgery and the possibility that biopsy samples won't be diagnostic. It is
not always easy to decide which way to go but I do like to try for a
diagnosis prior to using immunosuppressive medications, when it is possible
for us to do that.

Mike Richards, DVM
1/29/2001

 

 

GI Problems
 

    Question: Dr. Richards,

    I have a (presumably) black lab/pitbull/(maybe)dalmation cross, Nelson, with a GI problem. He
    is a humane society adoptee and is about 18 months old. I am hyper sensitive to such problems
    as my first dog died after his kidneys failed. This was after three weeks of progressively
    worsening vomiting and diahrea.

    Nelson first had GI problems after ingesting some ungodly grill drippings and some sort of
    solvent in my father-in-law's garage in August. after days of diahrea and vomiting culminating in
    slightly bloody stool, he improved to "normal." He had been on Pepto Bismol, boiled rice/boiled
    chicken. Since then, he has had occasional stools coated in thick mucous, occasional soft stools,
    and few loose stools. He produces between five and seven large stools per day.

    Five days ago (Weds PM) he began vomiting his food, undigested. He had three or four
    episodes of vomiting that evening. We took him to our vet on Thursday AM. The vet humored
    me and ran a CBC and stool sample for giardia. The vet prescribed Pepto Bismol, boiled rice
    and boiled meat for the first two days then transitioned to I/D. Nelson was fine Friday PM and
    all Saturday and Sunday AM. Then Sunday before dinner he vomited twice -- first about two
    thirds then the final third of his undigested breakfast. After two hours of no problems I fed him
    one half can I/D and waited two hours -- no problems so I repeated and again two hours later.
    He is generally an extremely active dog. Wired tight like a dalmation with the tenacity of a pitbull
    and the looks of a lab puppy. At 75 pounds he looks very good. He has been a bit slower lately
    -- more lying around than his usual pester-to-play self. As I'm home recovering from surgery, I'm
    with him nearly 24/7. The only other unusual things are more production of eye mucous and
    excessive floor licking (40 minutes) before he vomited the second time.

    His bloodwork was negative except for slightly elevated white cell counts. Again, I am
    hypersensitive to these things having provided the round the clock IV and SQ fluids for my first
    dog before cradling him while he was euthanized. One of the two clinicians assured me that the
    white cell count was elevated but within the normal ranges. I should say I think both my vets are
    exceptional and trust them completely. They have never been afraid to refer to specialists nor to
    say "I don't know".

    I've combed your site and looked at Megaesophagus, and Hypoadrenocorticism, as well as GI
    blockages. I wonder if doing an endoscopy would be wise, or if I'm just being paranoid. Other
    thoughts?

    Thanks,   Jared
 

Answer: Jared-

I think that Nelson's medical history justifies starting a work-up to determine if there is a problem
with inflammatory bowel disease or other GI tract problems. I am not sure that I would start with
endoscopy, but it would be a reasonable starting point if your vets prefer to go that route. I lean
towards deworming with a fenbendazole (Panacur Rx) as an early step, because it kills giardia and
whipworms, which are the two parasites that have the irritating habit of not showing up on all fecal
examinations. If that doesn't make a difference we usually move on to a blood chemistry examination
and complete blood cell count, which you have done, already. If this is normal, we usually try to talk
people into feeding an diet designed to rule out food allergies but lots of times this is too complicated
(especially if there are other dogs in the household) or the pet balks at the new foods, which must
contain protein that is hydrolzyed to make it less allergenic or contains proteins that the dog has not
ever been exposed to (so stuff like duck, salmon, egg and other proteins not usually found in dog
food are used).  If a food trial still doesn't resolve the problem, if the blood work is normal and
deworming didn't help, then we try to refer patients for endoscopic work-up or treat for
inflammatory bowel disorders, depending on what the client will let us do. In a young dog's case,
doing the work up is much better since they have to live with their GI problems a long time. Some
pet owners elect to live with the problems and refuse to let us do anything else. Most of these dogs
do OK, although I wonder how comfortable they are.

So I don't think you are being overly worried and I would encourage you to talk to your vets about
how they think it is best to proceed from this point, since they have a better idea of Nelson's history
and the best steps to take to find out what is going on.

Mike Richards, DVM
12/26/2000
 
 
 

Flatulence in Golden

Question: Dear Dr. Mike,

         Our Golden Retriever, Sammy, seems to have quite a bit of flatulence
lately.  We are not sure what to do as any change in diet or additive will
bring on an attack of diarrhea.  Sammy is 14 months old and was diagnosed
with colitis at 4 months of age.  We finally were able to get his diarrhea
under control after roughly six months of trying different foods and
medications.  Sammy has been off prednisone and metronidazole since July and
has been on a diet of Old Mother Hubbard Fish and Sweet Potato and Metamucil
(for his anal sacs, he has trouble emptying them).  During this time Sammy
has had only occasional gas and when he did "flutter" it was not overly
offensive.

         Sammy was diagnosed with Lyme Disease 9/26/00 and put on Doxycycline
for one month.  He was retested after the month was up and the blood work
showed no Lyme Disease.  We notice the flatulence after he had completed the
antibiotic treatment.  We waited a few weeks and then went back to our
Veterinarian who put Sammy on Prozyme 200.  This had no effect, the
flatulence has actually gotten worse.  We tried charcoal and other over the
counter medications for dog flatulence but to no avail.  Now Sammy has
diarrhea and we are assuming it is from the different medications we have
tried.  Because of Sammy's colitis and our inability to deviate from his
diet, how can we control the flatulence.  Sammy's "flutters" are so pungent
that the odor can actually make you sick and he has it continuously.  Sammy
passes gas about every 5-10 minutes.  We just about catch our breath from
the first bomb and he lays a second, third .....  The only good thing is
that the flutters are usually not the "silent but deadly kind" -- we hear
them coming so have time to hold our breath or leave the room.

         Some where we heard that being on antibiotics can throw off the good
bacteria in your intestinal tract.  Is this the reason for Sammy's sudden
excessive flatulence?  Will it eventually go away?  Sammy is accustom to
being with my husband and I just about 24 hours a day.  We love him with all
our hearts but it is getting more and more difficult to be within 20 feet of
him.  We feel terrible because Sammy doesn't understand why we leave the
room sometimes or leave him home when we run errands.

Any help you could give us would be greatly appreciated.

Sincerely,  Elizabeth

Answer: Elizabeth-

I think that you already have covered my best guess, that the doxycycline
has led to a change in bacterial flora in the intestinal tract, either a
bacterial overgrowth situation, in which a bacteria resistant to the
tetracycline suddenly found itself in a position to reproduce uninhibited
by the other bacteria in the intestine, or a situation in which the makeup
of the bacterial population has changed in some other detrimental way.
Fiber intake can lead to flatulence but this usually clears up after a few
weeks as the body gets better at accepting the increased fiber in the diet.

When bacterial overgrowth occurs it will sometimes respond to treatment
with metronidazole or amoxicillin, although there is some risk of making
the situation worse using a new antibiotic to try to correct the situation.

You do have the option of just trying to treat for the gas, by using
products like Beano (tm), Curtail (tm), which is Beano made for dogs, and
simethecone containing products like Digel (tm).  Beano and Curtail seem to
work pretty well but are expensive for long term use. Simethecone products
only seem to help an occasional patient, though.

It would be trying, but you could go back through the diagnostic process,
including experimenting with diets to see which ones might help. I know
that you would like to avoid that process if possible, though. If this
continues to be a problem and you find you must do that, using one of the
hydrolyzed diets might be a good first step (Hill's z/d, Purina's HA).

Ask your vet about small intestinal bacterial overgrowth (SIBO) and see
what he or she thinks about this possibility.

Mike Richards, DVM
11/26/2000

 

Clay colored stools

Question: I have a one year old Australian Cattle Dog, spayed female, that has had
clay/yellowish stools for the past couple of weeks.  Nothing else seems to
be out of the ordinary and there have been no changes of diet (she eats Pro
Plan Chicken & Rice) etc.  She is on Interceptor HW prevenatative.  Is this
color of stool anything to worry about?  Can it be a symptom of something?
What, if any, tests should be done?  She has a terrible habit of eating the
feces of some of the other dogs and searches out the rabbit feces in the
field.  Could this be a cause?  Any info/help will be greatly appreciated.
Thanks,  Karen
 

Answer: Karen-

Clay colored stools can occur when dogs or cats have deficiencies bile
production or obstructions to bile flow. This may be a transient problem or
it may indicate a serious problem. If the stools are still clay colored at
this time and you have not already talked to your vet about it, I think it
would be a good idea to do so. A general blood chemistry panel, liver
function tests, X-rays, ultrasound examination, liver biopsy or exploratory
surgery may be necessary to make a diagnosis -- but all of that would
depend on what your vet finds on the examination and each test as you go
along the diagnostic process.

Eating rabbit feces can be source of infection with campylobacter and
probably other bacteria but this probably is a rare occurrence. Many of my
patients exhibit this behavior and we do not see problems in most of them.
The same is true for eating dog feces, along with the risk of viral
illnesses and intestinal parasites. It is a good idea to occasionally check
for parasites in dogs that have this habit.

Hopefully, this has cleared up and there isn't a problem.

Mike Richards, DVM
11/6/2000
 
 
 

GI problems  - IBD or Pancreatitis in fila brasileiro

Question: Dear Dr. Mike:
I am a new subscriber.  I have a fila brasileiro who is almost 4 years
old.  I adopted him 2 years ago when I had an immediate need for home
security that my 2 springer's were not providing.  He integrated
beautifully to our household and is a treasure beyond words.  I have never
felt or been so safe, either!  The breeder consented to the adoption
because of several issues, the relevance of which will become
apparent.  His mother was a past international champion who died in a
routine veterinary procedure.  This caused the rural breeder to "fall out"
with the local vet.  When my fila, who was the pick of her last litter to
carry on the line developed a problem with his hind end --not able to push
up from sitting or laying down -- the breeder assumed "wobbler's" syndrome
and put him on prednisone which was obtained from a relative who worked in
a pharmacy.  My first project was to get him off the pred.  I took him to
my vet who is not only a DVM, but practices chiropractic, acupuncture and
naturopathic.  All that  she discovered was a torn ligament in the
stiffel.  I weaned him off the pred, supplemented with glucosamine
chondroitin and his gait completely cleared.  there were only two minor
issues that concerned me.  Every week or so, he would refuse food for up
to two days.  I didn't push it because I assumed the dog was listening to
his body.  Also, he had gas like a methane bomb, particularly after
bedtime.  He sleeps at the foot of the bed.  When took him for his annual
to the vet I use for normal issues, I mentioned the gas.  The vet
suggested I change his food from the Eagle pack dry and canned I was
feeding him to Eukanuba.  The gas went away but within a month, he
developed an infected callous. Two ten day rounds of  Primor.  The next
month, impacted anal gland (10 days on Baytril), then another infected
callous.  At that point, the vet recommended I take him to a dermatologist
and said that he was also antibiotic resistant.  Then an eye infection.  I
had been away when the eye infection occurred and the sitter did not
notice it.  The sitter also switched the feed to Nutro.  I had to be away
again for an extended period, so I brought the dog with me.  I took him
the the local rural vet where I am visiting whom I have known for 15
years.  We did 10 days of Keflex, Optiimmune, and a topical
antibiotic.  The day after the Keflex was completed, he developed a
cough.  This was over a weekend.  He was not eating at all at this point
and would not get up.  That Saturday evening, I syringe fed him warm
chicken broth.  Sunday, he was a little better and ate a bit of
food.  That Monday, the local vet did blood work and his amylase was at
1889 U/L.  He had also lost 10 pounds.  (Normal weight, 170, down to 160
in 2 weeks.)  She suggested pancreatitus was a possibility and prescribed
flagyl, pancryzyme and told me to feed him chicken and rice or hamburger
and rice and said that pancreatic dogs seemed to love cottage cheese.  He
does not like red meat.   Two weeks later, April 24, his amylase had
returned to 660 U/L.  He had also put on 4 pounds.  She said I would have
to cook for him the rest of his life which I have no problem with.  Also,
he would be prone to pancreatic episodes and that rich "people" foods
could be life threatening.  Since I eat a very clean diet, there is really
no possibility of him getting anything like that.  Currently, I am
pressure cooking chicken thighs and mixing this with steamed rice.  He
will eat this for a few days and then shun it.  I then go to turkey/rice
and cottage cheese for a couple of days until he accepts his chicken
again.  The only food the dog has "stolen" has been apples.  Prefers
organic royal galas but will eat a golden delicious in a pinch.  Spits out
red delicious. (?!?)  Twice, when I have been cooking his chicken, he has
come in the kitchen, smelled it, and promptly vomited clear fluid.  Once,
hours after a meal of turkey breast and cottage cheese, we were "playing"
and as it was his turn to chase me, he stopped short and vomited clear
fluid with a small amount of cottage cheese, curds in tact.  It upset him
and he sat down.  His stool has returned to normal.
At last, what is my question?
1.  From reviewing all material on your web site regarding pancreatitus,
the dog should go back to a normal diet as soon as possible.  What is a
normal diet for this dog?  I believe the Eukanuba which is not nearly as
clean as the Eagle Pack triggered the inflammation.  Switching to Nutro
only complicated it.  His "gas" has been minimal except for the last few
days and it has smelled very acidic. When his stomach gurgles for
prolonged periods,  I give him a flagyl.  Should I continue cooking him
chicken and rice?  Because you mention that people trigger major
pancreatic episodes by enticing their animals who are not eating with
things like bacon grease,  could I be doing the same thing when he refuses
the chicken by substituting turkey/rice and/or cottage cheese?  Should I
give him access to apples?  Carrots?  Supplements?  I discontinued the
glucosamine chondroitin ages ago because I thought it upset his stomach.
2.  Could the infections be related to the pancreatitus?  His skin is fine
right now.  This has been the longest period without any infections since
the fall.  I did not mention that he also had bad acne that has completely
cleared.  I reviewed your section on Cushing's disease and the only common
symptoms he has are the skin infections and his callouses are very large
and stay a little inflamed.  Do I need to watch for this or have further
testing?
3.  I cannot tell you how remarkable this animal is.  I really wanted to
breed him and my most knowledgeable and devoted dog owning friends have
all said, without solicitation, that if I ever were to stud him, they want
a pup.  So do I.  Should I not breed him based on this health issue?

I thank you for your patience and look forward to your reply.
 

Answer: Mary Ann-

I think that it might be best to just sort through the problems
individually and then try to sum them up.

It would not be unusual for a large breed dog to have a lot of difficulty
rising with one cruciate ligament damaged. Especially if there is a problem
with hip dysplasia, spinal discs or lumbo-sacral instability that would
make any additional weakness in a limb more important. Since your Fila
recovered well from the episode of lameness it is reasonable not to worry
about this problem in the overall history, right now.

Pancreatitis can not be reliably diagnosed by elevation in amylase levels
alone, although clinical signs and supportive evidence of a rise in amylase
to levels at least twice the normal value for the laboratory running the
blood sample is pretty suggestive of this condition.  Amylase levels that
are between the high end of the normal value and twice the normal value are
more difficult to evaluate. Amylase can rise when kidney function is
compromised and probably occurs in some inflammatory bowel disorders and
liver disorders. However, any rise in amylase level has to be considered at
least suspicious for pancreatitis.  When there is a question about whether
an amylase level represents pancreatitis, or not, testing for serum lipase
can help, as this enzyme level correlates a little more accurately with
pancreatitis in dogs and serum trypsin-like immunoreactivity levels that
are elevated can also be a strong indication of pancreatitis.  Even with
very good supportive evidence from clinical signs and lab values, the only
sure way to know if pancreatitis is present is to do pancreatic biopsies.
For most patients this degree of certainty is not required and the risks
associated with surgery are not justified as a means of definitively
diagnosing pancreatitis.

I went through all of that for one reason. It is not possible to say for
certain that your Fila had pancreatitis and therefore, planning a whole
lifetime of dietary restrictions around this one episode of disease may not
be necessary.  However, the dietary recommendation that is most
consistently made by nutritionists and internal medicine specialists is to
use a low fat diet to try to prevent future episodes of pancreatitis.

As you noted, our clinical experience, which does not constitute anything
close to scientific testing, suggests that it is better for most of our
patients to return to their normal diet than to try to make a lot of
changes while they are recovering from pancreatitis.  This is NOT the
recommendation of most veterinary nutritionists, though. Nutritionists
typically advise feeding highly digestible foods for a couple of weeks
while a dog is recovering from pancreatitis and then switching back to the
normal diet, or in some cases, just continuing with the highly digestible
diet or with a lower fat diet or other "therapeutic" diet.

After things seem stable, we do sometimes encourage a switch to a moderate
fat diet, especially if the patient is overweight.  Some veterinarians also
think that moderate increases in fiber in the diet are helpful but I am not
aware of much evidence to support this claim, in the case of pancreatitis.

If pancreatitis was not the original problem you may need to go on and
continue to try to identify another problem.  Metronidazole is frequently
used in inflammatory bowel disease and it works well for this purpose in
many dogs.  It is conceivable that the treatment may have worked well but
for a different condition than was initially suspected. Pancreazyme is
helpful in some cases of inflammatory bowel disease, as well.  This may or
may not be a problem ---  it is just that I don't think that there is
concrete evidence for any particular problem, at this point in the clinical
history and diagnostic process.

Manipulating diet can help with a lot of GI problems in dogs, including
inflammatory bowel disease and flatulence. I think that you need to work
towards some sort of balanced diet at this point.  I would probably lean
towards a limited antigen  diet. This is a food with one protein source,
preferable one that your dog has not eaten previously.  Examples would be
Purina's HA,  Walthams Limited Antigen, Hills d/d, and Innovative Diets.
There are probably others.  Your vet may feel more comfortable with a
highly digestible diet or with a moderate fat diet. There is no really sure
way to tell which diet would be best, in advance. You just have to try one
and then try others if that one doesn't seem to help.

I don't think that it is unusual that you had problems with infected elbow
calluses in a dog this large. We treat a number of mastiffs in our practice
and they have a lot of problem with infected calluses on their elbow region
and often with sores over the hocks, as well. These are very difficult
infections to clear up, sometimes requiring months of antibiotic therapy.
Getting a culture of the bacteria causing the infection and determining the
proper antibiotic based on sensitivity testing for that bacteria can be
helpful.  The sores tend to return because it is often impossible to
correct the underlying problem, which is usually that the dog likes to lay
on surfaces like concrete or wood decking that are hard.  We have had one
or two clients who have rigged up protective elbow pads that seem to help,
but it takes some cooperation on the part of the dog to wear these and not
all dogs are cooperative.

If you check out the April issue of the VetInfo Digest, in the subscriber
area, there is some information on disorders of neutrophil function, which
may be a major cause of dogs not responding appropriately to antibiotic
therapy and having chronic problems with infections. I don't think this is
a strong possibility but it is one of the causes of problems in dogs that
don't respond to antibiotic therapy as expected.

I think that it would be really unlikely that pancreatitis would lead to
the skin infections you are seeing. Pancreatic cancer sometimes leads to
skin disease and liver diseases can cause skin disease but I don't think
that there is a strong correlation between pancreatitis and skin disease.

Cushing's disease doesn't seem very likely based on the clinical signs you
are seeing so far.

I do think that it might be a good idea to consider the possibility of
inflammatory bowel disease especially since metronidazole works well when
there are problems.  You might want to talk about this possibility with
your vet.

Hope this helps some. Please feel free to ask for clarifications.

Mike Richards, DVM
9/12/2000

 

Stomach  problem - Cocker

Question: Hello Dr.Mike,
     I have the most peculiar problem that hopefully you can shed some light
on.

     I have an eleven year old American Cocker who needs to be fed every
five to six hours.  If he is not, the stangest of noises comes from his
stomach (borborygmus). And I mean loud.  We notice that when this happens
he becomes very uncomfortable and refuses to eat, sometimes for half a day.
He is also not interested in anything.  He simply sleeps and sometimes
tries to hide in some corner.  As the day progesses the noises continue in
his stomach and one point diminish.   He then slowly begins to eat some
bland food such as rice banana and eventually will eat his regular food.
The first stool is somewhat mushy and the next stool after that has blood
(which we have had checked).  He then goes back to eating normal and the
stools instantaneously returns to normal like nothing happened.  The only
thing is he has my husband and I busy.  He has now put on two pounds since
my husband and I worry when it gets to his feeding time. That we have to
feed him before his stomach begins to make these strange noises and have
the cycle start over.  This means that he cannot go from supper to the
following morning.  So he must be fed something at eleven pm and then at
4:30am. So you see our dilemma.   As long as we keep this up everything is
fine.  But he should be able to go the full night.
     The vet has already confirmed colitis because of blood in his stool,
and also said he needed no medication since the stool returned to normal by
itself.  He has switched our dog to a higher fiber food.  But our problem
is not solved in respect to being able to go longer hours.

Maria
 

Answer: Maria-

I think that it is important to find out what is wrong with your cocker and
to treat the problem, even if it there are some normal stools.

This type of problem sometimes requires a lot of work to diagnose,
though.  There are many possible causes of the diarrhea, gas production and
abdominal pain.  I am guessing that this has not been a lifelong problem
from your note, but I can't quite figure out how long it has been going
on.  If that is the case, the first step is probably to collect some
general information.  Checking a stool sample for worms and other
intestinal parasites, especially giardia, seems like a good idea. Since
giardia is hard to find, even when looking for it, we sometimes just go
ahead and treat a dog for it to rule it out. A general blood chemistry and
complete blood cell count would be a good idea, too.  If there is a
systemic problem then it would be best to treat the problem identified to
see if that helps.  If everything checks out OK, so far, then it is
necessary to do testing for gastrointestinal diseases. The best approach to
this is to have intestinal biopsies taken during an endoscopic exam but
many vets do elect to just treat for the likely disorders if testing is a
problem to arrange or if financial concerns make further testing
impossible. While that is a less than perfect approach it seems reasonable
to me in many cases.

If your vet is uncomfortable pursuing a diagnosis ask him to refer you to a
veterinary internal medicine specialist or veterinary school for a second
opinion.

In older dogs there is a chance of finding a problem like cancer that is
difficult to treat but most dogs with the symptoms your dog has can be helped.

Good luck with this.

Mike Richards, DVM
2/25/2000

 

Gastritis

Q: How do you treat gastritis?

A: Helen-

Most vets use metronidazole for its anti-inflammatory properties, rather than
its anti-bacterial properties, which appear to be pretty weak. It may
slightly favor "beneficial" bacteria in the intestinal tract and it can help
with anerobic infections (which are not that common in the digestive tract).
So the basic answer to your question is that it is probably OK not to use
metronidazole without worrying too much that you will be causing harm.

I am not a fan of amphoral because it contains kanamycin, which is a more
potent antibiotic than metronidazole appears to be, and anticholinergics,
which I think of as problematic in some cases of gastrointestinal upset.

For gastritis due to eating odd stuff or from dietary changes, I prefer just
to withhold food for 24 to 48 hours, give water in small quantities at one
time, but not restrict total water intake and to use something like
loperamide (Immodium AD, TM)  to control the diarrhea, if necessary. If the
problem persists beyond this time, then I lean towards making a diagnosis and
treating specifically for the problem found, if possible, rather than using a
product that has multiple ingredients for sort of a "shotgun" approach.

Lots of vets use Amforal (Rx), though. So I am probably in the minority in my
thinking, here.

Mike Richards, DVM
 8/13/99

 
 

Inability to digest food - German Shepherd

Q: My 5&1/2 yr. old shepherd has problems with her stomach. everything she  eats seems to go right through her. She is down to 41 lbs. My vet put  her on prednisone in hopes this will help. He says that she's not  retaining her protien. She lost 8 lbs. in two weeks. She got hold of  some bone and was bleeding pretty bad in her stool which was real runny.  What do you suggest. Or do you think the prednisone will help? Please  answer as soon as you can. We can't stand to loose any more weight. She  eats really well but like I said It goess right through her....Lottie

Lottie-

A: German shepherds are prone to several conditions that can lead to inability  to digest food or to absorb digested food from the intestine. The first  step in figuring out what to do is to differentiate between these two  problems. A blood test for trypsin-like substances in the serum is helpful  in determining if pancreatic enzymes are being produced properly. If they  are, then digestion is more likely to be occurring properly. Digestive  problems other than pancreatic insufficiency can occur but are more rare.  There are several conditions that interfere with absorption of food from  the intestines. Most are inflammatory diseases involving one of the white  blood cells acting inappropriately in the intestine and most will respond  to prednisone or other immunosuppressive medications. It is best when it is  possible to properly diagnose the exact cause of malabsorption diseases.
The best way to do this is intestinal biopsy and the best way to get biopsy  samples is endoscopy. This is impractical at many veterinary practices,  though. If so, using the medications as an aid to diagnosis is reasonable.  Food allergies can cause inflammation and difficulty absorping food.  Feeding a limited antigen diet such as Purina's HA, Hill's d/d, Innovative  Diets or other diets with one protein source may be helpful in establishing  whether a food allergy is present. This is a not as likely to be the  problem in a middle aged dog but may still be worth checking into. Finally,  there are non-digestive tract causes of protein loss, such as kidney  failure and liver disease. It may take several attempts at diagnosis or  treatment to find the right way to treat your dog so be prepared to stay in contact with your vet and to let him or her know the progress your dog is  making (or not making) towards recovery. Keep working with your vet to find  the cause. In some cases it is necessary to seek help from an internal medicine specialist but not always. Your vet can refer you to the closest specialist if necessary.

Good luck with this.

Mike Richards, DVM
 
 
 

Gas or flatulence

Q: Dear Dr. Mike, I have a male boxer/lab. For the past few days, my dog has had excessive flatulence . Should I be concerned? Should I worry about bloat? Thanks, Jenny

A: Jenny- Boxers are one of the breeds that seems to have more problem with flatulence than others. I know of no evidence that this makes them more likely to bloat and I have not treated a case of bloat in a boxer than I can remember. Sometimes using a low residue diet (highly digestible) such as Eukanuba helps with this problem. Most of the time it probably doesn't help much, though. There is a product sold to control flatulence called Curtail (tm). It is made by the company that makes Beano (tm) for people. Most of my clients think it is too expensive for daily use but keep a bottle on hand for emergencies like dinner with the boss or the in-laws.

Of course, if you don't like your mother-in-law.......

we won't go there

Mike Richards, DVM

Michal Response: Jenny, our Labs also had that particular problem - never bloated but could certainly clear a room. Keeping a bottle of X-O (or your fav room deodorizer spray) handy helps.
 
 
 
 

Sugar overload in Jack Russell

Q: I really love you web page!! As for my question....as a medical student I have been going round and round trying to figure out what happened to my 1 yr old Jack Russell Terrier last week. On Wednesday she went 'garbage diving' and ate an entire box of brown sugar + god knows what else. On Thursday, she had copius, cholera-like, watery diarrhea early in the day, then she progressively lost her spunk even though she was drinking fluids. During Thursday evening, she had a fever of 104.2, went into stupor, stumbled over herself, irregular gait, inability to get comfortable (stay still) etc. Although she was still responsive to her name and her favorate squeeky toys. Abdomen was distended, full. I took her to the ER where they said her reflexes were depressed, she had a fever, and was in danger of becoming dehydrated. Liver enzymes were just outside the high range of normal, and her WBC was elevated. Vet gave her a shot of ampicillin, and I took her home. During the night I gave her water, but she would not eat. Friday....much better prognosis, but still unsteady on her feet. Eye contact was more pronounced and she readily accepted watered-down baby cereal to which some salt was added. She ate/drank 3 bowls of it. After the first bowl, she had a seizure-type event which subsided and was not repeated. By Sunday, she was back to her JR terrier self, bouncing off the walls, What could have caused my dogs illness? Was it bacterial toxin from the garbage? (Can dogs get botulism or salmonella) Was it the dehydration ? For what it's worth, the Yellow Lab that shares her space has not been sick at all. Thanks for you insight and help! Dawn

A: Dawn- I think it is very likely that a whole box of sugar could lead to an osmotic induced dehydration or that it could lead to a bacterial overload or imbalance in the digestive tract that led to diarrhea. Dogs do get Salmonella and other food poisonings, so that is possible, too. Even fermentation of the sugar in the digestive tract seems possible, with excessive gas formation leading to pain and digestive problems and systemic signs. I'm just guessing at these things because I don't really have a reference that discusses ingestion of large quantities of sugar! It always amazes me how many things happen that aren't covered by the textbooks.

Mike Richards, DVM
 
 

 

Clear gel type diarrhea - Poodle

Q: Dr. Mike, I have a Toy Poodle, which is approximately 15 years old. She has had this problem for years, but not very frequently. Lately though this has been happening on a weekly basis. She is a very picky eater and I've noticed that when she doesn't eat until late in the day ,this is when the diarrhea starts. I only feed her Science Diet food mixed with chicken [this is the only way she will eat dog food], or ocassionally a rice and chicken recipe similar to yours. At the risk of sounding icky, I feel that I need to tell you that the diarrhea is almost a clear, gel-like substance with blood mixed in. I have had two different opinons from two different doctors. Could you please tell me what you think and what you would suggest for treatment? Thank-you ,I'll be waiting to hear from you.

A:  Sharron- Clear gel type diarrhea is pretty common when colitis is present and blood is not that unusual in it. Unfortunately there are a lot of possible causes of colitis. We see this with heart failure in older dogs, kidney failure, inflammatory bowel disease, whipworm infestation, other intestinal parasites, food allergies and probably a number of other conditions that aren't coming to mind immediately.

A good physical exam is the best place to start sorting through the possibilities. Labwork may be necessary. Hopefully one of your vets has already figured out what the most probably cause is and things are improving by now.

Mike Richards, DVM
 
 
 
 

Mucous in stools - Collie

Q: Dr. Mike, I have a one year old English Collie. She seems to be healthy, happy and active. She's had all her vaccinations and has checked out well. As of April 1 she has been on the monthly heartworm preventative and monthly flea preventative. Just this week we have noticed that her stools have been slightly loose and have what seems to be a mucus-like substance on them. She's active, is eating the same as always, is exercised daily, has lots of fresh water. What is this mucus substance? What does it mean? How should we proceed with this? Thanks. P.

A: The substance you are seeing probably is mucous. Dogs with colitis and sometimes with constipation will have mucous in their stools. The best thing to do if this continues is to have your vet examine your collie since there are a number of possible causes of both colitis and constipation.

Hope all is well by now.

Mike Richards, DVM
 
 

 

Gastrointestinal discomfort - Norwegian Elkhound

Q: Dr. Mike, Here's a question for you: I have a 2 1/2 year old female Norwegian Elkhound. Several times recently she starts "reflexively swallowing." Not a hiccup, or gagging reflex, but swallowing as if something is trying to work through. Often it is after eating something in the woods on a hike, though x-rays show nothing in her gut. She has had a couple of apparent stomach infections, due to eating bits of decayed creatures (we live in Alaska). She is generally a very healthy dog--hikes at least a few miles daily. We don't have a yard, so see most anything she could eat. Vet here suggested maybe her stomach is scratched. It seems to happen some days afterward sometimes, with no prior indication. Do dogs "burp" bile like humans do occasionally? Is there a treatment to help her discomfort? She gets very distressed, and is totally crazed at times to run and eat grass to try and assuage the discomfort. Is it okay to eat grass then, or better not to? She does not normally eat grass, so I'm at a loss here. What is the chance of an ulcer or other digestive tract disorder, and what might they be? She does get nervous when we change routines or travel, etc, so I wonder if that is all part of it, and she's working on an ulcer. Can I give her an ant-acid? Thanks for any answer you can give! S.Cha

A: It does sound like there may be some cause of gastrointestinal discomfort but it would be hard to say what that might be. Dogs can get spasms of the pylorus (the muscular valve between the stomach and intestines) which may be painful. Ulcers are possible. It may be useful to try to determine if food is being retained in the stomach or if there is delayed passage of food through the intestines. Barium X-rays or use of a new product called BIPS (I think that is what they are called -- they are little capsules with balls in them that show up on X-rays and their movement through the intestine can help determine if there is a problem.) Painful conditions like pancreatitis seem possible. Esophageal diverticuli, hiatal hernia and esophageal spasms may also be possible. Unfortunately, it takes a lot of work and diagnostic testing to try to determine what is going on -- this is a time it would be really nice to be able to talk to our patients!

You can use antacids in dogs but you might want to use cimetidine (Tagamet Rx) or something like that instead if you really think ulcers are present. I'm sure your vet will help you figure out an appropriate dose for your dog. Even if it doesn't help it's one of those things that isn't likely to hurt, either.

Mike Richards, DVM
 

 

Stomach problems - Boxer

Q: Hi Dr. Mike, I have a 6 year old boxer (Miller) and he has been having stomach problems. I took him to the vet on April 3 and they took a few tests which led the vet to believe he has pancreatitis. The tests were amylase and lipase, the vet said Miller's results were 2250 and they should be under 1000. We have been giving him amoxi tabs twice a day and metoclopramide three times a day, we have also been feeding him Prescription Diet i/d. He was doing better then on Sunday he ate a few pieces of smoked sausage and on Tuesday his stomach was making all sorts of funny noises and he didn't eat dinner, but he wasn't lethargic. He also ate a lot of grass. Today, Wednesday he seems fine. The vet wants me to bring him back in on Saturday to run more tests. If he is doing fine is it necessary to run more tests. I don't feel comfortable with the vet I have been taking him to, every time I ask him a question he mumbles stuff about tests that need to be done but doesn't explain to me why, even when I ask him he just says it needs to be done and to bring Miller in.

The first time I took Miller to this vet he said Miller had an ulcer (which he concluded from xrays), so we gave him Tagamet for a while and this seemed to help. Miller has had stomach problems on and off since Thanksgiving when he ate a plastic bag that we had cooked the Turkey in (which he threw up later), along with all the grease and fat, could these problems still be from that. We took him to an animal hospital then and they mentioned pancreatitis. Every once in a while his stomach acts up but then within a day or two he is fine. Also, 3 times in the past 2 weeks I have caught him eating feces, we have deer around here so it is either theirs or his or I not sure what else, could this be leeding to his stomach problems too? It is alright for me to request all the tests this vet has taken along with the xrays so I can go to a different vet? Sorry this is so long, but I really appreciate your help. Thank you for your time

A: It is definitely OK to ask for a copy of the records and to seek a second opinion. The best way to do this would be to ask your vet to refer you to an internal medicine specialist. That would give you the best chance of getting a good second opinion. This is not a foolproof solution since sometimes there are very good local practitioners and there are a few questionable specialists but on the average, this is the best approach. Failing that, it is still OK to get a second opinion at another local veterinary hospital. X-rays are sometimes required to be retained by the veterinary hospital that took them but usually it is possible to borrow them or to have copies made.

The history you give is suggestive of pancreatitis. It is often brought on by high fat, high salt meals. We often see dogs with this problem after big holidays. The lab levels are hard to evaluate without knowing the normals for the testing lab but they are in the range (for amylase) that would be suspicious but may not confirm the diagnosis. Retesting to see whether the levels have gone up or down can help to make a more sure diagnosis. That may be what your vet is doing.

I am not aware of anything in deer feces that would be likely to cause stomach problems in a dog, offhand.

When you do not trust your vet it is time to find a new vet or to tell your vet you need to communicate better with him or her. It is important that you understand why tests are run and how to avoid recurrences of disease problems. Sometimes you can have a very good vet you just can't communicate with. It is usually better even in this case to find someone you trust and who you understand. This may not be your vet's fault but that doesn't change the situation. Finding someone you can work with is important to the health of your pet!

Mike Richards, DVM
 

 

Dogs ate cooked chicken bones

Q: I will continue my search elsewhere on the net since I note you prefer not to respond to emergengies! However - if you are online, I would be grateful if you could indicate whether I should wake up my vet (its the middle of the night here in the UK). I woke up to find my 2 7-year old dogs (12 kg and 9 kg respective weights) had, between them, eaten a small cooked chicken carcass, stripped of meat (prepared weight of bird about 3 lbs). Should they receive emergency treatment (e.g. to make them vomit?) Or should I just wait'n'see? They appear fine. In the absence of a response, I shall contact my vet at 1st light. Meanwhile, thanks for your excellent service.

A: You picked a time I was out of town, unfortunately. I hope the dogs are OK. Most of the time chicken bones seem to cause more problems when they reach the colon than anywhere else. We mostly see dogs that have eaten chicken bones and have a sort of concrete stool that they are having great difficulty passing. Stool softeners help sometimes, some dogs just go ahead and tough it out and strain until they pass the stool and other dogs we have to give enemas to or remove the stool manually. So far, in eighteen years of practice, I have not seen an intestinal or gastric perforation or other serious problem I could relate to chicken bones. Just the really hard stool problem.

Again, I hope this is a crisis past.

Mike Richards, DVM
 
 

 

Chronic vomiting

Q: Dear Dr. Mike, We have a 9 year old male Lhasa/Terrier/Basset mix (Kirby) vomits at least once a week (primarily bile) up to daily. Kirby has seen two vets and has been given prednisone, amforal and digestive enyzmes to no avail. Kirby has been on several special diets such as Science Diet-ID and WD. There have been times when the situation requires we feed him only boiled hamburger and rice. As for Kirby's behavior-when he feels ok he is a pleasure to be around. If he starts snapping at us or our other dog we know a vomiting episode is imminent. This has been going on for four years and is getting progressively worse. Blood tests indicate no problems. We are at are wits end and close to putting him to sleep. Any suggestion?.

A: Mary- It would be a good idea to consider having an endoscopic examination with biopsy of the stomach and intestine (if it seems necessary during the exam). This is the most accurate way of assessing several situations involving vomiting, such as plasmacytic/lymphocytic enteritis, Helicobacter infection, lymphangectasia and other digestive tract disorders.

Your vet will probably have to refer you to a specialist in order to have this testing done. I know you have already done a lot for Kirby but it may be possible to make him comfortable and pleasant more often than he is now. Ask your vet about this.
Mike Richards, DVM
 
 
 
 

Chronic Diarrhea -Boston Terrier

Q: I own a Boston Terrier which is about 18 months old. Although normal in size at birth, it has never exceeded seven pounds, although it has always been pretty healthy and active otherwise. In the last six months, it has developed diarrhea and soft stools. Two vets have examined it, but both are at a loss (most recently, we did intestinal biopsies during a spaying, but the results were negative on the small intestine, and very slight inflamation in the large intestine). When the dog is placed on antibiotics (such as sulfasalazine) it seems to do better, but the problem returns shortly after the treatment concludes. She vomits occasionally, but just as likely on an empty stomach as a full one. I'm not aware of any environmental changes that may have brought on the condition. I've read your material on pancreatitis, and recognizing the symptoms are variable, it doesn't sound quite like this situation. The current vet is going to try cortisone, but my impression is that this is a 'trying to do something' effort. My wife is looking into acupuncture, which I don't know enough about to respond to (natural scepticism aside). Are there other digestive conditions in Boston Terriers or other purebreeds that might explain this condition, or other treatments we might consider or discuss with our vet? Thanks in advance for any insights you may have to offer.

A: The first thing I would like to say is that sulfasalazine is often used continuously for several months or more in dogs that respond to it. It is probably safer to do that than to use cortisones long term, but both can have side effects. Sulfasalazine is implicated in the development of tear deficiency and corticosteroids can suppress the immune system, cause increase in drinking, urinating and appetite, predispose dogs to pancreatitis and possibly to diabetes. Used carefully, these side effects can be minimized but still, they have to be considered when making a decision to use them long term.

There are A LOT of causes of chronic diarrhea. So many that I am sure I will miss a number of them in the following list, but here goes: malabsorptive diseases (anything causing an inability to absorb food, such as wheat gluten sensitivity or plasmacytic-lymphocytic enteritis), maldigestion syndromes such as pancreatic insufficiency, inflammatory bowel disease, intestinal parasites (protozoans, worms, coccidia), fungal infections (rarely), damage to vital organs such as the liver or kidney leading to secondary diarrhea problems, diabetes mellitus, hypoadrenocorticism, small intestinal bacterial overgrowth, cancer, ulcers, bacterial enteritis or colitis, cecal inversion and irritable bowel syndromes.

It is important to try to decide if this is a small intestinal problem or large intestinal problem. In small intestinal disease the diarrhea tends to be pretty large volume at one time but less frequent episodes of diarrhea. In large intestinal diarrhea the volume of diarrhea tends to be smaller but episodes are more frequent. Knowing which of these is likely to be the problem helps in deciding which tests to run.

In chronic diarrhea it can be very hard to find a diagnosis. The intestinal biopsies were are very good idea. It is too bad they were not more informative. It can take multiple fecal exams to find some parasites, particularly giardia and whipworms. There are pretty good blood tests now to aid in the diagnosis of pancreatic insufficiency (blood trypsin-like immunoreactivity, folate levels, it is always wise to do general lab panels to make sure other organ systems are functioning properly. It can be helpful to rule out food sensitivity/allergy using special diets (elimination diets). Culture of the stool will sometimes reveal a bacteria that is very likely to be pathogenic, such as Salmonella or Clostridium perfringens. Special cultures can be done for Campylobacter.

If sulfasalazine does help, that is a hint that the problem is likely to be in the large intestine. If biopsies did not include the colon it may be possible to obtain the necessary biopsy samples from the colon to make a diagnosis using an endoscope with a biopsy forceps. If this is not easily available where you are, I wouldn't be too uncomfortable just using the sulfasalazine (Azulfidine Rx) for 2 or 3 months and then stopping to gauge the effect.

I do not know if acupuncture or other therapies are effective for chronic diarrhea. In most cases, it is possible to find a cause for the diarrhea and to successfully treat it, if you are patient enough. You can tell from the long list of possible causes that it can be hard, though.

Good luck with this.

Mike Richards, DVM
 

 

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