Sensitive gut issues!

[Mary]

Hi everyone,

My puppy, Belfi, is 7 months old now. She had a sensitive stomach since we had her at 2 months old. We had couple of stool samples early on but nothing was detected. But her problems got worse a couple of months ago.

She got very soft and smelly diarrhea. After she started vomiting, we took her to a vet on Sunday. Her giardia test came positive in the middle of February. The doctor put her on Metronidazole  for 10 days, I know now that was a mistake not to add panacur. Per suggestion of Karen and others here, I started giving her probiotics to help her gut. After going back to her normal food, Orijen puppy, she was good for about 2-3 weeks after.

In the middle of March, we went to NY, also taking Belfi with us, where she started having this phase of diarrhea. It was worst than anything she had before, just water and she had to go every hour or so during the night. She also vomited couple of times. Imagine all that in Manhattan! We took her to the vet the next morning and she did some blood test, x-Ray, ... , but she did not really find anything. She later said she might have colitis. She again prescribed another round of Metronidazole to lower the inflammation. When we came back we took her to her regular vet, he also agreed that she should have gotten panacur at the first place and probably should not start on Metronidazole for a second round. He prescribed a five day course for panacur in addition to finishing Metronidazole which we started right away. She was good after that and I continued with probiotics and again transition to her food from bland diet and she was good on orijen for a while.

Then again at the beginning of April, she started to have the same watery diarrhea as before. We took her to the vet, they took an x-ray again, nothing found but the vet said that she might have colitis. They yet again prescribed another phase of Metronidazole and also royal canin GI prescription food. She got better right away while she was on the medication but couple of days after she was done it all started again. We took her back to vet yesterday again, he gave yet another round of Metronidazole and also panacur. This time we are supposed to stay with the GI prescription food and not transition to her normal diet after she is done with Metronidazole to see if she just have very sensitive gut or not. He said if the diarrhea returns then we would send a stool sample to a lap to do a complete test on it.

To be honest, I think the doctor does not really know what to do, because she looks and act healthy otherwise, she is not lethargic and the whole time in vet she want to play with people and any dog she sees.  

Anyone here had a similar experience? Any recommendation? I am completely lost here!

  

[Karen, Jasper and Jackdoodle]

It sounds like Belfi may have Inflammatory Bowel Disease or a bacterial overgrowth in the small intestine. Dogs with IBD and/or SIBO can act perfectly normal, and have prefectly normal bloodwork, and the disease will not show up in an Xray. It can only be diagnosed through endoscopy, which is very expensive and invasive, but there are some tests you can run that will point in that direction.

Ask your vet do run a GI panel. This is not part of the usual blood work that most GP vets do. It must be sent to TAMU and takes about 5-7 days to get results. It tests for only 3 things, cobalamine, folate, and something called TLI. 

Ask for an ultrasound to see if there is any thickening of the bowel wall. 

There is an RX food that uses hydrolyzed protein, Royal Canin HP, which is much better than the one your vet sold you. Ask for that. The alternative would be to find an LID (limited ingredient diet) that contains only a single protein that she has never eaten before. The Zignature line might work for you. 

While on Rx or LID food, the dog also cannot have any treats that contain any kind of animal protein that she has ever eaten before. She can only have proteins that she has never eaten and therefore cannot have developed a sensitivity to. Look for treats that are pure rabbit, kangaroo, venison or duck (assuming she hasn't had those), those should be okay, but pick only one. If she does have IBD, you are going to need to find others that she's never had. 

Ask your vet about giving her Tylan, which is a very benign drug that helps many dog with digestive problems. it usually must be compounded. 

Pick up a bottle of VSL# probiotics, which is a human probiotic sold in many drugstores. Call around for it. It must be kept refrigerated. It's also pricey, but it is a lifesaver for dogs with GI issues. It has also been extensively studied in dogs and is very safe. 

Most GP vets will not be familiar with the protocol for diagnosing IBD and may not even have heard of some of what I mentioned above, which is why I recommend that you consult an Internal medicine specialist (IMS). Ask your vet for a referral or use the ACVIM website: http://www.acvim.org/

It's very very common for puppies who have been on repeated courses of metronidazole to develop digestive problems, and the most common pattern is exactly what you describe: The drug kills all of the good bacteria in the gut necessary for proper stool formation. Whenever the drug is discontinued, the symptoms come roaring back. 

Please read through the following discussion, it has a lot of information on this: http://www.doodlekisses.com/group/thefoodgroup/forum/topics/an-upda...

I hope this helps and you are able to get a handle on Belfi's issues.

[Mary]

Thanks a lot Karen! Very very useful. The good thing is that Belfi has a very good insurance and we can do all necessary tests without thinking about the cost. 

I want to go and get some of the Zignature food, as she still after getting the new metro has diarrhea. Couple of questions, she had not a lot but a bit of duck, venison, and rabbit as treats, would that be a problem? Would you recommend switching completely to that right away or should I follow the transition method?

Thanks a lot, these are supper useful, unfortunately I have to wait until Monday ... I should go find VSL as well, does CVS carry it regularly?

[Karen, Jasper and Jackdoodle]

I buy VSL#3 at my local CVS, but not all stores will have the capsules (it also comes as a "sachet", which you don't want), so call first. If your local CVS doesn't have it, they can probably order it for you. Remember that it must be refrigerated, so you can't pick it up on your way to work, or doing other errands. 

It's really best if you do a diet change to switch cold turkey, in these kinds of cases. And it would be best if the food contained a protein that she's never had, or at least hasn't had for a long time. Has she ever had pork? That might be an option. There's also a kangaroo formula. 

[Mary]

Thanks a lot! I hope she gets better, I just gave her VSL#3 and Zignature duck! Fingers crossed!

Costco had it in stock :) 

[Mary]

Another question, she loves chewing on bones, should I take them away or they are fine? There are no meat left on the bones! 

[Karen, Jasper and Jackdoodle]

What kind of bones? Is she actually ingesting anything from them? 

[Mary]

It is: https://www.chewy.com/merrick-corporal-cap-dog-treat/dp/37516 

I am not going to give her any new one, but the ones she already have eaten all the meat off is just the bone but she likes to just chew on them!

Also are the antlers safe?

Karen, thanks a lot again, I cannot thank you enough! Belfi actually had a formed stool today. And she loooves the duck!

[Karen, Jasper and Jackdoodle]

It's really, really important right now that you not give her anything at all that can be ingested other than her food, unless it is pure (no other ingredients) duck, or a pure vegetarian treat like a sweet potato chew, also with no other ingredients. 

If she is not getting anything - and I mean, not a crumb- off the bone, I suppose there's no harm in it, but I would supervise like a hawk. 

The best chews for dogs with digestive problems are non-edible extra durable Nylabones. This is the one that was recommended to me by Jackdoodle's IMS: https://jet.com/product/detail/c052f6fe1e364ddd97abd83935687e4f?jcm...

Regarding antlers, it depends on what kind of chewer Belfi is. JD can have whole elk antlers because he only gnaws and scrapes at them; he never tries to bite them or break off a piece. They have to be the big ones and they cannot be the split kind. Again, if you try this, you must watch her like a hawk. 

[Mary]

Thanks, I am glad I asked! Otherwise, I guess duck would have been out of the picture too! 

[Karen, Jasper and Jackdoodle]

Well, since she's eating a duck-based food, you need to stay with that single protein.