Scottie Is An Old Man

[Scottsmum]

Background

So Scottie has been a bit down recently. He's (well, we have) actually had a really huge year in terms of upset but in the last 4 weeks he's been very happy & settled, until this last week where he's just been the slightest bit down. He had a tumble at the park last week so I put it down to that, but over the last week he's been turning us around at the top of the street on our evening walks & has started putting him self to bed - which is usually a ritual of me calling him, him wagging his tail but ignoring me, and me heading off down the yard to carry him back up to his crate - this week I've been going out to find him in his crate ready for me to shut the door. Still very active, playing tug, asking for morning walks, eating, pooing normally - so really 99.9% normal - just something a touch off.

I'd been tossing up weather I'd take him to the vet or not, then last night he yelped twice while I was giving him good night snuggles - so that was that. He got carted off for a full poke and prod today. (To my family vet who hasn't seen Scottie since I adopted him as I was living in Marrickville but am now back out in the Hills District of Sydney).

She agreed that he's got very basic arthritis - which I knew. We discussed options and what I'm currently doing for that - agreed we might try stepping it up a bit. Otherwise, eyes, ears, temp OK. So she was happy to chalk it up to him just feeling the cold and being a bit more creaky with his arthritis at the moment.

But... we also did a simple in house blood panel.

His ALT is slightly elevated. It's 296 U/L (normal is 10-125 U/L). Everything else is well within normal range. The Vet decided not to start any arthritis meds but rather send him home on 2 weeks of antibiotics to see if that helps the ALT levels.

But in my usualy neurotic dog mum style - I'm freaking out a bit here. Liver disease was what ultimately killed my last dog, Guin, and I still feel bad we didn't really catch it in time or make serious enough changes to her lifestyle (hence, part of the reason to drag him off to the vet when he's just a touch off). We just chalked her early stages of liver disease up to "old age". Annoyingly enough I only chucked her old vet records out the other day so I can't flick back through them to see what her first elevated reading was. I swore then if this every happened again I'd become the uber-mum who purees organic vegetables picked by virgins if that was what it took to slow the progression.

His current diet is a grain free kibble (Natures goodness / VIP from the supermarket), and Ziwipeak, but he's gone off the Ziwi a bit in the last 6 months, and beef mince. Occasionally he gets a grain free can. He will eat chicken and turkey - beef is just what's on offer at the moment. It's human grade meat from the supermarket. I have tried a number of other grain free dry foods - as is well documented on the forum. He's very fussy and strictly grain free.

He's on endep for separation anxiety he's been up as high as 20mg twice a day (full dose) but is currently down on a maintenance dose of 10mg once a day. I can probably get him down to 10mg every other day. I could wean him off it all together - but it makes him a much happier dog and easier to live with. He tends to be feral off it - so I don't think his being down is linked to his lower endep dose.

Here are my questions

I)

What can or should I be doing re: elevated ALP? Any easy changes to diet. Good books, websites, scientific papers where I can have a good read? (I did look through the forum - links to appropriate threads appreciated) OR should I just sit back and see what his bloods are like after the antibiotics? before I go into full nut-job uber-mum mode.

and II)

He's got quite a bit of build up on his teeth and it was suggested he was due for a dental but he only had one in November. He cant have TD as he's grain free (and burgh - yuck - Hills) and he wont chew bones- he buries them. He will eat carrots. What are my best dental care options for a non-chewing, grain free Senior? Brushing? More carrot?

Any ideas welcome - Yes I know I'm panicking and its super early - a pretty low elevation.

thanks everyone

Edited June 9, 2016 by Scottsmum

[RedFeather]

My brother-in-law just gave me a product that you can put on the teeth that doesn't require brushing, that will soften and theoretically eventually remove the plaque from the teeth. Pretty sure it was this http://www.petzlife.com/catalog/complete-oral-care.html http://www.greenpet.com.au/products/PETZLIFE-ORAL-CARE.html

I haven't used it yet but it seems to get good reviews, and it's 'all natural'

[SchnauzerMax]

I immediately think pancreatitis and too much fat in the diet when I see higher ALT levels in older dogs. In their twilight years, my oldies ended up with cooked meat where I could strain most of the fat off. Having said that, antibiotics may be the correct solution and it might have absolutely nothing to do with Scottie's diet at all.My vet recommended putting a stocking over a finger and using that to rub around all the teeth thus brushing their teeth.

[RuralPug]

If he won't chew bones, will he chew deer antlers or cow hooves? Both of those are hard enough to give the teeth and gums a decent workout.

If not, then really brushing is probably your only option - remember that the gums are just as important as the tooth surfaces when trying to avoid dental decay and make sure that these are cleaned as well as the teeth.

With regard to the elevated ALTs, I would be waiting to see what the antibiotics do before making any assumptions. If they clear up, all good, and i would schedule another senior blood panel in six months.

[Scottsmum]

If he won't chew bones, will he chew deer antlers or cow hooves? Both of those are hard enough to give the teeth and gums a decent workout.

If not, then really brushing is probably your only option - remember that the gums are just as important as the tooth surfaces when trying to avoid dental decay and make sure that these are cleaned as well as the teeth.

With regard to the elevated ALTs, I would be waiting to see what the antibiotics do before making any assumptions. If they clear up, all good, and i would schedule another senior blood panel in six months.

Nope - we've tried antlers and hooves too...He's just not a chewer. He's not food driven at all - It's a struggle to get him to eat as a rule.

Looks like brushing it is.

[Rappie]

At this point in time, Scottie has an elevated level of ALT - nothing more and nothing less. I tend not to get too excited by levels that are <3x the upper limit and would proceed in much the same way as your vet is at the moment. I am always super pleased to read that some blood testing is done in older dogs when planning to start anti-inflammatory medications. Althoug there may be changes in various levels, they do not always prevent us from using NSAIDs, but we might change our plan or use alternatives. I think a course of antibiotics is a reasonable place to start, as a subclinical cholangiohepatitis is reasonably common in older dogs. Re-testing after the course of antibiotics is complete is going to give more evidence about what the ALT is doing - is it just a blip in time, is it trending upwards or downwards etc etc.

There are a few important things to keep in mind about liver levels - with specific reference to ALT in this case. They are frequently a source of much concern, triggers for a lot of investigation and causes of much stress! ALT is what is referred to as a leakage enzyme and is released into the body after cell injury or cell death. The level of increase is related to the NUMBER of cells injured, not the SEVERITY of the damage and it can also be released from regenerating cells. It is also really important to realise that an the levels of the liver enzymes do not reflection liver function. You can have a huge elevation from an acute stress to the liver and normal enzymes in a failing liver (because there are so few healthy cells to release the enzymes!). This is where monitoring trends is more important. Mild elevations in ALT can be also associated with some drugs, cellular injury, muscle injury and heart disease.

So, I would not go into full on crazy dog mum mode just yet :laugh: Finish the antibiotics, retest the ALT then develop a plan with your vet - whether that be ongoing monitoring to establish a trend, or further investigation with bile acid testing or abdominal ultrasound.

With respect to his dental disease if there is significant tartar build up then dental treatment under anaesthetic would be indicated. This can still be done safely despite the ALT elevation with due attention to medication choices and consideration of his general condition. Once you have a clean, healthy mouth then meticulous home care with daily brushing would be required, and if other mechanical means of reducing plaque and tartar accumulation (such as t/d, chews etc) are not possible then consider supplements such as Healthy Mouth or Plaque Off.

Edited July 29, 2015 by Rappie

[Scottsmum]

Quick update - he seems to have really perked up. We were chatting about it at home tonight - lots happier in himself, looking to go for his two (or more walks) a day & so on.

What ever was brewing away seems to have settled on the ABs.

Well, I hope I'm not imagining it :) but another human adult agrees with me - so that's great.

[Scottsmum]

Update:

Mr Man had a vet check with a different vet this week (for export) and she was worries about his eye (it was a bit blood shot). So I packed him off to my normal vet today for one last visit with her. He had a full check up, bloods etc. He's 100% in perfectly good health. All bloods back in normal range - so that's great, nothing abnormal to report on the eye or ears (both of which the export vet was overly interested in).

So he's in good health and cleared for flying in a few weeks!

[persephone]

Good news!! :)

[Scottsmum]

6 monthly poke & prod today.

Eyes look OK. Heart, lungs sound fine. Temp normal.

He's put a touch of weight on - I'm still trying to get that down but it's not terrible.

Discussed a few "new issues" - mainly the hearing / leaving the room when I crack bones, night pacing & licking things (long story - but basically I've found him licking odd things lately).

Took bloods - they'll call back with results this afternoon.

Vet also suggested we could try Hills B/D to see if it makes any difference - which we can't because he's grain free. But I came home and had a look around the forum - found a number of threads which sound really similar to our current situation. Also note that a lot of threads which mention B/D also mention Vivitonin - so I'll ask about that this afternoon when they call with the blood results.

In other news - while the vet had nothing to offer on his sudden aversion to knuckle cracking *we* have decided he's deaf as a door knob & she said if we thought that there's not much to do - other than to live with it.

Edit: Bloods are back and are all well within the normal range. We spoke about the vivitonin & we're probably going to give that a try. The vet said it's not cheap(?) So she wanted to get a price to run past me before ordering it in.

Edited May 9, 2016 by Scottsmum

[Papillon Kisses]

It sounds like you and the vet are thinking Scottie might have something along the lines of Canine Cognitive Dysfunction? You might be interested in these two links:

http://www.ava.com.au/sites/default/files/AVA_website/pdfs/NSW_Division/VETS%20%2B%20NURSES%20COMBINED%20-%20Kersti%20Seksel%20-%20Canine%20Cognitive%20Dysfunction.pdf

http://dogdementia.com/

If Scottie can't have any grains for medical reasons, is there a grain free formulated food out there that is suitable for seniors and has some of the features of Hills? I've noticed that Hills has added omega-3s, vitamins and antioxidants, and l-carnitine, which are things I've seen added to super premium kibble. What are you currently feeding? Is Scottie completely grain free or just gluten free, because sometimes people get that mixed up?

Alternatively perhaps you could add in supplements that can/may help with brain function and anxiety. You would need to make sure they are ok with his existing medications and any other health issues. We've been told to give Malcolm omega 3 supplements and/or treats, so he's been enjoying cheap tins of sardines in springwater, dried salmon, etc. :)

Could other things help Scottie feel calm: Adaptil as mentioned, a night light if disoriented by night vision loss, Through a Dog's Ear for Seniors if he's not completely deaf (also available in iTunes).

Oh and here's another tooth/gum gel that hasn't been mentioned here is Maxi/Guard Oral Cleansing Gel. We got ours from our vet. http://addisonlabs.com/products/maxiguard-oral-cleansing-gel.php

Let us know how Scottie gets on. I'm so happy to hear his bloods are ok, amongst the other worries that must be a huge relief. x

[Scottsmum]

Lots in your post PK. :D Thanks.

Will try to address it.

I) Yes - I think from what I've read that it might be the start of CCD. When I searched here for Hills B/D I found myself nodding along to a lot of what other threads said. Especially WestieMum talking about dear old Mac. We're starting a drug (when it comes in) - name of which escapes me. We're not going to try the vivitonin straight away. As much as I hate saying it - we just can't afford it at the moment. The vivitonin is about $100 a month and the other one is from a different family of drugs but has similar outcomes for $20 a month - so we'll start there. (Bring on paid employment!)

2) I'm not entirely sure what his actual allergy is - I suspect it's gluten - he can eat fresh corn and normal rice - but admittedly I've never given him large amounts of either -just an occasional spoonful if there is some left in the pot at dinner time. So he's off anything commercial which does not explicitly specify grain free. "Low grain" kibbles have been known to stuff him up. I once grabbed some "low grain" wellness thinking it was grain free - it was in a place in petbarn which made me assume it was ... I didn't read well enough and he reacted to that. I also bought him some "gluten free" dog roll the other day and he reacted to that too. So fresh/frozen meat, grain free kibble (& other grain free goodies) only here.

He's currently on VIP grain free (because he likes it), Ziwipeak for training treats and the occasional meal (he likes it but not enough to eat every meal + its a bit rich for his belly) preservative free meat patties chicken and/or "power patties" (100% New Zealand chicken and mutton with offal [heart, kidney, liver and green unbleached tripe]), chicken necks & drum sticks. The power patties are a special treat - make up no more than 1/3 of his fortnightly feeds. I try to keep red meat to an absolute min to help his liver cope - not too willing to change that despite the good bloods. Eggs - fried or boiled about once a fortnight He gets the squirts on anything too rich.

He's not a huge fan of sardines or salmon I have tried both canned. I have also tried fresh salmon steaks. He will occasionally eat tinned tuna but I don't think there's a lot of helpful nutrition in it. I really only use it if we've run out of dog food. I've also tried green lipped mussel treats

I do use golden paste when I remember.

I usually give him 2 scoops of dry a day - might up the ziwipeak ratio / frequency.

We're using a night light - leave the kitchen light on - which covers the kitchen, some of the hall, the "back nook" with a dog bed in it and just enough light to navigate around the bottom of our bed.

Not sure how much he can hear. I walked up behind him and said his name the other day with no reaction at all. I am still leaving the radio/audio books on for him when I leave him alone. ??? Who knows.

Tooth/dental one is interesting. He had a full dental Nov/dec 2014 and I was told by two (Aussie) vets since he needed another dental. BUT Every vet I've seen here - two vets and two final year students - have commented that his teeth are pretty good.... so .... go figure.

Thanks again :)

[persephone]

Poor Scottie ...

Lots of 'little things' , which when combined add up to a general feeling 'off' , I'm sure .

he is getting good care - and you are certainly doing everything you can - he is a lucky lad to have an observant and willing slave ;)

[Scottsmum]

Poor Scottie ...

Lots of 'little things' , which when combined add up to a general feeling 'off' , I'm sure .

he is getting good care - and you are certainly doing everything you can - he is a lucky lad to have an observant and willing slave ;)

Yes. He certainly is lucky to have such a willing slave. I'm not sure he'd agree on the observant part. Observation usually leads to a visit to the vet for a poke & prod. :D

The latest thing is that the drug which we can afford (selegiline) can't be used with endep/Amitriptyline - he'd have to go off it completely for a few weeks before starting a trial of the selegiline.

It's a tough call to make - the endep/Amitriptyline has some pain relief aspect too. I'm very hesitant to take him off something which has served us so well. But we do need to try and treat the new symptoms - Possibly with a constant higher dose of endep.

Anyone here tired Aktivait?(off to search the forum) It costs the same as vivitonin

Edited May 10, 2016 by Scottsmum

[Papillon Kisses]

Selegenine has anti-depressant/anxiolytic properties. If you can't see a vet behaviourist due to the cost, there may be vets in your area who have an interest in behaviour medicine. Sometimes low doses of meds are prescribed in combination, but usually only by vet behaviourists as additional expertise is needed.

I mentioned the sardines as it's probably a cheaper option. You can get omega 3 liquid supplements as you're probably aware, but they probably have a fishy taste. There are various chews too but most have added grains.

I've sent you a PM about a Facebook group you might like to join.

Oh and I agree with Perse — Scottie is blessed to have you as his mum. :)

[Scottsmum]

Selegenine has anti-depressant/anxiolytic properties. If you can't see a vet behaviourist due to the cost, there may be vets in your area who have an interest in behaviour medicine. Sometimes low doses of meds are prescribed in combination, but usually only by vet behaviourists as additional expertise is needed.

I mentioned the sardines as it's probably a cheaper option. You can get omega 3 liquid supplements as you're probably aware, but they probably have a fishy taste. There are various chews too but most have added grains.

I've sent you a PM about a Facebook group you might like to join.

Oh and I agree with Perse — Scottie is blessed to have you as his mum. :)

Thanks PK - I was just about to hit Facebook. Happy enough with the vet care we're getting - We use the local teaching hospital so I feel OK we're getting a great level of care and anything outside the box will go up the chain if the vet thinks its needed. unfortunately, all that said, the behaviourist has closed her books anyhow - I looked locally a few months ago and settled with a trainer & the vet to help us through. I should just try what the vet is currently suggesting but I also need to get my head around it all - this time two days ago I was blissfully un-aware of CCD - we'll you know - it wasn't a factor in my life or on my radar.

Feeling terribly guilty we can't just treat as we would have in the "old days" - THIS is the number one reason not having a job sucks. I really hate making choices about his treatment based entirely on cost.

Will grab some Omega 3 / fish oil for him from the pharmacy when I'm in town next. He'll take it in some mince no worries - so that's OK. No hope in tell of getting him to eat sardines.

[Papillon Kisses]

Just check up on dosage first. We would not want to make him sick! I've seen some pet formulations in pet stores which you could use as a price and dose/ingredient comparison. And if money is tight there may be more important things to spend it on. Medication with a more substantial evidence base trumps complementary medicine.

These really are just the little extras. Veterinary care is important, but apart from that what does Scottie really need? To be loved. To be kept comfortable, with a warm bed and food in his belly. To be treated with compassion.

He has all those things in spades. x

[Scottsmum]

Just check up on dosage first. We would not want to make him sick! I've seen some pet formulations in pet stores which you could use as a price and dose/ingredient comparison. And if money is tight there may be more important things to spend it on. Medication with a more substantial evidence base trumps complementary medicine.

These really are just the little extras. Veterinary care is important, but apart from that what does Scottie really need? To be loved. To be kept comfortable, with a warm bed and food in his belly. To be treated with compassion.

He has all those things in spades. x

All good points.

[Scottsmum]

I don't have any suggestions but just want to say that you're an awesome dog mum and Scottie is super lucky to have you.

Thanks Snook. It really hit me today. Makes me so sad.

[JulesP]

His ALT is actually higher than Amber's. But I've certainly seen dogs with much, much higher ALT readings.

You need to be feeding highly digestible protein to give his liver a break. I wouldn't be feeding the Zwipeak at all. I would be looking to keep the protein % to under 25. He might not cope with L/D due to allergies. So I would suggest things like cottage cheese, yogurt, egg whites. Low fat white fish (eg cod) might be ok.

I've been feeding the VIP to Amber with no ill effects apart from her currently refusing to eat it.