Need advice/guidance about liver/kidney/gallbladder issues

[ladyjane]

Originally Posted by Scoobstersmom

My husband is afraid that waiting over a week to start treatment when she's already sick and has been so sick for a week is a really bad idea (I tend to think that, too, but I am SO afraid the steroids will kill her).


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By the way, Dana, I just wanted to add that you are NOT waiting a week to start treatment. You are doing many appropriate things to help her. Fluids, antibiotics, ursodial, denamarin - that is all appropriate treatment for liver disease. The pancreas just has to heal on it's own, and the fluids will help. I would not push her to eat, especially if she's vomiting. If anything you can try a very small amount of over-cooked and very mushy rice or boiled white potato (no skin) pureed in a blender and fed by syringe. Give her just 5 ml and see if she holds that down. If she does, give her another 5 ml an hour or two later. And continue that through the day. If she's holding that down tomorrow, you can add a little baby meat chicken to the puree and increase the amount a little but keep feeding her the very small amounts frequently. She won't starve in a day or two and it will give her pancreas a chance to heal. Just make sure she stays well hydrated. The one thing you need to do is get your vet on board with treating her kidneys. Giving fluids and getting the phosphorous down and feeding a low phosphorous diet are the best things you can do for her kidneys. If she were mine and I did not see a huge and significant drop in the phosphorous by today, I would be pushing to add a phosphorous binder. Since the vet's office is probably closed on Sunday, I would also see about bringing her home with sub q fluids that you can give yourself at home.


Let us know what the numbers are today.


All the best,


Diana and Scooby

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.

[Ellie May]

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.

[Ellie May]

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.

[107barney]

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?

[Ellie May]

ETA: Is she negative for lepto?

[Rhetts_mama]

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.

[Bumble]

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)

[Bumble]

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

[ladyjane]

Originally Posted by Bumble

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.

[theporkieyorkie]

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.

[Scoobstersmom]

[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

[Scoobstersmom]

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

[ladyjane]

[quote=Scoobstersmom;4364160]

Originally Posted by ladyjane

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

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.

[ladyjane]

Originally Posted by Rhetts_mama

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.

[ladyjane]

Originally Posted by Scoobstersmom

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


Diana and Scooby

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.