Tuesday, November 29, 2011


Summer progressed and so did the disease.  We stumbled along on a treatment treadmill to nowhere. Day after day after day of the same old/same old.  Stool quality hitting an 8 occasionally -- just enough to raise false hope -- but far too often in the range of 3 to 5.

Through it all Bravo! seemed to feel good.  When it was time to cut loose, he cut loose.  When it was time to grab a toy and spin, he grabbed a toy and spun like a maniac.  Whenever he spied an opportunity he'd bring me his ball and we'd play until I wore out.

True, he was skinny, but his abundant, shiny coat hid that fact.  Until very recently, his coat stayed in perfect condition.  Now I'm seeing a little bit of rattiness in the area of his rear end.

At first I vacillated about his training.  Early on I shut him down for several weeks.  But it was clear he wanted to go train.  He couldn't understand how I kept forgetting.  And he was perpetually looking me directly in the face in the morning when it was time to leave for the park.

I talked to Dr. Toben about it.  "If he wants to go, I'd take him," he said.  "I think it would be good for him.  Just don't overdo it."

We went and he loved it.  On Sunday mornings, when our Wow Wob Bassackwards Utility Group did ring run-throughs, I had always done Utility and Open with Bravo!  Now I found that he was sharp, rarin' to go in the first ring (usually Utility) but a little less so in the second.  I described it as "flat" in the second ring.  So I began limiting our Sunday practice to one ring, usually Utility.  After all, my little guy is OTCH-bound and Utility is where most of the points are.

Several times Chuck Toben offered to refer me to a veterinary internist to get a specialist's take on our problem.  But two decades-plus of extraordinary success with Dr. Toben, two decades of the most wonderful veterinarian/client relationship imaginable, made me reluctant to go anywhere else.  But come September, approaching the four-month anniversary of this maddening saga, I was ready to seek an opinion from a fresh perspective.

Having reached that decision, I didn't need a referral.  In Part 1 of this series I spoke of Dr. Jim Boulay, the Tucson orthopedic surgeon who had done exemplary work for three of my dogs.  In 2004 Dr. Boulay had added entrepreneurship to his Renaissance man career.  He had built a multi-specialty veterinary facility in north Tucson.  The new hospital opened with 10,000 square feet amid rave reviews and architectural awards for functional design excellence.  By 2011, Veterinary Specialty Center Tucson had expanded to 32,000 square feet and houses 26 doctors, 11 of them board-certified specialists.  Anyone who has spent a career in university teaching hospitals, as I did, knows how beneficial it is to patients to have a group of specialists like that all within bare-headed walking distance of one another.

Above all, what I had taken away from my several previous experiences with Dr. Boulay was this:  Everything he touches turns to excellence.

So I went online to see who in that group practice was board-certified in internal medicine.  Two were listed.  So I called Jim Boulay.  He immediately said, "Oh Willard, Mike Matz is the man for you."  He went on to say that Dr. Matz is nationally recognized for his work with the very types of problems Bravo! is having.

During that conversation I told Dr. Boulay what has been going on and that we were quite certain we are dealing with inflammatory bowel.

"How do you know it's inflammatory bowel?" Dr. Boulay wanted to know.

"We did an abdominal ultrasound in June," I told him.

He was adamant as he said, "I would never, never accept a diagnosis of inflammatory bowel on the basis of an ultrasound.  Bravo! needs an endoscopy."

Before I hung up the phone that morning I scheduled an appointment with Dr. Matz for September 22.  The plan was we'd begin with a consultation, then Bravo! would get an upper gastrointestinal endoscopy.

I knew it wasn't going to be a wonderful  day for either of us.  Bravo! would begin fasting the evening before.  We'd be up at 4:30 a.m., out of there by 6:30 for our 125-mile trip.  And by the time the procedure and the recovery room were over, Bravo! was discharged and we'd schlepped 125 miles the other direction, a grinding day would come to an end.

Dr. Matz did the most thorough diagnostic medical examination (workup) I've ever experienced. Question- and answer-wise he turned me every way but loose.  Great!

Then it was time for the endoscopy.  Dr. Matz left the examining room and I had about 10 minutes to think before a technician would come for Bravo!  Alone in the room with my little guy, I replayed this part of the consult:

Dr. Matz was going to switch Bravo! to a hypoallergenic hydrolyzed diet.  Hydrolyzed means the protein in the diet is broken down into molecules too small to excite the immune system. He would be sending us home with a big bag of Royal Canin HP 19.  As I waited in the examining room, one comment Dr. Matz had made stuck out in my mind.  He had said, "Since hydrolyzed diets came on the market several years ago, I've had to scope 50 percent less patients."

Well then, I thought, might it not make sense to try Bravo! on the hypoallergenic diet for a reasonable period, see if the symptoms improved, then, if not, come back for the endoscopy?  Why subject the little guy to a general anesthetic, only to learn after the fact that diet could control the problem?  Oh, and by the way, why do a procedure estimated to cost between $1363 and $1467 only to learn later . . . . .?

So when the technician came for Bravo! I told him I wanted to talk to Dr. Matz again.  Back in he came.  And he said if I didn't mind repeating the 250-mile roundtrip, my reasoning made all kinds of sense.

We were outta there and home shortly after noon.  I heard Bravo! tell Cheddar, "They never laid an endoscope on me!"

To be continued.


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