Inflammation in the body is beneficial, but too much of a good thing can be bad. Especially when excess, unregulated inflammation in the intestines leads to chronic diarrhea caused by a condition called chronic inflammatory enteropathy (CIE).

Diarrhea is considered chronic when it has been present for three weeks or longer. Anyone that has had the experience of helping their dog companion deal with diarrhea knows how stressful it can be. Worry, accidents in the house, frequent trips outside during the night, and occasional vomiting can be a challenge.

One report estimates that 20-30% of veterinary appointments are related to vomiting and diarrhea in dogs. This is perhaps not surprising because digestion is such a complex process, and there are numerous causes of diarrhea. Intestinal causes include parasites, viral infections, eating inappropriate things, changes in diet, food sensitivities, cancer, and inflammation. Diarrhea caused by problems outside of the intestines include liver or kidney disease, pancreatitis, adrenal dysfunction, and even heart disease. Issues like imbalance in the intestinal flora (microbiota), irregularities in autonomic nervous system control, and stress or anxiety can be contributors.

In one study of chronic diarrhea in dogs, it was determined that 90% had a problem in the intestines and not outside of the intestines like liver disease. Chronic inflammation in the intestine caused diarrhea in 79% of those dogs. These are the dogs with CIE.

Some dogs and some breeds like German Shepherds and Boxers have a genetic predisposition to an imbalanced immune reaction in the digestive tract. This combined with additional immune stressors like a disrupted intestinal flora, food sensitivities, vitamin deficiencies, and early life exposures can contribute to CIE.

Diagnosing CIE requires ruling out other causes of chronic diarrhea. This process involves a range of blood tests and stool evaluation. Abdominal ultrasound and even biopsies of the intestine are valuable. Biopsies confirm the diagnosis and provide information about the inflammatory cells. Unfortunately, obtaining intestinal biopsies is invasive and not always done.

When other causes of chronic diarrhea have been ruled out and the conclusion is that CIE is causing the diarrhea, a support plan should be initiated that addresses the contributors to the intestinal inflammation. Studies show that approximately half of dogs with CIE are triggered by food sensitivities that result in intestine inflammation. This means that a critical first step is a therapeutic food trial with a limited ingredient food or preferably a hydrolyzed diet. It can take 8-12 weeks to determine the effect or benefit of the food trial.

If the food trial does not control the diarrhea, immune suppressive drugs may be used as the next step. After a reasonable course of immune suppressive drugs, antibiotics may be used. However, antibiotic use is being discouraged. Current research indicates that antibiotics have no or minimal impact on shortening the course of the diarrhea. The antibiotics often distort the flora in ways that are difficult to recover from. Dogs that do not respond to the food trial, immune suppressive treatments, or antibiotics (if used) are considered to have idiopathic inflammatory bowel disease. This means that the cause has not been determined. Some dogs have a complicating factor where there is ongoing loss of protein from the blood into the intestine. This is known as a protein losing enteropathy.

During the feeding trial, other diarrhea contributors should be addressed. Supplementation with cobalamin, folate, and vitamin D may be indicated by test results. Keep in mind that it can take weeks to correct these deficiencies. Addressing issues with the intestinal flora is also fundamental to managing CIE. It can take 6-8 weeks or longer to effect a sustainable shift in the flora. Probiotics and prebiotics are generally necessary. In some situations, fecal transfer may be required. Abnormal intestinal motility can affect the flora in the intestine. Intestinal motility can be influenced by stress and anxiety.

Modulating stress can have important benefits. Regulation of digestion can also be impacted by spinal column alignment issues that influence the autonomic nervous system. Supplements like glutamine and arabinogalactan that support the intestinal lining may be valuable in the early support plan. Inflammation modulating herbs like boswellia and marshmallow root may play an important role in the health of the intestinal lining.

Managing chronic diarrhea in dogs can be challenging. Providing a comprehensive support plan is based on having a clear understanding of the causes. If you have questions about CIE in your dog, contact your veterinarian.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs. Dr. Carsten is the 2022 Colorado Veterinary Medical Association Distinguished Service Award recipient.

Last month, we reviewed basic information about the dog spleen function and touched on a few disease problems. That information was based on what some call Western medicine which focuses on anatomy, function, and understanding disease pathology. There is another medical approach that is based on centuries of observation of health, disease, and response to treatment. Some refer to this as Eastern medicine. It is a system that evolved to explain and treat symptoms.

This month, further discussion of the spleen provides an opportunity to explore a portion of Eastern medicine through a Traditional Chinese Veterinary Medicine (TCVM) perspective of the Spleen (capitalized to denote TCVM Spleen).

Keep in mind that Traditional Chinese Medicine is a highly developed and successful medical system for a large population. Its success in managing health and treating disease has stimulated widespread use and increasing amounts of modern medical research in an effort to more fully understand its concepts and how they relate to Western understanding of disease.

In TCVM, the organs, like the Spleen, are not the anatomy but rather a description of an abstract concept and their dynamic functions based on the anatomy. Organs in TCVM are visualized as webs of energy or systems with defined functions. These organs and systems have interrelated functions with other body organs and systems. Each organ is associated with an element, an emotion, and it opens to the outside of the body. TCVM considers such concepts as Qi and Blood, yin and yang, excesses and deficiencies, and the “six pathogens.”

Organs in TCVM are paired with another organ in terms of function. The Spleen and Stomach form one of these pairs and are thought to influence digestion, immunity, blood formation, muscle metabolism, body fluids, and more. Working together, the Stomach processes the ingested food into its components which are then transported to the Spleen for transformation and distribution. Substances derived from food are the sources of Qi and Blood. Through these processes, the Spleen is able to govern the transport and metabolism of water and nutrients in the body, regulate the circulation of blood, and influence immune function.

Keep in mind that the discussion here is a relatively simple description of a complex health care approach. When the Spleen is deficient, digestive disturbances such as poor appetite and abnormal stools can be seen. However, because other organs and systems can be involved, additional signs of deficiency can include muscle atrophy, weak pulse, fatigue, cold limbs, mental fog, anxiety, obesity, and a weakened immune system.

There are numerous factors not described here that are important to recognize when evaluating a patient. Common contributors of Spleen deficiency include anxiety and worry, eating cold foods, irregular eating patterns, and overexertion. These factors can impact our pet companions.

Even though TCVM describes a concept, there have been correlations with Western medicine. Interestingly, for centuries, until the recognition of the spleen as part of the lymphoid system, Western medicine also described the spleen as part of digestion. This separation from digestion has shifted in the West again with the realization that there is an interwoven relationship between the stomach and spleen during development in the embryo.

Further, in the 1970s blood circulation between the stomach and spleen was found to occur through certain arterioles (small arteries) from the spleen to the stomach tissue. Blood was also found to drain in certain veins from the stomach into the spleen. This relationship highlights the potential for secretory and resorptive functions between the spleen and stomach.

Other modern research has demonstrated correlations between dysfunction of the TCVM Spleen and Stomach and changes in Western anatomy and function. For example, Spleen dysfunction has been associated with muscle metabolism changes, alterations in the stomach lining, suppressed nerve function of the sympathetic nervous system that signals the digestive tract, and reduced immune activity. Gene expression studies of TCVM herbs are supporting physiological observations of functions attributed to the Spleen.

While it can be challenging to fully understand the principles of TCVM in the context of our Western society, it is fascinating to consider the interface between Western medicine and TCVM observations and descriptions. Recognizing these perspectives and the correlations with current scientific research can facilitate a deeper understanding of supportive care for our pet companions.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs. Dr. Carsten is the 2022 Colorado Veterinary Medical Association Distinguished Service Award recipient.

The blood-chemistry panel is an essential part of the health assessment for pet companions. It is used in conjunction with the complete blood count (CBC) to form a more complete picture of health status (see the Aug. 30 Glenwood Springs Post Independent article).

Unlike the CBC, which uses blood that has not clotted, the chemistry panel uses serum. Serum is the fluid that remains after clotting. The serum is removed from the clot before the blood-chemistry panel is performed. Removing the clot also prevents further changes resulting from ongoing contact with the blood cells.

It is important to remember that the CBC evaluates red blood cell (RBC), white blood cell (WBC), and platelet numbers and other blood-cell measures. This is in contrast to the chemistry profile that includes tests for organs like the kidneys and liver as well as basic tests like glucose, cholesterol and electrolytes like sodium, potassium, and calcium. Commonly available test profiles run from a handful of tests up to almost 30.

Beyond the basic chemistry profiles, an extensive list of specialized testing is available. Specialized testing would be requested based on the characteristics of the illness and the pattern of results from the CBC and the chemistry profile.

There are a number of situations where your veterinarian would recommend a chemistry panel (usually in conjunction with a CBC). These include when your pet is ill, when monitoring response to treatment or as part of a wellness evaluation or pre-surgery screening. Individual test results and patterns of results provide guidance for making a diagnosis or determining which drugs to use for anesthesia.

For example, it is recognized that kidney tests (like creatinine) are not abnormal until 2/3 to 3/4 of the kidney function is lost. The SDMA is a newer test that provides earlier indications than creatinine about potential kidney concerns. Adding to the challenge of interpreting kidney blood chemistry results, it is important to determine if the pattern of results indicates a problem preventing the kidney from functioning efficiently like low blood flow to the kidney, a primary kidney problem or something impeding the urine flow like kidney stones. Understanding where the problem is located or what is causing the change in test results related to the kidney is vital for formulating a treatment or support plan.

Another important consideration is determining if the kidney problem is acute or chronic. Pets with chronic kidney disease have the opportunity to adapt to the worsening kidney function, so they can withstand higher numbers for SDMA, creatinine, and BUN (blood urea nitrogen). However, the chronic change in kidney function can lead to elevated phosphorus, anemia and problems with blood pressure. Each of these patterns of results have impacts on how the pet is managed.

Blood chemistry results for liver tests can also be assessed for the pattern of values. Unlike the kidney tests, the typical liver tests don’t directly measure function. For example, the ALT is an enzyme released from liver cells as they die. Some amount of cell turnover (death) is normal. When liver cell turnover becomes excessive, the ALT will rise as long as the liver size is normal. On the other hand, liver tests like ALP provide information about the bile system. Complicating interpretation is that elevations in ALP don’t always mean liver. ALP can be induced to increase when there are increased steroids in the blood, either naturally occurring or given as a medication. Sometimes, it is important to perform additional tests like the bile acids panel to assess liver function.

Other common tests on the blood chemistry panel like the T4 and cholesterol may imply a low functioning thyroid in the dog. However, cholesterol can be elevated when the pet was not fasted prior to obtaining the blood sample. The T4 can be low due to the effect of diseases not directly involving the thyroid or certain medications. Untangling the thyroid results sometimes means performing additional tests like a thyroid panel that includes other tests in addition to the T4.

This brief discussion gives a glimpse of the power of the blood chemistry panel and how the different tests when interpreted together provide a broader understanding of the health of your pet companion. If you have concerns or questions about your companion’s health, contact your veterinarian. Perhaps a blood chemistry panel and CBC are indicated.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs.

COVID-19 cases are declining, mask requirements are being lifted, restrictions on indoor and outdoor gatherings are changing, and people are returning to their workplaces. During the past year, workplace changes associated with COVID-19 prompted many to work from home. This led to record numbers of pet companion adoptions across the country. Many pets, newly adopted or longtime companions, have had a high level of interaction with their caregivers while they worked from home.

As the workplace opens up, many caregivers will be away from home more. This change may contribute to heightened levels of separation anxiety, boredom, destructive behaviors, elimination problems and other issues associated with this change in household routine. Our pet companions may also develop an awareness of the anxiety and stress that their caregivers are experiencing, adding to their own anxiety.

It is important to consider the physical and emotional changes that will be affecting our pet companions and make plans for transitioning to a new routine. Preparation and gradual exposure to the anticipated changes in the household can be essential for a stress free transition. Make sure to give yourself and your pet plenty of time to adapt to your new routine.

Cats are generally more independent than dogs, but cats can still be stressed by the significant changes in routine created by returning to work. Avoid or reduce pet anxiety by creating a routine and practicing longer stays at home alone. Depending on your expected work schedule, you could be away form home for eight to nine hours or more. Start with a routine that will be similar to your anticipated work schedule. For example, go out for a coffee around the time that you would usually leave for work. Keep the initial time out of the house brief and build up. This will condition your pet to being home alone. The gradual process can help to reduce anxiety. Select a time that you can go for a regular daily walk with your dog or have a play session with your cat. Pets learn to anticipate these times and activities. They provide mental stimulation as well as exercise. Provide pet friendly toys that can help your pet to be distracted while you are out.

Arrange the feeding times so they function around your anticipated work schedule. Some recommend feeding in a room separated from the pet owner. This can help accustom the pet to being away from you and aid in reducing anxiety with separation, especially if your pet is constantly at your side. Food puzzles can be a way to provide distraction and mental stimulation.

Crate training can be beneficial for some situations. Even though it has advantages it is not the best option for every individual. If you think crate training is appropriate in your situation, start gradually so that your pet becomes accustomed. Make it an enjoyable place for your pet to spend time.

Pet day care or having someone come to your home for play activity is an option for some. Some people like to leave the television or radio on. Look for pet-friendly content options.

Watch for signs of anxiety or excess stress. These include destructive behaviors, excess barking, crying, pacing, shaking, and urination or defecation behaviors. Don’t punish for these anxiety behaviors. It is important to reassure your pet. If anxiety or excess stress is observed, back up and slow the transition process.

Separation anxiety is a complex issue. Sometimes changing the routine gradually and providing the other recommended options can be enough. However, some pets need more than this to manage their anxiety. You can use products that help to reduce anxiety like the calming pheromones in Feliway for cats or Adaptil for dogs, the Bach Flower remedy Rescue Remedy, calming herbs, and nutriceuticals like Composure. Keep in mind that these products can have subtle effects, and the effects are not always immediately observed. For pets with high anxiety, the use of anti-anxiety medications may be needed. Use of anti-anxiety medications should be coordinated with your veterinarian and a behaviorist or trainer.

Be patient with your pet through this process. If you have questions about this important transition process, contact your veterinarian and trainer.

Ron Carsten, DVM, PhD, CVA, CCRT was one of the first veterinarians in Colorado to use the integrative approach, has lectured widely to veterinarians, and has been a pioneer in the therapeutic use of food concentrates to manage clinical problems. He is also the founder of Colorado Animal Rescue (CARE). In addition to his Doctor of Veterinary Medicine, he holds a PhD in Cell and Molecular Biology and is a Certified Veterinary Acupuncturist and Certified Canine Rehabilitation Therapist. He practices integrative veterinary medicine in Glenwood Springs.