LET'S TALK ABOUT...DIARRHEA

How many of you remember the old TV commercial from Pepto-Bismol, during which an off-screen voice quietly says, "I'd like to talk to you about diarrhea"?  Amongst humans, this topic has always carried a certain stigma, in that one doesn't talk about it in public.  Well, at least, we humans are usually able to get to a bathroom without the act of "having diarrhea" becoming a public spectacle.

Think about the dog or cat, with even just the rudiments of house training "under its belt," having a bout of diarrhea somewhere in the house where everyone can see it.  The unfortunate animal knows that this wasn't a normal happening and may even sneak off to hide.  Indoor pets which have been properly house-trained (and their owners) will obviously have a bigger problem with this disorder than pets which are kept outdoors. 

Diarrhea is defined as: "...an intestinal disorder characterized by frequent and fluid fecal evacuations."  From statistics compiled by the pet insurance company, Trupanion, diarrhea is the 3rd-most frequently diagnosed problem in dogs.  That's not hard to understand, when you consider that most observant (and even a lot of the not-so-observant) pet owners can tell something's not right when they see their pet passing liquid stools.  A further understanding of this very common pet problem can help you keep your pet free from diarrhea or, at the least, help you get it resolved as soon as possible.  As the current commercial for Pepto-Bismol goes, "Don't let diarrhea ruin your plans."

What Is Diarrhea?

Diarrhea is characterized by frequent loose or liquid bowel movements. It can be caused by something as simple as a change in diet or a more serious illness or infection. Diarrhea may be sudden in onset and short in duration. It can also last for weeks to months or occur off and on. A single bout of diarrhea is generally not a cause for concern in dogs—but if it persists for more than a day, it can lead to dehydration, may indicate an underlying health issue and should be checked out by a veterinarian.  Acute diarrhea is a common clinical problem in veterinary practice. It is characterized by the sudden onset and short duration (three weeks or less) of watery or watery-mucoid diarrhea. Occasionally the fecal material is also overtly bloody.  Diarrhea results from excessive water content in the feces and is an important sign of intestinal diseases in the dog. Diarrhea can affect your dog by causing extreme fluid loss, which leads to dehydration, electrolyte disturbances, and/or acid-base imbalances.

At this point, you can see that there is a dividing line at about 3 weeks duration that separates "Acute" from "Chronic" diarrhea.  In this week's issue of Questions On Dogs and Cats, Helpful Buckeye will address acute diarrhea, while chronic diarrhea will be the topic for next week's issue.

What Are the General Symptoms of Diarrhea?

Loose or liquid, frequent stools are the most common symptoms of diarrhea in dogs and cats. Other signs include flatulence, blood or mucus in stool, changes in volume of stool and straining to defecate. Lethargy, dehydration, fever, vomiting, decreased appetite, weight loss and an increased urgency to defecate may also accompany diarrhea.  If your pet’s diarrhea is black, it could be experiencing internal bleeding of the stomach or small intestine and should be examined by a vet immediately.

What to Watch For

• Passage of loose, watery stools that persist for more than one day

• A change in the color of the stool

• The appearance of blood or mucus in the stool

•Decreased appetite

• Vomiting

• Depression, lethargy, listlessness

•Fever

 •May have an increased volume of feces

 •Fecal accidents

 •Straining to defecate

 •Abdominal pain

Acute diarrhea is often alarming, but may not be an emergency if your dog is still active, drinking and eating, and is not vomiting. However, acute diarrhea associated with vomiting, lack of water intake, fever, depression, or other symptoms should prompt a visit to your veterinarian.

What Causes Diarrhea? 

• Dietary indiscretion can include the eating of spoiled food, overeating, the ingestion of foreign material, and/or sudden changes in the diet. Acute diarrhea may also follow ingestion of a food that contains substances that are poorly tolerated by the gastrointestinal tract, such as dairy certain proteins, lactose, high fat content, and certain food additives.

• Ingestion of poisonous substances or toxic plant material

• Ingestion of foreign body (for example, toy, rubber band, plastic bag, etc.)

• Allergic reaction

• Bacteria and bacterial toxins (Salmonella, Clostridium, Campylobacter, Escherichia coli, Yersinia, etc. ) may cause acute diarrhea and may be contracted from contaminated food and water, or exposure to the fecal material of other infected animals.

• Internal parasites, such as roundworms, hookworms, and whipworms

• Viral infections such as parvovirus, coronavirus, rotavirus, distemper virus, and adenovirus may all induce acute diarrhea.

• Protozoal infections with coccidia, Giardia, Entamoeba, trichomonads, etc. may also be a cause.

• Fungal and algal infections (e.g. histoplasmosis, protothecosis, phythiosis, etc.) are more likely to cause chronic diarrhea than acute diarrhea, but occasionally acute diarrhea may occur.

• Inflammatory bowel disease

• Cancer or other tumors of the digestive tract

• Certain medications

• Colitis

• Stress

• Hemorrhagic gastroenteritis is a disease of uncertain origin in dogs. Affected dogs often have a sudden onset of bloody diarrhea.

• Hairballs (Cats)

• Hyperthyroidism (Cats)

• Drugs and toxins cause acute diarrhea by either directly irritating the lining of the intestinal tract, or by disturbing the normal population of bacteria. Examples include non-steroidal anti-inflammatory drugs such as aspirin, corticosteroids, antibiotics, anti-cancer drugs, and certain heart drugs (digoxin).  Offending toxins include insecticides, lawn and garden products, and heavy metals.

• Intussusception (telescoping of the bowel on itself)

• Intestinal obstruction, usually shows up with vomiting, but acute diarrhea may also be noted.

• Metabolic disorders, such as liver and kidney disease.  Diarrhea may be bloody and is often accompanied by multiple systemic signs in these cases.

• Pancreatitis (inflammation of the pancreas)

• Tumors of the intestinal tract or other abdominal organs may induce diarrhea. Although the diarrhea may begin acutely, it does not usually resolve on its own.

Diagnosis

Your veterinarian will perform a complete physical exam on your pet, checking for underlying illnesses and assessing for dehydration. You will need to give a thorough history of your dog’s health, including a background history of symptoms, and possible incidents that might have precipitated this condition. A blood chemical profile to help evaluate kidney liver function, and electrolyte status, a complete blood count (CBC) to evaluate for infection, inflammation, anemia and dehydration, an electrolyte panel and a urinalysis to evaluate kidney function and the hydration status of the animal will be performed so as to rule out other causes of disease. X-rays can help to rule out the possibility that your dog swallowed inappropriate items (foreign bodies), which may be blocking or irritating the intestine and to check for the presence of fluid or gas.

Blood tests can be performed to rule out an inflamed pancreas, or a pancreas that is not producing enough digestive enzymes. Blood tests can also be used to check levels of cobalamin and folate (vitamins) as these are normally absorbed in the intestine.

Laboratory tests can be performed on fecal samples to check for Giardia, Parvovirus and Cryptococcus infections. A smear of feces should be checked for parasite eggs as well. It is not uncommon to run multiple fecal exams, as some parasites are difficult to diagnose. Your veterinarian may perform an endoscopy to take a sample of your dog’s intestine for histopathologic examination at the laboratory.

Other diagnostic tests might include, ultrasound, cultures, endoscopy and biopsy. The diagnostic tests performed and treatment recommended will depend on how the long the diarrhea has been going on and the severity of your dog’s condition.

Although most cases of acute diarrhea are short-lived and self-limiting, there are some cases that require diagnostic testing to confirm an underlying cause. Such tests include:

Depending upon the clinical signs and results of the above tests, your veterinarian may recommend additional tests to ensure optimal medical care. These ancillary tests are selected on a case-by-case basis:

• Parvovirus test on the feces

•Bacterial cultures of the feces

• Fecal cytology to identify the type of inflammation present and to search for parasites, protozoa and bacteria

• Serologic tests for infectious diseases

•Abdominal ultrasonography, especially if the previous diagnostics tests have been inconclusive

• An upper gastrointestinal (GI) barium series to search for intestinal ulcers, masses, obstructions, intussusceptions and foreign bodies

•Endoscopy or colonoscopy to evaluate a portion of the small intestine or colon with a viewing scope, especially if acute diarrhea progresses to chronic diarrhea

• Specialized assays for toxins that can cause diarrhea

Treatment

Diarrhea is a symptom that can be caused by many different diseases or conditions, and specific treatment requires a diagnosis. Symptomatic therapy may be tried in mild cases of short duration, or may be instituted while diagnostic testing is underway.  If your dog is only mildly ill, it may be treated on an outpatient basis, but patients with severe dehydration and/or vomiting should be hospitalized for fluid and electrolyte therapy. Shock fluid therapy may be necessary. Potassium supplementation may be required in very ill patients but it should not be given simultaneously with the shock fluid therapy. Patients that are mildly ill, and are not vomiting should follow a period of fasting (12–24 hours), which is often followed by a bland diet, such as boiled rice and chicken or a prescription diet.

Patients with obstruction or foreign bodies may require surgery to evaluate the intestine and remove the foreign objects. Your veterinarian will prescribe the appropriate medicine for your dog’s diagnosis. Anti-secretory drugs, intestinal protectants or dewormers are the most commonly prescribed medications. Rarely, antibiotics are prescribed.

These treatments may reduce the severity of signs and offer relief to your pet: 

• Withholding food and placing the intestinal tract in a state of physiologic rest is an important aspect of therapy for acute diarrhea. 

Completely restricting food intake for 12- 24 hours allows the intestinal tract lining to start to heal.

• Food is then gradually reintroduced, starting with a bland, easily digestible, low-fat diet. Initially small amounts of this food are given as frequent meals. Examples of such a bland diet include boiled chicken or beef, mixed with low-fat cottage cheese, boiled rice or potato. Prescription diets that may be administered for acute diarrhea include Hill's Canine i/d, w/d, or d/d, Eukanuba Low Residue, and others. The bland diet is fed for several days, and then the original diet may be gradually reintroduced over a 2- to 3-day period.

• Fluid therapy may be necessary in some patients with acute diarrhea to correct dehydration and acid-base derangements, to replace electrolytes that are deficient, and to provide for ongoing losses.

• Antibiotic therapy for acute diarrhea is not required in most cases; however, it may be of benefit in animals that have hemorrhagic gastroenteritis, diarrhea containing fresh blood, or if a bacterial infection is suspected.

• Empirical deworming is often recommended even if the stool sample is negative for intestinal parasites, because parasites do not always show up in the fecal examination.

• Intestinal protectants and adsorbents (medications that coat, soothe and protect the lining of the intestines) may also be helpful.

• If your dog does not respond to conventional therapy within 48 hours, if fresh blood is seen in the diarrhea, if the animal is vomiting or showing other signs of systemic illness, then a veterinary examination is warranted.

The best treatment for your dog requires a combination of home and professional veterinary care. For optimal follow-up success in the treatment of your pet, please do the following:

• Precisely administer prescribed medications and follow any dietary recommendations. Contact your veterinarian if you are having difficulty treating your dog.

• Watch your dog for worsening of the disease. Signs of worsening may include the onset of bloody diarrhea, persistence of signs for more than two days, or any signs to suggest a systemic illness (vomiting, weakness, anorexia, collapse).

• If the signs resolve in a couple of days, no additional veterinary evaluation may be necessary.

• Once the diarrhea has resolved, keep your dog on a consistent, balanced diet and restrict access to garbage and other things that can cause diarrhea.

• Have your dog's stool checked at least yearly for intestinal parasites. Consider year round administration of heartworm preventative drugs that also prevent intestinal parasites.

• The prognosis for cure of self-limiting diarrhea is excellent. Affected animals are often successfully managed with dietary restriction, replacement of fluid deficits, and correction of the underlying cause.

• If your dog's diarrhea has failed to respond to the management outlined, it may require more extensive diagnostics. You should have your dog reevaluated by your veterinarian.

Are Certain Dogs and Cats Prone to Diarrhea?

There are certain breeds that may be predisposed to developing conditions that lead to diarrhea. German shepherds, for example, are known to have an increased prevalence of exocrine pancreatic insufficiency in the breed. Bernese mountain dogs are prone to gastrointestinal cancers. Young dogs are more likely to have infectious and parasitic-related diarrhea than adult dogs.

Long-haired cats who have frequent hairballs may experience periodic bouts of diarrhea. Furthermore, cats who spend a lot of time outdoors may be at an increased risk for internal parasites or ingestion of inappropriate food, which could lead to diarrhea.

How Can I Prevent Diarrhea in My Dog and Cat?

Keep in mind that even perfectly healthy dogs will sometimes get diarrhea. Here are tips to reduce the likelihood of occurrence:

• Keep up to date with your pet's vaccinations.

• Make sure your pet is free of parasites by following your veterinarian’s recommendations.

• When walking your dog, watch that he does not eat anything off the street, does not eat plant material or drink from puddles.

• Minimize stress in their environment.

• If you decide to switch your dog’s or cat's food, it’s a good idea to introduce it gradually, mixing it with his current food to ensure an easier transition for your pet’s GI tract.

Try to avoid giving your cat dairy foods, no matter how much he likes them! Almost all cats enjoy the taste of milk or yogurt, but some adult cats do not have a sufficient amount of lactase, the enzyme necessary for the digestion of diary products. Undigested lactose moves to the large intestine, where it ferments—and can cause a cat to have gas or diarrhea.

Be sure to follow your veterinarian’s time guidelines for deworming puppies. Parasitic infections that can cause diarrhea can be easily prevented. Watch your dog so that it does not eat from the garbage or from other inappropriate sources. Garbage can be dangerous to your dog’s health, especially if very fatty food is eaten, or if foreign bodies, such as bones are ingested. Also, there are several infectious causes of diarrhea that may infect people as well. Caution must be taken when cleaning up diarrhea and feces.

As a last reminder, acute diarrhea is often alarming, but may not be an emergency if your dog is still active, drinking and eating, and is not vomiting. However, acute diarrhea associated with vomiting, lack of water intake, fever, depression, or other symptoms should prompt a visit to your veterinarian.

Adapted from:

http://www.aspca.org/pet-care/dog-care/dog-care-diarrhea.aspx

http://www.aspca.org/pet-care/cat-care/diarrhea.aspx 

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

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

Helpful Buckeye will cover the problem of CHRONIC diarrhea in next week's issue of Questions On Dogs and Cats.

Any questions or comments should be directed to Helpful Buckeye at: dogcatvethelp@gmail.com   or submitted at the Comment section at the end of each issue.

 

SPORTS NEWS

The Ohio State Buckeyes did not play this weekend.  Helpful Buckeye must have jinxed Alabama by saying such good things about them last week...since they lost at home.  Oregon now remains at the top of the pack in my mind.  Kansas State and Notre Dame are still pretenders.

The Pittsburgh Steelers don't play until Monday night...the game is as close to a "gimme" as you'll find in the NFL.

  

PERSONAL STUFF

Helpful Buckeye took a last 70-mile bike ride this past week in preparation for the Tour de Tucson, coming up this Saturday.  It was a perfect day for the ride...70 degrees, sunny, and no wind.  My ground crew treated me to a happy hour/dinner at one of our favorite haunts.  The weather soon changed to a more wintry mix.  My final rides before the Tour will be in the gym due to the colder weather.  I'm really looking forward to this race since it will be the last of the 4 events I planned for 2012.  Getting ready for 2013 will require me to find some new challenges....

 

Riding my bike has allowed me to exercise to a much greater extent than that which I would achieve in the gym; it has allowed me to see some wonderful sights I would have otherwise missed; and it has allowed me to almost become as one with the bike when riding for long distances.  I can understand this quote by Tori Amos:

 

"Guys would sleep with a bicycle if it had the right color lip gloss on. They have no shame."

However, my more thoughtful side looks at it this way:
 
"When I go biking, I repeat a mantra of the day's sensations:  bright sun, blue sky, warm breeze, blue jay's call, ice melting and so on.  This helps me transcend the traffic, ignore the clamorings of work, leave all the mind theaters behind and focus on nature instead.  I still must abide by the rules of the road, of biking, of gravity.  But I am mentally far away from civilization.  The world is breaking someone else's heart."  ~Diane Ackerman

~~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.~~