Diarrhea and Loose stool

The following are real life cases of Dogs with Diarrhea and Loose Stools that have been treated by Dr. Mike Richards, DVM.

Loose Stools in Lab Puppy
Intermittent Diarrhea in Poodle
Diarrhea with Giardia to Start...
Severe Recurring Diarrhea, Coccidia and Giardia
Chronic Diarrhea in Dogs
Loose Stool in Cocker Puppy
Chronic Diarrhea Control with Complicated Medical History
Acute Diarrhea in a Puppy
Diarrhea in German Shepherd
Diet and Diarrhea
Diarrhea

Loose Stools in Lab Puppy 

Question: 

We were recently given two yellow lab puppies (male & female). They are 18 weeks old. We got them when they were 10 weeks old. Both puppies are healthy and growing at a normal rate.

The female puppy has always had loose stools (thick soup texture), in the beginning we gave them chicken and rice, then mixed the c & r with puppy chow, then we tried 4 types of puppy chow with 2 tablespoons of canned meat, now just dry puppy chow. We always allow at least 3 days to see if her stool will get firmer - no luck! The puppy chows have included regular puppy chow and puppy chow for large breeds. We stopped giving her rawhide chews and treats that have any kind of coating. The male puppy did fine on the original puppy chow. We feed the puppies together twice a day.

How can we get her to have firm stools? Should we give her regular dog chow? Thank you for any help with this.

Answer: 

Loose stools can occur for a number of reasons. It is best, when possible, to determine the cause of the loose stool and then to treat that cause. I couldn't tell from your note whether or not the puppy's stool had been examined by your veterinarian for parasites.

In almost can case of soft stools or diarrhea it is a good idea to examine a stool sample to make sure that there are no signs of intestinal parasites and to consider checking fecal smears for signs of bacteria associated with intestinal problems. If these tests are negative it is sometimes worthwhile to try one of the safer dewormers, such as fenbendazole (Panacur Rx) anyway, just to be cautious. A blood chemistry panel and complete blood cell count are also reasonable tests, to be sure that there is not a contributing systemic cause such as kidney problems or liver problems.

There are several things to think about while looking for the cause of the diarrhea. The first thing to think about is whether she is continuing to gain weight and grow at a normal rate. If she is, there is less need to rush into sophisticated testing procedures if nothing shows up on the initial testing that your vet can do. The next thing to think about is the pattern of the diarrhea or soft stools. If the problem is originating in the small intestine, the frequency of bowel movements tends to be normal, or about two to four bowel movements per day for a puppy. If there are frequent bowel movements and soft stools or diarrhea then the problem is more likely to be in the large intestine. Knowing the pattern of the bowel movements can help your vet in deciding what tests to pursue.

If your vet has done the routine testing and you wish to try dietary means for controlling the soft stools we have the best luck using Hill's w/d (tm) diet. This is a low fat, moderate fiber diet. You might be able to use Fit and Trim (tm) or Cycle Lite (tm) or some similar food, as well. An alternative is to use any low fat diet and add fiber (several companies make low fat diets). Fiber can be added by using high fiber cereals, canned pumpkin or psyllium (Metamucil tm and other products). Puppies have done well when fed these diets for several weeks but it is best to see if  you can switch to a puppy food after the stools are normal for a week or so. When these diets help they usually help pretty quickly, within a few days. If they don't help it would be worth trying the hypoallergenic diets (Purina LA tm or Hill's z/d tm) but these have to be used for at least three to four weeks before giving up on them, in order to really rule out the possibility of a food allergy.

If you get through the routine testing and easy dietary trials without a cure, it would be a good idea to do some more sophisticated testing. At least consider a trypsin-like immunoreactivity (TLI) test to be sure that there isn't a problem with deficient digestive enzymes. A bile acid test to rule out liver disease might be a good idea in this circumstance, too. Endoscopic examination of the digestive tract, with biopsy samples taken during the procedure, is another helpful test procedure.

Hopefully things are already better and you don't need this advice. If you have tried the easy stuff without success and need more information on the more sophisticated tests, please let me know.

I am not absolutely convinced that it is necessary to pursue advanced testing for puppies with soft stools who are growing normally and doing well otherwise and who show no signs of discomfort from the soft stool production. I think it is probably best but I have a number of patients with consistently soft stools who seem to be doing fine otherwise, so I tend to think it is possible for dogs to live a normal lifestyle despite having this problem.

Intermittent Diarrhea in Poodle

Question:

My 2 yr. old standard poodle has an episodes of diarrhea and some vomiting. I hadn't been too concerned as my other dogs and my friend's dogs were going through the same.

Mid July, after a 10 day stay in a vet's kennel, Sam came down with another bout of diarrhea. After a couple of days he was fine. A week later it recurred. I gave him some diatrim that had been prescribed for him on another occasion for the same symptoms but I didn't need to use it at that time. A week or so after the antibiotic , the same symptoms reappeared. The vet put him on Flagyl thinking he might have picked up Giardia from the kennel. A week or so later the same symptoms came back--a couple episodes of vomiting and diarrhea. this time the vet weighed him and he had lost 7 lbs so blood work was done. The bilirubin values came back elevated-1.1. Every other value was normal. So, the vet suggested bile acids test. Pretest values were 2.o, post test 2.9. My vet is stumped and is suggesting a major structural problem with Sam's liver. He will be conferring with a "super" vet and getting back to me on Tuesday. In the meantime I'm wondering what your thoughts might be and what direction you suggest we go to get more information aside from a biopsy which the vet has mentioned.

Interestingly enough in the last week, Sam has regained 1 pound which has been confirmed on 2 different scales. While he is a couch potato inside he continues to be full of it outside even during the episodes of diarrhea with exception of the last bout where he was somewhat lethargic.

Thanks so much for any advise you might have.

Answer: 

Just based on the bile acid response testing, I would tend to think that your poodle's liver is normal, unless the lab has different normal values than I am used to, or is reporting in units that I am not familiar with. According to information in "The Textbook of Veterinary Internal Medicine" by Ettinger and Feldman, the normal values for the baseline serum bile acid test is 2.3 +/- 0.4 uM in dogs and the post feeding value 8.3 +/- 0.3 --  but I know of no reason to worry if the bile acids are not elevated on the test after eating and our experience has been that this is not highly unusual. The bilirubin level is elevated but that is a less meaningful test result and it isn't elevated very much.

I know that doesn't help much in figuring out what is going on. It can take a lot of diagnostic work to figure out what is causing intermittent diarrhea. It is a good idea to try to rule out giardia, since it is hard to find and frequently present. Metronidazole (Flagyl Rx) is also helpful in inflammatory bowel disease, so a response to it can be an indication that problem is present, if there is a relapse after it is withdrawn. Trying a low fat diet sometimes helps. Using a novel protein diet can help rule out a food allergy or other sensitivity to food. Often it is necessary to do an endoscopic examination to see what is going on in the intestinal tract and to obtain biopsy samples for pathology examination.

It is good that your vet is consulting with a specialist and hopefully you will know more when you get the results of that consultation.

Diarrhea with Giardia to Start...

Question:

I have two dogs that began having diarrhea a little over a month ago. Our vet took a stool sample that was "loaded" with giardia cysts. He treated them with Metronidazole. After the treatment their stool was re-tested and was normal. Within a week the diarrhea started again. This time they were given Panacur and, because no one in our apartment community cleans up after their dogs, we decided to try the giardia vaccine.

The next day the diarrhea was worse and both dogs were in obvious discomfort. A stool sample revealed not only giardia but also a bacterial infection. They were put on a high dosage of baytril for 7 days. After about 5 days on the baytril their stools were completely normal, but both dogs remained very lethargic. We returned to the vet 6 days after starting the baytril and there was no giardia and no infection. Although the vet was not aware of baytril causing lethargy, he told me to reduce the dosage to half for another day and then discontinue. Within a week one of the dogs began having very loose stools. I took a stool sample to the vet but nothing showed up.

Two days later both dogs were having loose stools. We took them back to the vet, again nothing in the stool. We had their giardia vaccine booster done at that time. That was 4 days ago. One dog is now having normal stool, but remains very lethargic. The other still has extremely loose stool and is also lethargic. On two occasions he has had what appeared to be blood in his stool (very black).

I'm frustrated and worried. I've tried giving them pumpkin and live culture yogurt, which seemed to help one but nothing is helping the other. Do you have any thoughts? What do you know about the Giardia Vaccine? (My vet said they have had a lot of success, but it's still very new) Any direction you can give me would be greatly appreciated!

Answer:

I have not used the giardia vaccine from Ft. Dodge, yet. However, veterinarians who have used it seem to think that it works well. It may not help to clear up an existing infection but it may help to prevent future ones. In the vaccine company's studies the vaccine protected against clinical signs of the disease but did not prevent infection. Since the clinical signs are what most people worry about, this is probably OK.

Metronidazole (Flagyl Rx) and fenbendazole (Panacur Rx) are both used frequently to kill giardia, so they are good choices. If these do not seem to work, albendazole (Valbazen Rx) 12.5mg/kg every 12 hours for four doses may also be helpful.

It is possible that there is another problem. With both dogs affected it makes sense to look for an infectious cause, though. Since no other intestinal parasites have been showing up on the fecal exams and since Panacur also kills most intestinal worms, it may also be a good idea to consider the possibility of another problem at this time. Other possible problems include cryptosporidiosis, clostridium, salmonellosis and campylobacter. Protozoan organisms like Balantidium and Entamoeba species are also possible.

There is a good chance for most of these problems to clear up on their own but if intermittent problems continue it may be worth looking for one of these problems.

The lethargy is a little worrisome. It might also be worthwhile to consider a general chemistry panel and white blood cell count if that continues to be a problem, since there could be two problems or a systemic problem causing both signs. This can be seen with kidney problems and liver problems.

I hope that both dogs are doing OK at this time but if not, expanding the search for the cause seems like the most logical approach to me.

Severe Recurring Diarrhea, Coccidia and Giardia

Question: 

I am a subscriber and would be very interested in your opinion with regard to diarrhea/coccidia in dogs.

I have three dogs (3 year old Portuguese water dog, 5 and 7 year old mini schnauzers) who have had a number of bouts of diarrhea, over the past several months, but are otherwise very healthy and active. Stool specimens were positive for coccidia on two occasions, on all the other occasions, they were negative. One bout was particularly severe with much mucous and blood, (but never a diagnosis) that lingered for weeks, controlled somewhat by diet, but relapsing several times with every attempt to wean back to the old diet. After several weeks, a number of medications were tried all at once (Panacur, Flagyl and another medication, I believe, for Giardia) with good results (but never a diagnosis from stool sample). During another bout, the dogs had been noted to be nibbling on rabbit droppings in the back yard and stool at this time showed "a strange strain of coccidia," which my vet thought might have been caused from the rabbit droppings. What are your thoughts on all of these incidences of diarrhea, and is it possible for coccidia to "jump species?" Thanks so much for your input...

I've learned so much from your web site and info digest—they're just terrific. Bless you for sharing so much knowledge.

Answer:

I think that it would be very unusual for three dogs, all adults, to have diarrhea associated with coccidiosis, especially severe bouts of diarrhea. Most dogs have reasonably good immunity to coccidia after reaching their adult years. It isn't impossible that coccidia could cause problems but I would tend to look in other directions.

Coccidia are considered to be species specific, for the most part, so it would not be likely for a rabbit origin coccidia to cause problems in dogs. It is possible for dogs to ingest the rabbit feces and coccidia organisms within them and for those organisms to show up in a fecal examination done on the dog's stools.

Giardia is a potential problem. It is most often associated with contaminated water sources but seems to be able to survive in kennels, so it does not always  come from contaminated water. There has always been some question about how serious the threat of disease from giardia is. We find it in stools from dogs that are ill often enough to think it is a real pathogen, though. There are many clinical reports of chronic diarrhea associated with this organism and it would be killed by metronidazole (Flagyl Rx) and fenbendazole (Panacur Rx) so the response to medication might be a clue that it was present.

I think that food poisoning is more common in dogs than we realize, since few vets really try to confirm or refute its presence. We have seen several instances of whole neighborhoods of dogs coming down with symptoms of food poisoning (in one case botulism, which does have pretty specific clinical signs) associated with compost piles and other sources of contaminated food. If your dogs are not confined to your yard, this is potentially a problem.

There are other potential problems, including viral illnesses such as coronavirus, which may infect three dogs in one household at the same time. Coronoavirus infection is usually reported to cause a mild transient diarrhea but does affect dogs of all ages. There are a number of other intestinal bacterial pathogens, as well. Fecal cultures for bacterial infection might be worth pursuing if this problem continues to recur. Additional fecal examinations for parasites is reasonable, too. Whipworms can be hard to find on a stool sample and giardia probably shows up in normal fecal exams less than a third of the time in dogs that are known to have the problem. Repeated stool samples are often necessary to find these parasites.

Once in a while there are problems with food that don't appear to be bacterial or viral but that lead to diarrhea. We have seen this when a new bag of a dog food, same brand, is opened and all of the dogs in a household suddenly get diarrhea. I am not sure if it is food spoilage, changes in ingredients or what happens but I can remember several instances of clients complaining about this situation. It isn't a common problem but it is worth considering if you think back and realize that the problems occur when new bags of food are opened. If brands of food are suddenly changed it is not unusual at all to see diarrhea if the switch to the new food is not made gradually.

It may take more time to figure out what is going on, if there are going to be recurrent problems. Hopefully that won't be the case, though.

Chronic Diarrhea in Dogs

Question:

I have a 15 yr.old dog (Sugar) who has had diarrhea for 5 months. It started while she was on a series of antibiotics to clear up a recurrent infection in one of her hind feet, so we (the vet and I) assume that was the cause. Over the past 5 months we have tried various cures including metronidazole, fasting, hamburger and rice, yogurt and canned pumpkin but nothing has helped.

In spite of the diarrhea Sugar isn't losing weight, also she usually has no trouble controlling her bowel movements, although sometimes I can tell by the look on her face that I'd better get the door opened fast, and she seems to be feeling fine otherwise.

My vet has suggested that this may be something we will just have to live with, esp. since there is no weight loss. That's ok with me but I can't get rid of the nagging worry that the diarrhea is a sign of some other problem we shouldn't ignore or that it will in time cause problems. What do you think?

Thanks for your help on this question and thanks for your web site and digest, I appreciate all your hard work on behalf of pets and owners.

 

Answer:

Antibiotics sometimes do cause diarrhea and it can be pretty hard to control once it starts in rare instances. But I tend to agree with your gut instinct that something else is contributing to the problem.

When we have a patient with chronic diarrhea and we have tested for intestinal parasites a couple of times without finding them, have tried a brief period of fasting and highly digestible diets, a week or so of anti-diarrheal medication and metronidazole, all without success, we start to look for systemic problems that might be leading to diarrhea, try to rule out cancer as best we can and consider referral for endoscopic examination or other more advanced testing.

It is always hard to figure out how far to go with testing when dealing with an older patient but doing a good serum chemistry panel and complete blood count is almost always reasonable and sometimes uncovers a problem that is contributing to the diarrhea. Careful abdominal and rectal palpation sometimes reveals a tumor or polyp that is contributing to the diarrhea. X-rays are not often helpful but are worth taking just to rule out the things that do show up. Specialized X-rays, like barium studies, are also sometimes helpful and can be done by many general practice veterinary hospitals.

When clients can't afford to have further diagnostic work done and everything up to this point is OK, we will sometimes try amoxicillin—it seems to work for some cases of small intestinal bacterial overgrowth and we don't see any problem with controlling the diarrhea with loperamide (Immodium AD TM) or diphenoxylate (Lomotil Rx) if it makes the patient or client more comfortable.

If further diagnostic workup is possible we usually refer patients to an internal medicine specialist in our area who does endoscopic examination and biopsy. It is often the quickest way to get to a diagnosis.

It is a good sign that Sugar is maintaining her weight well. It makes it a little less pressing to get to a diagnosis but I'd still want to pursue one in a pet of my own. If you feel the same way, just let your vet know.

Loose Stool in Cocker Puppy

Question:

We got a new  cocker spaniel puppy 3 and 1/2 weeks ago and she is wonderful. We are a little worried because her stool is formed but wet and moist all the time and she goes up to 7 times a day. The breeder we got her from thinks that this is unusual.  We have had her stool checked for worms, the breeder mentioned giardia or coccidia as possibilities. Could this be it? What exactly are these diseases? We feed her Science Diet puppy food, is this a good food?

Answer:

I have a small cocker mix dog who is ten years old and she still has at least 6 bowel movements a day, usually small and moist. So I think that this could be completely normal. On the other hand, giardia and coccidia, two protozoan parasites, do sometimes cause enough enteritis to produce a frequent urge to defecate and softening of the stool or even diarrhea. Coccidiosis is fairly common and giardia is not uncommon. Coccidia usually show up pretty well on a stool sample but are not always present when a dog is affected with them. It sometimes takes several stool samples to find them. Giardia can be harder to find on a stool sample. There are other tests for giardia but I have not really been able to figure out how accurate they are at this point. We often just try treating for it when we are concerned it may be present.

I think that Science Diet puppy food is fine. In general, I think that most of the major brands of puppy food are trying hard to do a good job of providing the necessary nutrients and most do. Some dogs will do better on one brand than on another and I think it is OK to switch brands if there is any question. It just has to be done slowly. Mix the new food with the old food for at least four days, starting with about 1/4th new food and gradually increasing the amount.

Hope this helps. I'd probably just recommend checking a couple more stool samples before doing anything else, as long as the stools don't get looser but you probably should talk to your vet about this concern, too.

Chronic Diarrhea Control with Complicated Medical History

Question:

I have really enjoyed your website and have passed on the address to my regular vet clinic web site people since they like to reference useful websites.

I have a female spayed LabX that is almost 14 years old named Shadow. She has a number of medical problems and I have 2 wonderful vets that work with me to care for her. She is being treated for lymphosarcoma (one of the vets is a board certified oncologist). She also has some problem in her back (about L4) which requires her to be on 15 mg of prednisone each day. She has had a very sensitive liver to a number of medications over the years (before the cancer) which have caused her Alk Phos, ALT, and GGT to be above normal. In the past, Adequan and Rimadyl have been culprits. Recently we put her on Flagyl (500 mg, 2x day) for a chronic diarrhea problem. It helped the diarrhea, but after a while, she started panting excessively (a sign for me that her liver enzymes are probably high). Blood work showed the Alk Phos at 6100 and ALT at 1000. We took her off and her enzymes are going down and she is not panting as before. 

My questions are as follows:

1. Have you ever heard of Flagyl affecting the liver enzyme levels?
2. The drug Tylan has been suggested as an alternate for the chronic diarrhea. Do you know of any side effects or adverse reactions of this in long term use?
3. Currently I am controlling the diarrhea with Kaopectate as a long term remedy. It works well and I almost had her off of it but we had to give her chemo again which always causes the diarrhea to recur. Do you know of any side effects or adverse reactions of Kaopectate in long term use?
4. Currently I am preparing her food to control the diarrhea. It seems that all of the bagged foods are a problem for her. I feed her rice, chicken, egg and pumpkin. I try to give her mostly egg for the protein since in the past, foods based on that have been shown to be better for her liver (Hill's K/D, IVD Modified). I have a copy of home diets that Hills published in 1987. Calcium carbonate is one of the ingredients in most of the diets. I have called Hills to find out exactly how much calcium is required for a 55-60 pound dog. The answers were not helpful. Do you know how much calcium and what type is needed? I tried crushing egg shells and it's not that easy. I have also tried Tums and Shadow had diarrhea when I gave it to her (coincidence??). I would like to provide her with as balanced a diet as she will tolerate but I have to keep in mind the the restricted protein diet has worked the best for her in the past.

Thanks for all of your help. I believe that all of the information I can get will help me take care of Shadow the best way possible. I love her very much as she is like my child.

 

Answer:

1) Metronidazole (Flagyl Rx) is metabolized primarily by the liver. It sometimes causes liver damage or makes existing liver damage worse. This is thought to be a reversible effect which usually will resolve with withdrawal of the medication.

2) Tylosin (Tylan Rx) is excreted in the urine and in the bile without being processed by the body. It should be less likely to cause liver problems due to this. However, it can cause false elevations of SAP and ALT levels in tests that depend on colorimetry. That might be very confusing in Shadow's case if your vet's lab happens to use that type of test. We have used Tylan for long periods in several dogs and the biggest problem we have had is that dogs get VERY resistant to taking it after awhile. I think it must taste really bad.

3) I don't know of any problems associated with long term use of kaolin/pectate (Kaopectate) in dogs. There is some possibility that it could interfere with tylosin use (it interferes with some other antibiotics) so it would be a good idea not to give it at the same time as the tylosin if you use both. We tend to use other medications (primarily loperamide (Immodium AD)) for diarrhea so I don't have much personal experience to pass on regarding the use of Kaopectate.

4) I am not sure why calcium carbonate is the preferred calcium supplement for balancing dog diets but most references that include home made diets use it as the calcium source. It should take approximately 1.5 grams of calcium carbonate for a 60 lb. dog. I am never sure about the availability of various products in other areas but calcium carbonate is available at the pharmacy in our town as a powder. I think it probably is possible to find it at stores that specialize in health foods or vitamins, too. It would be a good idea to add a multi-vitamin tablet to the recipe you use, too. I can probably find equivalent dosages for other calcium products with some research but I am not absolutely sure of that because the quick search I just did to find the calcium carbonate dose didn't turn up any alternatives with specific dosages. Let me know if you can't find calcium carbonate, though.

Acute Diarrhea in a Puppy

Question:

I had a question about diarrhea. My dog doesn't have CHRONIC but just got it. what are some helpful remedies? He feels miserable. Please add those ideas to your site.

Answer:

Acute diarrhea in a puppy should not be treated at home due to the potential for parvovirus. It really is important to seek veterinary help pretty quickly, especially if the diarrhea is preceded by or accompanied by noticeable depression.

In an older dog with acute diarrhea there are some things that you can do at home that may be helpful. It is often beneficial to with-hold food for 24 hours and to keep fluid intake to small amounts at one time without restricting the total intake. A good method of allowing access to small quantities of water at once is to put ice cubes in your dog's bowl. As they melt water is produced in small quantities. It is usually OK to administer an anti-diarrheal product such as Immodium AD but your vet should calculate the first dose for you. Some vets advise giving a small amount of plain yogurt. If an older dog continues to have diarrhea after 24 to 36 hours without food intake it is a good idea to consult a veterinarian to begin the process of finding and treating the cause of the diarrhea.

Diarrhea in German Shepherd

Question:

My 2 1/2 year old German Shepherd, Simba, has had diarrhea for the last five weeks. He has lost twenty-two pounds (from ninety pounds). Initially, I didn't notice that he was eating outdated dog food from a pet store. It was manufactured in September 1995. In the last two weeks he has been eating new food, but the diarrhea has persisted. I took him to the vet, he tested his stool sample for parasites and pancreatitis. The vet said that pancreatitis was a possibility, but there were no parasites. I've done some research and don't believe that it is pancreatitis because his lower abdomen is not painful to palpations, has not had a loss of appetite and does not vomit. He was neutered and vaccinated just prior to the diarrhea.

Could this have affected the situation being that his system was malnourished from the old dog food and then had to combat the antibodies from the vaccines? He also spent four days in a kennel a few days after the vaccinations at this point is when I noticed the diarrhea. Is it possible that there could be parasites that were not detected and can pancreatitis be determined by just taking a stool sample? These are the things that I have tried: fasting him, giving pepto-bismol and white rice.

There was a slight improvement after the rice, but after eating regular food again, he resumed the diarrhea. Right now, I have fasted him and gave him charcoal tablets. I broke the fast slowly with vegetable broth, then cooked vegetables and now rice and oats. I don't have any more ideas, so any input would be greatly appreciated on my Simba's behalf.

Answer:

In any German shepherd with chronic diarrhea my first instinct is to look for pancreatic insufficiency. In this case, insufficient digestive enzymes are being produced to allow proper digestion. This leads to persistent diarrhea. Pancreatic insufficiency is reasonably common in shepherds. There are pretty accurate tests for this condition now. Blood tests for trypsin like immunoreactivity (TLI) and serum folate levels are an improvement over older tests utilizing digestion of X-ray film. It is important not to overlook other possible causes, though. These tests are simple enough to include in the initial workup of a case, along with the more obvious things you mention, such as ruling out intestinal parasites, a general blood panel to make sure that there is not an obvious organ system problem (liver, kidney) and an attempt to make sure bacterial enteritis is not a problem.

Pancreatic insufficiency is NOT pancreatitis. It is an entirely different problem. Your vet may have been referring to this but phrased the concern badly or may be thinking that pancreatitis is possible. I would tend to agree that it isn't too likely as a continuing cause of diarrhea, though.

If no problem can be found with the labwork above, then the possibility of malabsorption disorders like lymphangectasia becomes more likely. Diagnosis of these conditions is best done by biopsy, usually utilizing an endoscope. We refer patients to an internal medicine specialist for this procedure.

The food can't be ruled out as a source of the initial problems but something else is probably keeping the problem going. Lots of times stressful situations bring on the clinical signs of problems such as pancreatic insufficiency and lymphangectasia or plasmacytic/lymphocytic enteritis—and then these problems just keep on going.

Diet and Diarrhea

Question:

We have a 1.5 to 2 y.o. female beagle we rescued at a local SPCA. Our vet gave her a clean bill of health three weeks ago other than she may have a false pregnancy. The last two days her stoles have been very lose and a rust color. We've had trouble with her eating dry food (Iams) so we gave been giving her a combination of wet dog food and people food (chicken, carrots, canned tuna or beef, mixed with some gravy). The other night we gave her some spare rib meat that had been cooked in tomato gravy and she also got into some soft ice cream (vanilla) and ate the equivalent of a small cone before we got to her. The movements are not frequent nor uncontrollable. It is not the frequency of diarrehea. We can hear her stomach rumbling and she passes gas occasionally. Are we possibly looking at a diet adjustment problem, or something more involved? She has another vet appointment at the end of the month. What could we do diet wise to bulk up the stool? Thanks for your help.

Answer:

With your dog's dietary adventures I think that diarrhea or soft stools related to diet is the most likely problem but it is also possible that intestinal parasites or other problems could be present. If this problem persists it would be best to have your vet re-examine your beagle again. It is probably best to keep at least 90% of the diet a prepared dog food to ensure adequate nutrition. If this is not possible then a varied diet including all the food groups is the next best thing—but occasional bouts of soft stools or diarrhea will probably be a problem.

Diarrhea

Question:

We recently adopted a 4 1/2 month old puppy (shepherd, terrer) mixed breed. We got Shadow from a friend who runs a Pet Kennel. She had been found going through garbage, and was in terrible shape. She weighed only 16 pounds. You could clearly see her ribs and hind bones. She was very weak and not very playful. We fed her 5 small amounts of puppy food everyday for the first week. She responded very well, gaining 5 pounds in just a week. She is playful now like a normal puppy and seems to be easy to train. Our problem is since we have had Shadow, she has had diarrhea.

Our vet gave us Metronidazole 250 mg to her 3/4 of tablet twice a day for the first week. It helped as long as she was on the medication. But as soon as the med. was finished, her diarrhea would return, immediately. We tried it again for another week, only this a full tablet twice a day, with the same result. Then again for two more weeks. Shadow finished her meds. last night and she started with diarrhea again today. Please, can you enlighten me on what the problem might be and the overall prognosis.

Answer:

There are generally three things that metronidazole is useful in treating. Giardia (a protozoan parasite), bacterial overgrowth of the bowel and inflammatory bowel disorders. It is likely that one of these three things is causing the problems you are seeing, based on the fact that it responds so well to metronidazole.

Giardia is sometimes only partially sensitive to treatment with metronidazole. It may be worthwhile to try treating it with another medication. Recently there have been reports that fenbendazole (Panacure Rx) is effective in killing giardia, too. This is a pretty safe medication and it would be worth talking to your vet about trying it.

Bacterial overgrowth occurs when the "good" bacteria in the intestine are overwhelmed by the "bad" bacteria. This can happen when a dog is on antibiotics, with sudden dietary changes and when there is a great deal of stress. Your puppy obviously had both stress and dietary changes to content with. In this case, it might be helpful to add yogurt to his diet or a probiotic substance (I can't remember the names of any of these). This helps to shift the balance back in favor of the bacteria that should be there. It is also OK to use metronidazole for several weeks if that is necessary.

Inflammatory bowel disease is much more difficult to control over the long term. There are a number of causes and they must be sorted through. In general, intestinal biopsy using an endoscope is considered to be the best diagnostic tool. Once the underlying cause of the inflammation is known, a long term treatment plan can be worked out. We have to refer dogs for this sort of diagnostic work and your vet might have to do that, too. When either one of you becomes frustrated it is time to discuss this option.

In most cases, it is eventually possible to control even very difficult cases of diarrhea but it can be a long and frustrating diagnostic process so you have to be a little patient in the early stages. When it is not easy or financially difficult to pursue definitive diagnostic testing it is OK to use "trial and error" approaches to this problem but that often means lots of two and three week trials of medications or hypoallergenic diets and coping with the diarrhea for a while. Your vet will help work through this problem. Good luck with it.