I see this on Chewy.com, Zymox Veterinary Strength Enzymatic ... Rinse

Duoxo is one of the main shampoos sold by Vet Derms - but I always get mine wayyyy cheaper on Amazon. I've tried wipes before, but they've never done anything appreciable toward allergy response for me. Allergens are microscopic - so a wipe can only do so much. They *can* help a bit with getting some allergens/irritants OFF of the paw area - but keep in mind their main allergy exposure is breathing - so it may not do a whole lot.

Allergies are just a pain! Sooooo common in yorkies.

Allergy info: https://www.yorkietalk.com/forums/di...tart-here.html

Sorry for the lack of updates. Pax's biopsy result came back on Friday.

Here is the report:

Lesions in the specimen from the small intestine are compatible with the clinical syndrome of inflammatory bowel
disease. Lacteal dilation is slight and may be secondary to inflammation. Definitive interpretation of true idiopathic IBD
requires exclusion of recognized parasitic, allergic, and/or infectious causes of intestinal inflammation.

The internal medicine vet would like to treat for IBD and start him on prednisone (steriod) and cyclosporine (immunosuppressive) drugs.

However, Pax has not had diarrhea or vomiting in over 10 days. He is still taking metronidazole, but was having diarrhea issues even while taking it several weeks ago.

I declined to start him on the medications due the fact he's eating normally and not having vomiting or diarrhea anymore.

I honestly do not think this is IBD and do not want to start him on any steriods or immunosuppressive drugs right now. These drugs are quite serious in my opinion.

Pilot has been doing ok, no diarrhea or vomitting since stopping the antibiotics 2 weeks ago. However, he will no longer eat his normal food on his own. We did feed him bland food for a few weeks and he would eat that right away. Now he just stares at his normal food and will eat some if I feed him by hand.

I am so stressed out over this whole ordeal, it's starting to affect my health to a small degree.

Hi PILOTthePuppy,

It's hard not to be stressed--you guys have been through so much. I hope you are giving yourself credit for the all the good you have done. You are my hero!

Read the biopsy report several times. That last sentence that stuck with me, "Definitive interpretation of true idiopathic IBD requires exclusion of recognized parasitic, allergic, and/or infectious causes of intestinal inflammation."

Did you interpret as I did -- biopsy was not definitive, thus a need to exclude "parasitic, allergic, and/or infectious causes."

Is your "bland diet" still the chicken and mashed? Have you tried to re-introduce the salmon?

KatysMom, that sentence stuck with me as well.

I'm not sure why the internal medicine vet wants to jump straight to steroids if he's been asymptomatic for the 10 days.

The boys were eating chicken and mash for several weeks. We then added peas and carrots, then green beans and now today I cooked their normal diet.

Their normal food consists of chicken, white rice, and pureed veggies (boiled kale, peas, carrots, zucchni, and lima beans).

One thing I noticed, Pilot didn't like the food as much when I added his supplements to then bland food (calcium, etc.).

We do add the calcium to his normal diet as it's necessary to balance out the phosphorus from the meat.

I'm really nervous that he may be sick, even though he doesn't have diarrhea or vomiting.

He usually ate his normal food with no issues in the past.

Perhaps, the chicken and mash diet made him a little picky?

HI PILOTthePuppy,

Thank you for responding.

My late little one could be picky about a change in diet.

Still curious if you have tried to reintroduce the salmon.

Pilot had the calcium oxolate stone surgery. What were the symptoms of that condition?

We did not introduce any fish yet, wanted to make sure they were stable with no more diarrhea.

When Pilot had a calcium oxolate stone, he was peeing drops of blood very frequently.

The vet said he had to be on prescription food for the rest of his life due to the high potential reoccurence rate.

That's when I did research and found the home cooked diet we've been feeding since late 2013.

Thank you for the support and and your responses as well.

Any chance Pilot isn't just lovin' the hand feeding?

I guess that’s always possible, but he’s never been like that.

Pax would not eat the normal cooked diet this morning. However, he did eat it twice for lunch and dinner yesterday.

I offered him the chicken, mash potatoes, peas, and carrots. He ate it immediately with no hesitation.

I wonder if the boys don’t like the original food anymore? Almost like if you get sick from something you don’t want it eat anymore. The only differences are kale and lima beans.

Both of them had normal bowel movements this morning.

Does it sound like they are being picky versus being sick like they were before?? I hope it’s not a relapse.

I didn’t get much sleep because I’m so nervous they won’t eat or have issues like diarrhea.

Hi PILOTthePuppy,

Happy Memorial Day.

Thank you for the update. Hoping you don't have to work today, and pray you can take a nice long nap.

*Believe you feed them three times a day, correct? Ordinarily, as she had been drinking water, and was otherwise asymptomatic, I would not be concerned if my little one passed over a meal or two. Especially if I had changed her food, if my otherwise healthy little one didn't eat (or eat well) over a two day period, I would contact the vet. Your mileage may vary.

*Is the paw licking still in high gear?

*I keep bringing up the salmon because (a) it is something you have fed in the past, and (b) in part because Wylie's Mom posted earlier that "chicken IS the most common protein allergy in dogs who do have food allergies."

*When did each of them have their last (second) dose of Drontal Plus? Did the vet provide a date when their next dose would be due? I'm assuming it is sometime in early June.

While it may not be the case, I have formed a picture of your two little ones, posed at their doggy dishes, looking up at you with that, "What you pullin' over on me" look in their eyes.

Sending you hugs!

Happy Memorial Day KatysMom! Thanks for the replies and support! I am indeed off today and am very fortunate to have a successful career in IT.

Yes, we do feed them several times a day. They haven't skipped any meals lately **knock on wood**, but some have been a struggle.

I went to grocery store this afternoon and picked up chicken and frozen veggies. I boiled the veggies and made lunch consisting of fat free chicken breast, baked mashed potatos, pureed peas, carrots, green beans, and summer squash. I also added the probiotics, calcium, and some vitamin b complex to their food.

Pax was hesitant and did not want to eat a first but did eventually eat after a few minutes. Pilot also ate the food his own.

As far as the fish is concerned, I plan on adding it back eventually but we only fed small amounts. We do not feed it as the main protein source. White fish can be high in mercury and salmon is a fatty fish, even though it's mainly.

The main reason we feed chicken breast is due to the very low fat content. I do not know what other proteins we can feed them. Pax is also allergic to beef, he use to throw up immediately when he was younger after eating it.

I do not want to aggravate Pax's pancreas/digestive system with the fatty fish until I'm confident he's back to "normal".

Pax is still licking his paws, but he's been doing that for a long time. I think it's part allergies and part soothing/ocd for him.

We gave Pax and Pilot 3 doses of Drontal Plus in the last 6 weeks, 2 weeks apart. I don't have plans to give them anymore doses at the moment, but they are due for their heartworm medication at the beginning of June which has the ingredients to kill hookworms in addition to the heartworm.

I'm battling constant anxiety over whether or not they will even eat their next meal. I do not know if I'm fighting pickiness at the moment or the possible disease/illnesses.

As I stated before, Pax and Pilot's stools have been normal for the last 2 weeks.

Thank you again for the support and caring feedback.

Hi PILOTthePuppy,

So glad to hear both of them ate the meals you work so hard to prepare for them.

You all have certainly rounded _a_ corner. Once you've had a real scare (and you have), it takes a while to figure out what normal or a new normal looks and feels like.

If they stay asymptomatic for a while longer, will you take Pax back to one of the vets for some kind of update?

You are doing an impressive job with their nutrition. I hope _you_ can get some relief from the anxiety over ever meal and possibly every BM.

Yes, I want to follow-up with the vets. I really still think there is something infectious and not IBD since both boys had the same type of liquid diarrhea at one point.

I really want more answers but the vets are quick to medicate the symptoms.

Also, the boys also ate their dinner tonight, they ate the food I cooked earlier this afternoon.

Hi,

Thank you for responding. There are many positive signs.

I'm not a vet, but would having a vet tech take their temperatures rule out a persistent infection in the short term?

Hi KatysMom, unfortunately Pax has not had a temperature every time we've taken him to the vet.

I went back and looked at previous bloodwork for the boys and found that they both have elevated white blood cell count, which could possibly indicate an infection of some sort they have been fighting.

I'm taking this information to the vet tomorrow.

Pax

WBC Reference Range: 5.7 - 16.3 K/uL

2/1/17: 8.5
2/17/18: 10.2
4/25/18: 11.1 (diarrhea and vomiting)

Pax's Absolute Eosinophils is markedly increased

Absolute Eosinophils Reference Range: 100 - 1250 /uL

2/1/17: 366
2/17/18: 734
4/25/18: 1587 (diarrhea and vomiting)

I found this PDF:

https://www.idexx.eu/globalassets/do...ve-summary.pdf

Description: Eosinophils are white blood cells that are specialized to combat parasites and other infectious diseases. They are
also involved in allergic responses.

Increased Eosinophils

Common Causes
Parasitic infections: ectoparasites and endoparasites

Allergic/Hypersensitivity responses
Asthma
Eosinophilic granuloma complex
Allergic dermatitis/atopy
Food allergies
Eosinophilic gastroenteritis
Allergic rhinitis/sinusitis

Pilot

WBC Reference Range: 5.7 - 16.3 K/uL

2/1/17: 11.6
2/16/17: 9.2 (gallbladder and liver infection)
2/17/18: 12.9
2/27/18: 16.5 (pancreatitis)
4/25/18: 13.1 (diarrhea)

Pilot's Eosinophils seems normal or on the low end of the spectrum.

However, Pilot's monocytes and neutrophils seem quite high.

Absolute Eosinophils Reference Range: 100 - 1250 /uL

2/1/17: 116
2/16/17: 60 (gallbladder and liver infection)
2/17/18: 206
2/27/18: 130 (pancreatitis)
4/27/18: 197 (diarrhea)

Absolute Monocytes Reference Range: 150 - 1350 /uL

2/1/17: 429
2/16/17: 148 (gallbladder and liver infection)
2/17/18: 877
2/27/18: 1420 (pancreatitis)
4/27/18: 1376 (diarrhea)

Absolute Neutrophils Reference Range: 3000 - 11500 /uL

2/1/17: 6322
2/16/17: 5030 (gallbladder and liver infection)
2/17/18: 7121
2/27/18: 12360 (pancreatitis)
4/27/18: 9222 (diarrhea)

Again, I found these PDFs:

https://www.idexx.eu/globalassets/do...ve-summary.pdf

Description: Monocytes are white blood cells that are responsible for phagocytosis, antigen presentation, and production of
cytokines.

Increased Monocytes
Common Causes
Inflammatory response (local or systemic; chronic or acute)
Infections: bacterial, rickettsial, fungal, protozoal
Immune-mediated disease
Tissue necrosis
Neoplasia
Corticosteroid-induced: endogenous or exogenous glucocorticoids

https://www.idexx.eu/globalassets/do...ve-summary.pdf

Description: Segmented neutrophils are the most abundant type of white blood cell (WBC). They respond quickly to
inflammation and stress, are capable of phagocytosis, and have antimicrobial properties.

Common Causes
Decreased bone marrow production
Infection
Parvovirus in dogs and cats
Feline leukemia virus
Toxoplasmosis
Rickettsial disease
Neoplasia
Increased tissue demand
Sepsis
Viral infections
Sequestration: collection of cells within an organ system or body compartment: abscess, pyometra, peritonitis,
pneumonia, necrotic tumor, etc…
Toxicity
Estrogens
Chemotherapy
Chloramphenicol, sulfas
Idiosyncratic drug reactions, toxicities


Keep in mind Pax and Pilot have been on the home cooked diet throughout this period. I'm highly suspicious they both get IBD and/or a bad food allergy both at the same exact time.

I'm not experienced enough to interpret the results, but suspect the elevated white blood count means something. I'm impressed that you caught it.

So hoping you are able to rule out some on-going allergy.

Look forward to learning from you about comments from the vet. --KatysMom

Thanks KatysMom!

The boys are struggling in the mornings to eat. They eventually do eat but we have to feed them by hand. It's very stressful for us right now.

They seem to eat ok in the afternoons and evenings.

They also won't touch the original food we use to feed earlier this year. I'm assuming because they got sick off it? Just like we do.

What happens if .... You put down the food you want them to eat now (I'm assuming this is a tweaked version of the original food). Pick up what ever hasn't been eaten after 10 minutes. Put the empty bowls back down. Feed them the afternoon meal as you normally would.

In the last two weeks, they usually eat after a bit of time. I've not yet forced them to skip a meal, but I'm positive they would eat it.

They ate their lunch with no problems this afternoon.

We went to the vet today, and I laid everything out as in my previous post. We are running bloodwork on Pax to see where his numbers are now and we're going finish out the little bit of metronidazole that's left.

We've given Pax three doses of Drontal Plus and she said for parasites usually the symptoms are gone within 14 days.

If Pax's diarrhea returns we have Tylison powder on hand now which is a better long term antibiotic for diarrhea. The next step would be to start the prednisdone to reduce inflammation and tackle possible hypersensitivity or allergies.

The vet wants me to consult with a nutritionist and do a food trial. We currently home cook for another health concern, calcium oxolate stones. The diet has worked well for 4 years, so I'm looking for someone who will work with me and not try to change everything we've done to prevent the stones.

You already prepare a nutrient rich diet, but maybe the nutritionalist will have good ideas.

Wylie's Mom worked with a pet nutritionist after her Marcel had been treated for giardia. See her post here. (Related thread is here.) She feeds Marcel raw now.

They seem to be doing so much better. I'm hoping you can manage this without the steroids, etc.

When will the bloodwork results come back?

Sending prayers.

Hi there! wanted to provide another update.

I spoke to both our vet and the internal medicine vet and they agreed to hold off on the steroids since his diarrhea has not returned yet.

My normal vet wants me to stop the metronidazole and use Tylan going forward due to possible neurological side effects. However if the diarrhea comes back we're going to proabably have to try and control the inflammation using steriods.

Pax's blood work came back and has good and bad news.

The good news it that his WBC and Eosinophil values came down:

WBC is 8.9, down from 11.1
Eosinophil is 436, down from 1587.

The bad news is his ALT/AST have risen to 166/85, up from 33/44. I suspect this maybe from long term use of metronidazole.

The most worrying value is that his Creatine Kinase is now 1121, up from 407. This indicates some kind of muscle damage.

https://www.idexx.eu/globalassets/do...ve-summary.pdf

Perhaps it was from when the vet was holding him to examine his paws and heart? They had hold him tightly because he was wiggling so much.

He's not exhibiting any pain, panting, or signs of discomfort.]

Seems like this will never end!

Thanks for your support.

I'm unclear why they want to transition him from Tylan, as opposed to just stopping the metronidazole. (And starting up the Tylan only if the diarrhea returns.)

Ouch. Is this something they will re-test after he is fully transitioned to Tylan or off the antibiotics all together?

Very informative link. Thank you. I also read 2018 article "Dog and Cat Creatinine Levels 101," by Dr. Mike Paul, DVM on PetHealthNetwork. The article mentions that a high reading could mean various things, but does say "Veterinarians measure creatinine levels because it helps to identify kidney problems." (Also mentions different test "SDMA" that does a better job with kidney issues.)

It does sound as though Pax is doing much better--including that he was wiggling around! Did the vet comment to you about the high reading? I would surely ask...you guys have come too far to be caught off guard.

Please give all your little ones a hug from me (when they aren't wiggling too much)!

Hi again,

Possible the elevated creatine kinase would be worthy of a new YT thread to learn if others with more knowledge can chime in.

Hi KatysMom, sorry to confuse you! We are stopping the metronidazole and have Tylan powder should the diarrhea return.

I think based on his WBC values he's not fighting an infection anymore, so I'm hoping his bodys natural defenses can take over at this point.

The vet seemed more concerned about his liver values as that could indicate the infection spread. I told her I suspect it's the medicine making his liver work overtime.

I'll be giving him milk thistle in food to help detox and restore his liver, starting tonight.

Tonight will also be the first time we stop the antibiotics in over a month, I'm a little anxious over it!

Thank you for the additional information. That makes sense.

You wrote, "...milk thistle." You are the BEST BEST BEST pet parent.

That is such a good turn! I can understand your anxiousness. It's been one heck of a recovery period. The signs point to good things.

Let's hope this one is in the rear view mirror! Here's to Pax, Pilot, you and yours ALL getting a good nights sleep.

Thank you, I'll keep you all updated of the progress.

I sincerely appreciate you taking the time out of your day to support and provide feedback along the way. It really does help when there are other people who care.

I was on vacation and just trying to catch up here - can't believe allll that you are still going through :(. Was hoping to hear major improvements...but every little positive step is a BIG one :love:.

Hi Wylie's Mom! Hope you had an excellent time on your vacation.

Pax has been off antibiotics since Friday and continues to have normal stool.

He also hasn't vomited in several weeks like he was doing for the last few months.

He would occasionally vomit 4-5 hours after eating previously, and I could never figure out why. I'm wondering if it has to do with the infection or parasites he may have had this whole time?

This is all AMAZING new, yay :):):)!

Yes, that vomiting I'm sure was related to all that he had going on inside, no doubt!

Hi there! The boys are still doing well. No diarrhea :)

I did give them their heartworm medicine last night (Tri-Heart Plus), praying there is no diarrhea or other issues from this. They've been OK in the past.