Giardia

[leslks@aol.com]

Traci,
T. W. was on Panacur for 7 days, off for 7 days and began the 7 day stint again today. He has been the same only now he goes on the carpet all over the house. The girl told me that sometimes they see it get worse before it gets better. She spoke to the vet who said we should do xrays to see if there is a blockage or some other reason for the diarreah. That doesn't seem right to me. Wouldn't a blockage mean nothing would come out? Is a reason for diarreah going to show up on an xray? The reason I am skeptical about them taking xrays is they did that for Ivy who the vet said was constipated. She needed to see how bad it was. I agreed because I was sick and not thinking clearly. Then it occurred to me that you don't need an xray to see constipation. I think I should finish the course of Panacur and then decide what else to do. What else can I use?
Another thing is that I saw the report which said Giardia Neg.
I questioned it and was told that they tested twice and that is how they write it. I think that is careless and probably not what it means at all. If in fact they did 2 tests which are you going to believe? Maybe they should not be using Panacur if they aren't sure he has Giardia.
Thank you,
Lynda
What do you think?

[davet]

you can have diarrhea with a blockage, it the loose material ig going sround the blockage, ie between the block and the wall of the gut.. And sometime you do need an x-ray to diagnose a blockage because you may feel what you think is a tujmor or a blockage and you can't differentiuate without an x-ray..have no idea what they based the diagnosis on, ie giardia, but i agree i would keep up the panacure for a while longer for effect....are any antispasmotics being used...???

[Traci]

Your vet might also be thinking overgrowth of bacteria in the GI tract, so the panacur would be appropriate at this time. However, I am a bit concerned that the fecal was negative, was giardia all they tested for or were all parasitic and bacterial infections ruled out, was a culture ever done? (i.e., salmonella, e-coli, campylobacter, toxo, etc)

As Davet said, it's not easy to differentiate inflammation vs obstruction vs blockage without an x-ray. An x-ray can give you a pretty clear view on what's going on, whether there might be a blockage, mass, obstruction, even a fecal impaction. In the absense of a positive fecal exam, and wanting to be thorough beyond the exam, an x-ray would have been the appropriate plan of action.

Having said that however, I would retest the stool in another week after the panacur. If the stool is still negative (and of course other bacterials are ruled uot), then look at the chemical enzyme testing (if done recently), rule out IBD vs inflammation of some sort, and lastly, discuss the diet on the offchance he is developing a sensitivity to it.

[leslks@aol.com]

Davet and Traci,
Thank you for the insight. The only med being used for the diarreah is Panacur. I will finish the course and then xray if necessary. However, T.W. has had this for awhile. Maybe we need to repeat the entire course. Do you think that is wise or get an xray at the end of this 7 day period?
Should I increase Normosol since he is losing so much fluid? He is getting only 50ml. every three days (for CRF). He used to be on 50ml. every two. I am thinking he needs more.
Thank you!
Lynda

[Traci]

When was T.W.'s last exam and at that time, what did your vet say about the degree of dehydration? This would depend on the electrolyte replacement. Since you're already treating for CRF, you would probably do better to to use Lactated ringers solution for maintenance daily or every other day, depending on what your vet tells you. (fluids maintenance depend on degree of dehydration, weight, normal intake of water, normal urination habits, etc etc, ...don't take it upon yourself to increase or decrease the fluids maintenance, your vet needs to evaluate the needs for a maintenance schedule)

I would continue the panacur as advised and then retest the stool (also include previous mentioned possibilities -- bacterials vs parasitic infection), and then opt for an x-ray. Again, consider the diet at this point, it could be that T.W. might benefit from a bland diet such as Hill's Rx I/D to help form up the stool, or a hypoallergenic diet, at least temporarily (would need to run that by your vet, especially if T.W. is already on a low-fat, low-protein diet for the CRF).

[leslks@aol.com]

We switched vets. T.W.'s appt. was Jan. 8th. His numbers are not bad. He has had CRF since June 2000. She said to keep him on 50 ml. every three days. She didn't specifically mention his degree of dehydration. Must not be noticeable or she would have changed the amounts and schedule, especially since I asked if I should increase it.
T.W. eats Purina NF and tries to sneak the other cats' food. He is successful alot but I try hard to keep him from it.
Why do you like Ringers? He was originally put on Normosol and has done well with it. Why change?
Ivy was diagnosed with CRF Jan. 7th. She is also diabetic (under control currently without insulin). She is using Normosol as well. I asked about Ringers. The vet said Nor. is fine.

[Traci]

Mostly based on preference.....Normosol doesn't contain calcium, and Lactated doesn't contain magnesium, so your vet needs to monitor blood values to ensure the fluids are appropriate. Normosol is also usually used as a replacement rather than Lactated, which is usually used as maintenance. Again, bloodwork (particularly BUN and creatinine) and dehydration deficit allows the vet to choose which fluids are most appropriate per the condition. If your vet has advised to continue the Normosol for whatever the reasons, then don't change it, but if your vet hasn't asked for a followup or followup bloodwork since the 8th, might want to discuss this with him to ensure the fluids are appropriate, including the amount (doesn't mean exam necessarily, just at least discuss it). Remember that in CRF, electrolyte imbalances are quite sporadic, changing all of the time, so this is just one reason followups are necessary. In view of the diarrhea problem, you can't assume he is getting an appropriate amount of fluids on a daily basis. Diarrhea is just one way to have fluid losses occur, meaning they need to be replaced and/or maintained, depending on the condition, fluid losses, etc.

Which brings us back to the cause of the diarrhea, need to rule out bacteria, parasitic infection....vs possible IBD or other inflammatory condition.

[leslks@aol.com]

We are going to give 50 ml every two days or 100ml every three. I think I'll do the 50 every other.
The diarreah is worse in that now he goes all over the house. This is so disturbing. I was wondering what I could give him to stop it. Obviously the Panacur isn't working. Do you find that with Panacur the problem gets worse before it gets better? I am going to try something else before we go for xrays.

[Traci]

Lynda, get T.W. to a new vet (I realize you said you found a new one on the 8th, but...)....you are saying the diarrhea is worse now, there is no way 50 ml of fluids every other day or every three are going to replace the body's fluid needs, nor electrolytes,...T.W. could be suffering some very serious dehydration right now. If this is your vet's idea of treating severe diarrhea, I find it appalling she would recommend such a low amount of fluids in the face of persistent diarrhea.

The panacur should have helped the diarrhea improve....what you need to do now is get T.W. to a qualified vet for fluids, fecal exam and possibly another x-ray to find the cause of this persistent diarrhea. Since he is also CRF, you cannot take additional risks with the kidneys and insufficient fluid support.

You might also need to switch the NF diet to something he can tolerate better....maybe even add a fiber source to the diet, but this must be left up to the vet's discretion because you have yet to figure out the true cause of the diarrhea.

I can't stress this enough....I don't feel your vet is doing enough, nor taking this too seriously. Please, get T.W. to a NEW vet ASAP. T.W.'s current health records can be faxed.

[leslks@aol.com]

Traci,
I know what you are saying. I have said before I can't keep going to one lousy vet after another. Even at the emergency hospitals they aren't good. I know from experience. I really wish I didn't need another one as long as I live. I am scared of them because they are so inept!
T.W. had a better night. There was no diaarhea on the floors, just in the boxes. It is taking a bit of a loose form. Maybe since he had this so long because of the other vet, it takes longer to clear.
I have been reading. Acidophilas (?), slipery elm....there are things to help
that I can try. Other holistic remedies that those vets swear by.
I know the amount of fluids they told me to give is basically the same, just distributed over time differently.