cbd oil for lymphangiectasia

Plugging the protein faucet in dogs with PLE

A leaky gut has several potential backstories. But every type of “protein-losing enteropathy” (PLE) shares a common loss: albumin, a vital protein that regulates the oncotic pressure of blood, among other things. Although dogs with PLE are quite sick, advances in diagnostics and treatments have improved outcomes.

“It used to scare us,” said Scott Owens, DVM, MS, DACVIM, an internist at MedVet Indianapolis. “But now we have high success rates with treating and managing these dogs.”

Healthy dogs lose regulated amounts of protein through the gastrointestinal (GI) tract and the kidneys, but hypoproteinemia can result from excessive loss secondary to protein-losing enteropathy (PLE). Other conditions that can result in hypoproteinemia include protein-losing nephropathy (PLN) and decreased hepatic synthesis. The key feature of PLE is panhypoproteinemia, due to the loss of both small (albumin) and large (globulin) proteins. On a normal basis, anywhere from 10% to 50% of the total protein loss funnels through the gut 1,2 ; however, more than this amount leads to PLE. 3

Hypoproteinemia was once thought to result solely from decreased protein synthesis. But in 1949, investigators discovered increased GI losses to be the major cause. In 1957, radioactive iodine tags were hitched onto albumin so it could be followed along its journey through the intestines.

More of a syndrome than a discrete “disease,” PLE is now known to have etiologies that can vary between dogs as well as between species.

“PLE is not a diagnosis,” Owens said. “It’s just a beginning. You need to figure out what the underlying cause is.”

In humans, this underlying cause is usually either cardiovascular disease, liver disease, ulcerative colitis or Crohn disease. In cattle, Johne’s disease can result in protein loss from the gut, whereas equine PLE is often associated with GI ulcers and infectious diarrhea (eg, salmonellosis). In dogs, inflammatory bowel disease (IBD) is often the main suspect.

Mammalian species have a conserved microarchitecture that facilitates the absorption of nutrients from ingested food. Millions of raised villi line the intestinal tract. Within each villus, venules, arterioles and capillaries surround a central lacteal, which drains nutrients that cross the mucosa but are too large to be absorbed into the vasculature. The lacteals transport these particles, primarily dietary fats, to larger lymphatic vessels and then to the liver.

The job of the lacteals, Owens explained, is to “pick up the mess from all the leftovers that can’t be absorbed through the veins.”

Several different pathologies can disrupt this process. Anything that alters mucosal permeability and integrity can precipitate protein loss. These include erosions, foreign bodies, neoplasia, infection (eg, parvovirus, parasites), and inflammation (IBD). 4

Protein leakage can also result when lacteals burst despite a healthy intestinal mucosa, a condition called lymphangiectasia. 4 Although lacteals are flexible and can distend easily, Owens noted, “they hit that breaking point and then they all start popping and you get this massive, acute protein loss.”

In dogs, PLE is typically associated with either lymphangiectasia or lymphoplasmacytic enteritis. 5

Several breeds are predisposed to PLE. In Yorkshire terriers, lymphangiectasia can be primary (defective, dilated lacteals) or secondary (lymphatic obstruction due to portal hypertension). 6 In either case, Owens explained, “they ooze tons and tons of protein.” These yorkies often arrive acutely ill, with albumin levels as low as 0.8 g/dL (normal range, 2.6-4.0 g/dL).

Other breeds that are genetically predisposed to PLE include soft-coated wheaten terriers (specifically, a PLE/PLN complex possibly associated with food allergy 7 ) and Norwegian lundehunds (a severe chronic enteropathy seen in virtually all dogs in this breed due to genetic bottleneck 8 ), as well as Rottweilers, German shepherds, and shar-peis (all prone to chronic enteropathies).

Dogs with PLE often present with small- or mixed-bowel diarrhea, although some 30% of them do not have diarrhea as part of their clinical picture. Weight loss is typical and vomiting is rare. Some dogs can present with edema and pleural effusion due to severe protein loss.

Blood work may show hypoalbuminemia or panhypoproteinemia, hypocholesterolemia, lymphopenia, hypocalcemia and hypomagnesemia. Hepatic or renal protein loss should be investigated with a urinalysis, as well as an evaluation of serum liver enzymes and bile acids.

Coagulopathies (hyper- and hypocoagulopathies) may also be present due to associated vitamin D or K deficits or loss of antithrombin III. In a study of 138 dogs with PLE, 15% had evidence of clot formation.

Lacteals, normally microscopic, may be visible on an ultrasound when dilated. During an endoscopy, lymphangiectasia appears as a speckled white pattern within the small intestine. IBD, on the other hand, features cobbly intestinal mucosa. 9 Owens recommends administering corn oil 3 to 4 hours prior to endoscopy, thereby making the lacteals swell so they are easier to visualize. Endoscopic versus surgical biopsies are preferred in patients with severe hypoalbuminemia due to the postoperative risk for dehiscence in these compromised tissues.

The presence of hypoalbuminemia is a major factor informing treatment and prognosis. 10

In a study involving 80 dogs with IBD, 20% had hypoalbuminemia. Of the 10 dogs that were euthanized, 7 had hypoalbuminemia.

Another study found shorter survival times (701 days) in dogs with hypoalbuminemia compared with those with normal albumin. Approximately 75% of dogs survived the acute period, the crucial first month. Additionally, the extent of the hypoalbuminemia did not correlate with outcome: A dog with mild hypoproteinemia did not necessarily fare better than one with severe protein loss.

For dogs whose hypoalbuminemia was caused by intestinal lymphoma—rarer and more serious in dogs than in cats—survival times ranged from 2 weeks to 2 months, according to results from one study.

The main goal of therapy is to harness albumin loss. Acute cases require more aggressive treatment than those that have been festering for a while. If the albumin level is less than 1.5 g/dL, fluids are likely to go straight to the chest because there is not enough albumin to trap them in the vasculature. To avoid third-spacing of fluids, Owens recommends using half crystalloids and half colloids. If colloids are not available, fresh frozen plasma can be used; however, large amounts may be needed to substantially raise oncotic pressure.

If mild pleural effusion is present but the patient is eupneic, Owens cautions against thoracocentesis because it could lead to further albumin loss.

Antibiotics should be used only if diarrhea is present. Intravenous metronidazole can be given in the hospital, and then the patient can be sent home with oral metronidazole; tylosin can be used as an alternative. 11

If biopsies confirm that the PLE has an inflammatory component, as is usually the case, immunosuppressants play a huge role. According to Owens, most dogs respond to prednisone. Budesonide may also be effective, 12 and result in less systemic absorption, particularly important if heart disease is also present. For those whose hypoalbuminemia is severe or refractory to steroids, a second immunosuppressant can be considered. Cyclosporine is the gold standard for additive therapy, 13 but chlorambucil or azathioprine can also be used. 14

Anticoagulants are used in dogs with hypercoagulopathies, and vitamin supplementation with cobalamin (vitamin B12) can be used in case of cobalamin deficiency.

In the case of lymphangiectasia, low-fat diets such as Royal Canin Gastrointestinal Low Fat dog food, Hill’s Prescription Diet i/d Sensitive and home-cooked chicken or potato-type meals should be implemented. 15 For patients with food allergies or IBD, hypoallergenic diets can help to seal the gut.


  1. Hall EJ, German AJ. Diseases of the small intestine. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 7th ed. Saunders; 2009:1526-1572.
  2. Moore LE. Protein-losing enteropathy. In: Bonagura JD, Twedt DC, eds. Kirk’s Current Veterinary Therapy XIV. 14th ed. Saunders; 2008:512-515.
  3. Greenwald DA. Protein-losing gastroenteropathy. In: Feldman M, Friedman LS. Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease. 8th ed. Saunders; 2006:557-564.
  4. Bode L, Salvestrini C, Park PW, et al. Heparan sulfate and syndecan-1 are essential in maintaining murine and human intestinal epithelial barrier function. J Clin Invest. 2008;118(1):229-238. doi:10.1172/JCI32335
  5. Peterson PB, Willard MD. Protein-losing enteropathies. Vet ClinNorth AmSmallAnimPract. 2003;33(5):1061-1082. doi:10.1016/s0195-5616(03)00055-x
  6. Kimmel SE, Waddell LS, Michel KE. Hypomagnesemia and hypocalcemia associated with protein-losing enteropathy in Yorkshire terriers: five cases (1992-1998). J Am Vet Med Assoc. 2000;217(5):703-706. doi:10.2460/javma.2000.217.703
  7. Littman MP, Dambach DM, Vaden SL, Giger U. Familial protein-losing enteropathy and protein-losing nephropathy in Soft Coated Wheaten Terriers: 222 cases (1983-1997). J Vet Intern Med. 2000;14(1):68-80. doi:10.1892/0891-6640(2000)014<0068:fpleap>2.3.co;2
  8. Berghoff N, Ruaux CG, Steiner JM, Williams DAA. Gastroenteropathy in Norwegian Lundehunds. Compend Contin Educ Vet. 2007;29(8):456-465.
  9. Kull PA, Hess RS, Craig LE, Saunders HM, Washabau RJ. Clinical, clinicopathologic, radiographic, and ultrasonographic characteristics of intestinal lymphangiectasia in dogs: 17 cases (1996-1998). J Am Vet Med Assoc. 2001;219(2):197-202. doi:10.2460/javma.2001.219.197
  10. Owens SL, Parnell NK, Moore GE, et al. Canine protein-losing enteropathy: a retrospective analysis and survival study in 68 dogs (abstr). J Vet Intern Med. 2011;25(3):692-693.
  11. Kilpinen S, Spillmann T, Westermarck E. Efficacy of two low-dose oral tylosin regimens in controlling the relapse of diarrhea in dogs with tylosin-responsive diarrhea: a prospective, single-blinded, two-arm parallel, clinical field trial. Acta Vet Scand. 2014;56(1):43. doi:10.1186/s13028-014-0043-5
  12. Dye TL, Diehl KJ, Wheeler SL, Westfall DS. Randomized, controlled trial of budesonide and prednisone for the treatment of idiopathic inflammatory bowel disease in dogs. J Vet Intern Med. 2013;27(6):1385-1391. doi:10.1111/jvim.12195
  13. Allenspach K, Rüfenacht S, Sauter S, et al. Pharmacokinetics and clinical efficacy of cyclosporine treatment of dogs with steroid-refractory inflammatory bowel disease. J Vet Intern Med. 2006;20(2):239-244. doi:10.1892/0891-6640(2006)20[239:paceoc]2.0.co;2
  14. Dandrieux JR, Noble PJ, Scase TJ, Cripps PJ, German AJ. Comparison of a chlorambucil-prednisolone combination with an azathioprine-prednisolone combination for treatment of chronic enteropathy with concurrent protein-losing enteropathy in dogs: 27 cases (2007-2010). J Am Vet Med Assoc. 2013;242(12):1705-1714. doi:10.2460/javma.242.12.1705
  15. Okanishi H, Yoshioka R, Kagawa Y, Watari T. The clinical efficacy of dietary fat restriction in treatment of dogs with intestinal lymphangiectasia. J Vet Intern Med. 2014;28(3):809-817. doi:10.1111/jvim.12327

Joan Capuzzi, VMD, is a small animal veterinarian and journalist based in the Philadelphia area.

Cbd oil for lymphangiectasia

Hi everyone. I am confused and a bit worried at the moment as I’m not sure if I’m doing the right things for my precious Millie.

She is 13 and in relatively good health for her age. She is prone to pancreatitis (has had a couple of mild bouts) so I home cook for her. Her diet at present is pretty bland as she had some mucus in her poop last week so she is currently getting white chicken breast, calf liver, pumpkin (the canned Digestive blend), sweet potato and white and brown Basmati rice. Her supplements are calcium (NOW brand), zinc, iron, manganese and iodine which are added to the food when cooked and cooled. She gets a Vitamin E each morning and a Vitamin D twice weekly. I also give her a Glucosamine/Chondroitin/MSM capsule morning and evening (NOW brand) but only introduced this a couple of days ago.

In the middle of the day she gets 2 ounces of goats milk, the Primal Brand, which includes tuermic and I include a few drops of Milk Thistle as she has elevated ALT liver values.

Over the last few weeks/months I have been trying to wean her off Metacam by using CBD Hemp Oil (she is now down to a quarter of a 1mg Metacam tablet, and also wean her off Clomicalm (anti-anxiety med) with Zyklene, which is a natural product. Again, she is down to a quarter of a 20mg Clomicalm daily.

However, she has very bad rear leg trembling that has been getting worse since Spring and is spreading to her front legs. She is pacing a lot more than usual and is back to aggressively licking at her groin/upper leg/vulva area, which she had not been doing very much in recent times. I am concerned that I have withdrawn prescription medications that may have been helping her, even though I did so very, very slowly. But I felt that natural remedies would be safer for her, particularly the CBD Hemp Oil.

What I can’t be sure of and what is worrying me a lot at the moment, is whether it’s anxiety or pain that is causing her symptoms to return. Am I doing wrong in taking away the prescription medication in favour of the natural remedies even though my main aim in doing so was to protect her liver as her ALT has been at double the higher range for months?

Sorry for the long post – I can never seem to write brief posts!

Metacam doesn’t need to be weaned, don’t think Clomicalm needs to be either.

I take it you haven’t done a synthroid trial on her?

As for diet, you mention she’s now on white chicken – is she only getting chicken as a meat protein?

Yes, just white chicken and calf liver at the moment. She had a digestive upset (quite a bit of mucous in poop) so she needs a bland diet at present. But her other recipes contain beef, fish etc. Everything must be lean to avoid pancreatitis.

Her thyroid levels have been good in all her recent blood work so that’s pretty much off the table from a veterinary perspective at the moment.

As long as you understand that a dog cannot live on chicken and liver.

Personally, I would try a trial of synthroid for a couple of days, half a dose even. 25 mcg twice a day for 2 or 3 days, it’s not going to hurt the dog. There’s lots of wiggle room in those blood results to kick the T4 up a notch.

As stated before, it may not be classic hypothyroidism but if the dog shows any sign of improvement within 24 to 48 hours of being on synthroid – now you have a direction to go instead of spinning your wheels like you’ve been doing for the last year. Feeding synthroid can tell you if you’re dealing with an endocrine issue. You mentioned in another post that the vet was kicking around the idea of doing a synthroid trial, just do it. If nothing else, you rule out many things.

I had to bypass the vet and do my own synthroid trial on my ex’s dog, didn’t have a choice. It proved I was right. Hint: synthroid is the same for dogs and humans.

I fully understand that she cannot live on chicken and calf liver – her food also contains pumpkin, rice and sweet potato plus all the supplements I have listed about.

She’s 13 – she is showing early signs of Cognitive Decline (this is a veterinary diagnosis and one I only partially accept at present as most of her issues have been ongoing for some time)

I have gone the conventional route and the holistic route at this point and have failed to either establish what is causing her issues or get any definitive help in solving them.

To be honest I would be nervous about giving her a medication that I was unsure that she needed. I admire your confidence in doing so, but I am very cautious when it comes to Millie as I fear causing her any further issues – although I take on board your comment that it can’t do any harm. Hypothyroidism has not been to the forefront of my mind in recent months as her thyroid blood work has all been well within normal range – I even had it tested by Dr. Dodds.

By pure freak I had my other dogs urine tested earlier this week as I’ve been coming home to large amounts of urine on the floor for the past couple of weeks. Judging by the volume I assumed it was my male dog but his urine tested normal. I joking remarked to the vet that perhaps I was blaming the wrong dog so she immediately suggested testing Millie’s urine. It was tested this morning following a free catch sample and the results showed that it was more dilute than it should be and it also contained blood.
She goes in tomorrow for a cysto and fasting blood work so I will raise the thyroid issue again.

Another thing worthy of mentioning – since she has blood in her urine. Rice can be high in phosphorus (and carbs), which normal kidneys can generally deal with. At 13 years old, her kidneys are likely not functioning at peak efficiency. If she’s having kidney issues – then rice is probably the last thing you want to feed. Look up Hyperphosphatemia symptoms, could explain the tremors. Have her phosphorus levels been tested? What about calcium levels?

Can urine be too dilute? Is she drinking excessive water?

At some point, you mentioned dealing with possible yeast infection. The added sugars in her diet aren’t necessary and will promote yeast. To top it off, by feeding sugar and carbs, you’re forcing the pancreas to produce insulin which has a trickle effect throughout the body – affecting the liver as well. The idea of a bland diet is to give the system a rest.
And cooked fat is the main contributor to pancreatitis.
Dogs do not need carbohydrates either.

Just popping in, I haven’t been reading the forum (stll knee deep in elder care issues), but I have a few observations.

With the dilute urine the kidneys may not be concentrating it which is a problem. Kinda hoping there is a UTI which might take care of things when treated.

As for the mucous, have you tried different types of probiotics? It took me a long time to find the right ones here. There are some infections that cause toxins that create the symptoms you describe (stools and even the shaking) that are hard to find (mainly in the clostridium family). If the mucous continues, it’s an issue of the wrong bugs in the gut and need to be treated somehow.

The supplements you are using to replace the meds may or may not do the job adequately.

I used a hemp product for my dog’s anxiety at first. It worked well initially but then eventually made her more inclined to bark and go off on other dogs so I stopped it. I tried the zykliene product too and it didn’t help. St John’s wort helped a lot, but it interacts with a zillion different things so you have to be careful with it. Ultimately fixing the other things she had wrong helped the most, but she is still an anxious dog, and I believe it comes from the gut.

Metacam is an anti-inflammatory and and i’m not sure you have a replacement for that. Here I try things like boswellia or yucca if it’s tolerated. There are others, but I am not completely convinced the hemp oil is a strong enough anti-inflammatory. It’s possible that in high chronic doses any anti-inf supplement is also harder on the liver, but I don’t think they are as bad as the Metacam for that.

I would consider a b-complex, like a B-50 to help with the nervous system, which may include the cause for the shake and also contributes to anxiety.

My girl has tremors, we think are nervous system bases. I find that alpha lipoic acid (she gets r-lipoic) is very helpful, but she is also getting nongmo sunflower lecithin to help her utilize fats and protect her nervous system.

I do however combine her treatments with regular chiro treatments and also acupuncture.

As you know, once a dog deals with pancreatitis, they have to watch the fat in the diet. But there are many reasons why the pancreas may have become compromised. Allergies, infections, and also immune system attacks can all cause pancreatitis. Our vet internist says in most cases an actual cause is never found, but they treat symptomatically. For my chronic pancreatitis girl, I fed her lean pork and green beans for probably a decade, though she was able to tolerate hard-boiled eggs in the morning. I found foods would trigger her pancreatitis attack (chicken has been bad for all of my dogs), and I found when I wasn’t able to control her pancreas issues, she needed a round of panacur, even if all tests were negative.

These dogs are all so individual, best of luck getting this figured out!

Please excuse the typos above, i’m on my phone.

Can’t believe that I forgot to mention to rule out tick disease.

One last comment – different joint supplements seem to vary in how well they help the dog. You might also have to experiment with those to find the ones that work the best. Depending how bad the joints are, you might need a couple of different supplements depending on the ingredients. I start my dogs on them young, so I haven’t had the experience of a dog with badly deteriorated joints, but i’ve seen this with others. My first dog required cosequin and glycoflex to be at her best (her joints were real bad even though xrays were good she also had chronic lyme).

(I should clarify – she was started on supps at 12 months but she had problems requiring surgery due to bad hip confirmation. I kept her on supps and the joints at 13 were still not bad in terms of degeneration.)

So sorry to spam you, but an afterthought. With back leg tremors, you should also check if the anal glands are too full and need expressing.

About the thyroid, remember, it’s a hormone that replaces what is missing in the body and if a dog needs more thyroid hormone, there really isn’t a way to fix that without supplying the actual hormone for the body to utilize. Low thyroid can cause muscle and limb weakness, tremors and seizures, anxiety and cognitive brainfog. So if you are not treating a suspect blood value, regular testing to watch for further decline is warranted.

Thank you Maxi Lisa for your very detailed and helpful response.
To outline the positives from it first – she had her urine checked by cysto the following day and it was properly concentrated but it scheduled to be rechecked again in six weeks. She gets B 50 daily, has been checked for tick disease (negative), her anal glands were expressed this week and were not very full and she is also booked for a Rehabilitation Consultation to assess which therapy would help her most, ie; accupunture, laser, pulse, chiro, etc.
Today I made her Golden Paste to help with any discomfort she may be having without the Metacam until she has the consultation and I am enlightened as to the extent of her condition and, hopefully, the cause is identified so we can move forward with treating her.

You comment on the CBD Hemp Oil interests me as I really believed it was a good approach for her. But I certainly do not want to risk it having a negative effect of any kind. The Zylkene is difficult to gauge at the moment as she is not on it long enough to see if it is have a positive impact or if it is making no impact at all.

The thyroid issue is also now beginning to concern me again as Rhynes referred to it in an earlier comment too. But her thyroid blood work is not showing any cause for concern and is well within normal range, both on her regular clinic tests and on Dr Dodds test. By my reasoning (which could be wrong!!) I don’t see a need to give her thyroid medication if there is nothing in her blood work to warrant it?

Can I ask you a couple of questions on the other points you raised in your reply? I give her probiotics regularly but not daily and I use the Dr. Mercola brand as this was recommended to me. However, just a couple of days ago I saw a comment somewhere that this brand is not that good so now I am at a loss as to whether to continue with it or, more importantly, what to replace it with?
You also mention Boswellia and Yucca and, while I know the names, I know nothing about them. Where are they available from, how are they administered, are they given long term, it is a choice of one or the other of them and which one is more successful and most easily tolerated. And, finally, if it is not being tolerated why symptoms indicate that?
You also mention Alpha Lipoic Acid and you have lost me completely there as I am not familiar with it at all. How effective/beneficial is it? Where is it available? Is there a canine version of it? Is it easily tolerated?
And, needless to say, I have similar questions about non-GMO Sunflower Lecithin as, once again, I am unfamiliar with that too.

Finally (you’ll be happy to hear!!) did you add anything to your dogs combination of pork and green beans? Did you add any carbs at all or how did you make a filling meal from those two ingredients? Did you add any supplements (calcium, iron, manganese, iodine, Vitamins E and D) as these all form part of her current diet in order to keep it balanced.

I would be very grateful if you get a chance to answer my question whenever you log in again as, like I say, I am totally at sea with many of your suggestions but very interested in hearing your answers.
Thank you again for the time you took to reply – it is greatly appreciated.

I really wish people would research before giving their dogs CBD willy nilly. If vets aren’t aware, then there’s a problem.

Cytochrome P-450 enzymes are needed to metabolize certain medications – and metacam (meloxicam and NSAID in general) is one of those medications. CBD can interfere with cytochrome P-450 enzymes, and can inhibit the metabolizing of the drug. Furthermore, it can decrease blood pressure.

But, feel free to ignore.

I agree – it would be totally irresponsible not to check for drug interactions.
Equally, it would be irresponsible to use it ‘willy nilly’.

If you meant that comment for me personally rather than in general, I most certainly did inform my vet of my intention to use CBD oil for my dog. However, many conventional vets are totally ignorant (or choose to completely ignore) the growing use/benefit of CBD oil for pets – this is part of where the problem lies. Another factor is social media where uninformed people make suggestions for your dog without knowing its unique circumstances. This occurs daily on sites like Facebook and it really concerns me how readily people take suggestions on board without seeking professional advice or, at the very least, doing some research of their own.

I had my dog weaned down to 0.25mg of Metacam daily before I introduced the CBD and, as of Wednesday of this week, I have stopped the Metacam altogether based on my own research into the matter. I had intended to use the CBD and Golden Paste as an alternative to Metacam from day one, not as an addition to it.
What I wasn’t aware of is that you can just withdraw Metacam without weaning off it, otherwise she’d have been on CBD weeks ago.

My dog is 13 years old – some have argued that at this stage its quality rather than quantity of life at this point. I do not necessarily agree with that and I want to treat her as naturally as I possibly can while I can without filling her up with toxic medications. Obviously, if she develops something that can only be successfully treated with prescription veterinary medication I will have to review that – at present her issues are elevated ALT (so I’ve removed the Metacam and Clomicalm which can contribute to this), leg trembling (I am giving CBD Hemp Oil, Golden Paste and await an appointment from a rehabilitative vet with a view to acupuncture/massage/laser therapy of whatever is suggested), deafness (nothing I can do here but it happened following treatment with Surolan which I bitterly regret giving her) and, of course pancreatitis/digestive issues (I have paid a small fortune in food intolerance testing and in hiring a nutritionist who worked with her blood work and medical records to formulate her diet).

I have done and am doing my very best for my dog – but I know my choices may not always be right or in keeping with other peoples opinion and that I don’t have the store of knowledge that others have on these matters. But I don’t and never will act in a ‘willy nilly’ fashion and will always err on the side of caution before making decisions in relation to the health of my pets.

Finally, to Rhynes, I never have ignored your advice and always find your approaches enlightening, even if your chosen courses of action are sometimes a step too far for me (ie, giving thyroid meds as a trial is not something I am comfortable with). But I greatly appreciate your input and your knowledge sharing and have made notes of many of your past suggestions as reference.

This is going to sound really mean, but I’m going to say it anyway. You’ve been at this for a year now, and no further ahead. I told you a while back, get a new vet cause your current definitely can’t find their own ass with a map. And if this is a new vet, find another one. I recommended bringing your dog to one of 2 holistic vets in Edmonton, they would be glad to help you out – did you do it? Currently, you’re throwing crap at a wall hoping something sticks. Been there, done that, became wise to it – got tired of vets telling me "here’s my opinion, now pay me" and all the while my dog is suffering.

You were given bad advice about raw diets, started off on a protein that was too rich. I can guarantee that you didn’t verify the diet. Screwed it up based on bad advice and now you’re scared of it.

If the dog were mine, I’d have her on a strict raw diet done properly – dogs do not need sugar, carbs, starches, sugars etc. If the vet is telling you that – they ARE an idiot and know nothing about nutrition. Feeding rice to a 13 year old dog with likely kidney issues?

CBD and metacam? You didn’t check that out, you simply don’t feed an inhibitor of an NSAID to a 13 year old dog that’s taking NSAID’s – no matter the dose. If your vet recommended giving both, then they are an idiot.

I tried reasoning with you, pm’d you, you haven’t taken anything I’ve said to heart. And you’re no further ahead. Now would you like some real world advice? If not, tell me to leave you alone.

Hi Rhynes – thankfully I’m not a shrinking violet and quite appreciate straight talk when warranted. Kinda think you might be the same??

The vet that can’t find their ass with a map is my boss – I work at the clinic but in an administrative/PR capacity. Was a journalist for 30 years before moving to Canada but no medical background. Do I take what he says on board all the time? Hell no! I’ve rejected his ‘suggestions’ many times – thyroid meds, Apoquel, Pred, etc. Don’t feel the need to defend myself any further.

Did I take my dog to Edmonton? No I did not – but I did find a good holistic vet here. She suggested the raw – no, it didn’t work out. Did it make me scared of it – it did for my dog and, believe it or not, the vet agreed that raw is not an option for her due to her pancreatitis. Incredible as it may sound to you, not all dogs can eat raw food – shock, horror. If you believe they can then you really do need to check it out – pay particular attention to pancreatic dogs.

The nutritionist I use has 30+ years of experience. Doesn’t just send me recipes she thinks my dog would like – but bases the nutritional requirements on the dogs bloods and medical reports. Again, does not under any circumstances recommend raw for my dog, although she does formulate the large majority of her recipes for raw fed dogs. I’ve discussed carbs, sugars etc with her – her response is that nutrition must be geared towards meeting the individual dogs specific requirements and ability to process/digest their food. It’s not a ‘one size fits all’ situation. And guess what – the aforementioned Apoquel that my vet said that my dog needed for skin issues is no longer even a consideration as my dog’s very bad skin condition is fully resolved. Much to the Sat Nav requiring vet’s amazement.

Kidney issues?? If you mean the recent comment on the dilute urine and blood, I have no idea what the cause was. But the subsequent laboratory tested urinalysis (as opposed to the initial in-house test) showed no issues with her urine. I did mention that above.

CBD and Metacam – I will ignore the fact that you have basically called me a liar by saying that I did not research it. I admit I did not know about weaning off Metacam – maybe I’m ‘old-school’ and don’t believe in suddenly stopping a long term medication so thought I was right? But I didn’t just buy CBD oil and start pumping it into my dog on top of everything else she’s getting! There was a cross-over of about 2 weeks with 0.25mg of Metacam and the very minimum dosage of CBD. Now no Metacam and the recommended dosage of CBD. Dr Sat Nav was of no help whatsoever with any of this – wonder how I knew I couldn’t give both.

Yes – you’re 100% right with your remark about me being on this road for over a year. Is that so unusual when you have an elderly dog with a number of issues?? I don’t accept your remark that I have been ‘throwing crap at a wall and hoping something will stick’ – why would you say that? The way I see it is that I’ve been trying to find the right crap to throw with the certain knowledge that it will stick and show results. Perhaps you might consider rephrasing your remark to say that I haven’t given up my efforts to help my dog? And I have made some progress (note skin issues above plus now almost picture perfect thyroid blood work)

You ask if I want some real world advice – I never refuse advice! I may not always act on all the advice that I get (imagine the consequences of that) but I certainly assess it and pick from it and, while you give me no credit for having any intelligence whatsoever in relation to dog care) I would be intrigued to hear what approach you would take.

But, and I’ve wanted to ask you this before, what is your background in canine care? Are you self-educated (which is something I greatly admire if that be the case), do you have certified credentials, or did you just find yourself completely disillusioned by the veterinary system (conventional and holistic) and decide to rebel against it?