Digestive Problems of Dogs 2

Clay colored stools

Question: I have a one year old Australian Cattle Dog, spayed female, that has had clay/yellowish stools for the past couple of weeks. Nothing else seems to be out of the ordinary and there have been no changes of diet (she eats Pro Plan Chicken & Rice) etc. She is on Interceptor HW prevenatative. Is this color of stool anything to worry about? Can it be a symptom of something? What, if any, tests should be done? She has a terrible habit of eating the feces of some of the other dogs and searches out the rabbit feces in the field. Could this be a cause? Any info/help will be greatly appreciated. Thanks, Karen

Answer: Karen- Clay colored stools can occur when dogs or cats have deficiencies bile production or obstructions to bile flow. This may be a transient problem or it may indicate a serious problem. If the stools are still clay colored at this time and you have not already talked to your vet about it, I think it would be a good idea to do so. A general blood chemistry panel, liver function tests, X-rays, ultrasound examination, liver biopsy or exploratory surgery may be necessary to make a diagnosis -- but all of that would depend on what your vet finds on the examination and each test as you go along the diagnostic process. Eating rabbit feces can be source of infection with campylobacter and probably other bacteria but this probably is a rare occurrence. Many of my patients exhibit this behavior and we do not see problems in most of them. The same is true for eating dog feces, along with the risk of viral illnesses and intestinal parasites. It is a good idea to occasionally check for parasites in dogs that have this habit. Hopefully, this has cleared up and there isn't a problem. Mike Richards, DVM 11/6/2000

GI problems - IBD or Pancreatitis in fila brasileiro

Question: Dear Dr. Mike: I am a new subscriber. I have a fila brasileiro who is almost 4 years old. I adopted him 2 years ago when I had an immediate need for home security that my 2 springer's were not providing. He integrated beautifully to our household and is a treasure beyond words. I have never felt or been so safe, either! The breeder consented to the adoption because of several issues, the relevance of which will become apparent. His mother was a past international champion who died in a routine veterinary procedure. This caused the rural breeder to "fall out" with the local vet. When my fila, who was the pick of her last litter to carry on the line developed a problem with his hind end --not able to push up from sitting or laying down -- the breeder assumed "wobbler's" syndrome and put him on prednisone which was obtained from a relative who worked in a pharmacy. My first project was to get him off the pred. I took him to my vet who is not only a DVM, but practices chiropractic, acupuncture and naturopathic. All that she discovered was a torn ligament in the stiffel. I weaned him off the pred, supplemented with glucosamine chondroitin and his gait completely cleared. there were only two minor issues that concerned me. Every week or so, he would refuse food for up to two days. I didn't push it because I assumed the dog was listening to his body. Also, he had gas like a methane bomb, particularly after bedtime. He sleeps at the foot of the bed. When took him for his annual to the vet I use for normal issues, I mentioned the gas. The vet suggested I change his food from the Eagle pack dry and canned I was feeding him to Eukanuba. The gas went away but within a month, he developed an infected callous. Two ten day rounds of Primor. The next month, impacted anal gland (10 days on Baytril), then another infected callous. At that point, the vet recommended I take him to a dermatologist and said that he was also antibiotic resistant. Then an eye infection. I had been away when the eye infection occurred and the sitter did not notice it. The sitter also switched the feed to Nutro. I had to be away again for an extended period, so I brought the dog with me. I took him the the local rural vet where I am visiting whom I have known for 15 years. We did 10 days of Keflex, Optiimmune, and a topical antibiotic. The day after the Keflex was completed, he developed a cough. This was over a weekend. He was not eating at all at this point and would not get up. That Saturday evening, I syringe fed him warm chicken broth. Sunday, he was a little better and ate a bit of food. That Monday, the local vet did blood work and his amylase was at 1889 U/L. He had also lost 10 pounds. (Normal weight, 170, down to 160 in 2 weeks.) She suggested pancreatitus was a possibility and prescribed flagyl, pancryzyme and told me to feed him chicken and rice or hamburger and rice and said that pancreatic dogs seemed to love cottage cheese. He does not like red meat. Two weeks later, April 24, his amylase had returned to 660 U/L. He had also put on 4 pounds. She said I would have to cook for him the rest of his life which I have no problem with. Also, he would be prone to pancreatic episodes and that rich "people" foods could be life threatening. Since I eat a very clean diet, there is really no possibility of him getting anything like that. Currently, I am pressure cooking chicken thighs and mixing this with steamed rice. He will eat this for a few days and then shun it. I then go to turkey/rice and cottage cheese for a couple of days until he accepts his chicken again. The only food the dog has "stolen" has been apples. Prefers organic royal galas but will eat a golden delicious in a pinch. Spits out red delicious. (?!?) Twice, when I have been cooking his chicken, he has come in the kitchen, smelled it, and promptly vomited clear fluid. Once, hours after a meal of turkey breast and cottage cheese, we were "playing" and as it was his turn to chase me, he stopped short and vomited clear fluid with a small amount of cottage cheese, curds in tact. It upset him and he sat down. His stool has returned to normal. At last, what is my question? 1. From reviewing all material on your web site regarding pancreatitus, the dog should go back to a normal diet as soon as possible. What is a normal diet for this dog? I believe the Eukanuba which is not nearly as clean as the Eagle Pack triggered the inflammation. Switching to Nutro only complicated it. His "gas" has been minimal except for the last few days and it has smelled very acidic. When his stomach gurgles for prolonged periods, I give him a flagyl. Should I continue cooking him chicken and rice? Because you mention that people trigger major pancreatic episodes by enticing their animals who are not eating with things like bacon grease, could I be doing the same thing when he refuses the chicken by substituting turkey/rice and/or cottage cheese? Should I give him access to apples? Carrots? Supplements? I discontinued the glucosamine chondroitin ages ago because I thought it upset his stomach. 2. Could the infections be related to the pancreatitus? His skin is fine right now. This has been the longest period without any infections since the fall. I did not mention that he also had bad acne that has completely cleared. I reviewed your section on Cushing's disease and the only common symptoms he has are the skin infections and his callouses are very large and stay a little inflamed. Do I need to watch for this or have further testing? 3. I cannot tell you how remarkable this animal is. I really wanted to breed him and my most knowledgeable and devoted dog owning friends have all said, without solicitation, that if I ever were to stud him, they want a pup. So do I. Should I not breed him based on this health issue? I thank you for your patience and look forward to your reply.

Answer: Mary Ann- I think that it might be best to just sort through the problems individually and then try to sum them up. It would not be unusual for a large breed dog to have a lot of difficulty rising with one cruciate ligament damaged. Especially if there is a problem with hip dysplasia, spinal discs or lumbo-sacral instability that would make any additional weakness in a limb more important. Since your Fila recovered well from the episode of lameness it is reasonable not to worry about this problem in the overall history, right now. Pancreatitis can not be reliably diagnosed by elevation in amylase levels alone, although clinical signs and supportive evidence of a rise in amylase to levels at least twice the normal value for the laboratory running the blood sample is pretty suggestive of this condition. Amylase levels that are between the high end of the normal value and twice the normal value are more difficult to evaluate. Amylase can rise when kidney function is compromised and probably occurs in some inflammatory bowel disorders and liver disorders. However, any rise in amylase level has to be considered at least suspicious for pancreatitis. When there is a question about whether an amylase level represents pancreatitis, or not, testing for serum lipase can help, as this enzyme level correlates a little more accurately with pancreatitis in dogs and serum trypsin-like immunoreactivity levels that are elevated can also be a strong indication of pancreatitis. Even with very good supportive evidence from clinical signs and lab values, the only sure way to know if pancreatitis is present is to do pancreatic biopsies. For most patients this degree of certainty is not required and the risks associated with surgery are not justified as a means of definitively diagnosing pancreatitis. I went through all of that for one reason. It is not possible to say for certain that your Fila had pancreatitis and therefore, planning a whole lifetime of dietary restrictions around this one episode of disease may not be necessary. However, the dietary recommendation that is most consistently made by nutritionists and internal medicine specialists is to use a low fat diet to try to prevent future episodes of pancreatitis. As you noted, our clinical experience, which does not constitute anything close to scientific testing, suggests that it is better for most of our patients to return to their normal diet than to try to make a lot of changes while they are recovering from pancreatitis. This is NOT the recommendation of most veterinary nutritionists, though. Nutritionists typically advise feeding highly digestible foods for a couple of weeks while a dog is recovering from pancreatitis and then switching back to the normal diet, or in some cases, just continuing with the highly digestible diet or with a lower fat diet or other "therapeutic" diet. After things seem stable, we do sometimes encourage a switch to a moderate fat diet, especially if the patient is overweight. Some veterinarians also think that moderate increases in fiber in the diet are helpful but I am not aware of much evidence to support this claim, in the case of pancreatitis. If pancreatitis was not the original problem you may need to go on and continue to try to identify another problem. Metronidazole is frequently used in inflammatory bowel disease and it works well for this purpose in many dogs. It is conceivable that the treatment may have worked well but for a different condition than was initially suspected. Pancreazyme is helpful in some cases of inflammatory bowel disease, as well. This may or may not be a problem --- it is just that I don't think that there is concrete evidence for any particular problem, at this point in the clinical history and diagnostic process. Manipulating diet can help with a lot of GI problems in dogs, including inflammatory bowel disease and flatulence. I think that you need to work towards some sort of balanced diet at this point. I would probably lean towards a limited antigen diet. This is a food with one protein source, preferable one that your dog has not eaten previously. Examples would be Purina's HA, Walthams Limited Antigen, Hills d/d, and Innovative Diets. There are probably others. Your vet may feel more comfortable with a highly digestible diet or with a moderate fat diet. There is no really sure way to tell which diet would be best, in advance. You just have to try one and then try others if that one doesn't seem to help. I don't think that it is unusual that you had problems with infected elbow calluses in a dog this large. We treat a number of mastiffs in our practice and they have a lot of problem with infected calluses on their elbow region and often with sores over the hocks, as well. These are very difficult infections to clear up, sometimes requiring months of antibiotic therapy. Getting a culture of the bacteria causing the infection and determining the proper antibiotic based on sensitivity testing for that bacteria can be helpful. The sores tend to return because it is often impossible to correct the underlying problem, which is usually that the dog likes to lay on surfaces like concrete or wood decking that are hard. We have had one or two clients who have rigged up protective elbow pads that seem to help, but it takes some cooperation on the part of the dog to wear these and not all dogs are cooperative. If you check out the April issue of the VetInfo Digest, in the subscriber area, there is some information on disorders of neutrophil function, which may be a major cause of dogs not responding appropriately to antibiotic therapy and having chronic problems with infections. I don't think this is a strong possibility but it is one of the causes of problems in dogs that don't respond to antibiotic therapy as expected. I think that it would be really unlikely that pancreatitis would lead to the skin infections you are seeing. Pancreatic cancer sometimes leads to skin disease and liver diseases can cause skin disease but I don't think that there is a strong correlation between pancreatitis and skin disease. Cushing's disease doesn't seem very likely based on the clinical signs you are seeing so far. I do think that it might be a good idea to consider the possibility of inflammatory bowel disease especially since metronidazole works well when there are problems. You might want to talk about this possibility with your vet. Hope this helps some. Please feel free to ask for clarifications. Mike Richards, DVM 9/12/2000

Stomach problem - Cocker

Question: Hello Dr.Mike, I have the most peculiar problem that hopefully you can shed some light on. I have an eleven year old American Cocker who needs to be fed every five to six hours. If he is not, the stangest of noises comes from his stomach (borborygmus). And I mean loud. We notice that when this happens he becomes very uncomfortable and refuses to eat, sometimes for half a day. He is also not interested in anything. He simply sleeps and sometimes tries to hide in some corner. As the day progesses the noises continue in his stomach and one point diminish. He then slowly begins to eat some bland food such as rice banana and eventually will eat his regular food. The first stool is somewhat mushy and the next stool after that has blood (which we have had checked). He then goes back to eating normal and the stools instantaneously returns to normal like nothing happened. The only thing is he has my husband and I busy. He has now put on two pounds since my husband and I worry when it gets to his feeding time. That we have to feed him before his stomach begins to make these strange noises and have the cycle start over. This means that he cannot go from supper to the following morning. So he must be fed something at eleven pm and then at 4:30am. So you see our dilemma. As long as we keep this up everything is fine. But he should be able to go the full night. The vet has already confirmed colitis because of blood in his stool, and also said he needed no medication since the stool returned to normal by itself. He has switched our dog to a higher fiber food. But our problem is not solved in respect to being able to go longer hours. Maria

Answer: Maria- I think that it is important to find out what is wrong with your cocker and to treat the problem, even if it there are some normal stools. This type of problem sometimes requires a lot of work to diagnose, though. There are many possible causes of the diarrhea, gas production and abdominal pain. I am guessing that this has not been a lifelong problem from your note, but I can't quite figure out how long it has been going on. If that is the case, the first step is probably to collect some general information. Checking a stool sample for worms and other intestinal parasites, especially giardia, seems like a good idea. Since giardia is hard to find, even when looking for it, we sometimes just go ahead and treat a dog for it to rule it out. A general blood chemistry and complete blood cell count would be a good idea, too. If there is a systemic problem then it would be best to treat the problem identified to see if that helps. If everything checks out OK, so far, then it is necessary to do testing for gastrointestinal diseases. The best approach to this is to have intestinal biopsies taken during an endoscopic exam but many vets do elect to just treat for the likely disorders if testing is a problem to arrange or if financial concerns make further testing impossible. While that is a less than perfect approach it seems reasonable to me in many cases. If your vet is uncomfortable pursuing a diagnosis ask him to refer you to a veterinary internal medicine specialist or veterinary school for a second opinion. In older dogs there is a chance of finding a problem like cancer that is difficult to treat but most dogs with the symptoms your dog has can be helped. Good luck with this. Mike Richards, DVM 2/25/2000

Gastritis

Q: How do you treat gastritis?

A: Helen- Most vets use metronidazole for its anti-inflammatory properties, rather than its anti-bacterial properties, which appear to be pretty weak. It may slightly favor "beneficial" bacteria in the intestinal tract and it can help with anerobic infections (which are not that common in the digestive tract). So the basic answer to your question is that it is probably OK not to use metronidazole without worrying too much that you will be causing harm. I am not a fan of amphoral because it contains kanamycin, which is a more potent antibiotic than metronidazole appears to be, and anticholinergics, which I think of as problematic in some cases of gastrointestinal upset. For gastritis due to eating odd stuff or from dietary changes, I prefer just to withhold food for 24 to 48 hours, give water in small quantities at one time, but not restrict total water intake and to use something like loperamide (Immodium AD, TM) to control the diarrhea, if necessary. If the problem persists beyond this time, then I lean towards making a diagnosis and treating specifically for the problem found, if possible, rather than using a product that has multiple ingredients for sort of a "shotgun" approach. Lots of vets use Amforal (Rx), though. So I am probably in the minority in my thinking, here. Mike Richards, DVM 8/13/99

Inability to digest food - German Shepherd

Q: My 5&1/2 yr. old shepherd has problems with her stomach. everything she eats seems to go right through her. She is down to 41 lbs. My vet put her on prednisone in hopes this will help. He says that she's not retaining her protien. She lost 8 lbs. in two weeks. She got hold of some bone and was bleeding pretty bad in her stool which was real runny. What do you suggest. Or do you think the prednisone will help? Please answer as soon as you can. We can't stand to loose any more weight. She eats really well but like I said It goess right through her....Lottie

Lottie- A: German shepherds are prone to several conditions that can lead to inability to digest food or to absorb digested food from the intestine. The first step in figuring out what to do is to differentiate between these two problems. A blood test for trypsin-like substances in the serum is helpful in determining if pancreatic enzymes are being produced properly. If they are, then digestion is more likely to be occurring properly. Digestive problems other than pancreatic insufficiency can occur but are more rare. There are several conditions that interfere with absorption of food from the intestines. Most are inflammatory diseases involving one of the white blood cells acting inappropriately in the intestine and most will respond to prednisone or other immunosuppressive medications. It is best when it is possible to properly diagnose the exact cause of malabsorption diseases. The best way to do this is intestinal biopsy and the best way to get biopsy samples is endoscopy. This is impractical at many veterinary practices, though. If so, using the medications as an aid to diagnosis is reasonable. Food allergies can cause inflammation and difficulty absorping food. Feeding a limited antigen diet such as Purina's HA, Hill's d/d, Innovative Diets or other diets with one protein source may be helpful in establishing whether a food allergy is present. This is a not as likely to be the problem in a middle aged dog but may still be worth checking into. Finally, there are non-digestive tract causes of protein loss, such as kidney failure and liver disease. It may take several attempts at diagnosis or treatment to find the right way to treat your dog so be prepared to stay in contact with your vet and to let him or her know the progress your dog is making (or not making) towards recovery. Keep working with your vet to find the cause. In some cases it is necessary to seek help from an internal medicine specialist but not always. Your vet can refer you to the closest specialist if necessary. Good luck with this. Mike Richards, DVM

Gas or flatulence

Q:Dear Dr. Mike, I have a male boxer/lab. For the past few days, my dog has had excessive flatulence . Should I be concerned? Should I worry about bloat? Thanks, Jenny

A: Jenny- Boxers are one of the breeds that seems to have more problem with flatulence than others. I know of no evidence that this makes them more likely to bloat and I have not treated a case of bloat in a boxer than I can remember. Sometimes using a low residue diet (highly digestible) such as Eukanuba helps with this problem. Most of the time it probably doesn't help much, though. There is a product sold to control flatulence called Curtail (tm). It is made by the company that makes Beano (tm) for people. Most of my clients think it is too expensive for daily use but keep a bottle on hand for emergencies like dinner with the boss or the in-laws. Of course, if you don't like your mother-in-law....... we won't go there Mike Richards, DVM

Michal Response: Jenny, our Labs also had that particular problem - never bloated but could certainly clear a room. Keeping a bottle of X-O (or your fav room deodorizer spray) handy helps.

Sugar overload in Jack Russell

Q: I really love you web page!! As for my question....as a medical student I have been going round and round trying to figure out what happened to my 1 yr old Jack Russell Terrier last week. On Wednesday she went 'garbage diving' and ate an entire box of brown sugar + god knows what else. On Thursday, she had copius, cholera-like, watery diarrhea early in the day, then she progressively lost her spunk even though she was drinking fluids. During Thursday evening, she had a fever of 104.2, went into stupor, stumbled over herself, irregular gait, inability to get comfortable (stay still) etc. Although she was still responsive to her name and her favorate squeeky toys. Abdomen was distended, full. I took her to the ER where they said her reflexes were depressed, she had a fever, and was in danger of becoming dehydrated. Liver enzymes were just outside the high range of normal, and her WBC was elevated. Vet gave her a shot of ampicillin, and I took her home. During the night I gave her water, but she would not eat. Friday....much better prognosis, but still unsteady on her feet. Eye contact was more pronounced and she readily accepted watered-down baby cereal to which some salt was added. She ate/drank 3 bowls of it. After the first bowl, she had a seizure-type event which subsided and was not repeated. By Sunday, she was back to her JR terrier self, bouncing off the walls, What could have caused my dogs illness? Was it bacterial toxin from the garbage? (Can dogs get botulism or salmonella) Was it the dehydration ? For what it's worth, the Yellow Lab that shares her space has not been sick at all. Thanks for you insight and help! Dawn

A: Dawn- I think it is very likely that a whole box of sugar could lead to an osmotic induced dehydration or that it could lead to a bacterial overload or imbalance in the digestive tract that led to diarrhea. Dogs do get Salmonella and other food poisonings, so that is possible, too. Even fermentation of the sugar in the digestive tract seems possible, with excessive gas formation leading to pain and digestive problems and systemic signs. I'm just guessing at these things because I don't really have a reference that discusses ingestion of large quantities of sugar! It always amazes me how many things happen that aren't covered by the textbooks. Mike Richards, DVM

Clear gel type diarrhea - Poodle

Q: Dr. Mike, I have a Toy Poodle, which is approximately 15 years old. She has had this problem for years, but not very frequently. Lately though this has been happening on a weekly basis. She is a very picky eater and I've noticed that when she doesn't eat until late in the day ,this is when the diarrhea starts. I only feed her Science Diet food mixed with chicken [this is the only way she will eat dog food], or ocassionally a rice and chicken recipe similar to yours. At the risk of sounding icky, I feel that I need to tell you that the diarrhea is almost a clear, gel-like substance with blood mixed in. I have had two different opinons from two different doctors. Could you please tell me what you think and what you would suggest for treatment? Thank-you ,I'll be waiting to hear from you.

A: Sharron- Clear gel type diarrhea is pretty common when colitis is present and blood is not that unusual in it. Unfortunately there are a lot of possible causes of colitis. We see this with heart failure in older dogs, kidney failure, inflammatory bowel disease, whipworm infestation, other intestinal parasites, food allergies and probably a number of other conditions that aren't coming to mind immediately. A good physical exam is the best place to start sorting through the possibilities. Labwork may be necessary. Hopefully one of your vets has already figured out what the most probably cause is and things are improving by now. Mike Richards, DVM

Mucous in stools - Collie

Q: Dr. Mike, I have a one year old English Collie. She seems to be healthy, happy and active. She's had all her vaccinations and has checked out well. As of April 1 she has been on the monthly heartworm preventative and monthly flea preventative. Just this week we have noticed that her stools have been slightly loose and have what seems to be a mucus-like substance on them. She's active, is eating the same as always, is exercised daily, has lots of fresh water. What is this mucus substance? What does it mean? How should we proceed with this? Thanks. P.

A: The substance you are seeing probably is mucous. Dogs with colitis and sometimes with constipation will have mucous in their stools. The best thing to do if this continues is to have your vet examine your collie since there are a number of possible causes of both colitis and constipation. Hope all is well by now. Mike Richards, DVM

Gastrointestinal discomfort - Norwegian Elkhound

Q: Dr. Mike, Here's a question for you: I have a 2 1/2 year old female Norwegian Elkhound. Several times recently she starts "reflexively swallowing." Not a hiccup, or gagging reflex, but swallowing as if something is trying to work through. Often it is after eating something in the woods on a hike, though x-rays show nothing in her gut. She has had a couple of apparent stomach infections, due to eating bits of decayed creatures (we live in Alaska). She is generally a very healthy dog--hikes at least a few miles daily. We don't have a yard, so see most anything she could eat. Vet here suggested maybe her stomach is scratched. It seems to happen some days afterward sometimes, with no prior indication. Do dogs "burp" bile like humans do occasionally? Is there a treatment to help her discomfort? She gets very distressed, and is totally crazed at times to run and eat grass to try and assuage the discomfort. Is it okay to eat grass then, or better not to? She does not normally eat grass, so I'm at a loss here. What is the chance of an ulcer or other digestive tract disorder, and what might they be? She does get nervous when we change routines or travel, etc, so I wonder if that is all part of it, and she's working on an ulcer. Can I give her an ant-acid? Thanks for any answer you can give! S.Cha

A: It does sound like there may be some cause of gastrointestinal discomfort but it would be hard to say what that might be. Dogs can get spasms of the pylorus (the muscular valve between the stomach and intestines) which may be painful. Ulcers are possible. It may be useful to try to determine if food is being retained in the stomach or if there is delayed passage of food through the intestines. Barium X-rays or use of a new product called BIPS (I think that is what they are called -- they are little capsules with balls in them that show up on X-rays and their movement through the intestine can help determine if there is a problem.) Painful conditions like pancreatitis seem possible. Esophageal diverticuli, hiatal hernia and esophageal spasms may also be possible. Unfortunately, it takes a lot of work and diagnostic testing to try to determine what is going on -- this is a time it would be really nice to be able to talk to our patients! You can use antacids in dogs but you might want to use cimetidine (Tagamet Rx) or something like that instead if you really think ulcers are present. I'm sure your vet will help you figure out an appropriate dose for your dog. Even if it doesn't help it's one of those things that isn't likely to hurt, either. Mike Richards, DVM

Stomach problems - Boxer

Q: Hi Dr. Mike, I have a 6 year old boxer (Miller) and he has been having stomach problems. I took him to the vet on April 3 and they took a few tests which led the vet to believe he has pancreatitis. The tests were amylase and lipase, the vet said Miller's results were 2250 and they should be under 1000. We have been giving him amoxi tabs twice a day and metoclopramide three times a day, we have also been feeding him Prescription Diet i/d. He was doing better then on Sunday he ate a few pieces of smoked sausage and on Tuesday his stomach was making all sorts of funny noises and he didn't eat dinner, but he wasn't lethargic. He also ate a lot of grass. Today, Wednesday he seems fine. The vet wants me to bring him back in on Saturday to run more tests. If he is doing fine is it necessary to run more tests. I don't feel comfortable with the vet I have been taking him to, every time I ask him a question he mumbles stuff about tests that need to be done but doesn't explain to me why, even when I ask him he just says it needs to be done and to bring Miller in. The first time I took Miller to this vet he said Miller had an ulcer (which he concluded from xrays), so we gave him Tagamet for a while and this seemed to help. Miller has had stomach problems on and off since Thanksgiving when he ate a plastic bag that we had cooked the Turkey in (which he threw up later), along with all the grease and fat, could these problems still be from that. We took him to an animal hospital then and they mentioned pancreatitis. Every once in a while his stomach acts up but then within a day or two he is fine. Also, 3 times in the past 2 weeks I have caught him eating feces, we have deer around here so it is either theirs or his or I not sure what else, could this be leeding to his stomach problems too? It is alright for me to request all the tests this vet has taken along with the xrays so I can go to a different vet? Sorry this is so long, but I really appreciate your help. Thank you for your time

A: It is definitely OK to ask for a copy of the records and to seek a second opinion. The best way to do this would be to ask your vet to refer you to an internal medicine specialist. That would give you the best chance of getting a good second opinion. This is not a foolproof solution since sometimes there are very good local practitioners and there are a few questionable specialists but on the average, this is the best approach. Failing that, it is still OK to get a second opinion at another local veterinary hospital. X-rays are sometimes required to be retained by the veterinary hospital that took them but usually it is possible to borrow them or to have copies made. The history you give is suggestive of pancreatitis. It is often brought on by high fat, high salt meals. We often see dogs with this problem after big holidays. The lab levels are hard to evaluate without knowing the normals for the testing lab but they are in the range (for amylase) that would be suspicious but may not confirm the diagnosis. Retesting to see whether the levels have gone up or down can help to make a more sure diagnosis. That may be what your vet is doing. I am not aware of anything in deer feces that would be likely to cause stomach problems in a dog, offhand. When you do not trust your vet it is time to find a new vet or to tell your vet you need to communicate better with him or her. It is important that you understand why tests are run and how to avoid recurrences of disease problems. Sometimes you can have a very good vet you just can't communicate with. It is usually better even in this case to find someone you trust and who you understand. This may not be your vet's fault but that doesn't change the situation. Finding someone you can work with is important to the health of your pet! Mike Richards, DVM

Dogs ate cooked chicken bones

Q: I will continue my search elsewhere on the net since I note you prefer not to respond to emergengies! However - if you are online, I would be grateful if you could indicate whether I should wake up my vet (its the middle of the night here in the UK). I woke up to find my 2 7-year old dogs (12 kg and 9 kg respective weights) had, between them, eaten a small cooked chicken carcass, stripped of meat (prepared weight of bird about 3 lbs). Should they receive emergency treatment (e.g. to make them vomit?) Or should I just wait'n'see? They appear fine. In the absence of a response, I shall contact my vet at 1st light. Meanwhile, thanks for your excellent service.

A: You picked a time I was out of town, unfortunately. I hope the dogs are OK. Most of the time chicken bones seem to cause more problems when they reach the colon than anywhere else. We mostly see dogs that have eaten chicken bones and have a sort of concrete stool that they are having great difficulty passing. Stool softeners help sometimes, some dogs just go ahead and tough it out and strain until they pass the stool and other dogs we have to give enemas to or remove the stool manually. So far, in eighteen years of practice, I have not seen an intestinal or gastric perforation or other serious problem I could relate to chicken bones. Just the really hard stool problem. Again, I hope this is a crisis past. Mike Richards, DVM

Chronic vomiting

Q: Dear Dr. Mike, We have a 9 year old male Lhasa/Terrier/Basset mix (Kirby) vomits at least once a week (primarily bile) up to daily. Kirby has seen two vets and has been given prednisone, amforal and digestive enyzmes to no avail. Kirby has been on several special diets such as Science Diet-ID and WD. There have been times when the situation requires we feed him only boiled hamburger and rice. As for Kirby's behavior-when he feels ok he is a pleasure to be around. If he starts snapping at us or our other dog we know a vomiting episode is imminent. This has been going on for four years and is getting progressively worse. Blood tests indicate no problems. We are at are wits end and close to putting him to sleep. Any suggestion?.

A: Mary- It would be a good idea to consider having an endoscopic examination with biopsy of the stomach and intestine (if it seems necessary during the exam). This is the most accurate way of assessing several situations involving vomiting, such as plasmacytic/lymphocytic enteritis, Helicobacter infection, lymphangectasia and other digestive tract disorders. Your vet will probably have to refer you to a specialist in order to have this testing done. I know you have already done a lot for Kirby but it may be possible to make him comfortable and pleasant more often than he is now. Ask your vet about this. Mike Richards, DVM

Chronic Diarrhea -Boston Terrier

Q: I own a Boston Terrier which is about 18 months old. Although normal in size at birth, it has never exceeded seven pounds, although it has always been pretty healthy and active otherwise. In the last six months, it has developed diarrhea and soft stools. Two vets have examined it, but both are at a loss (most recently, we did intestinal biopsies during a spaying, but the results were negative on the small intestine, and very slight inflamation in the large intestine). When the dog is placed on antibiotics (such as sulfasalazine) it seems to do better, but the problem returns shortly after the treatment concludes. She vomits occasionally, but just as likely on an empty stomach as a full one. I'm not aware of any environmental changes that may have brought on the condition. I've read your material on pancreatitis, and recognizing the symptoms are variable, it doesn't sound quite like this situation. The current vet is going to try cortisone, but my impression is that this is a 'trying to do something' effort. My wife is looking into acupuncture, which I don't know enough about to respond to (natural scepticism aside). Are there other digestive conditions in Boston Terriers or other purebreeds that might explain this condition, or other treatments we might consider or discuss with our vet? Thanks in advance for any insights you may have to offer.

A: The first thing I would like to say is that sulfasalazine is often used continuously for several months or more in dogs that respond to it. It is probably safer to do that than to use cortisones long term, but both can have side effects. Sulfasalazine is implicated in the development of tear deficiency and corticosteroids can suppress the immune system, cause increase in drinking, urinating and appetite, predispose dogs to pancreatitis and possibly to diabetes. Used carefully, these side effects can be minimized but still, they have to be considered when making a decision to use them long term. There are A LOT of causes of chronic diarrhea. So many that I am sure I will miss a number of them in the following list, but here goes: malabsorptive diseases (anything causing an inability to absorb food, such as wheat gluten sensitivity or plasmacytic-lymphocytic enteritis), maldigestion syndromes such as pancreatic insufficiency, inflammatory bowel disease, intestinal parasites (protozoans, worms, coccidia), fungal infections (rarely), damage to vital organs such as the liver or kidney leading to secondary diarrhea problems, diabetes mellitus, hypoadrenocorticism, small intestinal bacterial overgrowth, cancer, ulcers, bacterial enteritis or colitis, cecal inversion and irritable bowel syndromes. It is important to try to decide if this is a small intestinal problem or large intestinal problem. In small intestinal disease the diarrhea tends to be pretty large volume at one time but less frequent episodes of diarrhea. In large intestinal diarrhea the volume of diarrhea tends to be smaller but episodes are more frequent. Knowing which of these is likely to be the problem helps in deciding which tests to run. In chronic diarrhea it can be very hard to find a diagnosis. The intestinal biopsies were are very good idea. It is too bad they were not more informative. It can take multiple fecal exams to find some parasites, particularly giardia and whipworms. There are pretty good blood tests now to aid in the diagnosis of pancreatic insufficiency (blood trypsin-like immunoreactivity, folate levels, it is always wise to do general lab panels to make sure other organ systems are functioning properly. It can be helpful to rule out food sensitivity/allergy using special diets (elimination diets). Culture of the stool will sometimes reveal a bacteria that is very likely to be pathogenic, such as Salmonella or Clostridium perfringens. Special cultures can be done for Campylobacter. If sulfasalazine does help, that is a hint that the problem is likely to be in the large intestine. If biopsies did not include the colon it may be possible to obtain the necessary biopsy samples from the colon to make a diagnosis using an endoscope with a biopsy forceps. If this is not easily available where you are, I wouldn't be too uncomfortable just using the sulfasalazine (Azulfidine Rx) for 2 or 3 months and then stopping to gauge the effect. I do not know if acupuncture or other therapies are effective for chronic diarrhea. In most cases, it is possible to find a cause for the diarrhea and to successfully treat it, if you are patient enough. You can tell from the long list of possible causes that it can be hard, though. Good luck with this. Mike Richards, DVM

Last edited 07/21/05