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My dog is a 17lb female cavachon. She was “finally”

My dog is a...

My dog is a 17lb female cavachon. She was “finally” diagnosed with Giardia after being ill since early April. (Nausea, gas, stomach pain, only 1 episode of diarrhea, lethargic) Has been eating bland diet of boiled beef and white potato since April 12. Began the following on 5/15/18, metronidazole 250mg 1/4 tablet 2x a day. Pepcid 5mg 1x a day. Probiotic 1x a day. Stools were formed, a little slimy looking, and only having a bowel movement every other day at best. Sometimes bowel movement every 2 or 3 days. No improvement, so added Panacur liquid on 5/25/18, 3.5ml once a day for 7 days. After adding Panacur stools started showing patches of green, still slimy, and sometimes ribbons of blood. During this time my dog seemed less nauseous and no more gas or stomach pain. Finished Panacur, but continuing to take the Metro and Pepcid. Stool today still shows patches of green and a little slimy, no blood. I know green can indicate parasites present. I’m concerned the Giardia is not only still present, but possibly getting worse and resistant to the medications being used. She has been on this bland diet for so long and I am also concerned her immune system is not strong enough to fight the Giardia. To date she has lost 2 1/2lbs. Fortunately that seems to have stabilized. Before Giardia diagnosis she was treated with Clavamox in April for a UTI. She also had an abdominal ultrasound and chest x-ray. Normal findings. Also normal blood work results from blood taken in April and again in May. Recent urinalysis was normal too. I feel like her environment is as clean as possible to avoid further contamination. House and belongings have been and continue to be throughly disenfected. She gets weekly baths and every time she goes outside now she gets her feet, legs and bottom wiped clean. Other than a follow up fecal test, what would be your suggestion for further treatment and/or testing? Should she continue on the bland diet?

Veterinarian's Assistant: I'll do all I can to help. This sounds like it might be serious. I'll let the Veterinarian know what's going on ASAP. Is there anything else the Veterinarian should be aware of about your dog?

She is six years old and has a history of bouts with diarrhea beginning a a puppy. I personally believe she has chronic Giardia that has never fully been cured and becomes active after stressful events given the history of when GI upsets have occurred. This time has been the absolute worst. We had to put down our other dog after a long illness in April 2. That and frequent stressful trips to the vet have caused her a great amount of stress.

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Answered in 4 hours by:
6/2/2018
Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,548
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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You're speaking to 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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I'm sorry that your question wasn't answered in a timely manner and I'm sorry to hear of this with your cavachon.

1) Fenbendazole is the drug of choice when addressing Giardia. It's important to note that Giardia-ELISA kits have limited usefulness for post-treatment diagnostic surveillance because of prolonged persistent antigen shedding even in dogs where clinical signs have resolved and no cycsts can be detected on zinc sulfate centrifugation. We need to depend upon evaluating stool quality instead. The lack of diarrhea usually suffices.

2) Green in the stool indicates excessive bile production - more than the intestinal bacteria can metabolize into stercobilinogen - the compound that gives stool its characteristic brown-black color. Slime indicates mucus which becomes more apparent if a colitis exists as the colon is rich in mucus glands.

3) Can you upload a copy of her most recent test results to our conversation? I understand that you might not have a copy at home but her vet can give you one which you can scan into your computer and then give me the file link or you can photograph the pages and upload them by using the paperclip icon (if you can see that icon) or by using an external app such as dropbox.com/

I not only review the test results but also note which tests should have been performed but weren't.

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Customer reply replied 2 months ago
I do not have a copy of the most recent lab results. I wouldn't be able to obtain one until Monday. I do have the following information from my notes with the internal medicine specialist that performed the most recent tests.
CBC normal, serum chemistries unremarkable, USG 1.030, pH 8.5. Abdominal ultrasound demonstrated a small amount of fluid in the pyloris and mild hypermotility (7-9 peristaltic movements per minute) No abnormalities of any organs. No free fluid within abdominal cavity. Fecal analysis positive for Giardia. Note that Helicobacter could be a possibility due to GI signs. Recommends gastroduodenoscopy ($2,600) if no improvement in the next 3 weeks.
Based on my own Giardia research I discovered the metronidazole is only 60-70% effective so I requested my regular vet also give Panacur. Treatment course I have found online says Panacur for 5 to 7 days, stop for one week, then Panacur again for 5 days, then two weeks after stopping the medicine perform a fecal float test. I have found different suggestions online for the fecal float tests, ranging from 3 tests over a period of 5 days to one test every month for 3 to 4 months. My vet wants to do the antigen test instead of the fecal float test. My research indicates the antigen test for giardia can show positive for 6 months or more after successful giardia treatment. It seems like a waste of money to perform the antigen test right away. At this point I can tell my vet is rather annoyed with me given my request for the Panacur and the fecal float follow-ups instead of doing the antigen test.
I initially took Daisy to our vet on April 3, 2018 for a physical including blood work and urinalysis. This wasn't a scheduled yearly visit. She had one in December. I took her because we had just put down our other dog and I wanted to make certain Daisy was in good physical health so we could establish a baseline and hopefully avoid any potential problems down the road by being proactive about her health care. The only issue she had at that visit was minor scratching of her ears, but no infection and no need for any medicine. Overall a healthy dog. One week later she started acting ill. This resulted in multiple stressful vet visits which included taking blood 3 different times, 4 cystocentesis, a UTI diagnosis, antibiotics, bland diet, x-rays, ultrasound, and more medicine. She is now terrified to go in the car for fear she is going back to the vet. She used to love car rides.
I am encouraged by the fact that my dog does seem to be less nauseous and has been a little more active lately. However, she is definitely not 100% better. I honestly cannot afford the endoscopy. At best I could medicate her for the possibility of Helicobacter. My biggest concern is possible long term damage from the giardia and the use of antibiotics. I am also worried about her being on this bland diet for almost 2 months. At the same time I do not know how I can try and switch her to a more complete diet given her GI issues. Money has also become a real issue given the thousands of dollars we have spent on vet bills and testing since February for both of our dogs. I'm not sure what else I can or should be doing for Daisy. I'm hoping she just needs time to heal from the giardia and with time she will be back to normal. By the way, no one at any point suggested doing a fecal test. Only by chance was it done because the morning of her scheduled ultrasound I picked up her stool, and something told me I should take it to her appointment. I feel like a lot of these vet appointments and expensive tests could have been avoided if a simple fecal test had been done weeks ago. I would really like to know your thoughts. I think it is important to hear from someone who isn't looking to be making money from treating my dog.

Thank you. Give me a moment to review that history...

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I'm pleased to hear that a specialist veterinary internist attended to her. It's very unlikely that I can add anything that you haven't already heard from the specialist.

1) Scoping is required to confirm Helicobacter but presumptive treatment for that infection is reasonable. It involves amoxicillin or tetracycline plus metronidazole, bismuth subsalicylate (Pepto Bismol or KaoPectate) or azithromycin or clarithromycin and omeprazole. I believe if you tell the specialist that you can't afford scoping and would like to try presumptive therapy, you won't get any resistance from him/her.

2) You're correct. Metronidazole can be helpful when administered in conjunction with fenbendazole but isn't appropriate as sole therapy against Giardia. I rarely test post-treatment; instead, if diarrhea persists, I'll simply repeat another 7 days of fenbendazole. If symptoms persist, I might see if febantel-pyrantel-praziquantel or ronidazole are helpful.

3) As mentioned above, ELISA testing alone shouldn't be considered post-treatment. Here's what you need to know about post-treatment testing:

Giardia ELISA Positive/Flotation Positive
The animal is infected with Giardia.

Giardia ELISA Positive/Flotation Negative
The animal may be infected with Giardia but is shedding cysts below the limits of detection by flotation. Alternatively, the ELISA is a false positive that may be seen most frequently when the results are in the low positive range. To resolve the issue, collect a second sample for analysis.

Giardia ELISA Negative/Flotation Positive
The animal may be infected with Giardia but is producing antigen below the limits of detection by ELISA. Alternatively, the ELISA is a false negative. To resolve the issue, collect a second sample for analysis.

Giardia ELISA Negative/Flotation Negative
The animal is not infected with Giardia.

It isn't clear to me why a bland diet needs to be fed at this time. If I were to feed a special diet, it would be presumptively hypoallergenic such as a hydrolyzed protein prescription diet available through your vet. Please continue our conversation if you wish.

Dr. Michael Salkin
Dr. Michael Salkin, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 35,548
Experience: University of California at Davis graduate veterinarian with 45 years of experience
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Thank you for your kind accept. I appreciate it. I can't set a follow-up in this venue so please return to our conversation - even after rating - with an update at your convenience. You can bookmark this page for ease of return.

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