When I prepare these posts, I first write them out on a yellow pad, do some rewriting and finally enter them on the computer. So there's a lag.
When last I communicated, Bravo! was on a regimen of 40mg. of prednisone each day, 20mg. of omeprazole twice a day and 37.5 mg. of azathioprine daily. And of course the special diet.
All of which had zero impact. The soft poops, punctuated periodically by old-fashioned diarrhea, continued. After a few weeks, Dr. Matz said, "That's not working," and he made some changes. Bravo! stayed on the prednisone, but the dose was dropped from 40 to 30mg. a day. Which did nothing to reduce his insatiable need for water and the resulting pee,pee,pee, 24/7.
Dr. Matz eliminated the azathioprine, much to my relief, and added 100mg. of cyclosporine each day. Ah, now we had graduated to the solid gold stuff -- $6 a day. And he added three 250mg. capsules of tylosin each day. "It acts pretty much the same as metronidazole," he told me, "but it's less toxic." That was music to my ears. Bravo!'s one bout with metronidazole toxicity was enough to last a lifetime. He added that there were studies indicating that metronidazole, taken in sufficient quantities, is a carcinogen. Wonderful.
And he again changed Bravo!'s diet -- at which point I threw away a nearly full bag ($80) of the previous diet.
So we set sail under the new regimen, and for a few days Bravo!'s stool improved dramatically -- I was picking up 8s (on my previously described 10-point scale) in the backyard. His stool hadn't been that good since the poop wars started on May 16.
Then, on a Wednesday morning, things started downhill. By late Saturday we were down to ones and twos -- diarrhea by any other name. By Monday he was running like a faucet. Curiously, only when it was a normal time for a bowel movement. Not once since this siege began in mid-May has he asked to go outside for that purpose. And not one accident in the house. Diarrhea, but no urgency.
I talked to Dr. Matz on Tuesday. He was convinced that the current regimen is the right one. But he said, "Try giving Bravo! a little Imodium AD. It comes in 1mg. tablets. Two-thirds of one of those three times a day should be right for him."
If you've ever taken Imodium AD, you'll understand this: I defy you to come up with two-thirds of one of those tiny tablets. So I bailed and gave him 1mg. in the morning, one in the evening and one-half at noon.
His stool began to improve immediately and sustained a level of 7 or 8. Most recently I'm seeing more and more 9s.
The Imodium AD was added in, pretty much as an emergency measure, only a few days after we started the new drugs, tylosin and cyclosporin. Which begs the question: Is the improvement due to adding the Imodium AD or due to the new drug combination? Seeking the answer, four days ago I began slowly withdrawing the Imodium AD while holding the rest of the regimen constant. So far the quality of Bravo!'s stool has held -- in fact, I'm seeing more 9s.
And that's where this series of posts ends. Bravo! isn't going to to be cured of the lymphangiectasia. Perhaps if we're lucky we can keep it down to a dull roar. In any case, lymphangiectasia is staggeringly expensive. I have a friend who refers to her lymphangiectasia-deceased border collie as "my $10K dog." Right now we're approaching $6,000 in vet bills. Most who have followed this series had never heard of lymphangiectasia, certainly never encountered it. Just hope you never do.
P.S. It Never Rains But What It Pours Department: To look at Bravo! you'd never know he has a problem. And his desire to train and compete has not diminished. Several weeks ago he competed in the Phoenix Field & Obedience Club trials. And while they weren't his all-time best runs, he did place in Utility B.
A few days later he began refusing jumps. I had his hips x-rayed. His right hip, which showed no sign of a problem when he was x-rayed at one year of age, is now badly arthritic. I retired him from obedience competition on the spot. He'll do a little rally just to keep him active. Rally novice at first, then we'll see if he's comfortable with the 16-inch jump.