When we last left Billy his story had reached present time and life was relatively calm. It is now approximately two months later, and happily, life is still relatively calm.
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Bath time for Billy. The tennis ball helps to keep him calm. |
Dr. Mitelman: We have had a few ups and downs, but for the most part we have been adjusting to Billy's "new normal". That isn't to say that we aren't still dealing with some issues.
We have discovered that food "trials" are called that for a good reason.
Some owners might find that the elimination process takes too much time and effort. It certainly can change household patterns and routines. In Billy's case the merits seem to outweigh the challenges and Barbara has made the commitment to the cause.
With the dermatologist's recommendations, we introduced a single ingredient for at least a 2-3 week trial period, unless, of course, Billy's system did not like that particular food item.
Barbara: My first surprise was that Billy's tummy and skin liked our very first food challenge, boiled beef.
My second surprise was he was only having two bowel movements per day. Concerned, I phoned Dr. Mitelman. Usually Billy produced 4-10 stools per day. I was thinking something must be wrong.
Happily, fewer daily bowel movements were a good thing.
The next food item, soy, brought quite the opposite results. Within three days, Billy was itchy as though he was on fire. He was chewing, biting himself and licking. He was very uncomfortable.
So we stopped the soy. It took a couple of days for him to settle down.
Knowing that our supply of the old formula kibble was nearing its end, we made the decision to re-introduce the new formula once again.
Within two days, Billy's stomach was reacting poorly. He had diarrhea, was pacing, trembling, and showing obvious discomfort. Even though we had been told by many sources the addition of the FOS to the new formula should not produce any reaction, clearly by process of cause and effect, it was affecting Billy.
So that, too, was stopped.
Next, we introduced boiled oats as this had been an ingredient in the old formula diet.
Success.
For the sake of time, we opted for a combination of boiled beef and oats rather than pursuing the next protein, chicken. Happy dog, happy gut, happy skin, happy family and happy Dr. Mitelman.
Next came the addition of boiled, mashed carrots.
Within 24 hours, Billy's stool looked like undigested carrot. He was once again pacing, uncomfortable, trembling and painful. I didn't expect this reaction. I stopped the carrots and it took 48 hours for everything to settle down.
We went back to the boiled beef and oats and a calm, happy Billy returned.
Dr. Mitelman: Now we have a base to start with. But we still do not have a complete diet to ensure he does not acquire any deficiencies over the long term. And we are not even sure what amount of food he should be fed. Within two weeks on mainly home-cooked food, Billy had gained a pound. This is in contrast to the ever-increasing amount of kibble and the slow but constant weight loss.
We have made a decision to involve a nutritionist to help balance Billy's diet.
The initial contact has been made and we will be pursuing this avenue.
Barbara: Seeing Billy more comfortable than he has been in years is a truly gratifying experience. We are still trying to work out some issues with the home-cooked meals. It certainly makes traveling more of a challenge, and it requires more thought and preparation.
But we will work through whatever we need to do since Billy is so much better now.
Dr. Mitelman: On routine ultrasounds to monitor the status of Billy's prostate I will scan around his belly and have a look at all of the other organs including stomach, liver, gall bladder adrenals, kidneys and lymph nodes.
About nine months ago, we noted little grains of "sand", no more than 1 mm in diameter, in his urinary bladder. These were stones. We tested and cultured his urine with the results coming back normal.
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Billy's most recent ultrasound |
Billy does not have any clinical signs but there is a potential that they might block his urethra causing acute and dangerous urinary out flow obstruction. At this point we are performing regular urinalyses and cultures to help us detect onset of infection or inflammation. Barbara and I have discussed a non-invasive laparoscope- assisted cystoscopy as an option when the time is right. Until then, we are giving anesthesia a break.
Barbara: The thought of another procedure for Billy under anesthesia is of concern. However, so is a sudden and acute blockage resulting in emergency surgery.
Hopefully routine urine testing and regular ultrasound checks will keep us on top of the situation.
Billy's skin still has minor flare ups and he seems more itchy some days than others. His once- or twice-weekly medicated baths are really helping to keep him comfortable.
Dr. Mitelman: Billy has had some sebaceous cysts, mainly under his right fore arm. These are abnormal cavities beneath the skin that arise from blocked ducts in the oil secreting sebaceous glands. When these fill up they become distended with solid or semi-solid paste.
Causes for this include inflamed hair follicles due to bacterial infection, yeast and mites, and endocrine disorders. It is quite benign but they are a symptom of greater skin problems.
In Billy's case we have washed and cleaned the skin with follicle cleansing shampoos to remove oil and plugs. So far we have not needed antibiotics to treat him.
Another issue has reappeared, one that we actually haven't really seen for over two years. Barbara reported that Billy has been tripping on his right fore leg. I have consulted with a neurologist who explained various causes are possible.
This might be as a result of orthopedic disease (pain related), cervical cord or nerve root disease or muscle or nerve disease of that limb.
It is possible that this dates back to either muscle or nerve damage resulting from the serious paw infection in the summer of 2009.
Barbara: Although Billy is still keeping us on our toes, he is in a pretty good place right now. He has been medication free for over a month. He enjoys his home cooked diet and even though we haven't determined the best balance yet we have some options to explore.
We are hoping his bladder stones will remain silent, but will continue to monitor this.
Related articles:
When A Small Sore Turns Into A Catastrophe: Billy's Story (Part I)
Life-threatening Infection Resolves; All Is Good? Billy's Story (Part II)
What Is Going On With Billy's Skin? Billy's Story (Part III)
The Plot Thickens: Billy's Story (Part IV)
I've Never Seen That Before: Billy's Story (Part V)
Billy's Diagnosis Still Unknown: Billy's Story (Part VI)
Neuronal Ceroid Lipofuscinosis (NCL)? Billy's Story (Part VII)
Time To Make A New Plan: Billy's Story (Part VIII)
Atopic Dermatitis? Billy's Story (Part IX)
It Is Not Neuronal Ceroid Lipofuscinosis But What Is It Then? Billy's Story (Part X)
My Dog Has A Gut Of Steel, Doesn't He? Billy's Story (Part XI)
Feeling As Though Running Out Of Options: Billy's Story (Part XII)
Fighting Fire With Fire Backfires: Billy's Story (Part XIII)
A Second Endoscopy: Billy's Story (Part (XIV)
Staying The Course: Billy's Story (Part XV)
Fewer And Fewer Solutions Left: Billy's Story (Part XVI)
When The Only Consistent Feature Is Inconsistency: Billy's Story (Part XVII)
What Is Behind The Fast-Growing Lipoma? Billy's Story (Part XVIII)
Back Into Surgery, Again: Billy's Story (Part XIX)
Removing The Masses: Billy's Story (Part XX)
The Biopsy Results: Billy's Story (Part XXI)
What Has Triggered This Reaction? Billy's Story (Part XXII)
The Return Of The Itchies: Billy's Story (Part XXIII)
An Illness Of Unknown Origin: Billy's Story (Part XXIV)
An Irregularity On Billy's Prostate: Billy's Story (Part XXV)
Billy Is Not Well
Tummy Trouble: Billy's Story (Part: XXVI)
Dental Emergency: Billy's Story (Part XVII)
The Crisis: Billy's Story (Part XXVIII)
On Even Keel? Billy's Story (Part XIX)
Where's The Beef? Let's Ask Billy
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