Urgent question Polina is very sick

[omichka]

BUN 19
Creatinine ?
ALT 112
AST 37
ALT 112
Alkaline Phosphatase 31
TP 5.9
Ca ?

[omichka]

Originally Posted by kjc

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

She was normal HUNGRY dog on Monday. Before and after Monday she does not eat much an hardly drinks. She lost weight.

[omichka]

I would like to repeat my question:

What is the most important and what I can skip?:



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

thanks-)

[Ellie May]

I'd like to answer those questions for you, but I can't because I don't know what hte internist is thinking. If the internist strongly believes it's a shunt, you may be able to skip all of that stuff, but it may be replaced with other testing (scintograph). It seems like there is so much uncertainty here.

If you go to the neurologist, just tell them you are limited on funds and do the bare minimum to start.

Was a lactulose enema given?
Does the internist want you to go to the neuro?

[Ellie May]

And remember lactulose is a prescription drug and should be given at the dosage recommended by your vet. If you think the dosage needs to be changed, they should okay it.

Because it does cause diarrhea, dehydration is a major concern.

[omichka]

yes, she wants me to see the neurologist first.

unfortunately, I gave one dose only today - supposed 3 times, and you recommend even more. the only reason - she is sleeping soooo good now, I just do not want to wake her up - seems like NOW she is relaxing after so much suffering. It is 7.30pm now. definitely I will give her all medicine tonight.

[omichka]

Just wondering if it is reaction for prednisolon

[kjc]

Originally Posted by 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. Possible AAI, disk problem
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) Toxins/fluid build up in brain from AAI or GME/Chiari and/or LS

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. HE treatment as stated before... need to give more often.
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. This med will help to reduce fluid in the brain, (AAI/GME/Chiari) which will then decrease her pain.
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

See statements above in blue also link for more info: http://www.yorkietalk.com/forums/sit...inks-info.html

I would do the lactulose orally and mixed with some warm water for an enema, and then read up on these links.

I'd have a Neurologist review her x-rays. I think she has at least two things going on, and I would try to see the Neuro before Monday. Did you tell them she is in critical condition and needs to be seen right away? I'd call them back tomorrow, or call around and try to get her seen asap. Also look for a Vet whose specialty is small dogs/ Yorkies if you can't get to the Neuro.

[Ellie May]

Originally Posted by omichka

yes, she wants me to see the neurologist first.

unfortunately, I gave one dose only today - supposed 3 times, and you recommend even more. the only reason - she is sleeping soooo good now, I just do not want to wake her up - seems like NOW she is relaxing after so much suffering. It is 7.30pm now. definitely I will give her all medicine tonight.

Then that's really what has to be done (neuro visit).

[omichka]

I went to emergency already. The are aware that Polina does NOT do well. I was calling them this morning, but was told that I am welcome to bring my dog, BUT "they are too busy and not sure that neurologist will have a time to see her". I was simply pissed off. Then internal called me back (simply because I was calling over and over again) and told me to bring Polina Monday night. they will check her without appointment.
The neurologist is best in the area and highly recommended, but he will be out of office from tomorrow until Monday. This is WHY I required more medication and this is why "on Monday".

thanks

[kjc]

Originally Posted by Ellie May

And remember lactulose is a prescription drug and should be given at the dosage recommended by your vet. If you think the dosage needs to be changed, they should okay it.

Because it does cause diarrhea, dehydration is a major concern.

The info I posted was given to me from the MVD/LS Support Group on YaHoo. Just passing it on.

[omichka]

I forgot to mention the most important info.

She is NOT young, she appx. 4-5 yo, she used to be a breeding female

So this age is not typical for liver shunt, but, unfortunately, "good" age for brain tumor.

[kjc]

Originally Posted by omichka

I went to emergency already. The are aware that Polina does NOT do well. I was calling them this morning, but was told that I am welcome to bring my dog, BUT "they are too busy and not sure that neurologist will have a time to see her". I was simply pissed off. Then internal called me back (simply because I was calling over and over again) and told me to bring Polina Monday night. they will check her without appointment.
The neurologist is best in the area and highly recommended, but he will be out of office from tomorrow until Monday. This is WHY I required more medication and this is why "on Monday".

thanks

I'd call around and maybe settle for second-best neurologist. I'm not trying to push you... but at this point with the symptoms you describe It's hard to tell what her prognosis is.... and it's already been a month since first neuro symptoms were seen.

Just a Note: Lactulose states on the bottle to be given hourly in the initial phase of treating H.E., when diarrhea occurs, cut back to normal reccommended dose. No reports of overdose.

If Monday's the best they can do, then it's extremely important she gets those medications. Are there any vet schools/universities in your area? They may be more willing to see her.

[kjc]

Originally Posted by omichka

I forgot to mention the most important info.

She is NOT young, she appx. 4-5 yo, she used to be a breeding female

So this age is not typical for liver shunt, but, unfortunately, "good" age for brain tumor.

My dog wasn't diagnosed till 3 years old, also breeding female. If it's mild, I'm sure many go undiagnosed.

Your dog's Bile Acids Test results indicate a shunt. Usually post test less than 100 means MVD.

[omichka]

I understand, and, yes, I was planning to see the neurologist today.

BTW, I live in Seattle area. If anyone knows a good Vet college to visit, I would LOVE to do it. Actually, it was my very first idea, but for some reason I couldn't find anyone close.

Thanks