Monday Pet Tip: Diarrhea and Your Pet

What is diarrhea?

Diarrhea is the passage of feces as unformed or loose stools, usually in increased volume and frequency of passage. It is a result of increased speed of passage of fecal material through the intestine combined with decreased absorption of water, nutrients and electrolytes. There are many causes of diarrhea. Diarrhea may occur as the only sign or in combination with other signs of more widespread disease, or with symptoms that result from prolonged or severe diarrhea.

What causes diarrhea?

Diarrhea is not a disease in itself but a clinical sign that may reflect one or more of many different problems. Most involve some degree of inflammation of one or more sections of the alimentary or gastro-intestinal (GI) tract. The GI tract is the continuous tube that carries food from mouth to anus. Inflammation can be caused by infectious agents such as bacteria, viruses, coccidia, and intestinal worms, or by non-infectious irritants such as chemical toxins, poisonous plants, and so on. Allergies to certain specific components of a diet may be responsible for diarrhea. Changes in diet can lead to temporary changes in the stool. If frequent liquid or semi-liquid stools persist for more than two days, you should consult your veterinarian. Diarrhea may occur as a sole symptom or as one of several symptoms of a more generalized disease problem. Many mild cases of diarrhea can be resolved quickly with simple treatments. Others are the result of serious or life-threatening illnesses such as cancer. Even diarrhea caused by mild illnesses may become fatal if treatment is not begun early enough to prevent severe fluid and nutrient losses.

When should I bring my pet to the vet?

Your veterinarian will attempt to determine how sick your pet has become as a consequence of the diarrhea. If your pet has experienced diarrhea for two or more days or any of the following symptoms are experienced in conjunction with the diarrhea, it is important to schedule an appointment with a veterinarian:

• Vomiting

• Dehydration

• Loss of appetite

• Abdominal pain

• Fever

• Lethargy

• Bloody and/or watery diarrhea

What types of tests are performed to find the cause of my pet’s diarrhea?

If diarrhea is associated with several of the above signs, your veterinarian will perform a series of tests in order to make a diagnosis. This permits specific disease treatment. Diagnostic tests may include microscopic fecal evaluation, abdominal radiography (x-rays) with or without barium, blood tests, fecal cultures, biopsies of the intestinal tract, video endoscopy, ultrasound and exploratory abdominal surgery. Once the diagnosis is known, treatment may include special medications, diets, or surgery.

If your pet does not appear systemically ill from diarrhea, the cause may be less serious. Some of the minor causes of diarrhea include stomach or intestinal viruses, intestinal parasites, and dietary indiscretions (such as a change in diet or eating garbage or other offensive or irritating materials). A minimum number of tests are performed to rule out certain parasites and infections. These cases may be treated with drugs to control the motility of the intestinal tract, drugs that relieve inflammation in the intestinal tract, and, often, a special diet for a few days. This approach allows the body's healing mechanisms to correct the problem. If your pet is not improving within two to four days, a change in medication or further tests may be necessary.  It is important to keep your veterinary clinic updated about your pet’s progress to optimize its recovery.

 How is the cause of diarrhea determined?

It is important to provide your veterinarian with a detailed medical history. Ideally you should write this out in chronological order before you go to the clinic. Be as detailed as possible on the date you first noticed a problem, even in retrospect. Also report the progression of the clinical signs. Note any changes in the normal routine of your pet or your household. How frequent are the stools? What is the color, consistency, and smell of the feces? Is your pet showing any other signs such as vomiting, loss of appetite, lethargy, or loss of weight? We have a checklist to help you put this history together.

Besides a thorough clinical exam, your veterinarian may recommend additional diagnostic tests. These tests may be deferred in mild cases of diarrhea unless initial treatment fails or the condition worsens. Tests may include blood work, stool and rectal swab samples for parasite examination and culture, radiographs, and endoscope exam.

How is diarrhea treated?

Initially, and often in advance of in-depth work-up, a non-specific approach may be adopted. It is a good idea to withhold food for twenty-four hours and encourage water consumption. Gradually reintroduce small quantities of a light, easily digestible diet. Boiled rice or other pasta with some boiled skinless chicken may be given if a special veterinary diet is not available. Anti-diarrheal medication may be used to help speed your pet’s recovery. Many cases of diarrhea will respond quite readily to simple treatment, without the initial cause ever being established. As the stools return to normal, your pet’s regular diet can be gradually reintroduced, mixed initially with the bland rice-chicken or similar diet.

If there is little or no improvement over two or three days, if your pet is not taking any water or if the pet’s health worsens, then your veterinarian should be notified at once. Treatment may be more aggressive based on the results of an in-depth clinical work-up as outlined above. Loss of fluid is one of the most serious aspects of severe or prolonged diarrhea, and if vomiting is present, dehydration can rapidly escalate. Correcting the dehydration may require intravenous or subcutaneous fluids.

Can I use anti-diarrheal medications from the human pharmacy?

Some of the preparations recommended for people are very dangerous for pets so never use a medication without consulting your veterinarian first. Products containing ASA or acetaminophen are extremely toxic in cats and can be harmful to dogs as well.

My pet has chronic diarrhea. Will it get better?

Chronic diarrhea that has been present for two to three weeks or longer may prove more difficult to diagnose and to treat effectively. Even extensive work-up does not always provide a definitive answer to the problem. But in many cases a thorough clinical work-up, including food trials, can result in a successful outcome.

 

DIARRHEA CASE HISTORY CHECKLIST

In order for us to narrow down the cause of diarrhea in your pet, please answer the following questions as accurately as possible and bring this information with you to your pet's appointment. If you are not certain about the answer please indicate “approximately” or “not sure”.

Timing

• How long has the diarrhea been present?

• Is the diarrhea more severe now than a few days ago?

Frequency and Nature of Stool

Consistency:

• Watery stool

• Stool is the thickness of pancake batter

Blood:

• Very bloody stool

• Only sporadic blood present

• Blood not present in stool

• Bright red blood present

• Dark, tarry blood present

Degree/Frequency:

• Entire stool is soft or watery

• Only portions of the stool are soft or watery

• Diarrhea with each bowel movement

• Diarrhea is sporadic (some bowel movements are normal)

• Only 1 or 2 bowel movements per day

• More than 4 bowel movements per day

Amount:

• Increased, large amount of stool

• Decreased or normal, small amounts of stool

Color:

• Stool is dark brown in color

• Stool is very pale in color

• Stool is black and tarry in appearance

Miscellaneous:

• Thick mucus or pieces of tissue present in stool

• Loss of bowel control (defecates in the house on the floor)

• Severe straining when having a bowel movement

• How powerful is the smell?

 Diet

• What is your pet's normal diet?

• Is your pet's appetite normal? If not, are they eating at all?

• What have you been feeding your pet during the last week? Include dog or cat foods, treats, table foods, milk, and anything else that you have fed your pet. Also state what percentage of the diet is each item or category.

• Does your pet have access to foods other than what you feed them? If so, what?

• Has there been a diet change in the last few weeks? If so, does that correspond with the onset of the diarrhea?

• Has the diet changed within the past two months?

• Do you feed your cat milk?

• Did you feed your pet table scraps within the past two weeks? If so, what?

• Has your pet gotten into any off-limits food recently?

• Does your cat hunt and eat prey?

General health

• When was your pet last vaccinated?

• Are there any other signs of illness?

• Is your pet as active as normal?

• Describe any change in water consumption (increased or decreased).

• When did you first notice any other signs of illness?

• Has there been any weight loss? If so, over what period?

• Have you seen any vomiting? If so, how frequently and for how long?

• Does your pet go outside your house?

• Does your pet go outside your yard?

• Does your pet have access to garbage cans, either within your house or yard or outside your yard?

• Does your pet have toys that it plays with that it could have swallowed?

• Does your pet have access to sewing materials, such as thread or needles, rubber bands, or string?

• Do you have other dogs or cats that live with this one? If so, does the other pet have diarrhea?

• Do any other animals in your house currently have a diarrhea problem?

Snail Bait Awareness by Frank Utchen, DVM

There are two main types of snail baits, and one is considered relatively safe for dogs. Look for the active ingredient and use the kind that contains 1% iron phosphate. This is relatively safe for dogs, because there is actually very little iron in the compound, and what there is, is poorly digested and absorbed by dogs, so most of it passes through them without incident. That being said, iron phosphate can still be toxic to dogs if they ingest enough of it: a 40 lb dog would have to consume about 3 lbs of this bait to receive a lethal dose of iron, although vomiting and diarrhea can occur with as little as about 1/10 of that amount.

Certain brands of snail bait contain an active ingredient called metaldehyde. Metaldehyde causes muscle tremors that progress to convulsions. Dogs can easily die from this poison. Each spring when the snails come out, we see numerous dogs at our practice that have ingested metaldehyde that require emergency treatment, including iv fluids, injections of anti-seizure medication, and a one or two-day hospital stay. Keep all potential poisons well out of reach of dogs. Pet-safe alternatives to snail baits with metaldehyde include Sluggo Slug and Snail Bait, handpicking, and copper barriers.

 

Ask the Vet: Feline Inappropriate Urination by Kristel Weaver, DVM, MPVM

 My cat is urinating outside the box and it’s driving me crazy!  How can I make him stop?

We see a lot of cats that eliminate outside their box.  It’s a very stinky, frustrating problem.  I’ll walk you through the questions I consider in order to figure out why a cat urinates inappropriately and some of the steps we take to correct it.

First question: Is this a medical problem or a behavioral problem?

Medical problems like a urinary tract infection, bladder stones, an inflamed bladder or a bladder tumor can make a cat urinate outside his or her box.  A metabolic disease, such as diabetes or kidney failure, which can make a cat drink and urinate a lot, can also make a cat urinate outside the box.  Have your veterinarian examine your cat and perform the diagnostic tests deemed necessary.  This will usually involve doing urine tests and blood tests. It may also involve either taking an X-ray or performing an ultrasound examination to look at your cat’s bladder. If your cat is free of any medical problems, then there is a behavioral issue causing him or her to eliminate outside the box.

Second question: If it’s a behavioral problem, then is your cat marking his or her territory, or does he or she have a litter box aversion or an inappropriate site preference?

Urine Marking - Cats that are marking their territory often urinate on vertical surfaces, like walls or the back of a chair.  When a cat marks (sprays), he or she will stand and their tail quivers.  Even when spayed and neutered, cats can still mark their territory.  Cats may mark their territory when a stray cat is hanging around, when there is a new pet or family member, or if they are stressed about something like a diet change or not enough attention.

Suggested treatment - First spay or neuter you cat.  Second, try to identify why your cat is marking.  Is there a stray cat coming around your house?  Did you add another pet to the household?  Have you switched foods? Have you been too busy to interact with your cat?  If you can identify the cause, take steps to correct it.  For example, block your cat’s view of the stray with frosted window covers or put in motion sensor sprinklers to scare the stray cat away.  Separate new pets and introduce them slowly.  Make diet changes gradually.  Try to spend more time interacting with your cat.  Provide multiple feeding, perching and sleeping sites.  Third, give your cat more appropriate ways to mark his territory: add scratching posts or use Feliway products, which encourage facial rubbing instead of spraying, as a cat’s method of territorial marking.

Litter Box Aversion – Cats with a litter box aversion urinate on horizontal surfaces, often close to their box.  They may be upset about the actual box, its location, or the litter in it.  Some cats may have difficulty physically getting in the box or may feel threatened by another pet hanging out close to it.

Suggested Treatment – Determine what type of box your cat prefers by temporarily giving him several different litter box options and seeing which he chooses.  In general, cats prefer a clean, uncovered box with a fine textured, unscented, clumping litter.  Most cats do not like their box in a busy, noisy, dark or smelly area.  If you have multiple cats you should have a box for each cat plus one more, in different areas of the house. Try putting the box in the location where your cat is eliminating inappropriately and then when he or she begins using it, gradually move it to the area you want him to go. 

Litter box hygiene is important for any elimination problem but is especially critical for cats with litter box aversion.  Clean up urine outside the box with an enzymatic cleaner such as Anti-Icky-Poo or Nature’s Miracle.  Scoop the box twice a day, change litter weekly and wash the box monthly with mild dish soap.  Carefully rinse away all traces of the detergent as cats find the smell of cleaning products offensive.

Inappropriate Site Preference – Some cats would rather urinate or defecate in places other than their litter box.  The most popular sites for cats are soft fabric (bedding, laundry, couch) or a smooth cool surface such as a tile floor or a sink. 

Suggested Treatment – For cats with an inappropriate site preference, the goal is to make that site less attractive and their litter box more attractive.  First, try changing the texture of the site. For example, you can place a vinyl carpet runner nub side up on your bed. Or put a sheet of foil, plastic, sandpaper or double sided tape on your couch.  Second, change the purpose of that site: place your cat’s food or water where he is eliminating.  Third, block access to the elimination site by closing doors, keeping laundry off the floor or putting a potted plant in the selected area.  Fourth, put the box as close as possible to the inappropriate location your cat has chosen, then gradually move it to where you want to keep it.  You don’t have to try these ideas in the above order -- use whichever order you think best for your cat.  Finally, do everything you can to make the litter box more appealing; see the solutions for litter box aversion above for options.

For some cats, these environmental strategies are not fully effective and we also treat them with Prozac or other behavior modifying medications. 

These are just some of the common causes and solutions. For additional information, one excellent resource from the College of Veterinary Medicine at The Ohio State University is www.indoorpet.osu.edu/cats/problemsolving/index.cfm. In all cases, I recommend you discuss your cat’s specific issues with your veterinarian to come up with a specific treatment to get your cat using his or her box consistently.

And that’s the scoop on litter box problems with cats!

Dr. Kristel Weaver is a graduate of the Veterinary School at the University of California, Davis where she received both a DVM and a Master’s of Preventative Veterinary Medicine (MPVM).  She has been at Bishop Ranch Veterinary Center & Urgent Care in San Ramon since 2007.  She currently lives in Oakland with her husband and their daughter, Hayley. If you have questions you would like Dr. Weaver to answer for future articles, please email info@webvets.com

Candice the Canine and the Mystery Meal by Erin Selby

Dogs really do eat the strangest things. Working in a veterinary hospital, you begin to feel like you have seen it all: plastic, entire chickens – bones and all, chocolate, snail bait, bags of trash, socks, shoes, underwear, rocks (!), nails, and of course their own and other animals’ bodily evacuations (yuck!).  But sometimes even we are caught by surprise by the mysterious contents of a dog’s stomach. Sometimes something that seems safe and even healthy can cause an unexpected visit to the vet.  

Candice, a seven year old Beagle, came to Bishop Ranch Veterinary Center & Urgent Care feeling very lethargic and sporting a distended, bloated abdomen. Understandably her owners were concerned, especially after she vomited the night before, so they scheduled an appointment with Dr. Baine.  After examining Candice, Dr. Baine decided to take some abdominal x-rays.  What he found was intriguing. Candice’s stomach was definitely distended due to a large amount of material that was not moving through her intestinal tract. But it was a mystery as to what exactly the material was. It was not apparent on the x-rays whether it was food or some kind of foreign material that was causing the uncomfortable bloating.

What could it be?

The next step was to induce vomiting and get little Candice some relief. Cue the big reveal: bright green peas were the culprit! When Candice’s owner learned what she had eaten, it all made sense - his wife had been using a frozen bag of peas the night before to ice her knee. Obviously Candice could not resist the temptation!  This wasn’t the first time Candice had to see a vet for something she ate; a couple years ago she had to go to the emergency room for eating chocolate. She is quite the little gourmet!

Those are frozen peas!

In general peas are not harmful for dogs and are perfectly fine for them to eat, even frozen ones. But Candice over ate and stuffed herself to the gills. She had a minor case of gastric dilation, otherwise known as food bloat. Her stomach was so stretched out it couldn’t function normally in order to digest the peas, leading to the distended abdomen, lethargy, and vomiting.

While some of her symptoms were similar, Candice did not suffer from Gastric Dilation and Volvulus (GDV) or what is also referred to as gastric torsion or bloat. This is a very serious medical emergency where a dog’s stomach twists, thereby trapping air and cutting off blood supply to the organ. This obstructs blood flow to the entire body and very quickly leads to shock and ultimately death.  Large breed dogs and barrel-chested dogs are the most susceptible to GDV. A distended or bloated abdomen, attempting to vomit but can’t, excessive panting and/or pacing are just a few of the possible signs. It is essential to get your dog to a vet immediately if you suspect they have GDV.

Luckily for Candice, she did not have GDV. Her food bloat was not very severe and was easily resolved. She was able to go home the same day, albeit feeling a bit queasy.  In retrospect, since everything turned out okay, it is hard not to have a little chuckle over the idea of an impish Beagle chowing down on a bag of frozen peas. But the ingestion of certain foods, materials, and substances that are potentially harmful is a serious matter. It is important to be aware of what our furry little friends can get into when we aren’t looking and to be quick to respond when they show the first signs of being ill, like Candice’s parents did. We are grateful that we were able to be there for Candice and her family in their time of need and that this story has a happy ending (our favorite kind). And now we can add frozen peas to the list of strange things that dogs eat!