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Old 12-04-2008, 06:29 AM   #96
Ellie May
And Rylee Finnegan
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Location: Metro Detroit, MI
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Originally Posted by bellasmomok View Post
I just wanted to update on Bella's visit with her new vet today. She is an holistic vet, and Bella and I (and Patrick, Bella's daddy) really like her! Today was just a consult just to talk to her and catch her up thus far....poor Dr. Coleman didn't know the puzzle she was going to have to dig through and put all the pieces together when she walked through the door! She looked Bella over, looked all of the test results over, had her "chart" requested at both of the vets she's been to and looked that over, and then asked us lots of questions about the what's and the why's and about any symptoms.

I also go Dr. Wakshlag's (nutritionist) "diet" in my email just before we went to that appointment, so she looked that over as well. There were a few things she disagreed with in the diet (and I really disagree as well), the main one being the kind of vitamins he suggested and the lack of vegetables or whole foods in getting those nutrients, which is really a matter of preference--not that the vitamins are bad by any means. So she adjusted that. She also doesn't want me to start the Lactulose or Vetri-DMG yet....she wants to wait a little while, check her labs again, and then we'll see. Since she isn't exhibiting any symptoms (and she feels the UTI WAS most likely from the spay....she said that on a dog so tiny it would have been very easy for her bladder to get bruised since it lays next to her uterus, and that very likely cause the infection) she feels the Lactulose is over-doing it at this point. She also wants me to hold of on the Azodyl until we re-do her labwork, which will be in several weeks at the earliest I think. (Though she wants the urinalysis repeated ASAP so that we can be sure the antibiotic did it's job.....since Bella still has hydronephrosis, though, I doubt it's gone yet--I ultrasounded her last night, and though it was a tiny bit better on one side, it is still there!) So here is the combination of what the nutritionist and the vet think Bella needs daily:
brown rice
cooked chicken
Friendship low sodium cottage cheese
soybean/vegetable oil
fish oil
tiny pinch of iodized salt (for the iodine)
milk thistle
Vitamin E
Choline**
Cyrofood Powder**
Canine Hepatic Support**
(** these are all made by Standard Process Inc. and are made from whole foods--organic "materials" that the company grows on its own farm so they are sure the ingredients are the best and safest. If you are able to look them up, some organs are listed in the ingredients, however Dr. Coleman assures me these are not the same as including organ meat in her diet, which she doesn't agree with, and that they will not result in her body producing ammonia)

Also, Dr. Wakshlag pointed out that I can substitute the chicken (it's a very small amount of chicken anyway) for Tofu if she starts exhibiting ANY encephalopathic signs. He also said that he would not use the Lactulose until/if she ever exhibits encephalopathic signs (which is what Dr. Coleman said too).

She also said that giving her bits of just about anything I normally would, would be just fine at this point and not to completely go over the top about limiting her. (She meant that I can give her teeny bits but obviously not tons of extras!) She said that Bella is still growing and that the picture the labwork paints isn't very clear at this point anyway, since any number of things could have cause it to be "off".

Also, I weighed before going in today on their digital pet scales which were zeroed (and I took her off and put her back on a couple of times just to be sure, which is what I always do ). Today she weighed 3.7 lbs., and last Monday (11/24) she weighed 4.0 lbs (on a different vet's scales, though they were the same kind and were both zeroed each time I took her off). That means she has LOST almost 10% of her body weight in 1 week, 2 days!!!! That is certainly not good! Dr. Coleman felt it was due to the completely vegetarian diet (and maybe not enough of it anyway). Hopefully she gains it back and doesn't lose anymore....she's too little to be losing weight like that!

Well, that's all I can think of/remember at this point.....hope that updated a few of you. I'll be emailing our nutritionist about the changes next and seeing what I need to do to make up large batches and freeze rather than make food each day (I told him that in the beginning, but I said a lot of things...I'm sure it got lost in everything else! ), and then we'll start this new home-cooked diet as soon as I can get the food for it (maybe tomorrow!)

*sigh of relief!! I didn't even realize how stressed out I've been from having to be so proactive and make all these decisions myself, rather than have a good vet who could help guide me. Dr. Coleman said that never should have happened...she wasn't happy about that, meaning the other vet. She said to put this burden on her shoulders and let her carry some of the weight, and to give her some time to sort through everything....then she'll have an even clearer picture and will be able to help me even more, which I'm REALLY glad about!!
It sounds like you had an interesting night.
I agree that with no neurologic symptoms, it would be okay not to use lactulose. If the BUN is coming down and the UTI was from the spay, the Azodyl may not be needed but I really would watch those kidney numbers close. At the same time, if this was Ellie, I would start Denosyl or Vetri DMG. Because the ALT has been that high twice and the bile acids are way too high, there may be liver cell death going on and I'd prefer to try and halt that just in case... When Ellie's post came back at 47, her vet consulted an internist and Ellie was given Denosyl for a month. Her BAT did go down (with low protein and a couple other things too). Then I stopped the Denosyl and it the BA went up again. It was my choice whether I wanted to start Denosyl again after her ultrasound was normal and her biopsy was close to normal. The internist said I could if I wanted. The vet said I could if I wanted. I was having a hard time deciding, so the vet said why not do it...she was doing pretty well on it. It is one of those things that can't hurt and I don't eally see a reason not to give it personally.

She may be just fine on chicken but I guess, reading what Yorkieluv is saying, labs can go up from it, so if I had to do Ellie's diet over again, I'd probably go fish at the most and probably egg white or possibly tofu. I don't know if chicken does raise the BA but there is some connection between high BA and pancreatitis. Ellie got pancreatitis about a week after her BA were 106, so anything that can make the BA go up is questionable. Hard decision because there isn't much research for any of this. At least you can change hers to tofu if there is a problem later.

Where are the veggies in Bella's diet?
Did I miss them?
Does the recipe meet AAFCO guidelines?
This is what seems to happen with nutritionists...they don't seem to be too concerned about ingredients, only final analysis. It would be very hard though (probably impossible) for a dog to eat enough vitamins and minerals from food along to meet their needs.

A vegetarian diet, as long as it is approved for the life stage of your dog, wouldn't make a dog lose weight in itself. Dogs can be vegetarians... They can do okay on a tofu diet, but of course that isn't optimal for most dogs. It has to do with the calories she was getting and evidently she wasn't getting enough. Since she is too young and I'm guessing the NB is low in fat, she likely does need something else...

I'm sorry you have felt like this has all been on your shoulders.
Most vets know so little about LS and MVD that I'm sure a lot of owners feel that way. You should have a vet that wiill take it all on for you if that is what you want.
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