Sunday, February 15, 2009

Current Regimen - update

OK. Back to Roland's current treatment. Morning meal between 7:30 and 8:00 am every day - even weekends and holidays. Meal consists of 1 and 1/2 cups of medium sized kibble with several spoonfuls of canned food, plus a long squirt of LipiDerm and one 500 mg capsule of tetracycline. These are for his symmetric lupoid onychodystrophy (SLO). Interestingly, the vet thinks that the chronic tetracycline might have contributed to his longevitiy with the megaesophagus. Don't know how to determine this and we are not going to stop the tetracycline to see if he gets worse. Oops... back to his morning meal. He also gets one sucralfate ground up and suspended in NutriCal, plus 5 mg of bethanechol.

Around 5:30 pm he gets a smaller meal of 1 cup kibble with some canned food, with one tetracyline and some LipiDerm along with 5 mg of bethanechol. Late night meal, around 10 pm, is 1 cup kibble with another 5 mg of bethanechol.

If you read the earlier summary of Roland's treatment regimen, you'll notice one difference. He was getting 10 mg of bethanchol with the latest meal and none at 5 pm. Last week was a rough week with repeated blurping epsiodes in the early evening. We didn't really want to increase to total dose, so tried giving 5 mg as soon as we got home from work. Too soon to really tell if this is helping. Overall, our feeling is that the disease is progressing and this is just breakthrough symptoms. For now, we can tolerate the blurping. Yesterday he blurped twice. Once early in the morning - almost a cough and only a small quantity. Around 5 pm a second blurp of moderate quantity, but fairly dry. He's hungry and eating well. I've also reduced the sucralfate to once a day. Since the blurping is much less frequent, I don't think it's really doing much. I've also reduced the NutriCal for now since he's eating so well. Soon we'll need to get back to the vet so that she can see how well he is doing. She's not seen him since we started the sucralfate and bethanechol.

Sometime along the way, before starting the sucralfate and bethanechol, we had stopped the niacinamide (part of his SLO treatment). Clearly it tasted bad and nutrition was a major concern. We decided that we would tolerate loss of a nail or two in order to have a dog with good nutritional status. He's eating well now, so we'll leave things alone for now. It does take weeks to months to see an effect on his toenails, so we'll wait and see.

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