Digestive problems of dogs

Antibiotic sensitive gastroenteritis, Liver values and IBD

Question: Dear Dr. Mike, I have the report from the Internal medicine Vet who did the ultrasound. It says "recent episodic vomiting may suggest GI inflammation secondary to indiscretion or idiopathic IBD. " He then recommends "start empiric therapy for chronic gastroenteritis............" I think the issue is they don`t know what it is. I have had him off the carafate and pepcid and noticed no change in his bowel movements or the occasional vomiting. It`s my understanding that the only way to biopsy the liver is through a surgical biopsy. I hate to put him through this, without trying a lot of other options first. Thanks for your thoughts. Susan

Answer: Susan- In most cases I think that I would want to do several things prior to considering a liver biopsy in a case like this but there may be physical or laboratory findings that are prompting your vet to think of liver disease as the primary problem and it is reasonable to try to understand why there were changes in the liver enzyme levels in the labwork and to try to estimate how serious this might be prior to working through a set of diagnostic procedures and tests to try to rule out various causes of inflammatory bowel disease. To help with understanding what is happening in the liver you have some choices other than liver biopsy: 1) It is almost always worth rechecking the liver enzyme levels to see what has changed. There are two main liver enzymes that are considered in most cases, alanine transferase (ALT) and alkaline phosphatase ( alk phos, SAP, several other abbreviations). ALT rises occur when liver cells die or are ruptured and leak the enzyme. Severe rises in ALT can occur with damage to limited areas of the liver. The half life of this enzyme is relatively short so rechecking lab values in 5 to 7 days can indicate whether there was a one time problem (in which case the level should have fallen significantly) or whether it is staying the same (ongoing damage) or rising ( may indicate more severe liver diseae). Rises in alkaline phosphatase are less specific. This enzyme level rises when there is a reduction in bile flow for any reason. It also rises when corticosteroids are used in many dogs, when benign nodular hypertrophy of the liver is present, when there is liver swelling for any reason (disease, trauma), in hyperadrenocorticism (Cushing`s disease) and less commonly when there is bone cancer (almost always there are significant signs of this before there is a rise in alkaline phosphatase). In the case of both of the above enzymes it is really important to understand that even very large rises in these enzymes on a single lab test may not indicate life threatening liver damage and that truly serious liver disease an occur without significant rises in these enzymes. It is entirely possible to injure the liver without doing serious damage and it is possible for serious damage to accumulate slowly over time without significant rises in ALT or SAP. It is also possible for liver disease to be a chronic process and in this case the liver enzyme levels may stay elevated for long periods of time. This inability to tell for sure what the meaning of rises in liver enzyme levels means is the reason that some sort of more specific testing has to be done when the rise in liver enzyme persists over time. 2) Bile acid response testing One test that can give you a lot of information about how much liver function is affected is a bile acid response test. This is an easy test to run. A blood sample is taken after a 12 hour fast. A small meal is fed. A second blood sample is taken 2 hours later. If there is a large rise in the fasting sample or the sample taken after a meal then the liver is not functioning as well as it should be. There has to be significant damage to the liver before it is unable to process the bile acids properly so this test can really help to determine how severely the liver is affected by whatever condition is causing rises in liver enzyme levels. 3) There is no reason not to repeat the ultrasound examination if you aren`t worried about the expense and want to choose a cautious approach rather than an aggressive one. Sometimes changes have occurred that are very helpful in figuring out what is happening. It can also be helpful to have X-rays taken. Most of the time X-rays aren`t all that helpful in liver disease but once in a while they help a great deal. It isn`t a common practice in veterinary medicine but my understanding is that MRI examination is pretty good for discerning some forms of liver damage, as well. A biopsy is sometimes the only way to really know what is happening in the liver. There is pretty good evidence that ultrasound guided biopsy is about as good as a biopsy obtained by exploratory surgery. The tricky thing, though, is that both techniques have advantages and so even though they give similar results overall when the ability to make a diagnosis from the sample is the criteria, they are each better at diagnosing some conditions and worse at others. Ultrasound biopsy works best when the ultrasonagrapher can identify a lesion in the liver that seems worthwhile to biopsy and can guide the biopsy probe right to that spot. Surgical biopsy works better when the ultrasonagrapher can`t identify a specific area of interest. The surgeon may be able to see a problem and if not, surgical biopsies are bigger so there is a better chance of finding a problem that isn`t confined to a specific area. Your vet and the specialist can help you decide which is the better approach if ultimately it does become necessary to do a biopsy. If the specialist is really saying that he or she doesn`t think that there is visible liver damage and if follow up liver enzyme levels show improvement in the liver values then it would be more reasonable to go on a hunt for a gastrointestinal cause of vomiting and/or diarrhea. We like to start with administration of a broad spectrum dewormer to rule out intestinal parasites that are hard to find on fecal examinations. Once in a while this works to resolve problems and it is inexpensive. It is far better to do this first than to do a whole workup and later discover that Physelopteran worms or whipworms were the cause of problems. Doing several fecal exams is always a good idea. There seems to be some controversy over what dewormers will kill Physelopteran worms consistently and finding it is reason to try more than one if necessary -- so there is good reason to do the fecal exams and to deworm even if they are negative. We usually try a low fat diet and if that doesn`t produce improvement pretty quickly we try a hypoallergenic diet or an elimination diet ( one protein source, one carbohydrate source, both of which the pet hasn`t eaten before, if possible). When low fat diets work they usually work quickly so we try them first. When food sensitivities are present it can take several weeks to resolve problems (up to 8 weeks or more) but usually there is at least some improvement on the diets within 2 to 3 weeks. If we think that the problem is severe enough that we can`t afford to wait long for an answer we move on to the other steps and come back to this one later, if necessary. I think that is reasonable to try a course of antibiotics to rule out antibiotic sensitive gastroenteritis. I like metronidazole but some vets prefer tylosin, tetracyclines, sulfasalazine or other antibiotics as their first choice. I am willing to try more than one antibiotic prior to moving on to endoscopic examination as long as there aren`t factors like rapid weight loss or other signs of a more serious condition. Testing folate, cobalamin and trypsin-like immunoreactivity (TLI) is reasonable prior to going for more invasive testing. This is done by drawing blood after a 12 hour fast and sending the serum to the appropriate lab. You have already had serum chemistry testing and blood counts done but there is no reason not to repeat this testing several times to see what changes occur. If you get through this much testing and still have a problem then endoscopic examination of the GI tract is a good idea. Biopsies can be taken during the exam as seems necessary based on what things look like. If the results are inconclusive you can consider biopsy by exploratory surgery. In this case another advantage of surgery is that you get biopsies of the liver, intestines, pancreas or whatever else looks like it should be biopsied during the surgery. Your vet can help you decide which testing or trial and error treatments are reasonable prior to trying to obtain a definite diagnosis through biopsy of the liver or intestines (whichever seems most appropriate as time goes on). Your vet can also help you decide when the symptoms make it more imperative that you proceed quickly or when you can take your time working through the process. I hope this helps some. Mike Richards, DVM 4/19/2005

Vomiting and diarrhea, elevated liver values, possible IBD

Question: Dear Dr. Mike, I am writing about my 11 year old American Eskimo, Gatsby. Several months ago, he began vomiting in the early am (usually around 4). As it was about every 10 days, I didn`t notice, at first. Eventually, I took him to the vet. A senior blood scan showed his liver values were elevated. He then got an ultrasound, which showed everything was normal, except his bowels looked inflamed. He was put on a rabbit/potato diet w/ carafate before meals, followed 1/2 hour later by pepcid ac. After 48 hours on the new diet, the vomiting started again. It was yellow bile. The vet recommended going to chicken and rice. After several days on this, the vomiting started again. At this point, he had lost 4 pounds in a month. The vet gave him a centadine shot and tablets. I was able to put him back on normal dog food and discontinue the tablets. The vet also recommended an endoscopy. I took him to a holistic vet for some ideas. He gave him an herb to balance the digestive system. This caused vomiting and diarrhea. He is now back on cottage cheese and boiled ground beef, as his stomach won`t settle down. He has remained happy and energetic through this whole ordeal. At this point, do you have any other suggestions than the endoscopy? Thanks for the help! Susan

Answer: Susan- I think that I would want to recheck the liver enzyme levels to see if they were getting worse, getting better or staying the same. If they are worse or staying the same I might add bile acid response testing as it gives a better evaluation of how the liver is functioning than chemistry tests run with most profiles, such as ALT, alkaline phosphatase, GGT, etc. There are a number of other possible approaches to inflammatory bowel disease if your vet suspects that as the primary problem. We often try several things prior to referral for endoscopy, including a broad spectrum deworming. We usually use fenbendazole ( Panacur Rx) and we give it even if fecal exams are negative for parasites. We also often try the use of antibiotics, especially metronidazole, prior to referral for endoscopy because it sometimes provides a cure and other times provides enough relief that we can use it intermittently. Our thinking is that if intermittent antibiotic use controls the problem then we may not need to know what it is, exactly. One thing that does worry me is that it looks like your vet might be treating for a gastric ulcer, since famotidine (Pepcid AC, tm) and Carafate (sucralfate) are often used for ulcers. If this is the case then an endoscopic examination might be more important since it would be best to identify and monitor an ulcer to prevent secondary complications or to catch and treat them early if they do occur (such as severe bleeding). Mike Richards, DVM 4/16/2005

Eosinophilic Enteritis or Lymphocytic/plasmacytic Enteritis

Question: Hello, I need to know what eosinophilic and plasmacytic gastritis are. There are several articles on the Web that discuss it, but from the layperson standpoint I`m really not sure what these problems are all about. Could you perhaps enlighten me as to what these diseases are? Or point me in the right direction? thanks, Anthony A.

Answer: Anthony- Eosinophils, lymphocytes and plasmacytes are different types of white blood cells. When a particular type (or types) of these cells invade the digestive tract in unexpectedly high numbers and this causes clinical signs, then the result is "eosinophilic enteritis" or "lymphocytic/plasmacytic" enteritis. Since some white blood cells are normal in the intestinal lining and since white blood cells are supposed to fend off bacteria, parasites and other invaders, it isn`t unusual to find these cells in the intestinal tract in high numbers in dogs or cats with chronic diarrhea or vomiting. However, it also seems clear that at least at times there are situations in which these white blood cells are there when they shouldn`t be and that they are the cause of the disease rather than part of a normal response to a disease process. When eosinophils are the predominant cell the most likely causes of the enteritis are parasitic infection, allergies or "idiopathic", which means that there is not an identifiable cause. When lymphocytes and plasma cells are the predominant cell types the most likely underlying causes are sensitivities to dietary components (wheat gluten is one example), parasites, bacterial toxins, cancers, heritable tendencies (occurs in Basenjis and wheaten terriers), and again a big group of dogs where a specific underlying cause isn`t identifiable, or the idiopathic cases. As you can see there is some overlap in these conditions and there are similar conditions associated with other types of white blood cells. When it is possible to identify an underlying cause and treat it, these conditions can sometimes be cured. When no underlying cause can be identified an effort is still usually made to eliminate as many of the common causes as possible, by using a wide spectrum dewormer (usually fenbendazole) to try to rule out parasites, dietary food trials to try to identify food sensitivities and allergies, biopsy of the intestines to try to rule out cancers and to aid in identifying other underlying causes and by the use of antibiotics to try to rule out the bacterial overgrowth/toxin issues. If none of these things help then it is usually necessary to use immunosuppressive drugs to try to reduce the immune system component of the disorder. Drugs such as prednisone and azathioprine (Imuran Rx) have been used for this in dogs and chlorambucil is sometimes helpful in cats. Cyclosporine may also help some dogs or cats with these problems. I hope that this is helpful. Mike Richards, DVM 10/12/2004

Gagging problems

Question: I was just on my way with the dog to the dog chiropractor, when I got your e-mail. I had been looking up megaesophagus, to see if that might be what makes my dog gag, but I don`t think that is it. You probably remember Platy, the old dachshund who always seems to have something mysterious. This time, she has started making sort of "ack, ack" noises and then acts as if she is going to vomit, but nothing comes up. She has been doing this on and off for a few months, and the vet couldn`t figure it out and was talking about megaesophagus and a barium swallow when we all got distracted by her awful neck injury, which is responding well to chiropractic after not improving with Rimadyl and steroid injections. She does this gagging thing if she gets overexcited (like when we come home), if someone picks her up putting pressure under the rib cage, spontaneously at night in bed, and once in a while just for no reason we can see. It doesn`t seem to bother her and she goes on about whatever she was doing after she makes the vomiting motion, and she will readily eat and drink and has no problem swallowing or retaining food or liquids. I wonder if she has a hiatal hernia and/or gastroesophageal reflux and so it happens at night when she is lying down and when something presses on her gut. You may remember she had a big laparotomy last summer to do the liver biopsy and see what else was wrong when she got so mysteriously sick (they never figured out what it was), and I`m wondering if something didn`t stay sutured inside and she now has some herniation or at least weakness around her diaphragm. I doubt it is megaesophagus since she never really regurgitates anything or has difficulty eating, etc., but maybe it is early stage. Anyway, any ideas would be much appreciated. Thanks for the latest VetInfo Digest! Helen

Answer: Helen- The biggest problem with a symptom like gagging is that it can occur in conjunction with a wide range of problems. It is also something that some dogs seem to do as a behavioral habit, or at least they never develop any discernible disease or disorder even though they continue to gag when picked up, swallow water or some other triggering event. These are the general areas in which problems can occur, with some detailing of possibilities.

1) Esophageal problems

a) megaesophagus (can be variable in its presentation)

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b) hiatal hernia -- probably occur more often than they are looked for

c) esophagitis // esophageal reflux

d) esophageal strictures and tumors

2) Neuromuscular problems

a) laryngeal paralysis

b) myasthenia gravis (mostly because it causes megaesophagus, though)

c) neurologic swallowing problems

3) Respiratory disorders

a) tracheal collapse

b) chronic bronchitis

c) chronic obstructive pulmonary disorders

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4) Cardiovascular disorders

a) chronic heart failure

5) Gastrointestinal / liver disorders

a) sometimes gagging is a symptom of inflammatory bowel disease

b) gastritis and pyloric stenosis can produce retching/gagging (hard to distinquish)

c) liver disorders sometimes cause gagging but I think this is probably nausea

6) Hormonal disorders

a) Cushing`s disease seems to cause some dogs to gag when picked up, probably by weakening the intercostal muscles, increasing blood pressure and compromising respiratory function

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b) hypothyroidism is supposed to cause some of the neuromuscular problems and possibly megaesophagus but there are very only very weakly proven links.

6) Other stuff

a) there is always other stuff, or at least patients that don`t have any of the above

The quickest test procedure to pick up most of these problems is endoscopic examination of the esophagus and upper GI tract. Chest X-rays help in some gases. Barium swallow X-rays are also helpful. If the GI system seems to be OK, endoscopic examination of the trachea may also be useful. The larynx can be examined prior to intubation for anesthesia for these procedures. A good physical exam should be done preanesthesia, of course. There is always the option of living with the problem if it isn`t severe but there are advantages to an early diagnosis of several of the above problems, especially the megaesophagus, myasthenia gravis, hormonal illnesses and cardiovascular illnesses. Good luck with this. If Platy continues to me a mystery on this issue, too, I hope she is as successful in handling it as she was the last problem. Mike Richards, DVM 5/22/2001

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Digestive problems in Shiba Inu

Question: Dear Dr. Richards I have a very bright and normally highly energetic 3 year old Shiba Inu named SaSi who has some sort of digestive difficulty. Our veterinarian is trying to stabilize her on MediCal Gastro Formula and, if successful, plans to try to get her back on an adult maintenance diet, and if not, is planning blood tests and endoscopy. The lipase amylase test was done and levels were slightly elevated. Sasi has always been a finicky eater, self feeding, and enthusiastic about a new dog food at first. Her breeder fed the puppies homemade rice and hamburger mixture. I have changed SaSi`s food regularly as she seemed to become disinterested over time, but always fed good quality brands and transitioned slowly. She has been difficult to train and we used a variety of treats to reward good behavior. She also has a habit of picking up all kinds of ugly stuff on the street. She has had regular bouts of tummy upset and diarrhrea and a couple of episodes of bright red blood in the stools. During these upsets she would be desperate to get outside and eat a lot of grass. I started to give her pepto bismal tablets instead and this seemed to help settle her down in a day and a bit. I first became concerned that these upset episodes were increasing in frequency and then she had an episode over Christmas where she seemed to be in a lot of pain over a couple of days. Our veterinarian recommended that we switch her to the Gastro formula and try to feed three meals a day. I stopped the pepto bismal and all other foods and treats, and have been somewhat successful in training her to stop picking up crap on the street. Since Christmas I have watched her closely, and she is still up and down. Recently she seemed back to normal for about four days and then relapsed (possibly as a result of something she ate during an unsupervised play in a neighbor`s backyard). The episodes consist of listless behavior, a characteristic odor, occasionally vomiting bile in the middle of the night, and formed but very soft stools. She still wants to eat, and walk and play, but with less enthusiasm than normal and occasionally seems quite depressed. Also periodically she has extreme flatulence. Many nights I hear her making mouth sounds and otherwise restless activity as if she is uncomfortable even though she does not vomit. (When she does vomit it almost always bile, or before, bile and grass.) During the period over Christmas when she seemed to be in a lot of pain and not improving, I stopped her food for twelve hours during which she tried to get me to feed her and after which she vomited a lot of very yellow bile. At that point our vet advised trying her on rice and a bit of honey until we could start the gastro, and she really liked it. I would appreciate, as well as your impressions, some help in deciding whether or not to do the endoscopy. For this procedure, what are the tentative diagnoses and resulting treatments.? What other blood work would be helpful, and in what order? How long and under what circumstances is the wait and watch approach acceptable? In human medicine I read about bacteria as a cause of ulcers and irritable bowel syndrome. Is this a possibility in dogs also? My main concerns are to not subject SaSi to unnecessary testing particularly where it is likely to be stressful. I am hoping that a detailed history will help narrow the range of diagnoses and treatments. I am, of course, speaking with our veterinarian regularly, but appreciate the opportunity to consult with you. Dianne

Answer: Dianne- I think it is hard to decide when it is necessary to really pursue a diagnosis hard when dogs have digestive problems that don`t result in weight loss or seriously affect their quality of life. In SaSi`s case, there does seem to be some discomfort based on the periods of being lethargic or depressed, though. Inflammatory bowel disease is kind of a catch-all term for a number of individual conditions that have similar symptoms. These include food allergies, food sensitivities that are not allergic in origin, small intestinal bacterial overgrowth, plasmacytic/lymphocytic gastroenteritis, colitis, eosinophilic gastroenteritis or colitis. Sometimes, problems like persistent parasitism with whipworms, giardia or some other parasite are present and are not showing up in fecal testing. This isn`t really inflammatory bowel disease but it does have sometimes have similar effects. Systemic illnesses such as liver disease, diabetes or kidney insufficiencies can sometimes produce these effects as secondary problems but these usually show up in blood chemistry examinations. Helicobacter infections, responsible for ulcers in humans, have not been conclusively demonstrated to cause ulcers in dogs or cats. When these parasites are found during diagnostic procedures it is hard to decide whether treatment is necessary but often it is attempted, on a "just to be sure" basis. Working through the possibilities and getting to a diagnosis is the frustrating part of dealing with inflammatory bowel disease. This is often a process of trial and error, especially when it is not possible for patients to have endoscopic examination and biopsy of the intestinal tract. The first step is to try to figure out if this is a small intestinal or large intestinal problem. In general, if diarrhea occurs more than three or four times a day the problem is large intestinal. Usually, the volume of stool is lower for large intestinal diarrhea, since there are more frequent bowel movements. Bright red blood is suggestive of large intestinal disease and maroon colored or black colored blood is more suggestive of small intestinal disease. If it is possible to localize the problem it helps in choosing where to take biopsy samples and it also can help in eliminating some of the potential causes of problems. We do some things for almost all patients with chronic diarrhea, prior to referring them for endoscopic examination. We usually deworm them with a dewormer capable of killing whipworms and giardia, fenbendazole (Panacur Rx), whether we find parasites, or not. We try limited antigen diets if owners are able to keep their pet from eating other foods and we use these for six to eight weeks before deciding that they are not helpful. We often try a course of metronidazole and if dogs respond but the problem returns on withdrawal of the medication we use sulfasalazine (Azulfidine Rx) for a while to see if that will resolve the problems. At this point, we usually want to have intestinal biopsy samples. We refer patients for endoscopy or take the samples surgically when referral is not possible. Many of our clients refuse either of these tests and in this case, we continue to try to figure out what is wrong through trial and error treatments. If we feel that we have eliminated most other causes, we treat for the lymphocytic/plasmacytic and/or eosinophilic enteritis diseases, usually using prednisone or other immunosuppressive medications such as azathioprin. I really prefer to have a diagnosis at the time we start using these medications, whenever possible. There is strong potential for adverse side effects with immunosuppressive medications and it seems better to have good reason to use them. Despite this, there are lots of times when we go ahead in the absence of a diagnosis and usually this works out OK. Obtaining a diagnosis makes it possible to direct treatment at a specific condition and it also helps to eliminate the possibility of using a medication with serious side effects for long periods of time when it might not be necessary. Those are the advantages. The disadvantages of pursuing a diagnosis through endoscopy or surgery are the risks of anesthesia and/or surgery and the possibility that biopsy samples won`t be diagnostic. It is not always easy to decide which way to go but I do like to try for a diagnosis prior to using immunosuppressive medications, when it is possible for us to do that. Mike Richards, DVM 1/29/2001

GI Problems

Question: Dr. Richards, I have a (presumably) black lab/pitbull/(maybe)dalmation cross, Nelson, with a GI problem. He is a humane society adoptee and is about 18 months old. I am hyper sensitive to such problems as my first dog died after his kidneys failed. This was after three weeks of progressively worsening vomiting and diahrea. Nelson first had GI problems after ingesting some ungodly grill drippings and some sort of solvent in my father-in-law`s garage in August. after days of diahrea and vomiting culminating in slightly bloody stool, he improved to "normal." He had been on Pepto Bismol, boiled rice/boiled chicken. Since then, he has had occasional stools coated in thick mucous, occasional soft stools, and few loose stools. He produces between five and seven large stools per day. Five days ago (Weds PM) he began vomiting his food, undigested. He had three or four episodes of vomiting that evening. We took him to our vet on Thursday AM. The vet humored me and ran a CBC and stool sample for giardia. The vet prescribed Pepto Bismol, boiled rice and boiled meat for the first two days then transitioned to I/D. Nelson was fine Friday PM and all Saturday and Sunday AM. Then Sunday before dinner he vomited twice -- first about two thirds then the final third of his undigested breakfast. After two hours of no problems I fed him one half can I/D and waited two hours -- no problems so I repeated and again two hours later. He is generally an extremely active dog. Wired tight like a dalmation with the tenacity of a pitbull and the looks of a lab puppy. At 75 pounds he looks very good. He has been a bit slower lately -- more lying around than his usual pester-to-play self. As I`m home recovering from surgery, I`m with him nearly 24/7. The only other unusual things are more production of eye mucous and excessive floor licking (40 minutes) before he vomited the second time. His bloodwork was negative except for slightly elevated white cell counts. Again, I am hypersensitive to these things having provided the round the clock IV and SQ fluids for my first dog before cradling him while he was euthanized. One of the two clinicians assured me that the white cell count was elevated but within the normal ranges. I should say I think both my vets are exceptional and trust them completely. They have never been afraid to refer to specialists nor to say "I don`t know". I`ve combed your site and looked at Megaesophagus, and Hypoadrenocorticism, as well as GI blockages. I wonder if doing an endoscopy would be wise, or if I`m just being paranoid. Other thoughts? Thanks, Jared

Answer: Jared- I think that Nelson`s medical history justifies starting a work-up to determine if there is a problem with inflammatory bowel disease or other GI tract problems. I am not sure that I would start with endoscopy, but it would be a reasonable starting point if your vets prefer to go that route. I lean towards deworming with a fenbendazole (Panacur Rx) as an early step, because it kills giardia and whipworms, which are the two parasites that have the irritating habit of not showing up on all fecal examinations. If that doesn`t make a difference we usually move on to a blood chemistry examination and complete blood cell count, which you have done, already. If this is normal, we usually try to talk people into feeding an diet designed to rule out food allergies but lots of times this is too complicated (especially if there are other dogs in the household) or the pet balks at the new foods, which must contain protein that is hydrolzyed to make it less allergenic or contains proteins that the dog has not ever been exposed to (so stuff like duck, salmon, egg and other proteins not usually found in dog food are used). If a food trial still doesn`t resolve the problem, if the blood work is normal and deworming didn`t help, then we try to refer patients for endoscopic work-up or treat for inflammatory bowel disorders, depending on what the client will let us do. In a young dog`s case, doing the work up is much better since they have to live with their GI problems a long time. Some pet owners elect to live with the problems and refuse to let us do anything else. Most of these dogs do OK, although I wonder how comfortable they are. So I don`t think you are being overly worried and I would encourage you to talk to your vets about how they think it is best to proceed from this point, since they have a better idea of Nelson`s history and the best steps to take to find out what is going on. Mike Richards, DVM 12/26/2000

Flatulence in Golden

Question: Dear Dr. Mike, Our Golden Retriever, Sammy, seems to have quite a bit of flatulence lately. We are not sure what to do as any change in diet or additive will bring on an attack of diarrhea. Sammy is 14 months old and was diagnosed with colitis at 4 months of age. We finally were able to get his diarrhea under control after roughly six months of trying different foods and medications. Sammy has been off prednisone and metronidazole since July and has been on a diet of Old Mother Hubbard Fish and Sweet Potato and Metamucil (for his anal sacs, he has trouble emptying them). During this time Sammy has had only occasional gas and when he did "flutter" it was not overly offensive. Sammy was diagnosed with Lyme Disease 9/26/00 and put on Doxycycline for one month. He was retested after the month was up and the blood work showed no Lyme Disease. We notice the flatulence after he had completed the antibiotic treatment. We waited a few weeks and then went back to our Veterinarian who put Sammy on Prozyme 200. This had no effect, the flatulence has actually gotten worse. We tried charcoal and other over the counter medications for dog flatulence but to no avail. Now Sammy has diarrhea and we are assuming it is from the different medications we have tried. Because of Sammy`s colitis and our inability to deviate from his diet, how can we control the flatulence. Sammy`s "flutters" are so pungent that the odor can actually make you sick and he has it continuously. Sammy passes gas about every 5-10 minutes. We just about catch our breath from the first bomb and he lays a second, third ..... The only good thing is that the flutters are usually not the "silent but deadly kind" -- we hear them coming so have time to hold our breath or leave the room. Some where we heard that being on antibiotics can throw off the good bacteria in your intestinal tract. Is this the reason for Sammy`s sudden excessive flatulence? Will it eventually go away? Sammy is accustom to being with my husband and I just about 24 hours a day. We love him with all our hearts but it is getting more and more difficult to be within 20 feet of him. We feel terrible because Sammy doesn`t understand why we leave the room sometimes or leave him home when we run errands. Any help you could give us would be greatly appreciated. Sincerely, Elizabeth

Answer: Elizabeth- I think that you already have covered my best guess, that the doxycycline has led to a change in bacterial flora in the intestinal tract, either a bacterial overgrowth situation, in which a bacteria resistant to the tetracycline suddenly found itself in a position to reproduce uninhibited by the other bacteria in the intestine, or a situation in which the makeup of the bacterial population has changed in some other detrimental way. Fiber intake can lead to flatulence but this usually clears up after a few weeks as the body gets better at accepting the increased fiber in the diet. When bacterial overgrowth occurs it will sometimes respond to treatment with metronidazole or amoxicillin, although there is some risk of making the situation worse using a new antibiotic to try to correct the situation. You do have the option of just trying to treat for the gas, by using products like Beano (tm), Curtail (tm), which is Beano made for dogs, and simethecone containing products like Digel (tm). Beano and Curtail seem to work pretty well but are expensive for long term use. Simethecone products only seem to help an occasional patient, though. It would be trying, but you could go back through the diagnostic process, including experimenting with diets to see which ones might help. I know that you would like to avoid that process if possible, though. If this continues to be a problem and you find you must do that, using one of the hydrolyzed diets might be a good first step (Hill`s z/d, Purina`s HA). Ask your vet about small intestinal bacterial overgrowth (SIBO) and see what he or she thinks about this possibility. Mike Richards, DVM 11/26/2000

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