Mikey is home from the vet

[Traci]

Ask your vet about adding metronidazole, this is a common med in chronic IBD patients, it might help. Imuran is often used in combination with prednisone, so perhaps the dosing and alternate schedules needed to be adjusted, but that should have been discussed amoung the vets.

The CBC is the main thing to be concerned with when dealing with immunosupporession, but some of the chemical enzymes can also be useful. Besides the ALT, were any other liver enzymes out of range...and were pancreatic enzymes unusual? (might want to rule out a pancreatic attack)

I don't know about all the dietary measures you've tried, but I would suggest taking a more conventional approach to his diet rather than home-cooked, or the other hodge-podge things you've tried. IBD prescription diets are available, as well as fiber supplementation...other meds available for gastric upset, vomiting, diarrhea, dehydration, etc. I'm assuming regular fecals have been done to rule out various forms of bacteria?

I don't know who you would talk to specifically, I would just assume your vet would be in the position to get specialist consults with any number of the available veterinary universities in the gastroenterology specialites/hepatology specialties. If she is a member of VIN, she can consult with a specialist on-line. If she's an AVMA member, she can also utilize on-line consults or get in touch with a specialist that way.

One step you might want to approach in discussion with your vet is an ultrasound, rather than exploratory or laparotomy/biopsy. An ultrasound may help rule out lymphoma or mass.

[JMM]

Traci, Mikey is ultrasounded yearly to monitor his kidneys, bladder, and portal pressures. He had endoscopy when he was younger and then exploratory and full thickness biopsies (stomach, small intestines, and liver) exactly a year ago.

He is on metronidazole, prilosec, carafate, denosyl, baytril, and cisapride. He cannot tolerate metoclopramide. Centrine doesn't touch him.

The remainder of his chemistry was normal, including amylase, lipase, alk phos, and his kidney values.

He is currently on Hill's d/d egg and rice. He prefers kibble. We have tried many, many commercial diets, careful to wean him over and give them a few months. It has been 3 1/2 years. I also tried home cooked with a variety of protein sources. He doesn't like canned food and the only home cooked he liked (tofu Maltese diet by Dr. Center) he could not keep down.

My vet has spoken to the University of TN, Cornell and Auburn. I don't know other than Iowa State who his internist spoke to. I'll have somebody post on vin. Good idea.

[JMM]

Okay, I have a vet posting on vin for me and I just heard back from a vet in the UK who would like to see M's slides. I'll call on Monday and see if we can get them from Cornell.

[Traci]

Was his last ultrasound a year ago then? If so, it might be a good idea to proceed at this time,...since thus far most treatment has failed, if there *is* a mass and if detected, this could shed new light on treatment. The ultrasound also would be less invasive, and it doesn't require anesthesia.

You didn't mention, but again, were fecal exams done recently, and negative for bacterials?

I wish I could help further on the dietary issues. The only thing I could recommend is getting your vet to talk to a board-certified canine nutritionist and together, hopefully coming up with something that is effective for both the IBD yet focused on the liver as well. A certified nutritionist might have some ideas on suspect ingredients and be able to form a diet for Mikey's specific needs. At this point in time, I would recommend a bland diet and continue to supplement (with your vet's specific direction) with denosyl...maybe try a different rice-based diet or something with vegetable-based protein rather than animal-protein. If he's doing ok on the D/D, don't change it, but if he is not tolerating it, talk to your vet about a nutritionist's recommendation.

[JMM]

I've been thinking about a UC Davis nutrition consult. Have you had any experience working with them? He is eating okay and likes the d/d dry, he just doesn't have much appetite right now. He has been vomiting liquid and mostly keeping the d/d down since we switched back to it.

His last ultrasound was in June, so not quite 6 months ago. It was actually a few months earlier than originally scheduled for his annual because he was doing worse and we wanted to make sure everything was okay.

We've done a fecal trio on him within the last few months. We usually check every few months. Once he has clostridial overgrowth...that was a long while ago and he hasn't since. Do any labs you know of test for things like E. coli? He's been on antibiotics and tylan trials, so I don't know if it is pointless to test or if it would still show up. He has also been empirically dewormed with Panacur three times, last time was just a few months ago (end of July).

I am going to try again and see if I can't get somebody to post to the CGS listserv for me.

By the way, Traci, thank you!!! I want you to know how much I appreciate your suggestions. I don't think it is ideal to have clients contacting specialist about cases, but if that's what it takes, that is what we'll do.

[JMM]

Cornell won't give us the slides they read, but will cut more. We're getting 2 sets of each (Stomach and intestines). One will go to the UK and we'll have the other in case somebody else would like to look at them.

The one suggestion off VIN was Leukeran.