Hookworm Treatment--Do Symptoms Usually Get Worse Before Getting Bette

[Guest AngelPup]

Hi all. Sorry about yet another hookworm post, but I'm wondering whether the symptoms of hookworm typically get worse before getting better. For those of you who have experience treating dogs with hookworm infestations, what was your experience once treatment began? I know some of you have said it took MONTHS to get rid of them and your dogs had bloody diarrhea and vomiting, but did it start out that way and gradually get better or did it seem to get worse before getting better?

 

I spoke with the vet yesterday to give her an update and told her that Brady's diarrhea is worse than ever (marbled rust/orange colored and very wet/slimy/gelly like) and he wasn't feeling well when he got up yesterday (ran outside and started eating grass while wimpering with gurgling sounds coming from his belly). She said she wants to see him Monday and that she will check his stool and do standard bloodwork on him to see if it could possibly be something other than symptoms of hookworm. I really hope his bloodwork comes back normal.

 

For those who haven't read my previous posts, we've been treating Brady for hookworms since May 13 (adopted him on May 10) with Panacur every three weeks, but lately we've been giving it to him every two weeks. He's on a bland diet, on Flagyl, and FortiFlora. With the exception of the FortiFlora, we have seen improvement in the past with both the bland diet and Flagyl, but it doesn't last.

 

I'm definitely going to discuss trying another dewormer with the vet. Other than Drontal Plus, what other dewormers work well treating hookworms?

 

Thanks in advance for any insight/help you can provide. This is so very frustrating and I feel so bad for Brady!

[KF_in_Georgia]

What is he actually getting to eat on his bland diet? Kibble? Are you cooking for him?

 

If you're giving him any dairy products--like yogurt to control gas--try cutting that out. Some dogs, like some humans, are lactose intolerant.

[Guest AngelPup]

Thanks. No dairy--just boiled ground beef and white rice. We do give him the occasional milk bone and kibble for training, but not very much at all.

[Batmom]

Might be worth trying one of the prescription hypoallergenic or limited ingredient diets. Is his stool still testing positive for hookworms? If not, might be time to look for other causes for his problems?

[tbhounds]

Agreed with Batmom-think you're barking up the wrong tree--I believe I alluded to that in my last post. Something else is going on here.

[Guest AngelPup]

Thanks. Since he's in the midst of being dewormed, I'm not sure if eggs would show up even if he still had hookworms. I was planning on bringing a stool sample in a couple weeks to check. That's usually when the symptoms seem to get worse (every two weeks or so).

 

I guess we'll know more after the blood work and anal/stool testing.

[Guest nonna49]

On Tuesday, September 3, my Dash had to be put down. The cause? Complications from hookworm infestation. Arizona's climate is not conducive to hookworm. Dash had gastro intestinal issues from the time she came to us. She would have bouts of diarrhea; her feces were tested, no apparent parasites. Courses of flagyl, amoxicillin, Panacur. Her stool firmed up, she seemed to be fine. Last October we brought another grey into our home. They both had diarrhea on and off, same routine...test, medicate, retest. No parasites.

 

Complete metabolic panel done on both greys, nothing to indicate a problem. One morning in May, I took them in for yet another blood draw after a weekend of bloody diarrhea, and the new dog spewed water, feces and assorted muck all over the exam room. My vet sent the fluids to a lab in Phoenix. The diagnosis was hookworm. Hookworm, in Arizona?

 

We started aggressively treating for hookworm. The new dog responded better than Dash, and it now appeared that Dash had harbored the parasites for YEARS...probably brought them with her from the track. Even with all the testing, we did not catch the eggs in a stool sample. The worms were not responding to Panacea, Drontal or Drontal-2. By this time, Dash was anemic and near death. My vet started treating her with pyrantel, and Dot, the second, and much younger dog's health improved. It was too late for Dash.

 

Her stool had always been a bit orangey, by now it was rusty pumpkin colored. Her appetite was gone, even poached chicken livers, boiled chicken or hamburger did not appeal to her.

 

Dash was a tiny grey, top weight 54 pounds, she was down to 47 pounds, and we could not get her to eat. We tried steroids and every other protocol in the veterinary arsenal. On steroids she gained a little weight, ate well. Within days of stopping the steroids, she started losing weight and went off her feed. By late August, she weighed 44 pounds and was losing her ability to chew and swallow.

 

Hookworms are one of the nastiest parasites on the planet. The worms migrate to tissues outside the gut and slowly kill the animal. They cause neurological damage as well as hemolytic anemia and a host of other problems. They may also be resistant strains that do not respond to medications.

 

We had a post mortem done on Dash to see the damage and what to look for in our other grey. Dash's spleen was three times its normal size, bloated and purple with bumps that looked like bubbles or knots on what should have been a smooth surface.

 

Dot is not out of the woods yet. We caught the infestation sooner and Dot is younger, so it's fingers crossed and pray that we can rid her of these horrible blood sucking worms.

 

The day after we put Dash down, a little red fawn greyhound came available through our rescue organization. She was a bit too much puppy, at two and a half for two families, and was going to be difficult to place. We took her. She's a hoot. Silly, playful and drop dead gorgeous. I took her to our vet within 48 hours of bringing her home. Preliminary findings: Multiple parasite infestation, round, possibly tape and hook worm. My vet sent the sample to the lab in Phoenix. By this afternoon we'll know exactly what types of parasites she has, and then we can start aggressive therapy.

 

All three of my greys came from the track in Tucson. Parasites are preventable. The cost is minimal. So why don't owners and trainers treat the dogs? It cuts into their bottom line. Racing is not a noble sport. Dogs who race should be treated like the professional athletes they are.\

 

It is not the fastest dog who wins; it is often the dog that is LEAST sick.

[Guest AngelPup]

nonna49, I'm so very sorry to hear what you and your beloved Dash have had to go through and the sorrow and loss you are having to deal with now. I wish I had the answers for you as to why this happened when treatment is readily available and typically inexpensive. But it does sound like you did all you could (testing and treating) and it still wasn't enough to rid her of those nasty worms. I absolutely HATE hookworms!!!!! and hope to God that Brady is finally completely rid of them!

 

As far as the racing industry goes, I'm sure it's like any other industry/business where most of the people care and do the best they can and of course there is always a few that couldn't care less--and I'm sure some kennels/tracks are better than others. There are positives and negatives to everything. I, myself, have been very frustrated with the number of greyhounds that have worms and/or digestive issues when they retire (Brady had both). But I also realize how much my greyhound LOVES to race and be around other greyhounds... so I don't think it's all bad. I DEFINITELY agree that they should be treated like the professional athletes they are by ALL kennels/tracks!!

[Guest nonna49]

Thank you AngelPup, I wish you and your grey the best of luck getting rid of hookworms.

 

Annie's blood work came in this afternoon, she too has hookworm. Three greyhounds, from different breeders/trainers, all raced in either Phoenix or Tucson. All came here from other states. West Virginia, Texas and Oklahoma. Two of the three were in Florida prior to arriving in Arizona.

 

Hookworms are rare in Arizona unless infected dogs are here from other states. Between Dash, Dot and Annie, eleven littermates raced in Tucson or Phoenix. Most of those dogs went; into the adoption/rescue community all five of Dot's litter went to the same rescue organization. Those infected dogs went into foster and forever homes with other dogs, creating an environment for more dogs to become infected.

 

A pup frequently gets hookworms from its mother. The problem may not be detected for years If the pup survives, or the worm goes dormant. Seeing eggs in the stool means the adult worms have migrated to muscle, brain and other tissues, where they feed on the animal's blood. They secrete an anticoagulant at the site of their feeding, and when they move on that tiny wound seeps blood. The cycle goes on indefinitely, and often unnoticed even with regular stool analyses.

 

Treating hookworm is rarely a treat once or twice and they are gone situation. Even with treatment, there is about a 40% chance of controlling hookworm. Depletion of red blood cells causes the animal to be anemic. The dogs system may look at red blood cells as foreign and attack the animal's small store of red blood cells. The prognosis is not good under the best of circumstances. These worms are a very serious concern, particularly in dogs that are whelped in areas where hookworm persists such as West Virginia, Virginia, Florida, Missouri and other places where the soil is damp. The aforementioned states are also home to wholesale greyhound breeding.

 

Be diligent with your pup, I hope you and your vet are able to rid him of hookworms. It's a long road and can be expensive, but each of these dogs is worth it.

[Guest AngelPup]

Thanks Nonna. They are definitely worth it! So far so good with Brady and the hookworms and hoping it stays that way!

 

Good luck with Annie!

[Guest elizabeth7418]

Nonna, I am SO sorry for your loss. Your post has me very worried about my girl Addy. She'll be 8 next month, and she's been battling hookworm since at least April. She came off the track last October, and I adopted her in January. She tested negative for hookworm until April, and it's been positive since then. She's been through drontal plus, panacur, and pyrantel with no success. I have an appointment with our vet scheduled for today, and hopefully we're able to come up with an aggressive treatment to finally take care of the infestation. Please keep us in your thoughts today.

[Guest nonna49]

Elizabeth,

 

My thoughts go out to you today. It is an ugly, ugly battle. Internally, Dash lost her battle with hookworms long before eggs showed in her stool. Dot came off the track in October 2012, went to the vet for spaying and I got her two days later; no visible eggs in her stool until May 2013. Within 48 hours of adoption, we knew Annie had hookworm eggs in her stool.

 

Both Annie and Dot are two and a half. Dash was seven when we finally found the hookworms. She could have had them since she was whelped, who knows.

 

Dot responded better to pyrantel, but we aren't sure she's free of hookworm yet. Annie is just starting treatment. Now it's treat, test, treat test. Until we get at least two or three clean tests. We treat all the dogs if one is positive, which gets a bit spendy. As I stated in another post...I'm totally unfamiliar with hookworms, they aren't a problem in Arizona.

 

From the time we adopted Dash in May 2009, she had dark urine and orangey stools. She also had little control over her tongue; we thought it was sort of silly. Like having goofy ears or something. Two weeks ago when my vet saw her eat, he realized that she had a neurological problem in her esophagus. By then we knew it wouldn't be long before she would have to be put down.

 

I researched orangey poo, and consistently came up with Pancreatic Enzyme Inefficiency, PEI, that would also explain her dark urine. She never drank or peed as much as I thought she should, but since each pooch is different, and she ate, peed and poo'd regularly I was not too alarmed. My vet did multiple metabolic blood panels and poop tests on Dash and she always came up healthy. She was a small, dainty, thin, female greyound.

 

After all the testing for enzyme problems, etc. my vet said that generally, orange poo and dark pee are bile for some reason. We could not find the reason, until Dot spewed stuff from her behind in his office, which he sent to the lab in Phoenix. That was when hookworm was found; more testing revealed hookworm in both dogs. Timing was finally on our side.

 

After speaking with a number of greyhound parents, I am beginning to believe there are numerous cases of hookworm that go completely undetected in our grey-babies. My rescue organization has never found one to have hookworm, until my girls were diagnosed last spring. Annie came from the same agency and was pronounced dewormed and healthy. Either something is going undetected or we are not being diligent enough in our treatment.

 

It is my newfound understanding that after detection of hookworm, and that is only possible when there are eggs in the stool, therapy requires repeated doses of meds, as close together as is safe, and in doses as high as is safe for MONTHS. This prospect does not thrill me; however, this is my vet's recommendation. He has counseled with his vet school professors and peers as well as researched over the past six months to find the best possible course of treatment.

 

Personally, I feel this parasite is more prevalent than either reported or treated. Low potency doses apparently do not rid the host of the parasite. It's an industrial strength parasite and it requires industrial strength treatment.

 

Best wishes...

[NeylasMom]

Personally, I feel this parasite is more prevalent than either reported or treated. Low potency doses apparently do not rid the host of the parasite. It's an industrial strength parasite and it requires industrial strength treatment.

 

Best wishes...

If this is true, I'm wondering why we don't hear more stories like yours. I'm not questioning you, what you've gone through is horrible and I think it's very important to be aware, I'm just thinking logically and wondering why this is the first time I've seen a story like this on GT. Also, do you have recommendations from your vet on how to catch it via testing? If you only see it when eggs are being shed, I'm assume you could time fecals based on the life cycle to ensure you'd catch them at some point? No idea what the interval would be, but for instance if the life cycle is 4 weeks and eggs are shed for a week each time then you'd run fecals weekly for 4 weeks to be safe.

 

ETA: Or alternatively, what other indicators would there be that your dog has a chronic hookworm infestation? Would something show up on blood work relatively early (dog is slightly anemic for instance) that might suggest you should start looking into this as a potential issue?

 

I've had Violet for 2 years now and I've always called her a "hard keeper". Initially I thought maybe she did have worms, but her stool is great on her raw diet and now I think it's just a function of her being a bit anxious and having a higher metabolism, but you do have me a little worried. She is also a petite girl.

Edited September 10, 2013 by NeylasMom

[Guest nonna49]

If one knows the animal has hookworms, fecals can be timed. If hookworm is nearly unheard of in your area, you test the stool at the wrong time, think the problem is gastrointestinal, bacterial, etc. treat with flagyl, the malady clears up, the dog seems healthy, happy, has good color in their ears and mouth, why would you do a costly blood test? For nearly four years there was no indication of hookworm, her blood work did not indicate a problem. It was on a course of flagyl that I noticed her gums were pale..side effects of flagyl can mimic anemia, when the course of flagyl was finished, she continued to have pale gums, ears, and panted at inappropriate times, i.e. at rest, in the middle of the night.

 

Apparently some dogs, Dash included, are able to bounce back after one of the bouts of diarrhea , and the episode it attributed to diet, bacteria, irritable bowel or some other cause. Dash became anemic at the same time that Dot was showing signs of diarrhea and after a weekend of hideous diarrhea we saw the vet on Monday morning. Dot, literally exploded. If Dot had not had eggs present in the fluids she expelled, and had my vet not sent the fluid to an outside lab for comprehensive testing, we may not have seen the parasite through smear or float testing.

 

Once we identified the parasite in Dot, we tested Dash through the outside lab as well. The critical issue for Dash was by this time she had been fighting the parasites for at least the four years we'd had her. Her immune system was beginning to attack her red blood cells as foreign bodies, so no matter how many she made, her system killed them.

 

Hookworms are also capable of remaining dormant for years, then resurfacing. They are often dormant in a female, waiting for the host to become pregnant, which is why so many pups have hookworm at birth in areas where hookworms are a problem. When Dash came into our lives we had two other dogs, neither of the greyhounds, neither had digestive or parasite problems.

 

Dot has a much better prognosis than Dash, because she is younger and we began treating her at age two, rather than age seven. Within 48 hours I had Annie in our vet's office looking around for worms, even though the adoption agency had treated her with panacur and Drontal-2 in July. Annie had no fewer than four types of round worms, eggs and unidentified worms, visible via float/smear. Her sample was immediately sent out to the lab for more comprehensive testing.

 

As a side note: Both Dash and Dot were dewormed before they came into our custody. I pick up poop as soon as it lands on the grass. Within a few days, I found 3-4 inch tapeworms in each of the girls, three and a half years apart. Both of those incidents won us a trip to the vet and all three dogs were treated. No sign of tapeworm after the treatment.

 

Hookworm is sort of like heartworm or lyme disease...if you don't live in an area where the parasites are prevalent, the veterinary community does not recommend treating for something that is not an issue.

 

The moral to this story, for me, is have your adopted grey tested early and often as soon as they enter your home, even though they may be certified parasite free when signed into your custody. Keep tabs on poop color and consistency and look for cycles, patterns of when changes occur. After the initial food change to your household, don't give toppings or special goodies to entice the pooch to eat, until you know for sure and certain that hookworms have not been ruled out.

 

In Arizona and Colorado, we tend to think giardia first rather than hookworms. We treat with flagyl, the problem clears up, and we think we're done. Another cycle of diarrhea and we think, for example, a feral cat or skunk passed giardia back to the dogs via the outside water dish. That is exactly what happened here. It was luck of the draw that we didn't catch a single fecal at the right time.

 

Dot is a healthy looking, playful 66 pound female who snarfs her food, drinks regularly with much gusto, has pretty pink inside her ears and mouth, and she has hookworms. We're still in the test/treat cycle with Dot.

 

Annie is nearly as tall as Dot, a bit of a wild child, weighs 54 pounds, has a very good appetite, drinks with gusto, and has hookworms.

 

Both girls blood work shows no signs of abnormality.

 

At the moment, both girls have nearly perfect poo.

 

We have another round of meds to start on Thursday.

[Guest AngelPup]

What a nightmare! I'm definitely going to keep a closer eye on Brady and have his poop tested again just to be QUADRUPALLY sure he's rid of hookworms!

 

Good luck with everything Nonna! I hope your two pups are hookworm free very soon--and stay that way!!

[greyhead]

There have been stories like this on GT -- from me! And I started reading on GT about problems around hook diagnosis and treatment in 2006, when we got the diagnosis. It's true that vets in many states don't expect hookworm, can't identify hook eggs in a fecal, don't have the best equipment for finding worm eggs (and don't send the sample to a lab that does have it), and treat by standard labeled instructions rather than aggressively. Back in 2006 I did an archive search here and found several people whose dogs had been bedeviled by hooks; they all recounted the aggressive treatment that had been required, including using Panacur, for instance, for 5 to 7 straight days instead of the recommended 3. They also spoke of needing to follow up with Drontal, as hooks not already killed would tend to have become resistant to Panacur.

 

The dormancy problem is what's responsible for the permanent hookworm cases, including Spencer's. The meds can't kill the dormant hooks since they're encased in impervious cysts. They hatch when who-knows-what motivates them to do so. Stress, anesthesia and, apparently, whelping are things of which I've heard that seem to persuade hooks to emerge from dormancy. The lifecycle of hooks is three weeks. Thus, an internist told us to administer the Interceptor we used every three weeks instead of every four as recommended on the label. She said she had one dog (a terrier, I think) she directed to take it daily (for some period of time), but that that was highly unusual, under supervision, and shouldn't usually be done!

 

As most folks on GT know, Spencer wound up with a raging Clostridium perfringens infection (SIBO) after a dental. It got that bad -- indicators were soft-serve poop that was first orange, then yellow, and eventually smelled totally vile -- because it took months before they did the right test to find it. They'd given a low dose of Tylan and, when that didn't clear it up, assumed that it was not the SIBO it actually turned out to be. And whenever I'd asked them to test the poop, they'd tested only for worms, not bacteria. I finally just *told* them to culture the poop, by which time he'd lost 20 lbs. I mention this because poop cultures are another thing that seem to be rarely performed.

 

And, most importantly, when we find one thing wrong, like hookworm, we and the vets tend to assume that we've found *the* problem. So I really want to urge people to keep looking for additional issues if worming doesn't clear all the symptoms. Spencer didn't have PLE or PEI despite the orange/yellow poop. He had orange poop because the undiagnosed Clostridium was wreaking havoc on his whole GI tract, ending in IBD.

 

It's also true that we learned to recognize a hookworm resurgence more reliably by symptoms than by fecal testing, due to the problem with timing the fecals. (You'd have to test three or four weeks in a row to be sure you tested during the egg-shedding stage.) In Spencer's case symptoms including inappetance in the morning; jumping as if being bitten by something (hooks do bite); and repeated throat clearing followed immediately by swallowing (they'd migrated to his lungs), which is easily mistaken for a backward sneeze.

 

I think that whatever worming schedule the kennels at the track follow when the dogs are racing may not carry over to the adoption kennels, or at least didn't back in 2005 when we started adopting. There may not be a budget for it? Anyhow, that might be an area to look into if we want to figure out why newly adopted racers turn up with worms.

[NeylasMom]

So do you think it's possible for a dog to have had an active hookworm infestation, not be treated (or have received only one dose), and have it go dormant on its own?

 

Are the kennels following any sort of worming protocol? I didn't think so. My group had always wormed the dogs off the hauler as a matter of course because we presumed they'd have them.

[Guest elizabeth7418]

Here are the results of Addy's vet visit yesterday: she has one of the most stubborn cases of hookworm he's ever seen (he's also the vet of choice for our adoption group...the group owner drives all of the new dogs & her personal dogs almost 4 hours round trip to be seen by him). He's prescribed 2 doses of drontal plus to be given 10 days apart, then four weeks of pyrantel followed by another 4 treatments two weeks apart. Addy had previously only had one dose of drontal and had been through four weeks of pyrantel. She's not exhibiting any symptoms other than pudding poop (not full blown liquid diarrhea). In fact, this afternoon, her poop was the closest thing to normal I've seen in weeks. Fingers crossed this infestation gets taken care of in the next 8-10 weeks.

[greyhead]

Yes, Jen, I do think that's possible. Much depends, I think, on how much hookworm they have when they're treated. If it's a brief and recent infection, so the number is small, then briefer treatment will probably do the trick. But if they are a lot of them and they've been there a while, have to treat much more aggressively. As to dormancy specifically, I don't think we know what motivates it. Just speculating, anything that makes their environment less than ideal for them could lead to dormancy; that would include the number of worms (e.g., increased competition for resources). It might also include Flagyl, since that seems to knock them back a bit but only temporarily.

 

Elizabeth, glad to hear there's an extensive treatment program planned! The only difference between Drontal and Drontal Plus, IIRC, is that the latter also treats tapeworm and is more expensive. I'll just add that Spencer never had diarrhea from hooks, and the pudding poop appeared cyclically. I was interested to note that the fecal picked up hooks at a time when his poop was in good form! (Of course, it was also found on equipment superior to what had been used for the fecals previous to that. But still, it may be worth noting that egg shedding doesn't necessarily occur when the poop looks the worst.) We'll cross our fingers and paws along with you! Please let us know how things work out.

[NeylasMom]

Well now y'all have me paranoid that Violet has a dormant case of hooks that will rear it's ugly head down the road. (Only sort of and sort of )

[greyhead]

Actually, Jen, what I've wondered about with Violet is whether she has an underlying TBD. Has she been tested? I say that because Shane has two, always tended to overheat, and the overheating went away after treatment -- until lately. And apparently you don't really "cure" a TBD, you just get it into remission, from which it can later reemerge.

[NeylasMom]

Actually, Jen, what I've wondered about with Violet is whether she has an underlying TBD. Has she been tested? I say that because Shane has two, always tended to overheat, and the overheating went away after treatment -- until lately. And apparently you don't really "cure" a TBD, you just get it into remission, from which it can later reemerge.

Yeah, she's a blood donor so she's tested yearly. I don't think I've ever done a full panel with someone like NC state, but she doesn't really have any symptoms of a TBD.

[greyhead]

Right, I forgot she's a blood donor! I wouldn't go for PCR either.

[Guest nonna49]

Do any adoptive puppy-parents have access to vet records from when their pooch raced? How do we know if/when the dogs were ever treated for hookworms? One of my three was kenneled a year after she came off the track...one I picked up at the hauler...the third was a little over 30 days from the track...the only vet record I have is rabies/parvo etc. immunization from when they raced and the receiving vet's treatment after they were surrendered.

 

I'm skeptical that they were tested or treated while racing at all.

[Guest AngelPup]

Hi Nonna. Brady came with documents that showed he had his required shots from the past two years and paperwork from the adoption group for his neutering and testing for heartworm, etc. I heard that the adoption group does deworm them, but there is no documentation for previous exams, tests, or treatments in his racing career. I agree that it would be VERY helpful to have ALL their records.