Possible Giardia not responding to Panacur + Metronidazole

[Itims]

Hi Everyone,

I'm a frequent lurker on DK and have had a lot of help on puppy planning, insurance, grooming, food, behavior and health with our 14 month Biba from here. Shes the best girl EVER and I'm a much better pet-owner/parent thanks to things I've learnt here. But shes sick now and I'm not sure what to do as I don't agree 100% with the vets advice. 

She has had pretty bad diarrhea since Thursday. I'm a bit lost about what plan of action to follow. I don't want to do more antibiotics. She has been on antibiotics for different things 4 times since May last year (fluid in lungs due to vomit-aspiration, hot spot and GI issues x 2). The current round would be the 5th time. 

Here are the details. I hope some can make some suggestions about what we should do.. 

Diagnosis:

Had normal poop on Wednesday. Totally watery poop on Thursday AM/PM  and night and then again Friday AM. We took her to the vet on Friday morning and she had a faint positive for a Giardia snap test (fecal float was negative).

Meds:

She went on Panacur (3 days) and Metronidazole (5 days) but her poop has only thickened slightly i.e. from absolutely watery to slurry-soupy.

Poop:

Started as total water and now is slightly thicker like soup but totally liquid. Frequency is not a major issue (2-3 times a day only). We have had no accidents at all. She has had no blood in the poop, maybe a little mucus (not very noticeable).

 

Current food:

Canned chicken breast and plain white rice.

Behavior:

Energy and appetite are normal. Doesn't drink as much water as usual but I've been adding a cup of water to her meals and we haven't been giving her long walks/dog park outings. 

Usual Food and body condition:

She eats the Acana Limited Ingredient line (chicken-potatoes, lamb-apple and a duck flavor). She eats slightly more than the bag recommends at 1.5 cups twice a day but is in good shape. Weighs 50 pounds is about 26-27 inches at the shoulder and is rated as thin but ideal by the vet. Looks quite skinny when wet.

Supplements:

She is on a probiotic powder from First Naturals called 4-in-1 (link below) and 1 teaspoon of BeneFiber (human dietary fiber supplement). She is used to both of these for about 3-4 months now. I made a mistake with not keeping a 2 hour gap between the probiotics and the antibiotics though. Started that today. Fyi, I haven't had any luck with pumpkin at all in the past. The dietary fiber has worked in the past though. 

http://www.firstchoicenaturals.com/Index/showroom.php?pid=5

Next steps:

The vet is suggesting Tylan Powder now. I'm in a mind to hold any more medicines for 2-3 days and see if her system will recover with continued bland food and probiotics. Is that a bad plan of action? Have other people had this issue - of resistant Giardia? Maybe it isn't even Giardia and the faint positive was from some old infection or something like that. 

We are thinking to go in again on this Thursday or Friday to recheck her stool. The vet also suggested testing for Addison's Disease and a food test for IBS or IBD but that might be a whole different thread to discuss. 

Thank you all so much in advance for your advice and suggestions.

. 

[Nancy, Ned, Clancy, and Charlie]

I have no information to add, but want to offer emotional support.  Thank you for posting as I am sure there are others in this predicament.  I will follow the suggestions you get.  Keep us posted.

[F, Calla & Luca]

It can take a long time for Giardia to be finished in terms of symptoms. I think your plan sounds OK but I would keep up reifection precautions and retest her stool in a couple of weeks.

[Karen, Jasper and Jackdoodle]

At this point I would ask for a referral to a veterinary internal medicine specialist. 

But Tylan is very, very safe, virtually without side effects. It's in the Angel Eyes products that people sue for tear staining. I'd give it a try.

The biggest problem is giving it, as it is very bitter, and the compounding pharmacies charge a fortune for it. I fill my own capsules with an inexpensive machine, much more economical. 

I am confused as to the "food test". There is no reliable test for food allergies, or for IBS, and the only way to diagnose IBD is with an endoscopy done under anesthetic. JD's cost $3000. You can have a GI blood panel run to check cobalamine and folate levels; that won;t diagnose IBD, but it can point you in that direction. 

[Itims]

Thanks, Karen, Nancy and F.

I have a toddler nephew visiting in 3 weeks and very nervous about disinfection. I have the CDC instructions on how to disinfect the home and we will rent a steam cleaner for rugs/carpets or put them away when he comes. 

Karen - the vet said that it would be a food trial with a novel protein or with the the Purina HA diet. I don't want to try the Purina food. I'm willing to try a novel protein if its made by Acana or Orijen or one of the brands we've read about on DK. I don't think she has IBS based on how well she tolerates so many different types of treats, grain and vegetables (in small quantities though). However, she has had hard to explain GI issues 3 times in 9 months. So we need to think through this a bit and research. 

Glad to know that Tylan powder is safe. She finished the Metro today. I'll start her on the Tylan powder tomorrow evening. I have an unused bottle from a previous episode that is already at home and paid for. We could mix the dosage with chicken stock and use a syringe? Or mix with peanut butter?

I'll be back with my experience. 

[Karen, Jasper and Jackdoodle]

Unless lamb or duck are novel proteins for her, you are not going to be able to use any Champion formula for a food trial. Oatmeal would also have to be a novel carb.

IBS is not related to any particular food ingredient, although the consistency of the food as well as the fat percentage may play a roll. There is no known allergic (or specific protein intolerance) component in IBS. Many IBS dogs tolerate all protein sources well, but need a low-fat and/or a moist (home-cooked, dehydrated raw, canned) diet. So the fact that she tolerates all kinds of foods well doesn't rule out IBS. 

IBD may involve a specific food intolerance or allergy, but most commonly does not. The only way to know is to do a biopsy, as the presence of eosinophils indicates an allergic component. In most cases, even when the dog does have the eosinophilic form of IBD, they still also have the more common form, lymphoplasmacytic, which is idiopathic and not triggered by food. Only two IBD dogs in ten are controlled with diet alone. 

You will have no luck with administering the Tylan with chicken stock and a syringe, lol. It is really, really nasty stuff.  The peanut butter might work, but it's going to take a LOT of peanut butter, which of course is not a great idea for any dog with GI issues, since there is almost no food on earth that has a higher fat content. :(

Your best bet might be a small amount of LID canned dog food.

Of all the Rx foods, Purina has the worst ingredients. Avoid it like the plague. 

[Adina P]

Would something SWEET dull the taste of Tylan at all (vs. savory like chicken stock)?

[Karen, Jasper and Jackdoodle]

It's not just sweet versus savory, I would think it would have to be a thick substance versus clear liquid like broth, too, to really mask it.  

I guess I am not conveying how bad this stuff is. Just the smell of it can knock you out. 

It is used off-label in dogs. It's only officially approved for use in chickens. 

[Karen, Jasper and Jackdoodle]

Just Google "Tylan taste" to get an idea of what you are dealing with, lol. 

[Itims]

Unfortunately, I didn't learn of the novel protein thing until much later. So she has had everything under the sun in some small quantity. Shes been on NutriSource (breeder), TOTW (puppy line- soft stool and didn't love it) and now the ACANA line. 

Should we go down the complex diagnostics route with IBS, then IBD or Addison's Disease route? The symptoms for IBD and Addison's seem to be vague and off-on until they are life-threatening. I want to believe that she just has a sensitive tummy and is a healthy dog otherwise but don't want to be bury my head in the sand and ignore what might be in the future either.

:( 

[Karen, Jasper and Jackdoodle]

Darn, I just lost my whole reply.

If you give me the exact formulas of Nutrisource, TOTW, and Acana, I can come up with a couple of novel proteins for you, and possibly a food recommendation. I know that rabbit would work, and there may be other proteins that would work as well.

There really isn't any diagnostic testing for IBS, which is Irritable Bowel Syndrome, and is basically a nervous stomach. It's completely controlled by diet, and is usually diagnosed by ruling everything else out.

IBD, or Inflammatory Bowel Disease, on the other hand, is an incurable immune-mediated disease which can only be diagnosed via endoscopy under anesthetic. I doubt that any competent vet would recommend that at this point. I also doubt that's what she has, because when a dog has IBD, you know there is something seriously wrong.  For one thing, they almost always lose weight. 

Which leaves testing for Addison's. 

This is why I really think you need to book a consultation with an IMS. Just to review and discuss. I think that's the only way you are going to know which route you should go down for now, and how to proceed from here.

[Itims]

Thank you so much Karen! I'll look for an IMS vet. Our vet has been going on about the food trial for IB (something) I wasn't sure which one. Might have been the IBS. She's never mentioned endoscopys. Shes mentioned blood tests for Addisons. 

These are the formulas she ate (um.. is a formula the same as the flavors?)

NutriSource: Large Breed - Chicken and Rice

TOTW: Bison and Venison; Salmon and Ocean meal; Lamb and Potatoes or Sweet Potatoes

Acana (rotate through every 2 months since June of 2013- working well)- Duck and Pear, Lamb and Apples, Chicken and Potato. She eats 3 cups over 2 meals very happily.

She has had rabbit and beef in treats, jerky, bully sticks. I am not sure about turkey. I don't see it in treats so maybe she hasn't had it? She has not had kangaroo (i think). Not been exposed to any veggie protein if that is a possibility. In the carb family, she has had wheat, oats (in some of the food above) and rice. 

In terms of energy levels, she is a medium energy dog. She goes to daycare (6 hours 2-3 times a week) and dog parks 30 mins-1 hour on 2-3 days a week. Both my husband and I are sort of lazy and don't have any issues keeping up with her.

Thank you again for taking the time. 

[Karen, Jasper and Jackdoodle]

If she hasn't had turkey, that would be your best bet for a food trial. I'd go with Wellness Simple Solutions Turkey & Potato formula. Pork is another option, but there are very few foods that use pork as the sole animal protein. Kangaroo would be another option, California Naturals has a kangaroo & lentil formula, but they are not on our recommended brands list. 

But honestly, it doesn't sound like any of this is related to a food allergy, the symptoms just don't match up. A food intolerance, maybe. But even that is a long shot, IMO. The nice thing about the Wellness food is that it also has a higher fiber and lower fat content than most other kibbles, and those things alone can be very helpful for dogs with digestive issues.