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My golden is 10 months old and continues to struggle with…

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My golden is 10...

My golden is 10 months old and continues to struggle with diarrhea. When we brought him home he had Giardia, since then he has had 5 negative stool samples. He has been put on metronidazole, been given a pancreatic and enzyme test which came back clear. Every time we stop the antibiotic 2 days later the diarrhea returns.I am running out of things to do to help him. He has also been on ID food for the last month.

Veterinarian's Assistant: I'll do all I can to help. What is the Golden's name?

Jordy

Veterinarian's Assistant: Is there anything else important you think the Veterinarian should know about Jordy?

Not really. He acts fine and plays well. He eats and drinks well. My wife and I do not feel we can leave him in his kennel for longer than a couple hours for fear of diarrhea

Submitted: 7 months ago.Category: Cat Veterinary
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Answered in 23 minutes by:
12/8/2017
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 7 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Cat Veterinary
Satisfied Customers: 34,762
Experience: University of California at Davis graduate veterinarian with 45 years of experience.
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You're speaking with Dr. Michael Salkin. Welcome to JustAnswer. I'm currently typing up my reply. Please be patient. This may take a few minutes.

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Customer reply replied 7 months ago
I have a dog, not a cat
Customer reply replied 7 months ago
Again, I have a Golden Retriever not a cat.
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 7 months ago

I'm sorry to hear of this with Jordy - dog, not a cat! Although metronidazole is not the drug of choice when addressing Giardia, Giardia isn't likely to be the reason for Jordy's persistent diarrhea if 5 fecal ova and parasite exams have been performed and have come back negative. Be that as it may, you can dose Jordy with the drug of choice - fenbendazole - daily for 7 consecutive days in case occult parasitism exists. Fenbendazole is effective against all of the nematodes - roundwomrm hookworm, whipworm - as well as the protozoan Giardia.

I'm suspicious that you're seeing a good response to metronidazole not because of its antibacterial effect but, instead, its immunomodulary effect which allows it to be a drug of choice when addressing inflammatory bowel disease (IBD). I'm going to post my entire synopsis of how I address chronic diarrhea in dogs. Please peruse it and then return to our conversation with further questions and concerns.

I would approach Jordy's chronic diarrhea in the following manner although the order in which I've listed the various approaches can vary:

1) Presumptive worm with over the counter fenbendazole (Panacur) available in many pet/feed stores. Fenbendazole addresses all of the nematodes (roundworms, hookworms, whipworms) as well as the protozoan Giardia. This should be done even if a fecal ova and parasite exam didn't reveal parasites. That exam is too often falsely negative.

2) If worming weren't helpful, perform a gastrointestinal diagnostic panel of blood and urine tests. This should include a specCPL blood test (most sensitive for detecting the presence of pancreatitis), a TLI blood test (to check for maldigestion), and serum folate and vitamin B12 levels (to check for malabsorption of nutrients). Fecal culture looking for the gastrointestinal pathogens Clostridium difficile, Clostridium perfringens, Campylobacter, and Salmonella can be considered as well.

3) If this testing didn't reveal anything untoward, an abdominal ultrasound should be considered. Ultrasound is the most sensitive and readily available imaging modality for the gastrointestinal tract itself. My concerns would be inflammatory bowel disease, lymphangectasia, and neoplasia (cancer) such as lymphoma and solid tumors such as adenocarcinomas.

4) Perform a hypoallergenic food trial in an attempt to identify food intolerance. 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 ***** 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.

5. Scoping and biopsying of the gastrointestinal tract which isn’t performed soon enough in too many of these patients.

Please respond with further questions or concerns if you wish.

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Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 7 months ago

errata: concerns, not cocnerns; Jordy, not *****

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Customer reply replied 7 months ago
How long would you do the panacur treatment for?
Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 7 months ago

Daily for 7 consecutive days. Please continue our conversation if you wish.

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Cat Veterinarian: Dr. Michael Salkin, Veterinarian replied 7 months ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Michael Salkin
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