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Doc Sara
Doc Sara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 952
Experience:  I am a dog and cat veterinarian with a lifetime of experience in our family veterinary hospital.
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I have a 50# ***** year old pit mix. She started with a

Customer Question

I have a 50# ***** year old pit bull mix. She started with a diarrhea about 4 weeks ago with occasional vomiting. We have seen two different vets during this time. She was recently put on a limited ingredient diet canned food diet to avoid roughage, but does not seem to like it and has now not eaten for 2 days but continues with the severe diarrhea. Basic fecal tests and blood work have both turned up negative.
Any suggestions as to what else I might try before investing the next $1000 on further tests?
Submitted: 7 months ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 7 months ago.
My general approach to chronic diarrhea is as follows:1) Presumptively treat with fenbendazole in order to address occult gastrointestinal parasitism. Fenbendazole (over the counter Panacur in pet/feed stores) is broad spectrum against all of the nematodes - roundworms, hookworms, whipworms - as well as the protozoan Giardia. Seven consecutive days of treatment is indicated.2) If I don't see a positive reponse to fenbendazole, I'll consider a hypoallergenic food trial. Food intolerance/allergy is addressed with prescription hypoallergenic diets. These special foods contain just one novel (rabbit, duck, e.g.) animal protein or proteins that have been chemically altered (hydrolyzed) to the point that her immune system doesn't "see" anything to be allergic to. The over the counter hypoallergenic foods too often contain proteins not listed on the label - soy is a common one - and these proteins would confound our evaluation of the efficacy of the hypoallergenic diet. The prescription foods are available from her vet. There are many novel protein foods and a prototypical hydrolyzed protein food is Hill’s Prescription Diet z/d ultra (a hydrolyzed protein diet is my preference because it avoids the possibility of my patient being intolerant to even a novel protein). A positive response is usually seen within a few weeks if we’ve eliminated the offending food allergen. Food intolerance can arise at any age and even after our patient has been eating the same food for quite some time.3) If I don't see a positive response to a food trial, I'll perform a gastrointestinal diagnostic panel of blood and urine tests. This panel contains a TLI blood test which is specific for exocrine pancreatic insufficiency (a lack of digestive enzymes produced by the pancreas), a specCPL blood test which is specific for identifying the presence of pancreatitis, and serum folate and vitamin B12 levels which can be helpful in determining if a malabsorption disorder is present and where in the GI tract it's present. 4) Additional testing may include fecal cultures and endotoxin testing for Clostridium difficile, Clostridium perfringens, Campylobacter, and Salmonella - the most common of the pathogenic bacteria encountered in the GI tract. 5) If 1-4) above aren't confirmative, I need to scope and biopsy my patient's GI tract looking for inflammatory bowel disease, infiltrative neoplasia such as lymphoma, or solid tumors such as adenocarcinomas. An abdominal ultrasound might be performed prior to scoping but can't be as definitive as scoping. Please respond with further questions or concerns if you wish.
Expert:  Dr. Michael Salkin replied 7 months ago.
Hi,
I'm just following up on our conversation about your pet. How is everything going?
Dr. Michael Salkin
Customer: replied 7 months ago.
Jerzee has seen 2 vets with 3 appointments ($800+) over the past five weeks, and I believe we have done pretty much all you recommended in steps 1-4. She has good days and not-so-good days. At this point, we are continuing to monitor her diet and bowel movements .. vomiting has stopped. It is difficult to justify another $500-1000 in diagnostics with still no cure.
Expert:  Dr. Michael Salkin replied 7 months ago.
I understand. I've given you all I have and so I'll opt out which will give other experts an opportunity to enter this conversation.
Expert:  Doc Sara replied 7 months ago.
Hi there, I'm Dr. Sara. I'm a licensed veterinarian who works exclusively with dogs and cats. It's likely that my progression of thoughts will be very similar to Dr. Salkin's, but I will share it with you as well. Diarrhea can be caused by really simple things like bacterial infections or imbalances, viral infections, dietary intolerances, or intestinal parasites. If she's taking a monthly parasite preventive like Heartgard or Interceptor, this makes parasitism less likely but still not impossible - microscopic parasites like giardia and coccidia aren't covered by these preventives and sometimes can cause diarrhea. I know that your vet has hopefully covered these bases well already with a deworming medication like Drontal Plus or Panacur (Fenbendazole) and/or a course of a drug called metronidazole. A bland diet which consists of about 3 parts rice to 1 part boiled white chicken breasts is likely something you've already tried. I typically use this until things start to firm up or we move on to a diet trial. Another good idea would be to purchase a dog specific probiotic product like FortiFlora to help re-establish the right type of bacteria in the gut:http://www.amazon.com/Purina-Fortiflora-Canine-Nutritional-Supplement/dp/B001650NNW/ref=sr_1_1?s=pet-supplies&ie=UTF8&qid=1444322278&sr=1-1&keywords=fortifloraAs the vet, I usually will start with a diarrhea case with a course of a medication called metronidazole which helps rebalance the gut and is also anti-inflammatory, a broad spectrum deworming, and the FortiFlora and bland diet. If that's not helping within a week or two, I usually will suggest running some blood work to make sure that everything is functioning OK inside. This may be where you are in the process. Sometimes we also need to send some blood out to the lab to check the pancreatic function and B12 levels, as problems with those can cause chronic diarrheas that won't respond to your typical treatment. I may also send out a fecal PCR test to check for a wider variety of infectious diseases. At this time, we will often try either a prescription food trial of a highly digestible food like Purina EN or a hypoallergenic food like a hydrolyzed protein source product like Hill's z/d Ultra - these are my usual choices but there are a wide variety of appropriate diets available, so your vet may choose something else. If all of the testing checks out normally and there's no improvement with a diet change, your next step would likely be an abdominal ultrasound or potentially GI biopsies. This is usually the best course of action to determine the underlying cause for the diarrhea. In a young dog, getting an appropriate diagnosis is really important, since treatment may require life long therapy with drugs that can have significant side effects. We typically do not want to embark on a long term course of medication in a young dog without first knowing exactly what we are treating. If further testing is out of the question, a course of prednisone is one of my last ditch efforts for pets with chronic diarrhea who haven't responded to anything else and have all the other testing come back normal. This is because inflammatory bowel disease or intestinal lymphoma can cause GI signs and it responds quite well to prednisone. The only down side there is that we don't know which disease we have initially, because they both respond well. The difference is that IBD can be managed for long periods of time, which lymphoma usually only responds for a few weeks to a couple of months. Depending on your lifestyle and ability and availability of further diagnostics like the scoping, it sounds like you are ready to move on to this or potentially discuss a prednisone trial with your vet. Please let me know what questions I can handle for you.~Dr. Sara ----------------------------------------------------------------------------------------------------------------------------My goal is to provide you with the most complete and accurate “five star” answer. If my answer isn’t what you were expecting, it’s incomplete, or you have more questions PLEASE REPLY to let me know what information you are looking for BEFORE giving me a negative rating! If my answer has been helpful to you, please show me by giving me a favorable rating. Thank you so much :)