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Dr.Fiona, Dog Veterinarian
Category: Dog
Satisfied Customers: 6273
Experience:  16 years experience as a companion animal veterinarian in British Columbia, California and Ontario
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my maltese is having stomach upset. about a week prior to

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my maltese is having stomach upset. about a week prior to christmas he had not been eating with his usual gusto..on christmas eve he vomited and had no appetite i brought him to the vet had xrays stool and blood work done. the xray and stool came back normal. i think the vet said there was a parasite showing in the blood and he was dehydrated. he received a shot (sorry i dont remember the name), antibiotics (amoxycilline)and flagyl to go home with. he also went home with cafatate ( i am guessing at the name as i tossed the container after use) which was to help coat his stomach for use 2 hours following the antibiotic being given. we fed him chopped meat and chicken breast boiled. he was on this about 10 days...with total improvement after about the sunday after christmas eve. he finished the full course. about 3 days following the course of meds he vomited once some bile then seemed fine. my concern is he vomited again tonight. i have more to say but am running out of room..
Hi there!

Welcome back! I remember that I talked to you about a year ago, I think, when Biscuit had that weird facial swelling and was so sick!

I'd be happy to help you and Biscuit again, but need a bit more information in order to better assist you.

So, when did he finish all his medications?

Has he been back onto his usual food?

Is he still on EN formula, which he was on when we last talked?

Customer: replied 8 years ago.
hi dr fiona.. whew its good to hear from you were so helpful last time.. ok i ran out of room with my question .. here is the end of my story.. biscuit has been fine since we last spoke when he had pancreatitus.   fast forward to present. no issues since that last problem but a year almost to the day later here we go... he finished all his meds this time around about 10 days following christmas eve. he was acting totally fine.. so i advanced his food about 7 days in to his normal kibble nutra brand and his wet food pet promise which he ate with gusto. about three days after meds were finished he drank alot of water and then vomited it...i figured he drank too fast and let it go..then after eating some sweet potato left overs from dinner he vomited again (middle of the nite) and it was liquid digested but tinged with the sweet potato color on my carpet (saw it when i woke up).. fine again for a few days but just tonight (having not eaten since 8 am it is now 7 ish.. he vomited bile. i was home today and he was fine in behavior all day until about 3 hours ago he seemed not himself..sure enough he must have been nauseous. he seems fine now running around barking etc but i decided to hold dinner ... and just gave him 2 heaping tablespoons of plain yogurt...wondered if the antibiotics maybe gave him some issue that yogurt might help with. he wants dinner but i havent fed him. im just worried. what if what had been the problem two weeks plus ago is not cured.. and i am running wild in my head with worse case scenarios. hope this is enough info... i am here waiting for your questions and assessment. i wish we could talk by that permitted? id be happy to call you in ontario.   pam many thanks!
Customer: replied 8 years ago.
oh i also forgot when he was treated at the vet they gave him sub q fluids as it was the holiday and he was dehydrated.
Hmmm... now Pam, you mentioned that he didn't eat today since 8am, and then vomited at about 7pm.

Does he usually go that long without eating?

Unfortunately, my terms of service of my contract specifically prohibit contact outside the site!

Customer: replied 8 years ago.
yes i feed him twice daily.... 8 am ish and 6:30 pm ish.
Customer: replied 8 years ago.
oh meant to tell you... on the vet exam he was afebrile
Customer: replied 8 years ago.
he had a lot of gas in his stomach the vet said on that exam too... i notice currently he burps on occasion. his stools have been fine ..this mornings the latest i noticed. sorry i keep thinking of things i will shush up now!
Ok - good about being afebrile!

LOL - no need to worry about hushing. The more information the better!

And how are his energy levels today?
Customer: replied 8 years ago.
fine with the exception of about 3 hours prior to his vomiting the bile...since then fine and he lapped up the yogurt with gusto.
Ok, that's good!

Pam, you are in the USA, right?
Customer: replied 8 years ago.
Ok - give me about 20 minutes to write up some detailed information for you!

Back soon!
Oh - just wanted to ask, could the shot Biscuit got at the vet have been an antibiotic called Convenia?

Or was it an anti-nausea shot to stop him from vomiting?

Was there ever any blood in the vomit?

Did he ever have black or sticky, tarry stools in the last couple of weeks?
Customer: replied 8 years ago.
darn i wish i knew.. i cant find the receipt for the from the vet.. i thought we were through the woods.. that med does sound familiar though. never had any blood in vomit. stools totally formed and normal the whole time til after the antibiotic started and he hadnt eaten for 2 days post vet treatment he had water and what i thought was the medication come out of him via wet diarhea. after that one time stools returned to normal.
Ok, just have to chase the kids up to the bath-tub and will be right back!
Hi again Pam,

Sorry for the delay - kids are a bit wingy tonight!

You have described to meCustomer who is an 8 year old Maltese who has recently been treated by his veterinarian for gastroenteritis. He was treated with an injection, and with antibiotics and carafate. He finished all his medications, and is back onto his usual food, but today seemed nauseated for 3 hours before finally vomiting up bile.

There are a number of things that could be going on with Biscuit, but from what you are describing it sounds as though his intestines are not back to 100% after his illness.

So, the vomitus today sounds like it was bile (this usually appears yellow, green or orange in colour, and foamy). The stomach makes acid and mucus, and the gall bladder makes bile, which flows down the bile ducts and into the small intestines, just below the stomach. Bile is orange, yellow, or even greenish!

When a dog vomits bile, it tells me that the stomach is very empty, and there is nothing to absorb the bile. In Biscuit, I suspect he may have "bilious vomiting syndrome." Don't worry - it's not as horrible as it sounds!

Basically, in small dogs their stomachs are tiny and their metabolisms are fast. They use up the food in their stomach very quickly, and then their stomach is empty. The stomach contains gastric acid, which is very irritating to the stomach lining, especially when there is no food to soak it up. When the stomach is empty, the acid irritates the stomach so much that the dog starts to feel nauseated. Then, he won't eat. So, the stomach remains empty and irritated. The dog then vomits - and it is stomach acid and bile that comes up!

So, it becomes a cycle - empty stomach --> nauseated --> vomit --> nauseated and so on.

The way to break the cycle is to get Biscuit eating many many small meals. Sometimes we have to give dogs with this problem an antacid to help them - common options are cimetidine (Tagamet), famotidine (Pepcid) or ranitidine (Zantac). When I see dogs and diagnose them with this problem, I often put them on famotidine (pepcid) that I have the owners buy at the local pharmacy.

Here is more about Tagamet:

More about Pepcid, including dose:

And more about Zantac:

Keeping Biscuit's stomach from getting empty will also help to break this cycle. This is particularly true of a bed-time meal. He needs to have something just before going to sleep in order to prevent his stomach from getting so empty overnight.   

Also, it is *really* important that he eats very soon after waking in the morning. Breakfast really is the most important meal of the day, so that we can get that stomach acid soaked up in some food and prevent the stomach from getting irritated. So, even if you have to resort to a bit of bread or low-fat crackers, then do that to get him to eat.

The other thing that I would recommend if Biscuit were my patient would be to put him on some Culturelle probiotic. You are lucky to live in the USA because it is widely available there in pharmacies! Here is more: In a dog the size of Biscuit, he would get about 1/2 capsule twice daily mixed in with his food. This will help to restore the "good" bacteria to his intestines. The yogurt you gave will help, too (make sure it has no artificial sweeteners in it!).

So, in summary, it sounds to me that Biscuit vomited bile and stomach acid because his stomach got irritated from being empty for long periods, and because it has not 100% recovered from his Christmas gastroenteritis. If he were my patient, I would treat him by giving culturelle, by giving frequent small meals and by giving antacids if needed.

Here's a link:

If getting your dog to eat breakfast is a challenge, you could try canned easy-to-digest foods from your vet (I/D or Gastro are a couple of brands) or pick up some jars of human baby food. Just make very sure the baby food has no onions, onion powder, garlic or garlic powder in it. Beech

I hope that this has been helpful. If it has, please hit the green "Accept" button and leave feedback.

I will still be here to provide more information if you need it!

The above is given for information only. Although I am a licensed veterinarian, I cannot legally prescribe medicines or diagnose your pet's condition without performing a physical exam. If you have concerns about your pet I would strongly advise contacting your regular veterinarian.


Customer: replied 8 years ago.
i held his dinner tonight because i read if a dog vomits to hold off on food... should i feed him now? it is 9 pm here and i bet he is hungry judging from his behavior. or should i just give him more yogurt? funny that you mention culturell i believe that is what i have in my refridge right now that i use from time to time. they are capsules.
Customer: replied 8 years ago.
fiona my father swears by chopped cook garlic for dogs.. i notice you mention to avoid that in baby food..why?
Well, if he were vomiting food after eating it, then I would definitely hold off on the food. But I actually think Biscuit vomited because he had not eaten in so long!

I would go ahead and feed him!

And put 1/2 of a culturelle casule on the food. Just open it and sprinkle out half the contents.

About garlic - onions are toxic to dogs. And garlic is in the same family as onions (allum), so they are also toxic BUT the dog would have to eat an enormous quantity. Still, I don't ever recommend them as they can be a problem for sensitive dogs.

Hope that helps! :-)
Dr.Fiona and 2 other Dog Specialists are ready to help you
Customer: replied 8 years ago.
many thanks! i will read up on all you have suggested and follow the other advice. you have been wonderful. nice talking to you again and many many thanks! pam
Happy to help! Feel free to let me know how Biscuit is doing at any time.

The system now allows you to update me any time - hours, days, weeks, months, years from now back on this same thread! Just save the link:

Hope he is 100% soon!

Customer: replied 8 years ago.
hi fiona

biscuit seems his old self.. he has been on the pepcid (with my vets final approval) he will be going in for his shots the end of this month and i will find out if he should stay on the pepcid or not. just wanted to thank you again. i will let you know once more how things work out. i had a question about making homemade dog food prompted by this problem.. id like to make sure you are the "expert" that responds as i value your opinion. can you get back to me on how to ask my question to you directly? many thanks pam
Hey Pam!

You can reach me on this thread at any time.

Or you can post a new question, and just write "Dr.Fiona I have a question" in the first line. Usually, my friends here will bring this to my attention if I happen to be offline when you send it. :-)

Customer: replied 8 years ago.
great here is my question so glad you were around....after biscuits experience i began to wonder if the commercial dog food route is the way to stay... id like to make my own meals for my dogs in as simplistic a way as possible. id like to make sure they are getting all the necessary nutrients...was thinking of cooking a big batch of boiled chicken breast and rice.. as an example. what food combinations would you recommend? what about additional vitamins? i always thought the hard kibble was jam packed full of all the important things they needed. i had been feeding them nutra lamb and rice formula. now i am reading about the pancreas of even healthy dogs going into overdrive trying to digest that hard stuff for their entire lifespan. what do you think about making homemade dog food for them? thanks
Hey Pam!
I think that home-made food is GREAT if you are willing to follow a recipe and make sure it is balanced.

Now, I have "met"Customerbut don't know your other dog(s). What ages and breeds do you have? Do your dogs have any medical problems (heart disease, kidney disease, other)?

I have to go get my son from his bus-stop but will be back in about 30 min...

Customer: replied 8 years ago.
terrific no rush fiona.. answer when you can..sorry thought of mentioning my other guys but forgot! biscuit is my oldest then i have jenna she is 3.8 years german shep female spayed and i have black jack my american black lab who is 3 years old neutered. they are all healthy no medical problems except what you have helped me with re biscuit. all are average weight and very healthy. i gave them all the nutra brand food (not sure if you have that where you are) along with occasional wet food pet promise (dr weil endorses). i supplement with chicken jerky treats or milk bones and occasionally scrambled eggs fresh from our bantam hens. they of course get the occasional table scrap not often and not fatty type foods lean meat or veggies. i switched biscuit to pet promise dry kibble since this last bout as i know it to be as healthy as i can find in dry dog food and it is chicken and rice not lamb. im thinking that may have gotten biscuit into trouble the lamb being too fatty but i dont know really. it gets real confusing when picking out commercial dog food..everyone has an opinion which generally differs from the next person! when i started doing the boiled chicken and rice for biscuit these last few weeks it got me thinking..what if i browned chop meat and alternated that with boiled chicken, yogurt,egg etc and would that be a good long term way to feed my furbabies. i could cook once a week and refrigerate etc.   
Hey Pam!

Ok, thanks for all that information! :-)
Customersure is *little* when he looks around at his fur family! ;-)

Yes, we have Nutro, and I recommend it as an excellent food. We don't have Pet Promise®, so I cannot comment on it from personal experience. The customer service department at Pet Promise®, and they do say that Purina® manufactures their food with Pet Promise®'s ingredients. When asked about AAFCO, they say they manufacture to "standards of", rather than by "feeding trials"... they only test for "palatability". It sounds as if they are formulating under the 'food family' rule, meaning they don't have to do feeding trials if the formula is similar to one that has already gone through feeding trials. This is not to say that it isn't a great food, just that it is so new it is hard to say.

As you know, every one has an opinion on dog foods, and even veterinarians disagree. It's hard to find the "right" answer. Another food that I like is Wellness, which has very good quality ingredients:

Now, on to home-made diets. These are GREAT as long as you can commit to making a balanced diet for your dogs. There are veterinary nutritionists who can help you make a BALANCED homemade diet for an ADULT dog.

The site, , has a section where you can get custom balanced recipes easily for your *healthy* adult pets. You can put in the promotional code HOMEMADE at checkout and the recipe will be free. I think it only lets you do that twice or maybe 3 times from your IP address, so if you need more than that, you will have to do it from another IP address.    Given that Jenna and Black Jack are about the same age and same size, they could probably share a recipe, but you might need to cook separately forCustomer

When you get to the payment/invoice type window, zero out the bottles of supplements (if you're going to buy them elsewhere), put the promo code in, and hit the "apply" button next to it. Then your invoice will recalculate and go down to zero if you only have one recipe there. You can continue on through the process without entering any payment info from there, and it will take you to the recipe for the pet you entered.

Finally, all home recipes for dogs need supplementation with essential fatty acids, calcium, phosphorus, potassium, vitamins, and minerals. The amounts of these are totally dependent on the animal and the base diet. There is no universal "supplement" that covers everything appropriately.

I think it would be wonderful if you could cook for your fur family and then refrigerate/freeze and use as needed. Your dogs are very lucky to have you!

Hope that all makes sense!

If this has been helpful, please hit accept. If you have more questions, just hit reply!
Best wishes, Fiona

Dr.Fiona and 2 other Dog Specialists are ready to help you
Customer: replied 8 years ago.
i will check out the resource info you gave me ty! i have heard of you favor it over nutra? also what about quantities> i forgot to mention their weights. jenna i slender and big for her breed she is about 80 lbs and black jack is very lean and muscular as he is a field lab.. he is about mid 70's in pounds. do you think wellness would be just as good as homemade? i dont want to recreate the wheel..just want to do right by these guys. thanks!
Customer: replied 8 years ago.
also what do you think about lifes abundance dog food>?
Customer: replied 8 years ago.
sorry also the nutro i use is the natural brand...lamb and rice
Hey again!
I have to go build a snowman... but will come back to answer this as soon as Frosty is made! ;-)
Customer: replied 8 years ago.
ha! have fun! i will accept in the meantime and await your response ty fiona! pam
Hi again,
Well, Frosty had to have an igloo... then there was hot cocoa and it was time to make dinner. I'm sure you know how it goes!

So, finally, here I am again! ;-)

Both Wellness and Nutro are good foods. I would probably put Wellness slightly ahead of Nutro, but if a dog were doing well on Nutro I would never suggest to switch away from it - it's a good food.

We don't have Life's Abundance dog food here in Canada, but I did a search on it for you over on and there is an overwhelming amount of negative information about it! I would stay far away from this one - apparently is does not meet minimum standards set by AAFCO and their website even suggests that dogs eating it would have to take a supplemental vitamin!   

In terms of quantity, it's hard to estimate the amount needed because so much depends on the activity level of the dog. The website will give you quantities of the home-made diet and the bags of food will also give you quantities based on weight (generally, they suggest quite a bit more than what the dog needs as they don't want to be accused of starving a dog, and they do want to sell dog food!).

For Jenna and Black Jack, I would guess they would eat about 3.5 cups and 3 cups per day respectively, but it could be a bit more or less depending on how much they exercise. Customerprobably only needs about 1/2 cup a day or so as he is just a little munchkin.

Now, is home-made better? I tend to think it is a bit better, as the ingredients are fresh and not overcooked. However, it is also very labour intensive.... I find that I resort to pre-packaged food for my family once in a while, so I am not sure that I could commit to making home-made food for my animals. Perhaps a good option would be to do half home-made and half commercial dog food like Wellness or Nutro. Then, your home cooking would go further and you would give your dogs the benefit of fresh foods!

Hope that helps!
Fiona :-)
Customer: replied 8 years ago.
huge help ty fiona

wow i was getting sold on the website for the lifes abundance. i am so glad i checked with you. as for your idea to mix home made with nutro .. that is what i was beginning to ponder. im gonna give it some thought. i cant get over how that lifes abundance was selling me. grr. many thanks for all your feedback. i will stay in touch. you have been so wonderful. will keep you in my prayers! pam
I can see why you would think Life's Abundance is good - the website is beautiful! However, it is reportedly a pyramid scheme!
Good night, best wishes,
Fiona :-)

Customer: replied 8 years ago.
ohhhhh wow.   well ty for the information. i really felt misled .. all natural ingredients with side by side comparison to brand name food backed by a holistic vet..glad you checked it out for me!! nite!
Customer: replied 7 years ago.
hi dr fiona

i am back with a biscuit question. i had switched to wellness for small dog breeds dry dog kibble for biscuit and some wet pet promise. i also feed him two snacks dedicated to keeping his stomach with something in it.... either ground turkey or chicken breast cooked, these are given between his 2 normal feedings. he has some good spans of time with no vomiting but then it eventually comes back sometimes with loose stool. i have been keeping a log and he averages at least once per month this scenario. i stopped the culturelle after a few months..and was wondering if i should start that again or that was not designed to be long term...i also have been giving him a quarter pill of pecid 10 mg. i was rotating and giving it to him every other day or sometimes longer time in between ...which helps him a lot. what i am finding though is the days he does not get the antacid he really changes for the worse. over the course of that one or two day span he starts having lots of stomach gurgling, he burps often and he often ends up throwing up. he gets loose stool often times although not always and he has smelly flatulence. so i really see him uncomfortable.   he even seems less happy.   on days when i give him the antacid he acts like a happy so fun loving ....a different dog. i wonder what if any damage long term use of the antacids can do =i was thinking instead of this roulette game if it made sense to just keep him on the antacids full time.    

there are some months he can have a good long span without symptoms but truthfully it does not last. i hate this merry go round. any suggestions?? thanks. oh ps for the last three weeks i have been only feeding him wet food (pet promise) thinking maybe the dry was a problem for him. he seems to prefer this food and even when symptomatic he will often eat. the only problem with this is his symptoms return much quicker between breaks from the antacid. it is really hard to stretch 2 days without him in a bad way.
Hi Pam!

Great to hear from you again! :-)

In terms of your questions about Biscuit:

1. Culturelle
Totally safe and very advantageous to keep him on this forever. There are no negative effects (other than the cost) and this really helps a lot of dogs. Also, this should help with the gurlging and burping, so do keep him on it!

2. Pepcid
Again, very safe and I have many dog patients that are on this every day for life. I see no long term problems and am totally comfortable with my patients being on this long term. Also, it makes such a difference to the quality of life of some little guy's like Biscuit, so again, a good idea to just keep him on it.

This class of antacids will do NO harm or damage even when used long term.

3. Food
Ideally, because of Biscuit's history of pancreatitis, it would be good to keep him on a fairly low fat diet. Usually, canned food is higher in fat than the dry food, so it may not be the best choice. If he is reluctant to eat, I'd rather you tempted him by adding warm water to his dry food, or making a gravy with a bit of the canned or using a 1/2 tsp of Parmesan cheese sprinkled on wet kibbles.

4. For flatulence - try Beano

Yes, you can use this in dogs! It is a digestive enzyme, and very safe. You can give 1/4 to 1/2 tablet with every meal to see how that works. Give it a week to see if there is improvement, though you may find it helps after even one dose. You can use this on those occasions when he has smelly flatulence, though you can definitely give it with every meal and do no harm, even if you keep him on it forever.

I hope that this helps you to helpCustomer

Fiona :-)
Customer: replied 7 years ago.
hi dr fiona

so wonderful to get your feedback although i am sorry it is due to this same problem! then again... it is not anything epic so that is a good thing. :) the flatulence i can tolerate as it does not happen that often unless he is symptomatic. it is good to know about the beano though. i will go back to the wellness dry with a small spoonful of the wet mixed in does that sound ok? he really is not finicky unless he is symptomatic. the last question to ask i neglecting something underlying by not addressing the acid issue more completely?? i sometimes feel in traditional medicine be it dogs or people we sort of take a pill to make a symptom go away and maybe there is something else i should be doing to help my little guy?   i even bought this digestive support product.   what do you think of it? should i try this? also should i change his diet any other way?? i just want to do the best for him. if i am neglecting something i should take care of i am willing to do most anything.   the fact he really feels better on the antacid makes me want to stop these symptoms and let him be comfortable but it seems like an easy way out ? maybe i am just nuts! :) pam

I know what you mean - medication just treats the symptoms and doesn't cure the problem. Sometimes it is hard to cure the problem and treating the symptoms is all we are left with.

That said, supplements can help. My colleagues (veterinarians trained in alternative medicine) recommend a make called "Standard Process" as they are very reliable and trustworthy. Here is the website:

the problem with Native Remedies (the link you gave me) is that the "about-us" page gives no indication of veterinary involvement in the development of this product nor of membership in NASC. You should always look for those 2 things when evaluating any supplement for animals.

So, I would say definitely try the products from Standard Process as they are trustworthy. Will they help - I don't know!

But, they will not harm him.

It would make sense to give:
- culturelle,
- the supplement from Standard process,
- small frequent meals of dry food (or add in rice and low fat cooked chicken), AND
- daily pepcid

Do this for 1 month. Then, slowly take away the pepcid. Take it away 1 day out of 3 (2 on, 1 off). Then after 2 weeks, see what he is like with every other day. And then with every 3rd day. So, gradually remove it ONCE you have everything else in place and see how he does.

Maybe he won't need it - but if he does, I don't think it will be a problem and I would much rather he was happy and feeling good. Constant stomach acid on the esophagus can be damaging, so this should be treated.


Hope that helps!


Dr.Fiona and 2 other Dog Specialists are ready to help you
Customer: replied 7 years ago.
i sort of did the taper you described but not exactly as you recommend and he def needed it ... i will try your suggestions and see where that takes me. ty re the mention of the acid on the esophagus...also his breath has gotten funky (his teeth have been cleaned a few months ago so they are fine). i thank you again for all your help! my best to you and your family! hugs pam
Customer: replied 6 years ago.
hi dr fiona..i hope you receive this as i did not want to go through the general box of "ask the expert" and get another vet instead of you. i want your opinion please re biscuit my maltese once again. he has been on the pepcid ac 10 mg as i think this long thread probably will show you from our history together. he takes one quarter of a pill each morning and that along with his meals 2x daily and a supplement of some chicken breast late morning (time varies based on my work schedule) has kept him generally speaking from vomiting and stomach upset. I must be diligent with the timing of all this or he will become sick but we have it pretty down at this point. in any case went to go get a fresh box of pepcid and the shelves are bare. asked the manager who said after the recall of one of their products they (pepcid) have not sent anymore product. I do not know what to use as a substitute...can you guide me? i remember asking you about the safety of using an antacid way back when and you told me pepcid was perfectly fine and would not cause any issues but certain other products could. HELP! thanks so much pam.

ps hope you and your family are well :)