is metronidozale ever okay?

[Jen W]

We are really struggling to find out why Dory can't shake this diarrhea. In the past it's gone away with a few days of bland food, but this time it is sticking around. It starts to get better with bland food and the Proviable paste, but as soon as I stop the paste or transition her back to kibble the diarrhea is back. She has been on bland food now since November 24.

All of her tests have come back negative, though we did run a course of Panacur on the off chance that she had whipworms that didn't show in the fecal (apparently there are lots of false negatives).

Now the vet wants to put her on a course of metronidozale, simply b/c there must be something she's got. Though I've fought against metro in the past, I'm tempted to go with it this time b/c I really don't know what else to do. But all of the warnings on here still have me leery. Is using metro ever an acceptable treatment (coupled with the probioitic, of course).

[Cindy and Olive (Ollie)]

I'll be following for the expert replies, but curious in meantime, what tests has she had done exactly other than a recent fecal? Did they do the fecal float? What kibble was she on? Are you saying that even since she has been on (boiled chicken and sweet potato?) bland diet since nov end, she is still having diarrhea? TIA for clarifying... Hope Dory gets better quickly! How frustrating...

[Karen, Jasper and Jackdoodle]

Yes, metronidazole has its uses. When Jack was first diagnosed with IBD, it helped a lot to get his stools back to normal, and allowed us to reduce his prednisone dosage. 

Metronidazole when used judiciously and for short periods of time is perfectly acceptable to treat certain types of digestive illnesses.

But we knew what we were treating. That's the big thing. There has to be a reason for Dory's diarrhea, and you need to find out what that is. 

My GP vet treated Jack for 3 and a half weeks with no success. I also thought he had "run all the tests". Turns out, he hadn't. He did a lot a of bloodwork, Xrays, fecals, ultrasounds, even a barium swallow, but the one simple test that would have pointed us in the right direction, he didn't do. That's a GI blood panel. It measures cobalamin, folic acid, and something called TLi. It's very expensive and must be sent out; takes about a week to get results. 

There's also no reason to ever stop the Proviable. It's a probiotic. There are lots of dogs and people with digestive issues who need to take probiotics on a regular ongoing basis. You might be able to switch to the Proviable DC instead of the paste once things are back to normal. 

It sounds like Dory's problem is related to a bacterial imbalance in her intestines. Probiotics help a lot with that, as you've seen.

Diet for dogs with chronic diarrhea need to be low in fat and high in fiber. Moisture helps a lot too. And you want a diet with limited ingredients. 

But you still need to get to the bottom of what's causing the diarrhea. Otherwise, the diarrhea is going to come right back once you stop the metronidazole, especially if she does have a digestive disease like IBD.

You might ask your vet about Tylan. It's much safer and has fewer side effects than metronidazole. And I'd ask about running a GI blood panel, too. 

[Jen W]

She's had 2 fecal floats (one standard (?) and one more advanced that they had to send out to a lab) and bloodwork that I'd need to run home and see everything they looked at there.

The diarrhea gets better with the bland food diet, but as soon as I start adding the kibble back in (Fromm's 4-Star Nutritionals Chicken & Veg) it comes back. So I revert back to bland diet which is why she's been on it since 11/24.

[Karen, Jasper and Jackdoodle]

I'd switch her to an LID formula using a novel protein and no rice. Wellness Simple Solutions Salmon/Potato or one of the Acana Singles line, maybe Lamb & Apple. 

[Shari Becker]

My gut instinct is that this could be food related. We had diarrhea off and on for months until we found the right foods for Lexi's belly. My friend had the exact same scenario as you, she did the course of meds, the diarrhea STILL came back. Then she changed her dog's food, and all the symptoms went away. (And my friend was feeding high quality, 'approved' organic stuff.)

Personally, I'd do an elimination or detox diet for the dog before meds. (But I always avoid meds if I can.)

I'd firm her back up on the bland diet, and then I'd introduce her slowly to a freeze dried raw food (rabbit is the most benign, but most expensive. Lamb is much cheaper, and easily tolerated, too.) It's not because the food is 'raw' but rather because it has minimal ingredients, and is minimally processed.

I'd give her the raw with sweet potato or pumpkin to help her stomach adjust. If she tolerates it well, I'd wean off the potato or pumpkin just to make sure she's firm off the fibre. I'd feed her raw (no treats other than raw treats) for 3-4 weeks to reset her system, and see how she's doing. (Some dogs do require pumpkin or potato always to keep their bellies in shape. We find that if we are strict about what Lexi does and doesn't eat, she doesn't need them all the time.)

If her stools remain firm, you KNOW it's food related. Then you can start exploring ingredients and kibbles again. We found that we had to go off and on kibbles for months until we found one she tolerated well - Orijen 6 fish. But we'd try one, she'd not adjust to it, we'd go back onto raw for two weeks. We'd try another, and another .... We still mix the raw and the kibble, but you shouldn't have to (if you don't want to) once you find something that works.

Of course, if her stomach doesn't improve on the raw diet with all other ingredients eliminated, then you may want to revisit your vets suggestions...

[Karen, Jasper and Jackdoodle]

Raw food should not be used if there is any chance of an infection or inflammation in the gut. The commercial raw diets are much safer in terms of bacteria than the homemade versions, but there's still a risk.There are lots of diets with minimal ingredients and less processing that are not raw.

Often, raw diets help not because they are raw or minimally processed but simply because their moisture content is so high. Wet foods are always easier on the GI tract than dry foods.

And it is not true that rabbit is any more benign than any other protein source, or that lamb is any more easily tolerated than any other protein. It's that rabbit is a "novel" protein for most dogs, i.e. one that the dog hasn't eaten before. The same may be true of lamb, for many dogs. Or duck, or bison, or venison, etc. If there is any type of allergic component to the issue, novel proteins can help because it's not possible to be allergic to something to which you have never been exposed. What is novel or "benign" for your dog might not be for mine. It all depends on what proteins the individual dog has been exposed to in the past. 

And one important thing to remember if an allergic component is suspected: If there is an inflammation in the gut, the dog may become sensitized to anything you introduce, so in cases of IBD, if you start a novel protein before the inflammation is under control, you have essentially wasted that protein.

There's also no reason that you ever have to wean a dog off fiber. Fiber is necessary for normal digestion in all mammals.  

[Shari Becker]

I can only share my experience solving our eating issues by switching to commercially made raw food and the Orijen 6 fish. (And my friend's. She ended up sticking with Stella and Chewy's, shocked by how well her dog did on the diet.) I would never make my own raw food or buy raw food that isn't packaged by a reputable brand. Certainly immunocompromised dogs should be careful. 

You're right, of course, about the allergy issue. But Lexi's issues were upset stomach and itching, and we really did get on top of both issues with diet changes. 

As for the fibre, to clarify, I was only suggesting weaning off for a day or so because in our experience, we couldn't tell if Lexi was tolerating a food well while on the sweet potatoes or pumpkin because it did such a good job of firming her up. Now we mix it in all the time, some of the time ... whenever. 

Anyhow, I remain a big fan of Stella and Chewy's freeze dried. I know it is controversial, but it solved all our issues. Everyone's dog - just like each person - is different.

I second the rice comment. I think sweet potatoes and pumpkin are far better. 

[Jen W]

Thank you so much! I was just out on The Food Group looking for an approved Limited Ingredient variety. I'm going to start there and ask for the GI panel before we go the metronidazole route.

She does take a proviable capsule every day, regardless of her GI issues. The paste is only for when she has a bout of diarrhea b/c it helps firm up the stools. I can order the capsules online, but I can only find the paste at the vet.

[Jill, Woody & Maxi]

I think the GI panel is a great idea, it will def give you peace of mind, especially when the fecals are coming back negative!

Good luck, and let us know how the bloodwork comes back.

[Jen W]

Karen - when you say "no rice" you just mean in the Limited Ingredient food, right? Or are you suggesting I eliminate it from the bland food diet she is currently getting, too? If so, would i just do boiled chicken and sweet potatoes then?

[Karen, Jasper and Jackdoodle]

I did mean no rice in the kibble, but it wouldn't be a bad idea to substitute sweet potatoes for rice in the bland diet, too. 50/50 mixture. 

[Jill, Woody & Maxi]

I also think sweet potatoes are so much easier to cook! Just poke some holes in it and microwave for 5 min!