GIARDIA Struggles

[Dr Karen Hoving]

Greetings all.

I'm new so apologies if I've put this on the wrong place!

Bella (5 1/2 mo Sheepadoodle) had some diarrhea prior to xmas. I did the chicken/rice/pumpkin diet. It didn't get better but vet was closed over xmas weekend and day after. So we went in on Tuesday. They did a fecal test at the vet and sent one out. GIARDIA- she then said it was either "medium" or "Moderate" ?

She put her on Flagyl (a 7 day script) and 5 days of Panacur. The first day on the Flagyl (she started with that first, then added the Panacur day 2)  her poop was great! Then we had issues getting the panacur down her- tried Peanut Butter(a bunch of people online said that was a good option) and she ate it. Her poop went back to mush. Vet's assistant said that it might be the peanut butter so I put it in pumpkin (real pumpkin not the pumpkin pie stuff) and divided it up into 2 dishes one am, one pm.

We are on day 6 and her poop still looks mushy! The vet is closed (I'm going to call tomorrow) but i don't know if this is normal. I know Giardia can be a bugger to get rid of. Is this bc of the antibiotics perhaps? I added Goats Milk (as Probiotic) about 3 days ago (1/2 cup according to bottle-for her weight which is 34 lbs).

Now 2 of her "puppy walking buddies" have it (so we are avoiding them obviously). The vet told us she could be around other dogs 72 hours after the antibiotics. We told everyone-they weren't worried. BUT the bottom line is since dogs can have giardia but be asymptomatic, and we all walk at the same park, we don't know (nor does it matter) where it started. 

So, in your non-professional opinions (disclaimer in other words) could she have been reinfected while on meds?Again her poop was normal the first day after Flagyl, then went mushy (could it be the Panacur? Although research says that is better for it that Flagyl).

Also she's not pooping more often, 2-3 x a day- its just pudding.

If you have any advice or thoughts let me know-

Hugs,

Karen and Bella 

[Karen, Jasper and Jackdoodle]

There is no nutritional curriculum in vet school; really, and that's been documented. The only information they get comes via the salesmen from Hill's and Purina. This is not much different from medical school, where they also don't study nutrition. The difference is, doctors don't try to sell you food. Nowadays, many vets are educating themselves on food, nutrition, probiotics, etc through seminars and continuing ed classes, but there's no requirement for that. 

As far as it being safe to spay her if she still has giardia, that's something your vet has to decide. 

I'm not sure what the Precise food costs, but your money would be better spent on something else. It's not a very good food in terms of macronutrient profile or the ingredients, (grain heavy, low in protein, cheaper quality ingredients and fillers, unnamed animal fat, etc) and the company is not real transparent about their sourcing. This is not the time to switch foods, but once things have resolved with her digestive issues, check our Food Groups' Recommended Brands list. 
I am absolutely positive that the pumpkin is not causing any problems, but as I mentioned above, it would probably help to use chicken or meat baby food for administering meds. 

[Nancy, Ned, Clancy, and Charlie]

I am not a vet and I know nothing, but I sure would give a probiotic - Proviable - or the more expensive human one that we finally used for our doodle who had a stubborn case of what began as giardia and I think became a gut problem - VSL#3.  We used it for about a month.

[Dr Karen Hoving]

Nancy-

thanks for the reply. Quick questions-

1)how long did your baby have the poops from Giardia,  

2) What did you treat her with and do you know what worked?

3)when/how did you know it was no longer giardia but a gut problem-probably form the antibiotics?

Thanks.

Karen

[Dr Karen Hoving]

Hi All

Update on Bella. We have finished Flagyl (1 week) Pancur (5 days). She still has diarrhea (it is worse since the Pancur stopped). They put her on a drug called Endosorb (which has the same clay that Kaopectate has). She has been on it for 3 days and her diarrhea is much worse- now just dark water. Bella is acting fine, but this concerns me.

I have called the vet several times with questions- I always get a tech, and  they all give me different info or seem very unconcerned. I called today bc when I picked up the Endosorb I was told under no circumstances to give it more than 4 days (instructions are every 4 hrs). So when I called (day 3) today I wanted to know 1)when I might expect if the drug would help it would start changing things and 2)if "every 4 hours" meant over night. I'd been giving it to her  during the day. The tech said "well yeah -but it would be better if you got up every 4 hours at night too." OK...looks like I'll be fried tomorrow but I love my baby. 

Tomorrow I am due to get the Proviable DC (I think) from Amazon. If it isn't cold I'll send it back. Since they won't let me speak to the vet, and the vet seemed uninterested unless I come in (I've paid about $400 so far-and that is a lot of money for me). She is supposed to be spayed on Monday- the info from the vet is no problem with spaying her with giardia.

So I need just some "I promise I won't hold you to this" advice. Am I being overly neurotic and should just wait for probiotics to see if things change or should I get a second opinion. Having poop tests are useless as she was positive (Medium amt) for Giardia. But what I've learned from so many on this site, and other friends is that giardia is very tricky to treat. She didn't get better at all on the Flagyl- it got a bit firmer on the pancur but after 5 days not major improvement.

Is it better to repeat BOTH drugs? Try a different drug? OR repeat just the pancur? 

A friend w/ a doodle had to have her dog on Flagyl for 3 times. But I don't know if that is safe-I mean if I get a vote.

I added the pumpkin back in her food (after the tech said to use CHEESE not pumpkin-why would I introduce a new food right now? But maybe cheese is ok?) bc I can't imagine that is the problem.

I know that Karen suggested at some point I change foods (Shes on  Precise Puppy). I had a leftover bag of Signature (I had her on that after I weaned her off the damn purina the breeder had her on when I got her) it was ok, just caused a bit of gas. But if the giardia is gone and the poop is from the Precise then should I start slowly weaning or leave the food be?

I feel like I'm going nuts (hey I'm a shrink, I can diagnose that LOL). She's acting fine-running ,playing. But this can't be fun for her. I just need some smart people to tell me what you would do. I'm going to try one more call tomorrow-and ask if they should do another round of something- Panacur?She was better on that then the flagyl. Repeating the test is useless as it will come up positive. And it doesn't look any different. Hundreds of dollars of meds, picking up poop and in the snow covering what is left with clorine and water. But I feel like a failure...

Thoughts?

Thank you, I know you are all as sick of me as the vet's office.

Karen writing for Bella who has to poop...again.

[Karen, Jasper and Jackdoodle]

This isn't going to help, but I'd start looking for a new vet. And when you call tomorrow, be Bella's advocate and firmly tell the tech that you want to talk to the vet and insist that he/she call you back. I would ask point blank why she hasn't improved after all the meds. 

I would not change her food right now, or even think about doing that. 

I do not think another course of Panacur would be a bad idea. Yes, giardia can be tough to get rid of, but you should have seen some improvement initially. 3 courses of metronidazole is NOT safe, it's setting a puppy up for life-long digestive problems, and we have the documentation here to prove that. 

She may be on antibiotics after the spay, and that's going to contribute to the diarrhea, so having the probiotics on hand is a very good thing.

Hang in there. 

[Dr Karen Hoving]

Karen, it helped more than you know.

I just want to make sure I'm understanding- you feel (as a Non-vet) that Panacur would be a good choice to try a second time but NOT The flagyl. Can you point me to where that article is so I can print it out and have it on hand?

Won't change food. 

I'm going to call the current vet tomorrow and have a come to jesus meeting. Meanwhile, I'll call another vet and get a second opinion (I hope they can fit her in on Friday/sat-so i can get the lab tests faxed to them since repeating is a waste).

One question to anyone- how long does it take to typically see things getting better? I saw NO difference after Metronidazole. Things a tad better on Panacur but not firm. But it wasn't water. It's water now-she's been off Panacur 1 day. 

I'm so grateful to have found this place. It is hard bc I can't get any info on how long the meds take to work (the endosorb has done NOTHING so that seems to me -as a non-vet- that it isn't helping bc it's still giardia) and they won't even tell how long it typically takes before I see a difference- I don't want to shove a drug down if it should have worked on day 2 and it's not working by day 3.)

Thank you all- Karen I appreciate your patience.

Hanging on my my nails...

[Karen, Jasper and Jackdoodle]

The symptoms of giardia almost always improve within three days of starting the meds. The issues most people have had here is that once the meds are discontinued, the diarrhea returns, often with a vengeance. But it's pretty unusual for it not to improve initially. 

The original article which we had posted here is no longer on the website for the School of Veterinary Medicine at the Univ. of WI Madison, although you'll still find it quoted on dog forums all over the internet. But here's the text: 

Treatment of Giardia infections in dogs and cats:

• Metronidazole (e.g., Flagyl) can be used in both dogs and cats (not in pregnant animals).
• Albendazole (e.g., Valbazen) was recently found to be quite effective in dogs, and may be more efficacious than metronidazole in stopping the shedding of cysts. However, both metronidazole and albendazole have been associated with significant adverse reactions in dogs and cats:
  • Albendazole: leukopenia +/- anemia and thrombocytopenia; anorexia, lethargy; CNS signs; vomiting and diarrhea; salivation; elevated hepatic and pancreatic enzyme levels; abortion and teratogenicity
  • Metronidazole: vomiting; CNS signs
• Fenbendazole (e.g., Panacur® or Drontal-Plus®) now appears to be the drug of choice. Used in dogs and cats at 50 mg/kg for 3 (-5) days, fenbendazole has been shown to be completely effective in eliminating experimental Giardia infections, and with only mild vomiting/diarrhea as potential side effects.

And similar information on this site, clearly stating that Panacur is more effective for giardia:

http://www.revivalanimal.com/product/giardia/

There are many ideas about treating and preventing Giardia. The top four are:

1. Safeguard® or Panacur® (Fenbendazole) are 96% effective, safe and can be used in dogs or cats. Treatment is done for five days to rid the gut of the organism and often repeated in the house pet one week later to ensure removal.
2. Metronidazole has traditionally been used to treat Giardia, but there has been resistance. It has been shown to be only 60% to 70% effective in dogs and has a sharp metallic taste which is nearly impossible to get down a cat more than one or two days. Treatment is daily for eight days to clear infection.
3. Metronidazole and Safeguard® combined. This popular treatment is a third choice for dogs as it combines two approaches to clearing infection. It is 98% effective with Safeguard® having most of the effect in clearing the organism.
4. Secnidazole given at 30 mg/kg single dose orally has proven to be effective in treating cats. It clears most cats of Giardia with one dose which is helpful since cats do not like to take meds orally. Secnidazole has also been used in dogs successfully. The drawback is it is a limited use drug and must be acquired with prescription from a compounding pharmacy

Hope that helps.

[Gail Sanderson]

Panacur takes a while to work. You should check her stool in a month. It sounds like you are not letting her settle down with one food for long. Watch out for things like bully sticks and cows ears for chews, they gave my one doodle loose stool.

[Karen, Jasper and Jackdoodle]

I don't know, I had a foster with raging giardia, and three days on Panacur was all it took to get things under control. 

Fecals are usually repeated 10 days after the meds are finished. 

[Gail Sanderson]

We did a couple of rounds of Panacur, probably until the stool was improved. But I was told the test would not show an absence of Giardia for about a month. The cysts were still being shed, I think. In our case, we discovered things cleared up when we stuck to a simple diet with almost nothing but kibble.

[Karen, Jasper and Jackdoodle]

I agree with the diet advice. 

[Karen, Jasper and Jackdoodle]

Karen, this is not for your vet, because it is basically anecdotal, but it's one member's story of how repeated courses of metronidazole in puppyhood set her dog up for a serious digestive disease. I have heard this same story many, many times from other parents of dogs with IBD. You might want to share it with your friend whose pup has had three courses of Flagyl: 

http://www.doodlekisses.com/group/thefoodgroup/forum/topics/an-upda...