Vet School 101 What’s your pet’s fecal test for, anyway?
So what’s that embarrassing caca test for, anyway?
It’s stressful enough to have your pet’s backside violated by a plastic rod, right? So what’s the point?
You say: If the goal is to make my pet healthier and parasite-free then I’ll trust your judgment, but I have to say, stool checks are a kind of cruel and unusual sort of punishment. I don’t get that sort of humiliation until I’m male and forty, right? And fecals aren’t that helpful, right?
I say: For starters, you need not have your pet succumb to the dastardly rod. A fresh sample is usually easily obtained the morning (or afternoon) before your annual visit or any time your pet suffers gastrointestinal symptoms. It’s not so tough, really. And if the timing’s not exactly right (stool should be no older than an hour for best results), your vet hospital will surely not deny you the right to bring in a super-fresh sample at your convenience. Promise.
And yes, fecal examinations, though relatively cheap and routine, are indispensable. But as this post will demonstrate, it’s also true that not all fecal tests will pick up a parasite infection in your pets. That’s why annual and/or serial fecal examinations may be necessary.
Now for the primary goal of the test:
Veterinarians are always on the lookout for parasites that may find their way into your pets’ gastrointestinal tracts. Sure, we humans can get parasites, too, but our modern lifestyles tend to be less conducive to parasite infection. (When was the last time you went snuffling in the yard, lips to the ground, just so you could inhale a feline turd or two?)
Yes, pets get lots of parasites. Here’s a sampling of the most common gastrointestinal parasites I see here [in the parasite heaven that is semi-tropical South Florida]:
Hookworms in pets
Whipworms in pets
Giardia in pets
Liver flukes in pets
Coccidia in pets
I’ll not go into the gory details on each but you can click on the links and check out the info for a better understanding of how these parasites can potentially affect your pets and even your human family.
Sure, pet-popular parasites don’t often infect humans in the so-called, “developed” nations all of you reading this likely live in, but that doesn’t mean it doesn’t happen. Roundworms and hookworms are still a factor in humans in the US, as is Giardia, which will give you the nastiest case of diarrhea you can imagine short of amoebic dysentery.
Since veterinarians are also on the front lines when it comes to public health, consider that fecal exams are not just necessary for healthy pets, they’re essential for healthy humans, too, more so if your family members are very young children, very old adults or otherwise immunocompromised (transplant patients, HIV-positive humans, chemo recipients, etc.).
How do we identify these critters in the fecal exam?
The short answer: With a microscope.
The long answer: We take a tiny sample of your pet’s stool (very fresh is always best). A few grams is enough (think an eighth of a teaspoon if that’s easier). Then we put it through one of three processes.
1-The smear: We take about a half gram of stool and smear it onto a microscope slide to search for parasites (and bacteria) directly. Many times we’ll see them swimming about. Finding evidence of parasites in a simple smear is often indicative of severe infection.
2-The float: This method relies on mixing the stool with a special solution. It filters out the big pieces of stool in a tube or other cylindrical vessel and allows the eggs and other small critters to float up to the top, buoyed by the solution’s specific gravity. A microscope slide’s cover slip is typically used to recover the floaters. Some parasites, however, aren’t amenable to flotation. Eggs seem to do best through this method.
3-Centrifugation: Spinning the heck out of stool in a centrifuge when it’s mixed in a sugar solution picks up about 50% more parasite eggs and oocysts than through flotation. Therefore, I like this method best for worm eggs, Giardia, and coccidia––though I’d never go without a smear. Problem is, most hospitals don’t yet use this method. It’s more expensive than others and research demonstrating it’s much greater efficacy is fairly recent.
So now you know the truth: Not all fecal exams are created equal. Not only does this test rely on careful selection of materials and methods, it also requires a trained eye. In our practice, for example, one of our techs detects parasites about 50% more often than the veterinarians and other techs/assistants. (That’s why we also do floats so that she can check them all at her convenience when she comes back from her day off.)
It’s also true that even a parasite-infected animal will often not come up positive on a fecal test. Human error and equipment choice are factors, but so is the parasite itself. Sometimes they do not make themselves known in the stool. Worms sometimes aren’t shedding their eggs and subclinical (low-grade or smoldering) infections may not reveal much, either.
Again, that’s why it’s important to perform this test as often as is reasonable. For all dogs and cats at least three times during the first few months of life. I want to see at least two negative tests in a row, a month apart, before I’ll feel comfortable that my patient is parasite-free.
For adults, once a year is great––that is, unless they show gastrointestinal illnesses. In this case, serial fecal tests make sense––or at least one every time the symptoms recur until a definitive diagnosis is made (whether it’s parasites or something else).
Ultimately, fecal tests are a critical component of our veterinary hat of tricks. Doing without may seem like the economically wisest thing in the absence of gastrointestinal symptoms, but consider: parasites can wear pets down in ways you might not expect. And it’s never wrong to be too safe in the presence of diseases that may also affect your family. ‘Nuff said.
March 10th, 2009
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Add Comment40 Comments
I know a # of people who just worm regularly without bothering with a float - prophylactically in effect, for their otherwise healthy dog. Their reasoning is that worming is inexpensive (esp if you purchase wormer in larger batches) & in those particular dogs, well tolerated with no adverse side effects. They say that, in effect, this is what many people do with flea meds - treat all the time whether they need it or not. Your comments on this strategy? (This btw is in the Pacific Northwest.)
hornblower March 10th, 2009 06:31:54 AM
The problem with worming without checking is that you don't know what you're worming FOR, and unfortunately, not all parasites are killed by all drugs. So, if you generally use one type of wormer (strongid/pyrantel for example) you'll kill most parasites of X type (ascarids). If there are any of Y type however (flukes perhaps, as they're common in the PNW), they'll go on about their happy little day. Conversely, the drug that does kill Y type doesn't touch X. And if you want to use all the drugs to kill everything prophylactically, then you're getting more expensive again, in addition to giving possibly uneeded chemicals.
lindabcs March 10th, 2009 06:42:22 AM
What about dogs who are on one of the heartworm preventatives that are also supposed to kill intestinal parasites - Interceptor or Heartgard Plus for example? How effective are they, and are yearly fecals still recommended?
Barb March 10th, 2009 07:25:11 AM
Our clinic (in conjunction with CDC recommendations) recommeds deworming every 3 months year round. With the exception of Profender, no available deworming medication we have here does all worms including tapeworms. Tapeworm medication is still left primarily to a select few. But overall, Interceptor, Advantage Multi, Revolution etc cover a broad spectrum to work well enough overall in our area. We do take into account patients lifestyle and who they come in contact with. Adjust recommendations according to that info. Works pretty well here. (West Coast Canada)
Kathy March 10th, 2009 08:02:35 AM
That's really interesting. My vet has never asked for a fresh sample, just a sample. I guess I try to bring in the freshest one in the box but they are usually more than an hour old. I'm thinking I get leeway because my kitties are strictly indoor in a high rise - there's no outside to get to, and the windows don't get opened much since they both showed me how fun it was to pretend to be window-cling garfields (I'm also an AC junkie so it's not much of a sacrifice).
Anne March 10th, 2009 10:58:38 AM
All my vets, good and bad, have advocated fecal tests. Now all I need is to ask them what they're testing for, methodlology, etc., etc. Thanks again for arming me with some information I can use to get answers!
That said, most have also said: Heatguard Plus monthly and a different generic wormer once or twice a year "for good measure". I'm curious where you stand on this too. (Frankly, I don't understand why fecals AREN'T part of human annuals either and I've never gotten a straight answer from the human docs on that. Makes no sense when the human adult female certainly doesn't get the free pass until age 40 before...)
PJBoosinger March 10th, 2009 11:20:43 AM
When I set up a float, I can't (usually) put the entire sample in the cup, mash and mix with sugar water/formaldehyde, strain it, drain it, and cover it, so if I'm only using a portion, the odds of something being in it are lower. So my reasoning in not doing fecals (floats) hardly ever is tied to the "we could test a pound of poop and the eggs might be in the next shovel full" problem, and with the lack of heavy exposure my dogs have anyway. And, while we might suggest fresher poop samples as better, quite often older, even frozen and thawed poop is tested, which isn't really helpful, IMO. It has most often been bacteria found in fresh smears that help with diagnosing gastro problems for my dogs, since they take HW preventative with broad spectrum wormers for 8 months and have extrememly low exposure the rest of the year.
With human docs and fecals, I also don't understand why they so seldom even suggest doing them. We had a puppy from a mill, who had a raging case of giardia, and the 4 yr. old kid got 'stomach flu' which we said might be giardia and the mother told the doc, who dismissed it until the child became dehydrated from diarrhea. Of course, the human test took a week to get an answer on, and the doc just had the parents give the kid Pedialyte in the meantime. I've had giardia (picked up without my dog's help, drinking from what I thought was a clean stream when I was a kid, many years ago), and that is why I am more in favor of smears.
KateH March 10th, 2009 12:23:36 PM
Thanks for breaking down the different methods, Dr. K - it's important for clients to be able to compare apples to apples when price shopping routine diagnostics such as fecal exams. For example, a fecal exam is about $23 plus a $9 "collection" fee at my clinic...lots of people think we're overpriced, but that buys you centrifugation in Sheather's sugar solution and a direct smear / stained prep if indicated. Much different than letting a fecalyzer full of solution sit for 10 minutes!
anna March 10th, 2009 01:38:54 PM
I know a large animal vet who dewormed his (human) kids every year or so while they were young...
But that's neither here nor there :)
Megan March 10th, 2009 02:56:00 PM
We're very anti-over medicating. VERY.
That being said, we still perform somewhat regular dewormings of all of our cats and dogs using Safeguard. It's incredibly mild, and the amount required to deworm is large - the amount required to elicit a negative reaction (or overdose of any severity) is ridiculous - to the point where a medium sized dog could pretty much drink the whole cow sized bottle (500ml) and come out just fine. (it should be noted that we use the cow variety of fenbendazole under the strict guidance of a veterinarian - and only when doing routine dewormings. When dealing with confirmed infections, we treat using more specific meds).
The reason we do this, however, is because we do rescue, we frequent heavily dog-trafficked areas, and my dogs often come to work with me, where they not only encounter and play with strange dogs, but also people and young children.
For the safety of my pets, myself, other people's pets and even other people, I do everything I can to ensure that my dogs are not carrying/transmitting anything that could cause harm to anyone else.
In addition, Safeguard works for roundworm, hookworm, whipworm and tapeworm, and can be used safely on puppies, pregnant dogs, dogs with other underlying illness, and those who are simply generally unwell.
Even with all that, we frequently perform fecal tests on our dogs (whenever they're in the vet's office, or whenever one of them happens to make a doodie right before we're on our way there anyways.. ;O) And yes, we spring for the centrifuge version. Our vet performs a smear and a centrifuge in house, and also sends a sample to an outside lab for conformation. The test is a bit costly done this way, but I'm ok with paying for quality (after all, whatever extra we spend on the testing our vet saves us with the Safeguard... lol).
Just think about finding one of those icky parasites inside YOU... or knowing your dog was responsible for transmitting one to someone else. Suddenly that fecal doesn't seem so extravagent, does it?...
Kim March 10th, 2009 04:37:29 PM
At the risk of grossing people out, someone I know works in recovering human body parts for transplant. The level of parasites in humans is more important in their book and they're finding it to be much more prevalent than once thought. Megan, I'd forgotten until you said that but I've known farmers who dosed their families at the same time as the livestock.
Do our parasites come from out pets? If a pet is positive, should the owner/family be tested? If a pet tested positive (even though you obviously can't treat the owner), would you be willing to run the owner's fecal test?
And just out of total and complete curiosity (and knowing what the human med students say they do), how many vets have run a fecal test on themselves?
PJBoosinger March 10th, 2009 10:52:09 PM
OK I admit to never having run a fecal on myself but one of my colleagues at work used to (at least I think it's in the past) run human fecals on Giardia-patient owners if he "didn't know it wasn't coming from the pet." Of course, he's an old timer. I can't imagine doing that myself considering our litigious society, but it certainly makes some sense.
Intestinal parasites by and large, however, (with the exception of Giardiasis and crypto) will not be found in your human stool. Modes of transmission may be fecal-oral but because we are not the definitive host these parasites tend to have alternative routes of infection (under the skin as for hookworms, to the eyes as for roundworms, etc.).
Dr. Patty Khuly March 11th, 2009 01:58:08 AM
As to prophylactic deworming: It's not a standard practice where I live, except via Heartgard, Interceptor or Revolution (ivermectin, milbemycin and selamectin) and sometimes Profender. Our parasites fall into so many categories it's tough to make a call on which full-dose dewormer to use. But that's also because so many of our patients are on smaller, more frequent doses of milbemycin, selamectin or ivermectin that it's easier to monthly dose for the basics and catch up annually on the other, more tough-to-kill stuff.
Dr. Patty Khuly March 11th, 2009 01:59:06 AM
Just a perspective from across the Atlantic. Funnily enough, in Ireland and the UK, we almost never do routine faecals. It is standard practice to give routine doses of broad spectrum worm doses. The UK companion animal veterinary association, the BSAVA, even has a policy statement supporting this stance: see http://www.filemanage.co.uk/pdf/worm_control_in_dogs.pdf
This may be partly because we have a more predictable worm burden in our pets, because we have less variation in climate.
Anyway, just thought I'd throw this angle into the discussion.
Pete
Pete the vet in Ireland, www.petethevet.com March 11th, 2009 08:24:34 AM
My college aged son spent a month in Peru last summer working at a medical mission clinic (he's a pre-med student). He said that the most common problem they saw was parasites, and the most common medication they dispensed was anti-thelmentics (dewormers). This is a tropical area, and intestinal parasites are endemic. He also saw a few cases of humans with blindness caused by roundworms. Impressed him enough that he asked if we'd checked our animals for parasites lately! When the group got ready to return to the U.S., the doctor in charge gave each of them a dose of dewormer!
Yes, I check my animals yearly. And I advise our clients to do the same.
Sassy March 11th, 2009 02:01:11 PM
Speaking of human parasites, our (very well known) parasitologist here at school is constantly reminding us that 1 out every 6 people has roundworms. Every time he mentions it in class we all seem to look around at our neighbors and wonder which 15 people in my class are harboring these creatures.
Anyone with a little time on their hands should watch his lecture from this year's NAVC. The video is almost an hour, but well worth it. He's a very interesting speaker and is the president elect of the CAPC (Companion Animal Parasite Council). It can be found at: http://www.cliniciansbrief.com/?p=sym_cpc_pres_1_2
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