Liver Or Gallbladder Troubles, Updated Post 21

[macoduck]

Tessa is my 10 y.o. iggy. We went to the e-vet at 3 am because she was having another spell of shaking, panting, disorientation and a look of terror on her face.

When this first happened in early September her appearance was worse than last night's. It looked like she was having a seizure or vestibular episode.

Lab results showed something off with her liver. She was given subq fluids, pain injection (bupe), and flagyl.

Last night we saw the same vet who, remembering how Tessa looked in Sept, only gave her the bupe injection and flagyl. It took an hour before Tessa was able to settle down and sleep. Now 3 hours later she acts normal and was demanding breakfast.

The e-vet suggested that it's time for an ultrasound of her abdomen. Vet for that is over an hour away but I'll be calling them this morning.

E-vet said with an u/s diagnosis she perhaps could be put on a medication. Can't remember the name but it was something like "urisol". I'm also wondering if Marin (denamarin) would help too.

Tessa has only been with us since May and her previous owners neglected her health for her whole life until IGCA rescue got her.

 

Any experience on liver problems or possible gall stones? Treated with meds or was surgery needed?

 

Editing to add: vet thought the severe shaking was from pain.

Edited October 15, 2012 by macoduck

[tbhounds]

They can get a sludgie gall bladder were ursodiol may be prescribed. Denamarin works wonders for an ailing liver. I would proceed with some imagings--abdominal radiographs and an abd ultrasound. It's best to catch a problem now while it could potentially be corrected with medication.

[heartdogs]

Don't have any experince with liver or gallbadder probs but am sending get well wishes & hugs to that sweet girl. I love her picture in your siggie.

[nessa]

Denamarin and Lactulose have been keeping our liver disease girl going strong since Feb 2011. She is doing spectacular. We originally did an ultrasound but would not do a biopsy as it was too invasive at the time. She had bloating and seizures on diagnosis and not a thing since. She is now 12.

[GreyTzu]

They can get a sludgie gall bladder were ursodiol may be prescribed. Denamarin works wonders for an ailing liver. I would proceed with some imagings--abdominal radiographs and an abd ultrasound. It's best to catch a problem now while it could potentially be corrected with medication.

 

Yup!! Marin and Denamarin are not the same thing. They are two different supplements that work together for liver health.

[macoduck]

We have an ultrasound appt set for next Monday. Other than heartworms meds Tessa is not taking any meds.

Are there any other meds I should ask about besides these:

marin

denamarin (not for longterm use?)

milk thistle

lactulose

flagyl

SAM-e

 

What do you think about the e-vet giving an injection of buprenorphine? It really did help with the pain, although it took her an hour to finally settle.

Is there a better injectable pain med for this situation?

 

Does an abdomen/liver/gallbladder ultrasound require the dog to be fasting like you do with humans?

Edited October 10, 2012 by macoduck

[GreyTzu]

Don't waste the money on milk thistle or SamE. Use the Denamarin and Marin.

 

[tbhounds]

You really should have your pup fasted--not because they will need to sedate but, because food will cloud the imagining.

Keep us posted!

[Newgreymom]

We have an ultrasound appt set for next Monday. Other than heartworms meds Tessa is not taking any meds.

Are there any other meds I should ask about besides these:

marin

denamarin (not for longterm use?)

milk thistle

lactulose

flagyl

SAM-e

 

What do you think about the e-vet giving an injection of buprenorphine? It really did help with the pain, although it took her an hour to finally settle.

Is there a better injectable pain med for this situation?

 

Does an abdomen/liver/gallbladder ultrasound require the dog to be fasting like you do with humans?

 

Denamarin is not for long term use??

[macoduck]

Newgreymom - don't take my word for it. The question of long-term use was mentioned on all breed message boards and definitely not by vet professionals.

[tbhounds]

Denamarin can be given long term but, depending on the medical condition and reviewing recent blood work it may be indicated that it's no longer necessary to continue its use (it's expensive so being able to d/c is often something one looks forward too!)

[GreyTzu]

Denamarin can be given long term but, depending on the medical condition and reviewing recent blood work it may be indicated that it's no longer necessary to continue its use (it's expensive so being able to d/c is often something one looks forward too!)

 

[greytpups]

Hope Tessa has something that is easily treatable

[JohnF]

If this is happening at random then, if associated with enlarged liver, they will need to rule out cholecystitis and also unusual cell growth. You could probably help your dog in the short term by feeding a diet that is lower in fat content.

 

The article in the link explains quite nicely how to look at disease in that area.

 

http://www.petmd.com/dog/conditions/digestive/c_multi_cholecystitis_choledochitis

[TheFullHouse]

We're dealing with Bullitt's liver issues right now. His protein levels are still showing very low normal at this point. We've tried to raise them adding extra protein to his diet by adding cottage cheese to his diet. The numbers stayed exactly the same. We're trying egg whites now. He had an ultrasound and the results were a perfectly normal looking liver. We're trying to avoid doing a biopsy if we can. I started him on Marin last week so we will see if that works. If not I may add the Denamarin to see if that works.

 

I'm beginning to think liver issues can drive you crazy!

[macoduck]

Another symptom I'd forgotten was that Tessa had vomited a bit of bile with a little bit of food. This happened twice in one day. It was the following evening that she had the pain attack that sent us back to the during the night.

Her last bloodwork was done Sept 3rd during her first nighttime pain episode. I also have an older report from the rescue group dated April 2012.

 

Recap here, still looking for suggestions:

-age 10, italian greyhound, all but 2 teeth removed in April

-in Sept had episode of severe shaking, legs splayed out in an effort to clutch the ground, no nystagmus, no temperature, no earlier exercise or exertion

-Evet wondering about a seizure until blood tests show elevated GGT 32, Total Bilirubin 1.0, Albumin 4.6, RDW 49.3 and a low Phosporus 1.8

All other values were normal. In April the only value off was Lipase high as 726.

- This week's nighttime episode started again with the severe shaking.

-With both episodes she was given a Bupe injection and Flagyl. The first visit also included subq fluids.

-With both episodes the shaking/pain abated within an hour of the bupe injection. A few hours later she acts as if nothing ever happened.

 

In an effort to control some costs, when Tessa gets the abdominal US on Monday can we skip a repeat the blood test since the last one was 1.5 months ago? Skip abdomen xrays?

If this new vet suggests prednisone should I ask about budesonide instead?

What kind of canned food might we be steered toward?

Edited October 13, 2012 by macoduck

[tbhounds]

Radiographs and ultrasounds work hand in hand--it's hard to judge the size of organs during an ultrasound. That said I would ask to have the u/s done first then if they really needs the rads then do them. Blood work can change overnight but, again unless they need to sedate for the u/s I would hold off on that too unless they really would like it run. (With the intention of remaining within a budget)

It's doesn't sound to me like a corticosteroid use case to me but, if it turns out to be a GI issue like IBD I'll always prefer to use budesonide over pred as there are less systemic side effects.

I'm curious to see what they say about the gall bladder. Keep us posted ok?

[JJNg]

Based on the history and your description of Tessa's clinical signs, I'm not convinced that the episodes are pain-related and not seizure/neurologic episodes. The bloodwork values you posted really aren't all that exciting, and liver/gall bladder disease may not necessarily be the primary problem.

 

I still think it's a good idea to do the abdominal ultrasound, but I wouldn't be surprised if it doesn't give a definitive answer. Is the vet doing the ultrasound also an internist that you can consult with? Especially since you're needing to budget, I'd suggest reviewing the full history and getting a 2nd opinion from the ultrasound vet before deciding which test(s) are most prudent to run/repeat at this time. Also, have you discussed the situation with your regular vet? It sounds like you've mostly been dealing with the e-vet?

 

Regarding pred vs budesonide, pretty much the only condition budesonide is used for is IBD. Pred is needed if it's being used for anti-inflammatory effects on any other organ system. The reason budesonide has fewer systemic side effects is because it mostly stays in the GI tract and is not absorbed systemically.

[macoduck]

JJNg, the vet we will see for the first time tomorrow is a regular general practice vet. His clinic is the closest for ultrasound.

The emergency vet saw Tessa on both times and thought she was exhibiting extreme pain. She is also a member of our regular local clinic's group, although she has not seen Tessa as a patient there.

She has only seen my (favorite) vet at our local clinic once. That was just as a new dog/well dog visit when we first adopted her in May of this year.

I've had a seizure dog and one that had vestibular episodes. Tessa's shaking did not look like either. She was extremely panicked but alert during each one hour episode.

I've heard great things about the vet we'll see in the morning from the IG rescue gal who uses him.

 

Editing to add: I saw my regular vet this week with another dog and she too suggested ultrasound.

Edited October 14, 2012 by macoduck

[JJNg]

Since I haven't seen Tessa's episodes, I'd have to defer to your e-vet who actually saw her. I'm just going based on your description, and it didn't really sound like an episode of severe pain. But each dog's response is different, and it can sometimes be hard to tell. IME, partial seizures can look like anything, and they can still be alert and responsive. Hopefully, the ultrasound tomorrow will provide some answers. Keep us posted!

[macoduck]

Thank you for your input, JJNg and tbhounds. Today the new vet agreed with you - that there's still a chance that this was a petit mal seizure.

He wanted the U/S first and then decided xrays and labs were not needed after all.

Ultrasound findings:

-kidneys and adrenal glands were normal

-liver slightly hypoechoic, no masses or abnormalities

-gall bladder, cystic duct and BG neck all normal

-spleen is normal sized, but with several perivascular hyperechoic regions near the hilus, which are very suggestive of hemangiomas

 

Tessa got an Rx for valium and tramadol that we can dispense if another severe shaking episode occurs. The frequency of those in the future will determine if we shift to a definite seizure diagnosis. There is also chance that a splenectomy might be needed if she developes more hemangiomas. He approved of the Blue Buffalo canned food she was getting.

 

Although Tessa hated the hour long car ride, I was very impressed with this vet and his staff.

[tbhounds]

That's actually a greyt report :-). You might want to monitor that spleen--many clinic will offer discounted ultrasound services if you are imaging every 6 months.

[macoduck]

That's actually a greyt report :-). You might want to monitor that spleen--many clinic will offer discounted ultrasound services if you are imaging every 6 months.

Thanks for the tip. I'll ask about that.

[JJNg]

Thanks for the update, and glad the ultrasound didn't show anything major. Hopefully she won't have episodes very often (or preferably, no more at all!).

[heartdogs]

Sure hope that sweet girl gets to feeling better. Give her an ear rub for me.