I did not say she is waiting a week for treatment. I don't KNOW what is appropriate treatment. All I am suggesting is that if she were my pup, I would be at a 24 hour facility now. I have never heard of having to wait for one week to see a specialist with an extremely ill pup. In my experience, a very sick pup is seen immediately once referred and, if the situation is emergent, hospitalized and then a plan made. I have never spent more than approximately $3,000 to $5,000 for the ICU and appropriate testing; and usually the pup is discharged in about 3 days with a diagnosis and plan. Going back and forth to a general vet is expensive, not to mention stressful on the pup. I personally would never allow a vet to give fluids day after day and test day after day....Just me and how I do things. I am very fortunate to have excellent vet care in this area. I have learned a lot over the years of having very, very sick pups in my care. I won't even allow pancreatitis to be treated at my general vet as it can turn bad very quickly.

You and the OP seem to have become bonded so to speak; and you seem to think you know best what this pup needs, so I will bow out. I am not here to monitor this pup's lab values and care....I don't do that as I am not a vet and feel those things are best left to vets. I have voiced my opinions and shared my experiences. Nothing more for me to add except that I will pray for Bumble.

I'm trying to follow all of this, but it is difficult. This vet is playing with your dog's life and it is sad. I'm not sure where you are in FL, but there are going to be major specialty hospitals within 2-3 hours. Even their ERs are going to be staffed by boarded vets.

BTW, Ursodiol can cause pancreatitis.

How about here?
Internal Medicine - Animal Emergency & Critical Care Center

Florida's vet school looks to be just three hours away.

If they are still going to insist on a referral when going through the ER then find any vet in your area that would do that for you. Everybody is open today. Just explain that it is urgent.

They don't insist on referrals when you show up with dog in hand. Just go, they'll see her. And leave behind this idiotic Internet nutritional advice. It sounds like it came straight from one of those listsserve groups that people join when they don't want to spend money to have individualized consults. The diet is the least of this dog's problems. Her biggest current problem is her vet, and if you don't change vets, then her biggest problem is you. Think about that - you're the one who can change her fate. Are you going to do it?

ETA: Is she negative for lepto?

It seems to me that right now she is being treated symptomatically, and some of that treatment may have actually exacerbated other things. Until there is a definitive diagnosis, how can anyone say this pup is being treated appropriately?

I know it's Christmas and many people are on vacation, but if it were me I would be on the phone with any specialist within a day's drive trying to get some answers and a safe and appropriate treatment plan.

Update this morning:
Bumble threw up last night, after holding two tiny meals and her ursodiol down for a couple of hours. She was obviously just exhausted, weak, and overall not feeling well. Hubby stayed up with her most of the night to keep an eye on her, and I took over around 4:00 a.m. We decided against steroids, I'm just too afraid of them with her kidney and other issues.

Took her to the vet this morning at 8:00 a.m., and the vet really didn't agree with my "no steroid" decision. He realized I wasn't going to be easily talked into it, though he kept telling me he thought she would die without the steroids and might die anyway (I realize that, it's a hard decision to make).

They drew blood first thing, and I waited there for the results. The GOOD news is that her BUN is down (over the past few days it has gone from 169 to 165 and now this morning to 111), but her creatinine didn't move again (still at 2.2). That's okay, I'll take that. Not great, but could be worse. Her ALKP and ALT are coming down (ALKP was over 900, and it's 703 now, should be 150 or less so it's not great, but it's moving in the right direction). The BAD news is that her phosphorous went from "over 15" (out of range, couldn't be measured) earlier this week, to 11.5 a couple of days ago, to "out of range" again today. SIGH. Oh, well, I guess you can't get everything resolving at the same time. The other BAD news is that her HCT worsened considerably, and the vet is currently giving her a blood transfusion. On 12/3, it was 35%, 12/18 it was 26.68%, and this morning it was down to 18.48%. Vet felt that level of anemia was dangerous so he immediately suggested transfusion, and I didn't argue. I've never had a transfusion done on one of my babies before, but now I'm hoping a LOT of her general depression and lack of energy may be from that. The cause of the anemia may be a problem to pin down, but I agreed we needed to deal with the immediate issues.

Considering the blood work, the vet feels her liver is FINALLY responding to supportive care, perhaps, and now agrees NO STEROIDS, pending further bloodwork, I'm sure. :)

I'm worried about the anemia, but as for the rest of her numbers I'm a lot happier. I know they're not great numbers, but I'll take an improvement over the continuing worsening we've been seeing.

Diana, thank you for taking the time to give me all of Scooby's information. I know we may not be as lucky as you were with him, but it definitely gives me hope that we're moving in the right direction in trying to stabilize her. I'm so glad he's doing well! :) Yorkies are just amazing little guys, full of joy and love, and I feel so bad for ANY of them being sick. I'm really happy to hear Scooby has been doing so well for quite a while now!

Everybody kiss your little ones for me and Bumble, and barring any more problems, we're on a course of treatment to keep her stable until her little body can recover from this. I know she might not recover, but we're very cautiously optimistic with the improved numbers (assuming this new problem of anemia doesn't mean something else is drastically wrong).

Dana and Bumble (who is rapidly losing her patience with being hospitalized daily)

One more thing for everybody, and I'm sure it got lost in my other HUGE posts: The specialist in the area (we're in kind of a smaller area without access to much top-of-the-line care) is currently on vacation, which is pretty bad timing from my point of view, but I can't blame the specialist for taking time off for the holidays. :) I assure you I am simply trying to get my little girl stabilized and dealt with as carefully as possible until I can get to the specialist. She WILL see a specialist, but right now if I go the ER vet, I'll just get luck-of-the-draw on whichever general vet is working this weekend, or during the week. They only have one internist, and she's not in until December 30th.

I am not avoiding an internal medicine specialist, I'm simply "stuck" without access until that specialist's vacation is over. I really do appreciate the concern, but I didn't want you to think I was sticking with a regular vet by choice at this point.

Dana and Bumble :)

I am not talking about a "specialist" in a private practice. I am talking about specialists in hospitals where someone is always there and someone is on call at all times.

Vet schools are there 24/7 .... you have been provided with links to FL specialists and they are not private practice vets who go on vacation. I have driven to Texas A&M quite a few times....2.5 hours each way to get the level of care my pups needed. Surely you have a hospital within driving distance that you could take Bumble to. No, you don't have to listen to us...it is your pup and your money....just giving you the best advice I can based upon my experiences with multiple sick pups over the years.

Again, if your pup needs daily fluids and care, I am quite certain she needs intensive care in a specialty hospital. In the long run you would save money AND save her life. I am very concerned about her at this stage of the game.

Thanks for the update. I would be hesitant to start on the steroids as well, with everything going on.

Vet schools have 24 hour ER's and when you take your pup there, they have all kinds of specialists there. My mom has rushed her yorkie to Michigan State several times. Because you are bringing the dog in through the ER, you shouldn't need any referrals like you would in a private practice.

I agree with Lady Jane in that it will probably be less costly in the long run. Going back and forth to the vet for the next week until you see a specialist, who's going to run more tests... is going to cost your more and more....If you take Bumble to the vet school, they have all of the specialist and the medical equipment to do the testing they need to do to get your little pup stabilized.


BTW...if you are having problems paying the vet bills, you could apply for Care Credit. It's sort of like a credit card for vet bills. That way you don't have to worry as much about coming up with the cash up front.

[QUOTE=ladyjane;4363989]I did not say she is waiting a week for treatment.

QUOTE]



Ladyjane, I hope it was just some confusion but since you quoted my post, I have to add that I never did say you said that she was waiting a week for treatment. I was referring to Dana's comment that her HUSBAND was worried about delaying treatment with steroids. Tough decisions to make.


For what it's worth, obviously at this point an internal medicine specialist would be the best option for treatment but Dana says that is not available to her right now, so there's no point in continuing to insist that is the only option. She's doing the best she can for her pup. I have literally spent thousands on my dog too through his illness, but not everyone has the $3000 to $5000 you mentioned to spend on their dog in three days time either.


Bumble seems to be improving and I'm grateful for that.


Diana and Scooby

Hi Dana. Just checking in on Bumble this eevening. I hope you have continued to see improvement throughout the day. How did the blood transfusion go? I have heard that large amounts of fluids can contribute to anemia so hopefully that is at least part of the cause of the sudden drop in her blood counts, and that the transfusion made a big difference in the way she feels and her energy level.

I have been thinking about her today and sending prayers. Please update when you have a minute to let us know how she's doing.

Diana and Scooby

[quote=Scoobstersmom;4364160]At the rate she is going with her vet, she is probably close to 2,000 ...maybe at least 1,000. Just a rough guess. In my opinion it sounds like a bad investment...any vet who is so against referrals and does liver and kidney (shudder) biopsies in his office is more than likely expensive...not to mention scary if you ask me.

As to no other treatment available...according to her zip code she is about 2.5 hours from the vet school. She came here looking for advice and suggestions and she got them. You might note that I am not the only one who is posting about the level of care here and the people voicing their concerns have a lot of experience as well with sick pups.

Prayers for Bumble.

:thumbup::thumbup::thumbup:

I am not sure where you got that idea. Lab values are almost the same and Bumble needed a tranfusion. I hope I am wrong, but it does not sound like improvement to me.

Just a thought...is is possible the blood loss is due to the liver aspirate that was done?

BUN down by 50 points, creatinine stable at 2.2, and the liver numbers have also dropped some. Dana also said Bumble was more alert and had eaten yesterday so it does seem like some improvement.

Ladyjane, anemia is a common complication with advanced kidney disease and the dog has also had an overload of fluids, which can also contribute. But if the anemia wasn't present prior to the biopsy I suppose that it could possibly come from bleeding at that site as well. Looking backwards at the posts though, the HCT was already dropping (although not into the danger zone) on 12/18.

I sure hope Bumble shows improvement today. She has a lot going on in her little body so I hope she has a fighting spirit.

Dana, we are thinking of you and Bumble.

Diana and Scooby

The numbers have not shown the improvement I would be looking for. Just want to add though.....if I thought the anemia was due to an overload of fluids, I would be running to another vet...if not a specialist, just another general vet. Surely there are more of them in her area.

As to your educational remarks, I know full well about liver and kidney issues as well as many other conditions. I have a wide range of knowledge but I don't read and interpret lab values for people...I merely do cautionary remarks. I also know what I consider competent veterinary care. There have been red flags on the OPs vet care since the beginning. I would have run out of that place long ago. She has chosen to stay and you support that. I don't because I believe I would be remiss in not pointing out what I see.

Linda, Cookie & ..........all the rest

Whoa...I do not support or NOT support her choice to stay with her current vet.

I support her right to choose what SHE feels is best for her dog. I support HER because she is afraid and worried about her dog. She feels she's offering the best she can for her dog's care. We don't know her circumstances, but not everyone can jump in a car and drive hours to a vet school. And not everyone can afford the level of care you were describing. In a perfect world, everyone could. We don't live in a perfect world. I have a very senior chronically ill dog myself. There are limits as to what I would choose to put him through, and not because of money. She has not shared her circumstances, financially or otherwise, so we don't know why she has chosen to stay the course with her current vet. And that is her business, not ours. But a little kindness and support never hurts. I am sure she has gotten the clear message that everyone here thinks she has made the wrong choice. But I am not judging her choices because I don't know why she has made them and she may very well have valid reasons for them. Its not like she's kicking back eating popcorn and asking for internet advice to keep from taking her dog to the vet. Her dog has had continued vet care through this crisis. She apparently trusts her vet, at least to the point that she has chosen to continue having him care for her dog, and feels she's doing the best she can and what more can you (general you) ask or expect from a person?

For the record, I did not support her choice to have a biopsy done on her critically ill dog. I also don't support the fact that her vet seems to be putting the kidney issue on the back burner in favor of treating the liver. Personally, I would want everything possible done to preserve the remaining kidney function because once it's gone it's gone.

But its her dog, not mine, and she gets to make the decisions.

Diana

A. I am not being unkind. I am being honest.

B. I said it was her decision.

C. It is not what I can expect from a person...it is what a dog would expect if able to express him/herself. I mainly speak for them because they don't have a voice...I do my best to give good advice, not just what a person wants to hear. It is what I expect from people when I ask for advice.

There is a problem with your statement that the lower BUN and Cr levels are a sign of improvement.

If you are assuming that the rapidly lowered Hematocrit is a result of the fluid overload (as opposed to an acute hemorrhagic event) then the lowered Bun and Cr numbers would also be reflective of that dilution as can the decreasing ALP and Alk Phos levels. You would need to look at the rest of the serum electrolytes to determine if the fluid balance was correct or not.

Of greater concern is the fact that the fluid was given at such an exaggerated rate. You don't normally run IVF at such high levels in order to increase the preload unless hypovolemia is suspected or confirmed since one of the main causes of renal failure is decreased cardiac output. Smaller, repeated boluses are much more effective and safer. You need to manage the cardiac output first. Fluid overload can lead to congestive heart failure which in turn decreases renal perfusion even more. The sudden appearance of a 2/6 murmur is of real concern. A blood transfusion can exacerbate the situation even more if her fluid balance is not managed correctly.

Again, at this point there is no definitive diagnosis, so what is or is not an appropriate or even effective treatment can not be said for certain. What's causing the renal failure at this point is still anyone's guess until she is seen by a specialist. Is it pre-renal, post renal or intrinsic failure? Is this an oliguric or non-oliguric failure? Those are just some of the questions that need to be answered by a specialist. The sooner the better.

Lastly, this is why I am bothering to try to help...her topic for this thread. It did not say please support my decision to use my general vet to do a. b. and c. I am not going to assume what she can/cannot afford or is capable of doing. I am merely going to give the advice asked for.

Need advice/guidance about liver/kidney/gallbladder issues

:thumbup::thumbup::thumbup: I see this a lot...people trying to read and interpret numbers without the educational background that such requires. Everyone thinks elevated this means this and lowered this means that and they don't know how they interact...not to mention the fact that the patient must be seen and examined. It all works together. It takes years of schooling to be able to do this.

Oops, I should have said her ALT and Alk Phos levels, not ALP. I need some more caffeine this morning!

:eek::eek: Didn't know that!! I know it has a whole list of side effects though!!

It's been more than a week since the last post. Any updates? Has the OP been able to see a specialist?

Thanks for all the support and information for Bumble. Last Monday, she was showing a lot of improvement, even barked for her dinner, and she hadn't been barking at all for about a week, nor was she overly interested in food during that time. She spent Christmas Eve and Christmas Day with us, apparently doing much better. On Christmas evening, she had a seizure, and we rushed her to the ER vet. We had to let her go around 5:00 a.m. on 12/26/13. We are heartbroken, and miss her so very much. I wish all of you the best with your little ones, and may you all have many happy, healthy years with them.
Dana and Angel Bumble

Oh no...my deepest sympathy, I am so, so very sorry for your loss.

My condolences! Sorry to hear of your loss:(

I am so sorry for your loss