Well, This is long so if you get bored bookmark it and come back LOL
The symptoms:
It was a very long day; appointment with the internal med specialist lasted 2 hours and was very satisfying. They went over all of Charlie’s records labs x-rays surgical noted etc. spent an enormous amount of time asking me very specific questions on his diet, activity, routines etc.
This Dr. feels that while the uric stones
clearly indicate an issue with the liver, IF Charlie has a shunt it is either a very small one OR it is MVD, her reasons being are that Charlie is not as she said “a typical example” of a furbaby that has a large shunt. She says that if he did have a large shunt there would be no way that he could have tolerated the “chicken only” diet he has been on for 2 years. Charlie can go months with no issues at all and then have a day or two that he feels puny. He has no neurological symptoms and his labs do not fit that of a patient with a large shunt. This Dr. pretty much mirrored what Dir. Tobias tech had discussed with me and felt about Charlie based on the records I sent to her.
The Ultrasound:
The facility that I took Charlie to had done an ultrasound in 2010 when he was very sick with the pancreatitis (that is when that was diagnosed) they confirmed that at that time, his liver was of normal size labs were not out of range and there was no indication of a shunt. We are doing another ultrasound but it will be done tomorrow, (I know I know) BUT the reason being this Dr. as did the UT tech said it is very very important WHO does this test. They both pressed that the person doing it must have extensive experience and have a high record of
successful diagnosis of shunt by ultrasound... There was a Dr. there that could have done the ultrasound today but the specialist did not feel this was the right person to do Charlie’s test, so I will take him early tomorrow and he will stay the day and I will meet with the Dr. tomorrow when I pick him up to discuss the results. (See there’s a sequel
)
The Diet:
As we all know Charlie has lived a king’s life of boiled chicken that must soon come to an end. While I was instructed by the regular vet to mix with cheese the specialist says that the cheese while ok for shunt issues is not ok for pancreatitis SO I explained how Charlie don’t eat “dog food” and they suggested Royal Canine Hepatic formula, they said that it is very tasty to dogs and Charlie might like it but I’m having trouble finding just a small bag of it. The large bag is like $60 and if he doesn’t like it man o man. I’m going to try several Petsmarts and if I can’t find it my regular vet says they can order it for me. The specialist also gave me a form to fill out for a nutritionist at U of MO Col, they can create a homemade diet for Charlie if he won’t eat the actual dog food. He will now need to eat 3 smaller meals per day as opposed to the 2 larger ones so that his liver can process better. (UT also suggested a nutritionist) No more bone marrow treats, no more milos kitchen treats.
The Meds:
Changed from Pepcid to Prilosec 5mg daily- to keep his belly settled.
Metronidazole 7.5mg/kg 2 times daily-antibiotic to help intestinal flora ( Dr went over side effects but states she only uses this in very low doses and does not feel there will be an issue but has instructed me on what to look for.
Lactulose syrup 1ml 2 times daily- used to reduce the amount of ammonia in liver patients
The meds were described to me to be a “maintenance formula” to help prevent gi issues and prevent the uric stones from returning. They said there is no way to know when the stones came to be and no way to know if he would ever have them again but an ounce of prevention……. I did ask about the SAM-e that the regular vet has prescribed but the specialist doesn’t feel it would be a benefit to Charlie.
Surgery:
This specialist doesn’t feel that surgery would be something she would do with Charlie, she bases this on his history and symptoms, the ultrasound will be the determining factor. She says that if a shunt cannot be seen she doesn’t feel that exploratory surgery would be something she would recommend since Charlie’s issues are not of a severe status. Unless something unexpected is found tomorrow treatment is going to be new diet and meds along with routine labs work to keep an eye on his levels since they now have a baseline to follow with him.
That is all I have I think I covered everything that we went over. I have to say that I was impressed that this group follows Dr Tobias, they knew all about her and her work and I know it to be true as they covered things that I was instructed to ask about from the UT group, before I even had a chance to ask. If you’re not too tired from reading and have questions please ask I’ll be here, and then we will have ultrasound results tomorrow.