My Teddy Bear had shunt surgery about a year ago and has some MVD. He is on moderate protein diet and no lactulose. I honestly thought they only used that for shunts, but I could be very wrong. He does have some tummy issues from time to time and we manage that with Pepcid which seems to help him.
Has Elliott been to an internal med specialist? If so, I would have the vet fax results to them and consult with them. All of my pups who have been to a specialist follow up at my vet who consults with the specialist.
Here is a link that is very informative. Perhaps it will help you.
https://vetmed.tennessee.edu/vmc/Dow...NAL-201304.pdf