Dont Run from Diarrhea

January 2013

Audience: Executive Leadership, Foster Caregivers, Public, Shelter/Rescue Staff & Volunteers, Veterinary Team

(This information is intended to be educational in nature. Shelters and rescue groups are expected to work with their veterinarians to determine appropriate treatment for the animals in their care.)

The appearance of brown splats in a kennel run or litter box can fill shelter workers with dread. But a mounting body of research and in-the-trenches experience demonstrates that a formalized set of basic protocols for prevention and management of diarrhea can keep pets moving as quickly as possible into their adoptive homes - without the splats or the dread.

"When I was in vet school, shelter animals were put down for diarrhea," says PAWS Chicago veterinarian Dr. Barbara Hanek. "In a lot of places, I guess maybe they still are. But diarrhea, while highly common, is also highly treatable."

"Most diarrhea seen in shelters is treatable," agrees Dr. Elizabeth Berliner, Director of Clinical Programs for Maddie's® Shelter Medicine Program at Cornell University. "It may take a few days of that prescription diet. It may take a few days of those nutraceuticals. It may take a few days of changing that animal's situation, putting them in some place that is less stressful and helping them adjust to the shelter environment. But as long as we follow those steps, I think most diarrhea is treatable in the shelter."

Those "steps" are a set of standardized protocols for prevention and treatmeThose "steps" are a set of standardized protocols for prevention and treatment of shelter diarrhea. These protocols are formalized, written and able to be understood and followed by staff members who are not necessarily part of the veterinary team. By formulating and implementing these specific intake and management procedures, Dr. Hanek estimates around 85% of all diarrhea in shelter dogs and cats can be dealt with successfully and inexpensively.

Certainly diarrhea can be a sign of serious disease, and protocols for dealing with it need to reflect that fact. But Dr. Heather Budgin, the Director of Shelter Medicine at Tony La Russa's Animal Rescue Foundation (ARF) in Walnut Creek, CA, thinks most shelters actually overreact to signs of digestive upset in their dogs and cats.

"I've found with clients and fosters over the years, people get very alarmed over one incident of diarrhea," she says. "Have you ever had diarrhea for one day and it's nothing? It's the same with many pets. Maybe it's more of a concern because we're cleaning up after them, but you wouldn't go to your doctor if you had diarrhea for a day or two."

Getting the Jump on the Runs

Beating shelter diarrhea starts at intake, and continues until the pets are adopted - sometimes even longer. While each shelter's or rescue group's protocols may differ in details based on their specific population characteristics and regional factors, they should include these elements:

  1. Prophylactically treat all incoming dogs and cats with age, population and species-appropriate preventive medications.
  2. Have formal, written protocols for shelter staff to follow if pets break with diarrhea in the kennels or adoption area. These should include medication as well as nutraceuticals (primarily probiotics), special diets, transfer to foster care and in-shelter stress reduction measures.
  3. Include guidelines on what should trigger an immediate call to the shelter veterinarian, and what can be handled on the basis of established treatment protocols without contacting the veterinarian.
  4. If diarrhea does not respond or worsens, all shelter staff should be empowered to escalate care to the veterinary team.

How do those four elements play out in real shelter situations?

At PAWS Chicago, most of the pets cared for in their veterinary hospital are pulled from the city's animal control facility, a population at high risk for diseases including diarrhea. That's why Dr. Hanek's team starts the fight against diarrhea the minute the pet enters their doors.

Dogs and cats coming in to PAWS are prophylactically treated with Strongid (pyrantel pamoate) for roundworms and hookworms, with a Droncit (praziquantel) injection for tapeworms, and Revolution® (selamectin) topically. For intake of large numbers of animals all at once, they give five days of Panacur (fenbendazole) starting on intake as well.

However, Dr. Hanek says, their protocols for new admits to the shelter aren't set in stone. "Our intake process is dynamic, and we modify it to respond to what we're seeing in the population," she says.

Kittens are such poster pets for shelter diarrhea that they deserve their own set of specialized protocols.

"Almost all the kittens we take in have diarrhea at some point," laments Dr. Budgin. "They can be pretty frustrating. You can run many, many fecal tests, not find anything, empirically treat, and see no change."

What's behind the high incidence of diarrhea in shelter kittens? Dr. Budgin speculates it's due to weaning too early, and says ARF tries to keep kittens with their mothers until they're at least 8 weeks of age whenever possible.

Both ARF and PAWS Chicago have started giving kittens the drug Marquis (ponazuril), a paste medication labeled for use in horses. Its use to treat puppies and kittens for diarrhea caused by coccidia is considered an extralabel use.

"For kittens under 5 pounds, we are giving a one-time dose on intake," said Dr. Hanek. "We see kittens come in with a poor body score. They may be eating but have a large belly. At PAWS we give just one dose, but some shelters do it three days in a row. We see fewer kittens with diarrhea, fewer who are poor doers and fewer extended abdomens if it's given on intake. We start it as young as 4 weeks, around the time they are being weaned."

Responding to Diarrhea After Intake

If animals break with diarrhea in the kennels at PAWS Chicago or ARF, the shelter staff is able to respond immediately.

"Unless the diarrhea lasts more than 2 - 3 days, or is very severe and raises concern about a disease like parvo, the kennel staff members don't even tell the vet staff," says Dr. Budgin.

"If I know I have diarrhea in a dog in the adoption center, I'll put him on Flagyl and Panacur, and also treat any other dog(s) in that room," says Dr. Hanek. "Panacur is over-the-counter, and we keep it in the adoption center. The staff will send a request/medical update, and I can prescribe medication because we've seen the pets on intake."

PAWS Chicago has seen great success using these protocols on the cats and dogs they pull from the city shelter. Even in those high-risk pets, reports Dr. Hanek, "only a small percentage of cats and dogs with diarrhea will require treatment beside Flagyl, Panacur and probiotics. At least 85% of them will respond to that alone."

Nor do they run for the diagnostic tests, which is reassuring given the lengthy list of possible causes of diarrhea. The prospect of diagnosing what's causing the problem in a specific animal is a daunting one in a shelter environment, where resources are limited.

"If a pet breaks with diarrhea in the adoption center, I don't necessarily do any tests," says Dr. Hanek. "I only do diagnostic tests, which take time and money, when it's going to change my course of treatment."

That's not just the consensus from the trenches, but from academia as well. In a pair of recent studies looking at diarrhea in shelter dogs and cats, the authors point out that animals often enter the shelter with parasites and pathogens detected on diagnostic tests, but that such infections don't correlate with symptoms, including diarrhea. Instead of testing, they conclude, "practical guidelines should be developed to treat routinely for the most common and important enteropathogens" in shelter populations.1, 2

Nor can they identify diarrhea that's caused by stress. In fact, one pathogen that can be responsible for diarrhea in cats, Tritrichomonas foetus, appears to be associated almost exclusively with the stress caused by overcrowding3, suggesting resources might better be spent improving the shelter's housing rather than on diagnostic tests.

However, controlling diarrhea in sheltered pets requires more than simply medicating them. "The basics that are responsible for diarrhea in our shelters, a lot of those can be managed relatively easily and affordably," Dr. Berliner says. "But it may mean addressing more than just medications. It may mean looking at your husbandry and your cleaning protocols. It may mean looking at your stress management for your animals. It may mean looking at your nutritional protocols."

For instance, she advises, "Make sure the animals are kept clean, especially puppies and kittens. If they're not kept clean and they're essentially grooming themselves clean, then they can re-infect themselves with parasites."

She also suggests shelters take a look at the food their pets are eating. "Nutrition is a huge issue for a lot of shelters because the animals coming in are being exposed to a new diet," she says. "At times they may have a diet change, particularly if shelters aren't able to maintain a standard food or a standard feeding protocol. So they may be being fed too much or different foods and that can throw them off."

(Note: For a detailed look at a successful protocol used to treat and prevent shelter diarrhea in in the United States' largest no-kill community, read Dr. Ellen Jefferson's companion piece, A Protocoled Response to Dog and Cat Diarrhea in a Shelter Setting. For more on diet and nutrition in the treatment and prevention of diarrhea in shelter cats and dogs, read Dr. Justin Schmalberg's companion piece here.)

The Adoption Cure


There's one last "cure" that usually works for diarrhea in shelter pets: getting them out of the shelter. That usually means a foster home, but it can and often does mean a permanent adoptive home.

Stress and dietary problems are behind many cases of diarrhea4, and both these problems will usually go away once a pet is in his or her new home.

"We definitely see pets helped just by being adopted," Dr. Hanek said. "To get them in a home environment where you're not having cats listening to dogs barking, where you're having a stable environment, where there's not a variety of different pathogens - it just makes sense that in a home environment, they're going to get healthy more quickly. You reduce the stress, get them settled and they're fine."

Dr. Budgin says ARF has seen success in placing kittens with loose stool in new homes, too. "If the kitten is not having full-on liquid diarrhea, we will place him in an adoptive home," she said. "And because we have an arrangement with a local veterinary clinic, if there were cases that didn't clear up, or horrible issues with this policy, we'd hear back, which we almost never do, unless something like Inflammatory Bowel Disease (IBD) is diagnosed down the line. The cases caused by parasites and stress go away once the kittens are treated and in a home."

PAWS has a similar arrangement with a local veterinary hospital, and has had equal success in placing dogs and cats with mild diarrhea and loose stool in new homes. "I can't think of one dog and only one cat in the last five years who came back with chronic diarrhea," Dr. Hanek said. "If the animal has diarrhea but is bright, alert, playful, gaining weight and eating - it's just a matter of time for that to correct itself."

Dr. Hanek counsels prospective adopters to look at the trend over time when deciding whether to take a chance on a pet with less-than-solid stool. "If the pet had diarrhea two days ago, has started medications, and is already improved, that would be a good sign," she said. "Once they show you that they're improving and they're clinically sound as far as appetite, energy, no vomiting and they're responding, they can continue the treatment after adoption."

Check out this slide show of shelter dogs and cats who were adopted with diarrhea. While a few of the cases were tough to beat, most cleared up with TLC and basic vet care and the pets went on to be happy, beloved members of the family!

For more information on treating diarrhea in shelter dogs and cats click here

References

1. Sabshin SJ, Levy JK, Tupler T, Tucker SJ, Greiner EC, Leutenegger, CM. Enteropathogens identified in dogs entering a Florida animal shelter with normal feces or diarrhea. Journal of the American Veterinary Medical Association 2012;241(3):338-343.

2. Sabshin SJ, Levy JK, Tupler T, Tucker SJ, Greiner EC, Leutenegger, CM. Enteropathogens identified in cats entering a Florida animal shelter with normal feces or diarrhea. Journal of the American Veterinary Medical Association 2012;241(3):331-337.

3. Diarrhea in a Shelter Cat; UC-Davis Koret Shelter Medicine Program.

4. Sokolow SH, Rand C, Marks SL, Drazenovich NL, Kather EJ, Foley JE.
Epidemiologic evaluation of diarrhea in dogs in an animal shelter. American  Journal of Veterinary Research. 2005 Jun;66(6):1018-24.

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