Decisions, Decisions-Deciding What To Do When Faced With a Chronic Illness in a Pet Or Ping and her Liver

 "I had to come away because the family were shooting me off to Harrogate to chaperone my Uncle George, whose liver had been giving him the elbow again."  Bertie Wooster

I included the above quote because recently Ping's liver has been giving her the elbow and I'm not too happy about it as its not good news for Ping and it means making decisions and putting together a wellness plan.   If there is one thing that cheers me up its a dose of P.G. Wodehouse and his most brilliant creation Bertie Wooster.

Personally I hate making medical decisions and I'm obsessive so I tend to spend hours weighing every option.    Ping's problem is also one we would not have caught it we weren't vigilant about every 6 month wellness exams for all of our Pets over seven years old, prior to that age we do exams yearly.  At the exams we make sure to have complete blood work and at least once a year we do a urine test and thyroid test.  

Ping's tests have revealed that over the last two years her liver enzymes have been rising.  First they were high normal, then slightly over normal, and then in June they spiked to significantly higher.   Since all of Ping's liver enzymes were elevated it was unlikely to be an anomaly and further tested was indicated.  If only one of a dog's liver enzymes are elevated its less of a cause of concern.  I made sure to do my own reading up on elevated liver enzymes on the dog aware website since I have noticed that vets, just like human doctor's, are very varying in their recomendations.   One vet at my practice what quite alarmist, another down played the issue, and the third my favorite said test further but don't panic since Ping is in no distress.   We got Ping a liver ultrasound at a specialist, its important to know that unless a vet is trained in reading ultrasounds they are not equipped to understand what they seen in the images, so make sure to ask what their experience and training with the machine is.   The ultrasound revealed an enlarged liver and problems with the liver's texture, but no overt signs of cancer.   Basically Ping's liver was sick but no one knew exactly why, so again we went with further testing.  Ping had a bile acids test which revealed her liver was not functioning properly.  Her numbers where in the moderate range, generally a pet feels and acts fine until less 20% of their liver is functioning and they are in liver failure.   Another reason regular bloodwork so important.

At this point we face a conundrum.  We still were not exactly sure why Ping's liver was having trouble, since the liver performs many functions there is a lot that can go wrong with this organ.   The first vet I spoke too, not my absolulte favorite vet at my practice, recomend a liver biopsy.  An invasive procedure done at a specialist hospital that involved anesthesia and removing a piece of a pet's liver for testing.  This procedure is not without risks and is very expensive.  The benefit of the procedure is that it is likely, but not guaranteed to, give you a definitive diagonosis.   However, as treatment options for liver disease are limited it is not necessarily going to provide a clear treatment plan.  In the past I would have likely immediately decided on doing the procedure, but as I've gotten older I've become more inclined to ask questiosn and do research.  I made sure to read online about pets and liver disease and to ask the vet questions.   I discovered that as Ping has not been poisined and is not suffering from acute liver failure, this comes on quickly and the dog is violently ill, and is not on any medications there is no substance that we can work on removing from her environment to make her well.   Since she is not one of the effected breeds, primarily Dobermans and certain types of terriers,  she is highly unlikely to have Copper Hepatopathy a disease in which copper accumulates in the dogs liver.  

This left essentially two options for what is wrong with Ping.  The first, and thankfully most unlikely, is liver cancer of an unusual type as there are no masses visible on ultrasound in Ping's liver or other signs of cancer in her body.   The second, and most likely, is chronic hepatatis related to her advancing years, Ping is ten.  While dogs livers are not the most common organ to worsen with age they can.   There is no way to reverse or stop this process but its progress can be slowed with a liver diet and vitamins.   Based on this we are going to consult with a nutritionist at the university of Tennessee and begin adding more supplements to protect Ping's liver, she is already on a few.   My favorite vet is in agreement with this plan and was opposed to the idea of a liver biopsy as being to risky.   He seems to think that with this plan and a bit of luck we can have Ping with us for quite a while longer.  However, if we had not caught the disease when we did the situation would be quite different, Ping would have shown symptoms only when in liver failure and at that point treatment would have been unlikely to sustain her life for very long.   The moral of the story: don't forget to do regular wellness exam with blood work, every 6 month for seniors, and don't forget to do research and ask questions!  (Also thanks to all the wonderful pet parents on the internet who gave me great advice while making this decision).