Need advice/guidance about liver/kidney/gallbladder issues

[ladyjane]

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

[Scoobstersmom]

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

[ladyjane]

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

[Scoobstersmom]

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

[ladyjane]

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.

[Rhetts_mama]

Originally Posted by Scoobstersmom

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

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.

[ladyjane]

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

[ladyjane]

Originally Posted by Rhetts_mama

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.

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.

[Rhetts_mama]

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

[theporkieyorkie]

Originally Posted by 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.

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

[Rhetts_mama]

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

[Bumble]

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

[wemple2]

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

[JuliannaB]

My condolences! Sorry to hear of your loss

[Verbena]

I am so sorry for your loss