An update on Woody & possible long term effects of metronidazole

[Jill, Woody & Maxi]

I am one of the many owners whose puppy (now 3 years old!) came home from the breeder at 8 weeks with loose stools, diarrhea, pudding poop, whichever you would like to call it.  After weeks of negative fecals, we finally received a positive fecal for giardia.  Our first vet prescribed a course of metro, which temporarily cleared it up, then, back again to diarrhea. Course after course of metro, hills I/D food, a prescription of clay (what was I thinking?!?!) 2 vet changes, more metro, (finally) Panacur..and then my breeder told me about Doodlekisses.  By this point, Woody was 5 months old, so this treatment has been going on for 3 months, with no resolve.  To make a long story short, after DK, and the help of Karen and friends I learned about the importance of a quality dog food, and the importance of treatment for giardia.  Throughout those 3 months, never once did I (or was I told by a vet) to give a probiotic..so Woody had 3 months of metro kill the bad bacteria in Woodys intestines…along with the good bacteria.  We tried all quality foods, and nothing would work..until The Honest Kitchen, Embark..and even then things still weren't perfect…we were finding pieces of undigested food in his stools.  After a bout of acute pancreatitis (from adding ground lean turkey to his Embark) We finally decided we need to take this further than our regular vet.  

We made an appointment at Cornell University Animal Hospital, where we found out Woody has an inflammatory bowel condition of his digestive tract that was causing diarrhea and preventing complete digestion of his food. In inflammatory bowel disease, the body's immune system attacks either proteins from the diet or self antigens or normal bacterial flora in the GI tract. The bowel wall becomes inflitrated with inflammatory cells and the result is destruction of villi and thickening of the bowel wall. This prevents normal uptake and digestion of food and leads often to diarrhea and weight loss. 

Inflammatory bowel disease can be grouped into three catagories: food responsive, antibiotic responsive, and steroid responsive. We are lucky enough, that Woody has fallen into the category of food responsive.  We have been home cooking for him full-time for well over a year now. I have a system where I buy in bulk, take one 4 hour period out of one day of the week, and prepare about 7-10 days worth of food, which I freeze, then take out during the week.  It is simple, now that I have a system.  This will now be a life long commitment, which I am more than happy to do..being that he is responding so well to it (we just had our follow up appointment, and all of his labs came back great!)

My point of this discussion is that you have to be your own advocate.  If I had the knowledge that I learned here on DK…who knows? Maybe this could have all been avoided.  Please, don't ever let your vet give you medicine without a good reason, and KNOW the side effects, and what you can do to avoid them..in the case of Woody, maybe taking a probiotic from the beginning would've helped?

So a BIG THANK YOU to all that have helped along the way..and please, if anyone has any questions, feel free to ask!

[Dolly Dykhouse]

Thanks Karen, I have a call into the vet already. I've done some more reading on Giardia and it gave me one more symptom that Henry fits to a T; extremely smelly stools. We've made several comments in our household about the odor of his stools for the past 2 weeks. I pick them up and bag them immediately after he goes and get them into the trash can because they stink.

Hopefully we can get into his vet today and at the very least I'll be dropping off the stool sample within the hour.

[Dolly Dykhouse]

I brought the stool samples taken over two days into the vet yesterday and asked specifically for a fecal float test. I started the Panacur on Sunday night with his dinner and gave him his second dose last night. I don't want to play Dr and self diagnose Henry but I have done nothing but read and research parasites for a week now and after finding an article yesterday that talked about the "extremely smelly stools" that cinched it for me. My gut tells me that this is Giardia, all the symptoms point to it. 

Last night Henry had his first "normal" stool; color, consistency, and normal poop smell. There was just a smidge of blood. It was also the first time that he did not have 7+ BM's in a day, just 5 which is better. I noticed a change in his energy level all day yesterday, more playful and bounding around like the puppy he is and should be.

Biggest plus? He slept from 9:30 pm (went from playing to zonked out) until 6am! He has had only one BM this morning and again, it looked almost normal and I did not find any traces of blood. Here's to hoping that we are on the right track finally!

[Karen, Jasper and Jackdoodle]

It sounds like you're doing the right thing. 

Hopefully, in the articles you read, you also came across the info on how to prevent reinfection by cleaning and disinfecting anything the stool touched. Very important! 

[Dolly Dykhouse]

Just spoke with the vet, Henry's test came back positive. She wants to put him on 5 days of Panacur and another 5 days of Flagyl/Metronidazole and retest in a couple weeks. I told her that I am not convinced that giving him Metro on top of the Panacur is going to do anything good for his GI tract and I got the textbook (which she was quoting treatment from as we spoke) This is the treatment and some strains of Giardia are hard to kill off so we need to do both, blah blah blah. I am so frustrated! And of course she wants me to put him on Royal Canin as it will be easier to digest while dealing with his compromised GI tract. Another added bonus is now treating my senior dog too because he has been exposed most likely even if he isn't showing signs of it.

I've trimmed around Henry's rear end to make it easier to clean him up and I'll be going and getting another gallon of bleach to wash down the patio and the bark area where he goes potty. He has only had 2 BM's today, one after each meal which is a huge improvement but he is not nearly as active as he was yesterday, he has spent most of the day napping. I'm hoping it's his bodies way of resting and healing as he hasn't had good solid rest other than the last couple of nights. Thanks again for your help and support Karen I greatly appreciate it.

[Karen, Jasper and Jackdoodle]

I would absolutely not feed the Rx food, it is untrue that it would be easier to digest than a homemade bland diet. That's absurd. 

I personally would not give the metronidazole at this point. You've already seen an improvement from the Panacur alone. IF this strain of giardia turns out to be "hard to treat", you can always get the metronidazole if the next fecal comes back positive again. Why give a potentially harmful drug if it isn;t necessary? As far as "this is the treatment", my vet, who owns his 6 doctor practice, felt that Panacur alone should be the initial treatment, so obviously giving metronidazole on top of Panacur is not a universal standard treatment. And for sure, your senior dog (who most likely doesn;t have giardia) should not be given anything other than Panacur. 

[Dolly Dykhouse]

Karen even the vet made a comment about the RX diet and said that she had her dog on it for some time and did well, but...the hesitation said it all! Why do some vets feel that they need to practically read from a script when treating a patient?! Part of the problem is this is a "clinic" which has always been fine for us as our senior dog and cat are very healthy and go in annually for thier boosters and that is about it. Henry on the other hand looks like he is going to be more of a challenge health wise possibly. We have UC Davis school of Vet Science about 45 minutes from here so I am thinking if the retest comes back positive (and with one false negative shouldn't I retest again a week or two later if the retest is negative?) we are going to make an appointment for him at UC Davis or find another vet that specializes in GI issues.

[Karen, Jasper and Jackdoodle]

Typically, you retest when the dog has been off the antibiotics for a week to 10 days. 

I'm not a fan of vet "clinics". You mention "annual boosters". that right there is a red flag, as all of the core vaccines now have 3 years versions available, and no dog should be getting vaccinated every year. Also, if the vet is an employee of a chain clinic, she may very well be getting paid on commission and is expected to bill X amount of dollars in a given time period. I would start looking for a private practice vet, preferably one who owns the practice, and develop a relationship that will hopefully last for all the years of Henry's life. 

[Dolly Dykhouse]

I took Henry in to the vet yesterday so they could weigh him and give me the additional doses of Panacur to complete the 5 day cycle of meds. She did tell me that this last fecal float immediately showed up positive and there were plenty of cysts visible in the float. It proves that there can be multiple false negatives before you hit on the right stool sample that contains the cysts. It is so important that if you think that your dog might have Giardia, insist on testing more than once! 

I did have a prolonged conversation about the use of Metro as a first step/combination with Panacur to treat Giardia and again I was given the protocol from a textbook answer which made me shake my head. I will not be giving Henry the Metro and will only be giving him Panacur this time. I see no need as his stools have firmed up to almost normal and there are no longer any signs of blood and he is eating like a champ. 

Of course they want to treat our senior dog for Giardia as well. The RX? Metro. I flat out told them no, I'll order Panacur for him as well, all the while making a mental note to research new vets in my area.

Thanks again for all your help and support Karen.

[Karen, Jasper and Jackdoodle]

I know this is from a drug company website, but it might be of interest to your vet regarding the use of Panacur versus metronidazole as well as using the combination: http://www.revivalanimal.com/product/giardia/

And this blog pretty much sums it up: 

"When it comes to that first treatment step, however, I prefer to use a veterinary drug that has the best chance to work with the least chance to harm my dog. That would be the drug Panacur (fenbendazole), which is considered a particularly safe drug, with few listed side effects. It also clears up around 90 percent of all giardia cases.

For reasons I can't understand, however, a lot of vets still reach first for a less effective, much more dangerous drug, Flagyl (metronidazole). It's only effective in around 67 percent of cases, and carries some pretty scary side effect warnings, particularly at the fairly high giardia dose.

Some very resistant cases will need both drugs, but for a first line therapy, there's no reason I know of to use Flagyl, and plenty of reasons not to, including the risk of neurological side effects."

http://www.doggedblog.com/doggedblog/2010/06/how-to-treat-or-not-tr...

[Karen, Jasper and Jackdoodle]

And you might also want to send your vet this article from a veterinary practice website. It not only discusses the advantages of the fecal float test over the ELISA test for accurately diagnosing giardia, it also discusses the benefits of panacur over metronidazole: http://veterinarycalendar.dvm360.com/giardia-infection-dogs-and-cat...
I think finding a new vet is a very good idea. Textbooks do get revised over time, and treatments change, lol. 

[Dolly Dykhouse]

Just a quick update on Henry. We completed the 5 days of Panacur (I did NOT give him Metro) and we have seen improvement in his stools. He has gone from 8+ per day to no more than 4 and most are firm (especially the first one after he gets up in the morning) and at worst they are soft but formed. Last weekend I pulled up all the bark that makes up our potty area in the backyard as we have 80% aggregate patio/pool and treated the soil with a bleach/water solution and put down 26 bags of new bark. I took the advice of another member and cut paper plates in half to catch Henry's stool before it even hits the ground and if I miss (Henry crabwalks and goes at least 2-3 times) I use a sprayer with the bleach solution and baby wipes to clean his rear end. All this in addition to the bleach/steaming of our tile floors and washing bedding, etc. This said, I don't think we are out of the woods entirely yet. Some stools still have that golden yellow appearance and smell badly some are fine. I will bring in a stool sample this week and request another fecal float and will not be surprised to find out that there are still cysts in his stool. I have already bought another 5 days of Panacur and will treat him with this if its positive and keep up with the Proviable and yogurt for his gut, but no Metro! I am convinced through reading everything here on the DK  boards and elsewhere that unless there are some really strong reasons for using Metro like watery stools consistently and/or blood in the stools that using Panacur to kill the Giardia and increasing the good gut bacteria is the safest way to go. Henry loves his food and licks his bowl of kibble with yogurt and sweet potato and is now 24# at 14 weeks! He is energenic and playful and is sleeping through the night so I feel that is a victory over where we were a few short weeks ago. 

Thanks to everyone here on DK and the great info (especially you Karen!) it has helped me tremendously and provided great education.

Karen, I don't know if you have ever come across information regarding Prozyme which is a digestive enzyme for canines. I read an article that said giving the powder mixed with water into a slurry and given by mouth via a syringe 30 minutes prior to food helps kill off the Giardia cysts by attaching to them (as there is no food for the enzymes to break down) and also helps to eliminate them. Have you read anything similar? I bought Prozyme just in case as it will help my older puggle and thought I might try this as well as it can't hurt and has no side effects. Let me know if you or anyone has any thoughts on its use.

[Karen, Jasper and Jackdoodle]

Here's the thing about digestive enzymes: Our bodies make them from the amino acids in the food that we eat, and the same process occurs in dogs. Our digestive system breaks down the foods we eat into their most basic form, which in the case of proteins is amino acids. When we (or they) take an enzyme supplement like Prozyme (or anything else sold OTC), it does absolutely no good, as our stomach acid will break down the enzymes in our stomachs before they can ever get into the intestines,  just like it breaks down our food. There is no possible way that these enzymes can "attach to the giardia cysts"...that's just not a physiological possibility. And I have known of these OTC enzymes actually contributing to soft stool/diarrhea. I wouldn;t use them.