Moving On

With the holidays and being away, I completely forgot to post about the appointment we had with Abby's new vet.  After getting some recommendations from people in the area, we decided to make the move to a vet that was just slightly further than the vet we were presently using.  We had received some great recommendations about both of the vets in this practice, and felt confident that if our main vet were not available we'd be able to feel comfortable with the other vet who would provide care. 

The first thing I noticed instantly about going to the vet was the difference in Abby when she approached the facility.  I'm sure there is something to be said for a new environment and a new modus operandi, but I think there is a common theme that exists amongst vets offices that makes it clear from the beginning what will likely go on.  But when Abby was inside of the building she easily settled on her mat and was fine just chilling there.  Even when she was called into the exam room she wasn't anxious upon seeing the table, which was a definite departure from the appointments she has had recently at her last vet. 

Her new vet was so incredibly thorough and kind.  When I brought Abby in, I was concerned because she had some soft stools and urgency overnight, and I was worried that another episode had kicked off.  The new vet took great care in understanding fully the issues Abby has had and what we've done as pet parents to investigate the source of these issues. 

During that appointment we came up with a great game plan to try Pepcid twice daily half an hour before Abby's meal to see if that aids with digestion.  Additionally we scheduled an ultrasound to make sure there wasn't a blockage or other structural problem going on. 

On the day of the ultrasound, Abby was a bit nervous to enter the building.  Now perhaps that is because I was nervous about the appointment and she sensed that.  I've never been one to notice Abby's sensitivity to her environment, but that doesn't mean that she isn't.  While I was trying to talk Abby into coming up the steps for the vet, we saw a woman leaving who very clearly was anxious.  Abby is not one for greeting strangers.  She is very shy and typically likes to approach people after they've ignored her.  But Abby saw this woman and instantly went up the stairs and approached her to greet her.  The woman looked at Abby and said, "Oh are you going to keep my guy company today?"  And Abby sat for her to pet her!  It was just the sweetest thing as Abby gave some comfort to someone who's pet was having surgery that day. 

But the ultrasound came back completely fine, as I suspected it would.  Actually by the time the ultrasound had come her stools were back to normal and we suspect she had a treat that did not agree with her.  I had given her two Healthy Edibles in the two days preceding the soft stools, so perhaps those were what did not agree with her.  Either way she has had solid stools since and we will continue feeding her the Hills I/D and Orijen Red Region combination that has worked for her.  If at some point that diet no longer works for her, the doctor who did the ultrasound suggested Purina HA or other hydrolyzed food. 

In other news my husband and I recently traveled for Thanksgiving and we boarded Abby for a week.  She was so happy to be home, and very tired as well.  Yesterday during her first full day home with us she moved the pillow on the love seat so she could sleep behind it, and inevitably realized she could rest her head on the pillow.  It was super cute! 

Your dog is on what?

In recent weeks I've come to realize that when you have a reactive dog, there is a certain stigma attached to it.  People ask you how your dog is.  And while some people are genuine in their interest in your dog, some people are clearly judgemental. 
I should back up at this point and tell you that Bill and I made an attempt at reducing Abby's clomicalm dosage.  A little over a year ago we put Abby on clomicalm.  It was a choice we didn't take lightly, but one that was the right choice for Abby at the time that we made it.  I cannot begin to tell you how heartbreaking it was to watch her get so anxious about her crate, insuring at least one foot was outside at all times for fear that she might be put in it.  Even just giving her a treat in the crate was clearly stressful for her.  If I put a treat in there for her to find so that only positive things happened for her in that crate, she would hop in and out of that crate at a speed befitting an Olympic Hurdler.  No matter what we did to make her crate positive, it clearly was not at all getting better.  Abby was so amped up to even look at the crate that we wouldn't be able to make it positive.  She clearly couldn't be receptive towards it in any way. 

Clomicalm has been a blessing and a curse all at once.  In combination with relaxation protocols that we work on, it allowed Abby to simply relax near a crate, and inevitably be crated while I am at work.  I would be lying if I didn't say that I tear up a little bit each day that I crate her in the morning because she literally races to the door of her room and looks back at me with a smile.  A year ago I would not have thought that was possible.  But clomicalm isn't without risks, and certainly its toll on the dog's physical health is one. 

However, there is another risk that most people don't realize accompanies the choice to give it to your dog:  judgement.  I cannot begin to describe the looks on people's faces if I do mention that Abby is on a medication for anxiety, or the way in which a vet she has not seen before will ask about the medication.  Some people are subtle about it, but most are not.  It all starts off the same way. 
Is she on any medication?
What is the clomicalm for?
Why clomicalm?
Have you tried (insert any form of accupuncture, vet behaviorist, or other things people have heard are effective)?

Ever since shows like "The Dog Whisperer" and "It's Me or the Dog," suddenly everyone is an expert on dogs.  Intentional or not, people have a way of being unable to ask the above questions without implying that I simply choose not to take my pet's health and psyche seriously and just choose medications as my easy fix.  They do not know the countless hours I have spent over many months doing relaxation protocols with Abby just to get her to lay down, then to drop her chin, kick out a back leg, sigh, etc.  Then to spend these hours once again to do all of this near a crate.  They do not know that Abby has her own iPod that we keep downstairs, that sits docked in the iHome I received as a birthday gift and plays "Through a Dog's Ear" for her all day while she is crated so that she can have some white noise.  And to ask the above questions so succinctly while the answer is not so succinct always leaves me feeling annoyed and judged. 

Clomicalm is not a medication that I necessarily want Abby to be on long term.  If she can be without medication that would be ideal.  But if she can't, I want to make sure that she is on the right medication for her.  Towards the end of June, we asked for instructions to taper off her clomicalm.  Abby was taking a half tablet twice daily, and the instructions given were to do a half tablet daily for two weeks, and then half a tablet every other day for two weeks, then off the medicine entirely.  I opted for a longer tapering off, and figured we would do the half tablet daily for one month before moving to the next level.  However, after only a week it became clear that a half tablet drop was too much too soon.  Suddenly the world seemed a scary place in general for our girl.  She barked at everything.  And while some dogs bark, Abby greeted every creak in the floor, or voice outside as an imminent threat.  She barked at everything in a way that communicated she definitely was freaking out.  Now granted, it wasn't a level of barking like when she was panicked to be in the crate.  But it was clear that she was nervous and anxious about every sound.  Hell, she was nervous about sounds we couldn't even hear!  We tried instead half a tablet in the morning and a quarter tablet at night.  After about a week this still left her amped up and really hadn't helped to improve her outlook either.

So we've now made an appointment with a Vet Behaviorist to discuss Abby and her anxiety.  Part of me worries that Abby is just an anxious dog, and perhaps the crate and separation anxiety was the most obvious display.  The crate anxiety is under control now.  But in combination with Abby's GI issues that kicked off around the time she displayed dog reactivity, and the GI issues she continues facing, I would not be surprised if we were to find that she has some sort of general anxiety disorder that we work on either through new methods of relaxation, or a different medication in a light dosage. 

In other news Abby continues to have issues with soft stools and diarrhea.  We switched her from the Purina OM as I had mentioned in the last post because of the way she was going through food bloat, was lethargic because she was eating too much, and burping up her food because of the volume she was eating.  So far I tried Wellness Simple Solutions in salmon and rice, and the results were rather mixed.  We were mixing it with the Purina OM as we were slowly integrating in the Wellness, and she was doing better.  But with her being on just the Wellness the stools weren't great - sort of a soft service ice cream consistency.  I tried the Natural Balance Bison and Sweet Potato, and that was disastrous.  She had what hubby and I like to call "Poop Soup."  So now we're back on Wellness, and I'm attempting to find a food that will work for her.  Orijen is probably my next one, and perhaps after that Taste of the Wild if I don't find one that works.  I have decided not to enlist the help of the nutritionist at Angell Memorial again because I felt like the food she chose was so grossly NOT the right food for Abby, both in volume and in effectiveness, that I'm not throwing more money her way.  If someone with a degree managed not to pick the right food for Abby, then it communicates to me that they're just going to go by trial and error, and frankly I can do that cheaper on my own. 

So stay tuned for an update once we go to the behaviorist on the 27th of this month! 

Food issues... again

So last I wrote, Abby was trying a new diet that consisted of Purina OM.  That had made a vast improvement in the consistency of her stools; however, other issues have emerged now that she has been on it a little over a month. 

I've never fed a canned diet to a dog.  That said, my mother feeds a mix of both to her dogs (except the older ones who are strictly on canned for their teeth) and she seems to like it.  However, prior to putting Abby on a canned diet, she ate half a cup of Merrick's Grammy's Pot Pie twice daily.  The nutritionst recommended that she should get 2 1/4 cans per day.  I won't lie - this seems like a LOT of food.  When I first put it in Abby's bowl it seemed like a lot in comparison to the volume she received on dry.  But we fed it, and honestly Abby seemed to go into a food coma.  We started noticing that Abby didn't have as much energy.  That isn't to say she was lethargic, but rather I noticed that any energy she had before dinner was quickly replaced with a firm desire to nap.  Almost like most people get after Thanksgiving.  It was as if she was in a Thanksgiving coma. 

It wasn't long before other things started to seem a little bit off.  I noticed that Abby was burping a lot.  But it wasn't just a burp.  She would actually be burping up food.  In most instances she would simply swallow whatever came up.  But sometimes she wasn't so lucky and she'd end up spitting up a good amount of food.  Additionally there were times where it was as if it either came up the wrong way, or she swallowed wrong, but she started to breathe funny for about a minute afterwards.  It almost sounded like a reverse sneeze, and if you didn't know better it was concerning.  The first few times it happened I would wonder if she was breathing OK. 

Additionally Abby has lost weight on the new food.  Now granted, I'm not very concerned about this.  But when you consider that the amount of food she was to eat was calculated based on her weight at the time that we started feeding her OM (40 pounds), it is noteworthy that she is losing weight (36.5 pounds).  I think that anything in the 35-40 pound range seems healthy for her, but if 40 were the ideal weight for her than I'd be worried about how I would correct that problem because admittedly she is getting a TON of food on the OM as it is and I don't know how much more I could give her. 

So hubby and I are thinking about switching her food and trying something else.  I'm not entirely sold on a prescription diet for her, much less one that targets weight management when she isn't an overweight dog.  Additionally I am concerned with her being on a diet that is presciption because I constantly have to worry about making sure to order her food.  And after one time where someone at her veterinarian's office did not forward a note properly for her food to be ordered, I am always worried that such a human error could happen again. 

In other news we have started to taper down her Clomicalm that she has been on for a year.  I am doing a really slow tapering with it.  Instead of doing a half tablet twice daily, I am giving her half a tablet once daily for one month, then half a tablet every other day for a month.  We'll see how that goes.  We have noticed that she is barking a bit more at sounds she hears or things she sees.  My hope is that as I try out a new food for her, I can find a kibble that works and use that to bump up the relaxation protocols. 

Abby did the funniest thing the other day, although I should say that seems to do funny things every day.  We were coming back from a walk and my husband had been running an errand.  He passed by us on our way back, and he had his window open.  Abby watched his car pass and about two seconds later stopped, sniffed the air, and bolted in the direction her Dad had just gone.  Too funny!

She also had her first agility class, and she was an absolute superstar!  It was only her and one other dog, and she did really well with jumping over the hurdles.  Inevitably Jess told us to take their leashes off, and admittedly I was worried.  Abby is NEVER off leash.  We just don't have an area that we could do that work with her.  But she did so well!  There were times where she wanted to be the social butterfly and go see Blue, but largely she stayed with us and sometimes came back when called.  The biggest thing I noticed was how willing Abby was to trust me.  She trusted that I wanted her to walk on equipment that was safe, and to me that was the best part of the class.  Throughout most of the class she looked like she was smiling - it was the cutest thing in the world! 

Next week we're going to try some rally, so I can't wait to see how she does with that! 

Easing back to normal

The past few months have been a little bit hectic as of late, and perhaps the biggest challenge has been our girl's GI issues.  The week of April 18th Abby started with soft stools that were later accompanied by an urgency with her bowel movements.  We brought her to the her veterinarian and got a prescription for Metronidazole and had a discussion about the food that she has been on.  At the time Abby was eating Merrick's Grammy's Pot Pie, and she was doing relatively well with it.  However, I had noticed that it seemed as if Abby periodically had GI issues since we adopted her. 
When we first adopted Abby and brought her to her first veterinarian appointment, her fecal results came back positive for giardia.  We put her on fenbendazole that was to be mixed in with her Science Diet puppy kibble.  I don't know if there was a taste to her medicine, or she didn't like the texture of the medicine in her food.  Either way, she inevitably wanted no part of her food.  She made it through one week of medicine, and then stopped eating even without having medicine in her food.  At that time we tried to change her dry food in an effort to get her to think that if there was a new food, then there was a new MO.  Inevitably she really seemed to dig the Merrick's Puppy Plate.  She did well on this medicine, but after a few months got diarrhea one time.  Her stool sample came back clean and we put her on metronidazole, and eventually the problem cleared up. 

Over the next several months it seemed like we went through periodic issues with diarrhea.  The stool samples were always clean, and the metronidazole cleared up the urgency that accompanied the diarrhea and inevitably helped with the consistency of her stools.  But then this last bout hit in April and we were not able to clear up her problems. 

We did a week of metronidazole, and although it helped with the urgency it did not really affect the consistency of her stools.  The first stool while on metronidazole was solid, and after that they were about the consistency of soft serve (presuming it wasn't full blown diarrhea).  Additionally, when we spoke with the veterinarian, they said that they were seeing a lot of dogs that had problems with Merrick foods.  They said that the fat content in the Merrick foods was very high, and as a result a lot of dogs seem to develop this problem; as if their pancreases have enough and blow out.  We switched her food to a low residue (Iams) and gave her Forti Flora, a probiotic.  After a week when her stools hadn't improved, I tried switching the food to Science Diet I/D dry because she had previously done better on this food.  The stools improved a bit, but not enough.  I called the veterinarian back and they extended the metronidazole and set us up with an appointment for a complete blood panel including TLI and folates, as well as a broader fecal test. 

In true Abby fashion, all of her bloodwork and fecal tests came back fine.  All levels were where they needed to be, which meant that her pancreas was functioning fine and that we weren't having any issues with malabsorption or maldigestion.  At this point we went on an exclusion diet.  Abby would only eat Science Diet I/D dry and the hypoallergenic cookies, and all other treats and foods would be cut out.  Abby's stools did not improve at all on this diet at all.  So we decided to take things a step further. 

One of the vet techs at Abby's vet hospital suggested a nutritionist at Angell Hospital, and I was able to set up a phone consultation with her for this past Tuesday.  She had some very helpful suggestions.  She said that when dogs have problems with digestion, they always look to simplify everything as much as they can.  The fact that Abby had been on a low residue, low fiber food and not improved showed that low fiber was not the way to go.  Additionally, we should also look to switch her from dry food to canned food as the dry food would have a lot more non-nutrative items in it, including preservatives.  That said, the second thing that we should try is a higher fiber food.  She gave us two suggestions:  either Purina OM or half Science Diet I/D and half Science Diet W/D.  Providing this food worked for her, we could then introduce treats for her training such as carrots, rice cakes, or mini marshmallows.  If this did not work either, then we would simplify further and try a novel protein diet. 

While I waited for Abby's Purina OM to come in, I immediately switched her to Science Diet I/D canned food.  I immediately noticed an improvement in Abby's stools.  Abby's new food came in on Friday, and she started with that at dinner and really seemed to dig the taste of it.  I have to say that since switching Abby to canned food, she has been SUPER interested in food.  She is actually salivating for meals, and is even more food motivated than she was before. 

I still am not sure how mini marshmallows are a good treat for her given the amount of sugar in them.  But I'm thinking that if I cut these in half to make them even smaller, I could integrate them in combination with the other treats as a trail mix for her training.  All I know is that it is so wonderful to have her finally on the road back to normal.