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Metronidazole cured diarrhea- now what? UPDATE (of desperation) on pg 2

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  • #21
    But look! Giardia makes the cutest stuffed animal: http://www.giantmicrobes.com/us/products/giardia.html


    • Original Poster

      Alto- would it please you if I change my statement to "Hey, I'm just glad we seemed to have narrowed it down to an infectious-type problem"?

      The poop transplant is next on the list but... uh... we're going to give the metro and pre/probiotics a good try before doing that. This treatment first came on my radar in nursing school when there was a C. diff outbreak at the hospital. Most of us were of the opinion that we would accept a fecal transplant if we were infected with C. diff, but I was also not the only one that requested I be delightfully sedated during and/or amnestic after the treatment (the pill wasn't available at that time).

      The EquiOtic ended up being more affordable than I had hoped for. It's about $2/day, and if it keeps the wet poop at bay, it's well worth the price. I have two more doses of the metro left to give (one tomorrow, one Sunday). He'll start the EquiOtic on Monday and I'll try remember to report back on how it's working for us. In my happiest dreams, it works well, I keep him on it through the winter, and then discuss switching to a SmartPak option with my vet.

      I still can't find any plausible reason for why this is happening seasonally, but perhaps there is something in the spring/summer/fall grass or hay that helped him keep the symptoms at bay? Maybe he was somehow consuming helpful organisms in the warmer temps that disappear when it starts to get cold at night? I'm totally grasping at straws and possibly making up biology at this point.


      • Original Poster

        UPDATE! (of desperation)

        Help, sciencey people!

        So today is my horse's last day of the metronidazole. We did 7000mg twice a day for 5 days, then once a day for 5 days, and then every other day for 5 doses (10 days). This past week the gross poops have returned- they were out full force yesterday, luckily it was in the 40s here and he got a butt bath. I will say that it's possible the poops have more substance to them, but they are still back to a consistency that leaves a wet trail down his butt.

        I posted a bit ago that the metro appeared to have cured it. And it did when he was getting it 2x/day and kept it fairly good at the 1x/day dose. Things started to fall apart when he went down to once every other day

        I'll be calling my vet in the morning, but can anyone in the mean time offer me words of wisdom?

        Does he maybe need to be on the medicine longer at the higher dose? Is is possible that metro didn't treat anything, but created a "side effect" of solid poops? Someone help me make sense of this. Truly, after the first week's worth of treatment my horse's derriere was so clean I couldn't stop petting his hindquarters. And now... we're getting back to as bad as it was before.

        Anyone? Any words? And I was so happy because I thought we found the cure... this disappointment is extra hard
        Last edited by Jaideux; Jan. 14, 2014, 10:39 PM.


        • #24
          You may want to consider pulling all his hay and stripping his diet down to just 1 thing. I did this with an old gelding who seemed to get bad diarrhea in the winter after a mild colic. I put him just on alfalfa pellets for a month, and added back one thing a month, hay last.


          • #25
            I think this is a good suggestion.
            "We, too, will be remembered not for victories or defeats in battle or in politics, but for our contribution to the human spirit." JFK


            • Original Poster

              Pheasantknoll- what was the rationale behind this approach?


              • #27
                How frustrating! Just when you think you have it figured out... ugh. Good luck figuring it all out. Just wanted to throw in some suggestions based on the experience with my horse. His was not so severe, but my horse always had slightly loosely formed stools as well. When I was boarding for a very short period of time at one barn with just pasture board and he was at the bottom of the pecking order, lost some weight, and yes it was also winter, he also had a lot of watery fluid with his poops. I talked to a salesrep at Biostar...and ended up putting him on hemp oil, and some liquid probiotics I already liked. Sounds strange, but google disbiosis or leaky gut. Some interesting info out there....some from some real quacks and some seems legit. The people at biostar also claimed the hemp oil can help heal the gut. Well now he has the best formed poop I've seen. No longer on the hemp, but still on the probiotics. The ones I use are abc's probi. I tried some others with no results. I keep going back to those. Dont need to be fridgerated. Glutamine is also a supplment that may be able to heal the gut lining...there's also some info out there on that.
                There is also the possibility he may just need to be on the med longer? I wonder if you could do lrobiotics while on the meds, just at different times of the day.


                • #28
                  Just a question here, this thread is interesting. Is it common to have an inflammation component in cases of recurrent diarrhea in horses (say, after the horse has been properly dewormed - ova and parasite test is clear, that metronidazole isn't working, diet changes aren't working)? I know we do in small animals, but just wondering if it is something commonly considered in horses or a rare occurence.

                  Usually metronidazole kills any "bad bacteria" overgrowth in the colon, but also the good ones... So it's possible that when you wean him off, the "bad guys" are colonizing faster than the beneficial bacteria and then diarrhea comes back?

                  In small animals at least, metronidazole definitely is used for diarrhea and definitely firms up the stools, sometimes even to the point of mild constipation the day after the initiation of the treatment. So if something else is going on, metronidazole can definitely be just a band-aid on the problem.

                  Feel free to tell me to stop my small animal input... I know people on here have much better knowledge of use of meds in horses!!


                  • #29
                    In humans the treatment course recommended would be the full dose (700mg twice a day) for ten to fourteen full days, then tapering off however the vet wishes or not tapering. So perhaps you just didn't treat long enough. Usually we begin the probiotics when the wean has begun (after day 14) but I have seen some GI docs start the probiotics with the metronidazole. I think our studies aren't clear on when the "right time" for probiotics to begin in or even if they show benefit which is why in the guidelines you will see they are actually not even recommended as having a role.


                    I know these are C. diff guidelines in humans and C. diff may or may not be exactly what your horse has but IME most GI docs treat infectious diarrhea of other causes similar. So this at least gives you some ballpark ideas.

                    Winsome - in humans right now it is trendy to treat the post infectious bowel inflammation with glutamine. http://www.clinicaltrials.gov/ct2/sh...utamine&rank=2 There are lots of smaller trials going on. It's been trendy on and off for a long time. I can't say I've seen any miraculous benefits but it is fairly benign when given oral and also cheap....


                    • Original Poster

                      I have gotten some very (academically) helpful information about inflammation, elements of grass that get lost when hay turns into hay, and supplements through PMs and the 2 threads that are going (it's 2 threads because my question about grass isn't necessarily inherent to my horse's issue and I didn't want it to get lost).

                      All of the information I've been getting in the past few days overlaps in a very interesting way. I have to get ready for an appointment right now, but since I'm expecting a call back from my vet practice later today or tomorrow, I will sit down and put all the information into one summary post to help clarify my thoughts/questions for the vet, and for the edification of others. Perhaps it will jog anyone else' mind, and if nothing else, if someone else does a thread search in the future maybe they can skip some of the headache I've been dealing with.

                      I think my vet and the whole practice is pretty excellent, but there is nothing quite like the combined minds of COTH to really explore an issue from all angles. Thank you SO SO SO much for your help and ideas!!


                      • #31
                        Let us know what he thinks!! And hopefully he can fix the dirty bum situation quickly.


                        • #32
                          Originally posted by pheasantknoll View Post
                          You may want to consider pulling all his hay and stripping his diet down to just 1 thing. I did this with an old gelding who seemed to get bad diarrhea in the winter after a mild colic. I put him just on alfalfa pellets for a month, and added back one thing a month, hay last.

                          I Had one that had started getting loose stools. Giving it some thought it occurred to me that we'd made a slight feed change. So segued back to original diet, and now peace reigns. Mine was easy, maybe because it was caught early.
                          Some riders change their horse, they change their saddle, they change their teacher; they never change themselves.

                          Remember the horse does all the work, we just sit there and look pretty.


                          • #33
                            A C. diff infection can recur like that because the metronidazole is only effective against the live form of the bacteria, not its spore form. So, another round of it is not a bad answer if it was controlling the situation. In humans it has been sadly common to have to do three or four courses.

                            You can consider more probiotics and also perhaps a blood panel investigating the horse's nutrient levels - severe diarrhea can affect the absorption of vitamins and minerals and enzymes as well as calories. The glutamine isn't a bad idea either.
                            If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket


                            • #34
                              I am not sure there was a rationale other than we did not know what was causing the diarreah. He was too old for metronidazole. The vet believed we might kill him with it. Also, we assumed that his system could not handle something that was going into it. So we started him from scratch. It was winter, so no grass, or I would have tried that. He did recover, so I think the "reboot" worked.


                              • #35
                                That's interesting PK - I'm not aware of any human ever being "too old" for metronidazole. I generally think of it as one of our safest antibiotics as it doesn't even require significant dose adjustment for end stage kidney disease and is pretty easy on the liver too.


                                • #36
                                  Well, he was an old (27)yo OTTB who already had gut problems. His system wasn't absorbing nutrients well already. Although I did get him past the diarreah, I elected to put him to sleep the following winter. He had been on a mash for several years, and all the hay he could eat. Despite having his teeth done, he didn't chew his hay all that well (he was missing some teeth). Really, he was just too old, and metronidazole is so drastic, we were afraid of destroying was gut bacteria he had. (He was on a daily probiotic). He was just old.


                                  • #37
                                    The reason to take his diet back to a single thing is so you can determine if he has an allergy.


                                    • #38
                                      In a human, when your gut is damaged, it's possible to develop temporary allergies to foods.

                                      Horses depend on microbes in the large intestine to digest their food for them, especially anything with heavy cellulose. Without those microbes, the digestive process is substantially impaired.
                                      If you are allergic to a thing, it is best not to put that thing in your mouth, particularly if the thing is cats. - Lemony Snicket


                                      • #39
                                        Have you tried Neigh Lox Advanced (has to be the Advanced) or another probiotic that work for the colon/lower GI and not just the stomach/gastric/upper GI? Per my vet, there aren't many that are designed for lower GI -- she named two but the Neigh Lox Advanced is the one I was able to get readily.

                                        Anyway. that is what our vet recommended for our oldest QH (pushing 30) last year when he started with formed fecal balls followed by the squirts, then got to where it was almost all liquid. The Neigh Lox Advanced took care of it pretty quickly.

                                        Thought we'd have to do it again this winter, but so far he's okay. Our vet said it is because he is older and has more trouble with the drier diet of hay than the grassy summer diet. We've got greener hay this year, and I think that is helping.

                                        I'm sure your guy's problem is not identical, but since you've used the metro to knock out the bad (and good) intestinal flora, perhaps this might help with building back the good flora along the entire GI tract.

                                        Just throwing out a suggestion -- I hope you find a regimen that works.
                                        If thou hast a sorrow, tell it not to the arrow, tell it to thy saddlebow, and ride on, singing. -- King Alfred the Great


                                        • #40
                                          Ok, I know dogs are different, but I throw this out anecdotally and you can just ignore if you want ...my dog (who did not test positive for giardia) had to stay on metro for over a month, then when we started weaning go back if there was a flare, but eventually she did get off of it. My point being she was on it for a long time. I think we went through two flares trying to wean her off.
                                          DIY Journey of Remodeling the Farmette: http://weownblackacre.blogspot.com/