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nekovet, Veterinarian
Category: Dog
Satisfied Customers: 22616
Experience:  Hello, I am a small animal veterinarian and am happy to discuss any concerns & questions you have on any species.
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Chronic diarrhea in 4 yr old gsd, please help he's wasting

Customer Question

hello chronic diarrhea in 4 yr old gsd, please help he's wasting away
Submitted: 2 years ago.
Category: Dog
Expert:  nekovet replied 2 years ago.
Hello & welcome, I am Dr. B,a licensed veterinarian and I would like to help you with your wee one today.
How long has he had this?
What does the diarrhea look like? Any blood?
Has his local vet done any tests? Which ones?
What are you feeding him?
What treatments have you tried so far?
Customer: replied 2 years ago.
hi I'll try to be brief, had him since 6 weeks, weaned and fed for first 3 yrs on TOTW, last November awful diarrhea, 10 days of metronizadole and he was fine, 4 weeks later same thing, same treatment, 4 weeks later again and then again, I suspected EPI test negative, bloods normal, poo sample showed lots of bacteria, treated for 6 weeks with metronizadole, for a year no problems at all, eating ready prepared raw ( natural instinct ) only turkey variety, weight 48kg's , to today - 6 weeks ago diarrhea started again, was put on Metro - no better, again took bloods, poo sample and test for epi all normal, now - still diarrhea, it's always the same , explosive, urgent , colour varies but very watery( pure liquid ) I guessed at giardia and treated at home with fenbandazole( panacur) for 3 days, the next day his first solid poo in 6 weeks!! I thought we had cracked it ! now back to square one, up until today he is eating normally ( in fact he's absolutely crazy for food like he's starving ) coat great, bounds of energy, drinking normally, vets are baffled
Customer: replied 2 years ago.
I might add he's lost 14kg's in 4 weeks and today won't eat but I put that down to the panacur and not too worried about that, the other thing is the smell! which sounds ridiculous as all diarrhea smells but this is awful, toxic almost a poison smell about it if that makes sense , thanks in advance for any help u can offer
Expert:  nekovet replied 2 years ago.
Hi again,
That isn't ridiculous at all. Some of our pathogenic bacteria and conditions do have pungent or specific odors. For example, had it been EPI, those stools tend to smell fruity due to the fat content in the stools.
Now just further to what you have said and this odor, did they ever note a specific bacterial species present in the stool samples? Or was it just an overgrowth of normal gut bacteria?
Customer: replied 2 years ago.
I assume an overgrowth of normal bacteria as SIBO was diagnosed ?? but I don't know for sure sorry
Customer: replied 2 years ago.
ps never seen any blood or mucous in it and he's never vomited,
Expert:  nekovet replied 2 years ago.
Thank you again,
Now as you have appreciated, chronic diarrhea in the dog can be caused by a range of issues. It sounds like you have covered a lot of bases but there are some more subtle concerns that remain.
First, I would note that to hear that this settles with Metronidazole but relapses, one concern would be a possible bacterial agent that is partially resistant to this antibiotic. If we did have one present, the antibiotic may reduce the population but once stopped it regrows to cause recurrence of signs. So, it'd be worth double checking what bacterial species has been found, if it is a pathogenic one or not, what else it may be more sensitive to and then consider an alternative antibiotic to treat it.
Though if a SIBO was diagnosed, then it may be that the culture only showed bacteria that should be present in the gut (but in higher then normal levels). Now it does depend on what that population was. If it is an overgrowth of one species, then a balanced probiotic (ie Protexin Prokolin, Canikur, etc) may be of benefit to try and restore a normal microflora population And I would note that some of these products contain Kaolin to slow the diarrhea and give stool form. So, that would be a bonus here since that weight loss is due to him being unable to properly absorb nutrients and thus losing them via his feces.
Further to all of this, the response to Metronidazole raises another concern. This is because it is a drug that has multiple positive effects when used for GI disease. Not only does it treat bacterial infection but it also has an immune modulating effect on the gut. The reason I bring this up is because his signs also raise worries of inflammatory bowel disease or even a possible allergic reaction to his food. So, if either of these were lurking, he could show positive results when on Metronidazole but then relapse when it is stopped. So, those are concerns here for him.
With that in mind, I would note that if you have not already, it may be worth a strict diet trial. Now with the massive amounts of weight loss, I would lean to trying a nutrient dense diet (ie Hills A/D, Royal Canin Recovery, or even supplementing with a liquid diet option like Clinicare) or a limited ingredient puppy food. The reason is because each has more nutrition per bite then adult food. And that could translate to us getting some more calories into him as we work to get to the root of his signs. As well, I would note there are hypoallergic diets (ie Hills Z/D) that could be another option.
Finally, with IBD and unfortunately GI lymphoma (another issue that can appear this way) being differentials in this case, I would note that this may be a stage where we need to think about endoscopy. This is where the vet uses an endoscope with a camera to access the intestines and assess them from the inside. At the same time, they can take samples from the gut wall to have analysed. This can be of real benefit to let us know if we have an IBD or gut based cancer causing these unrelenting signs. Depending on their findings, they can then advise you if these are issues and how to manage them for your lad.
Overall, it does sound like you have done everything correctly but that your lad has a challenging situation. If the vets have scoped already and SIBO is the definitive diagnosis, these are frustrating cases that often need treatment off/on for life. Though if they have not ruled out the other concerns I noted, then we should do so. As well, the above further supportive care measures should be considered, a dog safe anti-diarrhea would be ideal (to at least slow his losses while doing so), and if they suspect IBD from what they have done so far you could even discuss a trial on treatment for that too.
All the best, *****
If you have any other questions, please ask me – I’ll be happy to respond. Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Customer: replied 2 years ago.
thanku sorry it's hard to remember everything , he's on a probiotic permanently, can't remember the name now but it is one of the ones u mentioned, he is now due to have an endoscope next weds, I just was hoping for a miracle before then so I didn't have to put him thru a GA if I could help it, I've done a strict diet elimination with him, I think he can't cope with chicken or starch ( kibble ) of any kind, I've had him on the hills I/d and z/d for 2 weeks at a time each - no better on either , vet is adamant it's not the same as last time as the metro fixed it but hasn't this time, it's so frustrating he's so beautiful and I'm failing him somehow
Expert:  nekovet replied 2 years ago.
Hi again,
I know this is a very frustrating situation with your wee lad.
And no worries about not mentioning those other treatments, as it does sound like you have been through a lot here. I just wanted to give you all my thoughts and mention anything that may not have been used here already.
Still, from the sounds of it, you have done everything right here (though we usually use diet trials for 4-6 weeks) and really if he were my patient I would be looking at scoping to see if we have an IBD or anything else here. Though as I noted, in some cases, we can try IBD treatment first if an owner isn't keen to scope. But the risk with that is that even if we get a positive treatment response, we'd not be 100% sure of what we are treating if you know what I mean. So, its an option to consider but scoping would be the best next step in this situation.
Take care,
Dr. B.
If you have any other questions, please ask me – I’ll be happy to respond. Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Customer: replied 2 years ago.
ok thanks for ur help, I'll go ahead with the scope and hopefully get him sorted, poor baby , thanku
Expert:  nekovet replied 2 years ago.
You are very welcome,
I do think that is the best option to getting to the root of this and addressing it before he wastes away and becomes unstable for that to even be done.
Take care & best wishes for your lad,
Dr. B.
If you have any other questions, please ask me – I’ll be happy to respond. **Please remember to rate my service once you have all the information you need as this is how I am credited for assisting you today. Thank you! : )
Expert:  nekovet replied 2 years ago.
Please remember to rate my answer when you are satisfied as this is how I am credited for assisting you today. IF you have any lingering questions or concerns, please stop and reply to me via the REPLY or CONTINUE CONVERSATION button with the issue you have. I will be happy to continue further and do everything I can to provide you with the service you seek. Thank you & happy holidays. :)