Sabre’s Journey
A Few Things I’ve Learned Along the Way…
about EPI, SIBO, IBD and Leaky Gut Syndrome
by
Deb Zilisch
Like many of you, I spent most of my life taking my dogs to the vet for routine check-ups, vaccinations and the like…never giving it much thought until my dog actually became sick. What started out as a puppy with a bout of diarrhea, followed by somewhat soft stools and picky eating habits….a “sensitive Shepherd stomach”…developed into something more, and continued to snowball out of control, until my dog was near death, and I was facing recommendations to put him down. After talking things over with Sabre, we decided to fight on as best we could. But it can be a lonely journey when you have only questions and no answers. So this article is in honor of Surefire’s Cutting Edge, CGC (2004 – 2009) a/k/a Sabre…the dog of my heart, gone too soon.
By sharing what we learned during our four year journey, it is my sincere hope that it may help some of you avoid the pitfalls that so many of us have encountered when dealing with chronic GI issues in our dogs. 
It’s not, by any means, a substitute for your vet’s care. I am not a vet, and this paper is not intended to diagnose your dog. But I want you to know that I truly believe there are complimentary and alternative treatments available, that give hope to dog owners wishing for something other than a lifetime of drugs and ever spiraling health issues. Remember, you should always keep your vet in the loop and run any treatment changes past him/her, especially if your dog is already on medications that could interact with the supplements. Ultimately you are responsible for your pet’s well-being…you are his best advocate. If at any time you feel your dog is not doing well, I highly recommend having him examined by a vet.
While food changes can bring very quick relief when dealing with food intolerances, treatment with supplements generally takes more time. If you opt to try some of the alternative treatments, please keep in mind that all dogs are different, and as individuals, they can respond differently to treatment, so you need to tailor it to their needs. That means you need to be willing to do some sleuthing to figure out what works and what doesn’t.
It’s easiest to keep track of progress if you make only one change at a time, allowing up to a week in between additions to determine how well your dog is tolerating the new regimen. A journal helps, as do “markers”…raw carrot or corn…to identify how your dog’s digestion and stool quality was affected by a particular change. And although it takes time to heal the gut, if something is obviously not working…give some serious thought if it makes sense to keep doing it or try something else. Again, your journal can be your best friend as you work through the process. In addition, please keep in mind that most supplements should be added to your dog’s diet slowly, in small increments working up to a full dose over time, as your dog builds tolerance to it. And if your dog has a setback, try going back to the regimen that was previously working, many times that will get them back on track.
If you’re having trouble resolving ongoing GI issues, your vet can do a consult with the Texas A&M’s GI Department [email protected]or your vet can call Texas A&M Labs in USA 1-979 862 2861. You may also want to look for a holistically-trained vet in your area. Here’s the link to the American Holistic Veterinary Medical Association, where you can search for a holistic vet in your area: http://www.ahvma.org/
A note from the website owner. DO NOT assume that all natural remedies are created equal. DO your research, use products that have been independently tested by a 3rd party. One such source is: http://www.consumerlab.com/
THE MOST IMPORTANT LESSONS I HAVE LEARNED
LESSON ONE:
It’s my belief that many of the digestive issues we see in our dogs, actually start out well before we recognize that there is a problem.
I do not worm my puppies or dogs unless I have a positive fecal result. However, if I get a puppy that has had numerous doses of worm medication, or has a history of coccidia or giardia treatment, I will add L-glutamine to his/her food for a couple of weeks to help strengthen/heal the intestinal lining.
LESSON TWO:
If you use antibiotics to kill pathogenic bacteria, you should consider replacing the friendly flora that you are also destroying.
LESSON THREE:
Do not to rely on systemic antibiotic treatments if localized ones will do the job. When necessary to use them, choose the appropriate antibiotic for the condition. An injection of an antibiotic is, in my opinion, a very ineffective treatment for GI complaints such as SIBO or anal gland infections.
LESSON FOUR:
Clearly understand what is being prescribed for your dog and why. I make a point of asking about potential side effects of any treatment or medication my dog is given.
LESSON FIVE:
I learned that you need to treat the underlying cause, not just the symptoms.
LESSON SIX:
Dogs are generally not picky eaters. If your dog doesn’t want to eat…to the point of starvation…there is something wrong.
EPI dogs that have concurrent SIBO often experience anorexia due to the inflammation caused by the pathogenic bacteria.
Some additional reading for owners of dogs who won‘t eat: http://dogaware.com/articles/wdjinappetence.html
MY THOUGHTS ON CHRONIC SIBO, INFLAMMATION, LEAKY GUT SYNDROME and FOOD INTOLERANCES…
SIBO does not just mean the presence of bad bacteria…there are always bad bacteria in the gut. It is specifically the IMBALANCE of good to bad bacteria that is the issue. Antibiotics are an artificial fix for this imbalance. Besides removing the bad/pathogenic bacteria, they also destroy the good flora. If you’re lucky, your dog will have enough good bacteria left to colonize and restore balance on their own. The re-balancing is less likely to occur in EPI dogs due to incomplete digestion. The pathogenic bacteria thrive on the substrate of partially digested food, which is why SIBO is so common in EPI dogs. 
Friendly flora thrives in an acidic environment, while the pathogenic bacteria flourish in a more alkaline environment. This explains why a shortage of the friendly lactic-acid producing strains of bacteria would have a negative impact on the pH level in the intestinal tract, further encouraging SIBO.
The effects of uncontrolled SIBO are many, including weight loss, B12 deficiency, regurgitation, vomiting and diarrhea, anorexia, inflammation of the intestinal lining from the toxins released by the pathogenic bacteria, liver disease due to processing the toxins released by the pathogenic bacteria and eventually a permeable gut where larger-than-normal particles of partially undigested nutrients leak through the inflamed intestinal lining and trigger an immune response to those foods. This condition is also commonly known as Leaky Gut Syndrome, and results in watery diarrhea when even a small amount of the offending food is ingested. Keep this in mind if you’re trying to work through the issues of balancing enzymes, treating SIBO and identifying food intolerances…the appearance of the stool can be the key to the puzzle! A Quick Guide to Poop Patrols
Discounting dietary changes and food additives, the color of your dog’s poop can be an indicator of his/her general health. Here are some things I’ve gleaned from reading and also some things I’ve learned from observation. Generally, color variations in the stool, gas and loud gut sounds are indicative of small intestinal issues. However, anything out of the normal should be discussed with your vet.
Shades of Brown – caused by the normal breakdown of red blood cells in the waste product bilirubin and a good bacterial balance.
White to Gray colors can indicate a bile duct obstruction or liver disease, especially if paired with increased thirst and/or orange urine. Although some raw fed dogs with lots of bone in their diet may have white stools as well.
Green, yellow or orange shades can be an indicator of incomplete digestion, too fast of transit time, bacterial imbalance, or giardia.
Greasy – incomplete fat digestion
Shiny wet look or Mucous coating – large bowel irritation, shedding in the mucosal lining
Tarry black – small bowel bleeding
Red blood – large bowel irritation, clostridia, colitis, coccidia, HGE
Brown Water – food intolerance
Unproductive straining – constipation, large bowel irritation, bacterial infection
Dogs with SIBO have VERY smelly stools. If you can smell your dog’s poop from across the yard, it’s likely that s/he has a bacterial imbalance.
Extremely bad breath can also be present in dogs with inflammation and malabsorption issues.
In my experience, the goal must be to restore balance to the GI flora, reduce the inflammation and promote healing. I have had very good luck using holistic type treatments to achieve this end.Following is a link to one of the most informative articles I’ve come across, and highly recommend, since it is short and easy to understand. If your dog has ongoing digestive concerns, this article may hold some answers to condition:
Holistic Approaches to Inflammatory Bowel Disease by Dr. Tiekert, from the 2007 North American Veterinary Conference, as published on the IVIS website:
http://www.ivis.org/docarchive/proceedings/NAVC/2007/SAE/018.pdf
Holistically-trained vets seem to be more open to developing treatment plans to benefit the whole dog, which in turn allows the body to participate in the healing process. Whether or not you believe in acupuncture, homeopathic treatment or massage therapy, I have not had a lot of luck finding many allopathic vets that are open to using the herbal supplements that I believe extended Sabre’s life, giving us three additional years together.
(Reduce, Remove, Replace, Repair)
ONE: Reduce the load of pathogenic bacteria (and the toxins they produce)
with an antibiotic…Tylosin (Tylan), Metronidazole (Flagyl), Oxytetracycline or possibly something more broad spectrum, like Amoxicillin, if there’s already some antibiotic-resistant strains involved. Work with your vet to determine which antibiotic makes the most sense for your dog’s particular situation.
Antibiotics are weight-based. Tylosin has the least chance of side effects for most dogs. Metro can cause drooling, upset stomach and sometimes neurological issues (loss of balance, eye twitching, etc that typically resolve when the drug is withdrawn. (In the case of a Metronidazole toxicity reaction, you need to stop the drug and call your vet immediately.) My vet had trouble getting Oxytetracycline, so we never used this one. Amoxicillin wipes out more of the good bacteria than the other three, but is good for treating Clostridium infections and the hemorrhagic diarrhea it may cause.Milk Thistle can be helpful in supporting the liver as it works to remove the toxins.
TWO: Remove the undigested food
that the pathogenic bacteria is feeding on. Continue to use adequate enzymes to break the food down and make it easier for him/her to absorb. The pathogenic bacteria thrive on the undigested substrate in an alkaline environment, so it also helps in a lot of chronic cases to feed a grain-free diet if you aren’t already. Also, some dogs have less problems digesting raw due to the naturally occurring enzymes in unprocessed food.
THREE: Replace the good bacteria that has been displaced, or destroyed by the antibiotics with a good probiotic. Probiotics are the bacteria that normally reside in the healthy gut and are considered “friendly” to the host. In my opinion, lactic-acid producing strains of bacteria, that help change the pH level in the small intestine to a more acidic environment, are one of the single most important things you can do to resolve chronic SIBO. It takes BILLIONS of CFU’s (colony forming units) per day to re-balance the intestinal flora in a dog that has been on extended doses of antibiotics.
If your dog is lactose-intolerant, there are many brands of non-dairy probiotics available. Currently, I use Kyo-dophilus for myself and my dogs…it has 1.5 billion CFU’s per capsule of the three strains of bacteria that I prefer…L. Acidophilus, B. Bifidum and B. Longum. Keep in mind that some dogs tolerate the simpler products with fewer strains, than the more complicated multiple strains products. Whichever one you decide to go with, the important thing is to start low…maybe ¼ of the recommended dose for the first few days… and work your way up to your dog’s tolerance level. Too much too quickly can cause gas and/or diarrhea.
You can not give probiotics with the antibiotic, because the antibiotic will kill it before it has a chance to populate (colonize) the intestinal lining, so be sure to give the probiotic 2-4 hours away from the antibiotic. In most cases probiotics do not need to be given with food, but that varies from product to product, so you have to read the label. I do not incubate the probiotics, just stir them in after the food is prepared to maintain their viability…or if you prefer, give them in capsule form.
I prefer to use Larch Arabinogalactan as a prebiotic. A prebiotic is an insoluble fiber that acts as a food for the good bacteria (specifically Lactobacillus and Bifidobacteria). Some probiotics come with a prebiotic in the formula. It is not a requirement, but can be helpful in difficult cases… though you need to watch for gas caused by some prebiotic products.
FOUR: Repair the intestinal lining.
L-glutamine is an amino acid, and N-acetyl glucosamine (NAG) is an amino sugar. There are normally adequate amounts in the standard diet to provide energy to the cells in the body. However, in cases where the dog is under stress due to maldigestion, diarrhea or malabsorption, sometimes the diet does not provide enough to replace the damaged cells, so supplementation is helpful. I used both L-glutamine and NAG for Sabre, but if I had to choose one, I would use L-glutamine because what is not needed by the gut will be used to rebuild muscle in emaciated dogs.
Additional anti-inflammatory supplements that I found helpful are DGL, bromelain, quercitin and Slippery Elm. Boswellia may also be helpful in large bowel complaints.
Keep in mind that inflammation can be caused by a number of things, but in EPI dogs SIBO and/or food intolerances are frequent causes, so you need to remove the source of the inflammation in order for the intestinal lining to heal.
WHAT WORKED FOR US…
Sabre and I tried numerous diets…commercial, prescription, home-cooked, raw…switching as new intolerances developed while we worked towards healing his leaky gut. We had an extensive list of proteins and a few carbs, such as rice that tends to show up in many supplements, that he was unable to eat. For some time all I could get him to eat was a chowder made with very well cooked oatmeal, goats milk, ground raw fish and Seacure. Eventually, we ended up having good success stabilizing him on the Natural Balance Limited Ingredient Diets.
For SIBO, we ended up alternating between Metronidazole, Tylan and Amoxicillin. To get Sabre off the antibiotics we gave large doses of probiotics [12 Billion CFU’s of Allerdophilus (non-dairy Lactobacillus Acidophilus) and 1 billion CFU’s of Primal Defense] and a pre-biotic Larch Arabinogalactan. We also used apo-Lactoferrin to bridge the gap between antibiotic support and normalization of the GI flora.
To resolve the inflammation and heal the gaps between the cells that caused his food intolerances we split the listed dosages of the following supplements between 2-3 meals for Sabre, A GSD who ranged at various times from 55lb to 85lbs:
L-glutamine . . . . . . . . . . . . . . . . . . . . 2250mg
NAG (N-acetyl glucosamine) . . . . . . . . 750mg
DGL (deglycyrrhizinated licorice) . . . . 125mg
Quercitin . . . . . . . . . . . . . . . . . . . . . . . . 500mg
Bromelain . . . . . . . . . . . . . . . . . . . . . . . 375mg
Slippery Elm . . . . . . . . . . . . . . . . . . . . 1600mg
Totalzymes (plant-based enzymes, since he was intolerant of animal-based Pancreatin) ¼ tsp per cup of food. (Sabre was not a confirmed EPI dog; possibly why these plant enzymes worked for him)
Milk Thistle (70-80% silymarin) to support liver function, up to 600mg per day. I used this only for short periods of time (two weeks) when dealing with SIBO or drugs that put stress on the liver.
We used Tanalbit and then coconut oil to make sure we had any yeast overgrowth under control.
We completed the B12 injections according to the TAMU protocol, but Sabre did not respond, so we returned to weekly injections to try to bring his level up. A number of people whose dogs seem to be unable to hold their B12 levels on the injections have reported success using Metagenics Intrinsi-B12/Folate http://www.luckyvitamin.com/p-67028-metagenics-intrinsi-b12-folate-180-tablets . Knowing what I do now, I would consider the Metagenics Intrinsi-B12/Folate instead of repeating the failed protocol. It’s my belief that the fact that Sabre could not hold adequate levels of B12, even on the weekly injections, contributed to his deteriorating condition.
I am cautious about giving Imodium or similar products when SIBO is involved as it suppresses the body’s normal defense response and allows the pathogenic bacteria to gain a stronger foothold in the intestine, as well as holding in the toxins that are so damaging to the system. I will always wonder if the recommendation to use them contributed to Sabre’s permeable gut.On the other hand, it is important to make sure your dog is not getting dehydrated, so many people use products like unflavored Pedialyte (do not get it if it has Xylitol) or K9 BlueLite to keep them hydrated.
If you don’t have any on hand, here’s a recipe for a homemade hydration solution:2 quarts water, boiled and cooled
½ teaspoon baking soda
½ teaspoon salt, or better yet, Morton’s Lite Salt
3 tablespoons Karo syrup, or raw unprocessed sugar
Refrigerate unused portions and discard after 48 hours.
I also am not a fan of antacids to decrease stomach acid in a system that is already compromised by low enzyme levels, as is the case in EPI dogs. If your dog is regurgitating or burping excessively, then I would consider SIBO and inflammation as the underlying problem, not the amount of stomach acid. Also, if you are incubating the enzymes with the food, as has been found to be very effective by many EPI dog owners, then antacids are not necessary to preserve the integrity of the enzymes in the stomach. Partial enzyme activity occurs in the food dish due to a slightly warm temerpature and liquids required as enzymatic catalysts for certain enzymes.Each enzyme requires it’s own catalyst to activate. If your vet prescribes an antacid for your dog, discuss it in further detail with him/her to find out why. DGL might be a good alternative.In cases of chronic SIBO, I found it best to get all supplements on board, probiotics to the therapeutic level and the dog on a stable regimen BEFORE stopping the antibiotic. The goal is to have everything remain the same, so that if the dog develops soft stools or diarrhea, you can be pretty certain its SIBO…not something you changed. Then I would do a short course of antibiotics (3-5 days) to knock back the pathogenic bacteria, in hopes that the continued high doses of probiotics would eventually be able to keep them in check on their own the next time the antibiotic was removed. If this relapse occurred more than twice, I would consider increasing the probiotic supplement, if tolerated by the dog; adding a prebiotic if you are not already giving it; and/or using some Lactoferrin for a couple of weeks while you rebuild the good flora. Again, introduce a new supplement while stable on the antibiotic so that you can judge your dogs tolerance level to it, as opposed to a recurrence of SIBO.
It’s challenging scheduling all of this sometimes. Here’s what I did for Sabre, but ultimately you have to come up with something that works for you.
SAMPLE SCHEDULE:
6:00am Antibiotic
8:30am Breakfast with prebiotic/probiotic and L-glutamine
Noon Lunch with prebiotic/probiotic
6:00pm Supper with Antibiotic and L-glutamine
8:30pm Snack with prebiotic/probiotic
Bedtime Probiotic
SOME ADDITIONAL INFORMATION, THOUGHTS AND LINKS…
DIET
When making food changes, make transitions slowly since dogs that are short of good bacteria and brush border enzymes due to inflammation in the GI tract are more prone to upset with dietary changes.
The exception to that would be if you are dealing with food intolerances…in that case the food is adding to the inflammatory response, so you need to do fast food changes. Keeping in mind that until the intestinal lining is healed, more intolerances are likely to develop. A suggestion in this situation is to change to a novel “disposable” protein diet…something that you don’t want to feed for the rest of the dog’s life because it is harder to get and/or more expensive. Save the less expensive, easier to obtain proteins for when the intestinal lining is healed, and your dog is less likely to develop an intolerance to it.
Raw food has naturally occurring enzymes, this can aid dogs that are struggling with nutrient-dense commercially prepared diets. Keep in mind that the diet will need to be easy to digest…that means ground lean meat, steamed or pureed veggies…and enzymes. Here are some resources that will help you analyze your home prepared diet and your dog’s nutritional requirements:
Drs. Foster & Smith: Vitamins, Minerals, and Supplements
The daily nutritional requirements of dogs and puppies for vitamins, minerals, and other supplements, and their function, potential toxicities, and deficiencies are described.
http://www.peteducation.com/category.cfm?c=2+1659+1662
Self Nutritional Data
A great site that has tools to enable you to analyze your dog’s homemade diet, compare foods and find foods by nutrient.
http://nutritiondata.self.com/
If you are dealing with anorexia due to inflammation, you can try things like canned goat’s milk (available at Walmart) or jars of baby food to try to get him/her to eat. Seacure, a hydrolyzed fish protein which is generally very well tolerated, can also be extremely helpful for dogs who are not eating, or having other digestive issues.
Due to Sabre’s extremely sensitive digestive tract, when introducing a new food or supplement, I always gave a small amount ONCE, then waited a full day to determine if it was tolerated before giving any more to avoid long recovery periods.
If your dog is objecting to the enzyme product itself, I tend to think it has to do with inflammation, but it could also be due to mouth sores, or maybe s/he just dislikes the smell or taste. It can help to incubate the food longer. Some people have had good luck using encapsulated enzymes, such as Creon (this product is not incubated in the food), or you could try raw ground pancreas. Raw pancreas is available through a few online sources. I used to buy it from Hare Today. Tracy is great to work with if you have a special needs pet.
Reference books:
Natural Health Bible for Dogs and Cats by Shawn Messonnier, DVM
Herbal Dog Care by Randy Kidd, DVM, PhD
The Encyclopedia of Natural Pet Care by CJ Puotinen
Additional information can be found here:
http://www.petcarenaturally.com/articles/diarrhea.php
http://www.natural-dog-health-remedies.com/safe-herbs-for-dogs.html
B12 (cobalamin) + Folate -If your dog has low B12 (due to SIBO and/or lack of intrinsic factor) and low folate levels (due to malabsorption caused by inflammation or other small intestinal disease), or can not maintain appropriate B12 levels on the recommended injections, there have been successful reports using products like Metagenics Intrinsi B12/Folate where s/he would be getting both in one pill.
With either injections or the oral supplement, you need to monitor his/her levels for a few months until you find a maintenance dose that keep the levels on the mid t0 high end of the normal range, then re-check once or twice a year to make sure he/she is continuing to maintain levels. When re-testing levels, remember to fast your dog prior to the test and do the test PRIOR to giving the next scheduled dose to get the most accurate test result. If a dog that hasbeen tested and stable for a period of time, then suddenly has a drop in B12 levels, suggests possible SIBO.
http://www.vitamins-supplements.org/vitamin-B-deficiency.phpCoconut Oil (caprylic/lauric acids)
A medium chain triglyceride that is often used to treat systemic yeast infections. Recommended dosage is 1 tsp. per 10 pounds of body weight. Start with small amounts and gradually build to full dose. Divide between meals.
http://www.provet.co.uk/health/diseases/mcts.htm
Deglycyrrhizinated Licorice (DGL)
Used as an anti-inflammatory without the side effects (decreased potassium, increased sodium, adrenal gland suppression) of licorice root. It has been used for treating ulcers of the mouth and small intestine, as well as inflammatory bowel disease. Use with care in diabetic pets or those with heart disease or hypertension. Standard recommended dose is 25mg per 10 pounds, based on Gastriplex and Only Natural Pet GI Support products.
http://www.umm.edu/altmed/articles/licorice-000262.htm
http://www.truestarhealth.com/Notes/2122006.html
http://www.natural-dog-health-remedies.com/licorice.html
http://www.wellvet.com/licoricedgl.htm
Fish/Krill Oil
Supplementing with omega 3 (EPA & DHA) and omega 6 (GLA) fatty acids can decrease intestinal inflammation. The currently recommended ratios of omega 6:omega 3 varies from site to site, but 5:1 seems to be the most common. Careful storage of these oils is of utmost importance to avoid oxidation. Not all EPI dogs will tolerate the additional oil well, so you must start slowly when adding these supplements. Dosage is in most cases determined by your dog’s tolerance level, though you will find some good recommendations on Mary Strauss’ Dogaware site. Sardines are a good source of omega 3 fatty acids. You should also supplement with Vitamin E when giving fish oil.
http://www.petcarenaturally.com/handouts/fatty-acid-supplements.pdf
http://www.dogaware.com/diet/supplements.html
http://www.peteducation.com/article.cfm?c=2&aid=666
Ginger
Can be used for nausea to settle the stomach and reduce gas. Do not use in pets that are running a fever, or one week prior to a surgery or if the animal is on a blood-thinner. Ginger is normally well tolerated. Generally, use ½ capsule for small dogs and 1 or 2 capsules for larger, adult dogs.
http://www.umm.edu/altmed/articles/ginger-000246.htm
http://www.natural-dog-health-remedies.com/ginger.html
L-Glutamine
An amino acid that is required by the cells, it specifically provides energy to the cells lining the digestive tract, so aids in the healing process. Common recommendations are 500mg per 25 pounds. Amounts not required by the intestinal tract will by used to build muscle so this can be extremely helpful to emaciated dogs.
http://www.b-naturals.com/newsletter/l-glutamine/
http://www.umm.edu/altmed/articles/glutamine-000307.htm
LactoferrinA colostrum fraction that is a key component in building the natural immunity in the digestive tract. It is reported to have anti-bacterial, anti-fungal, anti-viral properties and anti-inflammatory properties.
http://www.beverinutrition.com/files/Antiinflammatory_Activities_of_Lactoferrin.pdf
http://www.ei-resource.org/treatment-%11-nutritional-supplements/nutrients-g%11l/lactoferrin/
Larch Arabinogalactan
A plant tannin from the Larch tree that enhances the immune system and is anti-inflammatory, often used for pets with chronic diarrhea. Larch Arabinogalactan is an insoluble fiber that is considered a prebiotic, supporting the colonization of Lactobacillus and Bifidobacteria. It has also been proven to elevate short-chain fatty acid… butyrate (an anti-inflammatory)…production and reduces ammonia buildup.
http://www.vrp.com/articles.aspx?ProdID=2202
http://www.dadamo.com/science_larch.htm
http://intelegen.com/ImmuneSystem/larch_arabinogalactan_unique_nat.htm
Milk Thistle
Silymarin in milk thistle is an antioxidant that increases glutathione levels and stimulates production of new liver cells. It is not recommended for long-term use unless chronic liver disease is present. If your dog has SIBO (remember the pathogenic bacteria produce toxins) or is on medications that stress the liver, resulting in elevated liver enzymes, milk thistle may help. Look for supplements that are standardized to 70 – 80% silymarin. I have found the average recommendations for dogs to be 200mg per 25 pounds of body weight, divided between two or three doses per day. The bound silymarin-phosphatidylcholine complex is dosed differently, so you will need to do some research on it if you use this product.
http://www.umm.edu/altmed/articles/milk-thistle-000266.htmhttp://www.natural-dog-health-remedies.com/milk-thistle-for-dogs.html
N-acetyl Glucosamine (NAG) – (made from shellfish)
An amino-sugar that is a precursor to glutamine…a supplement recommended for pets with IBD…that supports the production of mucus and can help heal the intestinal mucosa. Per Dr. Messonnier in his book “Natural Health Bible for Dogs & Cats“, Patients with inflammatory bowel disease cannot make N-acetyl glucosamine. This deficiency of N-acetyl glucosamine leads to further intestinal damage including increased permeability (leaky gut syndrome).
www.allergyresearchgroup.com/proddesc/discuss/NAcetylGlucosaminePDFProductSheet060705.pdf
http://www.umm.edu/altmed/articles/glucosamine-000306.htm
Probiotics
Beneficial bacteria that are required for digestive health. I highly recommend lactic-acid producing strains to help change the pH from an alkaline one, to an acidic one…which discourages colonization of pathogenic bacteria.
http://www.umm.edu/altmed/articles/lactobacillus-acidophilus-000310.htm
Lactobacillus bacteria are the primary strains found in the small intestine. Bifidobacteria are the primary strains found in the large intestine. I like to use a product that contains both types of bacteria. Some dogs do better with simple products 1 – 3 strains, others can handle the more complex multiple strain products. And some need a non-dairy formula. A rule of thumb to determine a minimum therapeutic dose would be 500 Million CFU’s per cup of food, keeping in mind that you must work up to your dog’s maximum tolerance level gradually.
Regarding Enterococcus Faecium: This strain of bacteria is used in many pet products. My personal preference is to avoid Enterococcus Faecium, especially as a primary probiotic in immune-compromised dogs. Some strains of E. Faecium are known to have antibiotic resistance and can become overgrown, according to one study it may also promote colonization of Campylobacter. So it’s my preference to use high doses of the Lactobacillus/Bifidobacteria strains rather than take the risk with E. Faecium.
Quercitin
A naturally occurring bioflavonoid found in many fruits and vegetables that reduces inflammation and is considered a natural anti-histamine. It is often used with Bromelain to increase absorption.
http://www.nutritional-supplement-guides.com/Quercitin.html
http://www.umm.edu/altmed/articles/quercetin-000322.htm
http://www.natural-dog-health-remedies.com/ulcers-in-dogs.html
http://wisdom-magazine.com/Article.aspx/1141/
Seacure for Pets
A hydrolyzed fish protein powder that helps dogs with digestive stress or who refuse to eat. Because it’s hydrolyzed it is easily absorbed and is a good source of L-glutamine and other amino acids. Dosage is ¼ tsp per 10 pounds.
http://www.propernutrition.com
http://www.seacure-protein.com/products/seacure_for_pets.html
Slippery Elm
A herbal remedy that coats and soothes the mucosal lining of the digestive tract. The plant tannins may also have an anti-inflammatory effect. I use 2 – 400mg capsules mixed in my dog’s food or pumpkin twice a day for a couple of weeks to treat inflammation and soothe the mucosal lining. For any type of digestive upsets Dr. Kidd’s recommendation is 1 tsp of the powdered bark per 20 pounds of body weight, mixed into water, and given as often as 4 -5 times per day. However, do not exceed 3 – 4 weeks without taking a break for at least a week in chronic conditions, as it may coat the intestine enough as to interfere with proper absorption of nutrients.
http://www.umm.edu/altmed/articles/slippery-elm-000274.htm
http://www.naturalherbsguide.com/slippery-elm-bark.html
http://www.natural-dog-health-remedies.com/slippery-elm.html
Soluble/Insoluble FiberThere is some controversy about whether to use fiber to aid digestive issues. Some sites recommend soluble fiber, others say insoluble is less likely to cause Leaky Gut Syndrome. EPI dogs, in general, do not always handle all types of fiber well, so this is one of those situations where you have to see how your dog responds and decide from there.
Tanalbit/Viracin
Plant tannins used to treat systemic yeast infections. I first read about this product in the February 2007 Whole Dog Journal in an article on Candida infections in dogs.
http://www.intensivenutrition.com/Tanalbit.htm
Zinc
A zinc deficiency, due to long-term diarrhea, can lead to lower stomach acid production. This can further complicate digestion in an already compromised system. Studies show a zinc deficiency is possible in EPI patients. If you decide to supplement, you need to know that zinc can deplete copper absorption in the body, so it is recommended to supplement with 1mg copper per 15mg of zinc. Do not supplement without discussing this with your vet, as levels should be monitored to avoid toxicity.
Don’t let this list overwhelm you…not all dogs needs all supplements. The above list is for your information in case you need to deal with a specific problem. Odds are your dog does not need all of them. Just keep in mind the 4R’s and pick one or two supplements to start with. Make changes slowly, wait at least 3 days and up to a week between changes. Keep a journal. Use markers (corn or raw carrot) to track transit time through the bowel if you want to know how something affected your dog’s stool quality. Here is a list of a few of the available digestive-aid products on the market:
Only Natural Pet GI Support
http://www.onlynaturalpet.com/products/Only-Natural-Pet-GI-Support/999044.aspx
Acetylator
http://www.vetriscience.com/acetylator.php
Gastri-plex
http://www.wellvet.com/gastriplex.html
Berte’s Digestion Blend
http://www.b-naturals.com/bertes-digestion-blend-1-lb-p-101
Hopefully you will find information within this article, or the links provided that will help you and your dog through the digestive issues you’re dealing with and lead to a lifetime of better health.
ADDITIONAL READING
The Canine Gastrointestinal Tract: Small Intestine
ttp://www.walthamusa.com/articles/cgismintes.pdf
Laboratory Diagnosis of Intestinal Disease in Dogs and Catshttp://www.ivis.org/journals/vetfocus/19_1/en/2.pdf
Selected Diseases of the Small Intestine Causing Vomiting and/or Diarrheahttp://www.newmanveterinary.com/VomitingDiarrhea_SmallIntestine.html
(scroll down to a chart on what the Cobalamin/Folate levels mean to your dogs health.)
Serum Trypsin-Like Immunoreactivity (TLI)http://vetmed.tamu.edu/gilab/service/assays/tli
Serum Cobalamin (Vitamin B12) and Folate
http://vetmed.tamu.edu/gilab/service/assays/b12folate
The Hidden Inflammatory Condition That Threatens Your Pet’s Well-beinghttp://healthypets.mercola.com/sites/healthypets/archive/2010/11/02/inflammatory-bowel-disease-in-pets.aspx
Canine Inflammatory Bowel Disease (IBD)http://www.natural-dog-health-remedies.com/canine-inflammatory-bowel-disease.html
Leaky Gut Syndromes: Breaking the Vicious Cyclehttp://www.ei-resource.org/articles/leaky-gut-syndrome-articles/leaky-gut-syndromes:-breaking-the-vicious-cycle/
Leaky Gut Syndrome Treatmenthttp://www.ei-resource.org/treatment-options/treatment-information/leaky-gut-syndrome-treatment/
Digestive Disorders in the Doghttp://dogaware.com/health/digestive.html
Sabre’s Legacy…New Perspectives on Inflammation By Deb Zilisch
Sometimes life throws us an unexpected curve, and we need to draw on all of our reserves to get us through. That’s the case with two of my dogs that were diagnosed with Blastomycosis. First Vada, in December of 2011, and then again near the end of December 2012 when she relapsed; followed by Nik, in the middle of December 2012. Yes, I had two Blasto dogs being treated at the same time!
Blastomycosis is a fungal infection that is very often fatal if not caught and treated in its early stages. Its spores are typically inhaled, where they settle in the lungs as a yeast infection, before spreading systemically. Blasto is treated with anti-fungal drugs…usually beaded Itraconazole (Sporanox) or Fluconazole (Diflucan). The literature, and many vets, will tell you that the treatment lasts 90 days and/or 30 days after symptoms resolve. In my experience, and as many on the Blastomycosis.ca site can tell you, that is not necessarily the case…and was probably a guideline written before the development of the MiraVista urine antigen test for Blastomycosis.
While many dogs “appear” cured within a couple of months, it took a full year for Nik to hit an undetectable level on the antigen test. He’s got one more month of meds, so he will be on the medication for 14 months. Vada was initially treated for 10 months, was off the drugs for a little over 2 months and then relapsed, so needed an additional 5 months of medication to try to completely clear her system and prevent another relapse. Both dogs have had elevated liver enzymes because of the use of the drugs, so both have been on milk thistle in order for us to successfully complete their treatment without destroying their livers. It’s been a long journey, that we are glad to see coming to an end. But this isn’t about Blastomycosis, it’s about Sabre’s legacy and how it very probably saved Vada’s life.
About eight months or so into Vada’s treatment, I noticed a distinct difference in the smell of her poop, though the consistency and color remained normal. It was the same “fermented” smell that Sabre developed prior to becoming so ill, so I immediately suspected a bacterial imbalance. Since stopping the anti-fungals was not an option, and everything else was normal, we had to wait it out and hope that her digestive system went back to normal once the drugs were stopped.
I routinely give my dogs probiotic supplements at a low maintenance level, but as time went on Vada became more sensitive to foods and her probiotic supplement, with occasional bouts of diarrhea. We persevered until the end of May, when her diarrhea became more troublesome. She had achieved a negative antigen test 6 weeks earlier, so I elected to stop her medication and work on re-balancing her GI tract. I started her on the supplements that I had such good luck with in the past and she seemed to get better, but every 7-10 days she’d have a “blow-out”. These episodes were preceded by a day of not eating. Once her system purged itself, she’d go back to normal for another week or so, and we’d start all over again. The vet wasn’t sure this was due to the Fluconazole, but felt that her system would eventually right itself now that the drug was stopped, if that was the cause. A month or so later, he suggested trying Metronidazole. I told him I had already ordered Tylosin…my reasoning was that Tylosin is easier on the liver than Metro and she had a recent history of elevated liver enzymes from the anti-fungal drug.
The Tylosin was a huge help with the blow-outs. However Vada continued to have anorexia, gas, and intermittent soft stools. I was soaking her food and adding enzymes to ease her digestion. She was also getting L-glutamine, Slippery Elm, B12, probiotics, arabinogalactan and DGL. We tried ginger and even a short course of prednisone, which did seem to help to some degree. But as time went on she started eating less and less food and more and more snow.
From the middle of November until the middle of December I was lucky to get a cup of food per day in her…needless to say she was losing weight and I was running out of ideas on how to deal with the obvious pain she was in. I was starting to suspect a food intolerance, because her diarrhea seemed to correspond with her meals. So I ordered some Purina HA hydrolyzed soy food…bad idea, it went right through her. A friend of mine spoke with her vet, who has also dealt with many Blasto cases. He confirmed my suspicion about the anti-fungal drugs causing inflammation in her GI tract…that bit of information gave me the confidence to continue looking for answers. I decided to simplify her treatment and in doing so came up with the answers I was looking for.
We continued the Tylosin to control the Clostridia Perfrigens toxicity that I am convinced caused the cyclical 7-10 day blow-outs. We added Simethicone to help with gas, per the vet’s suggestion…but honestly, it didn’t really seem to resolve the underlying issues that kept Vada awake and pacing the floor at night. I recall that Sabre did well with the supplement, Acetylator, so I replaced the L-glutamine with 750mg of NAG (N-acetyl glucosamine) twice a day. I discontinued the probiotics, which she was having trouble tolerating. And I stopped the DGL and the arabinogalactan. However, something was still causing intermittent diarrhea. And then it hit me…she’d go off her food, have a softer stool, and then a day or two later might have a day where she’s be really hungry and eat a “normal” 2 cup meal. Soon after she’d go from a perfectly normal poop to diarrhea. With more observation and reviewing our journal, it became clear that her system could not tolerate more than a cup of food at a time. No matter how much she felt like eating, I had to limit her intake to 1 cup of kibble soaked with enzymes and Slippery Elm, and feed her more frequently.
Over the course of all of this it appeared that I had finally discovered all of the pieces to the puzzle behind her diarrhea… 1) inflammation, most likely caused by the drug she was on, and the resulting bacterial imbalance and sensitivities she developed; 2) presumably an unconfirmed Clostridia perfringens overgrowth was behind the 7-10 day cycle of intermittent diarrhea…we controlled it with Tylosin; 3) any change at all in what she ate…she needed to stay on a very strict diet of Natural Balance LID kibble, soaked and mixed with a bit of canned food…NO other treats or taste tempters 4) probiotics…even a tiny pinch set her off, so I had to stop them until the inflammation decreased, which went against all that I thought I knew about resolving inflammation in the GI tract; 5) too much food at one time…she could have no more than 1 cup of food , soaked and treated with enzymes and slippery elm…I ended up feeding her 4 times a day.
Within a week of starting the NAG, she was eating 2 cups of food per day. I could tell we had finally turned the corner when I got up one night to check on her and found her sleeping contentedly on her back.
She’s now eating about 1-1/2 cups of food 3 times a day, still getting 400mg of SE and 1/2 capsule of Pancreatin with her food, still on the Tylosin and NAG twice a day…has fantastic poops and is putting on weight….and better yet, sleeping through the night!!!
Now that she appears to be stable, I started adding a small amount of Kyo-dophilus every other day. So far so good. I’m taking it slow until I’m sure she can handle it. I plan to discontinue the SE shortly, but will continue the Pancreatin, NAG and Tylosin until I can get her up to a full 2 billion CFUs of probiotics per day, then we’ll see how she does without their support.
Funny how life throws this stuff at us…testing us to see how much information we retained from our prior experiences…and then adding a few additional twists so that we end up learning even more!
I hope this accounting of Vada’s treatment helps some of you that may be dealing with a dog that has been difficult to stabilize.
CH. Vada von der Sauk, CGC, TT, HIC-s, VCC…one tough little chick!