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Candy, Veterinary Technician
Category: Dog
Satisfied Customers: 11619
Experience:  Practicing Veterinary Technician for 26 years.Former Veterinary Practice Owner, Technician Trainer
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My 6 mos old Shih Tzu has had stomach problems his entire

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My 6 mos old Shih Tzu has had "stomach problems" his entire life, so far. He weighs 5.8 pounds. Every single day there is something; either some diarrhea or just loose bowels, or slight vomiting. (He seldom vomits though). He avoids eating, I'm sure because of this problem. He's been checked and treated for worms; has had a blood test, checked for allergies; been in and out of the vets office for this problem since I got him at 8 weeks. I've tried every imaginable type of food, he avoids most all of it and never wants to eat a "proper meal". I give him pro-biotic and acidophilis for dogs, a quarter tab of Pepcid AD whenever he has rumbling and gas; yogurt at times and sometimes Pepto Bismol. I am taking him to the vet next week for a follow up. He refuses regular dog food except for (some) freeze-dried raw chicken patties. He accepts boiled liver and dark meat of chicken. I do not, at this point think he's just being picky, I believe he doesn't eat because of his stomach issues. He's active, playful and alert. His problem seems to be only in his stomach/colon, thus affecting his appetite. He is growing and gaining weight. What else can I do, or what could I suggest the vet do to find out what is ailing him and what I can do about it to help him?

Hello and Thank You for contacting JustAnswer


I am sorry your boy is having trouble.


I to am owned by Shih-tzus so I can tell you they often have digestive issues.


Can you tell me how often you are changing his food?


How many stool samples have been tested and have they been sent out to the lab?


Has he been placed on any medications or been dewormed?


How many times a day is he offered food?


Is he on any vitamin supplements?


Have x-rays of the abdomen been done?


I may have additional questions but this will get us started?


Customer: replied 6 years ago.
Thank you for your response and just hearing that Shih Tzu's often have digestive problems helps somewhat. The breeder called him "teacup", so he has always been very small.
- He is pretty much offered the same food because he wouldn't eat anything else- freeze-dried raw chicken patties (contain chicken, vitamins, fruits and veggies), boiled liver or chicken and small cheese snacks for treats or to give pills. He likes the liver at his 5PM feeding.
- I offer him food in the mornings around 10AM (we are up early, from 5AM on; he plays and naps early on), and at 5PM
- I often have to stand over him and nearly force him to eat the dry food. He will eat the meat off a plate but prefers to have it offered one piece at a time.
- If I just put food down and leave it for him to eat, he won't eat it; won't even go near it. Sometimes he barks at his food.
- He has been dewormed several times.
- He's been given metronidazole twice when diarrhea was bad (I still have some, as the instructions said to stop giving 3 days after diarrhea ends. I also have a vial of Pro-pectalin gel for diarrhea
- I walk him twice a day - he loves it, but he picks up stuff off the ground and eats it- I am constantly taking things out of his mouth.
- He has no pain, no blood in stools, however stools are always very dark, sometimes firm; mostly soft and very often contain mucus.
- I give him vitamin supplements and NutriCal
- His stool samples have been tested umpteen times (well, maybe 5) and sent to labs - the last one being at the end of Oct.
- No ex-rays of abdomen as yet
- He is due to be neutered; that can wait if necessary



Thank you for the great detailed info.


I just have a few more questions.


When you put the food down and leave it what kind of bowl is it in?


Did you see both parents we they considered teacup or are they normal size?


How often do you use the Pepcid AC?

Customer: replied 6 years ago.
- He wants the food on something flat. I usually put it on a saucer. He would actually rather have it on the floor if I'd do that. Many times, he takes his piece of food to the rug in the living room to eat it.
- No, I did not see the mother - the breeder said she was a standard size, and the father (that I did see) was a teacup about 41/2 lbs. I saw the pups at 3 weeks old and picked him out from his markings. He was about the smallest also. She said he would be teacup. I don't know if that's true or not; have read articles about breeders saying that to get more money. I just wanted a dog - a friend. He's very cute though.
- I use 1/4 of a 10 mg Pepcid AC pill in the AM and PM if he's having trouble. I don't give it to him if he's not.
Ok, I am typing up your answer. I do have a few things I want to discuss so it may take a few minutes to type up please bear with me.
Customer: replied 6 years ago.
PS - I wanted to tell you, I've been putting about 1/8 tsp of Benefiber in his drinking water every day because his stools seem so runny and he hardly eats any fiber. Is that OK?

Adding fiber is one of my suggestion discussed below, I would not add to the water, this may make him not want to drink and unless he is drinking the whole bowl he is not getting enough.


Ok, Most of what you are doing is right but there are some things that need to be adjusted.


The absolute first thing I would suggest is asking your vet to test for a liver shunt. This is very common in this breed and we almost always see it is the small pups(as this effects growth). This also causing vomiting and intermittent loose stool. This can be worse after eating as this is when the toxins are highest in the body, when the eat they feel bad so they try to avoid eating. Researchers at Cornell University College of Veterinary Medicine are actually researching the gene mutation in this breed that leads to Liver Shunts.

Read more here


These dogs should be eating 4 times per day, when they go to long without food acid builds in the stomach resulting in nausea refusing to eat.At 1 year of age they can go to three times per day. I would also try using the Pepcid daily for 7 days and see if that makes a difference. Give this on an empty stomach 30 minutes before offering food. This medication needs an acidic environment to work properly.


Always use a plate most of these dogs will not eat out of a bowl. The mouth and nose form a straight line in this breed and often eating out of a bowl allows the nose to come in contact with the food.

I know you are having trouble getting him to eat but right now he is not getting a balanced diet and is not providing enough fiber in the diet to regulate the stool.

I would like to you try a good quality dry food.I highly recommend Royal Canin 24. This is a Shih-Tzu specific food (even shaped for easy pickup)

I am going to give you a link to this food scroll down to and click on the Shih-Tzu guide you will see that this company has done extensive studies into the dietary needs of this breed.They have this in puppy as well


I know you are just making sure he will eat but I can promise you the longer he eats only human foods the less likely you will ever get him to eat dog food.


Mix the dry food 1/4 day 3/4 boiled chicXXXXX XXXXXver, ground chicken or turkey. This must be boiled to remove all fat or it too will cause stomach upset and diarrhea. Over a 4 week period slowly remove the human food and add more dog food. You can always add a small amount of the meat it just needs to be mostly dog food. Adding low sodium chicken or beef broth may also make it more appealing and soften the food if he prefers it that way.

To the food you also want to add 1/8 teaspoon of metamucil once daily to add fiber to the diet. Another way to add fiber is with canned pumpkin(not pie filling) this can be frozen in an ice cube tray and given 1 cube daily as a treat.

The probiotics should also be used daily.


I would suggest discussing the possibility of a liver shunt with your vet, have x-rays of the abdomen to be sure there are no abnormalities which is also common in the tea cups. When these dogs are breed down in size it is the body that is scaled down not the internal organs and we often see digestive trouble in these dogs. Change the feeding to 4 times per day add fiber and ask about using the Pepcid daily.


I would try the above things and I really think you will see a difference. Please let me know how he is doing, please reply back if you have additional questions or concerns.


Edited by Candy on 12/9/2010 at 4:38 PM EST
Candy and 3 other Dog Specialists are ready to help you
Customer: replied 6 years ago.
You've been very thorough and I appreciate all your research and effort. We had discussed liver shunt (vet and me) at another time. At that point she felt it not necessary. Perhaps we should start with the abdomen x-ray.
I have given him at least 20 different types of dry dog food recommended by vets and other veterinarian people. He refused ALL of them and I had to give them to the Humane Society. The ONLY thing in the form of dog food he has eaten is the freeze dried stuff. It is all right with me if he doesn't eat dog food as long as he is getting nutrients. I am willing to cook for him. Somehow, I feel he will never want to eat dry or canned dog food, but I'll try again.
As I said, you have been very thorough. I will discuss the tests with the vet next week.
Thank you again.
Customer: replied 6 years ago.
I read the info about liver shunt. He has none of the symptoms except the loose stool which is frequent; any vomiting very seldom (only twice since I've had him - 5 mos). He is not lethargic nor drinks/urinates too often, turn in circles, etc. I remember now, that's why the vet thought it wasn't a possibility. I'll mention it again. Is it fatal?
Can you see any evidence of this with a stomach ex-ray?
BUT, he does not eat 4 times a day and his appetite is not good.

Ok, I thought from your original question that this was more often.I would still test for the liver shunt often they only have one sign and his small size, continued diarrhea and unwillingness to eat would warrant testing in our clinic. You will see the one article I sent the Shih-Tzu never had any symptoms but the problem was found when treating for bladder stones.

X-rays will allow your vet to view the liver and in some cases the liver may be smaller then normal or abnormal in shape

The liver shunt can be tested for with a simple blood test and it is better to rule it out for sure.

Your vet may want to do x rays first. You mentioned he always picks thing up I have seen a partial blockage cause the symptoms you are seeing.


I know he is not eating four times a day this is our goal. Often these dogs when they go more then 5-6 hours without food they feel nauseous. This is a vicious cycle, when they do not eat the acid builds leading to nausea making them not want to eat. Even if he only eats a spoonful or two that is great. I would definitely try to get him to eat more often, like I said feed 1-2 teaspoons at a time. If nausea is the problem you may be able to get this under control.


I have one tea cup that I cook for here is what I do if you want to try it


6 cups of the dry food

1lb of ground turkey

2 small or 1 large sweet potato

1/2 package frozen green beans

1/2 package of frozen carrot pieces

24ozs of low sodium chicken broth.


Mix all in a bowel and allow the dry food to get soft. You can freeze in meal size containers. I freeze in daily ration sizes instead of the meal sizes.

This was designed by a veterinary nutritionist for my dog. Instead of adding vitamins and supplements to the foods I use the missing link


Please let me know what the vet says.


Edited by Candy on 12/9/2010 at 5:18 PM EST
Customer: replied 6 years ago.
Wow Candy! You are really thorough, helpful and concerned. I am very pleased with all you have had to offer. I printed out this copy of your answer to take to my vet relative to the testing you suggest. She has been taking care of Jake since I first took him in at 8 weeks, and has been through a lot with us. I thought the freeze dry was the answer, but he is still having the issues with weird stools, diarrhea and not wanting to eat hardly anything. Like I said, he sometimes barks at his food, or if he sees me coming with something in my hand that he thinks is food, he will head in another direction. I've never seen a puppy act like that - usually they eat everything. I will let you know what the vet says, using this "reply" method. I am feeling better that the liver shunt test is easy as a blood test and doesn't involve a lot of invasion.

You are very welcome. This is my favorite breed and all of my dogs are rescues with multiple heath problems so I have been through most of the typical Shih-Tzu issues.


I really think eating is making him feel bad and he is beginning to develop an aversion to food. We need to find out what is going on to help this poor boy. You may also want to ask your vet about using an appetite stimulant to get him going


Here is information on the Bile Acid test that is often done when looking for a liver shunt


Customer: replied 6 years ago.
OK, thanks much. Will keep in touch.
Customer: replied 6 years ago.
Hi Candy,
I did think about you because I promised to let you know the outcome of his liver shunt test. He tested normal on his fasting blood test, and was supposed to be between 15-20 two hours after eating. His was 35. My vet, her constituents, and I determined that it was only a slight elevation so we would check him again in a couple of months and see how it's doing. We don't think that 35 suggests liver shunt. Also, he doesn't have any neurological symptoms and his GI problems are MUCH better after adding Pepcid AD and acidophilus to his daily diet. He hasn't had any diarrhea or vomiting in several weeks; his stool looks normal, he's gained weight and is very active. He is still very very picky about his food; we're working on that. He does take food in the AM and PM plus daily vitamin supplement. He went from 5.6 to 6.8 lbs in a month. He's 7 months old and not thin.
I do appreciate your former help and wanted to update you. Thanks for reminding me. Keep up your good work.
Best, Julie

Thank you so much for the update. I am glad to hear he is gaining weight and seems to be on the right track. I am glad that using the Pepcid every day seems to be helping as well. I agree that with these test results while not overly high should be retested in a few months. He really is a tiny little guy at only 6.8lbs.

I hope he continues to improve.