AnimalNEWS 101: What Number Two Can Tell You

June 17, 2020 — This is the first episode of Morris Animal Foundation's new AnimalNEWS 101 webinar series. Titled "What Number Two Can Tell You," the episode focuses on diarrhea - one of the most common medical problems reported by pet owners to their veterinarians. It can be both frustrating and frightening, not to mention messy. We discuss the causes of diarrhea, when you need to take your dog or cat to see a veterinarian, and what you can do at home to make them feel better.

0:00:05 Dr. Diehl: I'd like to welcome everyone to the very first webinar that we'll be giving in our series called Animal News 101. What number two can tell you. And our plan with this webinar series is to cover topics that are of interest to pet owners and just animal lovers in general. We get a lot of inquiries at Morris Animal Foundation. We hear you and we'd love to share some of our knowledge with you. I want to give a shout out right away to AnimalBiome, who is the part sponsor of this webinar. And I saw Dr. Holly Ganz is joining us, she's the CEO. And so, hey, Holly, great to have you come be here for our webinar. And I want to tell everyone to go take a look at them on the web. It's an interesting company. We'll talk more about it later.

0:00:57 Dr. Diehl: We are going to go ahead and start our first poll. And I am also going to give a shout out to Sean Anderson by who is my co-pilot today for this webinar. So thanks, Sean. So Sean's going to run our first poll, which has to do with, "Have you ever had a pet with diarrhea?" I think, I know the answer to this, but I'm anxious to see what you guys say. So go ahead. And oh, you guys are great. Everybody's logging in, answering the poll. We're getting a few more. Come on. We've got 17% of folks voting, 18, go ahead. Great job. And while you guys are voting, I want to talk about a little bit, we're going to talk about today's agenda shortly. But if you have any questions, we'll go over this in a minute. Go ahead and use the question button on your screen test question. So we've got 78%. We're almost there. Oh my gosh, but I know the answer to this. We're going to share this in a minute or two. But go ahead and keep voting. We'll keep the poll open for another few seconds so everybody has a chance to vote. And then, we'll share the results of this.

0:02:24 Dr. Diehl: We're almost there. We've got 89% of you guys. Hopefully, you can find the poll and answer it, it should be up on your screen. And Sean, why don't we go ahead and close the poll now, we've got a quorum. So here are the results. I knew. I knew this is a really common problem, right? That we have to deal with in our pets, and so 93% of you have had a pet that has had a bout of diarrhea. So moving on to today's agenda, thanks again, Sean, for running that first poll, is we're going to do a few little housekeeping things. I already mentioned, if you could use the question function rather than the chat function, if you want to ask a question. And there's a raised hand function, but I'm going to ask you guys not to use that. And also, to know that we're going to have a question and answer time at the end of today's webinar. So if you guys want to go ahead and wait till that point, that would be great.

0:03:27 Dr. Diehl: If it's something really pressing, of course, go ahead and ask away, and we'll see if we can deal with it. Also, if you're having technical problems, you can use the chat function or the question function. And I also want to let you guys know, we're going to do a survey that's going to go out at the end of the webinar. And if you could answer that, you'd really, really help us out in choosing topics for the future. Let us know what you liked or didn't like about the webinar, so we can really tailor these to your needs. We're going to talk very briefly in the beginning about Morris Animal Foundation, particularly if you're new to us then we'll hit our topic, "What number two can tell you." And then of course, the question and answer time I mentioned.

0:04:07 Dr. Diehl: So moving on. Morris Animal Foundation has been around a long time, 72 years in June. So we've been around for quite a while. We were started by Dr. Mark Morris, Sr. who is a veterinarian and really a pioneer in companion animal medicine. And he recognized that there was a need for research that helped animals and improved animal health. We started with dog and cat studies, but as this koala bear reminds me, we actually do wildlife, exotics, horses, llamas and alpacas, so we have a really big portfolio and grant several million dollars to researchers all over the world every year. So today's lecture outline. We're going to... We have to start with the basics and I know people are wanting to know more about the nitty gritty of diarrhea, but in order to do that, we have to start with the parts of the GI tract and what happens where. So what does what were? Then we'll talk really briefly about what's in poop in the first place. We'll have some fun polls about that. Then, of course, when things don't come out as expected, and what to doo doo, so sorry for that really terrible pun, but let's move on. So I have a list of the parts of the GI tract here. But we're going to talk a little bit more on the next slide about what happens where and go over these parts. I think we think of the GI tract as being like the stomach and intestines. Right?

0:05:37 Dr. Diehl: But there are actually lots of other areas and organs that are involved in digestion. Starting with the oral cavity and then working down, liver, gallbladder, pancreas, we'll touch on them really quickly. I think we forget that they're actually part of the GI tract. They do other things too, right? But again, they're actually part of our digestive tract. And what I'm going to talk about now goes for cats and dogs. This next diagram is, of course, of a dog. But same thing for cats. Pig's kind of similar, we're kind of similar. When we get to thing animals like horses and ruminants and livestock, of course, things are, their GI tracts are quite different and quite cool, birds, the same thing. But this will get us a long way into understanding mammals in general. And I want to talk about really, the beginning of the GI tract is the mouth. And of course, we know our teeth help digest and chew. We have salivary glands which actually moisten the food for us, and some digestion begins in the mouth; we'll talk more about that. The esophagus which transports food to the stomach, it's quite muscular. It's not a passive tube, the configuration as far as the muscle layers in dog and cat differ slightly.

0:06:52 Dr. Diehl: But again, basically it's a very, very powerful muscle that transports food obviously into the stomach. Then and I'm really glad to report that animals have... This is exactly what it looks like when you actually dissect. They happen to have Morris colors. And I'm joking about that. But once food gets into the stomach, we think of, again, the liver, the gallbladder, pancreas, as being part of the digestive process, and located kind of right up near the stomach. Then things get into the small intestine, which is really the business end of the GI tract. A lot, a lot of stuff goes on in the small intestine. And then things empty in the large intestine, which is also some active processes take place there. It's not just sort of a passive place where stool hangs out till it's ready to come out the other end.

0:07:46 Dr. Diehl: And I tried to think about how I would cone down everything that happens in the GI tract, and I came up with four basic functions. Which is propulsion, right? Stuff has to come in the front, go out the back. So there are some propulsion functions. There's chemical and mechanical digestion, and we'll talk more about that. But mechanical being not just your teeth chewing stuff. There's actually churning and other contractions in the GI tract that help actually break food up. Absorption, obviously of these digested nutrients. And storage and elimination as well. There are other functions. And I'm sure Holly, who's listening from AnimalBiome can say there's lots of other stuff the GI track does. It's a pretty cool place. It has probably a lot to do with our immune function and all other kinds of things. We know that the gut bugs that live in our GI tract influence a lot of different things. And we'll touch on that a little bit later.

0:08:52 Dr. Diehl: But moving on again, it's a picture of a dog. It would have been the same for cats. So when we think of propulsion, we again think of the forward movement of ingesta from the mouth, all the way out to the other end. And then we move into chemical and mechanical digestion. So mechanical digestion, as I mentioned, we think of the oral cavity and teeth kind of breaking food up. But the stomach turns and mixes food. And for any of us who've ever we felt that. Our stomach churning sometimes. The small intestine also has kind of... it contracts down. Remember it's a tube so it'll contract circularly. And then it moves food forward, and it contracts. It moves food forward, and that contraction that's more circular also helps to mix and digest. The idea that all the enzymes that are coming from the pancreas, for example, the liver, the bile that is made in the liver and then stored in the gallbladder. Those are all very important in the chemical digestion of food.

0:10:00 Dr. Diehl: So we'll talk a little bit more about that because that's really important. And chemical digestion actually starts in the oral cavity with the salivary glands, because carbohydrate digestion actually begins there. Then food, of course, moves down the esophagus. Which again, is muscular and pushing things down into the stomach, where I think all of us know that the pH of the stomach is quite acidic. And that acidity actually helps start protein digestion. So again, the stomach's contracting, moving, mixing things together, pH is lowered. Enzymes are in the stomach that help with protein digestion. And once that all happens, the stomach empties into the small intestine, which has three regions. The duodenum, or duodenum, depending on how you want to say it. That's the very first part of the small intestine. And that is where enzymes from the pancreas enter, as well as bile from the gallbladder. And we'll spend a moment with the pancreas because I think many of us think of the pancreas as a place where insulin is made. And that's absolutely right. The pancreas is a really cool organ because it actually has two independent functions. One is the production of hormones that regulate blood sugar. The other cool part of the pancreas is it's a site of where digestive enzymes are made.

0:11:22 Dr. Diehl: And again, the pancreas empties into the first part of the small intestine. Bile comes from the liver via the gallbladder. And those enzymes are important in fat, and more carbohydrate digestion, a little bit of protein. So again, the small intestine is digesting, digesting, digesting. And then as the ingested material starts moving down the small intestine, you start to have more absorption. Again, under some hormone regulation. Pretty detailed. You don't need to know that. But the important part is, again, as food and ingested material moves down the small intestine, it is then absorbed. Now we reach the large intestine. Which again, I think gets kind of a bum rap because we think about it as just being sort of the storage place for poop, and then it comes out. But the large intestine is actually very important because water is absorbed in the large intestine, and electrolytes. So it has a very important function beyond just storage, but of course, it does function as a place for storage and elimination. So again, we think of propulsion, things moving through the GI tract. Chemical and mechanical digestion. Again, the chemicals that move into the various portions that digest food, that physical contraction of the stomach and the small intestine that mixes things. Lots of absorption, and then storage and elimination. So what is poop basically? And this is the composition of the abnormal stool. Dog and cat probably, yes?

0:13:00 Dr. Diehl: A lot of different mammals, again not talking about reptiles or birds. And it's 75% water, even when it looks totally normal. So that it just shows you how much water is still part of, in normal stool. So you can imagine how much fluid comes out when stools really lose. And then 25% other stuff, for lack of a better term. That includes proteins, not all proteins are digested and some may come out the other end. Undigested fats occasionally will be in stool, and it's normal to have some. Polysaccharides, which are carbohydrates. Bacteria, so we talked about the bacteria in the gut, we know that it's not a sterile place. And we're learning that these bugs in our GI tract, and actually bugs that we share our environment with that we've actually evolved with, which includes our animals, these bacteria are not just freeloaders. They actually do some very important things to help us with, not only digestion, but also in our immune function and a whole bunch of things that we're learning about these gut bugs now. And so, they're very, very important, but they come out. We know that stool is not sterile, right? So these bugs that are living there, there's a lot of them. Some of them are going to come out every time you defecate.

0:14:14 Dr. Diehl: That's okay and that's perfectly normal. Ash is actually the mineral content of stool. So we do have things like phosphorus and calcium that come out in stool, and then undigested food. Something that not only can our body not digest, but the bacteria that are in our body, which help us to digest food, they can't digest as well. So let's talk about the reason you guys are here, which is when things don't come out as expected. And I've written some characteristics down on what, as a veterinarian, I would be interested in if you showed up in my clinic or you called me on the phone and you say, "I have a pet, dog or cat, with loose stool." And these are the questions that I'm going to ask you, we'll talk a little bit about consistency, color, frequency, duration, and strange stuff. And it's now time for our second poll. How many of you have ever found something really strange in a pet's stool? You don't have to share exactly what you found. I can share some stuff, but anyway, go ahead and vote on this, on if you've ever found something odd.

0:15:25 Dr. Diehl: Yesterday I had one of my teammates from the foundation in here and her dog has a predilection for socks. So we gave a shout out to Toby, shout out to Toby again today for being a champion sock eater. Thanks, you guys, we're zipping up here with people voting. Wow, I wasn't sure what I was going to expect with this result. So we'll see how it all falls out and just share it with you guys. I'm lucky because I get to watch it as it's in progress and harass you guys to go ahead and vote. We're almost there, almost everyone. Vote if you can, don't worry if you can't. A couple of stragglers. Okay, why don't we close the poll. This is a nice round number and share it with you guys. So 75% of you have found some strange stuff in your pet's stool. I can share a few from my days in clinic, diaper, one time, Great Dane, the entire diaper panel. That was ugly. Straw, strings in cats. Right? Stringy, strings seemed to be popular with them. That's the most odd thing I've ever found in my kitty-cat's stool and I won't even tell you what I found in my dog's, sometimes it's horrifying.

0:16:54 Dr. Diehl: So let's talk about stool consistency. And this is a little chart that I have that I like. So I will say that we know what I will consider normal I'm going to give a little leeway to. So we have constipation, dehydration, and actually dehydration is a cause of constipation, so I'm not always sure I love that term. And that is really hard and nobody should be really dry, hard, as far as our cats and dogs. They should definitely, small, pebble-like, hard stools is abnormal. Always I will give a little leeway. I think some of us who have cats, particularly if our cats get elderly and particularly if they have kidney disease, right? They're kind of running in a constant state of dehydration. They're trying all the time to get water, as much water as they can reabsorb it in the large intestine. So they can have pretty dry stools, it's something to keep an eye on, but that we definitely can see with them, but I don't know that I would consider it normal, but maybe normal for them. Ideal, firm, number two, hard, segmented, cat, tootsie rolls. Right? They kind of have that kind of stool. Sorry, that's a bad image, but it's really a good one.

0:18:11 Dr. Diehl: And for dogs, maybe a little bit moister on average in general, holds form when you pick it up. Though I would also say they call stage four as diarrhea where it's a little soggy, log shape, but leaves a residue... Like you can't scoop it all up. And I think you could, under certain circumstances, especially with certain diets, four is perfectly fine. I will share with you, my dog, has a four kind of all the time. She's on a high fiber diet because she is a Labrador, and we know that sometimes Labs have the tendency to get a little chubby, and so she often has this kind of stool, but it's perfectly normal. And again, I think sometimes we have to think about what's normal for our pet. However when we get into cow patty, little drops of whatever hosepipe. Right? Puddle of poo, number seven, those are not normal really under any circumstances. And a lot of cow patty stools are really not normal, and then everything in between then...

0:19:12 Dr. Diehl: So, again, pay attention to stool consistency. It's actually really important for your vet to know because we're going to talk about when we try to decide where is the problem arising, this is key for us to know, is this a large bowel or small bowel problem. We'll talk more about that. Stool color. And I want to thank our wonderful graphics arts team, Jazzy and Claire, for making this lovely color chart of stool colors. So, thanks guys. Chocolate brown, normal. Again, sorry, I mentioned chocolate, food, but brown is pretty normal for most animals. Orange or yellow, sometimes we'll see this with the liver or biliary problem but not too often. Sometimes I see orangey stools when we have dogs with exocrine pancreatic insufficiency. We'll talk a little bit more about that. That's when the pancreas doesn't produce enzymes to help digest food and you'll get these partially digested light-colored stools that come out.

0:20:10 Dr. Diehl: Red streaks in the stool, pretty common. Sometimes blood, fresh blood. Red streaks, it's gross to think about but it's a little important to know. Are the red streaks all the way through the stool? Are the red streaks on the top and very fresh looking? Fresh blood means large bowel is bleeding, and we'll talk more about that, but it's always abnormal. Sometimes it's more of an emergency than other times, but definitely notice that. Sometimes if you have a mass of... We don't see a lot of cancerous growths in the large intestine but we can have them. Sometimes anal gland problems, and you'll see a red streak right across the top because as the stool's coming out and brushes against either an infected anal gland or something with the anal gland, or a mass that you'll see a red streak on the top but not through it. Sometimes if there's more small bowel problems that are more diffused, you can see red throughout it.

0:21:06 Dr. Diehl: Green, usually grass. Dogs and cats, we see greenish. They can also be liver bile. White spots that look like rice grains, especially when they move, those are really gross, right? Those are tapeworms. And again, it has to be interpreted with caution because if the stool's been sitting for a while and flies can land on it, sometimes you'll get equally charming picture of maggots that can be on there. But again, white spots, rice grains, tapeworms, call your vet. Black and tarry is the one that we're probably most concerned about because that suggests bleeding in the upper GI tract, in the stomach and the small intestine. And when blood is digested, it becomes very dark and it'll come out as black and tarry. So that is truly an emergency and you need to talk to your vet about that.

0:22:01 Dr. Diehl: Now, there is one exception to this which is, if you have a dog or cat, more problematic with dogs, that have received activated charcoal because maybe they ate something that's toxic, trust me, you will have black and tarry stools when that stuff comes out the other end. So that is the one exception to this rule but obviously, you're going to know if they have ingested something like that. And typically, we have those patients in the hospital. Gray and greasy. Ugh, sounds horrible. Sometimes we'll see greasy-ish, grayish stools, and I have to say, orange and yellow that are greasy, and those are often undigested fats. And again, typically, pancreas or a biliary issue. And we'll skip through these last three pretty quickly.

0:22:48 Dr. Diehl: Frequency, duration, and strange stuff. We talked about strange stuff. Frequency. When we're talking about large or small bowel diarrhea, this is going to become really important. Frequency could be, "My dog is asking to go out every five minutes." "All I hear my cat do is scratch in the litter pan and they're constantly and they're hardly producing anything," versus "Well, my dog is acting to go out a couple of times," or, "I definitely see more... Hear my cat more in the litter pan," or... It's really helpful because you clean the litter pan, so you may see that there's increased frequency of stools but above normal but not constant. And so that frequency is really, really important for us to know. Duration. What I meant about duration is not how long it takes somebody to poop, but that might be important sometimes, but really how long has this been going on. Is this something that just started, or is this something where you're running into a chronic problem? And it doesn't mean that they have to have loose stools all the time, but are they a dog or a cat that, boy, they seem to go through these cycles of having loose stool? That's really important for us to know.

0:23:56 Dr. Diehl: Strange stuff. There are conditions where dogs and cats are sometimes compelled to eat odd things. I think we see it as a vice in general. My cats love hair bands and rubber bands so you have to be really careful. String in cats. And dogs, I don't know what the attraction for socks and stockings is with them, but they certainly seem to like to eat those, but other things as well. Sometimes strange things can be because they have an underlying problem and they are eating weird objects. So let's move on to large bowel and small bowel diarrhea, which is something that is really, really, really important for us to figure out because each place comes with its own list of differential diagnoses, and it's really important for us to determine. And we'll ask you a lot of questions about this and we're not being weird about stools. We really need to know where is the origin of this particular problem.

0:24:57 Dr. Diehl: So we talked about frequency. Large bowel, they're going all the time, cats and dogs. They are constantly going in and out outside, in the litter box, producing very small amounts. With small bowel, you'll see some increase in frequency but typically not very dramatic which we see with large bowel. Pain and straining to defecate tend to be associated with large bowel diarrhea. So something in the large bowel is causing the loose stool. It's not that small bowel diarrhea can't be troublesome and be uncomfortable, but it's a classic sign of large bowel. Consistency. Small bowel diarrhea tends to be more hose pipe, watery, large volumes. We're not talking blood here, we're just talking about the volume. It's very semi-formed. Again, they go outside and they have like a hose pipe. Large bowel tends to be the classic cow potty, formed inconsistency. So typically, not watery with a couple exceptions. But again, we can get it pretty far in looking at the consistency.

0:26:03 Dr. Diehl: Appearance and volume. Again, small bowel tends to be big volumes. Again, think of a hose pipe. Very, very large volumes, very watery. Large bowel tends to be small volumes, again. Sometimes people are like, "It's like a drop and, boy, they worked at it for three minutes to try to get out a drop." Also, the appearance of mucus. The large bowel makes mucus. It makes sense when you think about it because it's going to make mucus to help ease the passage of stool out. When the large bowel gets angry, it makes more mucus, so you can get stuff that looks like jelly, almost, in cases of large bowel irritation, and I've had people with both dogs and cats say, "It look like they passed some jelly." That's classic large bowel.

0:26:53 Dr. Diehl: Then we get into the problem on small bowel diarrhea and this makes sometimes the detective work a little harder for us as veterinarians. Typically, that happens when the small bowel... Something starts in the small bowel. A lot of is particularly things like undigested fats are really irritating to the large bowel. So all this undigested food, for whatever reason, is dumping from the small intestine into the large intestine. The large intestine gets angry, makes some mucus, maybe some blood, and you get stool that has characteristics of both small bowel and large bowel. Typically, large bowel problems don't retrograde and cause small bowel problems, but we do see small bowel problems cause large bowel problems. And again, that can make our job as veterinarians a little bit trickier to sort out.

0:27:44 Dr. Diehl: Let's move to causes of diarrhea in dogs, a lot of the reason you guys are here, and I try to order it a little bit based on my experience as both a general practitioner and an emergency practitioner, and as an internal medicine specialist. And parasites are probably way high on the list. Here in Colorado, we are super lucky. We don't see internal parasites as much of this problem. But I grew up in New Jersey, I practiced in New Jersey, in New York, and I went to vet school at University of Tennessee, and parasites are huge problem. You'd be crazy not to look at an animal and not think of parasites first, and they don't even have to be coming out in the stool. We need to be cognizant of them all the time, and there's a whole big crew of them. We think of roundworms, hookworms and whipworms as the big three. Tapeworms are up there as well but we also have parasites such as Giardia that can affect dogs and cats. So we have a bunch of them and it's really, really important for us to to make sure that that's not part of the problem.

0:28:52 Dr. Diehl: Dietary indiscretion, which is the politically correct term for garbage gut, and this is my dog's problem as a Labrador. She loves getting in our compost pit after stuff sits there for a day or so. Yummy. I am sure there are lots of folks who have dogs who just think the garbage is the most fun thing ever to get into or they get up on a counter, they pull something off a table, they decide... Dogs eat stuff I have no idea why. This, after all, would be attractive jewelry I've seen. The best was, if you guys know what a pagoda looks like, the Chinese building, a dog that ate a ceramic pagoda. Really, really interesting and one of the best X-rays I've ever seen in my life. So they eat all kinds of things. Shout out, again, to Toby from Morris Animal Foundation, the supreme sock and stocking eater. So that's a really common cause of diarrhea. Typically, very sudden onset. Sometimes it comes out the other end and you can find it.

0:29:58 Dr. Diehl: Diet-related changes, and that can be a whole bunch of stuff. But changing the diet... Sometimes in cats, it just doesn't agree with them, and it could be changing within from one brand to another, changing types of food within a brand. And I don't always have a good answer why certain brands work with some dogs and certain ones do not. Sometimes it's just a temporary situation as you're switching diets and rotating. We often talk about making that transition gradually, but that's another big cause. We'll talk a little bit more about food allergies and intolerances in a second.

0:30:36 Dr. Diehl: Stress? Though I think most of us all agree that dogs can have stress diarrhea. This is typically large bowel. I'm going to use an analogy that's not the most perfect, but I think a lot of people can relate to, irritable bowel syndrome. Not to be confused with inflammatory bowel disease but irritable bowel syndrome in people; gas, pain, distention, diarrhea, big problem, and it may be stress-related and maybe even microbiome-related. There you go, Holly, because we've talked about that. But stress diarrheas can happen in dogs. They pick up on our stress. They could be stressed, and I use that term loosely, because they just had a surgery for a cruciate ligament rupture. That's a stressful event. Another illness. They're on chemotherapy for cancer and they develop a stress diarrhea. So it's Fourth of July and the fireworks are gone off. So we know that this can happen to our dogs.

0:31:37 Dr. Diehl: Diseases of the GI tract. There's a huge list. I'm going to try to summarize them a bit. We have lots of viruses. And thinking of parvovirus, it's a classic viral cause of diarrhea. I'm almost loath to say coronaviruses but there are coronaviruses that affect the intestines of dogs and cause diarrhea. Distemper, it can cause GI signs. We don't see that as much anymore since more widespread vaccination. Some bacteria. They can get Salmonella, Campylobacter, there's a few of that... Even though we have guts full of bacteria, sometimes a bad guy can overgrow or we have what's called dysbiosis, which is a skewing of the bacteria in our gut from a more normal configuration to abnormal. Fungal infections, they're rare. Foreign bodies can sometimes cause diarrhea. We think of them plugging things up but sometimes stool can leak around a foreign body and that can be really confusing because it looks a little bit like diarrhea but typically, the volumes are low. So it can look like small intestine but the volume is low.

0:32:41 Dr. Diehl: I mentioned the inflammatory bowel disease/chronic enteropathies. We're thinking about changing the name, all of us GI people, just to keep you guys on your toes, but it's similar to Crohn's and ulcerative colitis on people. Cancer. We don't see a huge amount of primary gastrointestinal tumors, but they do happen in dogs and that can certainly be a cause of diarrhea. Intussusception, which is telescoping of the intestine, that can cause diarrhea in dogs. Again, kind of weird because you think it would be obstructing really when the intestine folds on itself but sometimes we'll see diarrhea. And the exocrine pancreatic insufficiency, I mentioned earlier, when the pancreas isn't working well and food isn't getting digested. Outside the GI tract diseases, I'm going to put toxins in here, are things that dogs eat. And we think of more toxics, things like chocolate, some medications and including chemotherapy can sometimes cause loose stools. Opioids can do both that we think of them being typically more of a problem with constipation.

0:33:46 Dr. Diehl: And then you can find dogs with kidney and liver disease, diabetes, that have diarrhea. The one disease I do want to mention that classically has gastrointestinal signs that's an important disease that arises outside the gastrointestinal tract is hypoadrenocorticism, low adrenal gland hormone output. And many of you may have heard the term Addison's disease, that often shows up with GI signs, and it's a very important disease. It can be fatal if not treated, but it's something that is really peculiar because the main signs are often from the GI tract.

0:34:30 Dr. Diehl: So causes of diarrhea in cats. They do sometimes eat naughty things. So I think not as many as dogs, but that's for sure, I think diet-related. They can have problems, again, same thing, switching diets. Be very sensitive to those. They can have food allergies and intolerances, which I realized I didn't mention with dogs, but that can be a primary GI problem. So we have food allergy and intolerance is... There are probably people out there. You can't... There are certain foods that don't agree with you and it's not because you have lactose intolerance, but that they just don't agree with you. Beans, corn, there's a bunch that people just... It's not a food allergy, you're not allergic to it, but you just don't tolerate it. And we see the same in dogs and cats, as well as true food allergies.

0:35:21 Dr. Diehl: Internal parasites in cats as well. So all of the guys that I mentioned before and they get their own special bug called Tritrichomonas foetus. It's a protozoa disease that causes, typically, large bowel diarrhea, and that's something we can see in cats. Stress, too. I think, we all know. I'm a cat person, as well as a dog person, but I grew up with lots of cats. And people think of them as being aloof but they're really very sensitive animals. So they can be stressed by different things. Illnesses, they can pick up on stress in the household, they can pick up on our stress in the same way that our dogs can. Diseases of the GI track pretty similar to dogs. I think I see more cancer, inflammatory bowel disease, chronic enteropathies in cats that may be a little skewing, but they do get more GI lymphoma, at least in my experience, than dogs do. They can get the same things, fungal infections, bacterial infections, and not as much as we think with dogs. Outside, they rarely eat toxic stuff but plants. Our cats often being inside, in particular, they can nibble on plants that are naughty, so sometimes they'll do that. They don't seem to be as big into eating medications as dogs are but certainly the toxin can do that.

0:36:45 Dr. Diehl: Medications, antibiotics, both species but I think, I've seen more diarrhea in cats on antibiotics. Kidney, liver, pancreas, same thing. Sometimes the diabetes. But the important disease outside the GI tract that I want to mention in cats is hyperthyroidism. We see way more hyperthyroidism in cats than dogs, it's fairly common, and one of its classic signs are actually GI signs. So we talked about Addison's disease in dogs but hyperthyroidism in cats. They'll often vomit and have loose stools, and that is not uncommon. So I know you guys really want to know the answer to this question because I get this all the time, I used to ask myself this question sometimes, which is, when you can wait when you have a pet with loose stools and when you can't. And guidelines could be, are the attitude and activity normal or not? And sometimes this is not just the decision whether to go into a vet or not but really, is this an emergency or not? Do I need to pay an extra emergency fee in going at night and on a weekend, and when can I wait? And attitude and activity are important. This is what I used to call the happy squirts. Sorry, they're kind of bad image.

0:38:03 Dr. Diehl: But are they, cats and dogs, doing fine? Or are they feeling poorly? Are they eating and drinking normally? And that's very, very important. Particularly, as we mentioned, when you think of the fluid that comes out, especially, with the small bowel diarrhea, these guys can dehydrate really, really fast. So are they eating and drinking, or are they not? Because that might, if it's a very loose stool, small bowel, and they're not eating or drinking, then that is kind of an emergency. Blood in the stool, as I mentioned before, that's always, at least, a phone call for sure, if not a visit to the vet. And tarry, absolutely, no question. You need to bring your pet in. Presence of other clinical signs, kind of a no-brainer, right? If they're sick, not eating, if they're vomiting a lot, if they seem to be in pain for some reason, those might be a reason to go and seek emergency care, or at least a phone call.

0:39:03 Dr. Diehl: And then duration, we talked about this. And actually I talked about this with one of my colleagues at Morris Animal Foundation, because we talked about the happy chronic diarrhea patient. When can we just chalk that up to maybe repeated episodes of a dietary indiscretion versus that chronic intermittent loose stool might be a sign that something else is going on. And so sometimes we have to think about that. If you have chronic intermittent loose stools that go on for more than a few weeks that might be at least a call to your vet if not a trip in to discuss that. And for some of us, we probably have animals that do develop intermittent chronic loose stools. We learn how to deal with that in conjunction with our vet. But it's something that I probably wouldn't just watch for months at a time. And it's now time for our next poll, which is, has anyone actually had to go in with a pet and seek veterinary care for diarrhea? I have an idea how this is going to be, but I'm curious to see what you guys, your experience is.

0:40:16 Dr. Diehl: Okay, we're going along here. Yeah, it's kind of falling out like I think, but we need some more of you guys. Oh, here they come, a bunch more votes coming in. Yeah, kind of like I expected. A few more folks... We'll give you a few more seconds to cast your vote here, and then we'll share it with everyone. Few more, like two more seconds. We have a couple of late voters sneaking in right now. Okay, why don't we go ahead and close the poll, Sean. And lots of you, right? Almost 80%, that's not a surprise. Diarrhea and GI problems are one of the most common reasons people seek veterinary care for a problem, right? Up there with kind of itchy skin. And so it's... That's... You guys are exactly what we've seen in lots of different surveys on this. And I can share with you, part of the reason we're doing our first webinar on diarrhea is it is one of the most common, if not the most common search terms, and how people find our website. So it's a big... It's a big problem, right? It's a big, big problem in our pets. Thanks, Sean.

0:41:51 Dr. Diehl: So diagnostics, what would we do? And I'm going to zip through these, because there's a whole bunch of different things we might do. We're going to start with the obvious, which is like, we're going to do a fecal exam on your pet, right? So you're going to... Maybe you're going to bring in a sample of stool to us. Maybe we'll just do a rectal exam, right? And see if we can collect a sample. And we're going to do a couple of things. We're going to look for the presence of internal parasites. We talked about some of the worms. Obviously, if there's tapeworms crawling around, that makes our job easier, at least looking for tapeworms. But when we are looking for worms, we're not actually looking for worms, we're looking for the eggs they produce, and that is your basic fecal exam. Some of us would do what's called a direct smear which is exactly like it sounds like. We're going to take a piece... A little bit of fresh stool, we're going to smear it on a slide, we're going to put some saline there, we're going to put a cover slip on it, and we're going to look under the microscope. And that is a way we would look for things such as Giardia and some of those protozoa parasites, but particularly Giardia.

0:43:00 Dr. Diehl: And some of us who are really into poop will also make a very thin smear and stain it, just like we would an aspirate from a mass, or using the same stain when we look at white blood cells and red blood cells under the microscope. And I would do that periodically to kind of look at the bacteria. Now, obviously, there's millions, trillions of bacteria in the GI tract, so I'm not going to be there looking, and counting, and seeing. But I am looking for some odd balls. And in particular, we look for Campylobacter sometimes, because they'll have kind of this “M” appearance in the stool, and we'll also look for clostridial spores. Clostridium are absolutely normal inhabitants of the GI tract. And there's some controversy about if they overgrow or not, but they're great toxin producers. For example it's... Botulism is caused by a member of the Clostridium family as is tetanus. And we see Clostridium... And again, there's different ones that are normal inhabitants of our GI tract, but we worry about them kind of overgrowing sometimes. I will give you a human example many of you have probably heard about, which is C. diff, it's Clostridium difficile.

0:44:19 Dr. Diehl: And we know that that can be a big problem, right? When you've had antibiotics, if you're critically ill. And again, they can, they're kind of opportunistic and they can overgrow. Sometimes we'll look at that as a marker of maybe other disease, or that something has come and passed, but it has caused again, a skewing of the bacteria called dysbiosis, and that's why we're seeing more Clostridium. So sometimes we'll do that. Blood work and urinalysis, why would we ever do that? Well, for sure, if we're looking for a disease outside the GI tract that might be very important for us to know. Blood work, parvovirus... We do see viral diseases in cats as well, feline panleukopenia, and parvovirus in dogs classically decrease the white blood cell count, interestingly Salmonella will do that as well. So low white blood cell count in a patient with diarrhea, might send us in a particular diagnostic direction. And we're also ruling out some of those other diseases, like hypoadrenocorticism, or hyperthyroidism in a cat. Sometimes we'll move on in serious cases, and typically these are more chronic cases to special diagnostics.

0:45:29 Dr. Diehl: Or if we think there's a foreign body obstruction, an intussusception, X-rays are okay, as far as diagnostics, the GI tract typically has gas in it, and that doesn't always image very well, but sometimes a simple X-ray can tell us a lot. When we found the pagoda, in the dog's stomach, it was perfect, it was, we could see it on the X-ray, it was astounding. So sometimes we'll do something simple like that and take a peek. Ultrasounds are great, I love doing ultrasound. It's a great way to interrogate the abdomen. It's non-invasive, you don't need sedation typically for it, you just shave the abdomen. It's also not bad for obstructions. It's great for anus inceptions, you can... They have a very typical sort of appearance. We will often do an endoscopy right? Foreign body, maybe we can retrieve it with the endoscope, but it's also a great way to obtain biopsies, and we can go both ends from the front, and from the back, and obtain lots of good information that way, particularly if we're worried about cancer, or again, the chronic enteropathies or involuntary bowel disease.

0:46:39 Dr. Diehl: Exploratory, typically not necessarily as a diagnostic, but sometimes we have to go to that length, and there are other tests we can do, tests for parvovirus. Right? Maybe some of you have experienced that as a little snap test, that your veterinarian can do in the office. Sometimes we'll look for things such as cobalamin and folate, you may have heard that before. We can see cobalamin deficiencies, and those are related to inflammatory bowel disease and maldigestion, and malabsorption syndromes. We don't run them all the time, but we might do that, especially in cases of chronic diarrhea. There're special tests we can run for exocrine pancreatic insufficiency, which is different than pancreatitis, which some of you guys may have experienced in dog or cat, but coming from the same organ, similar task but not exactly the same. And occasionally, we'll do stool culture and that's just kind of touching on most of these special diagnostics. People are now getting into the use of CT scans, in the use of diagnosing abdominal disorders, we're not quite where people are, where they do that more routinely, but it's something that might be coming down the road if costs decrease.

0:47:49 Dr. Diehl: Trial treatment, I actually wrote this up there. I sometimes do this for things like, if I have a happy dog or cat and I think it's a food problem, a dietary issue, I might... After I did at least a physical exam and a fecal exam, maybe blood work, I might try a trial treatment. We also know that, again, we're talking a lot about this bio sys and bacteria skewing in the intestine. I've done changes and occasionally we see what's called antibiotic responsive diarrhea; there's some controversy about that term, but we do know, and probably some of you have had, a dog or cat on metronidazole which is also known as Flagyl. Tylosin which is Tylan, that weird yellow powder that sometimes you load into capsules. And so sometimes we'll try those if we feel like we're dealing with something not really serious. Obviously, I'm not going to do that if I think there's a foreign body or something that's more of an emergency. But anyway, sometimes we'll trial treat as part of our diagnostic plan because it may help us on treatment, clearly diagnose and treat any underlying diseases. You'll get nowhere in treating diarrhea, if you do not do this.

0:49:01 Dr. Diehl: And I used to see a lot in my referral practice of patients referred for chronic Giardia for example, out here in Colorado, and you know what the problem is? Very, very rarely was it that they were getting Giardia, over and over again. It was because they had an underlying disease like inflammatory bowel disease, or food allergy, or food intolerance, or some other problem that was causing them to have what appeared to be diarrhea caused by Giardia. So again, you will never get anywhere and you'll spend a lot of money chasing certain problems if you don't look at what the underlying, for underlying diseases. Diet, boy, we use that a lot, don't we? We change to low-residue diets, or easily digestible diets, or we go for hypoallergenic diet, or we're putting fiber in our diets. One of my most favorite things in the world.

0:49:55 Dr. Diehl: And so we'll do a diet switch. Sometimes we go to medication, but we really want to do other things with one exception for medication, which is deworming. In certain areas of the country, even if you don't find anything in a stool sample, boy we did it all the time down South, we did all the time in the Northeast. As long as we didn't think something else was going on, that was the first question we would ask on referral, which is, "Has this patient been dewormed?" Again out in Colorado we don't do it very often, but it's sure important in other areas of the country. Sometimes we put for example with inflammatory bowel disease, we might put a steroid on board, there are other drugs we can use. We use a lot of acid blockade, we might use antinausea medications, we might use appetite stimulants, all kinds of things as far as medication, but it really depends on the underlying problem. So I'm going to actually pop a new... Another poll in here, which is, "Have you ever had to change your pet’s diet as part of a treatment plan for diarrhea?" And I think I know the answer to this question too, but I'm interested to find out if I am right on this. Oh, people are flying on this one, and answering this one.

0:51:21 Dr. Diehl: We're flying now. Yup. Kind of like I think, actually even more than I've thought before. Lots of folks weighing in on this one. We'll give... We have a couple of stragglers, and then we'll share the results with you guys, and I bet you're going to be able to guess this. So why don't we go ahead and close this poll, because I've got two to run right now. And so yes, 80% of you, not a surprise, right? It's one of the first things we do. And sometimes we do it at home, right? Under the guidance of our veterinarian. So the 20% that have never had to do this, you're lucky, it could be coming for you. So let's turn to our next poll, because these are kind of fun. Do you have a pet that has an underlying GI condition requiring ongoing therapy? We talked about medications and diet. because sometimes those are permanent changes, right? Or long-term changes. And I'm really curious if folks have done, had that.

0:52:23 Dr. Diehl: Great job, thanks for voting you guys, and weighing in on this. Huh, this is going to be a little different than I thought. That's okay. So excellent, we're getting more, we have a few people. We're up to about 60% of everyone and now we're zipping up again on this. So I'm kind of curious about it. A little bit more. A few stragglers, I'm about ready to close this one down as well. Alright, why don't we close this one down, Sean. So about almost 70% of you are no, but 30%... 31%, yeah. So I figured a lot of folks who are dealing with this right now are probably on the phone and on the webinar listening to this. Here's another question, thanks for running the poll, Sean. What can I do at home? I get this all the time. As the neighborhood veterinarian, I get this from folks, and I'm sure you've thought of this too. What can I do till I can get my pet to the veterinarian?

0:53:51 Dr. Diehl: And one is maintain fluid intake. Never, never, never, never, never, never withhold water, even if it looks like it's just going right through, you just can't. These guys can dehydrate really quickly. Don't give them electrolyte solution, like don't give them Gatorade, don't do that. Dogs get a little bit different when they have loose stools sometimes than people do. And I'm sure you've heard of these electrolyte solutions that they give kids, is particularly in Third World countries where they have a lot of problems with different organisms that can cause loose stools. And those have been life-saving, there's no question, but those are... Typically, that's a different kind of diarrhea and causes than what we see in animals. So don't do that. Remove any obvious causes, Toby, access to socks and stockings. Another shout-out for Toby.

0:54:44 Dr. Diehl: And you know I've got to be careful what we put in our compost heap because our dog really, really likes to dig stuff out of there. And you know rubber bands for my cats, they can find them anywhere. And my one cat carries them around like babies, and then tries to eat them. So again, getting... And I know it's a pain, especially, if they're getting in the garbage, but it's really, really important to watch that. Sometimes I'll tell people, if you have a dog or cat that seems to be absolutely doing fine, but they've had a loose stool. And maybe you kind of know the reason why, there's no... That you don't think it's a foreign body you can withhold food for one meal. And sometimes that'll slow things down and then you can gradually reintroduce food. Never of course give any medications unless instructed by a veterinarian unless for those of us who have dogs with chronic loose stools where we're working with our vet, right? Maybe we have Tylan sitting at home, and our vet goes, "Yeah, go ahead and start that if you see a loose stool." Particularly, those of us with animals that have an underlying chronic enteropathies or inflammatory bowel disease, that's not unusual.

0:55:52 Dr. Diehl: Sometimes we give medications, because our dogs, our cats, but particularly dogs get stress diarrhea, Fourth of July, right? We know, thunderstorms, there's something coming that's, we know is could be a problem. We might give some medication, we might change the diet and add fiber. I love fiber. Fiber is very good, fiber makes the bugs in your gut very very happy. Your colon loves fiber. And often when I have a patient that has large bowel diarrhea, stress diarrhea, right? They're probably not going to get very... They're not going to get dehydrated, typically they're not losing a lot of fluid, but we'll add fiber to the diet. And I have people who do it in advance of an anticipated stressful situation. Some people will do it all the time, right? And there are all different kinds of fiber supplements. Lots of... I've talked to lots of nutritionists, and people... This seems to be we all have our own sort of opinions on what the best fiber source is, bran, Metamucil, but not the orange flavored, or any of the flavored stuff.

0:56:52 Dr. Diehl: You can add psyllium, the... I personally like yams, sweet potatoes, pumpkin from a can, but not the pie filling. And even cats will eat some of that sometimes. They'll tolerate a little bit increased fiber in their diet. But we might add that especially in the case of a large bowel problem. And it's quite... In general, it's quite a safe thing to do. Now, if you have small bowel, or small bowel problem, or small bowel, probably digestion absorption, like inflammatory bowel disease, for example, that's not the best idea necessarily, is adding fiber. So again, large bowel diarrhea, those cow patty mucousy stools that you may see is stress-related, adding a little fiber is probably not a problem.

0:57:40 Dr. Diehl: Very, very briefly, I want to touch on the other end of the diarrhea spectrum, which is constipation. And we'll often hear... I'm going to do some terminology first, on what constipation is and isn't. This is really common. I would hear... Because we just talked about large bowel diarrhea, right? What do they do? They ask to go out a million times, they're hardly passing any stools and they're straining like crazy. So, a common, common, common phone call is, "My dog or cat is constipated," because they're not producing anything. And just to discuss the terms, constipation is actually difficulty passing stool, but you do get it out. So, you kind of got an idea of constipation. Sometimes we'll call an animal obstipated and that's really intractable constipation.

0:58:26 Dr. Diehl: And sometimes you'll hear the term megacolon used for cats, which is when there's a persistent dilation with decreased function. These cats cannot contract and pass stool. Sometimes we'll see a megacolon. It implies that there's an inherent dysfunction versus a dilated colon that can happen due to other causes. And in some cases those other causes can cause constipation, and constipation is typically reversible. The signs are, again, not lot like large bowel diarrhea, so it can be confusing and I get that. Cat’s in the litter pan all the time and they're not passing hardly anything or they're passing loose stool, or they're passing some mucus or just little bits of water, same thing for a dog. And the treatment sometimes depends on the underlying cause. Common, it's not... Constipation is not really a common problem in dogs, it can be in cats and we'll talk a little bit about that in a second.

0:59:30 Dr. Diehl: Things like dehydration can cause constipation, right, so if we can treat an underlying problem. I have seen some drugs, opioids classically can be constipating. And so, again, we can work with those particular causes. I have seen constipation in dogs and cats because they've had a pelvic fracture, and maybe the pelvic canal is narrowed and they can't pass a big stool. And so, again, there's ways we can treat that and address it long-term. Megacolon in the cat is a problem where they actually lose tone and function in the intestine and they can get very, very, very constipated. And in all cases, the way we deal with this is enemas to clean, clean out. Sometimes we actually have to manually deobstipate, particularly cats and that sounds exactly like what I just said. You are using manual forceps, your fingers to try to get the stool out. It is not a lot of fun. You can use laxatives in dogs and cats, but never give a laxative to a dog or a cat because they're straining, because the chances are pretty high, at least in dog, that they have large bowel diarrhea and a laxative is going to make things worse. Same thing with cats.

1:00:52 Dr. Diehl: Stools softeners often are very helpful, particularly in those cases where I mentioned you might have a patient that has, for some reason, a narrow pelvic canal and they may be on some kind of soft stool. Prokinetics, which are things that help the colon contract. They're not terribly effective but sometimes we use them. And then comes the diet, which can vary. Some animals do better with high-fiber diets and if you know in people, that's how we treat constipation, because the fiber helps draw fluid into the large bowel. That's fine and sometimes even in cats with megacolon that can work. But if you have a narrow pelvic canal, that's a terrible idea, right? That's... You don't want to add bulk to stool. And in those cases, we might use a low-residue diet. And sometimes in cats and dogs that have chronic problems, we will use an easily digestible diet, something that's going to pass more easily, even in our cats. We can do surgery in cats to remove the colon, part of it, the majority of it, it's called a subtotal colectomy.

1:01:56 Dr. Diehl: Surprisingly in cats, they do incredibly well with this surgery. They actually have a very good long-term prognosis. So for reasons which, don't ask me, cats do not need their colons, that does not hold for dogs, they need their colons. It's a disaster if they have big colon problems, because that is not an option for us. Anyway, I see that we are coming up on our hour and I'm happy to take any questions. I'm going to look into the question window right now. Sorry that I'm looking away from you guys, but I'm probably going to pull it over and look, so if you guys have questions, let me see if I can answer some of them. I'm actually getting in here right now. So, I'm looking at what you guys have seen. Oh, best way to make a diet change. Thank you. Yes, how do we do that?

1:02:53 Dr. Diehl: And I will say, this is going to come down to the "Do as I say, not as I do." And we talk about gradually changing their diets. I am awful at that. I will often change my dog's food or cat's food to a different flavor without gradually doing it and I've been lucky, knock on wood, that that has not been a big problem. But for... Typically, what I would tell people is kind of do the 25%, 25%, like 25% new, 75% old for a couple of days, then 50-50, then 75% new, 25% old for a few days and then moved to 100%. So again, that's typically how I would do a diet change in either a dog or a cat. If they get loose stool, you got to back down, right? So you go back to the level where they were having these... So let's say, they do okay with 25% new diet, but then you get to 50% after a few days and that causes them to have loose stool, they don't like it, then you can move back and you stay at 25% longer. So, it's an art more than, I think, a science, and I'm terrible. I'm absolutely terrible. My dog, you could feed her just about anything and she does fine, but that doesn't hold for everybody, I know that. So, somebody who had a pancreatectomy.

1:04:10 Dr. Diehl: Oh, is it related to an insulin-secreted tumor? That is a pretty complicated question. Let's see, what that... I'm trying to get that a little bit. I can't get the whole question, unfortunately. Insulinoma. Removed gallbladder, does this affect all this? Great. Gallbladders in dogs, kind of like gallbladders in people, don't really need it. It's a storage place and we don't do as many gallbladder removals in dogs and cats as they do in people. They get different diseases and they don't get stones, very frequently at all. But the loss of the gallbladder is probably not a big problem. The pancreas has a pretty giant reserve for making pancreatic enzymes. So, you should be okay with the pancreatectomy. Now if they took a lot of the pancreas out, then your dog becomes like an exocrine pancreatic-insufficient dog. And I didn't mention that, but one way that we treat that particular disease is we predigest food with pancreatic enzymes. And so, that is one way. So we're helping them replace the digestive function that they're lacking because of the pancreas.

1:05:25 Dr. Diehl: So, let's see. Can black and tarry mean Kaopectate? Oh, that's good question. Yeah, sometimes. Anything with bismuth in it, so Pepto-Bismol can actually make stools a little gray. We used to use that stuff a lot more. We used to have a jug in it, which I'm going to date myself how old I am, when I first started in practice. And we would pour it out into a bottle and give it to people and say, "Use this." With the advent of a lot of H2 blockers, acid blockers, the more advanced, the proton pump inhibitors, like omeprazole, Prilosec, we don't use that stuff but that can turn the stools a different color. Thank you for asking that and reminding me. Can I put up the chart again? Oh, I see, Sean asked that. And we will have a link to this, we are recording it, that you guys can also refer back to. And that was some of the questions about that, so thank you.

1:06:28 Dr. Diehl: Somebody got it. Is rice good to harden the stool? We do that all the time. Rice is not my favorite for hardening stool. I prefer, if you want to firm up the stool, fiber. Sometimes rice can give dogs diarrhea. My dog does terrible with rice. My dog that I have right now. My old dog was fine, but sometimes it can actually loosen the tool. However, we often use rice as a nice carb source if we have a dog with a sensitive stomach or small bowel diarrhea. It's in a component of a lot of small intestine prescription diets that we do. Somebody asked about restricting water for their dogs with mild GI issues and that, we talked about that. You know, now, mild. It depends and I guess the question is, if they restrict water and it works, why is that happening? But in general, I get really, really, really worried about ever restricting water for dogs. Is there a role for probiotics? Thank you so much. Shout out to Holly again, and AnimalBiome about this. Good question. We're trying to figure that out. I think that there may be a role for probiotics particularly... And I could do a whole lecture on the gut microbiome and how we're learning to... What we're learning about it, and if we can tweak it, right? That's the main ideas.

1:08:00 Dr. Diehl: Can we eat things like probiotics or ingest things that would actually help skew our bacteria in our gut to maybe something that's more beneficial? There's also something called fecal transplants, and that's exactly like it sounds, where you take feces from a healthy animal and put it into an unhealthy animal. It is the treatment of choice for recurrent Clostridium difficile infections in people and I know that's a gross idea. But it works very, very well. And again, I'll steer you to find AnimalBiome to look at what they're doing with that and trying to tweak the microbiome. We're learning just tons and tons about what our gut bugs do for us. So, I have used probiotics before. I have found them to not hurt, but sometimes I wonder if they're helping or not. But we're getting better with that. We're going to have... That's going to be a really big area. So thank you, thank you so much. A couple of more, rice or pumpkin? I just... I think I answered that.

1:09:05 Dr. Diehl: Sometimes white rice is not my favorite for firming up stools, but I do love pumpkin. So, let's see, have you ever seen a spongy stool? Heck, no. I don't even know what that would be. That's kind of an interesting question. I'm going to take a few more and then I will try to get answers to everybody's questions. Eating grass, signs of an issue? And sometimes, we think of grass as being something that dogs may do to soothe their stomach. Cats, too. Sometimes it causes vomiting, which they want to do, particularly if they have an upset stomach. So, if I see a lot of grass eating, it definitely could be a sign of an issue. For others, it doesn't. Here's a really interesting one. What is a hydrolyzed protein diet prescribed for? And for those of you who are listening, when we have protein in the diet, it can often be a cause for food allergies. People can react to things that are not proteins, but proteins seem to be one of the major culprits that you can develop an allergy to, a variety of different protein sources.

1:10:17 Dr. Diehl: What's really interesting about proteins is, sometimes our body reacts to the protein in its folded configuration. These are pretty big molecules and they fold up, and our body recognizes the fold. However, you can break that protein up into smaller bits, that's called hydrolyzing it. So you have a protein in the diet that's broken up into bits, so it's almost like partially digested and for some reason, that makes it invisible to the immune system. And so, hydrolyzed protein diets were my very, very, very favorite for food allergies and intolerances versus switching proteins, right? So many of you may have a pet that has a food allergy or intolerance, and they go, "Okay, well, they're allergic to... " Like, chicken and beef are really common, because they're the most common proteins we find in diets and so therefore, we want you to eat lamb, fish, kangaroo used to be out there. I mean, there's a whole bunch, right? You guys have probably seen them.

1:11:23 Dr. Diehl: And that works okay too, but what I found is some animals don't like the flavor of some of those exotic protein sources, but a hydrolyzed protein, you can actually use chicken. The most common protein that animals are allergic to and if you chop it up, their immune system can't see it. So, I really like hydrolyzed protein diets, not just for food allergies, but actually inflammatory bowel disease. And I'm sorry to wax poetic on hydrolyzed protein diets, but I really, really do, do love them. I have a couple of questions, let's see if we can get one more. And I'm trying to see which guys are asking me that... About that. I'm trying to see what you guys have... Like, what people... Oh, somebody asked about Coccidia and I didn't mention it specifically. That is a parasite that we can sometimes see and it can be a problem in younger animals. And sometimes, again, I've had animals referred for chronic problems with Coccidia, but it was actually because they had another problem, like a food allergy or intolerance, which sometimes can happen in young animals. They can grow out of their allergies. I've had two dogs now that have grown out of their food allergies. They can sometimes grow into them and get worse over time. But thank you for reminding me about Coccidia.

1:12:52 Dr. Diehl: Oh, somebody said, "We would love to hear a lecture... Webinar about the microbiome." I'd be happy to do that. I love the microbiome. As a gastroenterologist, it fascinates me. So, I think that is about it. I will get to these other questions, but I know that we're kind of running long here and I really, really appreciate everybody tuning in. Come visit us at You can see all kinds of stuff. We have other videos. We have a blog. We have descriptions of all the studies we funded and you can see the what we do. And I really encourage you to come visit us. We would love to have you take a peek at what we're doing right now and what we've done in the past.

1:13:45 Dr. Diehl: And again, another big thanks to AnimalBiome and shout-out to Holly and her folks. And a big thank you to everyone for joining us for our very first quarantine in my office at home, with a beautiful setup that my husband helped, so I'm going to thank my husband, my roadie. And a big thanks to Sean, who's been helping me with all the technical stuff. And a big shout-out to my wonderful marketing team that helped me with the beautiful slides and were patient and sat in on all the rehearsals. So, thanks everyone for tuning in. Next month, we're actually going to talk about the Golden Retriever Lifetime Study, which is a one of a kind, huge study that we are managing and funding out of Morris Animal Foundation. We're following 3000 Golden Retrievers over their lifetime and I am looking forward to talking with you then. Again, thanks everyone for tuning in. I appreciate it.