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Repeated diarrhea and vomiting.

Species: Dog
Breed: Australian Shepherd
Age: 2-5 years
Dr. Marie: Thank you for your input and warning -- this will be a bit lengthy. I have a young Australian Shepherd, currently 18 months of age. He's always been a bit of a fussy eater even as a puppy -- maintains his own weight (food is put down morning & evening, picked up in about an hour), but quite often just doesn't want to eat. I thought he was a bit like me, takes awhile in the morning to look food in the face -- but I haven't been able to find a common denominator. More than once his not eating has led to diarrhea, continued upset, & we have struggled with overgrowth of bacteria in the gut in a number of cases. Seems to always respond to Metronidazole. He was neutered at 16 months of age (crypt) -- and he came from a litter of 8 pups -- only 4 survived. Bitch had a reabsorption pup that did NOT completely disappear and I believe this was one of the closest pups to it. That pup was obviously born dead, another one was born dead, & 2 others died shortly thereafter. About 10 months of age this child got into cherries (orchard at the back of the property) -- stopped counting at about 50+ pits on the x-ray and thought we were going to lose him as his gut basically shut down & he was going septic. (I still feel so bad about this, never had a dog do this one before). Three days in the vet on IV's, about 1/2 hour from opening him up, and things turned around. His problems never seemed worse OR better after that incident, but I wonder. We've played with food -- his sire & prior litters as well as littermates do NOT tolerate canned/wet food -- it comes out about the same way it goes in and he's no different. Finally settled on Nature's Instinct Dry Kibble, Salmon based -- no potato, no flaxseed, and about 3 or 4 bites of Wellness 98% Chicken (canned) just to get him to eat in a consistent manner.
My problem still is that at this age, at least once every 2 weeks, he doesn't want to eat a meal and we start this cycle. Monday evening he was a bit punky -- but we thought might be from a long weekend at a civic event (we took our 5th wheel & stayed up there). He seemed to enjoy it, ate well through the weekend, ate monday morning & PM, and Tuesday morning ate a couple bites and that was it. He goes to doggie daycare Tuesday & Friday (wear the Aussie boy out!) as both my husband & I work so try to give him enough play time, exercise, and socialization. I picked him up last evening from daycare, and he would NOT even take a treat -- no cookies, no soft treats, nothing. Sure enough, I got him home & he went into full cow mode -- you can tell when he's just nibbling for salad greens, and when his intention is to empty his stomach. He did that twice last night before coming in and curling up. I did give him a 5 cc dose of Kaopectate (vet's recommendation) -- later on offered some rice &/or bites of his chicken soft food, and he wanted none of it. I gave him a 2nd 5 cc dose of Kaopectate at bedtime. This morning he came out looking better and actually ate 5 bites of canned chicken wet food and maybe 1/3 cup of his dry salmon (I should mention this is the first food of any sort we've had luck with in keeping him eating or interested).
So here's my dilemma and any suggestions would be appreciated (PS: Love my current Vet, but he's also scratching his head a bit):I can certainly keep doing the Kaopectate thing, but know that I would rather him not keep going through this every couple of weeks -- I wouldn't like it myself.
We've tested his stool for every parasite possible JUST to rule that out -- no giardia, no nothing -- did it twice just in case. When his stool has grown bacteria, it's just been the typical overgrowth of the "bad" stuff that you find in small quantities normally and has responded immediately. Daycare that he goes to requires proof of vaccinations on file and they meet you at the door to stop you if you don't have them or need to update them (owner is a Vet Tech).
I'm concerned that either his in utero issue or cherry pit issue may have caused some damage? or could be adding to what's going on. I have a friend who's Begian Terv actually has an endoscopically proven case of Inflammatory Bowel and I'm worried that I don't want to go down that path?
This is a happy little boy that I just feel terrible for when I see him hang-dog and puking. I do obedience & agility, and hope to also move into herding and tracking as he gets a bit older (and if we can calm the rest of this down). I've done pretty much no showing to date, but have taken him on a few weekends to dog show sites -- again, he's eaten well and hasn't seemed stress.
At this point I don't know if I should push for a GI consult from a specialist? Or what you might suggest?
Thanks in advance
Michelle J.

Online vet, Dr. Marie

Dr. Marie replied:

Thanks for your detailed question. What a frustrating situation! I've had several cases like this. Sometimes we find a solution, but not always.

While I definitely won't have a diagnosis for you, let me give you some thoughts on what you have written.

First of all, this is unlikely to be due to something that happened in utero or from the cherries. I think there is something else going on.

You mentioned that he was tested twice for parasites. Do you know if he ever had a DNA fecal test done? This is one that has to be sent out to a lab. It costs more than a regular fecal exam. In my clinic it costs about $150. This test looks for certain types of bacteria and strange parasites that we wouldn't see on normal tests. Examples include clostridium, salmonella, cryptosporidium, etc. It may be worthwhile to do this test.

You mentioned as well that he has had issues with bacterial overgrowth. Has he been on probiotics? I'm not talking about giving him yogurt but rather, something like Florentero or Fortiflora. Often this supplement will help greatly.

I have had several cases like this that I have put on a medication called Tylosin. It is an "old school" treatment but many times it works. Tylosin is an antibiotic given for chickens. I will have owners put 1/8 tsp on the food twice a day every day. It is safe to do so. Many times this cures the problem.

Inflammatory bowel disease is a toughie...the only way to diagnose it is with biopsies of the bowel. It would be great to have your vet do this, but it can be expensive.

Another thought - do you know if he has had a PLI test done? This is to look for pancreatitis. Some dogs can have chronic pancreatitis which causes them to have recurrent bouts of vomiting and diarrhea. If this is the case then he will benefit from staying on a low fat prescription food and possibly having anti-nausea medication prescribed by your vet.

And one final thought - ask your vet about the possibility of helicobacter. This is a bacteria that can affect the stomach of dogs and cause repeated issues with vomiting. However, it doesn't usually cause diarrhea. It can be hard to diagnose, but if I am suspicious I will do a treatment for it. It is treated with a combo of drugs (usually amoxicillin, metronidazole and famotidine).

It sounds like your vet is doing all of the same things I would! I don't know that a referral to a specialist is necessary right now, unless you were wanting to do biopsies and your vet was uncomfortable doing them - or wanted them done with an endoscope.

Hopefully some of these tips help!

Dr. Marie.

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Disclaimer: Although Dr. Marie is a qualified veterinarian, the information found on this site is not meant to replace the advice of your own veterinarian. and Dr. Marie do not accept any responsibility for any loss, damage, injury, death, or disease which may arise from reliance on information contained on this site. Do not use information found on this site for diagnosing or treating your pet. Anything you read here is for information only.

Customer reply:

Thank you for your thoughts, exactly what I was hoping for! Will discuss these options with my Vet -- You definitley touched on some things that had not yet been mentioned, and I think the DNA fecal test sounds like my first choice -- I know we had sent his samples out, but nothing mentioned about these types of parasites. And I work in human health care, and never thought about helicobacter in a dog!
I appreciate it greatly, added a little something to say thank you for the info. Will drop back a note with what comes from the tests to let you know what we end up with.
Sincerely, Michelle & Steeler

Online vet, Dr. Marie

Dr. Marie replied:

You're very welcome! I should mention that the DNA testing is a little bit controversial. There are some vets who feel that the tests are not very accurate. But, I have been pleased with the results of most of the tests that I have done and have found them very helpful.

Thanks so much for the bonus. You made my day. :)

Customer reply:

Just a quick update -- after discussing the additional info with my present Vet, we sent out what I'm thinking is the PLI (pancreas, folate, cobalamin, etc.). Pancreas & folate tested fine, however, he is significantly low on cobalamin -- of course, question now is overgrowth of bacteria in proximal small intestine versus distal small bowel disease, but at least we've got a direction. He's been in touch with a GI specialist and we're going to start him on a B-12 regimen that they've had good success in a # of dogs as far as clearing up the issues. If not, then we'll proceed to the fecal DNA and additional GI work up from there.
Thank you again for your input -- I believe in the Vet that I have, but think sometimes we get handed unusual things and there's not that comfort level to spend a customer's money when you're not 100% sure you're going to get them an answer (I work in Healthcare & my husband has a business, we know how the public can react to that scenario). Again, thank you! Michelle

Online vet, Dr. Marie

Dr. Marie replied:

That's exciting that we found a low cobalamin level as this is something treatable. Thanks for the update!

Dr. Marie.

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Dr. MarieDr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.

Is an online vet visit just as good as a trip to your veterinarian? No! But, many times, asking an online veterinarian a question can help save you money. While Dr. Marie can't officially diagnose your pet or prescribe medications, she can often advise you on whether a vet visit is necessary. You can also ask Dr. Marie for a second opinion on your pet's condition.