Diarrhoea

[evelin]

My springer spaniel ha had diarrhoea for at least 8 months. he has had lots of tests etc and medications, but still the problem persists. His bowel movements are very powerful and liquid. He is currently on a low residue dry food diet prescribed by the vet; still no improvement. I am about to start him a weeks course of cortisone tablets to see if that helps. He is otherwise healthy, happy, hungry (always) and not losing lots of weight. He is about 29 kg 4 weeks ago. Does anybody have any ideas, the vet seems to have run out of ideas, his next step is to do a bowel biopsy Any suggestions would be appreciated.

Does your dog have the annual heartworm injections? Mine did and always had diahhrea and vomiting intermittantly, was always bright and happy, shiny coat and full of energy except for this problem. I found out too late that it might have been a result of the heartworm injections. We lost him a few weeks ago. Please have a full blood test done at the vets, including a Coombs test. We are highly suspicious that this death could be the result of the heartworm injection. Our vet has reported it to the manufacturers in the U.S. We are investigating it further. I have found many suspect cases on this forum.

I have posted a new thread "heartworm injections adverse reactions" so if you want to have a look, my dog Tobie's story is on it. Good luck with your boy. Don't waste any time. They put my dog on Prednisone, a cortisone product. Please get the blood tests to see how low the platelets are.

Let me know how you go. I am praying for your boy. :D

[evelin]

Surely if the dogs had runny poos for this length of time and they are talking the type of meds they are there should be some kind of diagnosis 

You'd think so Steve, but sometimes it just doesn't happen that way. This is one of those cases that goes in the category of complicated diarrhoea. From what I've read, the vet is doing the right things but I feel may not be thoroughly explaining what they are thinking and doing.

For uncomplicated diarrhoea the treatment is as most people would guess (through dealining with it themselves if nothing else) withholding food for 12-24 hours, gradually reintroducing highly digestible food (like chicken and rice, or cottage cheese and rice etc). Depending on whether there is likely gastritis or whether the diarrhoea is originating from the small or large bowel, an enteric mixture like Peptosyl might be added.

When diarrhoea becomes complicated, so does the diagnosis and treatment. There's a great many things that can cause it, some sinister and some not so sinister. The aim of diagnostic plans is then to start with the most likely causes, see if they can be identified, if not, move onto the next one. Often this is done therapeutically, so treatment trials - easiest first......if small intestinal bacterial overgrowth is suspected then antibiotics may be given, so even if it were some other bacterial problem - a positive response to treatment might narrow it down a little. As for the faecal culture - a great many cases will grow Salmonella - certainly can cause diarrhoea but its also normal gut flora, just like E.coli (but nearly all young animals can be killed by it.....). So its only if you're looking for something specific that it really becomes more useful to rule things in or out and thats really what making a diagnosis like this is about, getting the greatest amount of information with the least, or the most appropriate tests.

It would be interesting to know if the radiographic series included a contrast study, but it would show if there were something grossly (as opposed to microscopically long). The next step after that I suppose could be ultrasound to check out the structure of the intestinal wall, lymph nodes, stomach etc for other small masses or thickening. Exploratory laparotomy is always on the list somewhere (even if at the very bottom) because you can always tell a lot more by actually seeing and palpating and biopsying everything that you can - theres no other way to do it. Then at least you can get a histologic (microscopic) diagnosis but often, that only puts a name on something that you still need to work out how to treat - and even then individual dogs will respond differently.

As an example - we have a Cavalier King Charles that comes in to work who has had chronic episodic vomiting and diarrhoea for 2 or 3 years. We've done treatments trials and found him to be stable on Hill's i/d - then it started behaving differently so he was referred to a nearby specialist centre. There they did intestinal biopsy, examined the inside of the stomach and so on and found that the lining showed intense inflammation and ulceration as did the intestine. Definately the prime candidate for the diarrhoea? The pathology report said that apart from a change in structure of a couple of the glands it was essentially normal. I guess the point of this story is to just show how difficult things can become, we've got a diagnosis of "normal" but there is definately something happening......so what to do? Find something that works, treat the symptoms, stick with the treatments that result in an improvement.

Unfortunately....if it is IBD, the nature of the gut being inflamed impairs its ability to function hence the need to anti-inflammatory and immunosuppressive drugs like corticosteroids or azathioprine or cyclosporine. Also, added fibre can both help and hinder - really depends on which part of the bowel is affected. Sometimes it can bind really watery diarrhoea, sometimes it can make it worse. Also, although I know you all love your BARF (nothing against it!) the presence of food that makes the intestine work can increase the irritation to the gut lining and exacerbate the inflammation - hence food trials with low residue food, or food trials based on ingredient exlusion - sometimes it is a reflection of an atopy problem.

Edit to add: My Dog Stinks - if you are going to go to another vet, consider asking your own vet for a referral to a specialist. If not, let the other vet know why you are seeking another opinion so that they can obtain your dogs record from your vet. That way the vet giving the second opinion will have a clue what has been done etc and you'll save a bit of money from not having to redo tests.

Rappie, Did that Cavalier Cocker Spaniel ever have annual heartworm injections? I have posted on this site "heartworm injections adverse reactions" Please have a look as it sounds so much like what a lot of problems that people's dogs are having. My sad case has been reported and is being investigated. Cheers Evelin

[Rappie]

I no longer work at the clinic I had mentioned in that post, so I cannot check however the heartworm injection was rarely given to dogs that were not "difficult" - thus I suspect it was on a monthly treatment.