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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 24422
Experience:  University of California at Davis graduate veterinarian with 44 years of experience
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I have a 5 year old male pitbull. past couple months he

Customer Question

Good Morning,
I have a 5 year old male pitbull. For the past couple months he either has diarrhea or is vomiting one a week. He has a rash on his lower stomach that looks like little black heads. Our vet said it was a food allergy, and we started a food trial about 4 weeks ago, he is currently on Royal Canin Venison and Potato. The rash is still there, and he has had diarrhea and vomited a yellowish bile substance this week.
Any suggestions?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.

"Little black heads" (comedones) are consistent with quite a few skin conditions but a food intolerance/allergy isn't one of them. Pruritis (itchiness) about the head, anus, and extremities is the hallmark of food intolerance. Gastrointestinal distress as you've mentioned is supportive evidence of a food intolerance but isn't pathognomonic (specifically indicative) of food intolerance. I have no objection to seeing if the novel protein food you're currently feeding your pitbull is helpful but I haven't heard of symptoms strongly supportive of prescribing that food.

Comedones can be seen secondary to pyoderma (bacterial skin infection), demodicosis (the Demodex mange mite), dermatophytosis (fungal infection), Cushing's disease (not a consideration in your pit bull), and vitamin-A-responsive dermatosis. Diarrhea or vomiting so often has too many possible causes to list in this venue. I would presumptively treat such a patient with a broad spectrum anthelminthic such as fenbendazole (Panacur) which addresses all of the nematodes (roundworms, hookworms, whipworms) as well as the protozoan Giardia and if I didn't see a positive response proceed to diagnostics in the form of blood and urine tests. Advanced diagnostics in the form of abdominal ultrasound and scoping and biopsy of his GI tract might be suggested if nothing untoward were found in the blood and urine tests and particularly if the frequency of his vomiting or diarrhea increased.

Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
He had whipworm when he was a puppy, but the Vet had done blood and urine tests and nothing came up. I've also noticed that he is drinking more water than normal. He doesn't seem to like the Royal Kanin. Since we're over halfway into the food trial and his symptoms haven't gotten better or worse is there another type of food you would recommend, possibly one that doesn't cost $100 for a 25lb bag? Also, is there anything I can do to help calm his stomach other than chicken and/or rice?I'm thinking maybe I need to find a new doctor? He was great during Bud's (my pitbull) TPLO surgery at 1.5 year old so I've just stuck with him, but everything your saying along with some of my own research completely contradicts what he's telling me.
Expert:  Dr. Michael Salkin replied 1 year ago.

Thank you for the additional information. Considering his history of whipworms and the fact that fecal ova and parasite exams are too often falsely negative, I would purchase over the counter fenbendazole and administer it at 22.7 mg/lb daily for 3 days, retreat in 3 weeks and again in 3 months because of the long pre-patent period of the whipworm.

Here's my synopsis for food intolerance. You'll see that over the counter presumptive hypoallergenic diets may be less expensive but also less likely to be helpful...

Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that his immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from his vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (a hydrolyzed protein diet is my preference). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

You might find that an over the counter antacid such as famotidine (Pepcid) dosed at 0.25 mg/lb twice daily or omeprazole (Prilosec) dosed at 20 mg daily might be helpful but ultimately we need to identify the cause of his GI distress and treat effectively. Please continue our conversation if you wish.