suggestions for this heath issue, please ! - Page 1

Hello All,
I have 1 year male GSD show line, he always had this problem ( chronic diarrhea ) or very loose stole, after visting several vets, I finally found a decent clinic, I was goining to write the whole story but they when I asked them to send me a copy of the TLI/folate/B12 test, they sent me a copy of the whole file :) so kindly check below :)

Consultation Date: 16 March 2013
Reason for Visit: MQ - D++ and Check Hip (MQ)
MQ 1.00 x Consultation
1.00 x TLI, folate, cobalamin - canine
1.00 x Giardia Test
20.00 x Trimethoprim Sulf 480mg
15.00 x Metronidazole 500mg
OP 1.00 x EVD Dermatosis Dry Dog 5kg
1.00 x Payment by Credit Card
MQ Has diarhhoea > 6 months. From originally from Italy.
Dog is thin. Dewormed 1st of March. Good looking dog. Very
quick eater, not usually fussy, but was this morning.
Giardia test -ve
Poo is green, mucoid and some blood. Put on TMS and
metronidazole for 10 days anyway, take blood for TLI/
folate/b12
Weight altered to 29.4Kg.
1 twice daily
3/4 tablet twice daily. start tonight
Switch to dermatosis
o worried about HD - is cow hocked and bunny hops - so sotical in here - can't really check - adv xray when we sort out the faeces

Consultation Date: 24 March 2013
Reason for Visit: Phone Owner
Ozc stoop: diarrhoea has resolved nicely on meds. o rang to query whether shoudl extend cours euntil results are in as runs out of meds tomorrow. decided to wait and se if diarrhoea returns first. can have repeats of meds if diarrhoea returns before bloods back.

Consultation Date: 26 March 2013
Reason for Visit: Results
OP 1.00 x EVD Dermatosis Dry Dog 5kg
1.00 x Payment by Credit Card
TS Endocrinology

TLI (Canine) - 7.9 ug/L - 6.0-35.0
Folate - 6.7 ug/L - Low - 6.2-13.5
Cobalamin - 457 ng/L - >= 275.0

TLI within normal limits rules out exocrine pancreatic
insufficiency.

Folate and cobalim (B12) are preferentially absorbed in
different parts of the intestine. Therefore, reduced serum
concentrations of folate and/or cobalamin may be indicative
of disease of the proximinal and/or distal small intestine
respectively, either as a result of mucosal damage or
hereditary malabsorption (cobalamin). These serum levels
should be assayed after a 12-hour fast to reduce the
influence of diet on the results.

Increased folate and/or decreased cobalamin can be
indicative of small intestinal bacterial overgrowth (STBO,
or antibiotic responsive enteropathy) or can be associated
with EPT.

Lisa Tolley BSc
Clinical Pathology Group

Consultation Date: 27 March 2013
Reason for Visit: Phone Owner
KG ST IDEXX, sugg that the results do not sugg bacterial responsive D, but treat anyway. Otherwise bx.
SMc DDx of gross intestinal malabsorptive problems are EPI, IBD, bacterial overgrowth. Path at Idexx advised 2 x months of tetracycline + tylosin if nb.

Consultation Date: 28 March 2013
Reason for Visit: Vet Note
MQ STO - since had the antibiotics and the dermatosis the faeces has been normal but worried that the dog is not gaining weight - advise reweigh when O back and recheck in 2 more weeks


on 2 April 2013, I went again coz the diarrhea came back for a couple of days now, they gave me the same medicine ( Metronidazole & Trimethoprim Sulf) 1 tablet each twice daily but for 3 weeks not 1 week as last time.

can more experienced people tell me if I am on the right track?

Thanks in Advance.
Khaled

Just because the TLI is 7.9 does not mean your dog can't be symptomatic.  I would be using digestive enzymes for this dog, if you are feeding kibble, a plant based product may be enough for now.  I would also use tylan powder for 30 days and quit the metro.  I don't like metro due to possible side effects that I know occur in shepherds.  You can test for Iga deficiency.  research that online.  one of the effects of that is celiac disease like issues. You don't say what you are feeding, tell us food and treats.  I feed this dog grain free food or a raw diet.  I am not sure of the dermatosis you are talking about?  If it is dry and itching skin, this could all be food allergy or intolerance or both.  I have on dog that gets awful diarrhea after one treat or meal of any kind of chicken - kibble, fresh, raw, treat.   I would also keep regular check ups on the cobalamin folate as that can change.

Darcy

I would treat the dog with a long course of fenbendazole instead of the metro and assume giardia, despite a negative test. Even if it's not giardia, fenbendazole will kill other things that can cause the same symptoms, and it can do it far more safely than metronidazole! I second the need for enzymes and I would add probiotics. Whether that will help the original cause or not is debatable, but at this point, after a repeated metro, the dog needs them regardless. Probiotics are extremely important after antibiotics. 

Agree with Jenni78;  I would use panacur treatment for 5 days consequtively;  repeat panacur treatment in 3 weeks.  Should clean it up.  Even though the test comes back negative, I would still treat.  I would also put him on a good quality probiotic and leave him on it.  That will help put natural healthy bacteria and flora back into the intestional tract.  Sometimes less is better;  in otherwards I would drop the Metro also, and other med's that have not helped, maybe Tylan would be OK for another 30 days or so, then stop that also or at least wean him down on the Tylan and just maybe a small pinch every other day as it COULD also be aggrevating the intestional tract as it is an antibiotic powder made for swine, cattle, and ranch animals.

I would drop all treats until you get this problem solved.  If he gets along with his dry food OK, use that as a treat.  Pumpkin is also good added to diet to help to keep stool firm and loaded with nutrients for him.  A spoon full in each meal should help.

Are you able to contact a holistic vet in your area??  If so I would try that also as sometimes they have a more natural approach,  Metro and other vet drugs can be very hard on the kidney/liver etc.  I have a sammy boy that has intermittent problems like this; and am in the process of changing his complete routine to get to the bottom of the problem.  Best of luck for you   Nan 

AN afterthought:  What kibble's are you able to get in your area?  Be sure that your dog food has not gone rancid;  a little heat and it can cause a whole lot of problems due to the type of fat in the dog foods.  Nan

good suggestions above, I would also be careful not to over feed in trying to put weight on the dog.

Agree with Darcy.....

7.9 on the TLI is very low.

Digestive enzymes, a shot of B-12 and a 30 day course of Tylan, prescribed by vet.
Forever on a daily dose of B-12 with Intrinsic factor
http://www.wonderlabs.com/itemleft.php?itemnum=6881

Grain and gluten free dog food

2 hours after Tylan a good probiotic

Feed small meals 4 or 5 times a day.,,,
I think you will see a huge improvement in two weeks.
 

Here is a great link on digestive issues with dogs and digestive enzymes you could try.

My german shepherd had the same symptoms as your dog.  Her TLI score was 4.9 which is in a gray area. It wasn't until I got pancreatic pork based pancreatic enzymes and b-12 that she turned around.

Maybe because your score was 7.9 ( which really means low pancreatic function ) you may be able to get away with using the enzymes from Mercola.

http://healthypets.mercola.com/sites/healthypets/digestive-enzymes-for-pet.aspx

the food you  feed should have a fiber number 4% or below. fat not too too high and grain free and gluten free.  The gluten in dog foods slow down the absorption of nutrients from the intestines and can create bacteria.

If the vet is leaning towards a malabsorbtion issue... I agree with the others who said to use Tylan powder.  It works very well for treating long term chronic diarrhea.  Giving a dewormer that is not needed is not going to help that gut (unless there is truly a parasite).  Antibiotics (like the Metronidazole you are using) and Probiotics will... and that too was mentioned. 

His malabsorbtion issue could be hereditary, or due to previous parasites, or chronic intestinal upset (possibly dietary).  Not familiar with the diet your vet put you on, but assuming it is a bland, easy on the digestive system diet.

thank u all,

sorry for the late reply but i went to the sea with my I phone in my pocketa week ago so Internet is only at home now :)
I am feeding him Eukanuba ( Veterinary Diets) Dermatosis FP that what the vet recommended for him for 6 weeks, I give him 2 cups morning and 2 cups at night.
I really don't know what to do know coz honestly I trust u guys more than any vet here, shoukd I keep giving him the vet's prescription for the 3 weeks and see whats happens or stop at once?!

P.S
the diarrhea stopped next day I started to give him the pills again.