Food Question

[Nancy]

Good morning.....I am a frequent reader of doodlekisses and have enjoyed all the wonderful photos and stories about our precious doodles.  I've only posted a couple of times due to my hectic and busy life.  As I post this morning, my 3 year old Oliver is in the doggie ER recovering from Hemorrhagic (sp) Gastritis.  Thank goodness he is doing great and he will be coming home this afternoon. For some reason I'm sure stupidity on my part, I was unable to post this in the Food Group.  First off I have to say that his worst symptom was upset stomach and vomiting and not the most common symptom of HG which is usually bloody diarrhea.  Although I'm quite sure his food was not the cause of this, my question now is should I continue to feed him what I have been feeding him which is Merrick Classic Real Lamb and Brown Rice or gradually switch him to a different food. I have in the past tried Grain Free recipes like Earthborn and Wellness and Oliver has been disgustingly gassy from them so for our sake, I would like to avoid Grain Free :) I have browsed the recommended foods and think I should make a change.

[Karen, Jasper and Jackdoodle]

If you change his food, it should be to a limited ingredient formula that contains a novel protein and a novel carbohydrate source, i.e. one that he has not eaten on a regular basis in the past. You need to look at the specific formula and not just the brand. I would stay away from lamb and rice, and any other animal protein sources he has eaten in the past, which would most likely include chicken.

Wellness makes a line of limited ingredient foods called Simple Solutions. There are two formulas which contain oatmeal as the carbohydrate source, so they are not grain-free. Unfortunately, one is a lamb based food, but the other is Duck & Oatmeal. This line has worked well for my guy and for other dogs with GI diseases. 

I would not rule out grain-free formulas. The gas may have been caused by something other than the grain content. It typically takes a few weeks for the dog's system to adjust to some grain-free formulas, usually due to the higher protein/lower carbohydrate profile.

Acana's Duck & Pear or Pork & Squash in their Singles line might be very good choices for Oliver.

If the GI issues continue, I recommend that you consult a veterinary internal medicine specialist, as chronic gastritis is a serious issue; it's a form of Inflammatory Bowel Disease. IBD can only be diagnosed through endoscopy and requires a combination of medication, diet, and supplements to get the inflammation under control and the disease into remission. I hope Oliver just had the one episode and does fine in the future.

[Nancy]

Hello Karen, Robin and Jill.....I am going to try to keep this as short as possible but now I am really mixed up and just want my Oliver well again!!!  2 weeks ago, I found Oliver chocking on a stick, I removed the stick and all seemed well for a couple of days until he began whining, panting, drooling and somewhat gulping air.  Assuming it was related to the stick, I brought him to the ER.  The doc did a visual check and could not see anything so he recommended sedating him and using to scope to get a better look, also took an Xray of his neck or stomach (I think).  The result of that was that his esosphgus was inflammed and he could see evidence of acid and going by his symptoms, he was experiencing severe acid reflux.  He prescribed Clavamax (antibiotic), Famotidine and Omeprazole.  Oliver did well for 2 days and my husband and I had to make a trip to Florida.  Our regular dog sitter came to stay at the house.  We left on Friday.  On Monday, Oliver began vomiting and did so approx. 8 times so I told my dog sitter to bring him back to the ER.  Now under the care of a couple of vets and my husband and I still in Florida, They did a complete blood work up, more Xrays.  He was dehydrated so they began giving him fluids and withheld food (which he didn't want anyway).  They discontinued the Clavamox and started giving him Cerenia (anti nausea), Sucralfate (ulcer and inflammation) and metronidazole (prevent diarrhea).  

).  The vet in charge said that they were treating him for GHE, and said they needed to keep giving him fluids and he needed to stay. I checked in with him throughout the day on Tuesday and was told that he was still nauseas but doing a bit better.  We flew home late Tuesday evening and visited him on Wednesday.  He was still showing signs of nausea, had a bout of diarrhea and was not interested in food so they suggested he stay and the vet wanted to do an ultrasound.  By this time, all bloodwork came back normal with the exception of an elevation of his red blood cells and the xrays showed no signs of anything such as pieces of stick.  I agreed to the ultrasound which didn’t show anything abnormal and he stayed overnight again.  On Wednesday, I brought him boiled chicken and he ate it and seemed interested in eating more.  The vet agreed to let him go home, prescribed the same 3 meds to take as directed and to slowly introduce a bland diet.  She gave me cans of Purina EN and Hill ID.  Oliver wanted no part of either so on Thursday I began giving mixing in boiled chicken and gave him small amounts throughout the day.  I did the same on Friday and around 6pm he began racing around the house, whining, panting and gulping for air again.  We suspected he was again experiencing an acid reflux attack and called the ER.  I spoke to a doc who reviewed his previous case and agreed and told me to give him 20 mg of famotidine and 20 mg of omeprazole.  Well after about an hour, he finally calmed down and was fine through the night.  This morning, I gave him the Famotidine and the Omeprazole and he seems to be doing ok.  I am going to hold off on food until later on today.  After doing some research on the computer I have found that at least for now, he needs to be on a low fat, low protein diet and canned food is better then dry kibble.  So I am continuing to research to find out what is best.  I am thinking I should try a salmon or whitefish with sweet potato.  Any thoughts??  I am also going to speak with his regular vet but unfortunately it won’t be until Tuesday about what she recommends for a diet.   

 

Here is what really gets me…….I think the first vet that treated him with the Famotidine and the Omeprazole had it right but that Oliver may have had a reaction to the Clavamox.  When he was brought back by my dog sitter and kept for 2 days, he was not given the Famotidine or the Clavamox and……………again he is having a problem.  Not to mention the $1,500.00 that it cost me for the 2 days that he was there.  Don’t get me wrong, I would pay anything to treat my Oliver but I feel like the 2 days that he was there, he may not have been given the correct treatment.  My dog sitter is coming again today as my niece is getting married and will be gone most of the day.  I just don’t want to leave him alone.  I would appreciate any thoughts that you may have.

[Jill, Woody & Maxi]

Thank you for explaining better…now this is just my opinion..but I think Oliver needs to have a swallowing study. On a rare occasion, an X-ray would show a splinter of wood…I believe that he would need to do a swallowing study..this is where they will make Oliver drink barium, and take X-rays while he is drinking it..barium is a liquid that will show up on X-ray..so if there is anything obstructing his airway..OR if there is a laceration in his esophagus, it will show up.

Luckily, Oliver has a good palate :) Hills and Purina are foods made of very poor quality ingredients. If I were you, I would boil a batch of boneless/skinless chicken breast and bake a tray of sweet potatoes..portion it off into containers, and I would try feeding him that for a few days..it is soft enough, as not to irritate his esophagus any more, and it is low in fat.

I'm not sure if you have veterinary hospital/university by you, but I would look into going to a more specialized treatment facility.  I do love our 24 hr emergency animal hospital here..but for treatment of an issue like this, I think I would prefer to go to a university.

Best of luck, and please let us know how things go

[Nancy]

I totally agree with the quality of Purina and Hills and very glad that Oliver wouldn't touch it.  Of course, timing is just not good right now because of my nieces upcoming wedding!  I did just boil up some skinless chicken breast and I will have my sitter offer him a few small portions for the day and hopefully all will be ok while we are at the wedding.  I'm not sure where you are located but Oliver was treated at Tufts Veterinary Hospital and University in Worcester MA.  It is supposed to be one of the best teaching Hospitals around, but unfortunately, "teaching" is the keyword here. Somehow, I think what the first Vet diagnosed got lost in the shuffle. He did do a "scope" and did not see any obstruction but did see alot of irritation and inflammation and began a treatment regiment for the acid but unfortunately it was not continued when he returned to the ER.  So far, this morning he is doing fine, keeping my fingers crossed that he will be fine for the day.   Thanks again :)

 

[Karen, Jasper and Jackdoodle]

Just seeing this. If they did a "scope", did they do biopsies? The type and location of the inflammatory cells dictates the treatment.  

[Nancy]

So I have thoroughly read the release papers and I guess I misunderstood, they did not do any type of scope, only xrays, ultrasound, and bloodwork. I have been only giving Oliver small  portions of boiled chicken 3 to 4 times a day as well as 20 mgs of famotidine and 20 mgs of omeprazole since yesterday.  He seems to be doing fine.  I am going to add some sweet potato to his next meal to see if he tolerates it. If he has a problem with it, I will definitely talk to his regular vet about the barium swallow.  Thank you so much for sharing your past experiences with me.  I'm hoping this is nothing permanent and just an irritation as a result of the stick chewing incident. I am disappointed in the differences of opinion of which he received while in the hospital, it is obvious that he needs the acid reflux medication and it should not have been stopped when he was admitted.  

What is ironic is that I also have a 12 year old cockapoo who suffered from acid reflux on a regular basis, nothing to do with eating sticks, but she does have allergies to certain foods like chicken and wheat.  I switched her to a low fat  low protein fish and sweet potato canned dog food (wellness).  She used to vomit bile on a regular basis and now she is fine.  My husband suffers from acid reflux as well!!  LOL 

[Jill, Woody & Maxi]

Oh good! I'm glad you have access to university hospitals..I believe the level of care, knowledge & technology (at least in my experience) was a lot better there, than at a privately owned facility. Also, it was much more affordable too!

[Karen, Jasper and Jackdoodle]

I agree with Jill on the barium swallow, and you want this done by someone who has the kind of equipment that takes "rolling" radiographs and not stills. That was my mistake when my regular vet suggested the swallow study, he did not have the right equipment, and we really didn't learn as much as we could. It should have been done at the specialty clinic. 

It is possible for a dog to sustain permanent GI damage from the ingestion of a foreign body. That's what happened to my guy. If the GI lining becomes damaged, or if inflammation causes ulceration of the lining, you have an immune response and that's Inflammatory Bowel Disease. In JD's case, he had eaten part of a smoked ham bone (US made, sold for dogs) which splintered, and one shard remained in his GI tract for weeks, unbeknownst to anyone. By the time he brought it up, the damage had already been done. His immune system had declared war. IBD is incurable, and the sooner treatment starts, the better, because 20% of all dogs diagnosed with IBD die of the disease, no matter what treatment is used. Treatment always involves some type of immunosuppressant drug, at least initially. Often the dog needs a new diet incorporating a novel protein as well. 

JD also did not have the typical diarrhea, but rather, lack of appetite initially followed by regurgitation of almost everything he ate, sometimes hours later. The food was not being digested at all, and he was slowly starving to death.

Unfortunately, this will not show up on Xrays or ultrasounds. The only way to know for sure is to do an endoscopy under anesthetic. I wish I had done it sooner. My regular vet kept trying various medications and homemade diets (no Rx food, he knew I wouldn't use that) and meanwhile, JD kept getting sicker. After 3 weeks of this, he became critically ill and the endoscopy finally showed us why. The inflammation and ulceration of his GI tract was so severe, his pylorus had become stenotic. Nothing was getting through. There were inflammatory cells and ulceration in every part of his digestive tract. :(

Regarding blood work or tests, my vet also ran what I believed to be full blood panels and nothing showed up. That's because he did not run the one blood panel that would have told us something: A GI panel. This is not something that most GP vets ever do or are even aware of. I have known of some who had to be told what is being tested. A GI panel is very expensive ($190 in my area) and must be sent out. It tests for cobalamin, folate, and something called TLI, and it is the one blood panel that can pinpoint GI disease. If the dog's cobalamin (B12) levels are low, that's a pretty strong indication of IBD. If the folate is high, that indicates a bacterial overgrowth in the intestines. Since an endoscopy runs about $3000, a GI blood panel is a good first step. 

I'm not telling you all this to scare you but rather to explain how important it is to get the right kind of treatment from the right kinds of vets (internal medicine specialists) in cases of GI inflammation. 

[Nancy]

Hi Karen,

So here we are on Monday and Oliver seems to be doing fine.  I have been giving him 20 mgs of famotidine each morning 1.5 hours before he eats and then feeding him boiled chicken and sweet potato, about 3/4 of a cup 3 times a day.  I also give him 20 mgs of omeprazole on an empty stomach.  So now I am unsure of what direction to take.  If he is doing well, do I have more tests done such as the barium swallow?  I will make a call to his regular vet tomorrow but was wondering what you thought.  I would also like to see if he can tolerate kibble dog food but I am not sure if it is too soon and should I continue to go for a lower fat and lower protein food.  

I'm sorry that you have had such medical issues with your dogs and hopefully all is well now.  I only wish our pups could just tell us exactly what is going on.....they are so smart so I guess I'm just expecting too much!!!

[Karen, Jasper and Jackdoodle]

Three-quarters of a cup of boiled white meat chicken and sweet potatoes contains approximately 150 calories, so if this is all Oliver is eating, he is only getting 450 calories per day, which is not enough for a dog over 20-25 lbs. 

I do think it's time to see if he can handle kibble again. I'm pretty sure your vet will agree, although she will probably disagree about what brand of food to feed him. 

I'm not sure where the idea of a lower protein food is coming from, but there are very few health issues in which a low protein diet is ever a good thing for a dog. I would forget about the idea of lower protein and lower fat, and focus on a limited ingredient formula. If he were my dog, I'd get a small bag of Wellness Simple Solutions Salmon & Potato, and start adding a small amount to the homecooked diet, increasing the kibble and decreasing the homemade food a little bit each day. The Wellness food has a very low fat content and a fairly low protein percentage as well, so it takes care of those concerns, too. 

I don't think you need to have any more tests run unless the vomiting or other GI symptoms return. 

Thank you for the good wishes for JD. He is stable thanks to a very careful and structured medication/diet regimen, but unfortunately, IBD is for life. :( 

[Nancy]

Hi Karen,

I just wanted thank you for your advice!  Oliver is doing much better!  I picked up a bag of Wellness Simple Solution Salmon and Potato and began mixing that with the boiled chicken and sweet potato.  I have him up to 1 cup of the kibble mixed with a bit of chicken and sweet potato, twice a day and no signs of acid reflux.  He is still getting 10mgs of famitidine first thing in the morning and his vet said I should continue that through the weekend and then every other day for the next week.  So she also said that I could go back to the lamb and rice kibble but I'm wondering if I should?  She agreed that his problem was most likely not food related but probably tissue damage from the stick, which I tend to agree.  Just to answer your question about the lower fat and protein, the vet said that foods with a higher fat and  protein can increase the amount of acid in some dogs stomachs.  Again with the problem not coming from food, now that he is better, the lower fat and protein would not be necessary.  So what do you recommend I feed him once he is weaned off the boiled chicken and sweet potato?  

[Karen, Jasper and Jackdoodle]

I'm glad to hear that he's doing better. 

I would keep him on the Simple Solutions for now if he's doing well with it and likes it. It's a good quality food, and might help things calm with his digestive system. 

The protein content is the same as the Merrick formula you were feeding, so it's no lower in protein. It is lower in fat, but that's not a bad thing. :)