Ongoing Bouts of Diarrhea

[Nicole and Teddy]

Hi all! I'm at my wit's end with Teddy and hoping y'all can offer some guidance. He had lots of issues with rounds of diarrhea when he was a puppy and we tried everything- multiple rounds of meds, changed his food a bunch of times and after switching to fromm's he had a really good spell- about 6 months of doing well. Well, now he's back to having a sick tummy. This is his 3rd round of loose, runny stools and waking me up in the middle of the night to go outside. The first round we chalked up to picking up something at the dog park and got him on meds and he did fine. About a week later, he got in the trash and of course had a field day. 36 hours later he was a mess- doc suggested putting him on another round of meds- we did that and he was fine. About a week later I started a new obedience class with him and was treating with bacon and cheese (which he's tolerated before but maybe not in such large quantities- oops?!). About 36 hours later, we had another bout on our hands. This is the most recent. Switched him to I/D food (which we have on hand in case of emergencies because he seems to stabilize on it) and he was doing well until we switched him back to the fromm's- sick again. Loose, runny stools, with the urgency to go. I just got off the phone with the vet and they recommended a round of pectolate (I am SURE i'm not spelling this correctly, but essentially it hardens the stool) and fortifor (again, sp? it's a probiotic though). They suggested using both of these with his regular food and if this doesn't work, we may need to think about IBD and switching food permanently- of course, they recommend I/D or W/D (Hill's) which I am really leery of. In addition to IBD concerns, I'm also thinking maybe he has some kind of food allergy? He has no other symptoms- playful and energetic as usual and no loss of appetite. I just want him to fully well again :( Any thoughts/suggestions? Thanks in advance!!

[Shari Becker]

Hi Nicole, 

I can only tell you my personal experience, but Lexi had a lot of trouble with her stomach, off and on for about a year until we figured it out. In the end, for her, it all comes down to what she does and does not eat. She has a sensitive belly and system and little things can set her off. She cannot tolerate grains well.  I use pumpkin and sweet potato mixed into her food off and on all the time, and I give her probiotics (Proviable) off and on all the time, too. I always have Slippery Elm on hand. If I see one sign of a stool that is off (esp. with mucus) I sprinkle Slippery Elm on top of her food. (Slippery Elm should not be used if the dog is on medication though because it can inhibit absorption.) She can only have treats that I approve and where I know the ingredients. We use Real Meat (brand), homemade livery jerky, fish skins, and sweet potatoes and that is IT. Occasionally I let her have a Mother Hubbard from our local bank. She's fine with those. She cannot tolerate any bully sticks, but she can do the yak sticks and those stuffed Marrows with peanut butter. 

As for food, we ended up settling on a mixture of Frozen Stella and Chewy's raw and Real Meat (brand) dehydrated. She was able to tolerate the Orijen 6 Fish with her belly, but for reasons we cannot explain, all kibble seems to give her yeast issues. I know folks here will argue that it is impossible, but that's what we found. 

My advice would be to put him on a diet of sweet potatoes / pumpkin and boiled meat with probiotics for at least a week. Let the stomach settle. If the stools start hardening up, it is working. I would avoid rice because if it is a grain issue, the rice will make it worse. After you've had steady, firm stools for a good week, I would slowly start introducing a grain-free, high quality (With few ingredients) food. Use lots of sweet potatoes or pumpkin the week you introduce the food. Honest Kitchen is excellent for dogs with sensitive stomachs, although we found that after a few months it was too fibrous for her. But it did what it needed to do, which was settle her stomach. 

If there is no medical problem with the dog, I would personally avoid using the medications because they could be messing with his gut and causing rebound issues....

[Nicole and Teddy]

Thanks so much for sharing, Shari! It's weird though and maybe I'm imagining things, but I almost think he has issues with the grain-free foods. We had him on Wellness, Blue, and Nature's Recipe (and now Fromm's), all of which were either sensitive stomach or grain-free, and he had issues. It made me think that the high-protein diet was maybe too rich for him? When he does have bouts and we switch him to the I/D (which is definitely NOT grain free :) he seems to do fine. He's also done well on a chicken/rice and carrot diet too though so I think now I am contradicting myself- ha! Either way, frustrating and I feel bad for the little guy!

[Shari Becker]

Karen knows a lot more about IBS than I do. So listen to whatever she says below! :-) You need to rule out illness first.

Lexi's issues are all food related, for sure. I manage her exactly how I described. She got food poisoning last winter after eating something off the ground, and she ended up in the hospital. Her belly is just so sensitive. 

However, it was Karen that pointed out to me that the treats I was using were making Lexi even sicker. So I would really look to what he is snacking on as part of this process. We were using Zuke's for class, and she would be so ill every Monday after a Sunday training class.

 

[Nicole and Teddy]

For treats I give him pet botanics bacon flavor, halo healthsome peanut/pumpkin cookies, and occasionally Sam's Yams sweet potato rawhide- this something seems to produce loose stools so I don't do a ton. But I have been wondering if current issues are a result of the food OR the bacon pet botanics. He also doesn't do well with the bully sticks though he loves them! 

[Shari Becker]

I would ditch the rawhide and bacon. These are very rich. Just use tiny bits of cooked sweet potatoes and the boiled chicken while you are figuring it all out. Lexi's favorite treat in the world is dehydrated beef liver, and it is so easy to make yourself, and I break it into tiny, tiny pieces. She goes nuts for it. When she is healthy, I give her pieces of apple, boiled broccoli or carrot stalks even tiny banana bits. Honest kitchen makes great dehydrated fish sticks that you can break into tiny pieces. Simple, simple stuff. But for now, I wouldn't do any treats other than sweet potatoes and the boiled chicken. We have found that boiled, lean ground beef works great for Lexi, too. 

[Karen, Jasper and Jackdoodle]

I agree with Shari. I'd stop all of those treats. I recommend only plain pure protein treats. Pure Bites is a good choice, it's nothing but pieces of freeze-dried chicken, turkey, beef liver, etc. 

Jack should have been able to tolerate Sam's Yams, but couldn't. Very hard dry foods like jerky or dehydrated sweet potatoes seem to be too hard for him to digest. 

[Karen, Jasper and Jackdoodle]

It's not that those foods were too rich for him, or too high in protein. It's that they were too complex, with too many ingredients. Dogs with digestive issues need limited ingredient diets. They also need diets that are low in fat and high in fiber. That's why Shari and I both suggested sweet potatoes and pumpkin, for the fiber.

Hill's i/d is full of garbage, but it does contain limited ingredients (mostly corn and floor sweepings- I'm not kidding, look up "brewer's rice") but it does contain more than 7% fiber, which is probably double the fiber in those foods you mentioned that you tried. 

[Shari Becker]

Karen is right. Part of why Lexi does so well on Stella and Chewy's is because it is a single protein, food.  Even her Real Meat food is essentially just straight beef, and when we started it this summer, she did have stomach issues. We had to go very slowly with sweet potatoes at each meal for about a week until her belly adjusted. Fiber is your friend! Sweet potatoes and pumpkin are your best friends in dogs with stomach issues. 

[Karen, Jasper and Jackdoodle]

Was Teddy on probiotics at any point during all of this? 

Multiple rounds of antibiotics in puppyhood, (most often metronidazole, which is most likely what Teddy was given) have been shown to cause bacterial imbalances in the gut. The problem is that the antibiotics kill off all of the good bacteria in the gut which is necessary for proper digestion and stool formation. 

Fortiflora is a probiotic made by Purina, which contains some really lousy ingredients. The fact that the vet is recommending it now and you seem unfamiliar with it leads me to believe that Teddy has not been on probiotics before. 

Probiotics are so important in digestive health that they have been shown in large clinical trials conducted at vet schools to lessen the need for drugs in dogs with serious digestive disease. 

One cause of chronic diarrhea in dogs is something called SIBO, or small intestine bacterial overgrowth, which is often a direct result of too many courses of metronidazole in puppyhood. For future reference, you always want Panacur when a puppy is suspected of having giardia or parasites, and should never give metronidazole without a good reason. Unexplained diarrhea is not a good reason.

You don't want Fortiflora. You want Proviable KP and DC. You can order them online. 

Probiotics MUST be given at least two hours apart from antibiotics, and longer is better.

Have the vets run fecals? It would have been nice to determine the cause of the diarrhea initially before prescribing repeated courses of drugs, especially for a puppy.

Your vets, like most vets, do not seem to be well versed in dog foods or even in treating IBD. Dogs with digestive issues & diseases do need a bland, limited ingredient diet, but not Hill's i/d or w/d. And dogs with Inflammatory Bowel Disease (IBD, an incurable immune-mediated disease, not to be confused with IBS, or Irritable Bowel Syndrome) need to be on novel protein diets or diets made from hydrolyzed protein, like Royal Canin HP. My Jack has it, as do several other dogs here, and Hill's I/D or W/D would put them in the emergency room. 

If IBD is being seriously suspected, Teddy needs to be in the care of an internal medicine specialist. The tests that will need to be run include an ultrasound, a GI blood panel to measure cobalamin, folate, and TLi, (this cannot be run by your vet, it must be sent out and costs about $250) and to definitively diagnose it, an endoscopy/colonoscopy. My costs for diagnosing JD ran about $4000. 

If this were my dog, I'd order the Proviable ASAP. I'd feed him a homemade bland diet consisting of 50% plain boiled finely cut white meat chicken and 50% baked mashed sweet potatoes until the stool firmed up. Then I'd switch him to a limited ingredient kibble containing a single novel protein (one he has not eaten before, like rabbit or kangaroo possibly) and a single starchy carbs, preferably not a grain. Some choices would be Acana's Singles line, any of Zignature's LID formulas, or Wellness Simple Solutions. If you must go with an Rx food, choose one made by Royal Canin, the ingredients are much better than those in Hill's or Purina. Royal Canin HP has worked well for many dogs here, and they also have some LID formulas including a rabbit formula. You must limit Teddy's treats to only the protein sources in his food, as well. 

I would also talk to the vet about Tylan. Tylan is a very benign antibiotic that is very helpful for many dogs with digestive diseases. All of the DK members whose dogs have been diagnosed with IBD use it. Much less harmful than metronidazole. 

If none of that works, I would schedule a consultation with an IMS. 

[Nicole and Teddy]

Wow- this is awesome info, Karen, thank you. He had fecals the first few times we had issues, but they never found anything. So since then, they've just prescribed the metronidazole. In his lifetime (he's 1 1/2), he's probably had 6-8 rounds total. I'm not feeling good about that and didn't want to administer anymore meds - hence my question to y'all. Need to get to the bottom of this once and for all. I did some research at one point and got him Great Life enzymes pro+ as a probiotic but it seemed to produce loose stool? Maybe it was from something else though...the vet recommended I give the probiotic with his regular food though to see if that did the trick. Would you agree or do you think I need to go the route you suggested with boiled chicken, probiotic, etc? Again, thank you!!

[Karen, Jasper and Jackdoodle]

OTC digestive enzyme supplements are by and large a waste of money and can often make the issue worse. That's what caused the problem with Great Life. And a probiotic needs to contain at least 5 billion live cultures per dose to be effective.

I personally would feed the homemade diet while the probiotics do their work. They don't work overnight, lol. 

What is his "regular food"? 

[Nicole and Teddy]

His regular food is Fromm Four-Star Nutritionals Chicken A La Veg Formula Dry Dog Food. Seemed to do well for about 6 months or so but now we are back to tummy issues.