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Old 12-18-2013, 07:35 AM   #1
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Default Need advice/guidance about liver/kidney/gallbladder issues

Hello! My sweet little Bumble is almost 13 years old, and in October she went to the vet for a regular checkup and blood work. BUN was at 120, creatinine was in normal limits. Liver is enlarged, and liver enzymes were elevated. I have exact bloodwork numbers, and can post them later. The vet started her on ursodiol and Denamarin for a liver cleanse, basically.


December 2nd, we went back to the vet for follow up bloodwork, and her BUN was down to 54, creatinine at 1.0. Ultrasound showed "gunk" in her gallbladder, but apparently not a mucocele. Vet was concerned that perhaps she had a bleeding ulcer (causing the unusual BUN increase), so we treated her with antibiotics (amoxicillin and metronidazole) and Carafate liquid. Kept her on Denamarin and ursodiol. Within a week of the antibiotics, she started to not feel well, and throw up periodically. Over the weekend, she started throwing up once or twice a day, and she obviously feels bad today. Took her to the vet this morning, and bloodwork now shows that her BUN is 169, creatinine 2.5. Now her phosphorous is "beyond max range" for his equipment (over 15, when it should be no more than 6.6). He's going to do an ultrasound shortly to see what's going on, and put her on FOUR TIMES maintenance fluids for today. That frightens me, because I had a cat die in October because of that...his heart couldn't handle the amount of fluids being pumped into him.


I'm afraid my vet has no idea what's going on, and I don't know what tests to ask for. He's obviously reluctant to refer me to an internist, and the only one in my area is by referral only at the emergency clinic. Have any of you ever seen numbers like this in a yorkie, or have any idea what it might be? I just don't even know where to go from here. I'm terrified I'm going to lose her, and she was just fine until we started the antibiotics and Carafate.


Dana and Bumble
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Old 12-18-2013, 07:46 AM   #2
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I would definitely be leary of having a regular vet treat her. Sounds like her kidneys are perhaps an issue. You say he is reluctant to refer her...that is a huge concern to me.

If you don't have an internal med specialist in your area, I know LSU is a hike for you, but honestly, that is where I would probably go. Either that or Texas A&M. It is probably not much further than LSU.
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Old 12-18-2013, 07:48 AM   #3
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And, welcome to YT. I will say prayers for Bumble. Please keep us updated on her.
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Old 12-18-2013, 08:01 AM   #4
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Oops, I can tell how stressed I am! I have the flu AND I'm borderline hysterical over the idea that my baby girl is so sick. LSU would be quite a hike, since I'm in Florida now! I think I fixed my location now. Maybe.


I'm feeling anxious about the reluctance to refer me to a specialist, too. I asked about a CT scan earlier, and my vet told me that we're concerned about anesthesia (okay, I'm concerned, he doesn't seem to have any fear of anything), but pointed she would need anesthesia for the CT also, and then perhaps anesthesia the next day if the board surgeon wasn't on staff and needed to open her up, while HE could do it all in one day and for less money. Money is definitely an issue, but her life is more important to me! I'll live on canned beans for months if I could save her!


I'll post more after the vet calls with the ultrasound results. (Also, my vet isn't as cheap as he thinks he is. I spent more money in two days for day-only hospitalization for my cat with him than I did in a full weekend of round-the-clock hospitalization at the emergency vet. Neither one is even affordable, much less cheap.)


I'm so stressed. Thank you for the prayers! My sweet little girl needs them!
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Old 12-18-2013, 08:04 AM   #5
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I'm not sure exactly where you are, but there is a vet school in FL. We are a referral based state here in MI too The way to get around that is to go to emergency in one of the hospitals with internists.

I would not leg this vet waste more of your money by doing ultrasounds. And before pushing that amount of fluids he better be darn sure the heart is ok.

I would go get your pup and go to an ER of a major specialty hospital.
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Old 12-18-2013, 08:19 AM   #6
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Originally Posted by Ellie May View Post
I'm not sure exactly where you are, but there is a vet school in FL. We are a referral based state here in MI too The way to get around that is to go to emergency in one of the hospitals with internists.

I would not leg this vet waste more of your money by doing ultrasounds. And before pushing that amount of fluids he better be darn sure the heart is ok.

I would go get your pup and go to an ER of a major specialty hospital.


Oh! I assumed Bossier City, LA. My bad.
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Old 12-18-2013, 09:19 AM   #7
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My pup had sludge in his gall bladder...determined by a ultrasound. He had elevated liver enzymes and scarring his pancreas, but a lot of that, the vet thought, was due to the sludge in his gall bladder causing problems in those other organs. We've battled with it for a long time....not much vomiting, but loose stool and he wouldn't eat much. He's finally, after a year, starting to have less episodes.

BTW...I went through 2 vets and into a specialist to get my answers.

What you have going on sounds much more complicated. I agree with Lady Jane in that there may be kidney trouble. I would try to get her into a specialist.

Have you read up on the carafate at all??

It looks like your vet is using it to treat an ulcer....but it should be used with caution in patients with Renal Failure. Carafate contains aluminum. If someone is having kidney problems(which elevated BUN and Creatine levels may point to)....they may not be able to excrete the aluminum and they can suffer from toxic aluminum poisoning from taking this. Vomiting is also one of the possible negative side effects from taking the drug.

This may be why you noticed such a change when you started giving her the carafate.

Hopefully you can get your dog into an internist. Please keep us updated on what happens. Praying that Bumble has a quick recovery!!

Last edited by theporkieyorkie; 12-18-2013 at 09:21 AM.
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Old 12-18-2013, 10:27 AM   #8
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Why do you say your vet is reluctant to refer you to a specialist? Have you asked? If you have and he refused, what was his reasoning?

Remember, you are in charge of directing care for your pup. It's fully within your rights to ask for that referral if you feel you aren't getting any where with the current treatment. If your vet continues to balk at the referral, then i would be on the phone with every vet in the area until you find one who is willing to take you on and make the needed referral.

Good luck.
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Old 12-18-2013, 11:44 AM   #9
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I tried to post an update a few minutes ago, but I think it logged me out and didn't post. So here we go again. If this is a duplicate, I'm sorry!


Vet did the ultrasound of Bumble's liver, kidney and gallbladder. He said her gallbladder looks better (less material in it than in early December) so he feels the ursodiol is helping her. He said her kidneys don't appear irregular and deformed as they would with chronic renal failure, so he feels this is acute renal failure. He does feel that "subjectively" her liver appears a "little more dense" and a "little more enlarged" but nothing overly concerning. No sign of masses or bleeding.


He has her on IV fluids and IV ampicillin and famotidine. He feels that we need to get her stable (read: kidney values lowered) and then probably need an ultrasound-guided needle biopsy of her liver and kidney. He said he will do that with just propofol instead of general anesthesia, to lower the risk to her, but he wants to make sure her kidneys are improving and able to rid her body of the propofol first.


I asked again about a referral to an internist. He balked at that, didn't feel that an internist could do anything he couldn't, except cost a lot more money. I told him that I wanted another set of eyes, that the two of them could confer together on her treatment. He said he's posting the information on some veterinary board, and that would be the same as getting an internist's opinion. Okay, I get that BUT it's the same as if I had cancer and wanted to go to an oncologist. I just want to give my little girl as much of a fighting chance as possible! I guess we'll see how Bumble does this afternoon and tomorrow morning (when they re-run bloodwork) and then decide whether to fight over an internist referral, or whether to wait until we get a biopsy.


I'll try to post a picture of Bumble this evening. She's such a sweet little girl, never angry, never bad tempered (but she is stubborn! lol). We've never ever heard her growl in anger, though she's threatened her toys several times while shaking the daylights out of them. It's so tough to see her sick, and feeling awful. The vet said he was more concerned that she didn't squirm around during the ultrasound, and he realized how bad she felt.


Thank you so much for all the advice! I didn't realize Carafate was a potential problem for her kidneys. I will NOT give her any more of that! She absolutely hated the stuff, anyway.


My husband and I are heartbroken that we may be losing our little girl. She turns 13 in two weeks (she shares a birthday with my husband!). I always get a cake for both of them that says "Happy Birthday Gary and Bumble" and she gets first lickies from the edge of the cake. My husband holds her to keep her from diving into the cake, and I take a picture of her licking it. Obviously with her liver issues this year, she won't be getting buttercream frosting on her birthday, not even a little lick. We'll just have to convince her something healthy is her birthday treat.
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Old 12-18-2013, 04:43 PM   #10
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I changed my profile pic so you can all see Bumble.

My husband picked her up this evening. She doesn't have any signs of being overhydrated, as far as I can tell. She peed twice as soon as she got home, and then an hour or so later had diarrhea which was black and scared me (black is usually digested blood, right? But this morning's stool was normal and solid so I'm thinking this is from the fluids and IV drugs). She drank a good bit of water earlier this evening, but nothing for the past hour or so. She's resting in hubby's lap, and just doesn't seem to have any energy at all. Tomorrow morning the vet is going to recheck her kidney values and see if there's any improvement, and he's going to run a test for pancreatitis, in case she got into cat food when my oldest cat got sick. My oldest cat doesn't remember he's almost toothless and tries to eat the younger cat's dry food, and without chewing it, it tends to make a reappearance shortly after eating. Eww.

Prayers for my little girl would be greatly appreciated. We're scared, even more scared now that we see how depressed she is tonight. She's always been a lively little girl, energetic and into everything, and watching everything that goes on. Tonight she even seems to be having problems seeing. I trimmed her bangs back really well, just in case hair was blocking her vision, but she's been bumping into walls today when she tries to go around corners, etc. If she's suddenly losing her vision, that's another new symptom, and another scary one.
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Old 12-18-2013, 06:30 PM   #11
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I'm sorry, but if my vet suggested doing a biopsy of my pup's liver and kidneys I would leave and probably never use her again. I have used her since 2001 and she has never suggested doing something of this nature and trust me I have had some very, very sick pups. I think it is terrible that your vet is suggesting that you will pay more at a specialist. Like he is giving you a "deal".

One of YHR's foster moms took a pup to a vet who did the same thing only it was orthopedic stuff. He said the knees and hips all needed surgery and gave her a low quote for such surgery. We had her take the pup to the board certified surgeon that we use and he said she did not need ANY surgery!! This was a couple of years ago and she was adopted and is doing just fine!

I believe strongly from what you are saying that Bumble should be with a specialist. It concerns me greatly that your vet is doing this. Sounds like a money maker for him.
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Old 12-19-2013, 05:14 AM   #12
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Please leave this vet. He is hurting your baby. Part of kidney disease treatment is phosphorus binding. He does not know what is up and needs to send you out.

We have specially trained sonographers here and I don't think they even go near the kidneys with a needle. Renal artery - hitting it bad news. You need an IMS. I'm going to go out on a limb here and say gallbladder sludge is the least of concerns with kidneys shutting down.
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Old 12-19-2013, 05:18 AM   #13
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Dana I'm sorry you and Bumble are dealing with so much. My yorkie is 15 and has been dealing with a trifecta of issues involving his liver, kidneys and pancreas for the past couple of years. He also initially had some gall bladder issues but Ursodial has helped, and I'm told that he will be on that medication for the rest of his life. I would also be very cautious of having even a needle guided biopsy done by a general practice vet. We have considered having a biopsy done a couple of different times, but when I asked our Internal Medicine vet what she expected/hoped to find and how it would change his treatment plan, she said the information would be good to have, but that he was already on the standard of care for his condition anyway. And a needle guided biopsy is iffy anyway, as they have to hit exactly the right spot in the liver to get any information at all. Our IM vet actually admitted that in more cases than not, the results come back inconclusive. So we passed on it.


Your vet does seem to be on the right path with trying to get Bumble stabilized. IV fluids are the best way to get the BUN and phosphorous down as they are both extremely high. A phosphorous level that high can cause a lot of damage to your dog's internal organs and a BUN of 169 means that his system is very acidic and could definitely cause an ulcer. Luckily the creatinine is holding very well at 2.5. Yes, it's elevated, but my Scooby's creatinine has jumped as high as 3.5 with a pancreas flare and we've always been able to get it back down to under 1.5 once the pancreas is under control. All medications come with risks and cautions and precautions, so it is important to weigh the risk vs benefit but both Carafate and Aluminum Hydroxide are very often prescribed for dogs with Phos and BUN that high. I'm not trying to indicate that your Bumble's issues are exactly the same as my Scooby, but many dogs do have this trifecta of issues, especially with the liver and kidneys. Sometimes the answers are elusive and you just have to treat systematically and manage the symptoms. As I said before, my little Scooby is 15 and has been dealing with these issues for about two years now. He has a pretty good life. We manage his symptoms with denamarin, ursodial, metronidazole, Pepcid, various vitamins and supplements, a very strict diet with no fat, and he has been getting sub q fluids at home now for about a year. It takes five minutes out of my day and really improves his quality of life. He continues to have flare ups every several months but I have learned to recognize the symptoms and catch them early and he's usually back to normal in a day or two.


Hope today is the day your baby will begin to turn around and show some improvement.


Diana and Scooby
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Old 12-19-2013, 06:21 AM   #14
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Please leave this vet. He is hurting your baby. Part of kidney disease treatment is phosphorus binding. He does not know what is up and needs to send you out.

We have specially trained sonographers here and I don't think they even go near the kidneys with a needle. Renal artery - hitting it bad news. You need an IMS. I'm going to go out on a limb here and say gallbladder sludge is the least of concerns with kidneys shutting down.


I am very concerned for Bumble.
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Old 12-19-2013, 06:37 AM   #15
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Quote:
Originally Posted by Bumble View Post
I changed my profile pic so you can all see Bumble.

My husband picked her up this evening. She doesn't have any signs of being overhydrated, as far as I can tell. She peed twice as soon as she got home, and then an hour or so later had diarrhea which was black and scared me (black is usually digested blood, right? But this morning's stool was normal and solid so I'm thinking this is from the fluids and IV drugs). She drank a good bit of water earlier this evening, but nothing for the past hour or so. She's resting in hubby's lap, and just doesn't seem to have any energy at all. Tomorrow morning the vet is going to recheck her kidney values and see if there's any improvement, and he's going to run a test for pancreatitis, in case she got into cat food when my oldest cat got sick. My oldest cat doesn't remember he's almost toothless and tries to eat the younger cat's dry food, and without chewing it, it tends to make a reappearance shortly after eating. Eww.

Prayers for my little girl would be greatly appreciated. We're scared, even more scared now that we see how depressed she is tonight. She's always been a lively little girl, energetic and into everything, and watching everything that goes on. Tonight she even seems to be having problems seeing. I trimmed her bangs back really well, just in case hair was blocking her vision, but she's been bumping into walls today when she tries to go around corners, etc. If she's suddenly losing her vision, that's another new symptom, and another scary one.
Dana and Bumble
Wondering if she could get hepatic encephalopathy that quickly. I am not too familiar with it....just know that it's a secondary disease when they liver isn't functioning and it can cause blindness.

Praying for Bumble...hope she starts turning around today!!
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