Thursday, May 26, 2011

Liver Ultrasound and Biopsy Complete! Annual Opthamologist Appointment Complete!

Last Tuesday, May 17th, Dinglehopper had an appointment with an Internal Medicine Specialist at the VEC. It was a bit weird to be back at the VEC after so long. Weird in the sense that it brought back all the memories of Dingle's knee surgeries... but good because we were able to not go there for years.

The Internal Medicine specialist was amazing. So amazing. Dingle has a bunch of good vets, but I think this appointment goes on my list of the best. She spent close to 45 minutes taking Dingle's history, consulting with us, explaining the possible liver problems, drawing diagrams of the liver and different conditions, etc.

I opted to stay at the VEC and wait for Dingle, rather than going home. I figured it would be better worth my time, as it can take me a while to TTC it to the VEC and back. I was wrong. I ended up waiting about 3 hours and then they came out and said that the ultrasound was done. I made the mistake of assuming he would be going right in to the ultrasound after his consult... and didn't think about other pets being 'in line'.

The biopsy had not been done at that point. The specialist said that Dingle's liver looked normal - it had good blood flow and there were no obvious problems (no shunts, etc). His kidneys also looked normal and with one possible liver condition she'd have seen an underdeveloped/small liver and large (from compensating) kidneys.

She asked me if I wanted to go ahead with the biopsy and when we talked out the benefits and risks we decided to go for it, so we could totally rule out any of the possible liver problems.

About an hour or so later the biopsy was complete. She took 2 pieces from the liver to snd away to the pathologist for testing. The specialist said that Dingle's liver had bled during the biopsy (which is common) and so they wanted to keep him overnight just to be safe which I appreciated because I am a worrier and would have been scared to sleep - wondering if he'd be bleeding badly internally and die (okay, perhaps I'm a bit more than just a worrier)

This is the sign that was on his kennel:

Dingle isn't totally blind and the specialist knew that, but she wanted the sign on just to be on the safe side. She didn't want anybody caring for him overnight to open the kennel and expect to him to step into his arms and have him miss. I appreciated the extra caution. Dnigle probably liked the extra attention.

Perhaps the sign on his kennel should have said "Caution: HIGH"

Dingle was drugged, which was good because he wasn't in pain. He wanted out of the kennel, but eventually he settled down and laid down:

I stayed with him for quite some time. By the time I left the VEC I had been there for about 7 hours total.

The next day Razzleberry had an appointment with Dingle's opthamologist - because the pigment in her eyelid was changing color. Turns out she'd been scratching the hell out of her eyes.

Dingle likes attention and so I decided to pick him up from the VEC after Razzle's appointment so that he wasn't interfering with Razzle's appointment by demanding to be held or in the spotlight.

By the time I got to the VEC he was ready to go - they'd checked on his liver throughout the night and that day and there was no signs of continued bleeding or fluid in the belly. Yay.

I paid my $2,423.18 bill and called a cab because I had had enough TTC travelling - especially because Razzleberry barfs like crazy from motion sickness.

Dingle was happy to get home, as was Razzle. She was sporting her new e-collar and seemed pissed. I kept thinking "welcome to Dingle's world":

He was also happy to get the bright pink bandage off his leg. He spent the next 30 minutes (following the bandage removal) licking his patch of bare skin.

After he was satisfied that his patch was clean Razzle and him curled up on the couch and slept:

Clearly they have bonded and love each other.

On Monday I removed Dingle's stitch. He had one small stitch, even though they didn't cut him open at all (but rather stuck a big needle through his skin and info the liver). I was not looking forward to doing it myself, but it was most of the way out and it was easy to do.

Since Monday was a holiday the specialist said it might take until Wednesday to get the biopsy results.

I called yesterday morning and heard back that evening. The results were in and I was thrilled that we got positive results. Dingle rarely gets good news.


Yup, all healthy. I really couldn't believe it. Given Dingle's track record I was still (even after her saying on the ultrasound things looked good) expecting bad news.

So, since Dingle's bile acids have been high compared to most dogs, he's considered "abnormal, normal'. Any other dog the elevated levels may indicate problems, but with him they do not.

The plan is to put him back on the Zentonil (which he was on in September and October 2010) just to be safe. He will get it once a day, I think forever... I will have to double check that when Dingle sees the regular vet next.

Since his ALT was high in September we are going to check his liver values (not his bile acids, which are the most expensive tests) in 3 months. Then we will do it again in 6 months and then yearly with his shots/check-up as long as his ALT comes back normal.

We will only check the bile acids (since compared to the general dog population they will likely always seem abnormal) if he starts looking clinically unwell, which we think is unlikely.

Yesterday Dingle also had an appointment with the Opthamologist.

It was his annual check-up and we got more good news. Dingle's eyes look good (translation: as good as can be for a dog with KCS and PRA).

The vet thinks that Dingle's day vision has remained the same in the last year, which is good. Perhaps he may always keep some day vision. I believe his night vision is getting worse because Dingle has never been afraid of fireworks, but when we were out walking this weekend he seemed hesitant to move, with the fireworks going off. But we kept walking (with some resistance) so he could work up that confidence.

After getting not 1, but 2 pieces of good news today Dingle should look happy. Instead he looked irritated when I took the picture below. He was mad because Razzle always jumps on the bed and steals his food. That little girl has quite the appetite.

Above all things are looking pretty good for Dinglehopper.

Hopefully we can continue with this lucky streak (and hopefully he will pass it along to Razzle).

Wednesday, May 11, 2011

The Liver Issues Continue. Next Step: An Ultrasound and (perhaps) a Liver Biopsy!

Last week we got the results from Dinglehopper's most recent liver tests. While his ALT and enzymes were within normal ranges, his bile acid levels (pre and post) are not. They aren't crazy high, but they aren't normal. The vet wanted to consult with a specialist and get back to me on what the next step was.

On Tuesday night Razzleberry had an appointment at the vet for her third and final set of boosters. Here she is chilling out, waiting for the vet:

Though the appointment was for Razzle, we spent most of the time talking about Dinglehopper as the vet had consulted with the specialists.

Our plan is for Dingle to see an internal medicine specialist at the VEC.

Yes, back to the VEC - where Dinglehopper had his luxating patella surgeries and was seen for various other issues when his normal vets were closed.

The specialist Dingle's vet spoke to said that we should do an abdominal ultrasound - to look for vascular problems within the liver. We also may be doing a liver biopsy, which would require a clotting profile prior to it. Poor Dingle. I hope that they can see enough on the ultrasound so that he doesn't have to be put under anesthesia for the biopsy and have to deal with the risks associated with that.

The vet said that while these tests may be expensive (I can only imagine - any guesses as to what the total bill will be?) in the long run it will probably be cheaper than doing the liver tests (which run about $300) every few months to monitor the bile acids. True.

I'm really hoping that there isn't anything really major going on with Dingle. I hope that we just have to do a diet change or monitor him occasionally.

Our appointment is next week - Tuesday the 17th.