Monthly Doctor’s Blog: Common Questions Around Gastrointestinal Upset

Every month, the doctors of AtlasVet are writing a blog post to help pet owners with common questions. 

For January, Dr. Beth Durney discusses common questions around gastrointestinal upset (vomiting/diarrhea).

We’ve all been there: you think you are having a lovely night’s sleep and all of a sudden you wake up to the sound of either your pet frantically trying to ask to go out, or making that alarming pre-puke noise.  People move their fastest when they hear this sound!  Save the rugs! Not on the bed! Needless to say, this is not a fun way to start your day.   But what do you do next?   That depends on a lot of things.  Let’s break it down.

First, let’s discuss timeline: medical problems can be generally broken out into chronic and acute.  For the purpose of this article, we will definite ‘chronic’ as anything lasting more than 4 weeks.  So, if your pet is having an ongoing issue with any type of GI upset that lasts more than 4 weeks, that counts as a chronic problem.  That doesn’t mean it is ALWAYS going to be a problem, just that it has been going on for a bit.  For those pets, we always want to see them for an exam.  

Anything less than 4 weeks can be acute.  Really, the issues we will be talking about in this article will be even a shorter time than that (often less than 2 weeks, sometimes called ‘per acute’).   Per acute diarrhea or vomiting can be caused by a number of things.  Some of the most common are dietary indiscretion (ate something they shouldn’t have or that didn’t agree with them), viral infections, and parasitic infections.   Less common but more serious causes would be foreign bodies (swallowed something like a toy, acorn, etc and it is stuck or irritating the GI tract), toxins, or medication reactions.

Let’s run through how to trouble shoot your pet’s acute GI upset.  Keep in mind that if your pet is not doing well, seems lethargic, painful, or otherwise obviously sick, or has ingested a known toxin or foreign object, we’d recommend either contacting us or taking your pet to an ER.

My pet vomited or had diarrhea.  What now?

If your pet vomits once, or had 1-2 episodes of diarrhea, give it a bit.  Sometimes it is just a one and done.  If they vomit a few times in short succession (say, less than 30 minutes), we can still count that as one episode.    If your pet is a healthy adult that weighs more than 5 lbs, hold off on food for 6 hours for vomiting and 12+ for diarrhea.  The goal here is to give the GI tract a break from the work of digestion, so that we don’t put any more fuel on the fire of whatever is going on in there.  After that, you can offer a small amount of a bland diet (probably about ¼ of their normal meal size) and see how they do.   If they immediately throw that up, or if they don’t want to eat, or seem lethargic or off in any way, or throw up again in the next 24 hours, or diarrhea restarts, it is time for an appointment.  If they gobble up their small meal, seem happy and comfortable, then continue with a bland diet in small meals for another 1-3 days.   If they start vomiting again once they are back on their regular diet, reach out for an appointment.

When will my pet get better?

For simple GI upset, a short fast and a bland diet will resolve a majority of pets in 1-3 days.   For vomiting, we really don’t want to see that happen again once we’ve instituted our fast and then bland diet.  For diarrhea, it often doesn’t resolve as quickly.  We want to see 25-50% improvement in every 24 hour period.  Sometimes, once we start a bland diet pets won’t defecate for a day or two (or three!).  That’s ok! Their GI tract may be empty from all the previous upset, and it can take a day or two to get anything back into the colon and out.  As long as your pet is not straining to defecate, this is considered normal.

How will I know what caused this?

Sometimes, a cause becomes obvious (we find the evidence of a trash dive later, or you start to see worms or something else fun in the stool).  Other times, we never know and the pets get better with the supportive at home care outlined here.  For pets that do need to be seen in the clinic, sometimes we can run tests to identify a true cause, but other times it remains a mystery.  Most times, treating the signs we are seeing is the best medicine for these guys.

What about blood?

In humans, blood in the vomit or stool set off pretty big alarm bells.  In pets, while we don’t want to ignore these things, we also don’t get QUITE as worked up about it.  The cells that line the stomach and colon in our pets are just much more likely to bleed than in their human counterparts, so we see it even with simple GI upset.  That being said, most pets who are having bloody vomit or stool are affected enough that they should get checked out at AtlasVet or an ER.   If it is blood tinged and the pet is acting OK, you can schedule an appointment and start with the steps outlined above.  If you are seeing significant bright red bloody vomit, stool that looks like ‘raspberry jam’, coffee-grounds like vomit or dark, tarry appearing stool, or your pet has or might have ingested any toxins, those qualify as emergent and should be seen on an urgent care basis, again at AtlasVet or an ER.  

What about worms?

If you see live worms in your pet’s stool, please collect a sample and bring it in to us.  If your pet is also acting unwell, an appointment makes sense here.  Please see last months’ blog for more information on this topic.    

What is a bland food diet?

There are a lot of options.  Generally, the prescription bland food diets sold through veterinarians are the best option.  They tend to have the right balance of protein, fat, and fiber to help support healthy digestion.  Many of them have been shown to promote a quicker resolution of these issues in pets, so we like to use those when we can.  As an AtlasVet client with an active doctor-patient relationship (this means we have seen your pet for an exam in the last year), you can pick these up from us without an appointment or pre-existing prescription.   If you don’t want to use these or can’t for some reason, good examples of a bland food diet are:

–          Boiled boneless skinless white meat chicken + boiled plain white rice or boiled/steamed skinless sweet potato.  No salt or fat added.

–          Boiled hamburger (as lean as possible, boiled to remove fat then drained) + boiled plain white rice or boiled/steamed skinless sweet potato. No salt or fat added.

–          Low fat cottage cheese + boiled plain white rice or boiled/steamed skinless sweet potato. No salt or fat added.

–          Diets should be approximately 20% of the protein source and 80% of the rice/sweet potato

My pet seems really sick, and AtlasVet is closed, where should I go?

Trust your instincts.  If your pet seems really ill, please don’t wait until we are open to get our advice.  We are very lucky to have many excellent 24 hour tertiary care facilities in our area, all of which are listed on our website under “in case of emergency”.  We have complete faith in all those listed, so choose whichever works best for you.  You can call ahead, or just head in, just like a human ER/Urgent Care.