LET'S TALK ABOUT...DIARRHEA, PT. 2

How many of you will be going "over the river and through the woods" this week for the Thanksgiving holiday?  Desperado and Helpful Buckeye will be at the home of some very dear friends here in Flagstaff for Thanksgiving dinner...something we've alternated years on for quite some time.  Friends and family are important all through the year but especially so at certain times.

How many of you know who made the proclamation that designated the observation of Thanksgiving and when it occurred?  No, it wasn't one of the Pilgrims....

Helpful Buckeye thought you might be interested in reading the text of that proclamation:

PROCLAMATION OF THANKSGIVING

PRESIDENT ABRAHAM LINCOLN - OCTOBER 3, 1863

 
"The year that is drawing towards its close, has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature, that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever watchful providence of Almighty God..." 

"No human counsel hath devised nor hath any mortal hand worked out these great things. They are the gracious gifts of the Most High God, who, while dealing with us in anger for our sins, hath nevertheless remembered mercy. It has seemed to me fit and proper that they should be solemnly, reverently and gratefully acknowledged as with one heart and one voice by the whole American People." 

"I do therefore invite my fellow citizens...to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens. And I recommend to them that while offering up the ascriptions justly due to Him for such singular deliverances and blessings, they do also, with humble penitence for our national perverseness and disobedience, commend to His tender care all those who have become widows, orphans, mourners or suffers in the lamentable civil strife in which we are unavoidably engaged, and fervently implore the interposition of the Almighty Hand to heal the wounds of the nation and to restore it as soon as may be consistent with the Divine purposes to the full enjoyment of peace, harmony, tranquility and union." 

"In testimony whereof, I have hereunto set my hand and caused the Seal of the United States to be affixed."
 
By the President: Abraham Lincoln

That proclamation was, of course, made during the heart of the Civil War...a very difficult time for the USA.

Desperado and Helpful Buckeye are very thankful for the family that we have remaining, the good friends we have made over the years, our good health that allows us to enjoy the wonders of Mother Nature, and...for each other.

Happy Thanksgiving to all of our readers, wherever you are!

In one way, it doesn't seem appropriate to follow Thanksgiving wishes with an article on pet diarrhea, does it?  However, our regular readers will understand the other side of that coin.  Helpful Buckeye always cautions pet owners to be careful about giving their pets any of the Thanksgiving dinner and the warning is the same for this year.  Keep your pets as healthy as possible by watching them a little closer during the holidays.  Don't offer them any of the table food from your Thanksgiving feast and take care to see that they cannot get into any of your food garbage as well.  Those are some of the "dietary indiscretions" that are included in the following discussion.  I know this makes you the "bad guy" but your pet can only get sick from that stuff.  And, of course, diarrhea will be one of the consequences of not heeding this advice.

...received so many funny comments about our introductory "diarrhea" cat that I decided to run it again for this second part of our discussion on diarrhea.  As pointed out last week, Helpful Buckeye is now giving you some information on longer-lasting forms of diarrhea...what is known as "chronic" diarrhea.

Diarrhea, as we discussed last week, is defined as the rapid movement of fecal matter through the intestine resulting in poor absorption of water, nutrients and electrolytes. With diarrhea the stools (bowel movements) can become loose or runny. Chronic diarrhea refers to diarrhea that persists for three or more weeks. Occasionally the fecal material may contain fresh blood or mucus.

CHRONIC DIARRHEA

Chronic diarrhea is an important sign of intestinal disease in the dog and cat. Persistent diarrhea can lead to weight loss from poor digestion and loss of important nutrients. Chronic diarrhea can lead to loss of body condition, development of a poor hair coat, and may also affect appetite and activity levels.

Chronic diarrhea is a change in the frequency, consistency and volume of the pet's feces for more than three weeks. Starting in the small or large intestine, diarrhea can either be secretory (where it is very watery) or osmotic (not watery), and is due to various reasons, including diet, disease, or infection.

Symptoms and Types

Symptoms found when it originates in the small intestine may include:

 •Weight loss

 •Vomiting

 •Abnormally large volume of feces

 •Frequency of defecation increases (2–4 times per day)

 •Gaseous sounds from the gut

 •Black, tarry stool (melena)

 •Very hearty appetite (due to poor digestion and absorption of food)

Symptoms found when it originates in the large intestine may include:

 •Abnormally smaller volume of feces

 •Frequency of defecation increases (more than 4 times per day)

 •Bright, red blood in the feces and/or mucus

 •Straining to defecate and urgency to defecate

 •Pain while defecating

•Vomiting

Causes

Most causes of chronic diarrhea induce local irritation or structural abnormalities of the intestinal mucosa (lining). There are numerous diseases and disorders that can lead to chronic diarrhea.  

Small intestinal abnormalities which can cause diarrhea include:

◦Inflammatory bowel disease

 ◦Lymphangiectasia (protein-losing disease)

 ◦Infections (e.g., viral and bacterial)

 ◦Parasites (e.g., Giardia)

 ◦Cancer

 ◦Partial blockage

 ◦Abnormally short small intestine

 ◦Stomach and/or intestinal ulcers

Poor Digestion

Pancreatic Disease

 ◦Liver and/or gallbladder disease

 ◦Dietary indiscretion, intolerance or allergy; ingestion of foreign material

 ◦Gluten sensitivity (In Irish Setters)

 ◦Underactive adrenal glands

 ◦Urine waste in the blood

 ◦Toxins or drugs

Large intestinal abnormalities which can cause diarrhea include: 

◦Inflammatory bowel disease

 ◦Infections (e.g., Viral and bacterial)

 ◦Parasites (e.g., Giardia)

 ◦Cancer

 ◦Changes in diet

 ◦Low fiber in diet

 ◦Irritable bowel syndrome

 •Birth abnormalities such as a short colon 

Diagnosis

Veterinary care includes diagnostic tests to help determine the underlying cause of the diarrhea, whether it's small or large intestine, and to guide subsequent treatment recommendations. Many of the following may be necessary to diagnose the cause of chronic diarrhea:

• A complete medical history and physical examination

• Multiple fecal studies (flotation, smear and cytology, zinc sulfate test) to search for intestinal parasites, protozoal parasites, and bacteria

• A complete blood count (CBC)

• A biochemical profile (blood sample); might also include thyroid function tests since hyperthyroidism in the cat may produce chronic diarrhea

• A urinalysis to help evaluate the kidneys and level of hydration

• Abdominal radiographs (X-rays)

• Thoracic (chest) radiographs, particularly in geriatric patients and animals who are suspected to have cancer

• Bacterial fecal cultures

• Tests for absorption and digestion problems, such as serum trypsin-like immunoreactivity (TLI), serum folate and cobalamin levels

• Serologic tests for certain fungal diseases

Depending upon the clinical signs and the results of the above tests, your veterinarian may recommend further testing. These tests are chosen on a case-by-case basis:

• Abdominal ultrasound

• An upper gastrointestinal (GI) barium series (of stomach and small intestine) to help diagnose foreign bodies, partial obstructions, masses, thickening or displacement of bowel, etc.

• Barium enema if colonic disease (large intestine) is suspected

• Endoscopic examination and biopsy of the stomach, small intestine, and/or colon

• Serum bile acids for suspected liver disease

• A blood lead level test

• Exploratory abdominal surgery (laparotomy) if other diagnostic tests are inconclusive, or if a disease is suspected that requires corrective surgery

Treatment

Treatment options vary and are based on the underlying cause. Surgery may be necessary for problems caused by intestinal obstruction, intestinal mass, or bowel disease unreachable by other procedures.

If no definitive diagnosis is possible, treatment then focuses on dietary management and, in some cases, anti-infective medication. Dehydration is a big risk due to water loss, therefore fluids need to be replenished with a balanced electrolyte solution, such as saline. This type of symptomatic or empirical treatment may be tried in some cases of chronic diarrhea, especially if initial diagnostic tests are inconclusive and the animal is feeling well and relatively stable. Empiric treatment does not replace the need to define the exact cause of the chronic diarrhea, it at all possible. Empirical treatment may include one or more of the following:

• Deworming for whipworms, which may not show up on routine fecal tests

• Short course of antibiotics for clostridial bacteria

• Changing the diet to a high-fiber diet if large bowel diarrhea is present or to a hypoallergenic diet if small bowel diarrhea is present

Supportive therapy for ill, malnourished and unstable patients may involve hospitalization with intravenous fluids, supplemental nutrition and vitamins, intestinal protectants and adsorbents, etc. Plasma transfusions and infusion of other dense fluids may be required for animals with low protein levels. Intestinal protectants, adsorbents, and antacids may be administered while results of diagnostic tests are pending, etc. Motility modifiers (medications that effect the movement of food through the intestinal tract) may be tried in some cases.

Specific therapy of most cases of chronic diarrhea depends upon reaching a definitive diagnosis as to the cause, and then instituting therapy for that cause. Such therapy varies widely and can involve medications, dietary changes and surgery:

• Deworming agents are required for intestinal parasites.

• Products used for protozoal parasites include sulfa drugs for coccidiosis and metronidazole for giardiasis.

• Antibiotics are administered for bacterial infections, small intestinal bacterial overgrowth, and some forms of colitis.

• Antifungal drugs (e.g. ketoconazole, itraconazole) are given for fungal infections and may be tried for protothecosis.

• Corticosteroids and dietary manipulation may be necessary for inflammatory bowel disease, lymphangiectasia, and other immune-mediated inflammatory disorders.

• Dietary manipulation is helpful in cases of dietary intolerance, food allergy, colitis, short bowel syndrome, and irritable bowel syndrome.

• Chemotherapy, radiation therapy or surgery may be helpful in certain cases of cancer.

• Surgical exploratory is indicated to correct causes of chronic obstruction, intussusception, cecal inversion, remove foreign bodies, etc.

• Intravenous fluid therapy and specific treatments for any liver and kidney disorders may be indicated.

• Pancreatic enzyme replacement therapy is necessary in documented cases of exocrine pancreatic insufficiency.

• Motility modifiers (medications that effect he movement of food through the intestinal tract) may be helpful in cases of irritable bowel syndrome.

• Supplementation with cobalamin, folate and other vitamins is often required in the malabsorption/maldigestion diseases.

• If lead poisoning is diagnosed antidotes may be started either orally or by injection.

Home Care

Keep in mind that the resolution of chronic diarrhea is usually gradual with treatment. In a few cases, despite a correct diagnosis and proper therapy, diarrhea may not completely resolve or may worsen, especially in patients with cancer.

It is important to monitor your pet closely if he has chronic diarrhea. Pay particular attention to stool volume and character, the frequency of defecation, and any straining to defecate. Note the presence of any blood or mucus in the stool. Also monitor the dog's body weight, appetite and activity level.

Administer all prescribed medications exactly as ordered by your veterinarian. Notify your veterinarian if you have any problems medicating your pet.

Repeated follow-up examinations, fecal tests and blood tests may be needed to bring the chronic diarrhea under control and prevent it from returning.

If your dog does not respond to the treatment be sure to bring it back to the vet to be re-evaluated. Many of the parasitic and bacterial infections that cause diarrhea in dogs can also affect humans, so be very careful when handling a dog suffering from diarrhea.

Depending on the diagnosis of the cause of your pet's chronic diarrhea, your veterinarian might need to talk with you concerning measures to be taken to insure that this does not happen again.

Adapted from:

http://www.petplace.com/dogs/chronic-diarrhea-in-dogs/page1.aspx

http://www.petmd.com/dog/conditions/digestive/c_dg_diarrhea_chronic

http://www.petmd.com/cat/conditions/digestive/c_ct_diarrhea_chronic

As always, send questions or comments to: dogcatvethelp@gmail.com or submit them at the Comment section at the end of this issue.

 

SPORTS NEWS

The Ohio State Buckeyes went to Wisconsin on Saturday, a place where most visiting teams have difficulty winning.  The Buckeyes won the game in over-time to go to 11-0 on the year.  This sets up the Michigan game this coming Saturday to be the finale in a potentially undefeated season.  Helpful Buckeye was not able to watch the main part of the game due to being in the 60-mile portion of the Tour de Tucson; however, I did wear my OSU biking shirt and got back to the hotel room in time to watch the over-time.  So, yes, I was "helpful"....

The Pittsburgh Steelers hosted the Baltimore Ravens Sunday night...our most despised rival, but also a very good team.  Even with Big Ben at QB, the game would have been a tough one to win; but, since Ben couldn't play, our back-up QB gave his best effort...but it wasn't good enough.  We lost by 3 points.  

 

PERSONAL STUFF

Desperado and Helpful Buckeye went to Tucson for a 4-day weekend so that Helpful Buckeye could ride in the Tour de Tucson...a bike race that was celebrating its 30th year.  Tucson has been named as the #1 city in the USA for bicycling by Outdoors magazine and Helpful Buckeye and Desperado were very impressed with the city's efforts on this race.  The pre-race festivities on Friday, the race itself on Saturday, and the post-race celebrations were outstanding fun for all involved.  I thought the race was one of the greatest experiences I've ever had...at least in my athletic  endeavors.  My ground crew (Desperado) was top-notch and had a lot of fun in her own right.  I'll have some of the important stats and pictures from the race in next week's issue (after the official results are publicized).

 

 

 

 

 

 

~~The goal of this blog is to provide general information and advice to help you be a better pet owner and to have a more rewarding relationship with your pet. This blog does not intend to replace the professional one-on-one care your pet receives from a practicing veterinarian. When in doubt about your pet's health, always visit a veterinarian.~~