Good evening, all!
Thanks for all the information and support, and prayers for my little girl.
She spent today at the vet's office again on "four times maintenance" fluids, until the vet on staff today noticed that she had a 2/6 heart murmur, and upon xrays felt her heart was enlarged. Then he backed her off to 3 times maintenance fluids. I'm no longer comfortable with IV fluids at those rates, but more about that later.
This morning, after one day on fluids, her BUN dropped from 169 to 165, and her creatinine went from 2.5 to 2.2. Her phosphorous is down from "over 15" (off their charts) to 11.5. I insisted on a pancreatitis test, because this dog is a VERY good eater with an iron stomach, and the only time in her life that she's ever been sick to her stomach was a bout of pancreatitis from eating cat food many years ago. The CPLI (something like that?) test came back as a "strong positive" according to my regular vet, who was off today but called me from his home. He said that he and the on staff vet today had consulted about Bumble, and felt that all her bloodwork levels added together, along with enlarged liver, was most likely lymphoma (and even told me that the pancreatitis was probably from the lymphoma and not "true" pancreatitis). To be honest, I'm sick of hearing that word. It seems every time one of my pets has a mystery disease, it's "lymphoma" which has NEVER managed to be a definite diagnosis. The vet insisted that they needed a diagnosis to be sure, so they could figure out how to start treatment (chemo, etc.) and how advanced it is. Again, he pushed for the needle biopsy of her liver (not kidney, perhaps I misunderstood previously, but I made SURE it was liver only). Keep in mind there is no visible mass, just a generally enlarged, dense liver and high liver values. Also, the only enlarged lymph nodes she has are in her neck, and they've been enlarged since a particularly nasty infection/growth in her mouth in February this year. Against my better judgment, I allowed the biopsy of her liver. I was assured, many times, that she would be given propofol as a sedative, and told how safe it was, how quickly she would recover, etc. They ended up using butorphanol, I think he said, because of heart concerns. Also, to look for signs of metastasis (for this mysterious lymphoma), they wanted to do full body xrays. Okay, fine, I really have no problems with xrays. Apparently the xrays appear clean on first read, but they were also sent off for a radiologist to review.
The xrays DID show, however, that Bumble's heart is enlarged, larger than it was in xrays done back in February 2013. At that time we took her to a cardiologist who felt her heart was within normal limits considering her age and breed (he referred to her as a "barrel chested breed"). He did want to repeat the echocardiogram and EKG this fall, but one thing led to another with a cat who became sick and died in October, and now the entire month of December taken up with Bumble's illnesses, and we just haven't done it. Apparently this needs to be a priority in January, since the cardiologist only comes over from Gainesville once per month and I missed the visit in December already.
The on staff vet today, because of the murmur and the enlarged heart, was worried about stressing her heart and backed off on the amount of fluids. I know she probably SHOULD be on IV fluids for a few more days to bring her numbers down, but I just can't trust the vet to back off when he needs to. I told the tech this afternoon that I'm not bringing her back in for fluids tomorrow morning, and the vet could call me to discuss it when he's back in the office tomorrow. I anticipate an argument, to put it mildly. The straw that broke the camel's back, so to speak, was when the tech told me, at 5:00 p.m. tonight, that YESTERDAY Bumble seemed to have a couple of fainting/collapsing episodes while they were working with her. Nobody told me about this, and to my knowledge she has never ever EVER fainted or appeared to do so. I realize a lot of things could cause this, but in light of heart issues, I tend to think perhaps they were overstressing her little heart already.
In the meantime, I have taken all your VERY GOOD advice and both located a replacement primary vet, and talked to a specialist who will let me self-refer. The bad news is that the holidays are going to cause quite a delay for both appointments. To get in with our choice of vet, because of Christmas holidays and everybody's work schedule, I can't get her in to see her new vet until December 30th, a week from Monday. I set that appointment already. The specialist's schedule also looks like December 30th or 31st will be my first chance to get an appointment. If I get a lymphoma diagnosis from this biopsy, then I'll get Bumble in to see the oncologist. Otherwise, I'll get her in with the internist. For now, I will probably treat the pup instead of the numbers, and unless she gets worse, delay any other treatment until the biopsy results are back.
My husband picked Bumble up from the vet's office this evening. I didn't tell him that the vet had said this morning he'd give us prescription I/D food for Bumble. It wasn't ready for her, and they didn't give her any food to take home. Turns out they also haven't fed her, so she had not eaten in over 48 hours. I got my hands on a case of I/D (thank you Petsmart, and gee I hope this is okay food for pancreatitis) on the way home, and I've fed her twice tonight, about two tablespoons worth each time. I'll give her a teeny bit more before bed, but so far no signs of nausea. She's tired tonight (hungover from the drugs they gave her around 2:30 p.m.), but overall seems much more alert than last night. She's followed us through the house, and was incredibly happy to see me put food down for her. Poor little girl was probably starving.
I don't think she's out of the woods yet, and unfortunately it's going to take a while to get her established with a new vet, an appropriate specialist, and to get those biopsy results back in and interpreted, but tonight I think I can sleep. Last night I stayed in the den with her, with the light on, and only dozed, waking up probably every 30 minutes or less to make sure she was still breathing. My poor husband was in tears when he kissed her goodnight last night, and told me he didn't think she would still be here this morning. She was THAT listless last night.
Thanks again for all the guidance and support. Knowing that some of you have dealt with these multiple-organ issues without it being a diagnosis of lymphoma is comforting to me. I wish we could all have perfectly healthy little ones, but since that just isn't possible, I'm really glad there are wonderful groups like this one who are supportive and helpful and willing to share their experiences!
Now if I can just get her stable and back to her old self, I can bore you all to tears with stories about how wonderful she is, and all the silly little things she does!!
Dana and Bumble