Severely growth stunted puppy - need highest calorie food - no appetite

[Melissa]

Hi food group, I could use some advice. This is for a non-doodle but I know y'all are the experts on this kind of thing! I have 2 doodles that eat well - the are on canidae als. This puppy I acquired came to me severely undernourished and at about a fourth of the weight it should have been - poor coat still and no appetite. She's also had diarrhea off and on, sometimes explosive.

She's had stool looked at 3x by vet, never any worms or coccidea spotted. We just sent a sample off to the vet school lab to check for giardia.

She managed to refuse most food the first couple weeks I had her (weeks 10-12) and I did get her to eat by mixing orijen puppy kibble with the canidae als and hot water and topping with the chicken natures variety raw patties. She did eat about 60-75% of each bowl but her diarrhea got worse. Oh but she did almost QUADRUPLE her weight in about 6 weeks! She is no longer all bones but yesterday the vet said she's still too small and very little muscle for her bone structure.

She's had two short courses of panacur and metronidazole in case we were missing something in her stools and of course she firmed up temporarily while on the metro.

The vets advice is to find the highest calorie kibble she'll eat and stick with that only. He thinks she just has a damaged/immature digestive tract and it will improve with time and consistency.

She was also eating stools (hers and the big dogs! UGH!!!) and any mushrooms she could sniff out. Now that she's less starved looking the pica/copraphagia has diminished thankfully.

So what do you guys recommend? She hated the orijen puppy strangely enough. She'll eat a dozen pieces of kibble a meal but the vet said she ought to eat 3-4 cups per day of the canidae als going by the kcal! She's 19 pounds and probably should be about 40. She's 4 months old.

I'm willing to use any food on the list but if anyone has experience in this area I'd love to hear it. Thanks!

Eta that she checked out healthy otherwise at the vet and has boundless puppy energy.

[Karen, Jasper and Jackdoodle]

Well, the first thing I'd say is that she needs a good probiotic, after all that metronidazole. The good bacteria in her gut needs to be replaced for proper stool formation. 

But honestly, if your vet really said that "she just has a damaged intestinal tract", you need a new vet. A damaged intestinal tract is a BIG deal, there is no "just" about it, and if that's the case, it's interfering with her ability to process and absorb nutrients, regardless of what food they come from. And that doesn't improve with time; without treatment, it gets worse. She needs more than fecal testing, she needs bloodwork done to determine whether there may be a disease condition causing her stunted growth and malabsorption of nutrients. The fact that she has little appetite despite being "starved" points to a health condition and not just a case of not getting enough food. Do you know what breed(s) she is? 
I don't know of any kibble that is higher in calories than Orijen Puppy.
Can you tell me which Canidae ALS formula you are feeding, or what the calorie content is? 

[Melissa]

She is Bernese Mountain Dog. She's on proviable dc once a day. The canidae has 451 kcal/cup. That is actually a little higher iirc than the orijen!

This is the best vet I've found. He doesn't push overvaccination or rx diets. We did talk about doing blood work and I think he'd be happy to do that if I want but he says she appears really vigorous.

I talked with some breeders and trainers about liver shunt or kidney dysplasia but after watching her for ten minutes they've all said your puppy acts healthy as can be - not like any shunt puppy they've seen.

I don't think the vet thinks she has ibd or anything like that. Perhaps I didn't paraphrase it well. He thinks she had a poor start due to parasites or under feeding... and the food changes haven't helped. He thinks she needs time. But maybe he's too relaxed and non interventionist? He's the first vet who listens and doesn't push science diet.

But I agree it's just not normal for a puppy not to be hungry! At this point he's following her weight gain - she's done really well but we'd like to see her get closer to the size she ought to be. I guess what you're saying is she needs a full blood workup instead of watch-and-wait. Maybe I will see about a second opinion.

[Melissa]

Here she is with a golden doodle same age!

He is about 2-3x her size.

[Karen, Jasper and Jackdoodle]

This info about your vet makes me feel better. But a lot of GP vets are not well-versed in inflammatory bowel disease; that always requires a specialist for diagnosis and treatment. Hopefully, your vet is right and she just needs time.

Try the B12 injections. I'd give one every week for a month, and then maybe once a month until things improve. 

[Melissa]

Thanks, I will definitely follow up on this! I've never heard of it for dogs, only people!

[Karen, Jasper and Jackdoodle]

One easy and inexpensive thing you might do is ask your vet to give her a B12 injection. That can't hurt and may help. 

A little fish oil would be beneficial, too, but be careful with that, because it can cause loose stools in healthy dogs, and you don't need that! 

[Melissa]

Great ideas. Do you have a recommended brand?

[Karen, Jasper and Jackdoodle]

You could try the Nature Made human fish oil soft gels, they made a mini size that I've used. But anything should be fine. 

[Karen, Jasper and Jackdoodle]

Just remembered: Jack's regular vet, his dermatologist, and his physical therapy vet all recommend this company, and they make one for puppies: http://vrshealth.com/canine-products/early-omega-benefits/

[Melissa]

Thx for the recommendation. I actually have nature made capsules and the older dogs weren't impressed but the puppy ate it with her food, of course she had loose stools tonight but who knows why? I pushed her to eat a lot today so that could be it. The vet one looks good but ouch on the price. I'll try to use up the jar of human fish oil first maybe.

ETA it's hard to do this on my phone at this hour! :)

[Kat and Winston]

Origen puppy is high in calories but seems to be very rich and many puppies can't seem to handle it.

We had terrible GI issues with Winston since the week that we brought him home. We had to do a home cooked diet for quite some time because every time we added kibble the loose stools came back. When I didn't have time to cook him chicken I would use canned wellness beef/chicken. It has nothing added to it so you have to add your own calcium, which I bought some bonemeal from the vitamin store. We added to this oatmeal and pumpkin. He did well and started to gain a bit better and it gave his gut time to heal from its rough start. He'd had 5 negative fecals and two rounds of panacur just in case.

Slowly, we added in some wellness complete kibble and he gained two pounds in a week, but shortly after this  he started turning his nose up and walking away from it. I think part of it was he was teething and losing teeth and wellness kibble is very hard. I tried wetting it but that didn't seem to help.

So in desperation I started giving him some Royal Canin puppy for small dogs because he honestly just didn't have weight to lose while we waited him out. I felt like he'd already not gained like he should for the first four months of his life and was tired of the situation honestly. He was not the smallest boy in his litter, but he is the smallest now at least in weight by nearly 3 pounds. So even though I know that it's frowned upon big time around here, he could eat it and would. We used the small puppy formula because it has 430 calories per cup, so he didn't have to eat a lot to get his caloric needs and he's continued to gain and finally feels like a healthy dog. You don't feel the ribs so prominently and when we had him groomed recently he wasn't a starved looking puppy. 

We are now going to try and work our way back to Wellness since the majority of his teething seems to be complete and I've got him 100% on kibble so hopefully the fact he won't be going from the taste of real cooked meat to kibble will make it seem more appealing.

Anyways, I'd give the wellness a try if your pup will eat it. Winston's stools were very good on it. 

[Karen, Jasper and Jackdoodle]

There are a LOT of kibbles that are made for small dogs, and many of the companies on our recommended brands list sell them. The reason for staying with a recommended brand rather than something like Royal Canin is that calories are only part of the story; those calories need to come from high-quality ingredients. Otherwise, they're wasted.