Diarrhea issue - no history of intestinal problems

[Marcy and Cocoa]

Hello - I could use some help. About a month ago, the evening after a hike, my 10-1/2 yo 58 lb GD Cocoa vomited and the next day developed severe diarrhea. No further vomiting and she continued to eat and drink normally. I assumed it was something awful she ate in the woods, but when it didn’t get better after a couple of days I took her to the vet, who, no surprise, prescribed Metronidazole and Proviable Forte. He suggested Royal Canin Gastrointestinal food, but when I protested he said chicken and rice would be fine. She improved after about a week and we returned to regular food ( Orijen Fresh Fish). She was fine for a week or so, but then the diarrhea returned. Back to the Metronidazole and Proviable. She had had two fecal tests - fecal flotation and additional giardia screens both times  (vet’s standard testing), both negative. Back to the vet today and he suggested that before we do x-rays, blood work, cortisol, etc, we try the Royal Canin, along with Pro Pectalin Anti-Diarrheal Tabs. I gave in and got the food (and the tablets).  She has never had intestinal issues before and I am getting pretty worried although she continues to eat, drink and play normally.   Any thoughts?

[Karen, Jasper and Jackdoodle]

Was the Proviable given at least 2 hours apart from the metronidazole? 
The probiotics usually need to be continued for several weeks after the meds are finished. It sounds like you did not do that. That's the time that the good bacteria in the gut really has a chance to be replenished, when you stop destroying it with metronidazole. Otherwise, you end up with chronic diarrhea, as you have. 
I personally would not give any more metronidazole. There is no confirmed parasite or infection present, so there is no reason to continue messing up her gut flora. I would continue the probiotics indefinitely. 

X-rays may show some foreign body in the gut, so that's reasonable. Standard blood work will show nothing related to GI disease, unless you have a GI panel run. That cannot be done in house and will have to be sent out. I'm not sure why your vet wants to do a cortisol test, but considering all the diseases that can occur in dogs this age, for which diarrhea can be a symptom, that also seems reasonable to me.

The Rx food is not going to do anything to help. There are no therapeutic or medicinal ingredients in it. There IS cellulose, which may help firm stools now, but that's about it. 

Rather than chicken and rice, I would use a 50/50 mixture of plain boiled white meat chicken diced very fine, and mashed sweet potatoes. Giving rice to a dog who is used to a grain free diet is usually not a good idea. The sweet potatoes have more fiber and nutrients and may help with firming the stool. 

I really think the metronidazole and the too-short course of the probiotics is the cause of the ongoing diarrhea, which is a familiar scenario here. However, senior dogs can develop other health issues, so the testing may shed some light on whether this is due to some new health issue or not.
I hope this helps.

[Marcy and Cocoa]

They didn't tell me about separating the Metronidazole and the Proviable - I did ask about anti and probiotics cancelling each other out ....  I stopped the probiotic capsules that come with the Proviable paste when she seemed to improve, but I started them up again and will continue.   With her Orijen she normally gets a some pumpkin which I assumed is similar in effect to the sweet potato, but the vet said this morning that while useful for both constipation and diarrhea, in this case he thinks I should stop it for now and add back as she improves which doesn't sound unreasonable.  I guess I will go with the RC for now as I have purchased it, but it isn't going to be a long term change.  She certainly gobbled it down - it must be like junk food for us!  If she doesn't get better I will schedule the full testing - and yes, the blood work would be a GI panel.

Thanks very much for your input!

[Karen, Jasper and Jackdoodle]

Glad to help. Please keep us posted.

[Nancy, Ned, Clancy, and Charlie]

When we first got Charlie, he had lots of diarrhea - in his case he had some parasites, but mostly the diarrhea was probably from stress.  He had panacur which cleared up the parasites but he had diarrhea and was given Metronidazole.  Well, he developed 'rebound diarrhea' which was very severe. We used Proviable but it just wasn't quite enough for Charlie. With Karen's guidance we switched to a limited ingredient kibble and a human probiotic called VSL#3.  It is important to administer the probiotic at least two hours apart of the antibiotic.  Whatever you use as a probiotic or a food, you need to stay with it for longer than you think.  We found from this incident and the others he has had, that we need to keep up both for about 3 weeks or a month, then transition back.  We also feed our dogs Orijen kibble.

[Marcy and Cocoa]

Thanks - I have the probiotics and will continue on with them for the next several weeks. I will also continue with this food until it is gone which will probably be a couple of weeks as well. Hopefully we will then be able to get back to the Orijen since it has worked well for us for so many years. No more of the antibiotics!