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Tara, I just wanted to say HI, and wish you good luck with the new vet Wednesday. I've followed your thread as we are going thru similar issues in diagnosing possible liver disease. It has been a very stressful month dealing with it all, and learning so much about tests, diet, and supplements. Thank God for all the help we have both found from the YT members. Hope we are both closer to diagnosis soon! Tiki's u/s is Thursday, though I know it may not give us an answer. I'll look forward to hearing what your new holistic vet has to say about Bella's case. Oh, and your doggie food discussions have really been inspiring. I must get a little more creative with Tiki's food. |
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Thank you for your good wishes about Bella's appointment today....I'm crossing my fingers that it goes well! I've been very surprised at how little concern/attention the vet she was seeing has given her....I'm certainly not used to that, though I've only dealt with one other vet in my life, and he was above and beyond great (expensive, but great!) I'll be crossing my fingers for you tomorrow. It would be so wonderful if the ultrasound did diagnose it (if there is a shunt that is...obviously, it would be better if it was MVD or nothing at all for that matter!) Then, you wouldn't have to go through lots of other testing, and that would be great for both you and your pocketbook, and especially good for Tiki! (I know the last time Bella went to the vet, she was not her normal self as she always has been even there....I think she's starting to get the idea that bad things happen to her there, which makes me sad. :( ) As far as my food discussions go, I say if she'll eat the kibble by itself, that's great and don't change a thing! I've had trouble with Bella turning her nose up at the new food, so that's why I've had to get more creative with it. As long as it's not just plain kibble, she eats it just fine (she would eat just plain kibble before I switched it to NB Vege). I think I should be hearing back from the nutritionist I chose possibly tomorrow, so maybe I'll get to start home-cooking soon...I think she'd really like that! You use NB Vege too right? Do you soak Tiki's kibble in water before you give it to her? I only ask because since Bella got this UTI, I'm a big proponent of making sure she gets lots of water, which soaking her kibble is the only way I can "make" her drink more. Good luck Thursday, and keep me posted! I'll be reading your thread as well, and feel free to chime in here too (or PM me, either one)! As much as it stinks, at least we have someone to sort of go through this with us! |
In case you were wondering, Miko's main protein sources are egg whites and goat milk protein powder..I don't know if I posted that already, but I figured I'd share. |
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Hugs to you and Bella, we'll be watching you here. |
Yay for the new vet!!! 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 :rolleyes:). 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! :p), 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!! |
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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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I think the reason the vet wanted me to use the chicken for now and not use the Vetri-DMG for now is that she wants to check her numbers again before we start that. She said we need to slow down a bit, that we don't have to make all these changes quickly, and that it certainly isn't a life or death matter at all since Bella is fine really. (If she were exhibiting ANY symptoms, she said that she would advise differently, but since she isn't she doesn't feel it's necessary to jump off the cliff just yet.) I agree with her somewhat, but if her numbers are high on the next go round, I think she will agree with me that we need to go with Tofu instead of chicken (which she was looking for in the diet anyway), and need to start using the Vetri-DMG. The nutritionist included Choline in her diet saying that would be in place of the Vetri-DMG, so maybe I need to look into what Choline is and whether it's a substitute for that?? Anyone know? (The vet did agree with keeping Choline in her diet.) Also, this vet said that her ALT very likely could be high still because she is a puppy and she's not finished growing/developing yet. I have heard this from 4 vets now, and I looked up "elevated ALT" online and found that infants tend to have a high ALT (though it didn't give me an example of what "high" is in that respect) and that it tends to normalize after 1 yr. of age. All 4 vets have said they have seen those kind of numbers in puppies before, and that it really shouldn't be looked at as too high at this point. You can bet I'll be watching all those numbers carefully because I'm big on stopping a problem before it really gets started! If her UTI is gone and her BUN is still upper limits or high for that matter, I will restart the Azodyl (and the vet agrees with that). She only wanted me to wait until after the re-tests to use it, I think mostly because her Creatinine is so well within normal limits that it doesn't make sense to OVER-supplement, especially when her upper limits BUN may well be from the UTI. (I think she just wants to get a clear picture of what really is going on without supplements skewing that picture, which they would do essentially if they helped bring any of those values back to normal at this point as is their purpose. I agree in that respect but would want to get her started on them if the numbers were still not like they should be, and I think she would be for that too.) |
Dr. W told me: The DMG is fine but I would switch to using the Choline that you will be getting. Choline at higher doses has some hepatoprotective qualities and will function as a methyl donor much like DMG is doing. So the choline will be taking its place really. Spend the money on the choline instead. I have since asked him if I could use BOTH the Choline and Vetri and he said SURE :thumbup: ~ So I do give both. Also, Roxy's diet consists of ALOT of veggies (raw and pureed: organic carrots, celery, green bell peppers and zucchini) - but that's what I was feeding her when I went to Dr. W so he had a base to start with. He also told me that I may substitute the Cottage Cheese for Chicken, which I am going to do in Feb for 6 months, just to alternate and give Roxy a break/change from the dairy, as she only gets her protein from Cottage Cheese and shredded moz. cheese. My internist also feels that Lactulose (at this point) is not needed for Roxy. She doesn't show and serious HE. She was on Lactulose for 10 days and I could NOT see any slight improvement in her attitude/behavior so the Vet said it is not needed. Roxys post BAT ranges from (100 to 60). She just had major dental (infection in her mouth). She will be retested in Jan. and I am kinda hoping her post will come down more now that her mouth infection is gone (hoping...) |
Do they really need vegetables in their diet? A lot of the recipes I have seen for liver compromised dogs don't include vegetables including Dr. Center's tofu diet. 1 lb tofu 2 lbs cottage cheese 4 cups cooked rice 6 T safflower oil 1 tsp salt substitute 6 tsp dicalcium phosphate 1-1 tsp pectin. Can use a strong low salt cheese to flavor. (Center S. A., Reynolds, A., College of Veterinary Medicine, Cornell University, Ithaca, NY, 14853). |
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Dr. W told me that the diet needs to be HIGH in Carbs for liver issues, so veggies are probably second best :confused: |
I would concur with Dr. Wakshlag. It would be very difficult to get enough vitamins and minerals in her with the products that the holistic vet wants to use. Choline is in the vitamin B family. It should be in her diet but does not replace Denosyl or Vetri DMG as far as I know. I think most homecookers want to use whole foods to get vit/min into their dogs but it just is impossible to meet all their needs like that. I just gave into the vit supplement because it is healthier in the long-run then to have Ellie undersupplemented. Since all foods have a different make-up, you would have to constantly change things around to get the perfect mix into her. I had also read that it would take 43 apples with peelings a day for a medium dog to get all of just one type of vitamin (forgot what one it is now). I am thinking about changing to human vitamins (we would have about 100 bottles sitting around if I went this way) but right now I use an all-in-one called Balance IT K. It is made for liver issues and is complete and balanced. You would add nothing, no choline, no iodine, etc. It is made for dogs though and I'm not sure about the safety of the ingredients. From what I gather from Ellie's nutritionist, the vegetables are added last, shouldn't make up more than 50% of the diet because they can dilute the nutrients and are more filling than nutrient-rich. I think after your nutritonist has balanced the diet, it might be okay to add some to the diet yourself or just ask him to add some in... It is good fiber anyway. :) |
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Lady has other issues like diabetes and apparently now her pancreas is not producing digestive enzymes which triggered the HGE. I guess that is common in long term diabetics and dogs with chronic pancreatitis. Anyway, she is doing great on a recipe with chicken, brown rice, egg and cottage cheese as the main ingredients. I add green beans, blueberries, peeled apple, etc. as a treat, but her recipe doesn't call for it. She does get a multivitamin daily, though. I know people who have had wonderful results with Dr. Dodds liver cleansing diet, but Lady can't have it because of the white potato. |
Thank you ALL for your valuable input! I'm already feeling better about using a multivitamin etc. Dr. W. originally had me using a tiny bit of iodized salt (for the iodine) and a little salt substitute (for postassium). I have a feeling that's what we'll go with. He did say that I could go with Nature Made for Her Multivitamin since that would be a more natural alternative if that's what I wanted to do. He's going to be very tired of hearing from me :rolleyes:, but I sent him another email saying that now that I've had time to process it, I think I'll be going with his diet (and returning the supplements my vet had me buy yesterday....hopefully they'll take them back!--I did ask him if the Canine Hepatic Support one was any good, though, and if he thinks it is, I may keep that one, but I'm guessing she's getting everything she needs without it.) I still think I'd like to include some veggies (cooked or pureed--just for fiber and varitey), but that would really just be extra I guess. We'll see how this goes......not knowing enough combined with professionals who have a differing opinion, even though it's not a huge one, is really difficult! Thank goodness I get a lot more insight from all of you! That seems to help to clear things up for me a bit! |
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He is always there to answer any questions and is very supportive with changes that are OK - He is also very honest if he disagrees. He is a Pet Nutritionist AND a Vet :thumbup: I looked up the Canine Hepatic Support and "I" wouldn't give it to Roxy. There are too many ingredients that are questionable (for me), but that's just how I feel... I did ask him about the Hepato Support from homevet.com and he said that was good to give |
Needs some more help please! I just had Bella's urinalysis repeated this morning (I was unable to catch, but my bf did after I left for work, yay!, so no cysto this time!). I came back acidic with a pH of 8.5 (last time, 2 wks ago, it as 6.0), but otherwise normal. The "otherwise normal" part is really good...I'm glad her UTI is gone!! She has been taking Baytril (a chewable antibiotic) for the last 12 days.......the vet that gave it to her said 10, but we had 2 extras so I gave them to her just in case until I could repeat the urinalysis (I wanted to make sure it was gone before we had several days without it). So, she's been on Baytril the past 7 days. Yesterday was her first day to eat home-cooked, including veggies and supplements (multivitamin, Milk Thistle, Vitamin E....got the Choline today, but she hasn't had it yet, and haven't been able to get the added fiber yet). So, why would her pH change from slightly basic to acidic in just 2 weeks?? My new vet isn't in today, but her colleague wants me to purchase and use a product called "cranberry comfort" to help change the pH. This is an extra $36 on top of everything else I've had to buy so far in the past 2 weeks, so I'd rather not if there is anything else I can do. Plus, I'd like to know why this happened.....it's just so weird to me! |
I swear by Cranberry Relief and it is much cheaper. Anything you get from your vet will have a huge mark up.  Amazon.com: NaturVet Cranberry Relief, 50 Gram:... It will make her urine less acidic. Crystals and stones form when urine is not "neutral". |
Ok, I talked to Dr. W. today (because Bella seems to not like brown rice.....good grief!) and went ahead and asked him about the urine pH. He asked me if she'd eaten green beans yesterday (which she did). Then he said that green beans (and veggies in general) can acidify the urine. Struvite crystals/stones are the ones made with acidic pH's and urate stones/crystals with basic, and since struvite ones aren't nearly as common as urate ones, and since her urinalysis has been negative for both, he thinks I should just not worry about it. (He did say that I could discontinue veggies for a day or 2 and then test her urine myself with the strips they sell to see if the pH normalizes if I want to. But he thinks the higher pH is probably safer than allowing it to be lower and that she gets a lot of good out of the veggies, so he thinks it should be fine continuing to give them.) |
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Bladder Stones Struvite uroliths come in many different shapes and sizes, are radiodense, and form in an alkaline urine. Bladder Stones Urate and ammonium Urate ...There does not seem to be a connection with a urinary tract infection, and they tend to form in an acidic urine....Urate stones are radiolucent. If they get large or covered with other minerals they might become radiopaque. Urate calculi tend to be small and occur as several stones. These stones usually form in the bladder, and when passed through the urethra, can become lodged....Ammonium urate uroliths are sometimes formed in pets with PSS (liver disease) due to improper metabolism of ammonia to urea. This will cause excess uric acid levels in the bloodstream. The kidneys filter out this excess uric acid in the production of urine, thus increasing the level of uric acid in the bladder. The excess ammonia that is in the bloodstream from the liver problem also builds up in the urine in the bladder. These two compounds combine to form the ammonium urate bladder stone.... I find it strange that he said veggies are acidifying...They actually help alkalize the urine. Here are a couple of links with charts of alkalizing/acidifying foods. Most veggies are alkalizing...There are very few that actually are labeled as acidifying. Meats are the main foods that are acidifying. Chart of acidifying and alkalizing foods ACIDIFYING FOODS |
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Basic chemistry lesson in progress (chemistry was never my strong suit...oh boy!): pH < 7 is acidic pH > 7 is basic (alkaline) Is that right? I got it backwards I think......I started looking at the website you gave me about alkalizing/acidifying foods and saw that cranberries are acidifying.......and my vet's colleague had said today that I should use a cranberry product to help acidify her urine. But that would be backward if her urine was already acidic! So I looked up pH and acid/base online and thanks to our good friends at Wikipedia I now have even more proof to support my suckiness at chemistry!!! Whoops! So the veggies would have alkalized her urine (and it is 8.5 now), so that makes sense. And she would either need to skip the veggies for a bit to check that theory and then not worry about it (because that is higher risk for struvite's which aren't as common as urate's) OR I can use a cranberry product to acidify her urine and bring it back to normal pH. (She doesn't have stones or crystals by my ultrasound and by urinalysis, so that's good!) Whew....hopefully I got it right that time??? :xfingers: :rolleyes: sheesh, Tara! |
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But you're absolutely correct about the pH stuff. Strutive stones are actually quite common, especially in dogs that have had UTI. Canine Struvite Bladder Stones The most common stone types are Oxalate and Struvite and since the approach is completely different for each type, it is crucial to determine the stone type. ... Struvite stones in the dog are almost always formed because of the urinary changes that occur with specific types of bladder infection: almost always Staphyloccocal infection but occasionally a Proteus infection. If a urine culture from a patient with a bladder stone should grow either Staph or Proteus, this would make struvite more likely than oxalate. Also, struvite requires an alkaline pH to form while oxalate requires an acid pH to form; urine pH is a part of any urinalysis and thus provides another clue as to the stone identity. |
Bella update and ? about nutrition guidelines... Well, Bella seems to be doing great! (Except for her runny nose, sneezing, snuffling, and snorting as of late....she doesn't have a fever and seems to feel great, so I guess it must all be related to allergies/dry air/something???) She has gained back the weight she lost + a little....she weighs 4.2 lbs now!! She seems to still love her home-cooked food, and she still has no symptoms, so yay! Because her pH was 6.0 when she had the UTI after her spay, and then was 8.5 when we repeated the urinalysis after finishing the antibiotics, I ordered some pH test strips. We were pretty sure the 8.5 was from the veggies (esp. green beans) that I had been adding to her diet each day, and since adding the veggies seemed to affect her pH AND her stools became very loose, I stopped adding in veggies every day. Yesterday I used the pH strips for the first time, but I just touched them to a fresh wet spot on her pad instead of catching it and dipping the strip (which I will try to do this weekend)....it was 6.5. I emailed Dr. W with an update on how good she's doing and mentioned this to him, but he said that actually 6.5 is ideal for the prevention of urate stones which are what she is susceptible to precipitate. I'm a little confused by that but I didn't want to bother him about it until I asked you all....I was under the impression that urate stones and crystals (and calcium oxalate stones and crystals?) had the possibility of forming in an acidic pH (which is anything below 7 right?....but maybe it's lower than 6.5??) I would be grateful for any input on that! Also, I know Crystal asked me before if the recipe he provided me with met AAFCO guidelines awhile back, but truthfully I forgot all about that until today when I was reading a thread on dog food (I know some of you read it too :rolleyes:) So, when I emailed him today with her update, I asked him if it was within those guidelines, and he responded that it was not....that is it much closer to the National Research Councils (NRC) recommendations except that B vitamins are higher and the copper is marginal. He also said that he thinks the NRC recommendations are much more realistic. Soooo, Crystal, I need some input on that too....what do you think about conforming to NRC but not to AAFCO guidelines? I'm really hoping that is still okay for her since we're already this far into this, but if not.....I don't know. I would appreciate your insight very much! |
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I "think" Ellie's recipe meets AAFCO guidelines but not 100% on that. It's just that no feeding trial was done with her recipe. With diets for heatlh issues, they may not meet the guidelines and that's fine. NRC vs. AAFCO is a tough one because they both have flaws and I don't really respect either. Ellie's nutritionist is pretty adament about pet foods meeting AAFCO guidelines, so that is what I go with right now. If you Google it, you will find reasons to not go with either of them and ignore it all. It's one of those things that you have to just trust your nutritionist with but if my dog was on a diet that any adult dog could eat, I would expect that it meet either the NRC or AAFCO and not just be "close to NRC". Then you have a third system. The system of whatever your nutritionist feels like doing... Does that make sense? Now if the only reason it doesn't match NRC is to make sure it is meeting her liver's needs, then that is different. My preference at this time because it seems to be more preferred is AAFCO but just because a food is AAFCO approved doesn't mean it's good. I'm done rambling now. |
Update!--for anyone following us anyway ;) Bella is now a whole year old (my baby is growing up! :( :( ), so we had her BAT repeated.....the results were: Pre = 7.2 (which is normal); and Post = 97.7 :(. (Her previous Pre was 243, and post was 72.6.....so her post has gone up a bit.....I guess that UTI really did make a difference??? Strange....) Since her post was pretty high, I went ahead and had them do the Protein C test. Got the results back on that today.....89 (with a normal of 75-135)! Her vet feels that all this supports the likelihood of MVD rather than a shunt, so I am feeling much more at ease and relieved about that! Sooo, while I plan to occasionally home cook still using Dr. W's diet (and maybe he'll change it a bit now that we know more??), I don't plan to do this solely anymore. She gets bored very quickly with food, and really likes things to be rotated, so we're going back to kibble (NB Organic Chicken and Wellness Whitefish and Sweet Potato) and rotating those along with home-cooked. I think that will make her much, much happier! (And my wallet and free time a little happier too, though I certainly don't mind doing what I need to.) And, I'll still do the milk thistle, Vit. E, and fish oil daily too. I think as long as she continues to be asymptomatic with this routine, then we're good! IF she ever has ANY symptom, we'll go right back to what we've been doing, but I really think she'll do great!! (Oh! And she hasn't had another UTI since the first one she got after her spay. This time I had her U/A repeated BEFORE we did the BAT again just to make sure. Her vet feels like that UTI was just a result of her bladder maybe getting a little bruised during the spay.....good to know that it wasn't a symptom.) |
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