Hello, my name is***** and I have over 20 years of experience as a veterinarian. I am sorry that your fellow Geordie is thin and has been dealing with chronic diarrhea for many months, since 3 months of age. Dogs that have long term diarrhea have abnormal gut motility, and thus may have some reverse gut motility or stasis and that can lead to vomiting and nausea, thus a loss of appetite. The cramping that comes along with diarrhea can also affect appetite. Is his appetite at all off or is he readily eating at every feeding
but still not putting on weight? It is important to describe what sort of loose stools he has to try and localize the problem. Loose, small stools with mucous or bright red blood and straining or urgency to pass stools more frequently point more towards large bowel diarrhea or colitis
, whereas watery, voluminous stools with no mucous, no increased urgency or frequency to go, along with weight loss or lack of weight gain point more toward small bowel disease. Some dogs have both small and large bowel diarrhea, although even with those pups most seem to have more symptoms of one than the other that may point to where the trouble started. Chronic diarrhea can be secondary to heavy parasite infestation, but although that would explain his initial loose stools that is less likely in an adult dog, and I suspect he has already been wormed several times even with negative stools. If not I highly recommend that be done. I recommend Panacur (fenbendazole) as it has a wide spectrum against many parasites. Chronic diarrhea can also be due to bacterial overgrowth, an inability due to digest and absorb food due to metabolic organ disease, (especially liver disease), pancreatic disease or endocrine disease (hyperthyroid, Addison's disease), or primary intestinal disease. Chronic diarrhea does cause changes in motility of the gut and can lead to bacterial overgrowth in the gut. Probiotics such as Fortiflora or Benebac can help replace appropriate bacteria. I see that he has had stool samples checked to make sure that parasites aren't part of his problem. Have any other diagnostic tests on his stools been checked, such as fecal cultures or smears to look for bacteria or unusual parasites that may be hard to pick up of a regular fecal?If not I recommend a fecal culture and direct smear to check for abnormal bacteria such as clostridia ect. be done. Has he had basic blood tests to assess liver and kidney enzymes and blood protein levels?Dogs with intestinal inflammation are unable to digest or absorb nutrients from food and lose proteins through a damaged intestinal wall. Dogs with organ disease cannot digest and absorb food properly, nor metabolize it normally, and may lose proteins through their kidneys thus they cannot gain weight. It is quite possible that he has a food allergy/sensitivity or inflammatory bowel disease and that he needs a different low residue, easy to digest food or a hypoallergenic
food to be able to properly digest and absorb his food and not have loose stools. I highly recommend a trial of either Hills i/d or Purina Veterinary Diets EN. No treats
, table food or edible chewies while he is on his food trial. If he does well he can eat these foods for life as they are balanced. Having had 2 dogs with inflammatory bowel disease I have a personal preference for Purina Veterinary Diets EN. Dogs with food allergies can benefit from Hills z/d or Purina Veterinary Diets HA. There are other possibilities too as I mentioned.Addison's disease, which is a poorly functioning adrenal gland, can lead to chronic diarrhea and vomiting. These dogs cannot handle stress at all because their adrenal gland doesn't produce cortisone when stressed and their electrolytes can be off too if their adrenal gland isn't controlling that normally either. We see vomiting, diarrhea and sometimes physical collapse in severely affected dogs. Testing is an ACTH response test to check adrenal gland function and checking electrolyte levels. Treatment is steroid replacement therapy and electrolyte replacement. Pancreatic insufficiency (EPI) is another possibility. These dogs have a pancreas that produces a decreased amount of digestive enzymes, and the amount produced can wax and wane in some cases, especially early in the disease process. Testing is by running a blood test called a TLI which checks for digestive enzymes. Treatment is replacement of digestive enzymes at each meal. An easier to digest food would be expected to create less problems with digestion and as such less diarrhea.I understand his folate levels were low. Pancreatic insufficiency can affect folate levels, so we need to test his pancreatic function. If he has normal pancreatic function then low folate signifies proximal (closest to the stomach
) small intestine disease. Were his cobamalin levels checked too? Cobalamin is absorbed in the distal small intestine (closer to the colon). Low levels are often seen in patients with EPI, bacterial overgrowth in the upper small intestine, or disease affecting the distal small intestine. In short more diagnostics need to be done. They can be as simple as more fecal checks and cultures, as well as blood tests to check pancreatic and/or adrenal gland function. An abdominal ultrasound could be very helpful to look at his adrenal gland, liver and kidney size and shape as well as his intestines. Or more invasive testing such as biopsies of his gastrointestinal tract to look for inflammatory bowel disease, or rare fungal infections that affect intestinal function, can be done.In the meantime a diet changes as I described above may help.Please let me know if you have any further questions.