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Ask Dr. Michael Salkin Your Own Question
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog
Satisfied Customers: 37998
Experience:  University of California at Davis graduate veterinarian with 45 years of experience.
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I have a one year old Victorian Bulldog called Obi.. take a

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Hi I have a one year old Victorian Bulldog called Obi.. take a deep breath and I’ll give the history. About 4 weeks ago he had soft stools then watery Diarrhoea. Standard procedure starved for 24 hours and boiled chicken and rice for couple of days then slowly brought back in his old food and he went soft agin. Had allergy test done turned out he was Allergic to the two proteins I was feeding switched into a new food over a few days mixed with plain rice and chicken breast. Since then 2/3 nights a week he wakes up at 5am gets of my bed and vomits up white foam just one little bit then gets back on my bed and goes back to sleep fine. I’ve tried giving a small meal before bedtime ( 11pm) and half a Zantac. Last night I gave a small feed but no Zantac and again at 5 am he was sick white foam with a small amount of grass in it. He shows no sign of being ill. Isn’t The far Jake lethargic and he is happy to play and exercise. Short of him over heating during the night laying on the bed I’m a little lost as to what could be causing this.
Customer: replied 8 months ago.
Hello is anybody available??
Customer: replied 8 months ago.
I don’t believe anyone is working on my question as it’s tellimg me.
Customer: replied 8 months ago.
Hello anybody gonna reply or do I need to get a refund.
Customer: replied 8 months ago.
Last attempt. Is anyone going to help please or am I wasting my time

You're speaking to Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

Customer: replied 8 months ago.
Ok thank you.

I'm sorry that your question wasn't answered in a timely manner and I'm sorry to hear of this with Obi. It's important to recognize that allergy tests designed to spot offensive food allergens for Obi aren't dependable. Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that Obi's immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from Obi's vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (a hydrolyzed protein diet is my preference because it avoids the possibility of my patient being intolerant to even a novel protein). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.

His early morning vomiting suggests delayed gastric emptying; in other words, food eaten prior to bedtime hasn't left his stomach in the appropriate time and it then ferments and irritates his stomach lining resulting in vomiting. Delayed gastric emptying isn't a diagnosis but instead a clinical sign of either primary stomach disorders or disorders outside the gastrointestinal tract but which affect the GI tract. A conservative approach to delayed gastric emptying is to feed smaller amounts of food throughout the day instead of a large meal prior to bedtime. Dosing with a promotility drug such as metoclopramide (Reglan) can help the stomach empty properly. In most cases delayed gastic emptying is transient and no further care is needed. If it persists we need to investigate a GI disorder with blood and urine tests, ultrasound of the GI tract, and even scoping and biopsying of the GI tract in some pets.

Please respond with further questions or concerns if you wish.

Customer: replied 8 months ago.
Thanks for your response. I'm aware the allergy test I had done isn't binding and at best it's s guide. Soft poos to me me and the wet food protein isn't agreeing with him. I've put him on to a wet white fish meal. I feed 3 times a day with the last before bedtime being quite small. When this started I presumed it was because his belly was prob empty not the other way around. Would feeding him his evening meal help give him time to digest it? Just to be clear there is never food in the vomit just small amount of white foam. This doesn't happen every day just 2/3 times a week. This morning was first time in 4 days. Should I cut out the late meal before bed? Thank you.

The white fish diet is often a good choice when testing for food intolerance. You often will see a positive response within the first month of feeding although it can take up to 8-12 weeks to be effective in some patients. I don't understand "Would feeding him his evening meal help give him time to digest it?" Rather than a big evening meal, I would space out smaller portions of his usual daily intake throughout the day. You can still feed the late meal but it would represent no more food than you've fed at the other times during the day.

He's apparently able to empty the majority of his previous meal if you're only seeing foam come up and so simply limiting the amount of food in the late meal may suffice. If not, consider a trial of metoclopramide. There is a condition called bilious vomiting syndrome which describes gastric hypomotility causing vomiting when the stomach is empty. This is most commonly seen in middle-aged and older dogs. It's presumed to be caused by gastroduodenal reflux that occurs when the dog's stomach is empty for long periods or due to abnormal gastroduodenal motility. Curiously, feeding smaller meals throughout the day and dosing with metoclopramide is also the treatment of choice for this disorder.

Customer: replied 8 months ago.
Ok thank you. To clarify I meant would it be better if I didn't feed a late night meal. Apologies. I used to feed 2x a day 8am and 6pm. When this started I spilt the same portion of food into 3 meals instead of two because I presumed his stomach was empty. Will giving Zantac in the evening help settle the acid in his belly? Also he sleeps in a ball so his head is almost by his backside. Is it possible he's having trapped wind or something.
Customer: replied 8 months ago.
I should add obviously I'll.take him to the vets if it continues.

An antacid is certainly reasonable but neither ranitidine (Zantac) nor famotidine (Pepcid) appears to be as effective as omeprazole (Prilosec) dosed at 0.5 - 1 mg/kg once daily. I don't recall if omeprazole is available over the counter where you live, however. Please advise. No, his posture shouldn't be incriminated.

Customer: replied 8 months ago.
I've checked. It's prescription only in the UK.
Customer: replied 8 months ago.
Ok thanks I think I know what I need to now. I'll try him on Zantac and if it carry on I'll have him checked out by his vet. Maybe a quick 10 min walk before bed will aid digestion. Thanks very much.

That's unfortunate. Do you know of any other over the counter antacids in the UK? Nexium (esomeprazole), perhaps?

You're quite welcome. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

Customer: replied 8 months ago.
Only Zantac which is ranitidine and tums which is a chewable tablet at 35k a whole 75 tab would be ok wouldn't it?
Customer: replied 8 months ago.
Nexium is a over the counter drug here in the UK

I found esomeprazole in the UK. It was approved for over the counter in 2015. It can be dosed as 0.5 - 1 mg/kg daily just as omeprazole. The recommended dosing for ranitidine doesn't appear to do the trick: 0.5 - 2 mg/kg every 8-12 hours.

Customer: replied 8 months ago.
Thanks for taking the time to look it up. It's the same thing I believe ie nexium

It is, yes. A better choice than ranitidine for Obi.

Customer: replied 8 months ago.
Brilliant thanks I'll go get some now. So he can have a max of 35mg every 24 hours?

If he weighs 35 kg, yes. I would initiate dosing in the low range first - 0.5 mg/kg once daily. You can always increase the dose if need be.

Customer: replied 8 months ago.
Cool. Thanks for your help. I understand what's happening now and how to hopefully stop it. Have good day and thanks again

It's my pleasure.

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