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My 2 1/2 year old Siberian has had chronic diarrhea for the past 4 weeks. It's been pretty persistent, in 4 weeks I have only seen one solid stool. This happened in conjunction with an outbreak of unexplained scabs all over her back (from the base of her neck to the top of her tail) and touch sensitivity. He prescribed prednisone which has helped with the scabs and the touch sensitivity but did nothing for the diarrhea. He then prescribed metronidazole which also hasn't done anything for the diarrhea. She was also on Iams Prostora Probiotics, again no help.
We just did a comprehensive diarrhea panel which came back negative, so now he's told me he's wondering if this is a fibre responsive colitis and asked me to add pumpkin to her food.
I guess what I am really wondering is at what point to ask for more aggressive testing? He's mentioned in the past that this could be autoimmune and I am concerned that even if the fibre fixes the diarrhea we may be missing some underlying condition, am I being to paranoid? Is there anything else I should be asking him to do or consider?
I should probably also mention that since I got her (she was a rescue) a year and a half ago she's had diarrhea almost every month and sometimes more frequently. We've tried switching her food several times which seems to help initially but the diarrhea comes back.
Thanks so much for your help.
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Dr. Marie replied:
What a frustrating problem! It sounds like your vet is doing all of the same things I would do for chronic diarrhea - food change, metronidazole, probiotics and diarrhea panel. I have had a few cases like this that I just can't figure out.
While I may not have the answer for you, I'll give you my thoughts on Kaja's case.
I would likely try treatment with a broad spectrum dewormer such as fenbendazole (also known as panacur). I would do this even if fecal exams are negative. There are some parasites that can go through stages where they are hard to detect.
One of the other reasons for trying fenbendazole is that dogs with hookworm can have chronic diarrhea along with skin issues. However, the ones that I have seen usually have skin problems on their feet rather than backs. But still, it is worthwhile to try.
The other thing that would tie together skin issues and diarrhea would be an allergy. However, food changes and prednisone really should have helped.
Another thing that I usually do for dogs with chronic diarrhea is a couple of weeks of an antibiotic called tylosin. I have had several cases where we couldn't find an answer but the dogs did well with tylosin. Some of these dogs need a course of tylan whenever they have an outbreak of diarrhea and other dogs need a tiny amount daily to keep them having solid stools.
Here's something else you can ask your vet about - Addison's disease. Addison's can sometimes be difficult to pick up. It can cause chronic GI issues. If this were my case I would likely do a baseline cortisol blood level. It's a relatively inexpensive test to do. If she has Addison's then this is treatable, but it is a lifelong disease. If left untreated it can be very serious.
If none of these things are working then the next step is to have intestinal biopsies done. This can be expensive, but it is our best chance at getting a diagnosis.
I hope things look up soon!
Dr. Marie.
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Customer reply:
Thanks for the advice Dr. Marie.
In regards to dewormer and the antibiotics, I am not sure if it these are similar to what you suggested but when we first discovered the scabs her skin was red and inflamed so my vet prescribed Cephalexin which again helped bring the redness down and heal the scabs but had no impact on the diarrhea. My vet's theory regarding the scabs based on the way they appeared and her sensitivity to touch in the area (he actually saw her and did an exam the day before I found the scabs and they weren't there) was panniculitis but this was never confirmed, I think that's what has him thinking it might be autoimmune?
Kaja's also dewormed monthly with Revolution but maybe that's not as strong etc., as what you're suggesting?
With Addison's disease are there any other symptoms I should be on the look out for?
She's been more tired than normal, sleeping for large chunks of the day but we've just been chalking it up to her diarrhea.
Thanks again.
Dr. Marie replied:
There are a number of autoimmune conditions that can cause skin conditions. However, if the skin problem cleared up with Cephalexin this sounds more like a bacterial issue. While an autoimmune problem is possible for the diarrhea, it is really unlikely.
Panacur is much better than Revolution when it comes to intestinal parasites.
With Addison's the symptoms can be really vague. We can sometimes see episodes of weakness. But, often off and on gastrointestinal issues (i.e. diarrhea) can be the only issue.
Feel free to take this list to your vet. Ultimately, they can advise you better than I can as to what steps to take next though!
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Dr. Marie is a veterinarian who practices in a busy animal hospital in Ottawa, Ontario. She created Ask A Vet Question as a resource for good, accurate veterinary advice online. Dr. Marie treats dogs, cats, hamsters, guinea pigs, and rats. She has been a vet since 1999.
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