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Kara, we have a toy poodle, male, into his 16th year, weight…

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Hi Dr Kara, we have...
Hi Dr Kara, we have a toy poodle, male, into his 16th year, weight 3,8kg, recently became diabetic, usually has 3units caninsulin in morning after breakfast of about 125 kcal, and a further 3 units after dinner of about 125 kcal. He has a good walk in the morning after breakfast, and his blood sugar seems well controlled, and when we are in doubt, we do 2 blood glucose tests to ensure there is no chance of hypoglaecemia.
Over the last few weeks, he has increasing incidents of loud stomach gurgling sounds in the early morning, and then will not eat, despite offers of various foods. He then gets reduced insulin depending on blood glucose (1unit or 2units). We have taken him to our vet more than 3 times, and he has suggested trying 2ml. 3x daily of peptosyl oral suspension to settle the stomach, and after that didn't deliver sustained results, 1/2 of a 1000mg Carafate with 20ml water as a suspension before dinner meal. The poodle does not like this suspension, and has regurgitated it more than once.
We have also tried breaking up total food into three smaller meals of around 80kcal value. That also hasn't seemed to make any difference so far. We are concerned to keep his weight stable and have been trying bland foods like boiled chicken and cooked fish. Stools are in the main normal.
The poodle had general anaesthetic four times in the last year, three times for removing leaking lower sub mandular saliva glands on left and right hand sides, and one to remove a molar tooth. Prior to actual surgery, he underwent a full cat scan and bloods and he was found to be fine on all counts.
He does not get table food. In the past he has enjoyed small pieces of meat and fish, and never exhibited any problems.
After these morning problems, we notice a lethargy, and appetite comes back around lunch-time.
We are perplexed about this problem only being in the morning, never any other time. And there are sometimes 15 days with no issues at all. When refusing food in the morning, he may or may not eat grass. If he does eat grass, he does not regurgitate the grass, and we see it later in his stools. We have tried to introduce small amounts of psyllium husk as a dietary fibre. No difference. We have also tried introducing "The missing link" probiotic pet kelp distributed www.petkelp.com, also to no avail.
We are at our wits end now. Any suggestions will be tried!
Regards, Brian
Submitted: 4 months ago.Category: Dog Veterinary
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Answered in 13 minutes by:
11/28/2017
Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago
Dr. Kara
Dr. Kara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 18,138
Experience: Over 20 years of experience as a veterinarian.
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Hello, I'm Dr. Kara. I have over 20 years of experience as a veterinarian and I'd like to help. Please give me a moment to review your concerns.

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Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago

I am sorry to hear that Muffin isn't feeling himself lately, with a decrease in appetite and increased noise from his stomach.

These noises are the result of ingesta moving through the gastrointestinal tract and gas bubbles. In most cases they are completely normal and seem to cause the dog no distress. But in cases where the dog acts uncomfortable it is likely that the pup is experiencing some reflux or abnormal motility, or painful intestinal spasms that are more than the usual. In severe cases this can be linked to pancreatitis which is a painful inflammation of the pancreas leading to increased enzyme leakage.

His drive to eat grass certainly points toward nausea and abdominal pain.

Possible causes of a lack of an appetite include a change in diet, dietary sensitivities or allergies, or eating things that they should not like too many fatty table scraps or garbage, bones etc. Metabolic organ failures (kidney or liver disease), Addison's disease (hypoadrenocortisim), pancreatitis, inflammatory bowel disease or even infiltrative cancers are other possible causes.

Metabolic organ failure or infiltrative cancer seem less likely because his problem has been intermittent and his symptoms should be consistent with those disease processes.

I would be concerned most about inflammatory bowel disease, food sensitivities/allergies, pancreatitis, and Addison's disease because he is experiencing these symptoms more than once and they are intermittent.

Ideally I would recommend checking basic blood tests on him including a complete blood count, biochemistry panel and a blood test for pancreatitis called can spec PL (canine specific pancreatic lipase) which is highly specific for pancreatitis. If his electrolyte levels seem unbalanced (high potassium and low sodium) then testing for Addison's disease with a test called an ACTH response test.

If those things are normal then the next step diagnostically would be an abdominal ultrasound when he is showing symptoms and endoscopy to collect intestinal biopsies.

I understand that several medications have been tried that seem to not help, including Peptosyl (bismuth and subsalicylate) and Carafate. I find bismuth salicylate products to be more helpful for loose stools than nausea or vomiting. Carafate while very good at coating the esophagus and stomach lining is bitter and chalky, many dogs find it objectionable and may even vomit after taking it.

Has your veterinarian ever prescribed a medication called Cerenia (maropitant)? This drug is very good for nausea and vomiting.

I think your fellow does have painful gastroesophageal reflux, which is interfering with his appetite and causing him discomfort. This is often related to poor tone of the gastroesophageal sphincter. This tends to be worse in the morning after a dog lays flat as with a weak sphincter acid easily refluxes from the stomach into his esophagus, causing burning and pain.

To help with gastrointestinal upset and reflux you can give either:

1) Pepcid ac (famotidine) at a dose of one half of a 10mg tablet every 12 hours

OR

2) Prilosec (omeprazole) at a dose of one quarter of a 20mg tablet every 24 hours

These are acid reducers and either one could help him feel more comfortable. They are quite safe and can be used for a few days if needed. In some cases dogs remain on them long term if this is a repeated problem.

Some dogs that become diabetic have smoldering, low grade pancreatitis, which is a painful inflammation of the pancreas leading to increased enzyme leakage. This may come and go, and when it flares many pups may refuse to eat and suffer abdominal pain. I am concerned this is the case with him. Ideally dogs with pancreatitis should be fed a very low fat diet. I would consider putting your fellow on Purina Pro Plan Veterinary Diets DCO which is a low fat high fiber food good for diabetics too, or Royal Canin Veterinary Diet Gastrointestinal Low Fat diet. Any diet change should be done slowly to avoid stomach upset. It should take about 5 to 7 days to slowly convert him to his new diet.

Please let me know if you have any further questions.

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Customer reply replied 4 months ago
Hi Dr Kara,
Many thanks for your quick response.
After I sent you that information, the poodle made a very very smelly loose stool with definite signs of blood. I capture it in a medicinal container, and we have an appointment with our vet in about an hours. The poodle suddenly seems much happier after passing that wet loose substance, not really a stool. He's keen on food now, so we gave him 10g of cooked beef very thin and small pieces.
Hoping that the odious smell is not sinister, but with an old dog, and he is into his 16th year now, we are hoping it is something like an internal cyst that has been waiting to burst. Anyway I will send back news later.
Much appreciated.
Regards,
Brian
Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago

Thank you for the update.

It sounds like he has some colitis going along with his reflux and nausea. That tends to cause mucoid stools with blood. A high fiber, low fat food seems like a very good idea to me (Purina Pro Plan Veterinary Diets DCO would be great). That diet should help with blood sugar control too.

Let me know how things go for your fellow.

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Customer reply replied 4 months ago
Hi Dr. Kara,
Vet wants us to get two more specimens, then he'll send them to the laboratory for analysis. Suggests we don't allow the dog to eat grass, must go back to bland diet, not to worry so much about nutrition finer details until we get stomach settled down properly.
Regards, Brian
Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago

I think that sounds very reasonable. Please let me know how things go for him.

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Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago
Hi Brian,
I'm just following up on our conversation about Muffin. How is everything going?
Dr. Kara
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Dog Veterinarian: Dr. Kara, Veterinarian replied 4 months ago

Hello, I wanted to make sure that you didn't have any further questions for me, and I'd like to know how things turned out for your pup. If you could give me an update that would be great, thank you, ***** *****

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