Replying to Kathryn B. 11/12/2022 - 21:09
Hello!
Happy New Year. Thank you as always for all of your brilliant questions and on-going support. I have popped some thoughts under your questions below:
– at the start of a d+ work up would it be worth just testing for parasites and Giardia, rather than bacteria given how difficult interpretation of bacteria can be? Then revisit bacterial testing later on if still no diagnosis. Or would you still test for everything at the get go?
Hmmmm. This is a really good question. I feel the biggest issue is that we will often detect organisms that are not actually significant. Campylobacter is a good example of this. I always question the significance and always presume there is a chronic enteropathy underlying it all! I think there is probably more justification for faecal analysis in younger dogs. I would always consider parasitology in every case. I must admit that in my chronic GI cases, I will give them 7 days of fenbendazole regardless! This paper is helpful!
https://pubmed.ncbi.nlm.nih.gov/33277779/
– if you treat a positive faecal culture, be that parasitic/Giardia/bacteria, would you re-test a faecal sample at the end of the treatment course or just go by clinical cure?
Honestly. I would 100% go with how the clinical signs are. If the clinical signs resolve, I would not re-culture. I think it can end up confusing us more!!! I would be most careful when using the faecal antigen to monitor. The antigen will remain positive despite resolution of Giardia. If you are following up Giardia, I would use parasitology/floatation for monitoring.
– would you interpret faecal culture differently in a raw fed dog vs. commercially fed dog?
I think that the data show us that raw fed dogs probably will culture more pathogens:
https://pubmed.ncbi.nlm.nih.gov/35191029/
https://pubmed.ncbi.nlm.nih.gov/35923819/
I am not sure how much it would affect my interpretation. Even if there was Salmonella or Campylobacter there… the interpretation would always depend on clinical signs. \i would only ever treat the Salmonella if there was significant haemorrhagic diarrhoea and systemic disease.
– do you have any good stats I can fire at owners about what % GI cases will improve on diet trial alone. It’s like they don’t want their pet to have a problem that will respond just to diet change – they want something more exciting! I find it so difficult to get people on board, they just seem to decide it’s a waste of time without even starting it
Typically, response to diet was higher than 60% and reached 100% except for one study reporting a remission of clinical signs in 45% of dogs:
https://onlinelibrary.wiley.com/doi/10.1111/j.1939-1676.2010.0632.x
https://pubmed.ncbi.nlm.nih.gov/19750741/
– if you give a probiotic at the same time as an antibiotic, would that supercharge any resistant bacteria?!
Hmmmmmm… Good question! I don’t think so! It is more likely that the probiotics will protect against the dysbiosis caused by the antibiotics. I think using them together is a positive thing!
– what doses would you give for Sivomixx and VSL3 please, I’ve not used these before?
I will post the dosing chart separately!
– is there any evidence for feeding dogs with GI dz the faeces of a heathy dog?
Generally speaking FMT is given as an enema per rectum, However there are some case reports of oral administration:
https://pubmed.ncbi.nlm.nih.gov/35859811/
So, I think the evidence for this is limited, but definitely a possibility.
– I’ve worked with a lot of vets who give a one of jab of Betamox and dex to acute GI patients. Is there any evidence for/against the one off dex? (obviously wouldn’t give the Betamox!)
Me too! I also did this for years! There is no evidence for this. My suspicion would be that most cases would have self-resolved despite the dexamethasone. However, there is probably inflammation involved in these cases… so it may have helped!
Hope that helps.
Scott 🙂
