Friday, November 25, 2011


In Part 1 (Nov. 22) we learned that Bravo! had started with the "soft poops" on May 16.  All the standard initial tests were normal.  So Dr. Toben X-rayed the little guy's abdomen.  That word again: "normal."

And, of course, he drew blood for the obligatory valley fever test (coccidioidomycosis, a spore).  The Valley of the Sun is also the valley of the spore, and if a dog even blinks wrong around here the first thing they test for is valley fever.  The spores emanate from the soil in our arid climate.  Valley fever is common among people here in the desert, and it's much worse among dogs because their noses are closer to the ground.  Bravo!'s valley fever test was normal.  Everything was normal except what I was seeing on the ground in the backyard.

So we took the next diagnostic step, called  fecal culture toxin panel 1.  I called it the "loudenboomer" test because it cost $300.  That seemed high at the time, but little did I know that, expenditure-wise, we were only beginning batting practice.  Again, every test included in that panel was normal.

And the soft poops continued.  "My guess, Willard, would be inflammatory bowel disease," Dr. Toben said.  His guess!  If Chuck Toben were a stock broker, I'd be filthy rich.  Twenty-plus years of hitting the nail right on the head have made Dr. Toben's guesses almost sure things in my mind.

Across the next few months, we exhausted everything in the veterinary bag of tricks known to treat inflammatory bowel disease:  amoxi-tabs, metronidazole, low doses of prednisone, panacur granules, and probably a few things my mind is fighting to repress.  Years ago, with earlier dogs, I had success treating (normal) diarrhea with a drug called Amforal.  That drug is no longer on the market, but when all else fails . . .  Dr. Toben had the drug compounded.  The result of all this?  Zilch.  Zilch.  And more zilch.

On June 24 Bravo! had an abdominal ultrasound (ka-ching!) which confirmed Dr. Toben's "guess."  One loop of the small intestine showed signs of inflammatory bowel disease.  That hardly satisfied us.  Both Dr. Toben and I reasoned that  Bravo! has a lot more intestine in there to to a job that clearly wasn't/isn't being done.

Overly simplified, here's how it works.  As food and water pass through the intestines, nutrients and water are absorbed.  "Bravo! has a motility problem," Dr. Toben told me.  He meant that food and water were moving through the intestines much too quickly, not allowing time to be absorbed.  Resulting in varying degrees of soft stool -- all the way from what I called the "soft poops" to occasional watery diarrhea.

Well, Bravo! had an absorption problem, all right.  Early in the summer, across a period of slightly more than two weeks, my 38.5-pound border collie dropped to 32.25, a loss of 6.25 pounds.  Scary!

I've said that the "wetness" of Bravo!'s stool varied from day to day and usually from bowel movement to bowel movement within the same day.  How do you effectively communicate that to a veterinarian who is not standing next to you in the backyard?  On the phone, he's asking:  How is it now?  Is it better?  Worse?  How much better?  How much worse?

So I dreamed up a 10-point scale to describe what Bravo! was contributing to our dilemma at any given time.  A 10 would be dry, perfectly formed stool -- like what Cheddar, my golden retriever, was offering up (down?) most of the time.  A zero would be the worst diarrhea you can imagine, gravy-like and running like a faucet.

I found this quite effective as I gave telephone reports to Dr. Toben.

Then, flush with my own brilliance, I created a second scale, the Residue Index.  This index, also using a scale of 1 to 10, described, for want of a better word, the smeariness of what was on the ground, how difficult it was to pick up (using the baggie-covered-hand method), how much residue was left in the grass.  Residue I would then dispatch with a now-always-handy hose.

Alas, I quickly found that the values recorded using my Residue Index were badly skewed by a troublesome variable -- the length of the grass.  So much for the Residue Index.

Through all of this -- from day one of the soft poops on -- one thing has had Dr. Toben and me mystified.  At no time -- not once -- has there been any urgency about Bravo!'s need to poop.  Not once in these 6+ months has he asked to go outside for that purpose.  And not once has he had an accident in the house.  When I take him out, after meals, in between, whenever it's appropriate, he does his thing.

Dr. Toben has asked me about it multiple times.  I tell him what I've said above.  He shakes his head and says, "I have dogs in here with diarrhea evey day.  And those dogs are frantic to go outside, seven, eight times a day."  He shakes his head again:  "I don't understand it."

To be continued.


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