Iris update II

Iris is doing great! After I got home from the vet with her on Thursday I did some research into low-protein diets specifically for management of liver disease/liver shunts. I cooked up a small batch of a very low-protein diet for her; I'll only use it a week, then I'll switch her to a slightly higher protein diet made with tofu, cottage cheese, and rice. She ate a little of the new food on Thursday, but turned her nose up at it yesterday so I added a teaspoon of cottage cheese to jazz it up a little and she ate it all up at both meals. She turned up her nose again this morning, she wanted to be in with her sisters and eating what they were having.

The puppies are in a setup in my living room that consists of an extra-large wire crate with an exercise pen hooked onto the sides to make a "play yard". Iris clearly wanted to eat with her sisters this morning, so I put them and their dish into the crate and shut the door, and put Iris and her dish down in the play yard right outside the crate door. That did the trick, she ate all her breakfast and was looking for more, so I gave it to her.

Iris is getting metronidazole (generic Flagyl) twice a day to control bacterial buildup in her intestines. If she needs long-term antibiotic therapy, I'm going to ask Doc about switching her to Amoxi, it doesn't have the same toxicity risk that metronidazole has. She's also getting 2-4 doses of Lactulose, a mild laxative, a day. When protein is digested in the gut, one of the waste products is ammonia. A normal liver neutralizes the ammonia, but Iris' liver can't do that so ammonia builds up in her intestines. It's the ammonia that causes the neurological effects I was seeing. Lactulose increases the acidity of the contents of the intestines, reducing the absorption of ammonia. It also decreases the transition time of matter through the intestine, which also decreases the absorption of ammonia. The goal is to get stools that are soft but not loose, so I'll have to tweak the dosage of lactulose until I get the desired result. The good thing is that lactulose is sweet and Iris likes it, so getting her to take it is a piece of cake.

It's been about 48 hours since Iris got her first doses of metronidazole and lactulose, and about 40 hours since her first meal of the new diet. All her neurological symptoms are gone! She's clearly feeling better, she's back to normal puppy activity and hijinks again. I am much more optomistic about her future than I was the other day. Please keep our little girl in your prayers.