Dana, do you know what Bumble's liver numbers are? CAH is sort of a catch all diagnosis for liver disease and means there is an inflammatory or infectious process or both going on in the liver. Lots of dogs have a slightly enlarged liver and a dx of CAH. That's a big improvement over cirrhosis and CAH, which means parts of the liver have shrank and gotten hard and will not regenerate. If there is an infectious process (bacterial) going on in the liver it needs to be treated with antibiotics - often amoxicillin - which your vet is doing. Hepatitis is chronic and is mostly just managed. The liver numbers can drop quickly, but more often it is a slow process taking months, and in the meantime you're managing the condition with pulsed antibiotics, ursodial (not only for gall bladder, it is an awesome antioxidant for the liver), denamarin and other supplements, and diet and watching to make sure the numbers are decreasing instead of increasing. Many dogs live for years with chronic liver disease and just managing the symptoms. Some times hepatitis is treated with steroids (or becoming more common now - atopica - which is an immune suppressant) but both can be very damaging to the kidneys so I'm shocked your vet would want to treat with steroids at this point.
It took several months for my Scooby's liver numbers to show a significant decrease and about nine months before they were mostly in the normal range. Even after 17 months, Scooby still has an elevated ALKP, but ALKP is not liver specific, so may just be a response to the inflammatory process in his digestive system. He does not have any symptoms of liver disease now, but his numbers will jump when he has a pancreas flare.
An acute case of pancreatitis can elevate both the liver and kidney numbers so you really need to get the pancreas under control before you have a baseline on the liver and kidneys. The pancreatitis is probably what is causing Bumble the most discomfort as it is very painful. There isn't a magic medicine to fix the pancreas so treatment is mostly supportive care. Fluids, pain meds, rest the pancreas by fasting until the diarrhea and/or vomiting is resolved, and then slowly reintroduce a very bland and low fat diet, tiny amounts frequently and increase the amount slowly as tolerated. It can take days or weeks to get back to eating regular meals, and once a dog has had an acute case of pancreatitis they are more likely to relapse so that means feeding the low fat diet from now on. Some vets add an antibiotic but that is mostly to prevent a secondary infection, and some vets treat pancreatitis with steroids but that is dangerous territory for a dog in renal failure.
If Bumble is dealing with nausea or acid buildup, your vet can prescribe medications for that. Most dogs in renal failure take Pepcid or some other acid reducer, and sometimes need Reglan or Cerenia to get past a bout of nausea.
The kidney disease is a big problem because kidneys are non-regenerative and the disease is progressive. Once kidney function is lost it's permanent, so the goal - again - management of the disease - is to slow the progression as much as possible for as long as possible. That phosphorous level really needs to come down as soon as possible to prevent further damage to the kidneys and other organs. IV fluids will help but your dog really needs to be on a phosphorous binder. Fluids - either IV or subcutaneous - will also help to decrease the BUN and flush out toxins and help the remaining kidney tissue to function better. Bumble will need to be on a quality protein - low phosphorous diet for maintenance and management of the kidney disease. There are several supplements you can add to help the kidneys function and slow progression of the disease. You want to keep treating with fluids to get those numbers as low as possible, and then maintain them for as long as you can with the sub q fluids, diet and supplements.
Anemia can be caused by advanced kidney disease, or it can be caused by a bleed (which is often also caused by kidney disease as uremia is very acidic and can cause ulcers in the mouth, stomach or intestines). Your vet will need to determine whether the anemia is regenerative or non regenerative. ie is the anemia a result of the body not making the red blood cells and caused by the advanced kidney disease, or is the anemia regenerative and caused by an ulcer? The treatments are different for the different types of anemia.
Your Bumble has a lot going on in her little body right now, and if she recovers it will be a long road back, but it is possible. In August-September of 2012, we were right were you are right now and the vet only gave Scooby a 50/50 chance to make it through the acute phase. It's been about 17 months now and he is doing well. He still has liver disease, still has kidney disease, still has occasional flare-ups from his pancreas. We manage all of his conditions with diet, supplements, blood pressure medication, ursodial, metronidazole, occasional pulses of amoxicillin, and daily sub q fluids at home. His numbers are all mostly in the normal range because of the treatment protocol we follow. He eats, is active and playful and feels good about 95% of the time with an occasional bad day when his tummy is acting up. For a 15 year old dog, I guess that's about as good as it can get.
I hope this helps a little, and maybe gives you a little hope. Not all dogs follow the same course and your Bumble may have different things going on, but hang in there and just keep staying the course. Sending lots of prayers and positive thoughts.
Diana and Scooby |