Should I stay or should I leave (my veterinarian)?
January 14, 2017 2:44 PM   Subscribe

My 15-year old Westie Monty has had GI issues for many years. Our vet has been rotating through a small repertoire of remedies with varying results and we're starting to wonder if a change of vet is in order.

Thanks to your advice, he switched to a wheat-free diet several years ago (Canidae Lamb & Rice Formula, if it matters), which helped quite a bit. But over the last several months, his stools have gotten really soft and unpredictable. He's had a few accidents in the house when home alone and he often wakes us up to go outside during the night. More alarmingly, he will squat several times on our hour-long daily walks with nothing to show for it. When his bowel issues are under control, he's a lively fellow who acts like a much younger dog. On the bad days, though, he spends a lot of time sleeping and isn't interested in much beyond his walk, meals, and treats.

The vet started him on metronidazole some years ago, and we've used it mostly "as needed" to get his GI issues under control. A recent daily course of metronidazole worked great for a few days, then the issues returned. Now he's on tylan powder which has made a difference but he still isn't all better. Today, the vet suggested giving him a small dose of metronidazole daily in addition to the tylan powder. It seems to me that she (the vet) is just exploring a small number of options, trying to find the right combination. And maybe that's okay, but I feel like a significant portion of whatever years Monty has left are being spent with him not feeling well.

We've used this vet through the last several dogs and have always had great confidence in her. Before I upset the applecart and start in with another vet, I thought I would consult with the great people here who are more knowledgeable about dogs than I am. Are there other treatment options besides what our vet has tried? Do you have any advice for me?
posted by DrGail to Pets & Animals (11 answers total) 1 user marked this as a favorite
Even with the best vet in the world, if you're not sure about anything, by all means get a second opinion. Vets are people too, they're not perfect, and if they've been seeing the same issue for years they might be blind to other possibilities, not because they're incompetent but because they're human. You have to do what you feel is best for your dog -- don't worry about the vet's feelings. They deal with second opinions all the time. Heck I look at multiple products when i buy a friggen iPhone cable - why wouldn't I compare and contrast options when dealing with something as important as my pet's wellbeing?
posted by cgg at 2:49 PM on January 14, 2017 [2 favorites]

Can't speak to this issue in particular but I know that every health issue my cat has had has been ultimately resolved by switching vets and getting fresh eyes on the problem. I feel like most of the vets I've dealt with assume they're seeing you for the first time every time anyway. It's expected.
posted by bleep at 3:14 PM on January 14, 2017 [1 favorite]

Could you ask your vet for a referral to an internal medicine specialist in your area? Or, find one on your own and get a second opinion? Even amazing "primary care" vets are going to come up empty-handed sometimes. It sounds like it's time to see someone with more focused expertise in canine GI issues.

Also he is just the cutest. Feel better soon, Monty!
posted by schroedingersgirl at 3:56 PM on January 14, 2017 [2 favorites]

Aww, what a cutie! Hope he feels better soon. Agree that a referral to a specialist would be a good way of getting a second opinion without offending your regular vet (although they should not be touchy about a second opinion.

Also, my pug has had these issues from time to time over the years as well, and while a grain-free diet has helped, my vet has also recommended switching proteins from time to time. Not sure what is available in your area but Fromm's has a number of grain-free options that he seems to love.

Finally, could you train him to use a pee pad or litter box in an emergency? My guy uses a box when he needs to and that cuts down on a lot of stress for all concerned.
posted by rpfields at 6:01 PM on January 14, 2017

It helps if you tell the vet up front : "This is affecting us enough that I am willing to spend some money and take the time to find out what it is and what will help him."

There are so many other people that say "I don't want any tests, just give me something that might help in the short term" that vets sometimes get gun-shy about recommending a full workup.

Right now you are assessing the response to diet and antibiotics. This is an important step. You should keep really good records of all input and output - a diarrhea diary. For vague GI signs like this, the next steps on the road to diagnosis can include (very rough estimates): fecal test (~$60), full blood panel (~$100-$200), specific GI panel with folate/cobalamine/TLI (~$200-$300), ultrasound (~$700), endoscopy with biopsies (~$2000+). There's a chance that all these come back normal, and you end up with a diagnosis of diet-responsive or antibiotic-responsive diarrhea. Also note in dogs, *any* protein can be the culprit of a food sentivity, not just grains. A true hypoallergenic trial starts with a hydrolyzed or novel protein for 3 months.

Some people are happy to spend the money. Many people, after hearing all this, say "I can't do any tests, let's just try the antibiotics to see if it helps."
posted by metaseeker at 8:44 PM on January 14, 2017 [3 favorites]

I have a French Bulldog that went through the whole metro/tylan thing for years. We finally switched him over to raw food and it made a world of difference. We probably went through maybe 10-12 different kinds of kibble before finally giving up and making the leap. Through trial and error (a LOT of error), we found out he's intolerant to all poultry, grain and beef.

Ultimately we ended up giving him the raw venison and it's been working very well (I use Primal frozen raw nuggets - he eats 4-1/2oz per meal). The difference between kibble and raw was immediate. We've been off all antibiotics for months now and he's been fine. He does still get 10mg of pepcid and a half of Prilosec at night, although I aim to cut that out next.

What made the biggest difference, however, are these dehydrated carrots. I stumbled upon in my hours and hours of research online. It seems that they're used for horses and dogs. You rehydrate them with hot water and a little coconut oil. Obie gets about a half teaspoon of the dried carrots per meal and they rehydrate to roughly a heaping tablespoon or so. He *loves* them. They start out looking like rabbit food pellets and end up basically the consistency of applesauce. He's allergic to pumpkin (yes, he's really a Special Snowflake) but these are awesome and have helped tremendously. A 1lb bag from Amazon lasts about two months. Good luck with your Westie!!

Oh, one other thing I wanted to add. Please, please be wary of any suggestions of putting him on steroids (should that come up). My previous Frenchie was put on them to 'calm his stomach' and it was the beginning of the end. The steroids will eventually do permanent damage to the cilia that line his intestines.
posted by dancinglamb at 8:47 PM on January 14, 2017

Seconding metaseeker on giving the novel proteins a chance to work. If you have independent pet stores near you, I found them significantly more helpful than the big chains when searching out options. Also, many food companies will happily send you samples if you call and explain the situation so you're not out $20-30/bag each time you try another. Others will send you coupons.

I was also able to talk to some pet nutritionists at a couple of companies to discuss their opinions on where to go next. I was truly surprised at how helpful they were.
posted by dancinglamb at 8:59 PM on January 14, 2017

A second opinion is absolutely a good idea, but at the same time try to remember that even many human medical problems do not have treatments that are successful in the long term. It sounds from the other comments like there are probably lots of options to explore further, though, so take a different bit of human medical advice and remember that you are the best advocate for resolving your own medical issues. Doctors are not always anxious to suggest sometimes costly and potentially unproductive treatments, and vets see that even more frequently. Make your wishes known to your current vet, but if that doesn't result in some new treatment options, move on.
posted by jgreco at 8:04 AM on January 15, 2017 [3 favorites]

I agree with metaseeker - let the vet know that you're ready to go to the next step even if there is a financial burden. If at that point it's still not working out, yes, I'd take him for a second opinion.
posted by getawaysticks at 9:14 AM on January 15, 2017 [2 favorites]

Yeah, jumping back in to nth metaseeker's advice about telling the vet that you're willing to spend some money to get this resolved. Many pet owners are unable (or in some cases, able but unwilling) to spend $$$ on their pet, so some vets err on the side of caution. I've had good luck telling vets, "Look, regardless of the cost I will find a way to pay for basically whatever diagnostic tests you recommend."
posted by schroedingersgirl at 11:14 AM on January 15, 2017 [1 favorite]

Seconding the suggestion to consult an Internal Medicine specialist. Specialists work great on specific issues, but they do not replace your regular vet. Since you like your regular vet, but she hasn't been able to solve your dog's problem, it sounds like an Expert-in-the-Area-of-Concern is in order. If your experience follows what mine has been, your regular vet won't be upset or offended but will be happy to know that you're willing to get your pet the care it needs. And specialists are used to working in cooperation with the regular vet, keeping them informed regarding all tests and procedures, etc. It can be pricey, but it's well worth it. Best wishes to you and your pup!
posted by Boogiechild at 9:02 AM on January 16, 2017

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