This is a fairly major update since Elvis went in to see Dr. Walthall this morning for a checkup.
First off, she said he looks very, very good. He's put on weight since his last visit, but it's weight and not fluid. You could really tell that just by looking at him because the weight is distributed right. It's the sort of intangible that you know when you see it. So this is good. My feeling is the Prednisone he was on until last Saturday helped with this.
Now for the news that isn't the greatest. He came off the Prednisone on Saturday and there was a definite regression in his coughing/wheezing. This was the main reason I was hoping she'd want to see him (his last visit was nearly a month ago), because I really felt that the Pred was making a big difference in a lot of ways. Talking options led us to agree that Elvis needs to be on Prednisone on a full time basis. I say "full time" but that's a bit misleading. Like his last course, he'll start out with a half a 5 mg tablet once a day for four days, but then he'll drop down to 1/4 of a tablet once a day and then I will drop him down to 1/4 of a tablet every other day. How he reacts to that 1/4 once every other day will tell us if that's the maintenance dose he'll stay on or if he needs the 1/4 every day. We'll simply have to see how he reacts.
He's also going to have a prescription of Valium. What I was talking about with Dr. Walthall is that while the Prednisone seems to not only address the wheezing/coughing he has as a normal thing, it also seems to help with wheezing/coughing that stems from stress. But Elvis wakes up in a new world every day and things that didn't bug him yesterday bug him today. It's sometimes hard to know what's going to trigger his panic attacks (and that's really the only way I can describe them). The Prednisone really does help, and when he's in a coughing cycle, the Torbutrol can help knock that down, but the problem is he's a small dog. And while I can give him 1/2 a pill of Torb, if he needs something else, I'm SOL. So, the Valium is going to be for the times when the stress is evident and we can see he's having problems. There's a great deal of caution in mixing the two or even in giving Valium to a dog with a heart condition because it slows the respiration, but what I'm hoping is this will be a very rare thing.
So, we've got the Prednisone at some yet-to-be-determined dose as a permanent addition to his medicines, we'll have Valium for those times when the stress is getting to him and I can't get him calmed down, and he'll have Torbutrol for the times his cough won't quit. He also stays on Lasix, Enalapril and either Robitussin DM or Guafinisen depending on his breathing/coughing.
Next up is the heartworm situation. He's now got a six month supply of a heartworm medication to help deal with the baby heartworms (this is the normal treatment all dogs get), but next up is dealing with the adult infestation. Dr. Walthall really believes this is what is causing his wheezing, and once he gets stabilized again, she wants to start a treatment. I want to talk with her again about the method because originally she had talked about giving a heartworm tablet once a week for a few weeks rather than giving the injection because it would be easier on him. Today she mentioned the injection, so I want to confirm which way we're headed.
The issue with the injection is that it is very debilitating and needs to be done when our world is going to be boring for a month. I want to get the timing right on this because I'm supposed to go to Dallas in March to get a set of bottom teeth to replace the ones I had pulled prior to my cancer radiation treatments. I want to be sure that Elvis' treatment isn't going to bleed over into the time I'm gone. I can put off my trip, but I need to know in advance.
So, that's where we are. Even with the wheezing/coughing returning after the Prednisone ended Saturday, he looks good. And I think going back on Pred is going to be a real big help for his symptoms. I hate to add yet another pill, but if it's helping, I think he needs to be on it. Perhaps after the heartworm treatment we can reassess the need, but that's a ways away.
If the weather stays nice and his coughing gets back under control while the sun is shining, I'm hoping for a few outdoor pictures. If I get some good ones, I'll post a couple. Meanwhile, I suspect I won't post another update until sometime next week. I told Dr. Walthall I'd call later next week, so unless something happens between now and then, look for me to post something then.