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Diarrhea and Loose stool
Loose stools in Lab puppy
Intermittent diarrhea
Diarrhea with giardia to start...
Severe recurring diarrhea, coccidia and giardia
Chronic diarrhea
Loose stool in Cocker puppy
Chronic diarrhea
Acute diarrhea in a puppy
Diarrhea in German Shepherd
Diet and Diarrhea
Diarrhea
also see Giardia
also see Vomiting with diarrhea
also see Metronidazole
also see Digestion
also see Vomiting
also see parasites
also see infectious disease
Question: Hello Dr. Mike,
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.Shirley
Answer: Shirley-
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 or if she had been examined.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.Mike Richards, DVM
5/18/2001
Intermittent diarrhea in Poodle
Question: Dr. Mike.
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.
Sue
Answer: Sue-
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.Mike Richards, DVM
9/20/2000
Diarrhea with Giardia to start..
Question: Dr. Mike,
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!Thanks!
Jan
Answer: Jan-
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.Mike Richards, DVM
9/7/2000
Severe recurring Diarrhea, Coccidia and Giardia
Question: Hello!
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.Best regards
K. P.
Answer: K.P.
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.Mike Richards, DVM
10/21/99
Q: Dr.Mike,
I have a 15 yr.old dog(Sugar) who has had diarrhea for 5months. 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.Mary
A: Mary-
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.Mike Richards, DVM
7/21/99
Q: Dr. Mike,
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?We always appreciate your responses... thank you!
Shirleen
A: Shirleen-
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. Giaria 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.Mike Richards, DVM
6/10/99
Chronic diarrhea control with complicated medical history
Q: Dear Dr. Mike,
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.Debbie
Answer: Debbie-
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.Mike Richards, DVM
5/25/99
Q: 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. thanks. mj
A: mj-
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.Mike Richards, DVM
Q: Dear Dr. Mike, 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. Thank-you in advance, Judy
A: 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.
Mike Richards, DVM
Q: Dear Dr. Mike, We have a 1.5-2 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.
A: 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.
Mike Richards, DVM
Q: Dear Dr. Mike, 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.
A: 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.
Mike Richards, DVM
Last edited 02/21/03