One of the more common problems I see on an emergency basis is a disease process called hemorrhagic gastroenteritis, also known as HGE. I recently treated Sam, the little Beagle in the photo, for a severe case of this disease.

The history I hear from owners is always the same: “My dog started having diarrhea and then, all of a sudden, it became very watery and bloody.” This can be horrifying to first-time observers and usually prompts a trip to the ER.

Hemorrhagic gastroenteritis is a potentially life-threatening intestinal condition, which manifests as a sudden onset of bloody, watery diarrhea, with vomiting often being part of the syndrome. Sloughing of the lining of the intestines occurs from severe inflammation leading to “chunks” of tissue in the otherwise watery stool. We describe this as “raspberry jam” diarrhea. This process is extremely dehydrating—much more than you would think from the amount of diarrhea observed—and dogs can go from “near normal” to “near death“ in a frighteningly short time. If HGE is not promptly treated, the massive loss of fluid can cause life-threatening shock.

Smaller dogs seem to have a predisposition towards HGE, and it should be noted that the smaller the dog, the more dangerous the condition. Small dogs just don’t have the same bodily reserve as a larger dog; it simply doesn’t take much for them to become severely dehydrated. 

Thankfully, there are no long-lasting bodily effects of HGE, however, some dogs that have sensitive GI tracts to begin with can have the syndrome recur in the future.

What causes HGE?

Stress, sudden dietary changes and hyperactivity seem to be predisposing factors, but the actual cause remains unknown. A bacterium called Clostridium is also thought to play a role. In short, the condition is truly another medical mystery, and I can relate to an owner’s confusion and frustration when they ask, “Yeah, but what actually caused it?” I cannot point to an exact cause in more than 80 percent of HGE cases I treat.

How is this condition diagnosed?

There are no specific tests for HGE but a test called a packed cell volume (PCV) is helpful in narrowing down the diagnosis. Using a few drops of blood, the test measures the percentage of blood volume made up by the red blood cells. A normal packed cell volume for a healthy dog is between 37 and 55 percent, meaning that 37 to 55 percent of the blood volume should be red blood cells (the rest of the volume is fluid and white blood cells).

When the patient becomes very dehydrated, there is less fluid in the bloodstream and the percentage of blood fluid drops, and consequently the percentage of red blood cells increases. A dog with HGE will generally have a PCV greater than 60 percent.

The measurement of the PCV also includes a measurement of total protein (sometimes called total solids). In HGE, the total protein measurement from the blood sample is low or normal.

A very high PCV, low total protein and acute onset bloody, watery diarrhea can point to a diagnosis of HGE.

From a medical standpoint, one of the things that makes diarrhea difficult is that no matter what the underlying cause, the clinical picture looks exactly the same. Because of this, we may still recommend that additional tests, such as radiographs, a fecal exam (that includes a parvovirus test) and blood work, be performed to make sure there is not a more serious problem causing the clinical signs.

HGE really becomes a diagnosis of exclusion: When blood work, radiographs and fecal exams are normal, we highly suspect HGE as the cause.

What is the treatment for HGE?

The heart of therapy is very aggressive fluid replacement with intravenous fluids. The goal is to get the packed cell volume back to the normal range and keep (or get) the patient out of shock. Food is withheld for at least 12 to 24 hours and then gradually introduced after the vomiting has resolved. Symptomatic treatment for nausea and belly discomfort is typically included, as is antibiotic therapy. One to three days of hospitalization is commonly required for treatment.

With early and aggressive treatment, life-threatening complications are generally avoided and dogs return happily home. In the case of Sam, he unfortunately required four days of intensive care, including nutritional support through a feeding tube as pictured, but I am happy to report that he made a full recovery and went back home to Mom and Dad!

From humping to “targeted” sniffing, our pups have a plethora of odd habits—at least to those of us who walk on two legs instead of four. While no one knows for certain the exact “why” behind these behaviors, we do have some theories. And until dogs learn to speak human, divulging their best-kept secrets, we’ll just have to continue to make educated guesses about this weird-but-true realm of doggy deeds. The key is recognizing if a behavior signals poor health.

Tail-chasing

When puppies chase their tails, it’s like babies grabbing their toes—and this is a normal way for them to explore their bodies. But like anything in life, moderation is key, and problems can arise if this behavior becomes compulsive. So, how do you determine if your pooch has a case of Canine Compulsive Disorder? It comes down to whether you can distract them from this behavior. If your dog would rather chase her tail than go for a walk, she may have a compulsive disorder and veterinary assessment may be needed.

Scooting

It can be common for dogs to drag their bottoms across the ground after doing their business, particularly if their stool is loose. But if this behavior is noted frequently throughout the day, this may be a sign of impacted anal glands, a condition that can have serious complications if left untreated.

Humping

Watching your dog get personal with his stuffed toy can make you want to look away, but it’s not abnormal. Many dogs discover that humping feels good, it can relieve stress or serve as an outlet for excessive feelings of exuberance and excitement. Both males and females are known to partake in this behavior, though males do it more often.

Eating grass

People often think that dogs eat grass when their stomachs are upset or they are ill. However, a good ol’ lawn actually serves as a gourmet snack to many dogs. As omnivores, they like to eat their meat and veggies, too. Eating grass in moderation is a normal part of a dog diet, and a walk in the park for my dogs always includes a stop at the grass buffet. That said, if all of a sudden you see your dog frantically binging on grass, this could be the sign of distress, and a call to your veterinarian is in order.

Crotch-sniffing

It is general custom for Spot to greet Rover with a sniff of the behind, but why share this custom with us? Bad manners? Well, not according to the canine code of conduct, as this is a perfectly acceptable way of collecting personal information about one another, including humans. So the next time you are surprised by a nosey nudge, just know that you are being greeted and assessed (and don’t worry, dogs generally won’t be offended if you just give them a pat on the head in turn).

[Recently, Bark columnist Julie Hecht, MS, took a light-hearted look at the phenomenon.]

Eating excrement

Gross, right!? I’m asked about this all of the time and all I can do is give an empathetic cringe of the nose and a shrug of the shoulders. (I know the score: My dog Mickey used to raid the cat’s litter box, proudly returning with “kitty cigars.”) As stomach-turning as this is, eating excrement is a surprisingly normal behavior for dogs. In the early stages of domestication, dogs performed a hygienic function of cleaning up their own feces. Additionally, their digestive system is very efficient and they can actually get some quality nutrients out of it—although I can think of much better sources.

Rolling in garbage

When we see a decaying animal or a pile of garbage, our first inclination is to step around it … waaaaay around it. But, keeping true to our dog’s oddities, it is their greatest desire to jump right in, getting a good coating of ick with a strategic roll. The more foul the smell, the stronger the lure, and the more joy that is experienced by our now perfumed pups. One theory is that dogs like to cover their own scent with horrible odors to make it easier to surprise prey. You probably can’t curb your dog of this desire, so your best hope is to spot smelly things first and steer your pal in a different direction.

I hope this has shed some light on a few odd dog behaviors. Funny, as I sit here, I find myself looking over to my own dog, Bauer, wondering if he is looking back at me thinking, “Wow, there she goes again, sitting in front of that computer when she could be outside playing with her ball. Now, that’s just weird.”

As much as we might hate to admit it, flatulence is a normal biological function. A surprising amount of air is swallowed just with the simple act of eating, and if this is not burped out, it must exit through the other end. The amount of air swallowed tends to be increased when dogs feel they must eat quickly or in brachycephalic breeds (dogs with a compressed upper jaw and a short muzzle) that tend to breathe more by mouth than by nose.

Flatulence comes from an excess of gases in the intestinal tract. These gases may represent air that has been swallowed, gas produced in the biochemical process of digestion, gas diffusion from the bloodstream or gases produced by the bacteria that populate the intestinal tract. Contrary to popular belief, more than 99 percent of the gases that pass from the intestinal tract are odorless (whew!).

Dietary fiber in pet food is not easily digested by the pet’s own enzyme systems, but it is, however, readily digested by the gas-producing bacteria that live in the colon. As fiber is broken down here, hydrogen sulfide is produced, which is the cause of the really stinky gases. Therefore, a diet that is heavy in fiber further promotes a “happy environment” as well as “food” for the bacteria, ultimately producing more gas.   

Helping clear the air

Offering your pet a highly digestible, low-residue diet is one of the major ways to combat flatulence. A low-residue diet is designed to reduce the frequency and volume of stools, while prolonging transit time through the intestine. It is similar to a low-fiber diet, but includes restrictions on foods that increase bowel activity. Changing to a low-residue diet means that most of the nutrients of the food are digested and absorbed by the pet before they reach the colon, where the gas-forming bacteria live. Less food for the bacteria equals less bacteria, which equals less gas formed.

Sometimes just going through a case and/or bag of such a low-residue diet solves the problem and the pet can return to a regular food afterwards. If necessary, the therapeutic diet can become the pet’s regular food. Low-residue diets are available through your veterinarian, pet supply stores or can be cooked at home (boiled white rice, skinned chicken, cottage cheese and balanced with vitamins and minerals constitute low-residue ingredients).

Other easy changes that can help include:

• Feeding smaller meals several times daily instead of one larger daily meal
• Feeding a mixture of dry and canned foods
• Discouraging rapid eating by placing an overturned small bowl inside the pet’s regular food bowl, preventing them from taking large mouthfuls
• Avoiding soy, beans and peas in the diet
• Avoiding any treats containing milk, cheese or other forms of lactose
• Avoiding fresh or dried fruit treats
• Avoiding canned foods containing the texturing ingredient carrageenan
• Increasing activity: A sedentary lifestyle can increase the amount of gases produced as well as how long they “hang out” in the digestive tract. Activity increases gastrointestinal motility, which in turn expels gas and increases regularity of bowel movements.

Are there some medical conditions that can increase flatulence?

Changing the diet and ruling out actual intestinal disease are of primary importance in addressing flatulence. Some disease processes that can cause an increase in flatulence include:

• Inflammatory bowel disease
• Irritable bowel syndrome
• Antibiotic-responsive intestinal disorders
• Cancer
• Parasites, viral or bacterial inflammation of the intestines
• Food allergy or intolerance
• Inadequate production of digestive enzymes by the pancreas

Medications and herbal and botanical supplements

Sometimes medication can help. Although there are many products available, most are unfortunately not as helpful as they are touted to be, or not labeled for animal use. There are more than 30 herbal and botanical preparations available to reduce gas in the stomach and intestines; however, the dosage, safety and efficacy are unknown.

If further therapy is needed, the following products have some basis and support that they may be of help for flatulence:

• Yucca shidigera supplementation:
 Currently, this extract is labeled as a flavoring agent for pet food but it is also available as an oral supplement. Several studies have shown that it helps decrease the odor in flatulence.
• Zinc acetate supplementation:
 Zinc binds to sulfhydryl compounds in flatulence ultimately serving to deodorize the gas.
• Non-absorbable antibiotics: Such antibiotics kill the gas-forming bacteria of the colon and may be helpful as long as their use is not ongoing.

Some popular, but more questionable, products with regards to treating excessive flatulence include:

• Probiotics: There are many ineffective probiotics being marketed and so it is important to use one that has been shown to contain live cultures that withstand stomach digestion. It is unknown if this type of product will really help in flatulence, as it is asking a great deal for these bacteria to survive the acid environment of the stomach, travel through the many feet of small intestines, and finally reach the colon in the attempt to displace the gas-forming resident bacteria. Still, these are unlikely to be harmful, and can be beneficial in other ways outside of the realm of flatulence, such as helping to stabilize the intestinal microenvironment.

• Activated charcoal tablets: These tablets are not likely to be effective because the charcoal-binding sites are filled on the journey from mouth to colon, so by the time the tablet gets to the gas-forming large bowel bacteria, it has essentially already been used up!

• Simethicone: This product may control the volume of gas produced, but not the odor. It is an antifoaming agent that reduces gas bubbles. This may be helpful at reducing our doggy’s gas discomfort, but not our nose discomfort.

• Pancreatic enzyme supplementation: It is unlikely that these extra digestive enzymes would help a pet in the absence of actual exocrine pancreatic insufficiency. Furthermore, this treatment is relatively expensive for something that may only be slightly helpful.

While flatulence is a normal part of everyday life, if the problem persists or seems severe, it is recommended that you consult with your veterinarian. Even our pets sometimes need a smog check!

Got a portly Pug, a meal-loving mutt, or perhaps a chubby Chihuahua? How about a Labrador who loves lounging a little too much or a rambunctious Rat Terrier always raring to go? How do you figure out how many calories they need?

The new Doggie Dietitian app by Dr. Sheri Cone is designed to take some of the guesswork out of calorie-counting with a program calibrated to your dog’s breed, weight and activity level.

Pros

• Easy and intuitive to use.
• You can store and keep track of multiple pets in your home.
• Offers an extensive list of dry and canned commercial dog foods.
• Offers many types of popular commercially prepared treats.
• Offers a good list of commercially prepared raw diets.
• Offers a brief overview of common toxic foods to avoid.

I feel this could be an especially useful app for people who have growing puppies. You can easily reenter their rapidly changing body weight and adjust their food amounts to meet their nutritional needs as they grow.

Cons

I found it was not easy to go back and add a treat to the list of the day’s food intake, which can be somewhat of a nuisance if your dog’s food intake changes each day. For example, if you feed 2 cups of kibble and 1 broccoli stem, but later add a slice of deli turkey and want to figure where you are calorie-wise for the day, you have to go back and reenter the amount of kibble, the broccoli and then add turkey. This would not be an issue if your dog’s daily food and treats remained steady each day.

If you find you are over- or under-feeding your pet, the app only gives you the option of adding or taking away a portion of dry food. I prefer to give additional “people foods,” so this fell short for my needs.

The app has a very limited list of people foods and I would beg for a more extended reference.

Finally, I feel this app would not be quite as useful for people who fully prepare home-cooked diets and treats from scratch. However, the app would give even home-cooks a target calorie range that they should be feeding.

One size doesn’t fit all

The Doggie Dietician offers a database of hundreds of dog breeds with their ideal weight. While this is good information, take the “ideal” weight loosely because every dog is different. For example, the ideal weight for a Doberman came out as 88 pounds. My boy, Bauer, is slim and trim at 97 pounds, while my girl, Dharma, begins to verge on voluptuous if she is over 72 pounds.

Putting it to the test

I gave this app a go using my two Dobies as, well, guinea pigs. I “plugged and chugged” the app’s recommendations of breed, sex, weight and activity level and compared it to the actual calories I feed my dogs on a daily basis. Here’s what I found as I worked through the process:   

The formulation I use to calculate my dogs’ daily caloric needs can be found in my previous blog (Weight Management Made Simple). This is a formula for “obesity-prone” dogs and is therefore a little more calorie-conservative than the app’s formulation.

For example: Bauer’s calorie requirements using my formula equates to needing 1,370 calories per day, while the Doggie Dietician recommends I should feed him 1,885 calories per day. Although the app accurately calculates a pet’s daily requirement needs, I can say from experience that if I fed the caloric amount recommended by the app, that he would begin to pack on a few pounds.

However, I don’t think that this should deter its use; I only mention this to highlight the point that it may take some adjustment to find your dog’s daily caloric “sweet spot.” I feel the app is a good starting point that will allow you to get a big picture and then you can fine-tune from that point based on your pets’ weight gains or losses. 

Quick fix

I get asked all the time, “How much should I be feeding my dog?” This app allows me to quickly and easily calculate the cups of food an owner should roughly be feeding his or her pet right while I’m in the exam room.

Although it’s a more basic app, I feel that it is one worth fetching, and for just under two bucks, I give it two paws up.