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Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 28513
Experience:  University of California at Davis graduate veterinarian with 45 years of experience
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It puppy Lucas developed diarrhea about 6

Customer Question

Hi,So it puppy Lucas developed diarrhea about 6 weeks ago. Fecal tests for giardia and all else were negative prescribed flagyl twice. Worked wonders but everytime we tried to take him off it returned. I pushed to have him tested for pancreatic and some other test to ensure it was not a malabsorption issue even though the vet thought highly unlikely since he was gaining weight and flourishing every other way. Decided to put on hypoallergenic food and do a slow wean off flagyl from twice a day to once a day to every other day. He was doing great on the once a day but once we tried to wean him to every other it returned. so now we are back to twice a day until stool normalizes and then down to once a day. It has formed the stools up some but not back to had they had been after three days on this dosage. I really don't want to keep him on medication so long but I'm at a loss for what else to do or recommend we try at this point I think vet might be too! Looked to see if there were vets around me that specialized in gastro issues around me but didn't seem such exists. Vet assured me a once a day is very low dose and it's safe but still. They ordered a new food that's hypoallergenic and for sensitive stomachs or something to the like as this food she said can be very rich and actually seems to be making stool loser to some degree. At a lose and any suggestions or advice will be greatly appreciated! Every single test we have run has been negative!!Thanks!!
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Dr. Michael Salkin replied 1 year ago.

Tara, Lucas's positive response to the antiinflammatory antibiotic metronidazole strongly suggests inflammatory bowel disease (IBD) in my patients. This can be confirmed by scoping and biopsy of his gastrointestinal tract but I have no objection to seeing if metronidazole or a glucocorticoid such as prednisone is helpful in these cases as a positive response to either can be just as diagnostic as blood and urine tests.

It's important to recognize that a food intolerance can be found concomitantly with IBD and finding a diet that Lucas tolerates well might well obviate the need to medicate for IBD. I don't know which food was ordered but I prefer the hydrolyzed protein diets because there's nothing in them that Lucas's immune system would be intolerant to.

In summary, then, I see how a hydrolyzed protein diet affects my patient. If complete resolution of diarrhea isn't seen, I prescribe metronidazole and try to find the smallest dose given as infrequently as possible that controls the diarrhea. If that can't be done, I consider prednisone instead of the metronidazole. If the diarrhea still isn't completely controlled, I'll give metronidazole and prednisone concurrently. If I still don't see complete resolution of clinical signs, I scope and biopsy my patient's GI tract looking for less common disorders.

Please respond with further questions or concerns if you wish.

Customer: replied 1 year ago.
He is on Z/D. Like I said, he was doing fabulous on this paired with the once a day flagyl then when we tried to wean to every other day it started again and so now we are back to two a day till it normalizes then fade to one again for a month. Could it be a bacterial overgrowth in the bowel? Would that be treated differently? If it is IBD would he ever outgrow it? I'm just concerned about the long term effects of this constant medication on his health and ensuring I'm treating the problem rather than just masking it.Thank you!
Expert:  Dr. Michael Salkin replied 1 year ago.

z/d would be my first choice. Bacterial overgrowth - now called antibiotic-responsive diarrhea/small intestinal dysbiosis - is possible as a complication of other underlying GI and/or exocrine pancreatic disease (common). Most cases are diagnosed empirically based on a response to a course of oral antibiotics implemented when other common causes of diarrhea have been ruled out. IBD can wax and wane but "outgrowing it" isn't expected. I understand your concerns. You might be more comfortable obtaining a specific diagnosis by scoping and biopsying Lucas's GI tract. We don't do that soon enough in too many patients.

You're quite welcome. Please continue our conversation if you wish.

Expert:  Dr. Michael Salkin replied 1 year ago.
Hi Tara,
I'm just following up on our conversation about Lucas. How is everything going?
Dr. Michael Salkin

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