GI Issues

[Cynthia Shoe]

Hi Folks, 

We got Lambeau a year ago, when he was 8 weeks old. Since then, we have struggled with diarrhea and vomiting issues every few months. The vet has done all sorts of tests on different occasions and has never found anything of concern. In the past we have been prescribed a few medications and it seems to have worked. We moved off of Purina Pro Plan to Fromm Puppy in January and from Fromm Puppy to Fromm Chicken Ala Veg in May/June. In July, he got extremely ill (vomited 5 times in an hour) couldn't keep down water and was lethargic. He spent the weekend in urgent care with an IV and blood, fecal, and x-rays concluded nothing. We were not prescribed anything (although they gave him an anti-nausea shot that he freaked out on) but Hill I/D food and to keep him off kibble for a week. We did that, gave him pumpkin, sweet potato, steamed chicken, and eggs for a week (he loved it) and all was well. Over the past few days, Lambeau has been waking up in the middle of the night with vomiting and diarrhea. Nothing has changed and there is nothing we can identify that he might have eaten. He is acting normally (for the most part) and keeping down water. We kept him off food for 12 hours, and I made him an egg and that stayed down. I then gave him some sweet potato but he threw it up about an hour later. I know he is hungry (because he is begging for food and pushing at the kibble container and he never does that). I hate bringing him back to the vet to do the same test and have the same lack of results. Any ideas on underlying issues or concerns we should ask the vet about? Some one mentioned Addison's disease one... Or iIf it seems just like a GI sensitivity, would a probiotic help? If so, what one? I feel so helpless when he is sick. 

[Karen, Jasper and Jackdoodle]

Cynthia, did they do an ultrasound?  What kind of medications did they give you? Was he ever given a probiotic? 

There is a blood test called a GI panel which must be sent out to TAMU and takes about a week to get results. It's also fairly expensive. It tests only three things: cobalamin, folate, and something called a TLi ratio. You might ask for that. 

Have they ever given you Cerenia for the vomiting? 

Is he drooling and/or smacking his lips a lot? Do you notice any unusual noises from his gut when he drinks water? 

Regarding his food, I'd put him on a limited ingredient diet, preferably one with a protein source that he hasn't had on a regular basis before.

Probiotics are usually very beneficial when a dog has been on antibiotics, especially metronidazole. 

[Cynthia Shoe]

Hi Karen, 

We have never had an ultra sound. Back in July when he had a particularly terrible episode (he couldn't even keep down a sip of water) they did xrays 3 times over 48 hours. They did offer an ultrasound at that time, but for some reason all three ultrasound techs were gone (4th of July weekend). He seemed to be fine a few days later.

We have never given him a probiotic, but it is something I am happy to do! Do you have brands you recommend?

We have not done a GI panel, but have an appointment today at noon, so I can discuss that with the vet.

We have had Cerenia for car sickness, but have not used it since around Easter. They discussed Cerenia back in July, but apparently the xrays were showing some gas and diarrhea, so they didn't want to give him anything which would prevent him from eliminating that. 

He was licking his lips right before vomiting the past few days. I actually knew he was going to vomit before he did based on that. I have never noticed that before. And I noticed a bunch of grumbles yesterday in his belly, but he is hungry. It isn't something I have noticed before. He isn't really a gassy dog either. 

[Karen, Jasper and Jackdoodle]

Antacids can be very helpful for some of these issues, too. Jack's IMS recommended generic Zantac, some vets prefer Pepcid. They're also a good idea any time a dog is on prednisone. 

I'm still wondering what meds they've prescribed for him in the past. If he had metronidazole or any other anitbiotics, a probiotic should have been used too. 

[Cynthia Shoe]

I just opened the drawer of empty bottles and this is what he has had in the past: 

-Metronidazole 12/1/15

-Metronidazole 12/24/15

-Cerenia 12/24/15 (we also used this in April when we traveled for Easter)

-Metronidazole 1/15/16

-Rimadyl 1/15/16

-Simplicef 1/15/16

-Famotidine 7/9/16 

-Zofran injection 7/8/16 - this did not go well... 

[Karen, Jasper and Jackdoodle]

Okay, so repeated courses of metronidazole with no probiotics often causes a bacterial imbalance in the gut, and that can lead to chronic GI problems, especially in puppies. This in itself could be the problem. Rimadyl is extremely hard on the stomach, and can cause ulceration, which can also lead to chronic GI problems. Simplicef is another strong antibiotic and a probiotic should have been given with that as well. Vomiting is one of the side effects. The famotidine is just generic Pepcid, and it's too bad he didn;t get that earlier. :)

There have been a number of dogs here with chronic diarrhea that was caused by a bacterial imbalance from repeated courses of antibiotics, and the best way to deal with that is to start him on a good probiotic. Typically, I recommend Proviable, but in this case, I'm going to suggest that you get some VSL#3, which is a human probiotic that has worked wonders for some dogs with serious GI disease. You can buy it w/o an Rx at some human pharmacies. I get it at CVS. Call around and ask if anyone carries it in your area. You want the capsules, not the "sachets". Expect to pay about $50 for a bottle of 60 capsules, and plan on going straight home with it, as it must be kept refrigerated.

From what you've said, at this point I think it would be worthwhile to have your vet run the GI blood panel. It may rule out the more serious GI diseases. Depending on what that shows, you could then do an ultrasound. But I think it's possible that all Lambeau needs is a simple, LID diet and a couple of months on the VSL#3 to get a good strong colony of beneficial bacteria established in his gut. 

[Cynthia Shoe]

We just returned from the vet. They gave him an injection of Cerenia and Famotidine and are hoping for a stool sample, if he can provide one. We discussed IBS or protein intolerance and they indicated maybe putting him on a Kangaroo diet (which is prescription) or one that was a hypoallergenic chicken. They said they would call in a few days with information, but did not provide brand names at this point. I also left with a bottle of Metronidazole and Famotidine. I asked about probiotics and was told they didn't want to give him too many things at this point. I am wondering if I should skip the Metronidazole and just do the Cerenia and Famotidine for a few days and if he doesn't vomit again and start the probiotics... 

[Karen, Jasper and Jackdoodle]

If he were mine, I wouldn't give metronidazole again at this point, especially without probiotics. I would also make sure that they understand the difference between IBS and IBD, and which they are talking about. IBS is Irritable Bowel Syndrome. It's basically a nervous stomach. There are no diagnostic tests for it, and it's controlled with diet alone. IBD, on the other hand, is Inflammatory Bowel Disease, which is a serious immune-mediated disease similar to Crohn's Disease in humans. It can be managed in 80% of cases, but never cured. It is almost always diagnosed and treated by an Veterinary Internal Medicine Specialist, and requires an endoscopy or colonoscopy to definitively diagnose, although some tests (GI panel and ultrasound) can point you in that direction. If your vets aren't clear on this, I'd find an IMS NOW. 

There's also no reason to buy Rx food from the vet to do a controlled food trial. There are LID formulas available with novel protein sources such as alligator, kangaroo and rabbit. Of the Rx diets, the best one for GI issues is Royal Canin HP, which is a hypoallergenic hydrolyzed protein diet. Again, if your vet is not aware of this, I'd see an IMS sooner rather than later. 

[Karen, Jasper and Jackdoodle]

Another good discussion by a member whose dog was diagnosed with IBD: http://www.doodlekisses.com/group/healthandmedicalissues/forum/topi...

[Cynthia Shoe]

Thanks so much. I think I said the wrong thing. I said IBS to the vet, but she was saying they would need to do a biopsy to determine if there was a IB disease. I think she understood what I meant to say. At this point, my gut is telling me to stay away from the metro unless we get a stool sample and find out something else is going on. They didn't give us the metro in July and things cleared up with the Famotidine, chicken, and sweet potato diet, so I want to repeat that. Then once he feels better, I will get him on a probiotic. If this happens again, I will schedule with the IMS. The good thing is, we have the #2 vet teaching hospital down the road. I just looked and they have an internal medicine unit with almost 30 people working in it, so I bet if we need to go down that road, we can find answers there! Thank you so much for your advice. I will keep folks posted. 

[Karen, Jasper and Jackdoodle]

This sounds like a good plan, Cynthia. Please do keep us posted. I hope things improve for Lambeau. :) 

[Karen, Jasper and Jackdoodle]

Oh, and for now, I'd consider feeding a 50/50 mix of plain boiled white meat chicken, cut very fine, and mashed sweet potatoes. An alternative would be a canned LID formula. Wellness Simple Solutions makes one, as well as Wild Calling, and both are also available in kibbles for after things improve.  Wet food would be preferable to kibble right now because of the high moisture content. 

[Kamela & Beckett]

Years ago, when our mini schnauzer was young (and we lived in a different house), we had a similar issue. Seemingly unexplained bouts of diarrhea and vomitting. After the fact, we deduced she may have been eating spiders. That house was s breeding ground for black widows and our vet used to call her a champion floor grazer. She would patrol the borders, corners, every nook and cranny of the kitchen hoping to find a morsel of dropped food. As she was young and indiscriminate, we think she may have been scarfing up spiders living under the edges of the cabinets, in corners, etc. Lambeau's issues may be completely unrelated, but you might check your house for spiders. Also, do you spray pesticides? Our dogs like to eat bugs out in the yard (you'd think we don't feed them!) If pesticides are being applied, could he be eating poisoned bugs??