That is why after a day of driving to the distant hills of Kentucky and back again, I stopped by Guardian Animal Medical Center with both Whiskey and Tango to vaccinate (and deworm) them before heading home.
So, when Alivia was on my exam room table, I considered Parvo virus. Alivia was up, active, wagging her tail and eating. She had watery diarrhea, but no blood. Watery diarrhea in a puppy, is usually giardia (an intestinal protozoa or single celled parasite), dietary indiscretion or other parasites. Her mom was quick to tell us that Alivia had been vaccinated. That didn’t make me not think parvo virus.
All vaccines are not created equally. Often over the counter vaccines do not work. Either they have been handled improperly, given on the wrong schedule or lack ability to stimulate the immune system. The vaccine that we use with puppies has a guarantee from the company. If the pet comes down with parvo they will help with treatment. To be fully effective, the vaccine must be given at least twice a few weeks apart after the animal is able to mount an immune response. In fact, over half of our cases of parvovirus have an over the counter vaccine.
Alivia’s giardia test was negative. Alivia’s fecal exam was negative. Alivia ate treats for me and was very active and alert. Alivia was well hydrated. I stopped thinking about parvo virus and moved on to other causes of diarrhea. A change in diet can cause a problem, but she was feeding Purina which should not have been a problem. Changing from a high-quality diet to a lower quality diet causes diarrhea not the other way around. Food intolerance, ingestion of garbage or spoiled food is a possibility and in a well hydrated patient is usually only a 24-hour thing. Ingestion of poisonous substances or toxic plant material or toxic flea treatment didn’t match the history. Alivia had lice nits, but no active lice. The treatment would have been too long ago to be causing diarrhea now. Alivia did not have a history of eating a foreign body (for example, toy, stuffing, rubber band, plastic bag, bolt out of the carrier, etc.) (Why, yes, the Wixsom household is looking through poop for a bolt, why did you ask?)
Alivia did not have a fever, so an allergic reaction, bacterial or viral infection are unlikely. Inflammatory bowel disease, kidney or liver disease, cancer or other tumors of the digestive tract can all cause diarrhea, but Alivia is way too young for any of these. She was not on any medications that cause diarrhea. The owner had looked to Dr. Google and wondered about stress diarrhea. I would tend more toward Alivia eating something that she wasn’t supposed to, because she seemed pretty calm with an attentive, competent owner. Nothing looked serious and I sent her mom home with some dewormer and instructions to bring her back if anything changed.
I was in surgery when Carly said that Alivia was coming back in with bloody diarrhea. Beth quickly informed me that she didn’t go very far in for the stool sample and giardia test and that there was no blood in the sample.
But when I walked back in, there was a completely different pup. Alivia was now laying on the table. She didn’t care that I was there at all. We collected a sample for a parvo test and there was a small amount of blood. The few hours had made a huge difference. Alivia’s mom was quite upset with me also. She felt that I had not taken her seriously before. I had, but I get that I had not made sure that she knew I had. With a positive result on the parvo test, we were now very serious. We save 90% of the parvo dogs that we see. But that is not all and that is what I would like to save. We talked about IV fluids, IV antibiotics, IV intensive care. Parvo virus kills all of the rapidly dividing cells in the body. Intestinal cells get replaced every seven days. Bone marrow produce white blood cells even faster. Pieces of dead intestine cells give parvovirus its distinctive smell. The lack of white blood cells allows parvo to have a greater effect.
We also talked about the fact that I thought there was something else going on and I would check that out also. When I got her Complete Blood Count (CBC) back, I was even more convinced that there was something else. Alivia had a completely normal white blood cell count, which is unheard of in parvovirus.
Alivia stayed with us for the weekend. She started feeling better within hours of her IV. She bit her IV line in two a couple of times and acted like she wasn’t sick. Of course, it is easy to feel good on IV fluids and antibiotics. The goal of parvo treatment is to keep the pup or dog alive long enough to have the body fight off the disease. And while it is parvo season, I will continue to look for what else is going on with Alivia, because this case seems to be more. Easy answers aren’t always correct.