Hunger / diarrhea issues

[Josh Adams]

Our almost 5 month-year-old puppy is always hungry. I realize this may be normal puppy behavior but his constant hunger has increased recently. We feed him Fromm Large Breed Puppy food on a strict schedule three times per day - 7AM, 11AM, and 4PM. We feed him the amount the bag suggests which is 3 1/4 cups per day. Sometimes we increase slightly if he has a very active day. We provide treats during the day when we're training (inside the house and on walks). Nonetheless, he begs for food between meals. I swear if we put a bag of food in front of him it still wouldn't be enough. Also, he eats a lot of grass and dirt in the yard and on walks. Our vet says this is all normal, but it doesn't sit right with us. Any suggestions?

The second issue is diarrhea. I posted about this issue a while back. We tried switching from Life's Abundance to Zingnature. We did so gradually mixed with a bland diet. That didn't go well so we started over and switched to Fromm LBP. His stools we're okay and he loved the food so we stuck with it. He still has diarrhea issues. About half his daily stool is formed, but the rest is soft, sometimes very soft (usually in the afternoon). We tried removing treats one day and it sort of helped but he still got soft stool once per day. We added treats back in because he was enrolled in puppy school and we couldn't go without treats during training. I ordered Proviable DC which arrived today. We'll start it tomorrow. I hope this helps. Would love advice if I am missing anything. I'll add that we had a stool sample done a while back and it came back fine.

Here are the treats we use for training:

- Cloud Star Chewy Tricky Trainers Liver
- Trader Joe's Beef Liver Begging Treats
- Trader Joe's Joes Chicken & Sweet Potato Flavored Dog Treats
- Vet One Neat Treats
- Occasional pieces of hotdog for high reward training
- NF Greek yogurt

[Josh Adams]

We're also concerned they will prescribe the Metronidzaole. They originally perscribed it a couple months ago even though the fecal was clear. We won't give it to him. I assume they're testing for everything. Is there something we need to make sure they test for? Appreciate all the guidance you've provided us.

[Karen, Jasper and Jackdoodle]

It's hard to say, not all types of fecal testing are equal. Ideally, you want to know if there are parasites and if there is a lot of bad bacteria. 
You could ask for a GI blood panel. It's very expensive, and it takes 5-7 days to get the results; they have to send it out. Some general practice vets are not familiar with it. But it could tell you if there is an absorption issue or a bacterial issue. 

[Karen, Jasper and Jackdoodle]

You could ask the vet about Tylan. If a bacterial imbalance shows up, that's a much safer and effective treatment than metronidazole, assuming that the fecal is not positive for giardia or parasites. 

[Stacy]

Karen, what do you think about Lomotil? Basically immodium for dogs? They gave that to Ava when she had diarrhea. Is it possible that some dogs just have nervous stomachs with no underlying disease? And would it be a terrible thing just to control the diarrhea? I feel like metronidazole is often prescribed because it does seem to address the diarrhea while they are taking it. The vets just seem to ignore that the rebound GI problems after stopping the meds are just as bad. 

[Karen, Jasper and Jackdoodle]

Metronidazole also has neurological side effects over time. :(
I think the cause of the diarrhea needs to be determined before you use anything. I've never used lomotil or immodium myself and would have to look into that. But basically, chronic diarrhea is a symptom of soemthing wrong with the digestive system. It's not a normal state, and it doesn't just happen. I'm not sure that dogs have "nervous stomachs" on a long term basis. Sure, something traumatic could happen that caused a dog to lose control of his bowels, or have sudden diarrhea. But once, not every day or every week for weeks or months. 

[Stacy]

I hate it when we hit the end of a conversation thread and can't comment further! 

Fair enough. And certainly in this case there is a problem that needs to be figured out and fixed. I just sometimes think that we have high poop expectations for our dogs. I expect my girls to have nice formed stools every time - and on a schedule! If someone had those expectations of me... (sorry, I'm a nurse. We're gross) Of course, if we ate the way our dogs do it might be a different story. 

My old vet used to hand out metronidazole like candy, no stool testing required. Katie has never had it, but Olivia took it several times before I knew better. It just shows that there is a wide range in the quality of vet care out there. I'm now a huge fan of finding the right specialist. It might cost more upfront. But getting a diagnosis and fixing it instead of just putting a band-aid on it is priceless.

[Karen, Jasper and Jackdoodle]

So would it fall under the category of TMI if I told you that I personally could meet those "perfect stool every time, on a schedule" expectations? LOL 
The thing is, that is what really is normal in a healthy individual. Well-formed stools on a regular daily basis, for dogs and for humans. And it shouldn;t be difficult to achieve. Chronic stool issues are indicative of a problem, whether with health or with diet. In puppies, it's usually a case of an initial parasite followed by improper treatment. The main culprit is usually a bacterial imbalance in the gut.
Yes, many vets hand out metronidazole like candy. I had one who did that with a previous dog. I couldn;t understand why the dog would get better for a few days and then get worse, and it never ended. 
I'm also a huge fan of specialists. And in the long run, getting the right diagnosis and treatment plan from the beginning saves money. 

[Stacy]

Not TMI, but I'm seriously impressed. In humans I feel like we have a lot of diet related issues. I would like to read a study that compared the constipation rates of children 20 years ago to today. I have a feeling the numbers would be off the chart! Blame it on only eating food that comes out of a box or a bag and doesn't expire for 10 years. But I do get off topic. 

Poor little guy. Hopefully he'll get sorted out soon. Chronic diarrhea has to be miserable for everyone involved. 

[Nancy, Ned, Clancy, and Charlie]

I know stress/over-excitement affects Charlie’s digestion as well as too many treats, too much variation in food, eating lizards and other variety of ‘stuff’. We didn’t have him as a puppy, but I’ll bet he had too many doses of Metronidazole.  Stress affects my digestion. 

[Josh Adams]

I've thought a lot about stress as a leading factor to his diarrhea (my husband and I don't agree on this). Our pup is generally happy, loves people and all dogs, but at home, he's sometimes moppy and yawns a lot / licks his nose. He prefers to be in the corner if he's not playing with us. My husband says "he's just tired" when he yawns constantly but I know that's not the case. 

Maybe his diarrhea/stomach is causing the stress which is worsening his diarrhea? Just thinking out loud now. 

[Josh Adams]

Wow, a wealth of information. Thank you, Karen and Stacy.

We made an appointment with the vet. Over email, they agreed it's time for another fecal exam. They also mentioned the possibility of a "food trial". I'll get more info. at the visit, but sounds like Rx food to me. So I am armed with information, what are the issues/concerns of Rx medication? 

Side topic but related to earlier discussions - this morning while playing at his best friend's house, he kept begging to go inside their kitchen to eat her food. He's done this before (successfully). He didn't get to it today but I literally had to peal him away from the bowl and begged him to come outside with me. Made me feel like I don't feed him! At least I know he has his appetite. But he still doesn't finish his own food (today he left half of it). Does this confirm that he's getting bored with his own kibble? 

[Karen, Jasper and Jackdoodle]

It's perfectly normal for a dog to be very interested in "new" food, especially if that food is not of the best quality; believe it or not, the cheaper foods (those brands that are not on our list) often use rancid fats to create more appeal to the dog. I'd also prevent that kind of thing from happening, for several reasons, not the least of which is his digestive issues. But there are other reasons, which leads me to your next question, which is about food trials and Rx diets.

Your vet, like many GP vets, appears to be thinking along the lines of a food allergy being the cause for your pup's digestive issues. But that's faulty thinking. For one thing, actual food allergies are extremely rare in dogs; only one out of 100 dogs has a food allergy. Food allergies are only the 3rd most common type of allergy in dogs, far behind flea allergies and environmental/inhalant/seasonal allergies. 
For another thing, a dog has to have been eating the same food on a regular basis for months if not years to develop a food allergy. It is almost impossible for a puppy under the age of 6 months to have developed a food allergy. 
A food trial is a test for food allergies. For 8-12 weeks, the dog is fed a limited ingredient diet containing a single animal protein and a single carbohydrate, both of which he has never eaten before. The more proteins your dog has been exposed to, and the bigger the range of ingredients, the harder it will be to find a protein that is "novel" to him or a suitable diet for the trial. If you pup has been eating other dogs' food, you probably have no way of knowing exactly what proteins he has and hasn't had, and this also includes treats. So you end up having to go with an Rx food that uses hydrolyzed protein. This kind of diet is ultra expensive and also nutritionally inferior; these products typically are filled with garbage, the cheapest ingredients imaginable, with a huge price tag. I personally wouldn;t do it unless you have an adult dog with a confirmed serious GI disease like IBD and no other options. 
There are commercial LID diets that use exotic proteins like goat, kangaroo, or alligator, which you can be fairly sure your pup hasn't eaten, lol. If you want to go with the food trial, I can help you find one of those. Zignature makes some. 
But since your pup's digestive issues have been going on since he was quite small, IMO there is zero chance of this being caused by a food allergy, and you'd be better off looking in a different direction, i.e. bacterial imbalance in the gut, parasites, etc.