Metronidazole, probiotics and poop

[ks-man]

Yes, the title was intended to get Karen's attention ;)  Thought it was better to do a thread rather than PM in case others have similar questions. 

Cannoli had giardia 6 weeks ago and was put on Panacur, metronidazole and Proviable DC.  We continued the Proviable (and a little pumpkin) for 18 days after he finished the metronidazole.  Within a day or two of stopping the proviable his stool got very soft and eventually diarrhea.  

Our vet put him on a bland diet of wet RX canned food which firmed up the stool.  We gradually weaned him off the RX food back to his kibble but the day he had all kibble the stool started getting soft again. 

The vet recommended that we give him a quarter can of the RX food with every meal or 2 tablespoons of pumpkin with every meal for the foreseeable future to get him some extra fiber.

I'm now wondering if either instead of or in addition to the extra fiber if he should go back on a probiotic.  His stool is firmer then it was but he still has some soft stools here and there.

Also, this morning was the second time that he has thrown up in his crate at around 5am.  He usually gets up between 6:30-7am.  I took him out and he pooped a ton.  I think the throw up was simply a reaction to waking up or else because he had to poop and didn't want to go in his crate.  He didn't whine or cry to get out first, just heard him gag.

So two main questions, would you recommend I get him back on Proviable for a while and any reason I should be concerned with him throwing up in his crate (previous time was about a week ago).

Thanks!

[J and Riley (and Luna)]

When does he eat his meals?

We started giving Riley 1/4 cup of kibble (removed from her supper portion) right before bed.  She was throwing up in her crate about an hour before her usual breakfast time.  Breakfast usually at 6:15, supper at 4:30, snack around 8:30-9.  We figure it was just because her tummy was too empty, the evening snack seems to have fixed the problem for the most part.  Once in a while she will still throw up in the morning but it's very infrequent now.

[Karen, Jasper and Jackdoodle]

This is the classic story every single time a puppy is put on metronidazole. As soon as the drug is discontinued, the diarrhea comes back. This is usually due to a lack of good gut bacteria, as the metronidazole will kill that along with the bad bacteria. 
Because of this, you always need to continue probiotics for several weeks or even months after the drugs are stopped. Otherwise, you can end up with a bacterial imbalance, as the bad bacteria proliferates faster than the good. It takes a while to build up a colony of good bacteria in the gut. 

Many people seem to think that probiotics are themselves drugs, but that's not the case. They are simply beneficial bacteria that aids with digestion and proper stool formation. There is no reason any dog (or person for that matter) shouldn't take probiotics every day forever, if they want to or need to. 

It's really always a mistake to give a dog Rx food as a "bland diet". There is nothing therapeutic or medicinal in the Rx food; it contains the worst, cheapest kind of ingredients imaginable. IF a dog needs a "bland diet", your best bet is always to make your own, consisting of 50% plain boiled white meat chicken (or very lean - 90% or better- ground beef) and 50% cooked mashed sweet potatoes or white rice. The Rx food firmed up the stool because it contains a high amount of insoluble fiber in the form of cellulose, and that in itself can also cause loose stool when it's discontinued. Forget the vet's recommndations of adding either Rx food or pumpkin to his meals. Instead, pick up some plain unflavored psyllium fiber at your drugstore. Name brand is Konsyl, but most pharmaices will have a generic brand that is less expensive. Just make sure the label says 100% psyllium. Bake a sweet potato in your microwave, peel it, mash it with a fork and store in a container in your fridge. At each meal, mix a quarter to a half teaspoon of the psyllium into a tablespoon or two of the sweet potatoes and add that to your dog's meal. (This comes from two different veterinary internal medicine specialists, BTW, and is the best way to add fiber to the diet of a dog with digestive issues.) 
Do that and get him back on the probiotics. You should see an inprovement.
I have no idea what caused the vomiting. Early morning vomiting of bile is fairly common with some dogs; it's due to having an empty stomach for too many hours. Those whose dogs have this issue usually give a snack about half an hour before bed; either a couple of dog biscuits or a small portion of their dinner set aside for this purpose. Another idea is to give them a "dessert" consisting of two tablespoons of plain nonfat unflavored yogurt to which you can add a few blueberries or dried cranberries. Most dogs love this. 

[Adina P]

(There are people who shouldn't take probiotics actually--one example is those with small intestinal bacteria overgrowth...although they can take yeast based Florastor.)

[Karen, Jasper and Jackdoodle]

That's interesting, because a lot of IBD dogs have SIBO and part of the treatment is probiotics. 

[Karen, Jasper and Jackdoodle]

Yeast based as opposed to what? I'm looking at their website and all I see that seems "different" from any other probiotic is a particular strain of bacteria from lychee nuts. Which seems to be the ONLY strain the product contains. 

[Adina P]

Yeast (fungus) as opposed to bacteria.

[Adina P]

And maybe the Florastor is not the one I'm thinking of...  In humans SIBO can be caused by low stomach acid.

[Adina P]

The best part of psyllium dog poop is that even if it doesn't look very firm, it's nicely enveloped in that psyllium goo and stays together!

[Karen, Jasper and Jackdoodle]

Jack's poop never was encased in goo, and he got the psyllium twice a day. It just looked like well-formed poop. 

[Adina P]

Maybe that depends on the amount of psyllium vs. the mushiness of the poop (without psyllium)?

[Connie]

Yep.... I used to do intestinal fasts twice a year.... nothing but psyllium, bentonite shaken and juice or broth for 7 days. That gel is the gem LOL!

[ks-man]

Thanks for the responses.  I just placed an order of Proviable on Chewy and will also pick up some psyllium fiber.  

Cannoli has breakfast around 7am, lunch at 12:30pm and dinner anywhere between 5:30pm-7pm depending on our schedule.  I'm not sure if he vomited when he had an earlier dinner as we weren't home last night and my in-laws fed him.  He typically goes to sleep on our bathroom floor around 8-9pm and then I take him out for an evening potty before I go to bed around 10:30 or 11pm.  I could easily give him a small snack when he does a potty break if that will help.

I'm going to start monitoring if he throws up when having earlier dinners as that would be an easy way to get him the snack.  I'd love to get him off 3 meals a day but I was planning on waiting until at least 6 months for that.  Is that the general consensus on when to go down to 2 meals?  Thanks again!