Wednesday, March 7, 2012

Yesterday was Vomit Tues, Today was Diarrhea Weds

We all know that the crazy cases come in waves.

I remember one year where we saw 12 splenectomies in 12 weeks. It was incredible, and freaky! I was really beginning to think about sending a water sample into the the health department.

Well today we had three cases of diarrhea in a row.

Case 1 was Ruby, an 8 week old, just adopted 2 days ago, Boxer puppy. Ruby is quite possibly the cutest thing with two ears. She was so shy, and so kissable! Dr. C kept kissing her and telling us that she was pretty sure she was infecting herself with round worms every time she did. (That's typical Vet hosp humor). Ruby likely had diarrhea because she had just left the only place and the only family she ever known. This would be incredibly stressful to anyone, and it is especially stressful to a baby. She also is likely eating a new food, (hopefully a high quality large breed puppy brand), and having some "stress and dietary diarrhea" because of it. Dr. C. gave Ruby an oral de-wormer, and we sent her fecal to the lab for analysis. As long as Ruby's diarrhea is not profuse, she is eating and drinking well, on a good diet, and de-wormed, and monitored closely she will likely be fine in a day or two. Any puppy with diarrhea needs to be monitored very closely and needs a Vet immediately. I have seen puppies with Parvovirus die in 2 days.

I tell every new pet owner to expect some intestinal worms. It's part of the puppy/kitten package when you get a new pet. We check a fecal first thing, (and then yearly), and de-worm appropriately when the results come back positive. It's very important to bring your new pet, (and their poop sample), to your Vet within three days of getting your new pet. And make sure that you pick- up and dispose of all poop daily so you don't get your yard contaminated with the intestinal worms that might be making a home in your puppy or kittens belly.

Also, I recommend a follow-up fecal a month or so later to re-check that all of the worms are gone. And if your pet is having chronic or recurrent diarrhea we recommend that you check 3 consecutive fecals before we call your pet "intestinal worm-free." Some of the intestinal worms that pets can acquire are what we term "intermittent shedders." This means that we won't see them in the fecal exam at every fecal test we check. Three consecutive negative fecals and we usually call you negative.

Case number 2 was Maggie. A spayed 4 year old Papillon. Maggie's mom, Mrs. Kyrie, called us today to tell us that Maggie had woken them up at 2 am with bloody watery diarrhea. Maggie continued the projectile diarrhea sporadically throughout the night, and Mrs. Kyrie was very worried. The Kyrie's are very doting, watchful owners and they called us as soon as we opened to see if they could bring her to us.

When Maggie walked in the door she had her butt tucked under her and seemed to still be straining to defecate. Many owners incorrectly assume that their pet is constipated when they see this stance but in reality it is the complete opposite. Some owners have actually gone so far as to give their pets laxatives. Can you imagine anything worse than being given a laxative when you already have bloody, watery, poop dripping out of your butt? These guys are postured to poop because their over active intestines are full of watery diarrhea and their intestines are telling their brain to poop to get rid of it.

When Maggie was seen by Dr. C she thought that she looked nice and pink, (therefore indicating good circulation, good RBC count, and not septic) and not dehydrated. Dehydration is one of the things we are worried most about in pets, (and people) with diarrhea, especially with the small breed dogs. Everything in her examination looked normal and the fecal sample Mrs. Kyrie had brought in was loose but not discolored. Our plan was to send Maggie home with some SQ fluids, an anti-diarrheal, and a diet plan. She was in her mom's arms at the check-out counter when Mrs. Kyrie put Maggie on the floor to sign her check when Maggie tucked her butt, postured and produced what we call "raspberry jam" diarrhea in a Jackson Pollack application all over the reception area. This "raspberry jam" is a classic sign for HGE. Hemorrhagic Gastro Enteritis.

We diagnose HGE by a few factors. These include raspberry jam diarrhea, and  a high PCV. Maggies PCV was 63%. The normal reference range should be around 40%. Above 50% and we start you on i.v fluids to decrease the PVC. Maggie stayed the day with us to correct her PCV, monitor her diarrhea, and start her on antibiotics and anti-diarrheals.

Case #3 was Winston. Winston is a three year old wire haired fox terrier. He is owned by a couple who monitor his every move and love him like crazy. Winston's dad is retired so they are best buds that are inseparable. Winston's dad also spoils him terribly. I am usually not a stickler for feeding your pet some table scraps but I do not want you to feed them bacon, and fried eggs.

Winston sat begging by the dinner table on Friday evening as he has been trained to do by his parents. After they had eaten their portion of their stuffed shells that they had for dinner they handed him their plates to polish off. That evening Winston woke them up to notify them that he had just vomited and pooped in their bed. He had four other episodes Friday night. Saturday morning he refused his breakfast had 4 more episodes of diarrhea and was placed on plain white rice for dinner, which he readily ate. Sunday morning he seemed to be back to his normal self and sat begging again for their breakfast. Winston ate bacon and fried eggs Sunday morning. Winston's dad did mention that this was "his favorite Sunday breakfast foods."

I examined Winston on Monday and he seemed to be within normal limits for all of his physical exam parameters. I gave him some SQ fluids to maintain his hydration throughout the day and instructed them to not feed him anything else for the rest of the day. I told them to feed him boneless skinless boiled chicken or ground beef with plain white rice starting Tuesday morning. I instructed them to feed 1/4 cup servings every  4 hours as long as he wasn't vomiting. I asked them to do this for 4 days. I also sent them home with a gastro-protectanct and probiotic. I, as always, provided a written instruction sheet for dad to take home for mom to review. (I try very hard to document everything so that owners don't go home with questions, and because I know I talk fast).

I called this morning to check on him. His dad said that he had done great on Monday and Tuesday morning, but that his wife had started to add his normal food back into his food on Tuesday night's dinner. Winston's belly was apparently not ready for this and the diarrhea resumed. WInston and his dad came back to see me this afternoon. Winston still looked fine, but we all decided to stick with the chicken and rice for 4 days. Winston's dad asked me to write "No regular food for 4 days," in bold letters on his go home sheet. He was blaming his wife, and he wanted her to know that these were "Dr.'s orders!"

I will check on him again on Thursday.

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