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January 13, 2008

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Diana Guerrero

You know, one thing about good animal professionals--they are obsessed with poop...where were those nifty posters when I was studying?

Maybe you can send me one for Christmas. :-)

I am surprised at the reluctant clients--guess I have been way too compliant about the poop deal.

You post gives new meaning to "talking sh**."

Dr. Patty Khuly

I just found your blog through Embrace Pet Insurance's blog. This is great stuff! Whatever you do don't stop blogging. Oh, and you think Purina will send me one of those poopy posters if I ask nicely?

Doc

Thanks for the kind words. I've had that little poster forever, so they may not be available anymore. that's the trouble with being a geezer. Your favorite stuff is prehistoric. I played string bass with a regional jazz group a few years ago and brought my old Fender bass amp, vacuum tubes and all. "Hey, man, cool amp. Where did you find that thing?" [beat, beat, beat...] "Uh, bought it new."

Thanks for reading and writing.

Kyle

I found your site through alltop.com, and I've really enjoyed browsing through it today. It's nice to read a vet's-eye-view of the world.

Megan

Parts of your post were actually pretty gross. These are not things your read everyday except if you work in a bothell pet hospital at www.kenmorevet.com However, it was very informative. Thanks for posting.

Doc

Hello, Megan,

Hey, there's a warning at the top. What can I say?

Thanks for reading and writing.

lynn

What to do when you are in rural NM and have vets who claim that they "don't have good luck" with fecal exams? My dog has diarrhea again. I am giving him endosorb for now as clinic is closed. The last time he had diarehea the vet went ahead and wormed him for various worms without a fecal exam, gave him antibiotics (he had temp)and endosorb. Is a fecal exam really that iffy that he "doesn't have good luck with it"? How accurate is the fecal test? Or maybe he just doesn't have the time for it; he is a busy rural vet. There is definitely a different standard of care here. The dog's x-ray (which I insisted on) showed lots of stomach irritation. He is a shelter dog who I've had for 3 years who is otherwise healthy (after heartworm treatment) but vomits yellow bile. The vet was not concerned with the vommiting when I brought it to his attention unless it "increased dramatically"; so I kept a log and it did increase. It is usually in the morning, he wretches, and then produces a beaten egg like yellow bile. His vomitting decreased for awhile after advice from another vet to switch to a fish based kibble. Now the vomiting is increasing again. Is there a link to the vomitting and diahrreah? What tests would you recommend? The last time he had blood work the vet said it was as close to perfect as could be. Any suggestions?

Doc

Hello, Lynn,

What the clinical pathology people have told me is that they will do flotation exams on at least three different stool specimens before calling it "negative".

Because you are looking for microscopic eggs, you can sure miss them, even with a thorough examination of the stool. The parasites aren't little machines. Some stools will have lots of eggs, very few.

Typically, when we suspect parasites, but cannot find them, we treat for the most common parasites and assess the response: tapeworms, whipworms, hookworms and roundworms.

Whipworms often cause intermittent diarrhea with blood and mucus, and can also cause occasional vomiting.

I'm wondering what was seen on the X-ray, as soft tissues usually don't show up very dramatically. I'm guessing it was a lot of gas-filled bowel loops (which is abnormal).

Vomiting bile just means that you are vomiting on an empty stomach.

THere are certainly dogs who have dietary intolerances (not exactly food allergy, but sort of).

I have seen dogs with this problem become much improved when put on a hypoallergenic diet, like Purina HA, or Hill's Z/D. These hydrolyzed antigen diets can sometimes cause a mild loose stool, though.

Inflammatory bowel disease is poorly understood, seeming to be the dog's own body defenses causing damage to the intestines. Sometimes the hypoallergenic diet helps, sometimes you have to use corticosteroid drugs to suppress the body's defenses for a while.

Diagnosis is kind of iffy. To prove it's there, you need a full thickness biopsy of the intestine (requiring exploratory surgery). The problem is, if you've been having this kind of trouble for a while, the biopsy will show inflammation no matter what the original cause was.

Acid reducers might help with the vomiting. I often try using them twice daily. This is not addressing the root cause, but some dogs just have "nervous stomach" and reducing the excess acid production makes them quit vomiting (or reduces the frequency).

Chronic diarrhea can also be due to a shift in the bacterial population in the gut. Using probiotics (like Purina's Forti-flora) to re-establish the normal bacteria can help. Some dogs will really benefit from treatment with the antibiotic metronidazole. It kills bacteria that thrive without oxygen, and it has an anti-inflammatory effect on the colon.

The drug sulfasalazine is also used for chronic colitis.

Sometimes the testing is very frustrating and unrewarding, and you start trying one medicine after another. This is also frustrating, and makes you feel like a quack. On the other hand, exploratory surgery and biopsy sometimes just tells you, "Yeah, the bowel is irritated all right".

I once had a dog with histoplasmosis (a systemic fungus) in his intestinal lining. This is very unusual, and would not have been diagnosed without the biopsy that we did (via colonoscopy). Treatable, but a difficult case to diagnose.

Cultures of the stool sometimes reveal bad bacteria, but usually just show the "usual suspects" and don't tell you much. You don't know unless you try.

I wish I could give you specific advice, but I really cannot do that without seeing your dog.

Good luck.

Jody

Thank you for your response.

The X-ray showed "quite a bit of irritation to stomach and small intestines" and an "empty stomach" at the time.

Currently feeding him Core Ocean, softed with water, and I break up his meals so he is feed 3 times a day.
He is a Corgi-Chow or something Mix and weight ranges from 46-49 lbs of low-rider dog. He has a healthy appetite and looks to be a healthy weight; vets said he was at a health weight.

I feel somewhat reassured that he was treated for "all the usual suspects" you mentioned above. My concern was overtreating without a definitive diagnosis. But, as you've said, sometimes that doesn't happen. I was giving him generic pepcid twice a day, but then vet recommended just using the endosorb for awhile. Also, one vet did give metronidazole as you mentioned. It is hard to tell just what helped at the time.

Hiking off leash in the Gila Wildreness, he does roll in and sometimes eats who knows what wild animal feces and dead animal carcass. Any special considerations for worming or testing a dog regulary exposed to this?

Maybe I will try to collect 3 stool samples for next visit.

Thank you for time! I've often recommended your blog to others.

--Lynn

Doc

Hello, Lynn (jody?),

I an intrigued by the possible exposure to wildlife parasites. Perhaps you could get in touch with your state's conservation department (forest rangers?) and ask for a referral to one of their naturalists. These folks might be able to give you a line on wild animal parasites that are a risk to domestic animals.

Just a thought.

If the dog is repeatedly getting exposed to pathogens by eating yucky carcasses, then he may need repeated treatment for this (as in another round of metronidazole or fenbendazole).

Good luck.

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