Princess, My Soulmate

[Ullaluv]

This will be long, so bear with me. I haven't posted much on GreyTalk for quite a while. Last year was not easy, and so far this one is not any better.

 

Princess and I need your prayers and your knowledge and wisdom.

 

Eight year old Princess is my soul mate, and has been since she first came to me as a foster with an eye injury that was being treated (unsuccessfully) for pannus. She is a small white girl with a huge personality and a very strong will.

 

The Sunday before Christmas, December 19, Princess stopped eating. This worried me because I had lost another girl to an illness which no one could ever figure out, even on necropsy. On Tuesday I decided that she needed to go to the vet. Because of another dog's illness, we didn't get there until Thursday, Dec 23. She had dropped 4 pounds from her normal weight to 48.8 pounds. Her physical exam was entirely normal except for a low grade fever. CBC was normal. Blood chemistry was normal. Specifically, total bilirubin was 0.2 (0.1 - 0.3), ALT 38 (12 - 118), and ALKP 70 (5 - 131.) Urinalysis was normal except for 2+ protein. Full tick panel, done by Protatek was normal. The vet continued her on Clavamox and gave her Tramadol as needed for any possible pain, and I continued to try everything I could think of to get her to eat.

 

We went back to the vet the following Thursday, Dec 30. Again, exam was normal, fever resolved and no more protien in the urine. We switched her from Clavamox to Cephalexin, hoping it would be easier on her stomach, stopped the Tramadol (which had had no effect) and added Pepcid, hoping we could get her back to eating. Her weight had dropped to 46.4. The plan was to do x-rays and ultrasound the next Monday if she didn't improve.

 

I didn't wait until Monday. Sunday I decided she was so dehydrated that I had to find a way to at least give her fluids, so we headed off to the emergency clinic across town. On the way there, I decided that we might as well go ahead and do the xrays and ultrasound, so my vet would have that info on Monday morning. They did stat CBC and chemistry. The CBC was normal(0.0 - 0.9), ALT 3009 (10 - 100, had to be diluted to be read), and ALKP more than 2000 (23 - 212 - wouldn't read even with 2 dilutions.) Her chest x-ray was normal, and abdominal x-ray didn't show anything. The abdominal ultrasound was what gave some indication of what was going on: Liver: Abnormal. The liver was of normal size and echotexture. The portal highlights were adequate however they wewe markedly distended with anechoic bile. Gall Bladder: Abnormal. The gall bladder was very large and filled with completely anechoic bile. The bile duct was markely distended. Spleen, kidneys, bladder, adrenal glands, GI tract, pancreas and lymph nodes were either normal or not well visualized. They gave her 700 cc of sub-Q fluids (sub-Q because I wasn't willing to leave her over night,) and released her to my vet, with the suggestion that exploratory laparotomy might ultimately be required to obtain a diagnosis. Again, her physical exam was entirely normal. Her weight had dropped to 44.8. I started her that night on SAM-e, milk thistle, Vit-B complex and Vit B12.

 

I had her at my vet at 8:00 Monday morning to start IV fluids, and my vet saw her a little later that day. Switched her from Cephalexin to Amoxicillin and started Ursodiol 250 mg twice a day. They also fed her Hills I/D hepatic health and gave me the rest of the can to bring home. She actually ate it that night.

 

I thought I was loosing her that night. She lay almost without moving on a dog bed, with her head hanging off. Wouldn't even lift her head. I spent most of the night lying on the floor next to her, often with my hand on her chest to feel her heart beat. Her only movement during that night was to repeatedly reach her paw out to me.

 

However, about 9:00, after I had gotten up and opened the door to let the other dogs out, I looked at her bed and she wasn't there. She had gotten up and gone outside to Potty, then came back and jumped up on my bed. So back to the vet's office we went for another day of IV fluids. While she was there, she did eat a whole can of the prescription food, but that's the last thing she has eaten (on Tuesday.)

 

My vet is off on Tuesdays, so we saw her again yesterday morning. We drew blood for lepto and fungal titers since that's the only kind of infection we hadn't addressed. Kept her on the SAM-e, milk thistle, Amoxicillin and Ursodiol, added Vitamin E, stopped the Vitamins B and C (she had an injection on Monday), and started her on a 3 day trial of Cerenia 48 mg. Physical exam normal, weight down to 42.8. We decided it would be better to do the fluids her, so I've been giving her 1100 to 1200 cc's IV in 100 cc boluses every one to two hours. She's slept with me in my bed the past 2 nights, so I've been able to get some sleep, knowing that I would know if she stopped breathing and that if she left, she would die in my arms.

 

This morning her weight is down to 42.2. That's more than 20% of her body weight since this started a week before Christmas.

 

I love every one of my dogs, but this girl is my heart and my soul. She won't eat and is losing about half a pound a day. She is weak, but shows no sign of giving up, and has never in any way told me she might be ready to leave. Today, when I put my coat on to leave for an hour, she jumped down off the bed, ears up, ready to go with me, and when we go to the vet she's eager to go in to see all her friends there and check everything out. The things that come to mind that would account for the bilirubin, liver enzymes, and dilated bile ducts are infection, obstruction and cancer. Don't know if I'm missing anything. I'm not about to have anyone open her up without there being a reasonable chance of finding something that can be fixed. (My vet certainly agrees with this.) As of now, I have no reason to think there is.

 

I'm still having no luck getting her to eat even a bite of anything. I've thought of pureeing some food and trying to force feed her with a big syringe, but I'm not sure if this is a good idea.

 

I'm asking for your prayers or my Princess, and hoping someone here might have some ideas that neither my vet nor I have thought of.

 

Princess and I thank you.

Edited January 18, 2011 by Ullaluv

[Guest PiagetsMom]

I'm sorry, I don't have a clue, but I can only imagine how worried you are.......sending good thoughts your way for Princess

[tbhounds]

Wow, your poor girlie. The first thing that came to my mind was lepto. I assume you ran a lepto pcr panel? As far as force feeding-- if she's not vomiting you might want to pick up some a/d. It's a high cal food that's really easy to syringe (just add a tiny bit a water to make a gruel). You can also force feed it directly by placing it down her throat.

Did they suggest removing the gall bladder??? Maybe touchbase with Dr Couto???

[45MPHK9]

No advice. Just sending along good thoughts for your Princess.

[Remolacha]

I am sorry, no ideas, but

[Guest budsmom]

I don't have any suggestions as to what might be wrong, but several people on here have had really good results getting their hounds to eat using nutritional yeast. You can get it in most health or natural type food stores. I'll keep both of you in my prayers, and am sending gentle scritches for Princess.

[Batmom]

Hope, have you thought about repeating the ultrasound to see if the antibiotics have had any impact on gallbladder and bile ducts?

 

 

ETA: If it's still distended/nonfunctional, I'd be strongly tempted to get it out, sooner rather than later. I know that's a risky surgery in a debilitated dog, but.

Edited January 7, 2011 by Batmom

[Guest Bamn]

I have no experience with this only hugs and good thoughts sent your way.

 

I agree with TBHounds - gall bladder removal? It happens all the time in humans and from what I understand, can be quite painful (the possible reason for not eating?)

 

Luck and light sent!

Edited January 7, 2011 by Bamn

[Ullaluv]

Thanks, Jey. I've thought about repeating it. I don't know if my vet would be able to do it tomorrow. We could go back to the emergency clinic this weekend. I know they could do it, and their price was reasonable. Also wondering about repeating the blood chemistry to see what's going on with the liver values. We've sure been working hard with the fluids to keep flushing the bilirubin out.

[Ullaluv]

I have no experience with this only hugs and good thoughts sent your way.

 

I agree with TBHounds - gall bladder removal? It happens all the time in humans and from what I understand, can be quite painful (the possible reason for not eating?)

 

Luck and light sent!

 

I don't know if it's as simple as removing the gall bladder. Not something I know much about. If there's cancer there, I don't think it would make any difference. There's also the question if she would survive major surgery, weak as she is.

 

And I'm not sure that she's in pain. The Tramadol made no difference, and I wouldn't consider NSAID's in a dog that's not eating. Also, she's still roaching, both while lying on a dog bed, and in bed with me! And NO sign of belly tenderness on physical exam. Still, I could be wrong.

[ZoomDoggy]

If she's not vomiting and she is having decent stools (when she has enough food to produce stool ), I would definitely try syringe-feeding. Even if it doesn't solve the problem, it will give her enough nutrition to buy you a little more time to try and figure it out. It's not as horrible as you might think, most dogs really don't object to it as long as you're gentle.

 

Get the biggest oral syringe you can (ask your pharmacist) and cut the very tip of it off so the opening is a little wider (so it won't clog so easily). You can file the edges so they're not sharp against her gums. Puree her diet with broth or water. I used to puree batches of food and store it in the fridge so it was less labor intense at each of the very frequent meals. The meals are frequent because it's hard to give a full meal's worth in one sitting to a dog who hasn't eaten in a while. I fed a meal of about a half-cup every two or three hours with my Marla. The refrigerated pureed food will usually thicken up a bit, but can be re-liquified by adding a little more warm water or broth so it's easily syringed.

 

Sit with her and gently poke the end of the syringe between the side teeth near the back of her jaws and slowly plunge the food in. You'll be able to see her start to swallow. Don't plunger too fast, go at her swallowing pace. And give her a few breaks to breathe and catch up.

 

Good luck. I understand all too well how frustrating and heart-wrenching it is to helplessly watch your beloved pet waste away and not even know why.

[greyhndz]

From a human medicine perspective, alk phos that elevated, and grossly dilated common bile duct are suggestive of obstruction distal to the the CBD -- whether it's pancreatic duct, small bowel -- this is a surgical problem. At the very least, I'd push for a surgical evaluation ASAP.If the GB is already distended w/bile, I'd be very concerned about possible impending GB rupture -- and that's catastrophic.

 

The antibiotics, vitamins, Sam-E are all great if you're dealing with hepatitis or liver dysfunction, but in this case, I think the problem goes far beyond that.

 

I don't want to be an alarmist, but in human medicine, at the very least, she'd being either undergoing MRCP (MRI exam of the biliary tree down to the bowel) or going straight to the OR. I can only recommended (very strongly) that you ask your vet to have her seen by a surgeon immediately.

 

I'll keep you both in my heart...

[Ullaluv]

What stools she has are normal consistency and color. She's only vomited a couple of times, not a lot, and more spitting up than vomiting.

[AstasMinion]

No advice but wanted to send thoughts and prayers your way.

[TheFullHouse]

Oh gosh, I have no advice at all but will keep you both in my prayers.

[duncan41]

No experience, but just piecing the story together leads me to believe that it's a situation that needs intervention. I would take her to the E-vet for a consult with a board certified internist at the very least.

In the meantime, I will keep you both tucked tightly in my prayers.

[brandimom]

Sending prayers for Princess and white light. I have no advice but wanted u to know that Princess and your family are in our thoughts and prayers.

[Houndtime]

I have no advice except to say that this sounds serious. We will keep your little Princess in good thoughts and prayers.

[Ullaluv]

Does this mean anything to anyone? Princess went outside to pee. She didn't come right back in, so I looked and found her searching among the poop. She found an old, hard, dried up piece and brought it inside to her bed to eat. No interest in fresh poop, just the old dried up piece. But then she turned her nose up at both Arby's roast beef and a freshly cooked ground turkey patty with a slice of cheese on top. What would entice her about the hard, dried up poop?

[Guest 2dogs4cats]

Some people were talking about this on the Regap board. Apparently quite a few greyhounds like to eat poop and were calling them poopsicles, since the winter started. It seems some dogs just like the taste. Hey, they're dogs! Try feeding some raw ground beef, rather than cooked treats. What seems good to us humans doesn't necessarily appeal to dogs.

[maggiespet]

Prayers for Princess. And hugs for you.

[Guest PhillyPups]

Oh Hope, no advice here. You and Princess are in our prayers and thoughts.

 

Have you tried really stinky stuff on her food (i.e. Tuna fish or canned salmon, or cheap canned dog food) which might entice her to eat? Mine prefer raw chicken/beef, etc to cooked.

 

Gremlin seems to think frozen poopsicles are the cure for mouth cancer. I pray it works.

[silverfish]

I really think I'd get her to a specialist centre ASAP.

 

I'm so sorry you're going through this - I did with my Susan, only to find (when it was too late) she had advanced kidney cancer. I am still kicking myself about eight years later that I didn't push for a referral sooner, when it would have been possible to remove that kidney and save her.

 

Sending good thoughts to Princess and hugs to you.

[racindog]

[Ullaluv]

Oh Hope, no advice here. You and Princess are in our prayers and thoughts.

 

Have you tried really stinky stuff on her food (i.e. Tuna fish or canned salmon, or cheap canned dog food) which might entice her to eat? Mine prefer raw chicken/beef, etc to cooked.

 

Gremlin seems to think frozen poopsicles are the cure for mouth cancer. I pray it works.

 

Thanks, Pat

 

She ate sardines once - only one - then turned her nose up at them.

 

She's never been a poop eater before, and still has no interest in fresh poop, just checks it out and rejects it.