Stool Specimens

Warning: Bodily Functions are Disgusting

Broadleafplantain_2 So, the client brings in a ziploc bag with a few leaves just as bright green as these.  "I think that my dog has diarrhea from eating these plants."  "Have you seen him eating some like these?"  "Not like these, these plants right here. See how wet they are? They must have gone right through him."  "Trust me, lady, I’m a professional.  If these plants had gone all the way through your dog’s digestive tract, they wouldn’t be this bright green."  Of course, the dog had eaten the weeds and vomited them up.  I’m not kidding about that different color thing. I’m not kidding about being a professional, either.

Poop_sheet2_2 I advise you not to click on this picture to blow it up.  The title "Fecal Scoring System" could also be "Know your s__t".  I never use this chart with clients, though maybe I should.  Typically, when the client says the pet has diarrhea, I ask if the consistency is watery, or like paint, or applesauce.  Sometimes this works… sometimes they swear off applesauce.  In livestock country, you can ask if it’s "cow-pie" consistency, but few of our clients have been up close to a cow, much less a cow-pie. 

Dairy_cow Here’s a picture of a cow.  Cowpie_2 Here’s a picture of a cow-pie.  Happy now?

We always ask clients to bring a stool specimen as part of the pet’s examination.  People think I have some kind of poop fetish, because I always ask if they’ve  brought it.  As I’ve mentioned in a previous post, a microscopic exam of the stool is best way to check for most intestinal parasites.  Color and consistency can also give you clues about some other types of digestive ailments.

People are reluctant to even talk about the excrement, much less pick it up.  If they do bring a specimen, it’s "his job", "a present for you", "his homework" [my favorite].  Many clients (in fact, most clients) would rather not bring in the specimen.  Sure, I could fish some out, but you get a pretty tiny sample that way, and you can miss things just because your sample is so small.  With just a smear, you have the equivalent of pulling a handful off a truck-load — maybe that truck is full of soybeans… maybe it’s full of motorcycles.  You don’t know.  Really, we need about a tablespoonful, and we need it the same day it’s passed — within 12 hours; it doesn’t have to be steaming (thank goodness).

It’s always interesting to note the different responses to my request for the specimen.  Virtually nobody brings in a tablespoon-full.  You might get a smear on a Kleenex or a coffee-can full.  There are people who just forget (and I understand that: it’s the kind of thing you’d be happy to forget).  "The secretary didn’t tell me to bring one." [Yes, she did.] Then there are other people who just tell you flat out that they are not going to pick up poop and bring it in.  Fair enough, though it may handicap me a little.  And then there are the folks who are sure not going to bring you a sample, but they feel bad about it, because they love their pet and they know they really should.  These are the folks who slap their forehead and say, "Oh, I had one, but I left it sitting on the kitchen table."  In the butter dish, no doubt.

My favorite is the client who lets me fish a specimen out of the dog’s exhaust pipe and go through the whole exam.  As we finish, I say, "Now, if you can bring me a bigger specimen, we can do a more accurate check for intestinal parasites."  "Oh… I’ve got one."  He’s had it in his pocket the whole time.   What if I hadn’t asked for it?   How long would he have saved it?  Why?  We know how I lost my capacity to feel dirty, but what happened to this guy?

10 thoughts on “Stool Specimens

  1. Diana Guerrero says:

    You know, one thing about good animal professionals–they are obsessed with poop…where were those nifty posters when I was studying?

    Maybe you can send me one for Christmas. 🙂

    I am surprised at the reluctant clients–guess I have been way too compliant about the poop deal.

    You post gives new meaning to “talking sh**.”

  2. Dr. Patty Khuly says:

    I just found your blog through Embrace Pet Insurance’s blog. This is great stuff! Whatever you do don’t stop blogging. Oh, and you think Purina will send me one of those poopy posters if I ask nicely?

  3. Doc says:

    Thanks for the kind words. I’ve had that little poster forever, so they may not be available anymore. that’s the trouble with being a geezer. Your favorite stuff is prehistoric. I played string bass with a regional jazz group a few years ago and brought my old Fender bass amp, vacuum tubes and all. “Hey, man, cool amp. Where did you find that thing?” [beat, beat, beat…] “Uh, bought it new.”

    Thanks for reading and writing.

  4. Kyle says:

    I found your site through alltop.com, and I’ve really enjoyed browsing through it today. It’s nice to read a vet’s-eye-view of the world.

  5. lynn says:

    What to do when you are in rural NM and have vets who claim that they “don’t have good luck” with fecal exams? My dog has diarrhea again. I am giving him endosorb for now as clinic is closed. The last time he had diarehea the vet went ahead and wormed him for various worms without a fecal exam, gave him antibiotics (he had temp)and endosorb. Is a fecal exam really that iffy that he “doesn’t have good luck with it”? How accurate is the fecal test? Or maybe he just doesn’t have the time for it; he is a busy rural vet. There is definitely a different standard of care here. The dog’s x-ray (which I insisted on) showed lots of stomach irritation. He is a shelter dog who I’ve had for 3 years who is otherwise healthy (after heartworm treatment) but vomits yellow bile. The vet was not concerned with the vommiting when I brought it to his attention unless it “increased dramatically”; so I kept a log and it did increase. It is usually in the morning, he wretches, and then produces a beaten egg like yellow bile. His vomitting decreased for awhile after advice from another vet to switch to a fish based kibble. Now the vomiting is increasing again. Is there a link to the vomitting and diahrreah? What tests would you recommend? The last time he had blood work the vet said it was as close to perfect as could be. Any suggestions?

  6. Doc says:

    Hello, Lynn,

    What the clinical pathology people have told me is that they will do flotation exams on at least three different stool specimens before calling it “negative”.

    Because you are looking for microscopic eggs, you can sure miss them, even with a thorough examination of the stool. The parasites aren’t little machines. Some stools will have lots of eggs, very few.

    Typically, when we suspect parasites, but cannot find them, we treat for the most common parasites and assess the response: tapeworms, whipworms, hookworms and roundworms.

    Whipworms often cause intermittent diarrhea with blood and mucus, and can also cause occasional vomiting.

    I’m wondering what was seen on the X-ray, as soft tissues usually don’t show up very dramatically. I’m guessing it was a lot of gas-filled bowel loops (which is abnormal).

    Vomiting bile just means that you are vomiting on an empty stomach.

    THere are certainly dogs who have dietary intolerances (not exactly food allergy, but sort of).

    I have seen dogs with this problem become much improved when put on a hypoallergenic diet, like Purina HA, or Hill’s Z/D. These hydrolyzed antigen diets can sometimes cause a mild loose stool, though.

    Inflammatory bowel disease is poorly understood, seeming to be the dog’s own body defenses causing damage to the intestines. Sometimes the hypoallergenic diet helps, sometimes you have to use corticosteroid drugs to suppress the body’s defenses for a while.

    Diagnosis is kind of iffy. To prove it’s there, you need a full thickness biopsy of the intestine (requiring exploratory surgery). The problem is, if you’ve been having this kind of trouble for a while, the biopsy will show inflammation no matter what the original cause was.

    Acid reducers might help with the vomiting. I often try using them twice daily. This is not addressing the root cause, but some dogs just have “nervous stomach” and reducing the excess acid production makes them quit vomiting (or reduces the frequency).

    Chronic diarrhea can also be due to a shift in the bacterial population in the gut. Using probiotics (like Purina’s Forti-flora) to re-establish the normal bacteria can help. Some dogs will really benefit from treatment with the antibiotic metronidazole. It kills bacteria that thrive without oxygen, and it has an anti-inflammatory effect on the colon.

    The drug sulfasalazine is also used for chronic colitis.

    Sometimes the testing is very frustrating and unrewarding, and you start trying one medicine after another. This is also frustrating, and makes you feel like a quack. On the other hand, exploratory surgery and biopsy sometimes just tells you, “Yeah, the bowel is irritated all right”.

    I once had a dog with histoplasmosis (a systemic fungus) in his intestinal lining. This is very unusual, and would not have been diagnosed without the biopsy that we did (via colonoscopy). Treatable, but a difficult case to diagnose.

    Cultures of the stool sometimes reveal bad bacteria, but usually just show the “usual suspects” and don’t tell you much. You don’t know unless you try.

    I wish I could give you specific advice, but I really cannot do that without seeing your dog.

    Good luck.

  7. Jody says:

    Thank you for your response.

    The X-ray showed “quite a bit of irritation to stomach and small intestines” and an “empty stomach” at the time.

    Currently feeding him Core Ocean, softed with water, and I break up his meals so he is feed 3 times a day.
    He is a Corgi-Chow or something Mix and weight ranges from 46-49 lbs of low-rider dog. He has a healthy appetite and looks to be a healthy weight; vets said he was at a health weight.

    I feel somewhat reassured that he was treated for “all the usual suspects” you mentioned above. My concern was overtreating without a definitive diagnosis. But, as you’ve said, sometimes that doesn’t happen. I was giving him generic pepcid twice a day, but then vet recommended just using the endosorb for awhile. Also, one vet did give metronidazole as you mentioned. It is hard to tell just what helped at the time.

    Hiking off leash in the Gila Wildreness, he does roll in and sometimes eats who knows what wild animal feces and dead animal carcass. Any special considerations for worming or testing a dog regulary exposed to this?

    Maybe I will try to collect 3 stool samples for next visit.

    Thank you for time! I’ve often recommended your blog to others.

    –Lynn

  8. Doc says:

    Hello, Lynn (jody?),

    I an intrigued by the possible exposure to wildlife parasites. Perhaps you could get in touch with your state’s conservation department (forest rangers?) and ask for a referral to one of their naturalists. These folks might be able to give you a line on wild animal parasites that are a risk to domestic animals.

    Just a thought.

    If the dog is repeatedly getting exposed to pathogens by eating yucky carcasses, then he may need repeated treatment for this (as in another round of metronidazole or fenbendazole).

    Good luck.

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