BraindumpDiscussion on Dog's Nutrition and Health Status
Summary:
- Concerns about the dog's weight loss and diet intake were discussed, focusing on calorie calculation.
- The dog is currently eating low-fat ground beef, turkey, vegetables, and has ongoing issues with weight management.
- Dr. Oliver approved a balanced diet plan but there are complications logging it into the Balance It website.
- A nutritionist is being sought, with the University of Tennessee recommended as a potential resource.
- The latest blood work showed stable liver values but an increase in BUN, raising concerns about kidney health and protein intake.
- Clavamox is to be continued for three weeks, while adjustments to prednisone and azithromycin were discussed for management of the dog's health.
- The vet noted a possible vagal response may have occurred after the dog vomited, rather than a seizure.
- There were also discussions about fluid intake and how that relates to the dog's kidney health.
Content:
Um, would you say like eating a normal amount, or? Yeah, he seems hungry all the time, but I'm worried about feeding him too much and him getting sick again. Um, or do you know how many calories, how much he is taking in per day? Uh, no, I can try to calculate that up with my mom and get that to you. Okay. Like... Yeah, if you can, I'm just curious how much he's eating because he is still losing weight, so I just want to kind of see where his baseline is, you know, as much as he's taking in.
Um, because I have a calculation of like this is how much he should be eating, but it is just a calculation. So I'm just curious where he falls at on that scale. We've been giving him, like, um, the low-fat ground beef, the low-fat ground turkey, carrots, pumpkin, green beans, sometimes zucchini, and I was trying to use the balance it website, and it like kept saying that it couldn't come up with a balanced diet with that, but it wasn't telling me like what it was missing. And then I think I tried adding in like sweet potato, and finally it said that it went through, but it wouldn't give me the recipe, and so I had sent it to his primary vet, Dr. Oliver, and it said that Dr. Oliver approved it, but then when I went to log back in, there's nothing there.
So I wrote balance it, but it says that it could take five days for them to get back to me. And I also wanted to check with you, do you know, um, we're trying to find a nutritionist because right before he wound up being admitted to VCA, I had reached out to his nutritionist that we would do Zoom calls with, and she was, for a while now, wanting to retire, and she just basically said to me, oh, it's time to let him go, and didn't give me any advice, and that's before he even got really sick.
Do you know of anyone in particular? Like, I know VCA said that you guys used to have a nutritionist, but they moved. Yeah, she's actually not, she moved to Tucson, but then I think she even moved on from there. That was a while ago. So the only one that I know of that we use is through the University of Tennessee. Mm-hmm. And so you can request a consult with them. Last I heard, they are booked out for like a month or two. So, but other than that, I don't, like, they're hard to come by, so I don't know anyone else specifically, but you could at least try to, like, look into that.
Do you know who, who that doctor's name is? I don't know the specific name. I'd have to go back and look. We don't use them very often, so I don't remember the name specifically. And I don't know if they have more than one or just the one. But I know it is University of Tennessee. Who was it that moved to Tucson that I could maybe try to look them up as well? Let me see how you spell her name. It's Markovitch. Okay. Yeah, let me see. I'm not actually sure where she's at, but it's Dr. Markovitch.
I'll try to remember her first name. Because I was looking up, like, some on Balance It, and... Jessie Markovitch. Oh, Jessie, okay. The first one that came up is, I think, where his internal medicine specialist at Desert Vet Medical Specialists had sent the GI panel, the Texas one. I think, like, something came up there, but it was like, oh, it's going to be, like, close to $1,000 just for a Zoom call. And I just worry, like, I've had him on so many different foods and he still got sick, and his bills have just been so much.
I'm just worried about spending $1,000 and then him just getting sick again. Yeah, I know the University of Tennessee, I want to say, to meet with them, it'd be over a phone call, is, I think, $400 or so. So it's not quite that expensive compared to the $1,000. But just so you know for that one, I want to say it's around $400, if I remember correctly. Okay. Okay, so let me go over the results with you here. So we can see that his liver values are fairly static, I would say. So his ALT and ALP still hanging around like the 500 to 600 range for that ALT.
The ALP is around, technically went from almost 16,000 to around 14,000. Insignificant change, in my opinion. Overall, I think that's fairly steady, where we are seeing really good improvement in his bilirubin level. That's come down to 0.4, so that's almost normal. 0.3 is kind of that cutoff. So I was really happy to see that bilirubin come down, so that tells me that, hey, hopefully we're treating something there. So I'm happy with that. The white cell count has also come down, so that's improved a decent amount, too. It went from 46,000 to 34,000. So still pretty high, but that is significantly improved, in my opinion.
Still mainly the two types of white cells and neutrophils, monocytes. Those are still the types of the highest ones there. So not really changing anything. We know there's inflammation there. The question is, where is that coming from? And my suspicion is the pancreas and or the intestines. The only thing that's kind of gotten a bit worse is one of his kidney values, the BUN, went from 44 to almost 130. So that could be, because it sounds like he's getting a lot of protein, some of that could be related to his diet. Some of that could be related to, is his kidney disease progressing?
This panel does not measure creatinine, so we can look at that, but he's also eating better. So I'm hoping it's more so the protein intake. But that is something that we could always look at. Do we just recheck his creatinine value, too, and see if that's changed? But I think, you know, our main concern, of course, was the bilirubin and why that was going up. So I think whatever we're treating, you know, is it the antibiotic, is it the steroid? I still don't really know at this point, or is it both that's helping? But my suggestion for now is to, let me see what we first started the Clavimox.
That was around June 12th. So we're coming up on almost a month of treatment. I'd probably give him another two weeks of the Clavimox, because I'd like to see that bilirubin be normal, ideally, before we stop it anyway. So I'd probably give him another good two weeks on that to kind of give him a full, good round. I usually do like minimum four to six weeks of antibiotics, so that'll fall right in that range. And then I go a little bit longer, just... I always debate, but I always... Just because he seems to be tolerating it well, and I'd rather be safe than sorry.
So maybe let's do three weeks just to give him a little bit longer than what I normally do. And it's still technically within that six-week range there. So let's do an additional three weeks. And then I'm also trying to time it, too, because I'm going to be out of town a week and a half. Okay. So I'd rather have you do it until I get back so we can be on the safe side and check his blood work. Because I want to check his blood work one more time before we stop the antibiotics and see, hey, is your bilirubin now normal?
Okay. So we could plan for the week of the 27th to check his blood work at that point. And maybe on that panel, we include the kidney value on there too. Okay. Do you think that any of, I know we're going to need to get a refill of the Clavamox because I don't have enough for today. But do you think any of the other stuff we should discontinue? We actually did see his previous internal medicine specialist too. We had something scheduled with her a long time ago. And she was recommending to lower the prednisone just a little bit.
Like, do you agree with that? Yes, that was the other thing I was going to suggest, is do we look at prednisone now? So let me calculate what I would prefer to lower it to. I would, because you're doing one and a half mils twice a day, right? Yeah. And we saw her like maybe like five days ago and she said she suggested taking it down to one for a while. Perfect. That's what I calculated as well. Yeah. So let's reduce that to one mil twice a day. And that could be some of the reason why the liver values, like the ALT, ALT at least, are not improving.
Just being on the prednisone can cause that change too. So it makes it a little bit hard when I'm being on the prednisone to interpret, but I think he needs the prednisone. Yeah. But we can at least try lowering it and see what that does and continue the Clavamox for sure. How long do you think he should stay on the prednisone? And do you think, is the prednisone part of the reason why he feels, like I can really feel his spine besides him losing weight? Like, does it make you lose muscle? It does. Yes, it does.
And so the longer they're on it, it's more likely we'll see muscle loss, which is why we don't like them to be on it long term, but some dogs need it long term. So I'm going to have you, I think he's going to need to be on it for several months, to be honest. Okay. We're going to kind of, I want to give him the same three weeks. I don't want to change too much at the same time. So since we're continuing the Clavamox, we'll lower the Pred first. And then in three weeks, if his bilirubin is hopefully normal, we'll stop the Clavamox and then maybe like a week or two later, reduce the Pred more if he's still doing okay.
But it also depends what his weight is doing, and that's where I want to see, like, what is his actual calorie intake. Is there any of the other medications that you think that we should change for now or just, like the Clavamox will stay the same amount, right? Correct. That's not changing. Okay, so do you think we should just change the prednisone for now? I would. I would say maybe after, like, two weeks or so, we could, if you wanted to, try to get him off the azithromycin. That's the only other one that I'm like, I'm not convinced he needs that at this point, but I don't want to change it at the same time as the Pred.
So I guess I could leave it up to you if you would say, because the azithro is, like, pretty quick. We'll know in a few days if he needs it. Like, that is something where, like, we could wean him off the azithromycin first over the next week and then decrease the Pred. Or decrease the Pred, give him two weeks, and then try decreasing the azithromycin. What if we took him off the azithromycin in a bit? What are some, like, anything I should look out for? Just if he's starts vomiting again would be the main concern.
If his appetite goes down and he starts vomiting again. The azithro, what that's doing is it moves through the intestines, um, emptying the stomach. But even when he was here in the hospital, his stomach never really filled up with fluid. So that's where I'm like, I'm not sure that he needs it, but he was on it, so we're like, well, I don't want to rock the boat type of thing. But now, especially since he's eating better and more consistently, I feel like he'd be fine without it. So is that more like the motility one? Correct.
And did, uh, did BCa give you the message the other day when I think he might have had a seizure? Uh, I did see that. Um, yes, so I wanted to talk about that. Um, it sounds like it was right around the time he vomited, was it before or after vomiting? It was immediately after, so I was here by myself. It's really hard for me to give him his meds by himself. Like, one of the techs had showed me to, like, sit down on the floor, put him backwards between my legs so I could have one arm around him and the other arm to, uh, administer the medication.
And I try to go really slow and give him, and it was 6 p.m., so he was taking three things. I think it was, uh, the prednisone, the ondansetron, and maybe it was the Clavamox. It was three things. So he had just had, like, quite a bit of meds. And, like, I got up and I was like, okay, it's time to eat because I feed him, like, every three hours. And he got up and he followed me over to the fridge and then immediately just stopped, hunched over, threw up a very small amount, which that's the first time he's vomited since, uh, he was admitted.
And it was a, it was a small, like, golf ball size amount, but, like, I was alarmed. And then immediately after he threw up, he flipped over on his side and his legs went real stiff and he just started thrashing around. And so I grabbed him and held him down and it was probably only a few moments, but, like, my mom's like, well, we don't know it was a seizure. They had had a dog that had seizures every time the pest people came to spray. We don't do anymore. And it looked to me exactly like that.
Is there anything else you could think of that it would be since it was immediately after vomiting? Did, so you said he was thrashing his legs. Was, how was he after he recovered? Was he like back to normal in a few days? Yeah, immediately. He got up and he walked to the back door and I had ran up to get my phone to call my boyfriend because I was worried it was going to have to bring him back over. And he was just standing there by the door and I took him out in the back and then he took a huge dump.
So I don't know if that's possibly why he threw up as well. If he was too full because he's had an issue of that in the past where if he got constipated or something, then he would throw up. But he's been having bowel movements every day and they're like solid logs. He hasn't been having diarrhea or anything. I mean, what you're describing to me sounds more what I would call a vagal response. So after when it doesn't happen all the time, it's not actually that common, but we do see it where after they vomit, there's a nerve that runs right down next to their esophagus.
Sometimes it triggers that nerve and so it causes a significantly rapid change in their heart rate to be too low. So then they kind of collapse. So the thrashing part you were seeing was probably him like a either natural reaction because he felt like he fell over or to just like he collapsed for a second because he lost consciousness briefly from the low heart rate. And then he woke up and realized he was like, like laying on his side. He's like, oh no, I need to get back up. But the fact that he recovered so quickly, um just how fast it happened after vomiting, it's probably a vagal response.
So there's nothing we need to do about that. Um because it doesn't sound like an actual seizure. And do you think, like, he didn't stop moving. Like, he didn't, like, fall on his side and, like, lay there. Like, he fell over and immediately was like moving his arms, like, just, they were straight stiff out, just, like, going forth. Like, you still think that's probably what it was? Okay. And there's nothing I can do about that, right? It just... Correct. Okay. Correct. Yeah, yeah. Now if it's happening multiple times, then that would make me think, okay, there's something else happening.
But otherwise, it sounds like it's a fatal response. Okay. So I think, yeah, I guess it's up to you if you want to try to decrease the azithromycin first versus the prednisone first. You know, because again, I just want to try to avoid changing too many things at once. And then we don't know what actually, like if it did get worse, what's actually helping. So, but I would pick one of those so we can get them off at least one fat medication. And then we can wait until three weeks or so. In your opinion, which one do you think I should try first?
I mean, just because it's only a week waiting period with the azithromycin first instead of the two weeks waiting for two weeks for the pred to change it. So, and also azithromycin is more frequently given than the pred. So I'd be inclined to maybe save the azithro. So let's see. So then what's the, sorry, I'm like trying to write all this down as notes. So then what exactly should I do with this at this moment? So, yeah, with the azithromycin, right, like today, you could say, or tomorrow, depending on when you gave it today, we could go decrease the azithromycin to twice a day for three days.
So still the same amount, the 0.32, but you're going to go to twice a day for three days and then go to once a day for three days and then stop it. Okay. And then with the prednisone, should I just keep that normal for now then? Yep, I would keep that normal for about a week. So I would say like a couple days after, let's just say three days after he's off the azithromycin, then you could decrease the pred at that point. Okay. Okay. Let's see. And do you think, like, since he's improved some, or improved, I mean, fairly well, do you think it's still possible that it's cancer?
I think I can't rule it out because prednisone is one that is one of the treatments for lymphoma that can cause some of the things he has. But whenever we did the ultrasound, like the initial one, he didn't have that focal thickness there and the next one he did. So that's where I'm like, for it to happen so suddenly, I'm like, that's... So I guess I can't rule it out that it could still be there. Do you think, like, if it is, that would there be, like, a big change in him when we're decreasing things then?
Potentially, but he's still on a good dose. So it is still something where even if this was, even if we knew this was cancer, this is generally kind of the, we're still, even though we're lowering the dose, it's still in the range that we would normally use, even if there was cancer there. So he shouldn't get significantly worse if he gets worse at all, even if it was cancer. And then I guess the other concern, if he's, you know, taking in enough calories, then in theory, he, because he's still losing weight and he's taking in enough calories, that's the other worry where I'm like, are you still losing weight despite the calorie intake because there's cancer there and he's more than the pred, or there is just severe enough inflammation there that the pred alone isn't cutting it.
So that's where I just don't, I want to see where his calorie count is. Okay, and so I'll try to figure that out with my mom because I've pretty much just been trying to eyeball, like with the same utensils every day, like what I'm giving him. But I'll try to measure one out and figure it out from whatever my mom has bought and get that to you. Is it best for me to just call or is there an email over there that's best for you? Yeah, probably email would be best. I can give you that.
It's Areca, so it's A-R-E-C-A medicine at BCA.com. Okay, and if like when we get to the point where we're lowering the prednisone and like if a couple months go by, that's how long you said we would probably keep him on it, right? Yeah, I mean, and we'll be kind of slowly tapering it, you know, typically every three to four weeks. But again, it just depends what his calorie intake is too. Is there like a point where, I guess, if he started getting worse again, then it might show up more that it was cancer if there's like less prednisone or he's off prednisone or does prednisone like last for, I guess, masking like cancer symptoms or something for a set period of time?
Yeah, so because prednisone does treat the lymphoma cancer as part of the treatment, it kind of is hiding those cancer cells. And so it is something where as we lower the pred or especially once he's off of it, that it could flare back up if there is cancer there. So that's where when I'm decreasing pred, I'm usually decreasing it every three to four weeks to kind of give their body time to see how they're going to react to it. And if anything's relapsing, then I'd say, okay, well, we're going to go back up on the pred and see what he does.
And would it be the same kind of side effects as the azithromycin? Like if he's not eating well or throwing up? Correct. Okay. And then when should I... I think if you guys are putting in a refill for... Clavamox. Clavamox. And then there was two other things that I had text over there the other day that my mom said we were low on and they said... Let me try to see if I can find it to pull it up. Yes, yes. Those are fine. Everything else is good, right? Yeah, everything else is good. So we're just going to refill the ursidyl on Daytron and Clavamox.
Yeah. Sounds right? Okay. Perfect. So I'll get you three more weeks of the Clavamox and then I'll get you, let's see, do you want two months of the ursidyl on Daytron because you'll probably be on that for quite a while? Yeah. Okay. All right. So we'll fill that and then we'll send you a text as soon as it's filled. I know you need it today, so we'll send you a text as soon as it's filled. Okay, thank you. And if my mom has any questions, is it okay if I just email that address? Mm-hmm. Okay.
Do I need to put attention for you or anything? Nope, we'll see. I just mentioned Yogi. I'm sure we'll see your name that says for Yogi. And we'll know who it is. He seems like, like, he'll go through bouts of having, like, a lot of energy. Like, he's starting to do things he hasn't done since he got sick. Like, climbing all over me in the mornings, wanting me to... Get up to take him out, and I have bed rails all along my bed to try to keep him up since he has a ramp, and I was worried about him falling.
I had to use the bathroom today, and I had the bed rails up. He squeezed through the bed rails and jumped off my bed. And I said, you must have an angel looking out for you because I've been monitoring him and he seems fine, but it's a big drop. Yeah. Yeah. Well, I guess I would just say keep an eye on him. I didn't know if I should give him any gabapentin, but like, he didn't yelp or anything. He just kept on walking and he's been walking fine. If he's not limping or anything, I don't think you need to.
Okay. I'm just, I'm trying my best. It's just rough. I feel like I can't watch him 24 7. Thank you so much for all of your help. And do you know maybe how long it may take them to get the meds today? Hopefully here it says it should be in the next 30 minutes to half an hour or so. Okay, great. Thank you. Thank you. Okay. Well, thank you so much and have a good night. Thanks, you too. Did you want me to get you scheduled for three weeks? Yes, yes, yes. Sorry, I forgot about that.
Let's do that. So we'll do the week of the 26th. Is there a day that works best for you? So this is just for labs, right? Correct. Okay, let me see. I think any time is fine. We do have that Sunday the 26th if you are free on a Sunday. Otherwise, it's pretty open. So we have anywhere from 8 to 11:15 and 1 to 3:45. Sometime between, is there something like at 10:30? Yep, we do. Let me see. That's 10:30. Yeah. Okay, let's see. Let's do that because I'm pretty sure I give him something at 10 and then we could drive right over there to you guys.
All right, so we'll do that. We're just going to do the bigger panel that time. That way we can see what the kidney values are doing. All right. I got you booked for Sunday, July 26th at 10:30. And you don't think that I should... He used to take kidney supplements from... Oh, gosh. I'm having a brain fart. I forgot the name, but I did not give him the supplements right now just since there's been so many changes with him. If you want to send me a picture or maybe the name of which supplements, because I think it depends which ones.
Okay. And, hang on, I'm writing this down. And it's the VetraScience. Oh, VetraScience. No, that one's fine if you want to do that. That's not going to hurt anything. I wouldn't say it's a priority, given everything else, but it's not going to hurt if you give it. And I had an appointment scheduled a long time ago for tomorrow with Dr. Church, a cardiologist at Desert Vet. Do you think, like, I should just go ahead and do that and see if there's been any changes? I would, just in case, because it will help us, especially as we're still doing the fluids for him, so we can just make sure there's nothing going on that would contraindicate us if we needed to change the fluids.
And we have fluids every day now, just because he had been drinking a lot. I got, like, a pet fountain and then it stopped working today, so I ordered another one. And today he hasn't been drinking as much, but do you think we should continue the fluids every day, or if he's drinking a lot, then maybe back off some? Well, what's hard is, you know, with kidney disease, because he does have, like, early stages of it, and so that's going to make them drink and urinate more, but they're not really processing it normally, so he can still become dehydrated.
And that could be contributing to the BUN being high. So I would say just try to do that more consistently, even though he is drinking a good amount. And do you think, because I think the last couple times we just gave him 50 cc's because he is starting to wiggle around so much. And one time he was moving, like, I try to hold him down while my mom isn't holding the needle in. He moved around so much that I guess the needle moved and he yelped. Do you think we should be doing 50 or 100?
I would try to aim for 100 if you can. If you can get at least 50, that's good. And I would say try to do it, like, at least every other day, if not every day. But at least if you can, at least every other day, that would be ideal. Okay. At least for now. And then we can see what his kidney values look like and see if we can reduce that again. But just because I see the BUN at least is increased, I think that could not only be from the protein diet, but that could be from dehydration too.
Okay. Okay, thank you so much. You're welcome. Anything else? Uh, I think that's it. Thank you. Okay, you're welcome. You have a good rest of your day. We'll text you here soon when the meds are filled. Okay, thank you. Bye. Bye.
- Concerns about the dog's weight loss and diet intake were discussed, focusing on calorie calculation.
- The dog is currently eating low-fat ground beef, turkey, vegetables, and has ongoing issues with weight management.
- Dr. Oliver approved a balanced diet plan but there are complications logging it into the Balance It website.
- A nutritionist is being sought, with the University of Tennessee recommended as a potential resource.
- The latest blood work showed stable liver values but an increase in BUN, raising concerns about kidney health and protein intake.
- Clavamox is to be continued for three weeks, while adjustments to prednisone and azithromycin were discussed for management of the dog's health.
- The vet noted a possible vagal response may have occurred after the dog vomited, rather than a seizure.
- There were also discussions about fluid intake and how that relates to the dog's kidney health.
Content:
Um, would you say like eating a normal amount, or? Yeah, he seems hungry all the time, but I'm worried about feeding him too much and him getting sick again. Um, or do you know how many calories, how much he is taking in per day? Uh, no, I can try to calculate that up with my mom and get that to you. Okay. Like... Yeah, if you can, I'm just curious how much he's eating because he is still losing weight, so I just want to kind of see where his baseline is, you know, as much as he's taking in.
Um, because I have a calculation of like this is how much he should be eating, but it is just a calculation. So I'm just curious where he falls at on that scale. We've been giving him, like, um, the low-fat ground beef, the low-fat ground turkey, carrots, pumpkin, green beans, sometimes zucchini, and I was trying to use the balance it website, and it like kept saying that it couldn't come up with a balanced diet with that, but it wasn't telling me like what it was missing. And then I think I tried adding in like sweet potato, and finally it said that it went through, but it wouldn't give me the recipe, and so I had sent it to his primary vet, Dr. Oliver, and it said that Dr. Oliver approved it, but then when I went to log back in, there's nothing there.
So I wrote balance it, but it says that it could take five days for them to get back to me. And I also wanted to check with you, do you know, um, we're trying to find a nutritionist because right before he wound up being admitted to VCA, I had reached out to his nutritionist that we would do Zoom calls with, and she was, for a while now, wanting to retire, and she just basically said to me, oh, it's time to let him go, and didn't give me any advice, and that's before he even got really sick.
Do you know of anyone in particular? Like, I know VCA said that you guys used to have a nutritionist, but they moved. Yeah, she's actually not, she moved to Tucson, but then I think she even moved on from there. That was a while ago. So the only one that I know of that we use is through the University of Tennessee. Mm-hmm. And so you can request a consult with them. Last I heard, they are booked out for like a month or two. So, but other than that, I don't, like, they're hard to come by, so I don't know anyone else specifically, but you could at least try to, like, look into that.
Do you know who, who that doctor's name is? I don't know the specific name. I'd have to go back and look. We don't use them very often, so I don't remember the name specifically. And I don't know if they have more than one or just the one. But I know it is University of Tennessee. Who was it that moved to Tucson that I could maybe try to look them up as well? Let me see how you spell her name. It's Markovitch. Okay. Yeah, let me see. I'm not actually sure where she's at, but it's Dr. Markovitch.
I'll try to remember her first name. Because I was looking up, like, some on Balance It, and... Jessie Markovitch. Oh, Jessie, okay. The first one that came up is, I think, where his internal medicine specialist at Desert Vet Medical Specialists had sent the GI panel, the Texas one. I think, like, something came up there, but it was like, oh, it's going to be, like, close to $1,000 just for a Zoom call. And I just worry, like, I've had him on so many different foods and he still got sick, and his bills have just been so much.
I'm just worried about spending $1,000 and then him just getting sick again. Yeah, I know the University of Tennessee, I want to say, to meet with them, it'd be over a phone call, is, I think, $400 or so. So it's not quite that expensive compared to the $1,000. But just so you know for that one, I want to say it's around $400, if I remember correctly. Okay. Okay, so let me go over the results with you here. So we can see that his liver values are fairly static, I would say. So his ALT and ALP still hanging around like the 500 to 600 range for that ALT.
The ALP is around, technically went from almost 16,000 to around 14,000. Insignificant change, in my opinion. Overall, I think that's fairly steady, where we are seeing really good improvement in his bilirubin level. That's come down to 0.4, so that's almost normal. 0.3 is kind of that cutoff. So I was really happy to see that bilirubin come down, so that tells me that, hey, hopefully we're treating something there. So I'm happy with that. The white cell count has also come down, so that's improved a decent amount, too. It went from 46,000 to 34,000. So still pretty high, but that is significantly improved, in my opinion.
Still mainly the two types of white cells and neutrophils, monocytes. Those are still the types of the highest ones there. So not really changing anything. We know there's inflammation there. The question is, where is that coming from? And my suspicion is the pancreas and or the intestines. The only thing that's kind of gotten a bit worse is one of his kidney values, the BUN, went from 44 to almost 130. So that could be, because it sounds like he's getting a lot of protein, some of that could be related to his diet. Some of that could be related to, is his kidney disease progressing?
This panel does not measure creatinine, so we can look at that, but he's also eating better. So I'm hoping it's more so the protein intake. But that is something that we could always look at. Do we just recheck his creatinine value, too, and see if that's changed? But I think, you know, our main concern, of course, was the bilirubin and why that was going up. So I think whatever we're treating, you know, is it the antibiotic, is it the steroid? I still don't really know at this point, or is it both that's helping? But my suggestion for now is to, let me see what we first started the Clavimox.
That was around June 12th. So we're coming up on almost a month of treatment. I'd probably give him another two weeks of the Clavimox, because I'd like to see that bilirubin be normal, ideally, before we stop it anyway. So I'd probably give him another good two weeks on that to kind of give him a full, good round. I usually do like minimum four to six weeks of antibiotics, so that'll fall right in that range. And then I go a little bit longer, just... I always debate, but I always... Just because he seems to be tolerating it well, and I'd rather be safe than sorry.
So maybe let's do three weeks just to give him a little bit longer than what I normally do. And it's still technically within that six-week range there. So let's do an additional three weeks. And then I'm also trying to time it, too, because I'm going to be out of town a week and a half. Okay. So I'd rather have you do it until I get back so we can be on the safe side and check his blood work. Because I want to check his blood work one more time before we stop the antibiotics and see, hey, is your bilirubin now normal?
Okay. So we could plan for the week of the 27th to check his blood work at that point. And maybe on that panel, we include the kidney value on there too. Okay. Do you think that any of, I know we're going to need to get a refill of the Clavamox because I don't have enough for today. But do you think any of the other stuff we should discontinue? We actually did see his previous internal medicine specialist too. We had something scheduled with her a long time ago. And she was recommending to lower the prednisone just a little bit.
Like, do you agree with that? Yes, that was the other thing I was going to suggest, is do we look at prednisone now? So let me calculate what I would prefer to lower it to. I would, because you're doing one and a half mils twice a day, right? Yeah. And we saw her like maybe like five days ago and she said she suggested taking it down to one for a while. Perfect. That's what I calculated as well. Yeah. So let's reduce that to one mil twice a day. And that could be some of the reason why the liver values, like the ALT, ALT at least, are not improving.
Just being on the prednisone can cause that change too. So it makes it a little bit hard when I'm being on the prednisone to interpret, but I think he needs the prednisone. Yeah. But we can at least try lowering it and see what that does and continue the Clavamox for sure. How long do you think he should stay on the prednisone? And do you think, is the prednisone part of the reason why he feels, like I can really feel his spine besides him losing weight? Like, does it make you lose muscle? It does. Yes, it does.
And so the longer they're on it, it's more likely we'll see muscle loss, which is why we don't like them to be on it long term, but some dogs need it long term. So I'm going to have you, I think he's going to need to be on it for several months, to be honest. Okay. We're going to kind of, I want to give him the same three weeks. I don't want to change too much at the same time. So since we're continuing the Clavamox, we'll lower the Pred first. And then in three weeks, if his bilirubin is hopefully normal, we'll stop the Clavamox and then maybe like a week or two later, reduce the Pred more if he's still doing okay.
But it also depends what his weight is doing, and that's where I want to see, like, what is his actual calorie intake. Is there any of the other medications that you think that we should change for now or just, like the Clavamox will stay the same amount, right? Correct. That's not changing. Okay, so do you think we should just change the prednisone for now? I would. I would say maybe after, like, two weeks or so, we could, if you wanted to, try to get him off the azithromycin. That's the only other one that I'm like, I'm not convinced he needs that at this point, but I don't want to change it at the same time as the Pred.
So I guess I could leave it up to you if you would say, because the azithro is, like, pretty quick. We'll know in a few days if he needs it. Like, that is something where, like, we could wean him off the azithromycin first over the next week and then decrease the Pred. Or decrease the Pred, give him two weeks, and then try decreasing the azithromycin. What if we took him off the azithromycin in a bit? What are some, like, anything I should look out for? Just if he's starts vomiting again would be the main concern.
If his appetite goes down and he starts vomiting again. The azithro, what that's doing is it moves through the intestines, um, emptying the stomach. But even when he was here in the hospital, his stomach never really filled up with fluid. So that's where I'm like, I'm not sure that he needs it, but he was on it, so we're like, well, I don't want to rock the boat type of thing. But now, especially since he's eating better and more consistently, I feel like he'd be fine without it. So is that more like the motility one? Correct.
And did, uh, did BCa give you the message the other day when I think he might have had a seizure? Uh, I did see that. Um, yes, so I wanted to talk about that. Um, it sounds like it was right around the time he vomited, was it before or after vomiting? It was immediately after, so I was here by myself. It's really hard for me to give him his meds by himself. Like, one of the techs had showed me to, like, sit down on the floor, put him backwards between my legs so I could have one arm around him and the other arm to, uh, administer the medication.
And I try to go really slow and give him, and it was 6 p.m., so he was taking three things. I think it was, uh, the prednisone, the ondansetron, and maybe it was the Clavamox. It was three things. So he had just had, like, quite a bit of meds. And, like, I got up and I was like, okay, it's time to eat because I feed him, like, every three hours. And he got up and he followed me over to the fridge and then immediately just stopped, hunched over, threw up a very small amount, which that's the first time he's vomited since, uh, he was admitted.
And it was a, it was a small, like, golf ball size amount, but, like, I was alarmed. And then immediately after he threw up, he flipped over on his side and his legs went real stiff and he just started thrashing around. And so I grabbed him and held him down and it was probably only a few moments, but, like, my mom's like, well, we don't know it was a seizure. They had had a dog that had seizures every time the pest people came to spray. We don't do anymore. And it looked to me exactly like that.
Is there anything else you could think of that it would be since it was immediately after vomiting? Did, so you said he was thrashing his legs. Was, how was he after he recovered? Was he like back to normal in a few days? Yeah, immediately. He got up and he walked to the back door and I had ran up to get my phone to call my boyfriend because I was worried it was going to have to bring him back over. And he was just standing there by the door and I took him out in the back and then he took a huge dump.
So I don't know if that's possibly why he threw up as well. If he was too full because he's had an issue of that in the past where if he got constipated or something, then he would throw up. But he's been having bowel movements every day and they're like solid logs. He hasn't been having diarrhea or anything. I mean, what you're describing to me sounds more what I would call a vagal response. So after when it doesn't happen all the time, it's not actually that common, but we do see it where after they vomit, there's a nerve that runs right down next to their esophagus.
Sometimes it triggers that nerve and so it causes a significantly rapid change in their heart rate to be too low. So then they kind of collapse. So the thrashing part you were seeing was probably him like a either natural reaction because he felt like he fell over or to just like he collapsed for a second because he lost consciousness briefly from the low heart rate. And then he woke up and realized he was like, like laying on his side. He's like, oh no, I need to get back up. But the fact that he recovered so quickly, um just how fast it happened after vomiting, it's probably a vagal response.
So there's nothing we need to do about that. Um because it doesn't sound like an actual seizure. And do you think, like, he didn't stop moving. Like, he didn't, like, fall on his side and, like, lay there. Like, he fell over and immediately was like moving his arms, like, just, they were straight stiff out, just, like, going forth. Like, you still think that's probably what it was? Okay. And there's nothing I can do about that, right? It just... Correct. Okay. Correct. Yeah, yeah. Now if it's happening multiple times, then that would make me think, okay, there's something else happening.
But otherwise, it sounds like it's a fatal response. Okay. So I think, yeah, I guess it's up to you if you want to try to decrease the azithromycin first versus the prednisone first. You know, because again, I just want to try to avoid changing too many things at once. And then we don't know what actually, like if it did get worse, what's actually helping. So, but I would pick one of those so we can get them off at least one fat medication. And then we can wait until three weeks or so. In your opinion, which one do you think I should try first?
I mean, just because it's only a week waiting period with the azithromycin first instead of the two weeks waiting for two weeks for the pred to change it. So, and also azithromycin is more frequently given than the pred. So I'd be inclined to maybe save the azithro. So let's see. So then what's the, sorry, I'm like trying to write all this down as notes. So then what exactly should I do with this at this moment? So, yeah, with the azithromycin, right, like today, you could say, or tomorrow, depending on when you gave it today, we could go decrease the azithromycin to twice a day for three days.
So still the same amount, the 0.32, but you're going to go to twice a day for three days and then go to once a day for three days and then stop it. Okay. And then with the prednisone, should I just keep that normal for now then? Yep, I would keep that normal for about a week. So I would say like a couple days after, let's just say three days after he's off the azithromycin, then you could decrease the pred at that point. Okay. Okay. Let's see. And do you think, like, since he's improved some, or improved, I mean, fairly well, do you think it's still possible that it's cancer?
I think I can't rule it out because prednisone is one that is one of the treatments for lymphoma that can cause some of the things he has. But whenever we did the ultrasound, like the initial one, he didn't have that focal thickness there and the next one he did. So that's where I'm like, for it to happen so suddenly, I'm like, that's... So I guess I can't rule it out that it could still be there. Do you think, like, if it is, that would there be, like, a big change in him when we're decreasing things then?
Potentially, but he's still on a good dose. So it is still something where even if this was, even if we knew this was cancer, this is generally kind of the, we're still, even though we're lowering the dose, it's still in the range that we would normally use, even if there was cancer there. So he shouldn't get significantly worse if he gets worse at all, even if it was cancer. And then I guess the other concern, if he's, you know, taking in enough calories, then in theory, he, because he's still losing weight and he's taking in enough calories, that's the other worry where I'm like, are you still losing weight despite the calorie intake because there's cancer there and he's more than the pred, or there is just severe enough inflammation there that the pred alone isn't cutting it.
So that's where I just don't, I want to see where his calorie count is. Okay, and so I'll try to figure that out with my mom because I've pretty much just been trying to eyeball, like with the same utensils every day, like what I'm giving him. But I'll try to measure one out and figure it out from whatever my mom has bought and get that to you. Is it best for me to just call or is there an email over there that's best for you? Yeah, probably email would be best. I can give you that.
It's Areca, so it's A-R-E-C-A medicine at BCA.com. Okay, and if like when we get to the point where we're lowering the prednisone and like if a couple months go by, that's how long you said we would probably keep him on it, right? Yeah, I mean, and we'll be kind of slowly tapering it, you know, typically every three to four weeks. But again, it just depends what his calorie intake is too. Is there like a point where, I guess, if he started getting worse again, then it might show up more that it was cancer if there's like less prednisone or he's off prednisone or does prednisone like last for, I guess, masking like cancer symptoms or something for a set period of time?
Yeah, so because prednisone does treat the lymphoma cancer as part of the treatment, it kind of is hiding those cancer cells. And so it is something where as we lower the pred or especially once he's off of it, that it could flare back up if there is cancer there. So that's where when I'm decreasing pred, I'm usually decreasing it every three to four weeks to kind of give their body time to see how they're going to react to it. And if anything's relapsing, then I'd say, okay, well, we're going to go back up on the pred and see what he does.
And would it be the same kind of side effects as the azithromycin? Like if he's not eating well or throwing up? Correct. Okay. And then when should I... I think if you guys are putting in a refill for... Clavamox. Clavamox. And then there was two other things that I had text over there the other day that my mom said we were low on and they said... Let me try to see if I can find it to pull it up. Yes, yes. Those are fine. Everything else is good, right? Yeah, everything else is good. So we're just going to refill the ursidyl on Daytron and Clavamox.
Yeah. Sounds right? Okay. Perfect. So I'll get you three more weeks of the Clavamox and then I'll get you, let's see, do you want two months of the ursidyl on Daytron because you'll probably be on that for quite a while? Yeah. Okay. All right. So we'll fill that and then we'll send you a text as soon as it's filled. I know you need it today, so we'll send you a text as soon as it's filled. Okay, thank you. And if my mom has any questions, is it okay if I just email that address? Mm-hmm. Okay.
Do I need to put attention for you or anything? Nope, we'll see. I just mentioned Yogi. I'm sure we'll see your name that says for Yogi. And we'll know who it is. He seems like, like, he'll go through bouts of having, like, a lot of energy. Like, he's starting to do things he hasn't done since he got sick. Like, climbing all over me in the mornings, wanting me to... Get up to take him out, and I have bed rails all along my bed to try to keep him up since he has a ramp, and I was worried about him falling.
I had to use the bathroom today, and I had the bed rails up. He squeezed through the bed rails and jumped off my bed. And I said, you must have an angel looking out for you because I've been monitoring him and he seems fine, but it's a big drop. Yeah. Yeah. Well, I guess I would just say keep an eye on him. I didn't know if I should give him any gabapentin, but like, he didn't yelp or anything. He just kept on walking and he's been walking fine. If he's not limping or anything, I don't think you need to.
Okay. I'm just, I'm trying my best. It's just rough. I feel like I can't watch him 24 7. Thank you so much for all of your help. And do you know maybe how long it may take them to get the meds today? Hopefully here it says it should be in the next 30 minutes to half an hour or so. Okay, great. Thank you. Thank you. Okay. Well, thank you so much and have a good night. Thanks, you too. Did you want me to get you scheduled for three weeks? Yes, yes, yes. Sorry, I forgot about that.
Let's do that. So we'll do the week of the 26th. Is there a day that works best for you? So this is just for labs, right? Correct. Okay, let me see. I think any time is fine. We do have that Sunday the 26th if you are free on a Sunday. Otherwise, it's pretty open. So we have anywhere from 8 to 11:15 and 1 to 3:45. Sometime between, is there something like at 10:30? Yep, we do. Let me see. That's 10:30. Yeah. Okay, let's see. Let's do that because I'm pretty sure I give him something at 10 and then we could drive right over there to you guys.
All right, so we'll do that. We're just going to do the bigger panel that time. That way we can see what the kidney values are doing. All right. I got you booked for Sunday, July 26th at 10:30. And you don't think that I should... He used to take kidney supplements from... Oh, gosh. I'm having a brain fart. I forgot the name, but I did not give him the supplements right now just since there's been so many changes with him. If you want to send me a picture or maybe the name of which supplements, because I think it depends which ones.
Okay. And, hang on, I'm writing this down. And it's the VetraScience. Oh, VetraScience. No, that one's fine if you want to do that. That's not going to hurt anything. I wouldn't say it's a priority, given everything else, but it's not going to hurt if you give it. And I had an appointment scheduled a long time ago for tomorrow with Dr. Church, a cardiologist at Desert Vet. Do you think, like, I should just go ahead and do that and see if there's been any changes? I would, just in case, because it will help us, especially as we're still doing the fluids for him, so we can just make sure there's nothing going on that would contraindicate us if we needed to change the fluids.
And we have fluids every day now, just because he had been drinking a lot. I got, like, a pet fountain and then it stopped working today, so I ordered another one. And today he hasn't been drinking as much, but do you think we should continue the fluids every day, or if he's drinking a lot, then maybe back off some? Well, what's hard is, you know, with kidney disease, because he does have, like, early stages of it, and so that's going to make them drink and urinate more, but they're not really processing it normally, so he can still become dehydrated.
And that could be contributing to the BUN being high. So I would say just try to do that more consistently, even though he is drinking a good amount. And do you think, because I think the last couple times we just gave him 50 cc's because he is starting to wiggle around so much. And one time he was moving, like, I try to hold him down while my mom isn't holding the needle in. He moved around so much that I guess the needle moved and he yelped. Do you think we should be doing 50 or 100?
I would try to aim for 100 if you can. If you can get at least 50, that's good. And I would say try to do it, like, at least every other day, if not every day. But at least if you can, at least every other day, that would be ideal. Okay. At least for now. And then we can see what his kidney values look like and see if we can reduce that again. But just because I see the BUN at least is increased, I think that could not only be from the protein diet, but that could be from dehydration too.
Okay. Okay, thank you so much. You're welcome. Anything else? Uh, I think that's it. Thank you. Okay, you're welcome. You have a good rest of your day. We'll text you here soon when the meds are filled. Okay, thank you. Bye. Bye.