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I have a seven month old boxer that is having chronic

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I have a seven...

I have a seven month old boxer that is having chronic diarrhea now for abou three months. All stool samples have come back good he has been on 2 different types of antibiotics, I have also changed is dogg food twice he does fine with the rice in the food but as soon as I remove the rice from the diet it comes back . PLEASE HELP!!

Veterinarian's Assistant: I'm sorry to hear that. What is the dog's name?

Jax

Veterinarian's Assistant: Is there anything else the Veterinarian should be aware of about Jax?

As far as medical conditions no. He is still very active and playful but he also feels the need to relieve himself after playing outside with kids, which is abnormal for him because he usually only goes to relieve himself after a meal.

Submitted: 8 months ago.Category: Dog Veterinary
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Answered in 7 minutes by:
9/19/2017
Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 33,795
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Dog Veterinarian: Dr. Michael Salkin, Veterinarian replied 8 months ago

I'm sorry to hear of this with Jax. Before I post my entire approach to chronic diarrhea in dogs, please be aware that in boxers we need to be concerned about "boxer colitis" which refers to the inflammatory bowel variant of granulomatous enteritis/colitis. This is confirmed by scoping and biopsy of the GI tract. It's treated with the antibiotic enrofloxacin alone or in combination with the antibiotics metronidazole or amoxicillin. A low-fat, fiber-enriched commerical diet can be helpful in these boxers as well.

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

1) Presumptively 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 and endotoxin assays 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 Jax's 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 his 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 patient.

Please respond with further questions or concerns if you wish.

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Experience: University of California at Davis graduate veterinarian with 45 years of experience

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