Alrighty! Here is a bit of a summary of what information I've received via postings and PMs from you helpful COTHers! Hopefully someone in the future researching "diarrhea" will find some benefit from my struggle
- Disbiosis (leaky gut)
- Allergy: can result from (medical/illness) trauma/stress to intestines
- C. diff (or other bacteria/protazoa): This can damage intestinal lining. Metronidazole is effective against part of the C. diff lifecycle, may need multiple dosing to get it all.
- Inflammatory Bowel Disease
- Right-dorsal colitis
- Persisent salmonella infection
To heal gut lining:
- Aloe vera juice (1c daily)
- Hemp oil
- Strip diet down and add back 1 at a time for allergy rule in/out
- Metronidazole has anti-inflammatory properties in addition to antibiotic
- If Inflammatory Bowel, do dexamethasone course and diet review (winter conditions w/ hay may be harsher to digest) **steroids can exacerbate non-IBS diseases, must have confirmed diagnosis before starting steroids!**
To manage biotics:
- Probiotics (abc’s probi)
- Neigh Lox Advanced (must be advanced) for colon/lower GI
- Try probiotics overlapping with metronidazole
- Get a blood panel (look at absorption, etc)
- IBS: diagnosed via ultrasound (measure intestinal walls), possibly scoping rectum, possibly biopsy duodenum
- Soaked alfalfa or timothy cubes with vitamin E added (can use human gel caps)
- Replace vitamin E, omega 3 fatty acids (is found in grass but not hay)
- Pollen and/or spirulina, flax or chia seeds
Also, the vet in the practice who has been working with me the past 2 winters on this is out of town until the end of the month so I got a consult from one of the other vets. She's going to email the out of town vet to clue her in just in case there is any objection/concern, but I get the impression it's a personal vacation so she may not check her email (and good for her!!).
Given my horse's otherwise robust health (knock on wood, knock on wood!!) we are going to put him back on metronidazole until my main vet returns. We'll start back at the original 2x/day dose and then try the 1x/dose once he stabilizes a bit. Though he had some loosening at 1x/day before, it was totally TOTALLY manageable. It turned very disappointing when he was on the every other day dosing. And if 1x/day isn't enough, I'll bump him back up to 2x/da. Or try a 1.5 dose 1x/day.
The consulting vet was very interested to hear what kinds of information I'd picked up along the way and she feels that IBS may be a very real possibility given the seasonal component, the grass vs hay issue, and the anti-inflammatory property of metronidazole. She isn't saying that's what it is, but she gave me recommendations about incorporating omega 3s and vitamin E into his diet in the mean time- it's not like it will hurt him, even if they aren't the cause of this problem. Also, I will start him simultaneously on the EquiOtic probiotics to help reintroduce good flora as we're killing other flora; it may be moot but it will make me feel better.
When my vet gets back, I think it may be time for another in-person visit so I'll probably get labs, etc, done again even though they were perfectly beautiful last winter. I will also pursue a possible internal workup via ultrasound when my vet returns. There is a vet in the area that this consulting vet mentioned, who is an abdominal pro, but I also mentioned I'm not opposed to a referral to Cornell so we may just jump to that. But once my vet returns, hopefully we can do a well-monitored (one at a time) trial of a few of these supplements to help rule in/out inflammation before doing imaging and biopsying, since they can yield false negatives... and though steroids are cheap, the diagnostics (and shipping... oh, the shipping) aren't!
Not sure if it was mentioned, but my vet has had very good results on chronic diarrhea cases with just one dose of iodochlorhydroxyquin. Cheap, although I believe you have to get it compounded. Might be worth a try b4 going back to he metro.
My gelding had watery manure for a few years (he came to me with it). I finally have it resolved with the prebiotic/probiotic product from Horsetech.
However, my vet once explained to me that hay is often the cause and that lots of owners switch to a pelleted complete feed for that reason. I did not want to do that as a long-term solution, but at one point he needed a cracked molar pulled. Vet said no hay for a month. Put him on a complete feed, and everything firmed right up! I can't remember the explanation about the hay. Something about different sized particles and water in the colon. I will have to ask her again one of these days.
I would try either a quality prebiotic/probiotic supplement or removing the hay. While it is preferable for horses to eat hay, plenty of Sr. horses (without teeth) live on pelleted feed with no problems at all
ETA: A probiotic alone did not help my gelding. It was the combo pre/pro that resolved his issue!
PLease look into Leaky Gut and Cushing's syndrome as a possible cause. The seasonal nature of the horse's problem may be in response to some hay or feed he is getting in the winter.
The changes that take place within the gut of a Cushings horse increase the chances for infection by many organisms that may lead to diarrhea and other problems. Keep in mind that a horse does not have to look overtly "Cushionoid" to have the syndrome.
Has your vet not yet considered sending a fecal out to determine if there is a "bug" in there causing this?
Many vet schools will run a panel of aerobic/anaerobic culture, gram stain, PCR, Salmonella, and sand analysis, as well as a Chem/CBC and standard fecal for parasites on a chronic case like this.
He could be suffering from multiple issues and the metro is treating one of these, but not conquering the actual issue. I would be pursuing further diagnostics at this point, rather than just trying to stop the flow.
Strong promoter of READING the entire post before responding.