The Mysteries of the GI Tract: Demystifying Chronic Diarrhea in Dogs
Stanley L. Marks, BVSc, PhD, DACVIM, (Internal Medicine, Oncology), DACVN,
Professor of Small Animal Medicine, University of California, Davis,
School of Veterinary Medicine, Davis, California
Diarrhea is generally regarded as the most consistent clinical sign of intestinal disease in dogs and cats and is one of the most frustrating disorders for many veterinarians to diagnose and manage. Incomplete resolution of the problem can result in frustration and dissatisfaction for the owner and potential suffering for the animal. Antibiotics are commonly administered injudiciously to diarrheic animals, with resolution of clinical signs often wrongly attributed to eradication of a putative infectious pathogen.
Image (above). Endoscopic view of the duodenum of a 5-year-old castrated male Rottweiler with histopathologically confirmed IBD. The mucosa is erythematous and granular in appearance.
Chronic diarrhea is persistent or relapsing over a period of 3 to 4 weeks or longer. In contrast to acute diarrhea that is often self-limiting and does not typically require a comprehensive workup, chronic cases warrant a step-by-step approach to obtain a diagnosis and formulate an optimal therapeutic plan. The exception to this rule is in dogs with acute hemorrhagic diarrhea syndrome that can be associated with a number of infectious and non-infectious causes and typically lasts less than 1 week.
Vomiting Cat Cases: You Can Figure Them Out
Debra L. Zoran, DVM, PhD, DACVIM
College of Veterinary Medicine, Texas A&M University
College Station, Texas
Vomiting, one of the most common reasons for cats to be presented for evaluation, is often considered to be “normal.” There is some truth to the idea that cats vomit more readily from eating too much or too fast; eating foods that are unusual, especially food that contains toxins; or grooming (vomiting hair). However, such vomiting should not be routine. If it is, there is often an underlying cause that needs to be addressed. Adult and senior cats have different causes of vomiting than kittens do, but there are similarities in the approach to diagnosis of vomiting in cats of any age.
To simplify the process, it is sometimes helpful to separate the multitude of causes of vomiting into two more distinct groups: vomiting caused by diseases or disorders of the gastrointestinal (GI) tract itself or vomiting due to systemic or non-GI diseases and disorders that trigger either peripheral or central neural pathways (Table 1). Vomiting caused by primary GI diseases includes such differentials as infectious, inflammatory, parasitic, anatomic, (obstructive, trichobezoars), neoplastic (alimentary lymphoma), and drug-related or food-related (hypersensitivity, intolerance disorders). 1-3 Cats that are vomiting due to extra- GI diseases may have a myriad of different systemic problems, but endocrinopathies (eg, hyperthyroidism), metabolic diseases (eg, renal or liver failure), inflammatory diseases of the liver or pancreas, cardiovascular diseases (eg, heartworm disease), central nervous system (CNS) disorders (eg, vestibular or inflammatory CNS diseases), and neoplasia (eg, mast cell tumors, other cancers affecting visceral organs outside the GI tract) are the most common.3-6
Nutrition for Senior Dogs: New Tricks for Feeding Old Dogs
Julie A. Churchill, DVM, PhD, DACVN
College of Veterinary Medicine, University of Minnesota
St. Paul, Minnesota
Senior dogs commonly present to veterinarians for primary care and represent approximately one third of the pet dog population.1 Life spans are increasing and thus both the percentage and the age of elder dogs may be increasing.2 Pet owners perceive that most pets, including senior dogs, are healthy and do not require a therapeutic food,3 but they are still left with hundreds of pet foods from which to choose. Advice and information recommending the best food is available almost anywhere—from trainers to pet food retailers, from magazines, internet sources, and social media. It is important to remember, however, that there is no established AAFCO nutrient profile for a “senior” life stage; thus the nutrient content of products marketed for senior pets varies widely. This makes it even more critical for the veterinary health care team to play an active role in providing credible nutritional advice, especially for senior dogs that have unique nutritional concerns
What Is Old?
The point at which a dog progresses from adult to a senior or geriatric life stage is variable and subjective. Life expectancies vary widely among dogs depending on breed and body size. Aging changes can also be variable, including loss of senses (hearing or vision), reduced energy requirements and lean body mass, as well as a decline in various organ functions. The American Animal Hospital Association (AAHA) Senior Care Guidelines suggest that, with the exception of large-breed dogs, most dog breeds reach middle age by 7 to 8 years of age and should be considered seniors when they reach the last 25% of the predicted life span for their breed.4 Despite this arbitrary categorization, physiologic changes that occur in middle-aged and senior dogs make them less tolerant of nutritional deficiencies or excesses. Middle-aged dogs are “at risk” or more vulnerable to age-related health problems. Middle age may bring an increasing incidence of chronic diseases, many of which can be influenced by nutritional management.5 A vital component of preventive medical care thus should include a “senior” screen or health risk assessment for early detection of health problems and adjustments to care to prevent or slow onset of age-related diseases. Every senior health screen should include a thorough nutritional assessment followed by an individualized nutritional recommendation.
Pet Food Myth Busters: Answering Common Questions Owners Ask About Pet Food
Lisa M. Freeman, DVM, PhD, DACVN
Cummings School of Veterinary Medicine, Tufts University
North Grafton, Massachusetts
Many owners make decisions about pet foods based not on fact, but on the many current myths and misconceptions that prevail. The first step to dispelling pet food myths is to be aware of what your patients are eating.
A complete diet history for every patient at every visit is important for a number of reasons. Knowing what a patient is eating can help to diagnose health concerns—for example, if owners are feeding an unbalanced homemade or vegetarian diet; foods with potential hazards, such as raw meat diets (or other raw products, such as rawhides, bully sticks, or freeze-dried treats); commercial diets that are not nutritionally complete and balanced; or diets manufactured by companies with questionable nutritional and quality control protocols. The diet history also can help to determine whether the current diet is optimized for maintaining health or, in the case of animals with medical conditions, for helping to manage disease.
In addition to collecting information on the animal’s current diet, which includes the pet food, treats, table food, rawhides, dental products, dietary supplements, and foods used to administer medications, it also is important to make a specific recommendation about the animal’s diet. This may be as simple as saying, “You’re feeding an excellent diet to Fluffy and are keeping her in perfect body condition. Keep up the good work!” Supporting sound nutrition decisions can help to reinforce these behaviors and makes it less likely that the owner will seek out nutritional information from other less reliable sources. Conversely, if the owner is feeding a diet that is not optimal, make a specific recommendation for a more appropriate diet (or treats, supplements, etc) and explain why you’re making this recommendation. Providing reliable nutrition resources and helping owners understand how to make more objective decisions about what they read or hear can help to ensure their pets are receiving optimal nutrition. In addition, it is important for the veterinary healthcare team to be prepared with answers to common questions and to be able to debunk myths.