He's eating Hill's d/d. I can imagine he may be allergic to something in it, but I keep it fresh so I doubt infection would be from the food.
We are already tapering his pred and he feels soooo much better. I need to bandaid him for a bit longer with the other meds so that it is a good time if he potentially needs endoscopy or crashes when we take them away. I want to be able to give him all of my attention. I'll do it under his vets' supervision.
Traci, you are so helpful! Thank you! I've added a few other things onto our question list LOL It always gets longer.
Mikey Man update (its been a while)...
Re: Mikey Man update (its been a while)...
JMM -- JaMi Maltese -- Dust Mops with Drive
Ok, nothing wrong with the D/D, but I'm not sure is is truly sufficient in nutrient availability with long-term use. I wonder if you could bring up with your vet maybe slowly and carefully trying a sample trial of one of the following: L/D, G/D or Z/D, the first two ideal for liver and enteritis, respectively, and the Z/D to help rule out offending allergic ingredients (especially with eosinophilic conditions).
I know you don't want to upset the cart with his diet, but in the event there is an allergic reaction or malabsorption, I hope you'll talk to your vet about the above...also maybe start focusing on infection possibilities. Where to start? I wish I knew. Perhaps as simple as his environment....does he chew on things that aren't appropriate.....if you have well water, by chance, perhaps offer distilled or bottled water....do you use stainless steel food/water dishes....rule out dairy products (like the cheese given with his meds, other possibilities like that, if you're giving eggs, cease them, etc)....treats given outside of the diet, offending ingredients?....
I know you don't want to upset the cart with his diet, but in the event there is an allergic reaction or malabsorption, I hope you'll talk to your vet about the above...also maybe start focusing on infection possibilities. Where to start? I wish I knew. Perhaps as simple as his environment....does he chew on things that aren't appropriate.....if you have well water, by chance, perhaps offer distilled or bottled water....do you use stainless steel food/water dishes....rule out dairy products (like the cheese given with his meds, other possibilities like that, if you're giving eggs, cease them, etc)....treats given outside of the diet, offending ingredients?....
..........Traci
Re: Mikey Man update (its been a while)...
He can't tolerate l/d or z/d at all. I've never tried g/d. He actually seems to prefer Hill's foods to other brands. I'm thinking if we're going to switch diet, it would be more productive to go with a nutrition consult than keep playing with kibbles.
He's not a chewer. He has a favorite stuffy, but I replace it often and it stays in the house only. My mother stays with the dogs when I am out of the house and she does smoke. I have always thought that probably contributes. I try to keep Mikey in a different part of the house but still where she can see him.
We switched from stainless steal to ceramic a few years back and wash everything in the hot dishwasher. He drinks filtered water (we don't have well water, we actually have quite good water, but I filter it anyways) or bottled if we're away from home. Again out of his own clean ceramic dish. He doesn't get any treats other than cheese. Maybe I'll try bread instead for a while unless you have some other suggestion. It is really just so he gets a little food with his pills.
He's not a chewer. He has a favorite stuffy, but I replace it often and it stays in the house only. My mother stays with the dogs when I am out of the house and she does smoke. I have always thought that probably contributes. I try to keep Mikey in a different part of the house but still where she can see him.
We switched from stainless steal to ceramic a few years back and wash everything in the hot dishwasher. He drinks filtered water (we don't have well water, we actually have quite good water, but I filter it anyways) or bottled if we're away from home. Again out of his own clean ceramic dish. He doesn't get any treats other than cheese. Maybe I'll try bread instead for a while unless you have some other suggestion. It is really just so he gets a little food with his pills.
JMM -- JaMi Maltese -- Dust Mops with Drive
Re: Mikey Man update (its been a while)...
You could try peanutbutter or tiny piece of hotdog to give the pill in. Although, both could be suspect allergies for him 
...only one way to find out....
Which leads me to another q....although I don't know if they are completely reliable, has your vet ever opted for an allergen testing panel?
...only one way to find out....Which leads me to another q....although I don't know if they are completely reliable, has your vet ever opted for an allergen testing panel?
..........Traci
Re: Mikey Man update (its been a while)...
That we've done! Nothing significant as far as inhalents go (borderlines to some weeds) and the food was a mixed basket...allergic to rabbit, carrots, and a few other things. Overall, I didn't find the results particularly valid because it said he was not allergic to chicken and the dog can't keep chicken down ever! It also said he was not allergic to something else that he cannot eat at all...barley I think? I'd have to look up in his record. It was the Spectrum labs test.
JMM -- JaMi Maltese -- Dust Mops with Drive
We're off to the internist for a recheck this week (ALT and CBC while we're there).
Goals:
1. Stop some of the medications, probably prednisone, maybe metronidazole and cisapride, too. If his ALT is normal, should we try to wean off lactulose and see if HE comes back? Discuss Azathioprine dose. I understand that could be a cause of his inappetance, but it has made such an improvement overall...
2. Diet: consider UC Davis consult vs. any other commercial diets. He feels crappy after he eats. Lower protein diet trial?
3. Lack of weight gain (he's 5.5 lbs): other underlying absorption problem or infection. PLE/PLN? Prozyme? TLI/PLI/folate? We're already checking a CBC...
4. Discuss Dr. Hall's path review.
5. Plan for next few months including annual ultrasound (radiologist to check portal velocity and for acquired shunts vs. with internist), any weaning of medications, and monitoring bloodwork.
His incision from his skin thing is healing up wonderfull. We'll keep bandaging his foot for another week probably until there is no scabs or anything at all.
I forgot to add: My thinking is if we wean some meds and he crashes, we'll endoscope if he is off meds that would greatly affect the results. I think we should chance the anesthesia since there would be no cutting or anything.
Goals:
1. Stop some of the medications, probably prednisone, maybe metronidazole and cisapride, too. If his ALT is normal, should we try to wean off lactulose and see if HE comes back? Discuss Azathioprine dose. I understand that could be a cause of his inappetance, but it has made such an improvement overall...
2. Diet: consider UC Davis consult vs. any other commercial diets. He feels crappy after he eats. Lower protein diet trial?
3. Lack of weight gain (he's 5.5 lbs): other underlying absorption problem or infection. PLE/PLN? Prozyme? TLI/PLI/folate? We're already checking a CBC...
4. Discuss Dr. Hall's path review.
5. Plan for next few months including annual ultrasound (radiologist to check portal velocity and for acquired shunts vs. with internist), any weaning of medications, and monitoring bloodwork.
His incision from his skin thing is healing up wonderfull. We'll keep bandaging his foot for another week probably until there is no scabs or anything at all.
I forgot to add: My thinking is if we wean some meds and he crashes, we'll endoscope if he is off meds that would greatly affect the results. I think we should chance the anesthesia since there would be no cutting or anything.
JMM -- JaMi Maltese -- Dust Mops with Drive
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TheSkeptic
- Posts: 1703
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Re: Mikey Man update (its been a while)...
Nothing valuable to add, just best wishes for a rapid diagnosis and recovery. ....
Re: Mikey Man update (its been a while)...
Thanks! I'd love to see him back to normal.
JMM -- JaMi Maltese -- Dust Mops with Drive
Re: Mikey Man update (its been a while)...
I don't have anything to add either, but I applaud you for doing all you are doing for Mikey. going the extra mile is an inspiration for others. Mikey Man, you are loved very much!
1. I don't think lactulose would be one of the meds I'd consider omitting, at least not at this point.
2. Low-protein diets are usually the long-term recommended diet for liver disease anyway.
3. I would again, discuss the possibility of malabsorption. PLE/PLN would be rule outs to consider, but have any of Mikey's labs indicated anything remote to warrant testing further? (Again, bacterial infection somewhere would be a primary rule out, and you could probably save costs with an endocrine profile as opposed to specific TLI etc, unless baseline bloodwork indicates the need for testing further )
4. I thought this had been discussed already?
5. Agree.
Curious, did the pathologist recommend endoscopy at any point before any of the meds were lowered or ceased? (I wouldn't opt for an endoscope unless labs and ultrasound found anything unusual or significant since last labs, but am curious if the pathologist had any comments on endoscopy)
2. Low-protein diets are usually the long-term recommended diet for liver disease anyway.
3. I would again, discuss the possibility of malabsorption. PLE/PLN would be rule outs to consider, but have any of Mikey's labs indicated anything remote to warrant testing further? (Again, bacterial infection somewhere would be a primary rule out, and you could probably save costs with an endocrine profile as opposed to specific TLI etc, unless baseline bloodwork indicates the need for testing further )
4. I thought this had been discussed already?
5. Agree.
Curious, did the pathologist recommend endoscopy at any point before any of the meds were lowered or ceased? (I wouldn't opt for an endoscope unless labs and ultrasound found anything unusual or significant since last labs, but am curious if the pathologist had any comments on endoscopy)
..........Traci