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Dementia in Senior Dogs

When I talk with people who are struggling with the decision to let their senior dogs move on to their next expression of spirit the issue of dementia often comes up, but I’ve found that people are sometimes unwilling to consider euthanasia if the problem isn’t physical. Somehow it’s easier (well, actually I know it’s never easy) to come to terms with the fact that a dog is suffering physically and needs to move on than it is to understand that mental and emotional suffering need to be taken into consideration as well as physical problems. My experiences with my own dogs, as well as many conversations with people about their dogs, has brought me to several thoughts that I’d like to share with you.

1. My bottom line is always quality of life when I’m talking with people about end-of-life decisions for their dogs. Dementia is an insidious and relentless condition that is very difficult for a dog to handle … and for you to deal with if you’re the person who loves the dog. Here are some behaviors to look for if you have concerns about your dog’s mental/emotional health:

A) Pacing, anxiousness, movement that doesn’t seem purposeful, disorientation

B) Staring for long periods of time, getting lost in corners, standing on the wrong side of a door waiting for it to open, unable to figure out the next step, acting dazed, seeming to be lost in familiar places

C) Peeing/pooping in the house: Seniors with dementia may forget to go outside to do their business, but it’s important to rule out a medical problem (urinary tract infection, gastrointestinal problems) before assuming the problem is related to dementia.

D) Withdrawing: A dog with dementia often won’t seek out human companionship, sometimes will even walk away while being petted, and often won’t greet family members when they come home.

E) Barking for no reason: The dog may no longer recognize people, or the dog may be lost in the yard or behind a door, or is generally confused … which could cause barking, especially at night.

F) Appetite changes that manifest in either losing interest in food or always being hungry

G) Sleeping pattern changes: A dog with dementia may sleep more than normal, or have night and day reversed—sleeping during the day and awake and confused at night.

H) Not responsive to your voice : You need to first rule out hearing loss, but if that isn’t the problem, the dementia may be interfering with your dog’s ability to process what you’re saying and act on your request, or the dog may even may be confused about his or her name when you call it.

I) Any other behaviors that might be unusual for your dog.

If you notice some of the above signs I’d suggest you keep track of what behaviors you’ve noticed so you can determine how often they’re occurring. Then, make an appointment with your vet to discuss what’s going on. Your vet may prescribe medications/supplements that can be helpful with dementia in its early stages, but you need to be mindful of the fact that often some medications are aimed at just reducing anxiety and you may end up with a dog that is not only confused, but also tranquilized and barely responsive, which means you’re trading one unhealthy state for another.

2. Don’t buy the tee shirt “Denial Ain’t Just a River in Egypt.” If you’ve read through the above list of common symptoms of dementia you may find yourself trying to explain away any symptoms your dog is experiencing by saying things like: “He’ll be better tomorrow.” “She’s just having a bad day.” “I don’t think she really minds being confused; after all, people are confused all the time.” “He isn’t in pain.” Please don’t rationalize what’s going on mentally or emotionally with your dog. Like people, dogs function on many different levels and like us, they like to be in control of their minds and bodies. Don’t compare your senior moments to what your dog is experiencing with dementia. When you walk into a room and forget why you’re there that’s often a momentary lapse caused by distraction on your part. Or, if you find your socks in the refrigerator, you just laugh and chalk the misplacement up to not paying attention. Your dog isn’t laughing when he can’t figure out how he got stuck in a corner. And … dementia is painful on an emotional and mental level.

3. Is the light still there in your dog’s eyes? I do understand that if your dog is blind or is vision impaired it’s difficult to tell whether or not the light is still there, but even with blind dogs you can sense whether it is or isn’t. The light I’m talking about sometimes isn’t so much a tangible thing as it is just a sense that your dog is still in there. If you feel like your dog isn’t fully present any longer and that no one is home, the light is fading or gone.

4. There’s a big difference between existing and living. Dogs can exist with dementia for a long time, but that existence is without joy, eventually is filled with fear, and can’t be called living in any true sense of the word.

5. When your dog loses his or her sense of identity that’s serious business. Recently I had to say goodbye to two of my dogs that were suffering from dementia. It was heart wrenching to watch them lose their sense of identity because dogs function on an intuitive level most of the time and their sense of who they are as dogs is important to them. Their sense of identity gives purpose and joy to their lives and when they become confused about who they are that sense of purpose and joy is compromised.

After reading the above paragraphs I know you must feel helpless and frustrated, but if your dog is in the early stages of dementia and you aren’t seeing the above-mentioned behaviors to any significant degree to cause you to consider euthanasia here are a few things you can do to help:

  • Offer your dog reassurance, physical comfort, and a constant reminder that you’re there.
  • Dementia isn’t something a dog should have to deal with alone. Be physically with your dog as much as possible.
  • Trust the bond you have with your dog to hold strong. Offer your fully present self to your dog on every level.
  • Provide external stimulation (rides in the car, walks, visits to the dog park, playtime with other dogs) to keep the world available to your dog.
  • Look for the positive. Allow your dog to see the light in your eyes. Practice being optimistic.
  • Try whatever your vet might prescribe because often you’ll see some good short-term results with the non- tranquilizing meds that will stimulate brain activity. Also, there are several dog foods on the market that claim to help with cognitive dysfunction. In short, with your vet’s suggestions in mind, try whatever’s out there.

Ok, I’ve said enough. I’m sure you get my point by now. What I’m talking about here is a steady progression of what I call the “foggy boy” syndrome. What I’ve found with my own dogs is that initially the confusion and disorientation isn’t terribly upsetting to them. They just roll with it and relax into a kind of “It’s no big deal; my person will take care of me” state of mind. But, eventually the confusion frightens them, they begin to panic and become fearful. That’s no way to live.

Please take dementia seriously when you’re considering your senior dog’s quality of life and think very hard about whether it’s really in his or her best interests to just exist instead of living a happy life in which he or she is fully present.

Socialization ideas for your dog

Not just applicable to puppies! This is a great checklist for dogs of all ages.
But do be cautious and be patient when introducing anything new to your dog.

When to consider adopting another dog after one has passed

(From Victoria Stilwell’s “Positively”) by Jennifer Kachnic

If you are like most people, you will eventually decide to get another dog after yours has died. This is a personal decision and one that should be made very carefully. The entire family should be involved in deciding the best time to commit to a new relationship. The time frame for this is different for everyone. Bringing a new dog home to the family before everyone is ready can hurt someone by implying that the dog’s death is insignificant. You may feel that you loved your passing dog so much that you can’t bear the thought of bringing another dog into your life and going through the loss again. Give yourself time. Try not to rush into making a decision until you have sorted out your feelings and grieved.

Well-meaning friends and family may encourage you to adopt another dog before you are ready. Resist this. When you see a new pair of yearning eyes looking into yours, you will know when you are ready.

During your time of grief, remember to pay attention to the other animals in the home. They also will be affected by the loss of your senior, as well as by your own grief and stress. They may react in various ways, including exhibiting personality or behavioral changes. This is usually temporary. If you have another dog that is suffering from the loss of his senior friend, try to keep his routine as normal as possible and lavish him with attention at this time.

My experience has shown me that one of the greatest legacies you can give your passing dog is to provide your love and compassion to another dog that so desperately needs it. Some people eventually find comfort in going to a local animal shelter and adopting a homeless senior dog. This should be done with some care. Often, people feel that adopting another dog of the same breed and coloring as the dog that has passed will help them deal with their grief. This is usually a mistake. The second dog is not the first dog, and it is unfair to expect him to be. By choosing another dog that is physically different from your passing dog, you will learn to love and appreciate his unique qualities. If you are not quite sure you are ready for another dog in your life, try fostering an animal through a local animal rescue group.

You will not only provide housing and love to a homeless dog while he is waiting for a permanent home, you will be able to test your own readiness without a long-term commitment. Every dog, especially a senior animal, has so much to offer and will surely enhance and bring joy to your life. If you feel you have grieved and your heart is telling you to open yourself up to another relationship, you are probably ready. For some, there is no better medicine for a hurting heart than the love of another dog, while for others, the best medicine is time.

Jennifer Kachnic, President of The Grey Muzzle Organization and author of Your Dogs Golden Years –Manual for Senior Dog Care

Heartworm basics

Click above to read more from the American Heartworm Society.

Behavior modification in dogs

(From the Merck Veterinary Manual)

Check out the link for the full article, with links to additional information.

Below is the main page text for your reference:

Behavior Modification in Dogs
By Gary M. Landsberg, BSc, DVM, MRCVS, DACVB, DECAWBM, Director, Veterinary Affairs and Product Development, CanCog Technologies, and Veterinary Behaviourist, North Toronto Veterinary Behaviour Specialty Clinic

Behavior of Dogs
Introduction to Behavior of Dogs
Diagnosing Behavior Problems in Dogs
Behavior Modification in Dogs
Normal Social Behavior in Dogs
Behavior Problems in Dogs
The techniques used most commonly to modify dog behavior include habituation, extinction, desensitization, counterconditioning, response substitution, and shaping. A behavior modification technique called flooding, described below, is not used very often because it is more likely to make animals worse. While it is claimed that punishment is frequently used with varying degrees of success, few people use punishment correctly. For punishment (such as screaming at the dog) to be successful, it must occur at the beginning of the behavior,be consistently delivered, and be strong enough to stop the unwanted behavior. Most punishments are not given at the right time or are not the appropriate type for the situation. “Dominance” training techniques that encourage owners to assert leadership through physical confrontations are also not recommended. Multiple studies have shown that training based on punishments or confrontations are more likely to lead to fear, avoidance, and increased aggression. Dogs trained with rewards have fewer behavioral problems and are less fearful.

Behavior Modification Techniques
Most of the techniques involved in behavior modification are not hard to learn and can be successfully used as preventive techniques. They do require a regular investment of time and effort, however. The following is a short review of the basic principles involved in these techniques.


Look for trainers who use positive reinforcement for good behavior rather than punishment for unacceptable behavior.
Observe an obedience class without your pet. Are the dogs and people having a good time? Talk with some of the participants after the class. If someone will not let you sit in on a class, do not enroll.
Do not allow trainers to work with your dog unless they tell you beforehand exactly what they plan to do.
Do not be afraid to tell a trainer to stop if she or he does something (or tells you to do something) to your dog that you do not feel comfortable with.
Avoid trainers who offer guarantees. Such trainers are either ignoring or do not understand the complexities of animal behavior.
Avoid trainers who object to using food as a training reward. Food is one of the best ways to motivate a dog.
Avoid trainers who insist on using a choke chain. Head collars are humane alternatives to choke chains and pinch collars.
If you believe your dog has been subjected to cruel treatment by a trainer, get the names and phone numbers of witnesses. Take your dog to your veterinarian immediately for a complete physical examination. Tell them that the results of the examination may be used as evidence in a court case so that your veterinarian will document the procedures with that in mind.
Habituation is a simple form of learning that involves no rewards. It is merely the ending of or decrease in a response to a situation that results from repeated or prolonged exposure to that situation. For example, horses placed in a pasture bordering a road may at first run away when traffic passes, but eventually learn to ignore it. A dog that habituates to one type of sound does not, as a consequence of this habituation, automatically become habituated to other sounds. Habituation is not the same as failing to respond to stimulation as a result of fatigue, sensory adaptation, or injury. The effects of habituation are generally long lasting. However, if an animal is repeatedly exposed to a potentially harmful stimulus (such as a predator) without being harmed, habituation does not generally occur. Because of this, scientists believe that responses to dangerous stimuli may have an inherited resistance to habituation. If the fearful response is too intense, the dog may become more fearful instead of adjusting to the stimulus.

Spontaneous recovery is associated with habituation. If there is a long period of time between when a dog has experienced an event to which it had habituated and re-exposure to the same event, the dog may again react. For example, a puppy barks to get a reaction. The more the owner attempts to quiet it, the more the puppy barks. It will continue this pattern because it is getting the attention it wanted. Even if the attention is “negative,” some puppies will find it rewarding. The best method to discourage the behavior is to ignore it. Eventually the puppy stops barking if the owner consistently ignores it. However, the bad behavior comes back every now and then. This is called spontaneous recovery.

Giving a small food treat is a good way to reward your dog for obeying a command.
Giving a small food treat is a good way to reward your dog for obeying a command. Giving a small food treat is a good way to reward your dog for obeying a command.
Conditioning refers to associations between stimuli and behavior. For example, a hungry dog drools (the behavior) when it sees food (the stimulus). After this, every time that the hungry dog sees the food a bell is rung (a second stimulus). Once the food and bell have been paired several times, the dog will drool even if it just hears the bell. This is called conditioning. The bell generates the same response as the sight of food. After several times, the dog has learned to associate the bell with the food. Conditioning can be positive or negative. For example, the sound of a doorbell can cause fear or excitement in a dog, depending on whether the dog likes or dislikes visitors.

Reinforcement is any event that increases the chances that a certain behavior will be repeated. Reinforcements can be positive or negative. When positive reinforcement (a reward) is used in training, there is a positive relationship between the behavior and its consequences. The more the pet does a behavior, the more it gets positive reinforcement. This makes that behavior increase. A negative reinforcement (which is mistakenly thought of as punishment by many people) is something unpleasant that increases a behavior when it is removed. For example, being held tightly may be unpleasant to a squirming puppy. But the hold is released only when the puppy calms down. After several times, the release from restraint will increase the chance that the puppy will relax faster.

Second-order reinforcers are signals that can be used at a distance to let the dog know that a reward is coming. Commonly used second-order reinforcers are words, such as “good girl,” hand signals, and clickers. By carefully pairing these with a primary reward (such as food or petting), second-order reinforcers can elicit the same response that the reward would. For example, a clicker can be associated with patting on the head as a reward for sitting and staying. By associating the clicker with a reward, you can train the dog to sit and stay from farther away and still reward the behavior by using the clicker. Positive training and clicker training have become very popular. However, it is possible to do an excellent job at positive training without using any second-order reinforcers. Clicker training requires frequent practice and excellent timing. In some situations involving problem behaviors, the incorrect use of a clicker may hinder, rather than help, a behavior modification program.

Extinction is a response that stops when a reward is removed. A classic example of extinction involves a dog that jumps up on people for attention. If people pet the dog, the behavior continues. If they stop petting the dog, the dog will eventually stop jumping up because the reward is no longer there. However, even occasional petting of the dog in response to its jumping will reinforce the pattern. The more valuable the original reward, the longer it has been present, and the more uncertainty there is about whether the reward has been truly removed, the greater the resistance to extinction. Resistance to extinction can also occur even without reinforcement if the reward was good enough and was tightly linked to the behavior.

Because there is often an association between getting the reward and the intensity of the behavior, the intensity or frequency of the behavior you are trying to eliminate usually increases at the beginning of extinction. In other words, a behavior you are trying to extinguish may get worse before it gets better. It is critical that you do not give in. Giving in will only make extinction more difficult. The dog will learn that, although your threshold has increased, the dog can override it by working harder.

Overlearning is the repeated performance of an already learned behavior. It is frequently used in training for specific events, and may also be useful for preventing fearful responses in dogs. Overlearning accomplishes 3 things: it delays forgetting, it increases the resistance to extinction, and it increases the chance that the behavior will become an automatic or “knee-jerk” response in similar situations. This aspect can be extremely useful in teaching a dog to overcome a fear or anxiety.

Shaping is a learning technique that works well for dogs that do not know what response is desired by the trainer. Shaping works through gradual approximations and allows the dog to be rewarded initially for any behavior that resembles the desired behavior. For example, when teaching a puppy to sit, giving the puppy a food treat for squatting will increase the chance that squatting will be repeated. This squatting behavior is then rewarded only when it becomes more exaggerated, and finally, when it becomes a true sit.


Avoidance of a problem behavior is essential until you can seek qualified help, particularly in a case of aggression. With treatment it may be possible to reduce the aggressive behavior, but avoidance is the key in minimizing danger. Avoidance does not mean that the pet has control, or that you are giving in to the dog. Instead, it may help extinguish the aggressive behavior. Every time a dog becomes aggressive, it learns that aggression may help it cope with the situation, thus reinforcing the problem.

Desensitization is a way to gradually teach a dog to tolerate a situation by carefully exposing it to that situation in small steps. If a puppy gets overexcited at the sound of the doorbell, a tape recording of the doorbell could help stop the undesirable behavior. If the tape is played very softly at first and then only gradually increased in volume as long as the puppy remains calm, then the puppy may stop reacting to the doorbell.

Counterconditioning is a method for reducing unwanted behavior by teaching the dog to replace it with another more favorable behavior. In the doorbell example above, the puppy will learn faster if it is first taught to sit, stay, and then relax in exchange for a treat. The puppy must be absolutely quiet and calm, and convey by its eyes, body posture, and facial expressions that it would do anything for its owner. Once this behavior is learned, the desensitization is added by playing the tape recording at a gradually increasing volume. If at any time the puppy starts to get too excited, the tape recording should be lowered in volume until the puppy relaxes. Relaxing is the key and is the first step to changing the behavior. Counterconditioning and desensitization can take a lot of time and effort. The exercises must be frequently repeated so that the unwanted behavior decreases until it is no longer a problem.

Flooding is prolonged exposure to a stimulus until the dog eventually stops reacting. This is the opposite of the approach taken in desensitization. It is far more stressful than any of the other treatment strategies and if not used correctly will make things worse. The most common problem is increased fear. This technique should be used only by a professional and only as a last resort.

Punishment is also known as aversive conditioning. It is any unpleasant event that lowers the chance that a behavior will be repeated. Punishment can be positive or negative. Positive punishment refers to applying something unpleasant to decrease a behavior, whereas negative punishment refers to removing something positive to decrease a behavior. Punishment is not the same as negative reinforcement (see Behavior Modification Techniques). To be most successful, punishment must occur as early as possible (within a few seconds of the start of the behavior), and it must be consistent and appropriate. Critical factors in punishment include timing, consistency, appropriate intensity, and the presence of a reward after the undesirable behavior ends. This is the most frequently ignored part of treatment for people whose pets have behavior problems. Owners often resort to physical punishment as the first choice, but punishment does not need to be physical. Furthermore, punishment is just as hard to use correctly as counterconditioning and desensitization. Punishment is never an “easy out” and has a high chance of failure. It can also lead to other negative consequences, such as increasing the chance of fear or aggression.

The Premack Principle states that more likely behaviors will reinforce less likely behaviors. When misbehaving increases the likelihood that a dog achieves a goal, the more likely the dog is to misbehave. To prevent the misbehavior, the owner can teach the dog an alternative, positive behavior; for example, teaching a dog to sit and stay before allowing it outside may deter bolting.

Response substitution involves the replacement of an undesirable response with a desired one. An example is teaching a dog to lay down instead of jumping up. Owners should begin in a calm environment where success is likely, then progress to places with more distractions as the behavior is learned. Dogs may first need to be desensitized to the stimuli for response substitution to be successful.

Use of Medication to Treat Behavior Problems
Your veterinarian may prescribe medication to help treat a behavior problem of your pet. Drug treatment for almost any behavior change is most useful when combined with behavior modification.

In recent years there has been an increase in the use of medication to treat a variety of behavior problems in pets (see Table: Drugs Used to Treat Behavior Problems in Dogs). There are a number of potential disadvantages to the use of medication for treating these problems, however, and you should know that there is no “magic bullet” that will easily and quickly solve the problem. The limitations of medication use include the potential for adverse effects, cost, the need to treat for a considerable length of time before the medication takes effect, limited information on what medication is most effective, and the potential that the problem will reappear once the medication is withdrawn.

Drugs Used to Treat Behavior Problems in Dogs



Tricyclic antidepressants


Anxiety, compulsive disorders

Cheaper than many other drugs, but may be more likely to cause adverse effects


Anxiety, aggression, compulsive disorders

FDA approved for use in separation anxiety in dogs

Selective serotonin reuptake inhibitors


Anxiety, aggression, compulsive disorders

May take 3 to 4 weeks before affecting behavior; also FDA approved for treating separation anxiety in dogs


Anxiety, aggression, compulsive disorders


Anxiety, aggression, compulsive disorders






Thunderstorm phobia, anxiety

Longer acting than other drugs of this class


Anxiety, noise phobia

May cause physical dependence

Monoamine oxidase inhibitors


FDA approved for use in cognitive dysfunction in dogs

Must not be combined with serotonin reuptake inhibitors or tricyclic drugs due to adverse drug interactions

All medications have the potential to cause side effects. Fortunately, most of the modern antianxiety and antidepressant medications used in pets are well tolerated. Gastrointestinal upsets (leading to reduced appetite, vomiting, or diarrhea) are the most common side effects seen. In some pets, decreased activity or lethargy may occur in the first week or so of treatment as the animal adjusts to the medication. (This reaction typically disappears on its own.) More serious side effects, including potentially fatal inflammation of the liver, seizures, or other signs of toxicity have been reported in rare cases. Most of the medications used for behavior problems in pets were designed for use in people. Few have been directly approved by the Food and Drug Administration for use in animals, although such use is not prohibited. This means that there may be limited information available on safety, toxicity, and effectiveness in dogs or other animals.

Because this is a relatively new area of veterinary medicine, demonstration of effectiveness through research has not been done in many cases. Veterinarians often must rely on case reports, their own clinical experience, and presentations at meetings to learn which medications and what dosage to recommend. Individual pets vary in their response to medication, just as people do. As a result, there will always be some element of trial and error in determining whether a particular medication will help solve a behavior problem.

If medication is used without behavior modification or environmental changes (and even when it is used with these techniques in some cases), the unwanted behavior may return once the medication is discontinued. Some problems may require treatment for a year or longer. In most cases medication is used for a period of several months.

Despite these limitations, medication has the potential to be very helpful in a wide range of pet behavior problems, including fear-related problems like separation anxiety and thunderstorm phobias, compulsive behaviors like lick granulomas, and some types of aggression. Drugs and some supplements can help normalize your dog’s emotions and improve your ability to train anxious, overreactive, or fearful dogs. They can also improve a pet’s welfare. Your veterinarian can discuss whether medication might be appropriate for your dog.

Dogs and diarrhea (causes and remedies)

A common problem – here’s a good (long) read for you:
(From The Whole Dog Journal, Sep 2018)

Dog Diarrhea Causes and Remedies
The messy truth about dog diarrhea: diagnosing the cause of s dog’s diarrhea and firming things up can be complicated!
By Catherine Ashe, DVM

All dog owners know the feeling of coming home after a work day and smelling that smell. Uh-oh. Your dog has diarrhea. It’s a pretty common affliction of our canine friends. Now comes the inevitable question: “Should we go to the veterinarian?”
The truth is, much like people, sometimes dogs just get diarrhea. Much as we do not see the doctor for every bout of diarrhea, similarly, dogs do not always need medical attention for a short-lived enteritis (inflammation of the intestines). Often, diarrhea can be managed with at-home therapy and convalescent care.

Why Do Dogs Get Diarrhea?

The causes for acute diarrhea in the absence of other signs are varied and include dietary indiscretion (for example: getting into the garbage), gastrointestinal bacteria including Campylobacter, and GI parasites such as hookworms, roundworms, whipworms, and protozoal infections. In most cases of acute, self-limiting diarrhea, a cause is never identified.

If your dog seems otherwise normal, and he is currently on monthly parasite preventative medication, then symptomatic treatment at home is appropriate. Usually most diarrhea will run its course within two to four days, although in some cases, it can last longer. If there are any other signs of illness like vomiting, loss of appetite, depression, or pain, a veterinary trip is in order.

At-home treatment for acute diarrhea can include the following: a bland diet such as boiled hamburger or chicken with broth and rice for a few days, a probiotic such as Fortiflora (available only through veterinarians) or an over-the-counter probiotic and frequent walks. Avoid using human remedies such as loperamide, also called Immodium. This medication has an opioid in it, and it is easy to overdose a dog unintentionally.
If your dog continues to do well other than diarrhea, three to four days of at-home treatment is appropriate.

Diarrhea can make anyone sad and miserable, but if your puppy doesn’t respond to symptomatic treatment in a couple of days, or your dog fails to respond within three or four days, it’s time to head to the vet for an examination and testing.

If Your Dog’s Diarrhea Doesn’t Go Away:

If diarrhea doesn’t resolve with treatment, or your dog develops other signs, it is time to seek a veterinarian’s opinion. Diarrhea is considered chronic when it persists for more than three weeks despite treatment.

Diarrhea may seem like a simple problem, but it can actually be very complicated. Your veterinarian will proceed in a stepwise fashion (outlined below) to find the cause:

Thorough Questioning

Your veterinarian will ask a series of questions about your dog’s overall health, diet, vaccine history, and preventive care strategy. He will then ask more in-depth questions about the diarrhea itself. This will help determine what kind of diarrhea is occurring.
Diarrhea can be characterized as small bowel, large bowel, or mixed. In the case of small bowel diarrhea, you may see a normal to increased frequency, small volumes of loose, watery stool that can be tarry or black (representing digested blood). Often, your dog can “hold it” until going outside.

In the case of large bowel diarrhea, there will be an urgency to go. Your dog may not make it outside unless you are paying close attention. There is often mucus covering the stool, and there may be bright red blood as well. Your dog will usually strain for quite some time during or after having a bowel movement.

In some cases, the diarrhea can be mixed small and large, and this can be more difficult to sort out. Your veterinarian will likely ask many questions during this part of the visit.

Head-to-Toe Physical Examination

Next comes a thorough physical examination. Initially, your pet should be weighed. Weight loss is always a concerning sign. The exam will include checking the eyes, mouth, ears, palpating the lymph nodes, listening to the heart and lungs, deep palpation of the abdomen, and a rectal exam.

The rectal exam is the most important part! This will help the veterinarian see what the diarrhea looks like, as well as feel for any problems in the rectal area and descending colon. A temperature should also be checked. If a fever is present, this can help focus your veterinarian’s attention to certain areas such as viruses and bacteria.
Once this is completed, your veterinarian should have a good sense of what type of diarrhea your pet is having, possible causes, diagnostics, and treatment options.

Small Bowel Diarrhea

Generally, veterinarians will start out with conservative diagnostics and treatment for this type of diarrhea. The causes for small bowel diarrhea can be incredibly varied and run the gamut from fairly benign and treatable (parasites) to more serious (Addison’s disease).

Initially, a fecal examination may be the only test conducted. This requires a small sample of stool from your dog. The veterinarian will check this to rule out parasites such as hookworms, roundworms, whipworms, protozoal organisms, and bacterial overgrowth.
Even if your dog is up-to-date on monthly prevention, it is still possible to find breakthrough parasitic infection. This is why a fecal is done. If parasites are found, your veterinarian will treat with an anti-parasiticide like fenbendazole, pyrantel, and/or Albon. He will also discuss environmental control, as these parasites can persist in the soil for long periods of time.

If nothing is found on the fecal, your veterinarian will likely still prescribe a course of the dewormer fenbendazole in case of a false negative fecal. Other treatments at this stage should include a novel protein diet, as your pet may have a dietary sensitivity or allergy. This means switching your dog to a protein and carbohydrate source to which he has no previous exposure. Examples include bison, venison, duck, and kangaroo usually paired with potato, rice, or pea.

At this stage, many veterinarians also prescribe metronidazole (also known as Flagyl). Metronidazole is an antibiotic, but it is also thought to have immunomodulating properties that help calm an inflamed GI tract. Many dogs will have an “antibiotic-responsive” diarrhea that will clear up with this treatment.

With this initial approach, your dog should be back to normal within three to 10 days. If within a week, you are not seeing improvement in your dog’s signs, then your veterinarian will move on to further diagnostics and treatments.

A complete blood count and chemistry analysis should also be run (see “Physical Exams for Senior Dogs”). This will give a global picture of your dog’s health. Significant dehydration, a decrease in protein levels, or changes in your dog’s condition (loss of appetite and/or weight loss) can indicate a more systemic health problem.
If metronidazole is not helping, then Tylosin may be used. Tylosin is another immunomodulating antibiotic that can help with GI inflammation. It may also have a probiotic effect in the gut by increasing the numbers of enterococci bacteria in the small intestine. It is very unpalatable to dogs and cats, and your veterinarian will have this medication compounded, in most cases (or have you place it in their food).
Again, your veterinarian will monitor for around a week. If symptoms do not improve, more advanced testing will be recommended.

A gastrointestinal panel (blood test) must be submitted to an outside laboratory. The veterinarian will likely recommend fasting your dog beforehand. This evaluates levels of vitamins found in the body – particularly cobalamin (vitamin B12) and folate (vitamin B9). Dogs with gastrointestinal disease often display impaired absorption of these critical vitamins. This diagnostic also evaluates trypsin-like immunoreactivity. These tests can indicate whether there is a bacterial overgrowth or a condition called exocrine pancreatic insufficiency.

In the case of bacterial overgrowth, antibiotic therapy may be needed.
Exocrine pancreatic insufficiency is a common disorder of German Shepherd Dogs, as well as other breeds. With this disease, the pancreas does not secrete appropriate digestive enzymes. Treatment is supplementing the diet with enzymes to help break down food and assist your pet in absorbing nutrients.

Another test that may be done concurrently is a resting cortisol test. Cortisol is a steroid made by the adrenal glands. In Addison’s disease (also called hypoadrenocorticism), the body does not produce enough cortisol or water-regulating hormones (called mineralocorticoids).

Addison’s can be difficult to diagnose, as symptoms can present in many ways including weight loss, shivering, decreased appetite, lethargy, chronic diarrhea, intermittent vomiting, and electrolyte imbalances.

Treatment for Addison’s involves replacing the cortisol and mineralocorticoids that the adrenal glands are not making. There is also a form of Addison’s called atypical. This occurs when only cortisol production is reduced. Replacing this lack with oral steroids can manage this condition.

If all of these tests are normal, and no obvious cause is found for the ongoing diarrhea, your veterinarian may offer referral to a veterinary internal medicine specialist (DACVIM). At that time, more extensive testing such as abdominal ultrasound, exploratory surgery, and biopsy may be recommended. These will rule out invasive fungal infection such as histoplasmosis and pythiosis, inflammatory bowel disease, and cancer.

Large Bowel Diarrhea

Large bowel diarrhea presents a diagnostic dilemma. Frequently, the causes are difficult to fully diagnose. In many cases, a response to treatment rather than extensive testing is used to make a presumptive diagnosis.

Like small bowel diarrhea, large bowel diarrhea can be caused by parasites, particularly whipworms. An initial diagnostic test will be a fecal examination. Keep in mind, however, that whipworm eggs are very heavy and are not always found on a fecal examination.
If your veterinarian does not find parasites, as with small bowel diarrhea, he will likely still recommend a course of fenbendazole, an effective anti-parasiticide that kills whipworms. They persist for long periods of time in the soil, so managing the environment is critical to preventing re-infection. Further, not all preventives cover against whipworm infection. Check with your veterinarian regarding your monthly treatment to ensure that your dog is protected against whipworms.

An antibiotic trial may be the next step. Clostridial colitis is a possible cause of large bowel diarrhea. It is poorly understood, as some dogs can have Clostridium bacteria but not be ill, while others can become very sick. Diagnosis is very tricky and recommendations change continually. Generally, clostridial infections respond very well to amoxicillin or Tylosin, so your veterinarian may try a course of antibiotics to both diagnose and treat the diarrhea.

A fiber trial – a dietary trial with a fiber-enriched food – may also help diagnose and resolve the problem. In some cases, the addition of a fiber-enriched food may be all that your dog needs to get back to normal. Your veterinarian can help select a fiber diet appropriate for your dog.

Many dogs are allergic to certain components in food (the immune system responds and causes the diarrhea), while other dogs are just “sensitive to” to specific dietary items (immune system is not involved). Again, diagnosis might be tricky. As a result, your veterinarian will likely prescribe a dietary trial. In this case, your dog will be placed on a hypoallergenic diet. There are several on the market that are made from hydrolyzed protein. This is when the protein is broken down into such small units that the immune system does not recognize the initial protein. This type of diet must be rigorously followed if it is to be successful. Treats, flavored heartworm medications, and table food will render the trial useless.

At this point, more blood tests will likely be called for. If your dog has evidence of bloodwork changes and weight loss, concerns for more serious systemic illnesses such as fungal disease and cancer come to the forefront. At that time, you should consider that referral to a veterinary internal medicine specialist (DACVIM) is likely best for your dog.

A Note About Boxers

About 30 years ago, Boxers were noted to have a severe, progressive disease of the colon (histiocytic ulcerative colitis) that caused very bloody, mucoid, large bowel diarrhea and resultant weight loss.

It was recently found that this is highly responsive to a common antibiotic called enrofloxacin (also known as Baytril). If empirical treatment is attempted, it must be continued for several weeks to ensure that all the bacteria are killed; if the bacterial population is not completely eliminated, the most resistant bacteria can come back with a vengeance.

If enrofloxacin doesn’t work, a biopsy of tissue from the colon is the best way to diagnose or rule out other possibly treatable diseases such as fungal infections.

Dog Diarrhea: Not A Simple Matter

As you can see, diarrhea can be a complicated problem to solve. Keeping a thorough history on your dog, documenting his diet and parasite prevention strategy in particular, as well as monitoring bowel movements closely, can help your veterinarian tremendously.
When diarrhea becomes chronic, it can take weeks to months to sort out the underlying cause and find an effective treatment. Be patient and work closely with your veterinarian. Follow recommendations and do not try random remedies recommended by random sources! With time, patience, and a good veterinarian, a solution can generally be found.

Catherine Ashe graduated the University of Tennessee College of Veterinary Medicine in 2008. After a small-animal intensive emergency internship, she practiced ER medicine for nine years. She now works as a relief veterinarian in Asheville, North Carolina, and loves the GP side of medicine. In her spare time, she spends time with her family, reads voraciously, and enjoys the mountain lifestyle.