Wednesday, December 7, 2011


I called Dr. Matz on Monday morning and told him about our Saturday siege with metronidazole toxicity.  “We’d better give him another day,” the Tucson internist said.  “Let’s move him from Tuesday to Wednesday.”  The endoscopy schedule was already full for Wednesday, “but we’ll work him in,”  Dr. Matz said.  “Have him here by 9 o’clock.”

So here we went again.  Up several hours before dawn. . . . same drill.  Only this time around Dr. Matz wanted him to start fasting after his breakfast on Tuesday morning.

“Working in” an endoscopy turned out to require a scheduling shoehorn. We arrived at 8:30; they finally took Bravo! in for his procedure at 4:30 that afternoon.

I had brought a lunch, which I ate in my van.  Early in the afternoon a person at the reception desk gave me directions to a gelato place a few miles away.  There I had not one but two large chocolate malts . . . made with chocolate chip ice cream.  Who ever heard of making a malt with chocolate chip ice cream?  And why is that important enough to chronicle here?

 Baby, you sit in a veterinary hospital waiting room for ten straight hours and a chocolate malt made with chocolate chip ice cream becomes the major adventure of your day.

Bravo! was out of the recovery room and we were pulling out of the parking lot at 6:30 that evening – 12 hours after we had left home and 37 hours since Bravo! had eaten his most recent meal.  I had brought a light meal for him, and my little guy wolfed it down in the back seat.

But we had a diagnosis.

Yes, Bravo had inflammatory bowel disease.  He also had a duodenal ulcer – bacterially caused, Dr. Matz presumed.  But the biggie, a condition secondary to the inflammatory bowel disease, was lymphangiectasia.  Until early that Wednesday evening in Tucson, I had never heard the word – and oh! do I wish that were still the case!

Lymphangiectasia can be caused by a host of things.  In Bravo!’s case, the inflammatory bowel disease seems to have led to inflammation of the lymph vessels in his small intestine.  That inflammation and the resultant swelling have caused reduced lymph flow, which, in turn, has created a malabsorption problem.  Hence the near-diarrhea and weight loss.

Treatment of the disease involves rigidly controlled diet and medication.  Lymphangiectasia is rarely cured but can remain in remission for a long time. It can be fatal if the dog is unresponsive to treatment, and many dogs are.  Since it became known that Bravo! and I are battling this disease, I’ve heard from several people who have gone through this nightmare.  I have yet to hear about one happy outcome. (If you have been there and have a story with a happy ending, please share it with the readers of this blog.)

And what is Bravo!’s treatment?  Oh Lord!  (What follows here is the regimen we started in mid-October.  There have been some significant recent modifications which  I’ll discuss later.)

Following the endoscopy, Dr. Matz started Bravo! on:

n      20mg. of prednisone twice a day.  I have never before had an animal on such high doses of prednisone, and the immediate effects have been an eye-opener.  Literally.  His intake and output of fluid are keeping us hopping 24/7.  His urination schedule is at least every two hours.  And if we’re smart – that is, if we want to avoid an accident in the house – we better get him out in the backyard at 90-minute intervals.  Which means someone has to be here.

“Why don’t you put in a doggie door?” I’ve been asked ad nauseam.  We live at the base of a mountain . . .  and there are critters.  No doggie door!

Three or four times overnight one of us gets up and sends Bravo! out.  It’s what happens when he gets out there that astonishes me.  How can a dog pee that long?  How can he hold so much urine to begin with – and not let fly in the house?  (So far, so good.)  Talk about a good dog!

I couldn’t resist.  Finally I took a stopwatch out there with us.  Picture this:  It’s 2:30a.m.  Bravo! and I are out in the backyard, illuminated by the floodlights.  I’m in my pajamas, holding a stopwatch on the dog while he pees.  1 minute and 43 seconds!  That’s a long time to hold your leg up and pee.  Try it.

Then there are the possible long-term effects of the prednisone.  Not the least of which is possible shortening of the dog’s lifespan.  Add to that increased susceptibility to viral, fungal or bacterial diseases enhanced by the immunosuppressive properties of prednisone.  To say nothing of possible pancreatitis.  And at least some amount of muscular weakness.

n      37.5mg. of azathioprine each day.  It’s an immunosuppressant – another one! Known by its brand name of Imuran, it’s often used to suppress kidney transplants in humans.  The side effects of azathioprine can be nasty and can include damage to red blood cells, white blood cells and platelets.  To say nothing of the long-term effects of its role in suppression of bone marrow.
      The possible ravages of prednisone and azathioprine certainly warrant vigilance, in the form of frequent blood tests.

n      He’s also getting 20mg. of omeprazole twice a day.  Initially that was prescribed to treat the duodenal ulcer, but it also protects the stomach from possible damage inflicted by the prednisone.  We get the omeprazole at Costco, over the counter.  And you wouldn’t believe the packaging.  If you didn’t see the name splashed all over the multi-hued box or didn’t know what it meant, you’d think you were purchasing a box of cheap Easter candy.

* * *

What about the possible long-term ravages of some of these drugs?  In a word, scary!  But it comes down to choosing the lesser of two evils.  You can sit back and watch the progression of the disease wipe him out, or you can administer powerful (albeit risky) drugs that give him the best chance to recover – or in this case the best chance at remission.

The decision here is to stand and fight.

To be continued.



No comments:

Post a Comment