Chronic Diarrhoea (groan)

Re: Chronic Diarrhoea (groan)

Michael Woodhouse — Thu, 05 May 2011 23:41:19 GMT

[quote user="Busybee"]Am finding this isn't as easy as it sounds when faced with a 9 year old dog that's had chronic diarrhoea on and off for nearly 9 years but is allergic to numerous food stuffs including beef, chicken, maize, rice, corn.....![/quote]

Try rabbit - if you live in the country often available for free

Re: Chronic Diarrhoea (groan)

Mark Hedberg — Thu, 05 May 2011 20:48:21 GMT

Um, yay preds? :p

Re: Chronic Diarrhoea (groan)

Busybee — Thu, 05 May 2011 17:48:27 GMT

[quote user="Busybee"]65% of chronic diarrhoeas will respond to diet changes[/quote]

Am finding this isn't as easy as it sounds when faced with a 9 year old dog that's had chronic diarrhoea on and off for nearly 9 years but is allergic to numerous food stuffs including beef, chicken, maize, rice, corn.....!

Re: Chronic Diarrhoea (groan)

Rob Loxley — Thu, 07 Apr 2011 18:21:53 GMT

[quote user="Thomas Ward"]though cost constraints meant this was only done on one of the dogs[/quote]

Too late now, but why not pool multiple stool samples from both dogs?

Re: Chronic Diarrhoea (groan)

Tom Ward — Thu, 07 Apr 2011 12:58:38 GMT

Thanks everyone for your help. I treated the giardia with 3 days panacur, and then resampled afterwards which was negative (though cost constraints meant this was only done on one of the dogs, though both were treated). I think my next move will be to try to convince them to use a hypoallergenic diet, though the dogs' food has been chopped around quite alot recently so they may not be very keen (the kennel owner had them on a puppy food and I/D mixture to try to get some weight on them!).

Re: Chronic Diarrhoea (groan)

Dagmar Steele — Thu, 07 Apr 2011 10:25:45 GMT

[quote user="CatherineBoden"]

Nelson and cuoto small animal internal medicine says 3-5days at 50mg/kg sid, so I give 5 days.

[/quote]

there are many protocols out there. We've had so many problems that nowadays we give a course of 50mg/kg over ten days which works considerably better. Hygiene though is a major factor, clean bowls and cat litter boxes with steam cleaner or boiling water every day. It gets difficult with dogs kennels and gardens though....

Re: Chronic Diarrhoea (groan)

CatherineThomas — Thu, 07 Apr 2011 10:15:33 GMT

Nelson and cuoto small animal internal medicine says 3-5days at 50mg/kg sid, so I give 5 days.

Re: Chronic Diarrhoea (groan)

Kate Richardson — Thu, 07 Apr 2011 09:09:10 GMT

What do you use to treat Giardia- the formulary says 3 days of panacur at 50mg/kg sid but I don't always find this is effective. Do you repeat this treatment, go for a longer course or use something else such as metronidazole?

Re: Chronic Diarrhoea (groan)

Anthony Todd — Wed, 06 Apr 2011 23:14:27 GMT

[quote user="Michael Woodhouse"][quote user="Busybee"]Quote from Karen Allenspach - "65% of chronic diarrhoeas will respond to diet changes".[/quote][/quote]+

I remember Colin Burrows in Florida telling me that 90% of diarrhoeas referred to him were dietary sensitivities.

Always was my first elimination, except I used just boiled chicken or boiled fish before all these fancy diets were around.

Re: Chronic Diarrhoea (groan)

Rob Loxley — Wed, 06 Apr 2011 18:00:02 GMT

[quote user="Thomas Ward"]have been diagnosed with a range of parasitic infections (campylobacter treated with erythromycin in 2009, campy and giardia in late 2010 treated with fenbendazole) for which they have been treated, improved and then worsened again[/quote]

What's the current Giardia status of these dogs - maybe worth doing flotation on multiple samples, SNAP and/or IFA to really rule out ongoing parasitic disease? As per other threads previously, giardia can be a sod to clear...
What is the current Campylobacter status too?

[quote user="Thomas Ward"]and are often put into kennels where the D+ seems to get worse[/quote]

Might the kennels have a chronic giardia/campy problem?

I would certainly go for a good quality elimination diet (I find Eukanuba FP to work well) or hypoall diet (if they've too many previous foods to determine a novel diet!) at this stage. Probiotics might help but you need to give a fair few weeks IME.

Re: Chronic Diarrhoea (groan)

Edward Jones — Wed, 06 Apr 2011 14:09:02 GMT

Chappie might be worth a go

Re: Chronic Diarrhoea (groan)

Dagmar Steele — Wed, 06 Apr 2011 13:57:41 GMT

as far as I know it has reduced fat content and it is definitely designed to be easy digestible, hence I have used it. But I may stand corrected....

Re: Chronic Diarrhoea (groan)

Rob Loxley — Wed, 06 Apr 2011 13:38:24 GMT

[quote user="Dagmar Steele"]reduced fat (i.e. Hills i/d)[/quote]

Is Hill's ID particularly 'low fat'?

Re: Chronic Diarrhoea (groan)

Bob Russell — Wed, 06 Apr 2011 11:13:55 GMT

[quote user="Dagmar Steele"]

we see a fair amount of Giardia infections these days and I certainly do not intend to be rude, but has reinfection been excluded (I got suspicious when reading the kennel bit)?

Personal experience is that Giardia affect the guts much longer than they are present in some dogs and a lot of them will need diet, either hypoallergenic or reduced fat (i.e. Hills i/d) for quite a while. When switched back to normal diet after a year or so to my astonishment many of them did ok. Buts this is just my personal experience, nothing ebm or scientific at all.

[/quote]

We have a similar 'problem' dog. He is on monthly panacur (3 days). The owner has been told to pick up the poo ASAP. This one is probably reinfecting so hopefully things will settle now.

Adding a good teaspoon of Forgastrin to each meal seems to help a bit as well.

Re: Chronic Diarrhoea (groan)

Michael Woodhouse — Tue, 05 Apr 2011 21:01:44 GMT

[quote user="Busybee"]Quote from Karen Allenspach - "65% of chronic diarrhoeas will respond to diet changes".[/quote]

I've been doing it right by accident! It's amazing what Eukanuba Intestinal will dry up.

Re: Chronic Diarrhoea (groan)

Stephen Courtney — Tue, 05 Apr 2011 20:54:46 GMT

There is a PCR for Giardia antigen, sometimes works well to nail a diagnosis. Crytposporidia is another possibility, there is a PCR for that too ( Idexx)

I think what has probably happened is that early in life, infections such as Giardia can open up the mucosal barriers and allow antigen presentation that results in food intolerance and or allergy.

Apart from worrying about current infection or reinfection, I also consider novel protein diets ( venison and rice DD often works well) then try hypoallergenic diets like ZD/ other hydrolysed proteins. then try low fat, then try high fiber. Any dog with long lasting diarrhoea most likely has a low Cobalamin, and supplementation is cheap, easy and can be very rewarding. Usually somewhere in here is something that leaves things at least better than they were. But you have to make sure clients know it's a long job, there are no short cuts or quick fixes, and stress not even a mouthful of anything other than the food in the bag...amazing how many people bollix this one, spending £60 or £70 on special Rx diets, then give the dog food off their own plate, or his joint care or dentastix...!

The other big issue is, getting a proper diagnosis - this can be really hard Gut biopsies are important but people often are put off by this. not surprising, as endoscopic biopsies can be unrewarding, and full surgical biopsies carry something like a 10% risk of post op infection according to figures I have heard on CPD courses. I don't think it is wrong to have a therapeutic trial through the various dietary and medical options but it can get confusing, and the time taken to educate the client before embarking down such a road is an important part of the outcome.

Re: Chronic Diarrhoea (groan)

Busybee — Tue, 05 Apr 2011 17:40:21 GMT

She's a fab speaker, was lucky enough to have her as a lecturer at uni!

Re: Chronic Diarrhoea (groan)

Mark Hedberg — Mon, 04 Apr 2011 20:47:20 GMT

[quote user="Busybee"]

The first use of my congress knowledge!

[/quote]

I saw that lecture too, was really good! Not sure how many of my clients can afford bude instead of pred, but overall really enjoyed that one. :)

Re: Chronic Diarrhoea (groan)

Dagmar Steele — Mon, 04 Apr 2011 20:37:54 GMT

we see a fair amount of Giardia infections these days and I certainly do not intend to be rude, but has reinfection been excluded (I got suspicious when reading the kennel bit)?

Re: Chronic Diarrhoea (groan)

Busybee — Mon, 04 Apr 2011 20:12:57 GMT

The first use of my congress knowledge!

Quote from Karen Allenspach - "65% of chronic diarrhoeas will respond to diet changes". Bascially, yes you may well be looking at an IBD type disease. This could be diagnosed on intestinal biopsies. Treatment starts with a dietary trial using a hypoallergenic diet. Continue with this for 2-3 weeks in which time you should see a response. If it does respond, it can be called FRD (food responsive diarrhoea). Continue for a further 8-12 wks if you do see a response, then re-challenge with original diet. You can also use fibre supplements such as Psyllium to improve consistency of the faeces.

If it doesn't respond to a food trial within 2-3 weeks, give up. Can try abs such as metronidazole or immunosupressive doses of steroids. If the dog responds to steroids you can switch ti Budesonide as has less systemic side effects due to 1st pass hepatic metabolism (0.5-3mg/dog SID or EOD). Treat for 1 month.

If steroid treatment fails and for severely affected dogs, try Cyclosporine used at 5mg/kg PO SID for 8-10wks. Side effects incluse vomiting,alopecia, anorexia and gingival ulceration. Can check cyclosporine serum peak concentrations 1-2hrs post pill. If >700ng/ml decrease dose by half for 1st 2 weeks of treatment.

That's all I have! Credit goes to Karen Allenspach for all the above

Re: Chronic Diarrhoea (groan)

elizabethellison — Mon, 04 Apr 2011 20:12:09 GMT

I have a similar case, tho mine is a 1.5yr old Border Terrier. Very similar history, including campylobacter and giardia. she has now been on a prescription hypoallergenic diet for 6 weeks and has been fine. the owners wish to try introducing other foods so I have advised to do this really gradually and carefully...so we shall see. Would be SUCH a relief to not have to see this dog for a while...my heart sinks whenever I see her on my list!!!