Thursday, July 25, 2013

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). 

27 comments:

  1. We hope you find a regime that will allow you to slow down the deterioration. Poor Ping. We know the worries of having an old dog. We just take it one day at a time with Pip. Sending POTP and big hugs.
    Best wishes Molly

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  2. You have certainly done your very best for Ping. I hope Ping has many more happy years!

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  3. I am so sorry to read this. Thank goodness you're good about doing your wellness check ups and caught this early. Poor Ping. Like you, I try to avoid invasive procedures, especially with senior dogs, and I think your plan sounds like a good one.

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  4. You have done your homework and taught me a lot today. I tend toward the conservative approach medically...avoid invasive procedures if at all possible, weigh your options and choose the course least likely to cause harm while continuing to be observant...Please keep us updated on what the nutritionist advises...Sending healing prayers to Ping today

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  5. I have really learned a lot from reading this and I really respect how you've been researching every angle. We wish the best for Ping, our friend we met in the furs.

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  6. Sending best healthful wishes to Ping. I know you will make a good decision because you are thorough and weigh all the choices thoughtfully. It is so hard though.

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  7. *Cairn cuddles* for Ping. It's not easy to make such decisions but I am with you in that starting from the least invasive approach can be best. I sure hope the nutritionist can help Ping stay healthy and happy.

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  8. I think it's the best plan you have chosen. I'd want to avoid liver biopsy, too, as it's risky and won't guarantee clear plan for treatment. I agree it's hard to make medical decisions. Especially when risks and side effects are involved, I think it's best to do your own research and ask second or third opinion. I hope the new supplements help Ping's liver.

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  9. So sorry to hear about Ping, but sounds like she's doing well and you are taking excellent care of her. We had an ultrasound machine at my last clinic, but not every doctor could use it to make proper diagnosis. The exotic specialist was well trained with it, but she was a specialist. The doctor who owned the practice was also very skilled with it and did all of the in-house ultrasounds. We occasionally called a board certified radiology specialist to do the scans too. This is great info!

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  10. You are a good momma and certainly have did all the research. I hope the supplements help Ping to start feeling better. It is very hard to know what to do sometimes but like I said before listen to your heart, and head..you already know the answer.
    stella rose

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  11. You are soo right that early detection is the key (just as it is with us humans) in dealing with health issues.
    We would probably be obsessing also and in the end following the same more conservative course. Will be interested to hear what the nutritionist recommends.
    lots of love to Ping, we will keep all paws crossed for her
    hugs
    Bailey, Hazel & Greta

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  12. You're doing an amazing job with your dogs. I'm very impressed. Here's to a long, happy life for Ping!
    www.dogtreatweb.com

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  13. We all have this to come when our pets get older, so worrying. We will make sure when Mollie is six to have 6 month check ups, just to be on the safe side. You are a wonderful Mom . StellaRose has the right idea. Sending love and hugs to you all xx00xx

    Mollie and Alfie

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  14. We think you are doing the right thing. At this point you don't want to put her at any more risks than are absolutely necessary. Stella Rose knows what she is talking about. Give Ping pug hugs and kisses for us and a big boxer kiss.

    Janice, Snuggles, Sassy, and Dixie

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  15. Oh Ping is so fortunate in having such thoughtful and caring parents. Not only that, but they quote my namesake too!
    Stay comfortable, dear Ping.
    Toodle pip!
    Bertie.

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  16. I really hope you find something that works for helping Ping. One of Bridge's problems is high liver enzymes, we are hoping that this comes down with the medication eventually.
    As you say, at Ping's age the best thing is to manage her symptoms in the way that would cause her the least stress.
    Good luck.
    Lynne x

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  17. Good advice. Vets sometimes recommend test after test just eliminate problems....and you never find out what the problem is!

    XXXOOO Daisy, Bella & Roxy

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  18. You know that Ping is in my prayers.
    Love,
    Christy

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  19. We are glad that Ping most likely doesn't have cancer, but are still sad to hear that she's having issues. We started asking a lot of questions at the vet's too and sometimes, I feel like they're getting annoyed of us. But it's always better to ask questions than to dive right into something, especially something as invasive as cutting a piece of liver! We hope you find a regimen that works for Ping.

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  20. Awwww this is so sad to hear but I hope that you find something that works for my little Ping, Ping is in our prayers, as you know Ping is my favorite of your pack!
    Love, Licks and Hugs from your furiend Frank xxxxxxx

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  21. It seems to me there is a prescription drug (or supplement?) that the vet can prescribe to aid Ping's liver. When my old Cardi boy, Dylan, was going through chemo treatments, they checked his liver often and gave me something to help. Sorry I am not more specific, it was a long time ago now. And I am sure your research mentioned Milk Thistle as a support supplement as well.

    Here's to many more healthy years w/ Ping.

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  22. From the bottom of my heart, I am truly sorry that you, your husband, and Ping are facing this challenging, highly stressful situation.

    We always take Stella (our cat) and now Annie in for very regular checkups, blood work and shots, which some people comment on because it does add up financially in the long run, but I couldn't care less about the money, because the well being and health of my pets is so incredibly important (as I know it is for you guys too), and I would happily spend my very last dime on them, if need be.

    My thoughts and heart are will all of you. Please keep us informed about this situation and know that I'm always here if you need someone to talk to.

    Endless hugs,
    <3 Jessica

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  23. We are praying for Ping!

    Love Zoe, Peyton, Webster, Liberty & Whitney

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  24. It sounds like you've really done some excellent research and have thought this through very thoroughly. Ping is lucky to have such caring and thoughtful parents. Like others have said, it does sound like your approach is best for Ping as the risks outweigh the rewards of the liver biopsy approach. Thank you for sharing this with all of us. I feel the same way with Sid's medical issues and allergy treatment. Decisions where you have to decide what's ultimately best for the dog are extremely difficult - especially when you don't always have complete information or are getting different advice from different professionals. Thank you for the reminder to get check-ups and blood panels done regularly. I've been thinking about that myself and this is yet another good reminder. I'll keep Ping and you guys in my thoughts.

    -Brian (and Sid)

    P.S. Also appreciated the B.W. quote - I'm also a huge fan of "Plum".

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  25. Its lucky for Ping that you are so vigilant. Hope you find something to help her xx

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  26. Thinking of you and Ping. Ping is lucky to have you as her caregiver.

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  27. We understand what you're going through. We are keeping everyone in our thoughts.

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