# Chronic Vomiting



## Julia Jones (Aug 10, 2010)

I have a pretty specific problem and was hoping people here could offer suggestions on questions or research I should be asking/doing to help solve my problem. I've hit a bit of a brick wall and could use some help.

I have a 16 month old intact female belgian malinois. She had giardia around 3 months of age and was treated/tested clear. She began some weird vomiting around March or April of last year (around 5-6 months) where she was diagnosed with giardia again. We ran a follow up stool sample that tested negative but it took some time for her symptoms to subside. We started with the typical 5 days of panacur but she went right back to diarrhea (no vomiting) so she was put on a 2 week course of metronidazole. This seemed to do the trick. Another follow up stool sample tested negative. I have two other dogs in the house who all tested negative and displayed no symptoms despite all having access to the same property. I treated a water source I suspected may be contaminated. She has tested negative since.

After a month of no symptoms and gradually weaning her back from chicken/rice/probiotics to kibble, she began randomly vomiting again. It started every morning ranging from 3am to 10am, usually mucus bile and she was done. Energy levels went down a touch but no diarrhea.Started feeding her later at night to no change. Fed her as late as 1a.m. a small meal but still vomited. Took her in to be seen, started back on a bland diet, and put her on famotadine twice a day to see if that helped. After a week, it went away.

This dog now will randomly start vomiting every day, sometimes twice, for as long as a 3 week to 3 month stretch. I have done basic panels on her looking at kidney function and liver (as this dog can clear out a water bowl that puts the all the other dogs combined to shame) and everything came back within normal levels. We began discussing atypical addison's disease, ran a resting cortisol which came back juuuuust on the low "line" of the bar graph but still within normal range. This dog is an anxious dog in public, not good with strangers and generally very stressed in the office as she was during the time of blood draw. Due to the overwhelming cost I had put into her at the time (going up from $800 now) and running into dead ends at ever corner, I did not pursue the SC TH stim test due to her age and the lack of other addisonian symptoms. It just didn't fit the bill and seemed a pointless waste of $400.

For a while she went almost 3 months without problems. For a while I thought the PITA morning vomit cleanup was over but she started back up again. This was her longest stretch yet of intermittent chronic vomiting. Just as randomly she's stopped again without any change in diet, routine, supplements, etc.

I have gone through several diet changes. I went from a chicken and rice basic food to a higher quality. I then switched to turkey and rice. I then switched to beef and potatoe and she is currently on fish and potatoe. This last episode she went to a different vet (I have seen 4+ over this) who tried putting her on metoclopramide once a day at night. Her vomiting typically happens in the morning and occasionally in the afternoon/evening. Needless to say, the metoclopramide did nothing and I yanked her off the medication after a month of giving it a shot. The other medication suggested were steroids but I adamantly refused.

I do notice she is a grazer. Always has been and it never comes up in her vomit. All the other dogs are grazers as well with no ill effects. I notice a ton of hair in her stool. The last 4 months or so she is throwing coat all over the place and I have to wipe out her kennel almost every other day. She also munches or chews on her "pants" on one side. I still can't figure out why, I've never caught her doing it, but I can see where she has shorn away the hair. Can anyone think of anything I can try? Anything I may have missed to question or anything to research? Has anyone experienced anything like this? I am banging my head against a wall trying to figure this out. I am debating transitioning her to raw (though her stool is perfect) but I haven't made the plunge. I would like to exhaust all other options before going that route, if I can. She is on a fish oil supplement appropriate for her size and I keep her at a lean working weight.

Thank you for all of your help if you can provide it.


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## Katie Finlay (Jan 31, 2010)

Minus the coat problems, it sounds like my Corgi with IBD. I'm assuming that's been ruled out though? Conan would go months without vomiting or diarrhea but it would always start back up again. Sometimes IBD presents as vomiting, sometimes diarrhea, sometimes both.

I switched him to The Honest Kitchen. The Force and Embark blends. I haven't had a problem since. We tried every limited ingredient and hypoallergenic food out there, every grain free kibble, and even traditional homemade raw. Nothing works like THK.


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## Julia Jones (Aug 10, 2010)

Thank you for the reply.

I haven't noticed diarrhea with her since the bad case of giardia. She typically only gets runny stool now when she takes her monthly dose of heartworm preventative and it's really not so bad. It's definitely something I can start researching, though, and I'm definitely willing to start playing around with the diet a little to see if that fixes this. I'd almost prefer an easy fix like that than something more serious.

I should note that her coat isn't thinned our or balding or anything freaky like that. I seem to remember we tested her T4 at one point and that was within normal levels, too. Figured I'd throw that out there in case it was pertinent. 

Thanks!


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## Tashauna Medrano (Jul 23, 2011)

My dog has almost identical symptoms to yours and has for most of her life and is about to turn 4. I have tried the metaclopramide, didn't work, and she gets famotadine everyday. I've run all the blood panels and the next step looks like it's going to be an ultrasound (because she recently vomited blood and I'm now worried about an ulcer) and probably an endoscopy. The only thing I didn't see on your post was how your dogs appetite was. My dog is on a home cooked chicken with vegetables and will go days without eating, which is usually when her vomiting comes back, and then sometimes eats like she's never turned her nose up at a meal. I feed twice a day 12 hours apart and when she eats regularly her vomiting seems to be under control. One thing that my vet did mention was that it could be a hiatal hernia or a duodenal ulcer but until we get the endoscopy I won't know. Not sure this helps you any but you are not alone in this boat. One thing that did help us is acupuncture and chinese herbs but the stress of going to the vet every week turned her in to a basket case so we had to stop.


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## Larry Krohn (Nov 18, 2010)

Have you tried feeding her a small meal before bed?


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## Katie Finlay (Jan 31, 2010)

Your dog doesn't need to have diarrhea to have IBD. It's definitely something I would look into. We did an endoscopy and an abdominal ultrasound. I would highly recommend trying THK before spending the money we did.


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## Tashauna Medrano (Jul 23, 2011)

I would agree that the honest kitchen is a great food if your dog will eat it. I have literally tried every one of their varieties but my dog won't touch it. When i have to force her to eat food to settle the rumbling noises in her stomach it is easy to mix and put in her mouth, and it does calm her stomach almost immediately.


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## Julia Jones (Aug 10, 2010)

I'm sorry your dog is going through similar issues, Tashauna. I gets pretty frustrating not being able to fix it. Her appetite is great. She eats twice a day, properly spaced out and never misses a meal. She is the first one chirping in the morning and the first one chirping in the evening for her food. When she hears the dishes rattle she goes bananas. She has great food drive and isn't picky at all in what she eats.

I have tried feeding her a small meal before bed. I have even tried feeding it at 10pm, 1am, and earlier, and she will still vomit in the morning or early afternoon. She was on pepcid/famotadine twice a day for almost a month and a half without any help or ease in symptoms so I stopped giving it. I'm starting to consider raw more and more and have already ordered THK to see if it helps. Luckily, right now, she is in the no-vomiting stage but I'm never sure how long it lasts. 

I am collecting more information on IBD, I never really considered this seriously, for whatever reason, until now. It was always a topic that bounced around when talking to the vets but it never took hold. Thank you all for the suggestions and replies so far.


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## rick smith (Dec 31, 2010)

re: "After a month of no symptoms and gradually weaning her back from chicken/rice/probiotics to kibble, she began randomly vomiting again"
- so why did you do this in the first place ???? did you consider the kibble might have been the cause ?
what is "kibble" btw ?
imo if your vet is against raw, the vet may be of little help regarding what to feed and may tend more to the "find another drug" solution

last did you consider that the nerve issues you mentioned may have an effect on how she is digesting food ? .. i say this because of the hair issues .. another possible red flag

also haven't read anything that the breeder has mentioned .. are you in touch with the breeder ?


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## Tashauna Medrano (Jul 23, 2011)

Probably a long shot but have you discussed Exocrine Pancreatic Insufficiency (EPI) with your vet? may be something to look in to especially since the vomiting cleared up after a round of probiotics.


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## Julia Jones (Aug 10, 2010)

At the time of weaning her back onto "kibble" (dry dog food) we had switched her protein source to assure it wasn't a food allergy. She went from a chicken/rice formula that, I believe had wheat, to chicken and potatoe formula without grains/wheat/etc. When the vomiting started again she was slowly transitioned to fish and potatoe without grains/wheat/etc which is what she has been eating since. At the time of weaning her back onto kibble food she was just assumed to have started vomiting due to the giardia and GI upset. We've since learned that this isn't the case.

The multiple vets we've seen haven't been against raw, it's just not something we discussed as an option. I am thankful to have a plethora of people around me who feed their working dogs raw and have a valuable source or reliable information at my fingertips!  So far the vets have all either wanted crazy testing (endoscopy, biopsy, etc) or have shrugged their shoulders and told me "she just vomits". I don't buy that my dog will just vomit almost every day for the rest of her life; that seems off. 

I'm not certain it's nerves just yet. It's definitely a consideration, along with blowing her coat everywhere recently. When she is in stressful situations it never seems to prompt the vomiting. She is either vomiting or she's not regardless what goes on around her. I do have a holistic supplement I can start giving her to see if it helps, I suppose, I'm just not convinced yet it's the source. Thank you for the suggestion, I can start her on the supplement and see if it works. 

I'm in touch with my breeder and have supplied copies of the blood work. They are just as stumped as I am. The litter is absolutely fine, as well. Only my dog makes a hobby of puking all the time, ha.

I haven't discussed EPI yet with my vet, but I have been reading up on it. I seem to remember a GSD I used to know having this so I am trying to get in touch with them and see if they can tell me how it started in their dog. When I go in for a recheck I'll ask the vet and get quotes for testing. I can't remember now if we had tested for this prior as it has been a while.

Thank you, everyone, for the suggestions! I think I may try switching her to raw over this weekend (I wont be able to pick up my order for THK until the week after) and see how that goes.


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## Tashauna Medrano (Jul 23, 2011)

Good luck. I sure hope you can get to the bottom of it.


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## Gina Pasieka (Apr 25, 2010)

I have to wonder if you have truly been commited to a diet trial. If it is potentially a food hypersensitivity, you need to be hypervigiliant about not allowing other foods or treats in as all during a several week time period. I think that if this has been going on for weeks, it is time for further diagnostics. I would recommend an Internal medicine consult, as an endoscopy may be the next diagnostic test of choice. You could consider doing an easier test...which would to send a GI panel to Texas AM...you can talk to your primary care veterinarian about this. http://vetmed.tamu.edu/gilab/service/assays...


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## Maren Bell Jones (Jun 7, 2006)

Yes, I was kind of thinking the same. Commit to a single protein/single carb source she's never had for a full 12 weeks and see how she does. Then you can slowly add in items that she has had before and see if that triggers the vomiting. I also agree on the endoscopy. There are weird stories out there where the dog had something like a chronic small foreign body for months causing off and on chronic vomiting or pyloric (a part of the stomach near the small intestine) flow obstruction and the least invasive way to see is with endoscopy. They get put under gas general anesthesia and the internist will use the endoscope to take a look around in the stomach and take biopsies. They are usually back to normal by the end of the day after anesthesia.


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## Julia Jones (Aug 10, 2010)

What carb source would you recommend? She has been on a rice based carb source as well as a potatoe based carb source. I know California Natural has a kangaroo meat but the carb source escapes me at the moment. Switching to raw would vary the protein sources, should I wait to do this and try an alternate protein source instead? 

Can dogs have a diet sensitivity and not show any other signs like,webbing of paw pads, inside ears, etc? 

Thank you both for replying, I was hoping you would both see this.  

Maren; would pyloric flow obstruction be potentially caused by her ingesting so much of her own hair? Would you recommend x-rays prior to an endoscopy at all? Thank you!


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## Maren Bell Jones (Jun 7, 2006)

There are several possible signs of food allergy and food insensitivity. Vomiting, diarrhea, weight loss, itchy paws/belly/tail/ears/anal sac glands and so on are all possible. They can have all these or just one. Unfortunately, there is not a good way to tell the difference between an allergy (which involves an immune response) and an insensitivity (which does not). Pyloric outflow obstruction can be due to a foreign body but can also be an anatomic narrowing of where the stomach contents go into the small intestine. Could also be from cancer, polyps, or ulcers. This is potentially why endoscopy would be a good idea if the strict food allergy diet trial does not work.

The California Natural Kangaroo & Red Lentil uses lentils and peas as the carb source. I would not do a raw diet with her yet because we don't know if she has a chronic pyloric outflow obstruction (usually caused by a foreign body, but there are other reasons) and that could make it worse if you add bones. I would do a cooked diet to start out with. If she has never had bison or venison before, I would start with that since it's not super commonly used and you can usually get it at most natural food grocery stores or from hunters. To start with, you don't want to give her a real protein heavy diet to start out with. This is why most allergy diets (either the over the counter ones like Wellness Simple Solutions or California Natural or the prescription ones) are typically low in protein. There is some evidence that while even just a little protein that an animal reacts to will trigger the allergy (like a dog who has a beef allergy will react to even the once a month beef flavored Heartgard), but keeping the relative levels low is also helpful.

So I usually have people do around 30-50% meat and 50-70% carb source. You can use whatever you absolutely sure she has not had before. I usually recommend cooked venison and cooked sweet potato because it's pretty simple and if you have hunter friends, you may be able to find some pretty cheap or free if they have older stuff in their freezer. So you would lightly cook the venison and bake the sweet potato and add approximately equal amounts. How much will depend on her caloric needs, which I can help you calculate. Then that is all you would feed her for up to 12 weeks (hopefully just 8, but can take up to 12). No treats or flavored pills either. Though you could give her venison jerky and dehydrated sweet potato as a treat. 

If that ends up working with no vomiting or other GI signs, we could either stick with that (I can help you balance it as that would obviously not be balanced long term) or slowly try to introduce ingredients to see how she reacts.


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