# Lola and I need your help!



## pammy4501 (Aug 8, 2007)

OK, we have a set back here with Lola. Dr. Sullivan did a liver panal on Friday to confirm that we were OK to start the Cytosar. Well, not such good news. Very high values. I did not get a copy, so I am not able to tell you how high. She did request on Sat. that I get my local Vet to do another bile acid. Well that is way elevated as well. Her post bile acid prior to prednisone was 50, and is now 240. Now the ASG vets want to do a ultrasound and possibly a liver biopsy. I am not so in favor of this. I went to my regular vet today, and he talked to me for an hour. He also agrees that the UTZ and biopsy will show some kind of liver failure. So....then what? I feel that we could treat her as if she has liver failure based on her values and see where we go. I understand that will not rule out an infection, but maybe they could treat for that as well. We cannot start the cytosar until her liver improves. They are having the internal med doc call me tomorrow.

Here is where I need the assistance of all of you that have had dogs with liver issues. I know there is a lot of experience and knowledge on this site. I got my vet to start her on some denamarin (?) today. At Tamizami's suggestion I cooked some of Dr. Dodds liver diet (just white fish, white potato and sweet potato and I added baby vitimins) and she has been eating that since Sat. Is there anything else I can do to better support her liver function? I really want to avoid anymore invasive tests if I can. I would like to get her liver into good enough shape to start the cytosar.

I very much want to help Lola, and get her better. I do not want to get into a situation where we are chasing test value after test value, all to have the same outcome. All opinions are welcome here. 

Thanks,

Pam and Lola


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## k/c mom (Oct 9, 2004)

I'm sorry I'm no help medically but just want to offer my support and hugs to you and Lola. :grouphug: :grouphug: 

Is it possible that all of the problems she has had and what was diagnosed as potentially something else could actually be a liver-related issue?


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## jmm (Nov 23, 2004)

I would start with the ultrasound. 

As far as getting a sample goes, there are a few options...
1. Ultrasound guided needle aspirate. Most of the time can be done with only mild sedation or nothing at all. Least ideal sample. Easy to miss things with such a tiny sample. 
2. Exploratory laparotomy. This means you open up the abdomen, get a really good look at the liver and take a full chunk biopsy. This is major surgery and she would spend at least one night in the hospital. This is the ideal sample. 
3. Laparoscopic biopsy. 3 tiny incisions are made and a little camera and tools are used to get a sample. The ability to perform this procedure on a tiny dog depends on the surgeon's skills...this may or may not be available. If there are complications during surgery the surgeon does not have total access like in an exploratory. 

The main complication past the surgery itself is bleeding. This is why the dog is kept in the hospital for at least a day after. 

The main question I would ask is: How will the biopsy information change how we will treat her? 

Also, if the prednisone may be the cause, is it a viable option to change her treatment plan and see if the liver values improve?


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## dr.jaimie (Mar 23, 2004)

well i would at least have a specialist do an ultrasound...that is in evasive and possibly a protein C test to rule out a shunt


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## pammy4501 (Aug 8, 2007)

QUOTE (JMM @ Nov 23 2009, 05:35 PM) index.php?act=findpost&pid=854174


> I would start with the ultrasound.
> 
> As far as getting a sample goes, there are a few options...
> 1. Ultrasound guided needle aspirate. Most of the time can be done with only mild sedation or nothing at all. Least ideal sample. Easy to miss things with such a tiny sample.
> ...


This is the question I am asking. What info will an ultrasound give that will change her treatment pathway? Biopsy and surgery are so invasive. I don't know how she would tolerate (cost also an issue)and I am worried about coagulopathies as well. At what point are we treating the disease and not the dog?

QUOTE (Dr.Jaimie @ Nov 23 2009, 05:36 PM) index.php?act=findpost&pid=854176


> well i would at least have a specialist do an ultrasound...that is in evasive and possibly a protein C test to rule out a shunt[/B]


Jaimie, what info would be apparent from just a ultrasound and no precutaneous liver biopsy? Even if she has a shunt, would she be a treatment candidate with GME? I am in a quandry. Why not just treat her as if she has MVD and some liver failure and see if her profile improves? Is that a reasonable or viable option?


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## Nikki's Mom (Feb 13, 2008)

I don't know much about how to treat your baby from an allopathic pov, but I think you've got that well covered with some great doctors, and the medical help here on SM

Milk Thistle is an herb that helps the liver. A tincture or extract is the best way to administer. If you care to have more info on it, you can always pm me or do some research on your own. 

I wish you the best, and I am praying for your baby, and for you. 

:grouphug:


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## harrysmom (Sep 28, 2007)

I was in exactly the same position when we first realized that Harry had a problem. All of the vets, with the
exception of Dr. Center, insisted that they needed to perform a liver biopsy in order to effectively treat
Harry. I understand that they wanted a definitive diagnosis... but I didn't need one and I didn't want to put 
Harry through that and now, 2 years later, I am so grateful that I didn't. I really don't think that Harry could 
have lived through it. 

I am so lucky that I was able to see Dr. Center and the doctors at Cornell.

I'm no expert, but ... I would advise you not to have a liver biopsy until all 
non-invasive options have been exhausted and no treatment is helping. Harry's 
issues seem to have been exacerbated by food allergies, so I would start with a change
in diet. Harry eats a rice, tofu, and cottage cheese diet, and I would be happy
to pass on the info. to you. Harry also took vitamin e initially and he has been
on a very small amount of dexamethasone every 3 days since his diagnosis.

Good luck with whatever you decide.... keep us posted.

Debbie


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## jmm (Nov 23, 2004)

Is she currently on antibiotics? My Mikey would get ascending infections in his liver and go into liver failure when he was on azathioprine. I suppose that would be a very simple thing to try if she isn't.


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## pammy4501 (Aug 8, 2007)

QUOTE (JMM @ Nov 23 2009, 06:21 PM) index.php?act=findpost&pid=854200


> Is she currently on antibiotics? My Mikey would get ascending infections in his liver and go into liver failure when he was on azathioprine. I suppose that would be a very simple thing to try if she isn't.[/B]


Well she just completed a nearly full cycle of clindamycin and doxycycline. But, all her titres came back neg. so we stopped. She has only been off them since last Thursday.


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## bellapuppy (Dec 1, 2008)

Nothing to offer except my prayers. hugs to you and Lola. :wub:


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## bellaratamaltese (May 24, 2006)

i'm so sorry to hear about Miss Lola's complications! *hugs you* I love this forum, so full of awesome information


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## pammy4501 (Aug 8, 2007)

QUOTE (Bellapuppy @ Nov 23 2009, 06:35 PM) index.php?act=findpost&pid=854204


> Nothing to offer except my prayers. hugs to you and Lola. :wub:[/B]


Thanks! I will take all the hugs I can get right now.

QUOTE (BellarataMaltese @ Nov 23 2009, 06:36 PM) index.php?act=findpost&pid=854205


> i'm so sorry to hear about Miss Lola's complications! *hugs you* I love this forum, so full of awesome information[/B]


I know, when I got the news, the first thing I thought was "I have to put this out on SM!" Such an vast collective of knowledge here. And I still have to say, *I love my Vet*. I called him, upset this morning. He called me right back, and then called ASG on my behalf. This afternoon he took about 45 minutes of his time to sit and talk all of this over with me in person. No charge. Who ever says Vets are only in it for the money... you just don't know my Vet!


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## tamizami (May 1, 2007)

I'm not sure who in this area is experienced enough with ultrasounds for liver shunts. The internel specialist near us was awful. I prefer to start with the Protein C - a simple blood draw that Antech Diagnostics will send to Cornell - or the colorectal scintigraphy. CS is a little invasive (radioactive dye injected into bum, dog needs to stay at vet until late afternoon), but it is VERY conclusive. It will not tell you where a shunt is, but will tell you if blood is bypassing the liver. 

Here is more info on it. Dr. Broome did this procedure for us, he is the best in the LA area.


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## Snowbody (Jan 3, 2009)

Pam, I can't give any medical input but as you said our members are a wealth of information. Wish you were on this coast!! Know that I'm thinking and praying for you and Lola and we're here to support whatever you do. :grouphug:


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## Furbaby's Mommie (Jul 10, 2004)

As mentioned by Sher, it is possible all her symptoms could be from the liver failure. Have you asked the vets about that? I would make sure she has a protein C test then is indicated do the scintigraphy. Google *Hepatic Encephalopathy* *in dogs*, and *symptoms of*. Getting her on Dodds diet is excellent start. There are forum groups just for liver failure that can be helpful. Probably the first thing they will mention is Lactulose to get the ammonia out of her system.

I'm praying continually that the vets will have the correct diagnosis and treatment and that Lola will get well. rayer: rayer: :heart: The drugs for GME could I would think be really hard on her with liver failure.


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## pammy4501 (Aug 8, 2007)

QUOTE (Furbaby's Mommie @ Nov 23 2009, 09:16 PM) index.php?act=findpost&pid=854262


> As mentioned by Sher, it is possible all her symptoms could be from the liver failure. Have you asked the vets about that? I would make sure she has a protein C test then is indicated do the scintigraphy. Google *Hepatic Encephalopathy* *in dogs*, and *symptoms of*. Getting her on Dodds diet is excellent start. There are forum groups just for liver failure that can be helpful. Probably the first thing they will mention is Lactulose to get the ammonia out of her system.
> 
> I'm praying continually that the vets will have the correct diagnosis and treatment and that Lola will get well. rayer: rayer: :heart: The drugs for GME could I would think be really hard on her with liver failure.[/B]


the liver failure has only really started since the prednisone was started. All her liver numbers were essentially normal when we first tested her. She had already had three seizuers. Hepatic Encephalopathy was my vets first thought. When that didn't pan out, we visited the neurologist, MRI, spinal tap etc. We are certain of the GME. Just need to get her well enough to treat it.


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## Maidto2Maltese (Oct 19, 2004)

Don't have any helpful advice but sure will be sending out the prayers for your little Lola that all this can be resolved for her!


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## The A Team (Dec 1, 2005)

Pam, personally, I don't know much about liver problems, but my friend Elaine does. She has one dog that had a shunt removed and both her yorkies have MVD and her maltese also has liver problems. 

I can't tell you how excited she is that Maya (her chihuahua) is completely healthy!!!!!!! :chili: 

She does a lot of research on-line and knows a pretty lot about it and she loves to talk with people about it. If you'd like her e-mail address, I'm sure she'll be happy to talk with you. I'll PM you, if you're interested. 

I've tried to get her to join SM, but she's stubborn!! She spends most of her time on the computer looking things up (and shopping for the dogs)


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## pammy4501 (Aug 8, 2007)

Had a phone consult with all the docs today. They really want the ultrasound, so we are going tomorrow at 10.


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## bellapuppy (Dec 1, 2008)

Good luck. We will be praying for you and Lola.


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## Nikki's Mom (Feb 13, 2008)

QUOTE (pammy4501 @ Nov 24 2009, 07:34 PM) index.php?act=findpost&pid=854531


> Had a phone consult with all the docs today. They really want the ultrasound, so we are going tomorrow at 10.[/B]


I am praying for her. Please keep us updated. :grouphug:


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## elly (Sep 11, 2006)

Praying for sweet Lola.


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## I found nemo (Feb 23, 2006)

I wish you both the best of luck..
Your both in my thoughts and prayers :grouphug:


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## CeeCee's Mom (Sep 14, 2006)

I have prayed for good results for Lola.......Pam, please keep us informed!!!!


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## Furbaby's Mommie (Jul 10, 2004)

rayer: rayer: rayer: rayer: Hoping for the best for you Lola. :heart: :heart: :heart: :heart:


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## Kissie and Prissy's Mom (Dec 28, 2007)

Pam, I continue to keep you and Lola in my prayers. Jan


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## pammy4501 (Aug 8, 2007)

Well we went for our ultrasound today. As I suspected, the vet really wanted to needle aspirate her liver. I stuck to my guns though and said we need to wait and try to improve her with medical management first. She was very nice and seemed to understand my position. So the utz showed an enlarged liver (I already knew that) and was brighter on utz. "this may be due to prednisone therapy, infection, inflamation or cancer." There is a stone and mineralized debris in the gallbladder, no obstruction. So they are calling it cholangiohepatitis. New meds added today:
Amoxicillin, pepcid, ursodiol, baytril, and continuing with 10mg pred daily, denamarin and K-Bro.

Then they said that she needed a re-check in three weeks. I asked if the blood draw could be at my vet. Then there was a little attitude thrown. If I want my vet to do the labs, then he will be managing this for her. Color me surprised. I was only trying to save myself a 1.5 hr drive through terrible traffic. I didn't think that would step on anyones toes. They sent me to him over the weekend when they needed a stat bile acid drawn. He is my most trused vet, and he refered me to these guys. Maybe I'm tired and read to much into that. What do you all think?

The one other thing that I found a little annoying today was, I was scheduled for a 10 am appt. I assumed (because no one told me any different) that we would talk and they would do her procedure (no sedation needed) and I would be on my way. Well, they don't start doing procedures until 1pm and she might be realeased by 2pm. So I went out and shopped around. I went back at 2:30 since they had not called me. They came out and said that she would be ready to go at 4pm, because the vet was doing another procedure and still needed to do her discharge. By the time they did my discharge instructions, billed me :shocked: and got my meds, I was out of there at 4:45. Let me tell you, hitting the LA freeway system at 5pm on the day before Thanksgiving is a nightmare. i finally made it home at about 7pm. Whew, what a day!


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## iheartbisou (Feb 13, 2007)

wow- you did have a long day! I'm sorry about little Lola. I really am praying for a good outcome for her.


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## CeeCee's Mom (Sep 14, 2006)

Oh my goodness Pam, you had a terrible day. I suspect they do not like the Lola's Mommy to think for herself. I pray that these meds will do the trick and there is nothing more going on with Miss Lola. I read your post with horror about getting on the LA Freeway at 5:00 o'clock traffic. You deserve a medal for that. Give Lola a big hug and kiss for me!!! I hope you all have a Happy Thanksgiving~~~~and keep managing her progress the way you see fit. She is your baby and you are using your judgement and trying to protect her from pain and harm. Good for you!!!!!


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## harrysmom (Sep 28, 2007)

I'm so sorry to hear about your bad day! I know all about waiting for discharge, etc.... but usually I
am sitting there waiting with Harry on my lap... which makes it very bearable. I'm glad that you
stuck to your guns about the needle aspiration.... my vet told me that they probably wouldn't get
enough information that way to come up with any definitive diagnosis... so why do it?

As far as the remark about your local vet managing your care if you get the blood work drawn there,
I know that I would be upset and offended by the attitude. However, giving her the benefit of the
doubt, maybe she just didn't explain herself well. Although I have occasionally gotten blood
tests for Harry done at my local vet in an emergency, the vets at Cornell explained to me 
that since the people and machines that process blood tests are different from one place to another, 
we might be getting a result that's not valid if I were to test Harry locally.

Also, because I am usually so nervous and upset when I'm at Cornell :blink: , when I first
started going up there I took everything that the resident said and read a lot into it 
and got myself all upset. Once I learned his manner of speaking and working and realized
that he wasn't really trying to upset and offend me... I grew to really trust him and 
value his opinions. So maybe it's a case of not knowing each other well enough yet. 

I also have to tell you that I initially brought Harry to a group of specialists about
45 minutes from my house... and that didn't work for me. Is it possible for you
to go to a vet school? At Cornell there is a vet who is a specialist in ultrasounds
and they have a special kind of ultrasound, where they can see the blood flow in
the liver. After that procedure, they seemed to know a lot more about what to do 
for Harry.

When I read your post, it brought me back to where I started with Harry... and all I can
say is hang in there.... it will get better.

Sorry this post is so long... 

If you need to talk.... feel free to PM me.

Hugs and kisses to Lola.

Debbie


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## Nikki's Mom (Feb 13, 2008)

Pam, 

So sorry that you had to deal with all that on top of sweet Lola's health issues. I am praying for Lola and you. :grouphug:


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