Thought I'd update this thread.
I'm so glad that I pushed my vet to refer us to the internal specialist. First they did an abdominal ultrasound to rule out a blockage and they also looked at her liver, which looked normal, then they suggested we run more tests, which we agreed to so we could find out what the heck was going on with Mocha. They did an upper GI endoscopy, an ultrasound-guided liver biopsy, and ran a ton of tests on her.
I'm pasting the email we received from the internal specialist below:
------------------------------------------------------------
Hello all- just wanted to pass along Mocha's test results - almost all completed, and to the point that I think we have a good plan moving forward. I am out of town so am emailing you all so as not to delay her management. I will followup with her final special stain results (liver biopsy) by next week.
Her GI function panel was normal, so her pancreas works well and she has no evidence of malabsorption/maldigestion.
Her intestinal biopsies showed marked eosinophilic inflammation; this is supportive of food allergy component for her diarrhea. We discussed and figured out that chicken seems to be a trigger food for Mocha.
The liver biopsies do show excessive copper accumulation and mild inflammation. Her copper level of 1760 ppm is in the toxic range; normal range is 120-400 ppm.
SO...she needs a copper chelator and a low copper diet, but also ideally a hypoallergenic/ novel ingredient diet to manage these conditions together.
---I am having my technician Shaina call in D-penicillamine (copper chelator) 280 mg capsules to Wedgewood pharmacy for us. She gets one capsule by mouth twice daily on empty stomach or with a small bit of meat. We will give this for six months to no more than 12 months, depending on her liver enzymes.
---As for her diet, I looked at the Hill's prescription l/d ad Royal Canin Hepatic Support. The L/D canned and dry formulas are based on pork, egg, and soy; the only chicken-derived ingredient is chicken fat, and if pure, fat should not be allergenic. So, this could be a feasible option for her diet to try.
The Royal Canin dry is soy-based, while the canned is chicken-based. So, the dry RC Hepatic is an option as well
****I am wondering if someone from Tiny Town could help get Mocha onto one of the diets above? We do not sell pet food.
She needs to transition slowly over 4-5 days from her current diet to the new food. If these diets do not work well, then we can see about using a custom cooked diet such as JustFoodForDogs Hepatic Low Fat fish/rice-based cooked/frozen food.
I would like to recheck Mocha in about three to four weeks for exam and liver enzymes.
---------------------------------------------------------------
Tiny Town is the name of her regular vet.
As you can see, we're in for some major changes around here. And we're so happy we caught the copper storage disease before there was any damage to the liver. It's going to be a bit tricky dealing with food allergy and copper storage at the same time. What if neither the Royal Canin or the Hills agree with her? If that's the case, and I hope it isn't, then I'll have to talk to the internal specialist and do a ton of research about preparing home-made food for Mocha.
And FYI, this ordeal has been very expensive. Between the tests our regular vet ran, and all the tests the internal specialist ran, plus the hospital stay and the meds they gave us, we've spent around $4,500 on this girl in the last 2 weeks. Now comes the liver medicine which is $80 a month, the Rx food which after taxes comes to almost $100 per 27.5 pound bag, and the Denamarin which is $60 a month. And the reason I bring up the money is because it's been brought up numerous times on this site in many threads that this is not a cheap breed to own so as a prospective or current owner, it's a good idea to 1. have pet insurance and 2. set aside some money for something like this. Thank God we have a "rainy day for Mocha" fund, and we also have pet insurance but unfortunately elevated ALT levels are a pre-existing condition so I doubt they'll cover our bill from the internal specialist. We're hoping they'll at least cover some of it...we'll find out soon enough.
So, that's where we are right now, at least both of Mocha's conditions can be managed with medicine, a proper diet, and regular checkups.