Urgent question Polina is very sick

[omichka]

The traffic in this section is better, so I apologize for writing in wrong section.

Anyway, if you read the topic "puppy mill raided", you will figure out the history of my dog.
I was very proud of Polina's improvement.
She became a member of my family no matter if she has never became a friend of my first yorkie Jessica, or she completely ruined my carpet. She is just our baby.

Polina started to show some bad symptoms in middle of April. First what I noticed was her back legs' weakness, a little bit balance disorder, and she started to be afraid of stairs.
Same time I was wrongly thinking that I pleasing her by giving a pretty fat beef bone because all symptoms started about that time (later I will figure out that it is not good for liver).

Then I noticed disorientation, more behavioral abnormalities, some sings of vestibular syndrome, and some signs of blindness, although I didn't think that she might be blind (her eyes are healthy looking)

In late April or early May she had first seizure (at least first I saw). It was during the night, she urinated, and screamed so badly like someone was torturing her.
I called to the vet same day.

May 10 - 1 vet visit. I explained all concerns, asked for x-ray and blood test. I also told that she has beaten her head a few times because it looks like she doesn't see where she is going. Stroke? vestibular disorder?
Doctor said - she is FINE, and her x-ray is perfect.

Same night she had another seizure. Screaming and urinating. I called for a blood test result and was told - not too bad for panic. Guess, I was NOT satisfied at all.

I immediately tried to figure out what it can be and received some online advices from vets. One vet pushed me to show result of blood work.


ALT (SGPT) 163 HIGH (reference range 12-118).
google shows LIVER problems....
BUN/Creatinine ratio 40 HIGH (reference range 4-27)
google shows: An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration. It may also be seen with increased protein, from gastrointestinal bleeding, or increased protein in the diet. The ratio may be decreased with liver disease (due to decrease in the formation of urea) and malnutrition
T4 0.8 LOW (reference range 1.0-4.0)
the total T4 result is less than 1.0 mog/dl. A free T4 by equilibrium dialysis may be helpful in supporting the diagnosis of hypothyroidism in patients demonstrating clinical signs compatible with hypothyroidism. ease use test code 7589 for this additional testing.
hypothyroidism? but it is not about her.....
Protein Trace (HIGH) negative

When 'online vet" saw the result, she was disagreed with my vet regarding result and pushed me to do another blood test.

May 12 - vomiting/seizure with foam.

May 14 - second vet visit. The vet agreed that she lost more then 80 % of her vision and became worst (I was not happy with my doctor because she was not FINE at our FIRST visit). My vet started to think she might have a brain disorder, he did NOT think she might have a liver shunt. But previous night, when I called to neurologist for an appointment, they also didn't like the blood tesult and mentioned liver shunt, so I went back to make 'a liver shunt" test.

May, 15 - Polina was diagnosed with liver shunt. Again, I was not happy with my doctor, because he didin't recommend any liver medication, so I had to go to a pharmacy and bought a so-called "healthy liver tonic" (aka silibirin, that doctors use for liver shunt treatment)
I canceled the neurologist appointment instead of Internal medicine specialist.
May, 16 - during the day she was very bad, completely blind, and had a seizure when I gave her "healthy liver tonic"
May 16 night she became better, was hungry, ate good, and drunk. Good sing!!! and we were so happy, but... too early.
May, 17 - seizure, but she felt pretty normal, even started too see better.
May, 18 - Internal medicine specialist appointment. They did NOT find a liver shunt. Polinka was diagnosed with possibly Hepatic encephalopathy. they gave her enulose/lactulose andneomycin, three times daily. I was told that sometimes dogs get better in 24 hours, but I will see result in 7-10 days. If no improvement, then prognoses are bad and probably no surgery is necessary.
May, 18 night - two seizures in 4 hours. With urination and poop. Shaking with no stop. hard breathing.
Same night, at 5am - emergency. Blood glucose test, administer enema and administer medication. They didn't find anything critical. IIn a few hours I went home.
May, 19 - evening. No seizures, but same symptoms - frequent shaking with no stop, hard breathing. Call to emergency, advice to see neurologist (brain tumor)
Same night - seizure/urinating.
May, 20 - today. Morning call to make an appointment to neurologist and MRI. They were extremely busy today (many surgeries), and next appointment only on June, 4.
Doctor, who taking care of her for last couple days, called me and offered bringing Polina on Monday evening overnight and make neurologist see her. I asked for seizure medicine and went to pick up PREDNISOLONE. So from today, she is taking one more medicine.

NOW.

Since Polinka does not do better after liver treatment started, do you think is it really necessarily to make very expensive procedures like MRI in a case she has a brain tumor? Is it too early to give up? should I wait a little bit more days (5 or so)?
Brain tumor is fatal, dogs can live without treatment a few months, with radiology treatment can be up to 2 years (as I was told).
Polinka IS suffering now and it is killing me. I am crying with no stop, trying to make her comfortable.... but....

Although my bills are already high, I WILL do NECESSARILY tests IF I know she can live longer without suffering.

But I do NOT want, I mean, I am not able to pay for unnecessarily tests just to hear - prognoses are bad, she will not survive.
This is what I might do for her:
IV Catheterization peripheral $45
Anestesia, MRI/Ct $200
MRI Brain $1,100
CSFF Analysis w/Cytology $151
Spinal Tap CCisternal $110 (she has good x-ray. What is it for??!!!!)
Contrast Administration catheter $22
MRI Interpretatiobrain/spine $67
total 1,800 (+/-)


Who was in similar situation, please advice !!!!!
what is a must, whatt is not.

I have to decide it before Monday
Sorry for reading so long post.

sorry for grammar, English is not my native language.

thank you from Polina

[Mysweetbabies]

I am so sorry to hear all of this. Sounds like the first vet doesn't have a clue. I wish I had some advise,but haven't dealt with anything like that. I do so hope Polina can get a diagnosis soon. You and Polina are in my prayers.

[motomomma317]

I am sorry I cant help you. But I do pray you get the answers you need to make the best choice for your furbaby.

[red98vett]

oh man how awful for her - I wish I had help too but wanted to wish you well and hope you can find the answers you need.

[PANAMA69]

I'm sorry you are going through this, I will look for a second opinion, hope some one can be more help to you

[Ellie May]

What were the bile acids test (liver shunt test) results?

These neurological symptoms could be from so many causes. It could be a liver shunt or microvascular dysplasia (microscopic shunting throughout the liver). Or it could be something else altogether dfiferent. A neurologist isn't a bad idea since the internist is stuck.

But how do they know it is a liver shunt? Did they do testing? An ultrasound?

There are things that can be done when dogs with liver shunt are prone to seizing (increasing lactulose, lactulose enema, extreme regulation of foods given, etc.), but I couldn't tell you if these things should be done because there is no diagnosis (it doesn't seem like there is anyway).

[omichka]

thank you all.

Yes, they did ultrasound. Sorry, forgot to mention. Also, they think there are possibilities of microvascular dysplasia.

BUT. The problem is - treatment does not help so far, and usually it DOES help. This is why prognoses are not good.

[omichka]

it is hard for me to type each single result of asid test.
There are too many. Which one exactly is most important?

When Internal saw it, she concerned that Polina really has a shunt because many results are not typical for shunt.

the first vet told about shunt this is why he sent me to IM.

[Ellie May]

A bile acids test should have two results (two numbers). One is before eating and the other is after.

Ultrasounds, while good for looking at the size of the liver, etc. and the bladders, they aren't the best for diagnosing a shunt. There could be one present and the vet just didn't see it.

What food did they give you?

A neurologist doesn't look like a bad idea rgiht now because they would be experienced with all possible causes.

[kjc]

MVD and Liver shunt can have the same symptoms.

If she is still showing signs of Hepatic Encephalopathy, the treatment would be to give her Lactulose every hour until she has bad diarrhea, and a lactulose enema may also be given if she has a seizure. You will see a more rapid improvement (almost immediate) as the toxins have to be removed from her brain and intestinal tract as quickly as possible. (If it's not MVD/LS the Lactulose won't hurt her.)

What were the BUN, Creatinine, ALT, AST, ALP, Alkaline Phosphatase, TP, Ca results?

[omichka]

I see

Bile asids, pre-meal 79. 8 High (reference range 13)
Bile asids, post meal 116.4 High (reference range 25)

they gave me L/D CANINE

thanks

PS: Polina is deeply sleeping after prednisolon dose

[speleogirl37]

Hope your baby is well soon!

[omichka]

Originally Posted by kjc

MVD and Liver shunt can have the same symptoms.

If she is still showing signs of Hepatic Encephalopathy, the treatment would be to give her Lactulose every hour until she has bad diarrhea, and a lactulose enema may also be given if she has a seizure. You will see a more rapid improvement (almost immediate) as the toxins have to be removed from her brain and intestinal tract as quickly as possible. (If it's not MVD/LS the Lactulose won't hurt her.)

thanks

oh, she had a diarrea when I came from the hospital

she didn't poop for daaays

[kjc]

Give the Lactulose every hour until she has blow out diarrhea. Imperative to get the toxins out of her gut and brain.
L/D will help, put the Lactulose on the food, it needs to be in her system at the exact same time the food is there.

[kjc]

Originally Posted by omichka

thanks

oh, she had a diarrea when I came from the hospital

she didn't poop for daaays

That may have been from stress. Is she eating and drinking at all?