Mikey Man update (its been a while)...

[JMM]

Mikey's ALT has finally fallen back to normal at 58 this week. Everything else, including his CBC looks good. So, the good news is his hepatic injury was probably related to his IBD, not any of his drugs or primary liver disease.

He is on:
Azathioprine 5 mg EOD
Metronidazole 20 mg BID
Prilosec 2 mg SID
Lactulose 0.5 ml BID
Cisapride 2.5 mg BID
Denosyl 90 mg SID
Carafate 250 mg TID
Prednisolone 1.25 mg SID

Since starting the lactulose, he is doing much, much better as far as responding like my normal Mikey Man. He is not head pressing any more either.
His internist added Pred back in at his recheck this past week to try and increase his appetite. His is just over 5 lbs now...he was just over 6 1/2 before. He eats maybe 1/2 of what he should a day, sometimes less. About once a week, he'll eat really well.
I also think he is responding to the azathioprine as his vomiting has drastically reduced in frequency to one or twice a week (from once or twice a day). He still has diarrhea which seems to cycle from just soft stool back to jelly. That isn't a big deal at all as he has no blood in his stool and it is controllable.
He mostly sleeps all day...I'm getting use to his new "normal" activity level.

I hope everyone has been enjoying the holidays! Mikey's vets didn't think he'd be around this long after he got so sick, but he's still kicking and seems comfortable and happy. His improvement has really made my holiday!

[Traci]

Just a question...what seems different for the one day a week where he seems to eat better?

[JMM]

Hmmm...

I got out his book (daily log). The only medication that alternates days (Azathioprine) does not coordinate with eating. He ate well an equal number of on and off days in the last month. Day of the week (my routine) does not match either.

He did start eating twice a day less frequently after he got sick mid November, but that isn't really surprising as he had a hepatic insult. I have his weight history in the computer at work so will write that down tomorrow.

He did get a steroid belly and gain weight when he was on dex and then pred last spring.

[Traci]

Is he on a scheduled feeding, or do you free-feed him?

[JMM]

Scheduled feeding. I normally offer 2 meals a day. If he skips the morning meal I will offer him lunch. I leave the food down for about 30 minutes (sometimes he takes a while or will nibble some) and then pull it up.

His internist lowered his pred dosage since he was so lethargic. We had it compounded so we can be more precise.

[Traci]

Well, just a thought, but since his metabolism might be slow, maybe offer more of a free-feeding schedule....could gradually introduce several smaller meals throughout the day.

[JMM]

Can't hurt to try! Thanks!

[JMM]

I've been free feeding him (but measuring how much I put down so I know how much he's eating). He is eating more consistently and has gained 0.5# over the last 2 weeks which is good. He is still too skinny and could use almost another pound (about 6 1/2 would be ideal for him...maybe a touch less). However, the pred is hitting him hard. I'm sure with his recent liver insult and all he is more sensitive this time around. I am pleased he has gained a little weight, but would rather have him skinny, happy, and comfortable instead of nauseous and too lethargic to get up in the morning. His internist dropped him back further today to 0.25 mg every other day. If he tolerates that, we'll leave it. If not we'll just stop the pred and let him be. We also got the go to try another herbal remedy from the holistic vet (Mikey also gets acupuncture).

[Traci]

Just a q, but why do you think it's the pred?

I had a feeling smaller, more frequent meals would help some, glad to hear he is gaining, albeit slowly.

[JMM]

That is the single thing we changed and, in the past, when pred was tried, he became very lethargic. This resolved when the dose was reduced and he was weaned off. I'm assuming the nausea is related, but, I do realize that could be from eating more.