004 Diarrhea: Large Bowel or Small Bowel? The Scoop on the #2

In this episode we discuss poop. Yup, you read that right! Come on, we talk about this almost daily anyway, so you knew WE would talk about it too!
This week we discuss small bowel vs large bowel diarrhea, and how to tell what you are dealing with.
​

Show Notes:

Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about:

• Large and small bowel diarrhea and understanding their causes
  
   Resources We Mentioned in the Show
• Texas A&M GI Lab: 
  • https://vetmed.tamu.edu/gilab/research/cobalamin-information/ 
• IMFPP Blog Posts:
  • https://www.internalmedicineforpetparents.com/ultrasound.html 
  • https://www.internalmedicineforpetparents.com/vitamin-b12-in-dogs-and-cats.html  
  • https://www.internalmedicineforpetparents.com/gi.html
  • https://www.internalmedicineforpetparents.com/blog/how-to-know-if-your-pets-poop-is-normal 
• Probiotics:
  • https://www.amazon.com/Proviable-DC-Cats-Dogs-Capsules/dp/B001O3UE9E/  
  • https://visbiomevet.com/ 
• MILA Product:
  • https://www.milainternational.com/index.php/products/fecal-management-system/fecal-management-system.html?___SID=U​

Thanks so much for tuning in. Join us again next week for another episode! 
 
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• Visit us and give us a ‘like’ on our Facebook page!
  • https://www.facebook.com/internalmedicineforvettechs
• Email us at podcast@internalmedicineforvettechs.com ​

– Yvonne and Jordan 
 

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004 Diarrhea: Large Bowel or Small Bowel? The Scoop On Understanding The #2 transcript powered by Sonix—the best audio to text transcription service

004 Diarrhea: Large Bowel or Small Bowel? The Scoop On Understanding The #2 was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Yvonne Brandenburg, RVT, VTS SAIM:
Welcome to the Internal Medicine Vet Techs Podcast. If you haven't joined us before, we're passionate about all things internal medicine and helping you become the best tech you can be. We'll be discussing interesting internal medicine diseases, how to work closely with pet parents, and how to become the go to tech in your practice. Now let's start the show.

Jordan Porter, RVT, LVT, VTS SAIM:
Welcome back. Thank you for listening to Internal Medicine for Vet Techs podcast. We hope you guys are doing well and we appreciate you guys joining us back again this week. I am joined by Yvonne.

Yvonne Brandenburg, RVT, VTS SAIM:
Hello!

Jordan Porter, RVT, LVT, VTS SAIM:
And I am Jordan, of course. And this week, we will be talking about diarrhea.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, yay.

Jordan Porter, RVT, LVT, VTS SAIM:
All the good stuff about diarrhea.

Yvonne Brandenburg, RVT, VTS SAIM:
I'm sure that's what everybody wanted to listen to. Right now, is talk about diarrhea or stool, but diarrhea.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, most mostly diarrhea. Last week we discussed vomiting and we had our question of the week so do please feel free to still go and comment on any previous questions of the week. We are happy to hear from you guys and we'll hopefully be shouting you out as we get more rolling in. And then, of course, answering any questions you guys might have.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. So last week was episode number three. So if you go to InternalMedicineForVetTechs.com/podcast, look for episode number three, we have the question there. Just like Jordan said, we will be going back to those because we are recording before we launch the podcast. So, we'll have some catching up to do and we'll do that pretty soon. So, definitely go check that out.

Jordan Porter, RVT, LVT, VTS SAIM:
Diving into diarrhea. Hopefully not.

Yvonne Brandenburg, RVT, VTS SAIM:
That sounds horrible.

Jordan Porter, RVT, LVT, VTS SAIM:
It sounds like OSHA would have a big problem with it.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
So, the definition of diarrhea is increase in stool weight, increase frequency, and increase water. What that means is not just soft stool, but you see an increase in the amount, the amount of liquid within it. And then the amount of frequency that the pet has to go out. But diarrhea is definitely one of the most common reasons clients bring their pets to the vet, general practice and specialty. Well, not all specialty, but internal medicine I definitely would have to agree with.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, I think gastrointestinal disease in general is probably the biggest thing that we see just consistently.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, definitely when discussing diarrhea. What we want to think about kind of when you see one of those patients on the schedule to come in for diarrhea, go back to your anatomy. So, we have the link on our Web page for InternalMedicineForPetParents.com. And you can go through kind of the anatomy of the GI tract. So, you definitely want to know which sections of the bowel you're discussing or you're seeing these symptoms coming from. When you have these clients come in and you want to try to determine the origin for which their pet is having diarrhea. So, where's the diarrhea coming from? Small bowel tends to be a larger volume increase frequency and watery soft stools or soft water stools. And then you see weight loss with small bowel diarrhea versus the large bowel diarrhea you tend to see a little bit more mucus. You can see blood and straining. And then melena can be tricky because it's not really blood in the stool. The breakdown of hemoglobin caused by the bacteria in the GI tract. So, it's old blood. It's blood that you're going to see in upper GI tract versus a lower GI tract.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And lower GI tract is going to be more frank blood. So, seeing that the red streaks in the blood versus melena or the black tarry stool. Right. That's kind of how we talk about it to clients.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah. So, I try to try to explain to clients like if you're seeing the black stool, then you're looking at a bleed in the stomach or the small bowel.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Versus if you're seeing the streaks of bright red blood and it does make a difference. I mean it makes a difference in what medications you use. So, I think it is a very important thing to write down on your history, on your intake forms and stuff.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And it's funny how many clients don't realize that they can actually see that. "Oh yeah, I've seen the black tar stool for a while" and you're like OK, well that could explain why your dog's anemic, you know. So, it's really important to make sure that you cover that.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes. I think trying to just get that thorough history can kind of help you put all the pieces together. So, I know we talked about history a lot in episode three. Trying to in these kind of go hand in hand, these two episodes, because you want to try to see if there's any known toxin exposure, any known trauma, any chronic issues. So, they do have chronic vomiting or chronic arthritis and they're chronically on NSAID's. And see if I can see a chronic one more time. But congenital issues that they may have previously had or previously diagnosed with. Like I said, long term medications and then parasite exposure and travel history. Travel history, I feel like is big, especially when we see them, I think in internal medicine, just because stress is pretty big when it comes to colitis.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, a factor. And the other thing, too, is, you know, I don't know if we talked about this in the last episode, but I'd like to ask my clients. You know, any changes in the household? Did they move, you know? Is there a new baby in the house? Is there a new pet in the house, you know? Do we? Did somebody move out? Like, is there a divorce? So, I know sometimes it's difficult for some clients to talk about, but it's good to remember to ask. I just feel like any changes in the household that could cause stress or, you know, changes in our pets, too.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And I think a big thing to remember, though, to at least I see this a lot where I'll go in and I'll ask all these questions. And the clients don't really give me a straight answer right away, but it gets them thinking about it. Actually, there was this change and then so they mentioned it to the doctor when they go in.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah, that's a great point. It primes the pump almost.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, exactly. Kind of going back when you're in that room with the client and trying to obtain that thorough history, you definitely want to just be sure if you can get the basics out when did the diarrhea start. How long's it been going on? Has this happened in the past and have meds helped it? And then, of course, eating something unusual. We get a lot of those pets who will eat things out in the yard preferably, wildlife things. And that makes a difference.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah. I was gonna say we ask about raccoon, possum, and even just like large animals. So, horses and cows.

Jordan Porter, RVT, LVT, VTS SAIM:
So yeah, we frequently have those clients that're like, "Yeah. My dog eats deer poop all the time. It's totally normal." And then swimming too, I think. I know around here we have a lot of that algae issue right now with the blue algae. The green algae. Well and we have you have salt water, too. We have salt water. But so, it's a lot of that like saltwater ingestion will definitely make a difference in their GI system and other complications that we'll get to, I'm sure, at a later date.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And the opposite of that is standing water. So, the blue, green, blue green algae you definitely talked about. But also, there's just all sorts of parasites like Giardia, all that stuff that can be in standing water. And I think people forget about that. But they let their dogs swim in it. It was like, yes. GROSS. So. Yeah, yeah. Asking about that is big too.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Because I don't think people realize that like even something just a swimming is like a little pond or drinking from a little puddle on a walk is like got to be a game changer and it could be.

Yvonne Brandenburg, RVT, VTS SAIM:
It could be. Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
And then diet change. Oh, I have a lot of those clients who are like my dog gets bored on this food and just switches it up every now and then. But that can be an indication that either they have food version or something else is underlying. There could be intestinal inflammation which we'll kind of get into it, but can cause them to not want to eat. And just discussed it in episode three as well with the vomiting where if a cat is vomiting or they get sick while they're eating a different diet, that gives them food aversion so they want to switch. But switching diets too often can definitely be detrimental.

Yvonne Brandenburg, RVT, VTS SAIM:
And I don't know about you, but I have those clients that are like, oh, they get bored with it. And it's like, does the dog get bored with it or do you equate food to love? And,

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
You don't want them to eat the same food for their entire life because you would be bored with it.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
I think there is a lot of that too.

Jordan Porter, RVT, LVT, VTS SAIM:
My parents my own parents are like notorious for the I got what was on sale.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, oh my God. So, no gradual transition, just a straight switch over. That's awesome.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, we try not to discuss it anymore because it's just like in one ear and out the other. Maybe they'll listen and they'll be like, oh!

Yvonne Brandenburg, RVT, VTS SAIM:
They're not going to listen to this podcast. Don't worry, it's fine.

Jordan Porter, RVT, LVT, VTS SAIM:
We'll see.

Yvonne Brandenburg, RVT, VTS SAIM:
My parents aren't gonna listen to me either. So.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, right. I think the one thing I get a lot or I try to get a lot when I'm getting a thorough history is the color of the stool. Orange, green, brown, black. Those are kind of the main color changes there. And then consistency. A lot of people, I don't need to know, specific odor. It just is helpful if the odor is changed. At one point it wasn't noticeable. And now it's like,

Yvonne Brandenburg, RVT, VTS SAIM:
Clearing the room.

Jordan Porter, RVT, LVT, VTS SAIM:
extremely, yeah. It's extremely noticeable. But pictures help. I'm not opposed to looking at poop pictures. Yeah, it does get a little excessive when they get emailed to me frequently though. Where like when they're normal and I'm still getting poop pictures and I'm like, OK, great.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. It's funny. I don't know if you've ever had one of your own pets just have like a chronic GI thing. But you become very obsessed with it and you're like, oh my god today is a happy, normal poop. Yeah. So, yeah, I'm glad I don't have to deal with that much anymore. But at one point I did. And I definitely understand why clients are sending me happy poop pictures and I'm like, great, thanks.

Jordan Porter, RVT, LVT, VTS SAIM:
But I do think it makes a difference on the appointment though to if they come in and they're like, well, it's kind of like this weird coppery color and they're like, well, is there blood in it? And they're like, "I don't know. Like, I don't know. There could be streaks of blood in it or it could just be orange." So, pictures do help.

Yvonne Brandenburg, RVT, VTS SAIM:
We have on our website, the InternalMedicineForPetParents.com, there is a page that is how to know if your pet's poop is normal. And it talks about the different colors and the consistency. I don't know if you guys use the fecal charts?

Jordan Porter, RVT, LVT, VTS SAIM:
No, not really.

Yvonne Brandenburg, RVT, VTS SAIM:
I only use it for certain clients. I don't use them for all. But sometimes if they're having a really hard time describing it, I'll grab that because we have it in the drawer in the room. I'll be like, what is it on this? And they go, oh, sometimes it's between this one and that one. So, it is a good tool to use. I think we probably could use it more often, but yeah. Yeah, it's a total arsenal.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And we can definitely direct the clients to the how to know from a pet's poop is normal page. So can our wonderful general practice friends who are listening hopefully.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
And then of course any other symptoms, the general symptoms that kind of go along with G.I. distress like decreased appetite, anorexia, vomiting, regurg.

Yvonne Brandenburg, RVT, VTS SAIM:
Straining.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, straining. Straining, straining. Nothing's coming out. That's always fun.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. We had a dog that came to see us because every time it pooped, it would just start screaming and we went and we found a stricture. So, I mean, obviously, yeah, that's something that needed to be fixed because the poor thing and like every time it tried to poop, it was just really painful. And then there'd be blood afterwards and we're like, "OK, something's not right here.".

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, pain is not a good symptom to have.

Yvonne Brandenburg, RVT, VTS SAIM:
And dogs will kind of be weird about the pain, right. So sometimes they'll do the scooting thing. Sometimes they'll do the licking thing or they'll just like look at it really quick and be like, "what's going on back there?" So.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, I love that. That usually means that my dogs have something sticking out of their butt and they're like freaked out by it.

Yvonne Brandenburg, RVT, VTS SAIM:
They just farted and they're like, "oh, my God, where'd that come from?" You're like, "that was your butt.".

Jordan Porter, RVT, LVT, VTS SAIM:
Farting is a symptom, too.

Yvonne Brandenburg, RVT, VTS SAIM:
I was gonna say, the farting, the excessive borborygmus. We had a dog with really bad EPI, we can talk about that in a minute, but it just was not digesting properly and it just was burping. And the burps would be really foul smelling and farting and just gurgly, gurgly guts. So that's something, too, that you can ask the owners, you know, do they burp a lot? Do they fart a lot?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Well, take your stethoscope and listen. You know, I think that's huge, too, because like there's some patients at least that come in through us in the ICU who just have severe like gastric distention. And those dogs need an NG tube and suction. And like it's all it's all actually a lot of technical fun. I enjoy those patients.

Yvonne Brandenburg, RVT, VTS SAIM:
Right?

Jordan Porter, RVT, LVT, VTS SAIM:
Just because I get to use my skills. But those poor dogs are so uncomfortable.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
So kind of going into the differentials you mentioned EPI, which is exocrine pancreatic insufficiency.

Yvonne Brandenburg, RVT, VTS SAIM:
Yep.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes. Exocrine versus endocrine we'll have to get into that next one. But I like, we'll get into the diagnostics of that too. But TAMU has a good panel for that. IBD of course, which is inflammatory bowel disease, we see a lot of that internal medicine. Then you have the allergies. There's a lot of food allergies out there. Not necessarily the grain free gluten free diets. A lot of it's a protein allergy and parasites like we talked about infectious diseases. One thing I did learn recently was vegetarian diets and vegan diets don't actually have supplemented cobalamin mean in there. So, when you're testing for low B12 and you suspect that they're having chronic GI issues, but they've been on a long-term vegan diet, they're cobalamin could be low.

Yvonne Brandenburg, RVT, VTS SAIM:
Interesting.

Jordan Porter, RVT, LVT, VTS SAIM:
So if they are at a vegan or vegetarian diet, they should be supplementing with B12.

Yvonne Brandenburg, RVT, VTS SAIM:
It's interesting because we're talking about inflammatory bowel disease, I think the newest consensus statement, I'd have to double check it. Well, I'll try to find it and we can put a link to it in the notes. It talks about the first thing you want to do is de-worm patients because just because we have a fecal float with no ova or parasites seen at the time. Right? Because you never want to say it's negative because there could be worms up there that aren't shedding at the time that we do our fecal float. So, you want to do that. But we de-worm because we don't see all the eggs necessarily. So de-worming is big. The diet trial making: sure, that we try the diet trial and see how they respond to that. And it's a strict diet trial. We can definitely have an episode just on diet trial and how to do it appropriately. We talked about that.

Jordan Porter, RVT, LVT, VTS SAIM:
That's a big one that needs to be communicated with the clients like no treats.

Yvonne Brandenburg, RVT, VTS SAIM:
It's hard because again, people say food is love with their animals.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, exactly.

Yvonne Brandenburg, RVT, VTS SAIM:
You know, cutting out everything except for the food for some people is just really difficult. Or, you know, I always feel super bad for people that have little kids at home. Kids are just like, "I'm going to throw this goldfish at Fluffy because it makes me laugh." Right?

Jordan Porter, RVT, LVT, VTS SAIM:
I couldn't imagine trying to do a full trial in my house like it would be impossible. So, I mean, I definitely feel for me. We're on vacation and like we didn't have the dogs with us and the kids were dropping food left and right. And I was like, "what is this mess that I have to clean up?"

Yvonne Brandenburg, RVT, VTS SAIM:
And you're like wait, the dogs normally clean this up!

Jordan Porter, RVT, LVT, VTS SAIM:
Why am I stepping on a poptart? Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So you get the food and then if de-worming and the food trial isn't working, then doing endoscopy to get biopsies, which we can talk about in a few episodes. But we want to de-worm and try the food first because if that's there you're going to have the inflammation in the guts. So, you want to rule out those things before, you know, getting more in-depth.

Jordan Porter, RVT, LVT, VTS SAIM:
And I want to say I saw the consensus study and it said that the majority of inflammatory bowel disease can be treated with just diet change. So that is definitely nice. But I mean, I think going back to do your basic fecal float, do your basic work, rule out Addison's disease, renal failure, liver toxins, liver disease, other issues that could be causing diarrhea. I don't think a lot of people put diarrhea with Addison's and stuff.

Yvonne Brandenburg, RVT, VTS SAIM:
But no, it's just funny because G.I. signs are like one of the biggest parts of Addison's.

Jordan Porter, RVT, LVT, VTS SAIM:
I know. I think every time we have any sort of G.I. case, one of the first things we run is a cortisol. We'll get into that as well.

Yvonne Brandenburg, RVT, VTS SAIM:
And we talked about it last episode, too. But just as a reminder that heart disease, so heart disease can also cause diarrhea and gastric upset.

Jordan Porter, RVT, LVT, VTS SAIM:
So we talked about kind of like the baseline lab work fecal, including the fecal exam, assessing hydration status. So that's where doctors will do it too. But technicians, it's like those are your skills, do it. Lift the gums and do that crit time and do the skin turgor test. And, you know, check to see if you feel like they are visibly dehydrated because a lot of these dogs too, especially if it's been going on for a while. You have that Friday evening appointment of my dogs been having watery bloody diarrhea since Sunday afternoon and now it's Friday evening. We have to get it taken care of.

Yvonne Brandenburg, RVT, VTS SAIM:
Right?!

Jordan Porter, RVT, LVT, VTS SAIM:
Especially if they're not eating. So, we run we talked about this again already before. But I want to touch on it because I do love the test is the G.I. panel at Texas A&M. And that kind of goes in, so it's TLI, PLI, Cobalamin, and Folate testing. The cobalamin was the vitamin B12. So that like I said, that can be low in certain diets. And then obviously if they have excessive losses going out, excessive fluid losses, that's water-soluble vitamin, it's kind of gone. And then you throw in not eating well on top of it, they lose that B12 and if it becomes severe enough, they actually won't get better until you start supplementing the B12. So, you can be throwing all the metronidazole or Proviable at them you want, but all they need is just a little bit of B12 to get that back to normal.

Yvonne Brandenburg, RVT, VTS SAIM:
And the other thing to remember, too, is if you've got severe inflammation, that the body can't absorb the B12. And so, you know, it may be, and that's why we do vitamin B12 injections, because we bypass the guts and get that in there. And then, you know, some pets can transition to oral B12 supplementation, but some may not be able to just because they have such severe gut disease that we just have to supplement it with the injection. And we'll put a link to you on the recommendations from the GI lab. But typically, it's: you start with a once a week injection for six weeks and then go to once a month. And then usually what my doctors will do is: do that for a few months. And if people really find it, you know, they don't like doing the injections. What we do is right before the next one month injection, like the day before/the day of, we draw blood and check their quality and level again and see, you know, do we really need to keep supplementing or can they stop or it's totally fine to keep supplementing because it is a water soluble, so the body will just urinate it out if it doesn't need it. But if it needs it, it needs it. And you'll.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And it's cheap.

Yvonne Brandenburg, RVT, VTS SAIM:
It's really cheap. It's a once a month hopefully injection. We've actually, I don't know about you but a lot of our clients say that they can tell when they do get it because all of a sudden there are animals energy level and their appetite just tanks.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah, I do. I feel like the B12 is like such a simple fix, but it can tell you so much, because if that test comes back low, like, you know, B-12 is absorbed in the ilium, which again, go back and review the anatomy. But if that's low, you either have inflammation there, which could be, how I see a lot of lymphoma cases that are strictly small bowel and just their B12 is low, but everything else is normal. So obviously just B12 won't fix that. But whatever.

Yvonne Brandenburg, RVT, VTS SAIM:
But it does make them feel better. Right? So, you get the chemotherapy on board and you get the B12 on board and they feel immensely better, which is great.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, we supplement folate here in there. That's probably about half of like when we have normally low B12 we supplement fully occasionally and that's from the proximal intestine. So yeah, I like that G.I. panel.

Yvonne Brandenburg, RVT, VTS SAIM:
I don't see folate nearly as much as the others, but it definitely is there sometimes.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I don't think it's. Yeah. It's definitely not as much. It's just I do like that test because I can tell you so many different parts of the bowel that are diseased.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Because low TLI, is that trypsinlysed ammuno, what is that?

Yvonne Brandenburg, RVT, VTS SAIM:
Trypsin-like immunoreactivity.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
TLI, it's long.

Jordan Porter, RVT, LVT, VTS SAIM:
And that's the test that can indicate for EPI. So, if that's low,

Yvonne Brandenburg, RVT, VTS SAIM:
EPI again is exocrine pancreatic insufficiency. Yeah. We could talk about EPI in an episode too, but basically what it is the body is no longer creating enzymes to break down the food. So, you get the low TLI because the body's not producing it. And so easy fix is supplementing for that. But it is a big deal because they're not digesting properly.

Jordan Porter, RVT, LVT, VTS SAIM:
So which I'm sure once we get to that episode to the powder is better than the tablets to supplement that. But we'll get there. But then it kind of leads into so say all of your lab work comes back normal. You want to do contrast studies. You're still going to be looking for possible foreign bodies that have just kind of migrated, but not far enough or, we've done this before in general practice, there is like a suspected foreign body: do a rectal if there's diarrhea. Just do rectal first before you do anything else, because this dog ends up going to surgery and having a sock in the colon. And we just end up pulling it out, via finger versus surgery. Things can get overlooked. So even if you're with the tech just holding, just be like, "hey, doc, you want to do a rectal real quick? just to check for anything?"

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And it's interesting because, I'd have to double check this, but I think there's the paradoxical diarrhea. Yeah. Where it's kind of that idea where there's something in the way, like it could be like really hard stool. It could be a foreign body, but the body's able to get diarrhea, so soft stool around it. Yeah. And it's a problem. So again, rectal or an X-ray or something like that to see if there's anything in the way that's causing the diarrhea to go around, but there's actually something obstructing it.

Jordan Porter, RVT, LVT, VTS SAIM:
The body's wonderful way of being like, hey, you still need a poop?

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
There's a mass there. We've got to we've got to get this taken care of.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
I personally like ultrasounds again because you it's so cool to just see like the wall layering and like the thickness and you're like, that's super abnormal. That's super thick. So, ultrasound is definitely a huge tool when it comes to like, yeah, GI disease in general, especially if you're like worried about lymphoma.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. The other thing, so you're looking at that the structure of the gastro-, or not the gastric, but of the intestinal walls like the different layers. But you're also seeing like the movement of the intestines. And so, you know, we do a lot of ultrasounds for our emergency department. And it's like, is it a foreign body or is it just gastroenteritis? So, with gastroenteritis you're just seeing it's swooshing back and forth and there's so many peristaltic waves pushing things and we always joke, we're like, "oh, God, stay away from the back end." You know, you'll push too hard because sometimes you push and things come out. Versus if it's a foreign body, we'll see the dilation right behind whatever the object is, and we're like: "there it is." So, ultrasound, it really can tell you a ton of information.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, well, it looks for, you can look for ileus, so if you do need that nasogastric tube and stuff like that, I just, I do love ultrasound cause you can see masses if there's just like one specific thing in there and you're like, we need to aspirate that. And it's great. I do love it. And then endoscopy. We always try things before trying endoscopy right off the bat. So that's something that we discuss with clients too, like let's try this first for a month. See how this goes. And then if it doesn't work, then we'll do endoscopy. Now before we kind of get too far in that once starting steroids endoscopic procedures and biopsies don't always come back as accurate once those have been started. So, we do try to inform clients that if you are still considering an endoscopic procedure, let's try to do that before we start steroids.

Yvonne Brandenburg, RVT, VTS SAIM:
And it's hard because sometimes we'll get a consult from the primary vet and they're like, "well, we started steroids last week." And you're like, "great, well, that makes things a little bit harder to diagnose." But, you know. OK. They're feeling better. OK. Is it inflammation or is it cancer? We don't know.

Jordan Porter, RVT, LVT, VTS SAIM:
Exactly. You're like, well, we could do a scope and we might get an answer, but it's a little bit less than our normal we might get an answer.

Yvonne Brandenburg, RVT, VTS SAIM:
So most general practices probably aren't going to have scope. But, you know, if you ever get a chance, if you do work in a general practice and you want to see it, you know, reach out to your local specialty practice and see if you can just hang out with them for a day. Because I find scope's super fun.

Jordan Porter, RVT, LVT, VTS SAIM:
I do love scopes.

Yvonne Brandenburg, RVT, VTS SAIM:
We always have the one person monitoring anesthesia and then the other person that's helping the doctor with the scope, because the scope really you can't do it by yourself very efficiently. So, the doctors usually, well, my doctor's kind of the driver.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
And then we do the biopsies. So, we're actually running the instrument through the scope and getting samples. So, it's a very tech intensive process. Which is also very definitely cool.

Jordan Porter, RVT, LVT, VTS SAIM:
Especially if you have like the two techs, you have the one helping obtain biopsies and then you have the one monitoring anesthesia. Like those are your skills. That's what you're there for.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
So it is super nice to be able to do those things. And then, of course, as a tech, I'm sure, especially in general practice, you can do contrast studies. We don't do them as often in internal medicine.

Yvonne Brandenburg, RVT, VTS SAIM:
I was going to say, we don't do them because barium will ruin a scope.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So we don't do barium in our department. I've seen a couple of cases in emergency where they'll do it because the owner, you know, doesn't want to do ultrasound for some reason or they came in from the primary vet with barium already in them.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I definitely used a lot more barium in general practice. I think in general practice we definitely do the, well? I think it's an option for clients to know that they can do outpatient care versus inpatient hospitalization. And it also depends on the status of the patient. Obviously, if hydration status is pretty severe, we should definitely try to recommend hospitalization. Now, again, a lot of clients can't always afford to do this. So, in my opinion, giving them the best option, number one option is this is what we strongly recommend. But like, if we can get away with some of these other options, we offer first recommendation first, and then if that doesn't work, we try to communicate as to what might work a little bit better financially or some clients just don't want to leave their pets at the vet for personal reasons. So that's fine too. So inpatient care versus outpatient care I think is a pretty fun topic.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, we tend to see if a patient is transferring from the emergency department, they usually are at the point where they need to be hospitalized.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, us too.

Yvonne Brandenburg, RVT, VTS SAIM:
Versus like we're just like, you know, we're doing an ultrasound and we're like, yeah, you know, some GI upset. That's it. No, that's more outpatient care. But if it's transferring to us, it's usually because they're hospitalized and then consult's most of the times can be outpatient care, because they've waited a while to get to that appointment anyways, right?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, it's usually it's usually a pretty well-defined line.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
There's not really that gray zone. It's more of just a matter of like if you can talk your client into doing inpatient hospitalization. But I think when it comes to like managing a patient with diarrhea, it's. I figured we'd focus a little bit more on the impatient part because with the out-patient, they come in, they complain about diarrhea and you kind of send them on their way.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, those are those are long term clients, usually in internal medicine.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Okay. Outpatient care. Great. Well, let's see what we figure out.

Jordan Porter, RVT, LVT, VTS SAIM:
Your outpatient care consists of communication and trying to find out like how things are working. But your inpatient care is going to really kind of revolve around hygiene. I think we see a lot of butt soars and especially when you get that like you get those patients who just aren't really getting up much and they're just oozing. That ooze is wonderful.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. It's like, it's a fecal scald.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Right? Where it's just on their butt and they're so raw and you're cleaning it, which also makes it raw. So, we use these like an ointment.

Jordan Porter, RVT, LVT, VTS SAIM:
Silver sulfadiazine.

Yeah. I was going to say SSD.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
I call it the super sour cream. Silver Sulfadiazine. Super sour cream.

Jordan Porter, RVT, LVT, VTS SAIM:
I like to shave as much of the hair as I can. It's like a hot spot. Like you shave it. You clean it really well. You dry it. And then I do a lot of tail wraps so like vet wrap their tail all the way down. So. Especially Goldens with all their long, luscious flowing hair. But yeah. Like we also have like a barrier spray. So, if for some reason I feel like the cream might not be good enough or it's not bad enough for the cream yet, then I'll spray it with a barrier spray and it just protects the skin from fecal matter.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And we also use A&D ointment.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
We just make sure it doesn't have, was it zinc?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Making sure it doesn't have the zinc in there because of zinc toxicity. Cleaning and keeping it dry and as comfortable as possible. Yeah. And the one thing about tail wraps. Just make sure you're checking the tail.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Because I've seen like tissue necrosis from a tail wrap being on too long from a primary vet. And I was like, "oh, oh no".

Jordan Porter, RVT, LVT, VTS SAIM:
We make a point really, well, we change our tailor ups daily usually anyway or multiple times a day because they get kind of covered in poop or I slide off or they get wet from butt baths and. Oh but yeah, I think that's a really good point is to just be sure. It's just like a bandage on a leg, like don't wrap it too tight and don't leave it on too long.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
They have Mila makes them, they're like a urinary catheter but a butt catheter like a fecal, it comes with like a fecal bag and it's just like a foley. So, it's like a wide bore catheter that you can slide up there and then you inflate the balloon or fill the balloon with water and then it, but these are only good for like liquid diarrhea. Like once the stool gets soft and cow paddy like you can't really use them anymore. Yeah. It keeps the patient clean and keeps the smell trapped and you just throw the bag away like.

Oh my god, I've not used this. But I saw this recently on Facebook. There was a vet tech group that they shared a picture of it. And I was like, what is this thing? But. I can see for the liquid diarrhea, that just projectile comes out the butt.

Jordan Porter, RVT, LVT, VTS SAIM:
Or it's just leaking.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And the other I mean, the other cool thing, not just for sanitary reasons, but the other thing is you can actually have a better idea of their ins and outs at that point too.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
Because you can you can weigh the amount of fecal water that is coming out and replace it if needed.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah, definitely. I will put a link to them because I found the website so you can order directly from Mila. I think they are $60. But the main thing with those is like you've got to be sure, same thing with the tail wrap, you really want to be conscious of necrosis. So, you got to deflate the balloon and rotate and then re-inflate. So, it's not just sitting in one spot applying pressure to the colon in one specific area for five days.

Yvonne Brandenburg, RVT, VTS SAIM:
So because you don't, I mean, that would cost structure, necrosis, all sorts of bad stuff.

Jordan Porter, RVT, LVT, VTS SAIM:
So more internal medicine problems.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly.

Jordan Porter, RVT, LVT, VTS SAIM:
I don't know. You, I think we've talked about this before? You've done these before like a fecal transplant?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
That's the right word?

Jordan Porter, RVT, LVT, VTS SAIM:
Right?

Yvonne Brandenburg, RVT, VTS SAIM:
What is your definition of fun? I don't know.

Jordan Porter, RVT, LVT, VTS SAIM:
It's my sarcastic fun.

Yvonne Brandenburg, RVT, VTS SAIM:
Because I was like, no! We've done, I would say maybe a handful. A couple years ago this was like the craze that everybody was talking about. The issue with that is you have to find a fecal donor that has really healthy gods. And so, you have to screen for all the stuff that you want to make sure that it's healthy getting into. And we had one patient that was really successful with it and actually ended up having multiple fecal transplants just because after the first one, did not have diarrhea for about two months.

Jordan Porter, RVT, LVT, VTS SAIM:
Nice.

Yvonne Brandenburg, RVT, VTS SAIM:
But then it kind of came back and then they did another one in it and it worked. So, yeah, for some patients. I can see that. Yes, it would work. So, in case you're wondering what the heck of fecal transplant is. So, basically what we were doing is you take the healthy, it's usually a dog, I don't I can't imagine a cat. I guess you probably could.

Jordan Porter, RVT, LVT, VTS SAIM:
But you also have to be sure that these dogs have not been on antibiotics for six months? I think it's six months.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. There's like there's a lot of there's a lot of stuff because antibiotics change your GI biome. Right? You get the fresh poop. It's got to be fresh poop. And then what you do is you put it in a blender and you add some water to it and you make poop soup. It's what we call it, the poop soup.

Jordan Porter, RVT, LVT, VTS SAIM:
It's like a specific measurement, though. It's like it was great measuring out the poop and then like measuring the water and then putting them together.

Yvonne Brandenburg, RVT, VTS SAIM:
Our doctor wasn't quite as precise with it. It was a consistency thing more than anything else. And then we sedated our pet that we were doing the transplant on. So, sedated him so they don't move. And then you take your poop soup and a really long catheter like a red rubber catheter, go up the butt, infuse all the poop soup into the butt, into the colon. And then we used a tampon.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So you close the rectum, so nothing can come out. And I think we tried to keep the poop soup in for about 20 to 30 minutes.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, that's what we did, too.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And the idea is that the good GI bacteria from the healthy dog gets transplanted into the unhealthy dog. And I think this really came from cows. Because they had the, you know, the port in the side that we all looked at when we were in tech school.

Jordan Porter, RVT, LVT, VTS SAIM:
That was pretty cool.

Yvonne Brandenburg, RVT, VTS SAIM:
We're like, holy moly, you're putting your hand in a cow. And so, I think that's kind of where the idea came from. And also, in human medicine, this is a thing.

Jordan Porter, RVT, LVT, VTS SAIM:
But I couldn't do it in humans. Because I think I'm pretty sure they do a gastric tube down the mouth into the stomach.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
And I'm pretty sure infuse in the stomach. I couldn't.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, god. Which I mean for people, I think that I can't do people stuff. Anyways. But dogs, dogs eat poop. So, there's that as well.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. I just think,

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah there is some theory that going into the stomach, the gastric juices can, you know, kill some of the good bacteria. So, it's hard. We also, we had one or two patients that responded really well and then others that didn't.

Jordan Porter, RVT, LVT, VTS SAIM:
Yes.

Yvonne Brandenburg, RVT, VTS SAIM:
We ended up not doing it nearly as much.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. We kind of use it as a last ditch effort. We've had those like severe PLE patients who are just not responding to meds anymore and they're just getting sick, sicker. And so, we do it. But we have a designated blender. We have a designated strainer. We have lots of fun. Gloves, mask, goggles that's all necessary when doing that.

Yvonne Brandenburg, RVT, VTS SAIM:
Especially depending on who you work with, because we had one doctor, she, yeah, she did not put the lid on before she plugged it into the wall.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, my god.

Yvonne Brandenburg, RVT, VTS SAIM:
And oh my god. It went over many-a-shelf. And so, she was no longer allowed to do that.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
And she wasn't allowed to touch the blender afterwards. And then from then on, we always did it in our like run area that we can hose down just in case.

Jordan Porter, RVT, LVT, VTS SAIM:
Oh, yeah. All right.

Yvonne Brandenburg, RVT, VTS SAIM:
Because that was disgusting to clean up. It was horrible.

Jordan Porter, RVT, LVT, VTS SAIM:
I couldn't, oh, god, I couldn't imagine if that went everywhere. It's like it's kind of bad enough just having to, like, try to infuse it into another dog's butt. We've never sedated for it because our patients that we try to do it on are so sick. And so, they're usually just lying there anyway, unfortunately.

With a tampon up their butt.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. We've used foley's to like inflate and then,

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Anyway so off the topic of fecal transplants. So that's kind of like our in-hospital tips of like just, main thing is just keep them clean. The best way you possibly can. And sometimes that takes one technician dedicating themselves to managing that one patient for the day and cleaning up every 15 minutes. It sucks. But we, we all do it. So best thing for the patient. So yeah. And then for that outpatient care, like I said, it's mostly client communication. Make sure that they understand the medications that they're going home with. Make sure that they understand what results they should be seeing. And if they're not seeing results, then definitely have them give you a call. I have so many clients call and be like, "what if they become constipated?" And I'm like, "don't stress about your dog not pooping unless they're straining to poop and nothing's coming out."

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And I think that's a big thing. I always tell my clients I'm like, look, they probably weren't eating great to begin with. So, they're not producing as much. But we also completely cleared out their system. It's gonna take a few days to build backup. So, they have normal stools. And again, as long as they're not straining, as long as they're eating, they're not vomiting. We say give 'em, I usually tell them, three to five days. I'm like, it's fine. Three to five days. If after that there's issues. Let us know. But most times by then,

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. Yeah, definitely.

Yvonne Brandenburg, RVT, VTS SAIM:
And to go along with that when they go home a lot of times they're going home with a bunch of medications. So, you know, having a way for them to keep track of it, making sure they get it is good, so the journal, like the One Month Pet Health Journal or the six month Pet Health Journal for them, is a really good idea to help keep track of it.

Jordan Porter, RVT, LVT, VTS SAIM:
Especially if they are those clients who take notes on like what their poop looks like for the day. Is it cow patty? Is it ice cream?

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah, they could put comments in there and just be like this is what the stool looks like, you know, or you can give them the fecal scoring chart. Right? And be like, tell me what it is and you can write it down in the journal. That's really good for clients because then they feel like they're doing something.

Jordan Porter, RVT, LVT, VTS SAIM:
And then it makes it easier for you because they can just email it you and you can scan it right into the record. It's great. I mean, it's like here's my communication to this client. Here's what they're doing. And, you know, you don't have that like, "well, I'm giving you I'm giving the meds that you told me to give", and I'm like "we told you to give like six. So, which ones are you still on?"

Yvonne Brandenburg, RVT, VTS SAIM:
Right?

Jordan Porter, RVT, LVT, VTS SAIM:
Are you giving them according to the dose? Like, I do think that journal is a really big help as to trying to keep that line of communication a little bit more simple. And then, of course, like just trying to find out, like after stopping the meds, I think it's super important, like if you're not gonna schedule a recheck. It's super important to at least put in a follow up call like we gave them a 10 day course of metronidazole or they're trying two weeks of tylan or something. You want to put in that callback for when they're supposed to finish a day or two later and just see what happens. Are they still doing well? Are they still eating? Do we need to move on to something different? Do we need to move on to a food trial or do we need to add in probiotics? I use a bunch of different probiotics. We talked about this a little bit, too. I like this Visbiome. It's refrigerated. It's more expensive. So not everybody likes it. But it's easy to buy online. So, we'll have to sell it.

Yvonne Brandenburg, RVT, VTS SAIM:
There's, is that the VSL?

Yes. VSL number three or something like that.

Yeah. Oh, the capsules?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
So there's a new one out VSL. They have a new veterinary product, veterinary specific that the issue with that one is you can only get it from a veterinary hospital because it has to be refrigerated, but it is specific for veterinary versus some of the VSL's, they don't have the same gut bacteria. Because that's technically it's for humans which our bacteria is a little bit different than dog and cat. It's just one of those things that we just have to know.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, we use also like so because of this Visbiome can be so expensive sometimes for people. We use a lot of like Proviable able Proviable Forte. Proviable you can buy on Amazon. So, we have a lot of our clients. Get on there, but the Forte you have to get through vet clinic as well. And then recently I think Mycequin is fairly new-ish, but it has like the same count of bacterias like Proviable Forte. I think it's like 10 billion or something like that versus the normal right volume.

Yvonne Brandenburg, RVT, VTS SAIM:
I don't know that one.

Jordan Porter, RVT, LVT, VTS SAIM:
It's a chewable tablet. That's kind of what it breaks down to.

Yvonne Brandenburg, RVT, VTS SAIM:
Oh, interesting. Okay.

Jordan Porter, RVT, LVT, VTS SAIM:
Versus like the typical capsule's or the paste. I don't like the paste.

Yvonne Brandenburg, RVT, VTS SAIM:
Most pets don't like the paste, but in theory loads the guts and then you follow up with the capsules for the Proviable.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
The other the other part of that, so we have the probiotics, but there's also prebiotics. So, the big ones that we think of is like fiber is gonna be the prebiotic that helps. It's the food for the bacteria. There's some new diets out there that have some of the prebiotics in there. So, it's just something to kind of keep in mind as well. And fiber is a good thing.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah. And it's a wonderful suggestion you can make to your vet about like, "hey, what about trying this?" Definitely don't be afraid to speak up. I think that's why hopefully people are listening to kind of broaden their knowledge and then be able to speak up for their patients and be like. I love doing that personally just because it's nice to not really step on toes, but to be like, "hey, what if we tried this?" And then your doctors like, "actually, that's a great idea. I don't think about that." They're so smart. Like our veterinarians are so smart that their brains are just like engulfed with like all the other knowledge that sometimes things can get overlooked, like simple things like, well, let's just try this new I/D food with this biome in it.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Or tests for B12. But I do think, aside from kind of what you are recommending your clients do and discussing with your veterinarian, discuss the long term goals and the risks that you can see with like chronic diarrhea that goes untreated. So you do run the risks of PLE, or protein losing enteropathy, can occur if you have severe diarrhea going on for so long, low B12 can actually lead to some neuropathies at times which I don't think people realize because it's just a vitamin and it's a water soluble vitamin, so doesn't seem like much. Hydration status, malnutrition. A lot of those things can occur pretty rapidly, especially if it seems, we all have those clients who I don't see my dogs' poop, so I don't really know. Like they go outside and they do their business and then they come in. So, unless they have an accident in the house, it's one of those things that unfortunately sometimes do get overlooked where you have an outdoor dog who the owners just aren't really paying close attention to. They care.

Yvonne Brandenburg, RVT, VTS SAIM:
Or multiple dogs, right?

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah.

Yvonne Brandenburg, RVT, VTS SAIM:
And you're like, "I don't know which ones did what". So yeah.

Jordan Porter, RVT, LVT, VTS SAIM:
Yeah, there's multiple dogs are really pain in the butt.

Yvonne Brandenburg, RVT, VTS SAIM:
You mean when you have like five dogs in your household. Is that what you're talking about?

Jordan Porter, RVT, LVT, VTS SAIM:
So it's like how am I supposed to know who's eating and who's like pooping and doing all this stuff that they're supposed to do.

Yvonne Brandenburg, RVT, VTS SAIM:
Well and to go along with that as multiple cat households. That's really difficult. Half the time, I don't even know what came from what an animal. And I have two cats.

Jordan Porter, RVT, LVT, VTS SAIM:
So I think I think just kind of learning to keep the lines of communication open with your clients and your doctors. Just make suggestions. Don't feel bad by suggesting something to your veterinarian to maybe try next, because again, at least the doctors I work for do tend to appreciate it. So, it is nice to feel appreciated. That's what we're there for. So, don't feel bad about it.

Yvonne Brandenburg, RVT, VTS SAIM:
We talked about this, I'm going to I'm going to do a shout out to some of my nutrition peeps: Every pet, every time. Right? We should be looking at the food and making sure they're getting the nutrition that they need because, you know, malnutrition can occur from this. Right? And you can see severe malnutrition with these kids, both from vomiting and from diarrhea. Because everything's going out, not absorbing, because, again, most times it's a gut disease versus, you know, you've got your short term, but I mean, chronic it's gut disease. So, yeah, you need to pay attention to that.

Yvonne Brandenburg, RVT, VTS SAIM:
It's the tip of the week.

Yvonne Brandenburg, RVT, VTS SAIM:
So this week's Tip of The Week, we have the Mila Fecal catheters. So, I've never used them. I'm interested to see if our clinic would use them. I don't even think we have them. So, I think this is also going to be a tip for me is to check into them and see, you know, about potentially using them in our clinic. And then barrier's sprays, creams just to keep things clean and not have the sores that can be associated that just, you know, the red baboon butt, so keeping that to a minimum.

Jordan Porter, RVT, LVT, VTS SAIM:
I think those are some good tips to take away, especially if you do your best to kind of maintain hygiene in a patient. But it's just you're like, I need that one extra little thing to help kind of heal faster.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. Exactly.

Yvonne Brandenburg, RVT, VTS SAIM:
And now for the Question of the Week.

Jordan Porter, RVT, LVT, VTS SAIM:
So, our Question of the Week this week is going to be what did one of the craziest diarrhea or poop stories or experiences that you've been a part of while working in a vet clinic? I know everybody has one. I know everybody finds poop in their pocket. So, I know that there is something funny out there that you guys want to share with us. If you want to leave us a comment on InternalMedicineForVetTechs.com, we would be happy to hear from you and hopefully shout you out on our next episode.

Yvonne Brandenburg, RVT, VTS SAIM:
So this is episode four, at InternalMedicineForVetTechs.com/podcast and then look for episode number four. Share your answers. You know, if you have a tip that you know you want to share that we didn't cover that, be great as well.

Jordan Porter, RVT, LVT, VTS SAIM:
Let us know how those Mila butt catheters are if you use them.

Yvonne Brandenburg, RVT, VTS SAIM:
Exactly. And then we will also include resources again in the show notes. So, you'll definitely get a chance to see that. We'll also, remember we are creating a checklist for you guys for getting history, because diarrhea history you're going to get a lot of information from it. So, we'll include that as well. All right. Well, I think that's it for this week. Anything else that you want to share before we had to take off for the day?

Jordan Porter, RVT, LVT, VTS SAIM:
Nope, I think just keep listening. Like I said, comment. Try to get in touch with us if you have anything specific you want us to talk about or share or if you want to, again, share any of your stories. I love hearing them. So just reach out to us.

Yvonne Brandenburg, RVT, VTS SAIM:
Yeah. And you don't share with your vet tech friends, let them know about the podcast. Most of us have at least a little bit of a commute to work so you can listen to something and feel a little bit smarter and join in with what we're talking about. And then I believe next week we are going to be talking about pain management in our veterinary patients. So, stick around for that. Yeah, I think that's it for this episode. All right. You guys have a wonderful week. Keep being the most amazing technician you can possibly be. Get your learn on and we'll talk to you next week. Bye guys.

Jordan Porter, RVT, LVT, VTS SAIM:
Bye!

Yvonne Brandenburg, RVT, VTS SAIM:
Thank you for listening to today's episode of the Internal Medicine for Vet Techs podcasts. If you like where you heard, we'd love for you to share with someone you think might enjoy the podcast. And make sure to subscribe so you never miss an episode. Want to give us a boost? Please leave a review on i-Tunes or your favorite pod catcher and we'll be sure to say thank you. Find out everything about us at InternalMedicineForVetTechs.com. Talk to you next week. Bye!

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