Continued from part 12
When we last left Billy he had been diagnosed as having Inflammatory Bowel Disease, Atopic Dermatitis, adverse medication reaction and food sensitivity.
Dr. Mitelman: We were trying not to lose our wits. Trying to control Billy's day-to-day symptoms was taking our eye off the ball. If we weren't able to win each battle, how were we going to win the war? Barbara was bathing, cleaning, and medicating Billy, and still managing to keep life coordinated.
Despite her care, the dog's symptoms were perpetual.
Barbara: Once we had the results of the allergy testing, we were so hopeful the custom-made serum would help Billy. As long as we had a goal, another avenue to explore, our motivation outweighed our frustration.
But I have to say, it was hard. Our family felt the strain and we often turned to Dr. Mitelman for support and encouragement.
The goal of this immunotherapy was to tease his immune system with tiny amounts of these allergens and teach his body to become refractory (not responding to a stimulus).
Gradually increasing doses over time would hopefully make him increasingly refractory until his body would give up reacting to allergens around him.
Mites, molds, pollens. Billy was much more reactive to these than any other dog I've seen.
In immunology, the concept of fighting fire with fire has proven merits. What a great idea. A proven idea. An idea used for decades in human and veterinary medicine.
On average, one out of four patients does great with their itching symptoms and subsequent skin pathology reduced considerably. Two out of four show 50% improvement, and finally one out of four show minimal improvement.
We were hopeful to achieve even baby steps if it helped.
Barbara: Dr. Mitelman explained the odds of success regarding the allergy injections and sensitized me to the possibility they might not achieve the maximum relief for Billy we all desired. But, on the other hand, even removing some of his discomfort was better than not trying.
I was again not prepared for Billy's reaction.
Dr. Mitelman gave Billy the lowest dose, the starting point for the injections.
Later that day the dog's ears were flaming red and he constantly shook his head. Billy acted as though his body was on fire. He was so agitated that we could barely touch him.
Dr. Mitelman: When Billy exploded into an itching tirade with the least concentrated serum, it was necessary for me to prescribe steroids to extinguish the fire.
And again, our vehicle of anticipated success had stalled at the starting line.
Barbara: Throughout this time Billy was still suffering from diarrhea, flatulence, frequent and urgent trips outside and abdominal cramps. We had exhausted our supply of "novel" proteins in dog food and I was making regular calls to the pet food company to check on the production of the KO.
At this point we were told it might be another couple of months before our vet clinic would receive the food again.
Dr. Mitelman: The delicate equilibrium, a functional immunochemical "truce" amongst the bacterial flora, intestinal mucosal lining and the digested food matter along Billy's gut was thrown off kilter.
The result was diarrhea and cramping caused by food that wasn't properly digested, a runaway population of bacteria that thrives on chemical imbalance and the continued inflammation in the intestinal lining.
How do you control this vicious cycle of inflammation and chaos?
In addition to anti-inflammatory medication to attempt to cool the gut, and probiotics (which help sustain and select the desired bacteria to colonize the gut), additional help was needed.
Stool cultures and cytology showed heavy growth of sporulating clostridium, a sign that gut health was being compromised and itself perpetuating the diarrhea and discomfort.
Additional fiber in the form of bran flakes and/or pumpkin was added to slow down gut transit, acidify its contents and disfavor clostridium growth. A potent antibacterial drug called Tylosin was also added to control the gut's flora.
But the diarrhea continued.
Was Billy getting too little medication? Or was it too much? It seemed no matter what we tried, it didn't work.
So, we tried something different. Something to slow down the colon contractions. An over the counter medication called loperamide was added with the intent of reducing Billy's uncomfortable, too frequent bowel movements.
Barbara: Billy had a couple of doses of the loperamide and his diarrhea stopped.
It looked as though we had our solution.
It was a Saturday night and Billy showed us an unfamiliar symptom, he started to vomit. A lot.
So I made a midnight phone call to Dr. Mitelman. He said we needed to bring him in.
Dr. Mitelman: Billy had never regurgitated his meals until now. Perhaps the loperamide worked a little too well. The conveyor belt stopped, and backed up too.
Barbara: We left a very sick Billy at the hospital that night.
The emergency doctor would perform some diagnostics and consult with Dr. Mitelman in the morning. We were at the point, yet again, when further investigation was warranted.
When A Small Sore Turns Into A Catastrophe: Billy's Story (Part I)
Life-threatening Infection Resolves; All Is Good? Billy's Story (Part II)
What Is Going On With Billy's Skin? Billy's Story (Part III)
The Plot Thickens: Billy's Story (Part IV)
I've Never Seen That Before: Billy's Story (Part V)
Billy's Diagnosis Still Unknown: Billy's Story (Part VI)
Neuronal Ceroid Lipofuscinosis (NCL)? Billy's Story (Part VII)
Time To Make A New Plan: Billy's Story (Part VIII)
Atopic Dermatitis? Billy's Story (Part IX)
It Is Not Neuronal Ceroid Lipofuscinosis But What Is It Then? Billy's Story (Part X)
My Dog Has A Gut Of Steel, Doesn't He? Billy's Story (Part XI)
Feeling As Though Running Out Of Options: Billy's Story (Part XII)
Fighting Fire With Fire Backfires: Billy's Story (Part XIII)
A Second Endoscopy: Billy's Story (Part (XIV)
Staying The Course: Billy's Story (Part XV)
Fewer And Fewer Solutions Left: Billy's Story (Part XVI)