Canine Liver Issues

February 4, 2007 8:32 PM

Is the best dog in the world (according to me) going to beat his liver rap?

My almost-11 year old Shepherd/Husky mix (Jake) has had on-again/off-again liver problems for 5 years or so. It's never been pinpointed to an exact issue, rather a 'let's watch and see.' He became violently ill 2 months ago where he ended up dehydrated and then in the vet-hospital for a day and a half. His blood work came back looking iffy but the vet put him on 45 days of antibiotics and our dog bounced back. Now, he hasn't totally rebounded because the same weekend that landed him in the hospital was the same weekend we had to put his 'brother' (of 10 years) down. His 'brother' (or deranged partner in crime) had an abdominal mass and starting vomiting/excreting blood. We didn't know about the mass until the morning he was put down. Jake has been lonely without his bud ever since. We've tried VERY hard to off-set it but ... they were together from day 1.

The vet wanted Jake back in this month to have another round of blood work, an ultrasound, and possible biopsy. He had this appointment scheduled to coincide with his annual booster shots. I got a call mid-afternoon that they only did the ultrasound (wouldn't tell me the results) and asked for my authorization for an extensive blood work up. I asked about the booster shots and was told that they would only give him his rabies shots and nothing else - just for the 'in case he bites somebody' scenario. When I pressed further, the tech said that the vet wanted to see the blood work results before he was able to give me a 'plan.' The fact they didn't want to give him the rest of his booster (parvo, distemper, etc.) AND didn't do the biopsy (though he passed the clotting test) really sets off a bunch of alarm bells.

To be honest: this freaks me out. Is there any chance in hell that the vet's "plan" is going to be one filled with hope? Or is this just the beginning of the end of my relationship with the best dog in the world?

posted by popechunk to pets & animals (11 comments total)

I'm really sorry to hear about your buddy's troubles.

It sounds like the vet is not being straight with you [at best]. I can't imagine why they would expect you to authorize more tests when they haven't told you the results of tests that are already done. It's puzzling.

Is it maybe time to try another vet? At this stage in your dog's life the vet's job is to help you understand how he's doing, how happy he is and is likely to be, and whether he's in pain, so you can decide what's best for him. Hiding results from you is not doing that.

I wish you (and him) the best.
posted by putril at 8:50 PM on February 4, 2007

One thing you should know is that the vaccines actually last considerably longer than one year so he doesn't technically need his annual booster. The rabies vaccine in particular takes a lot out of a dog, I would space it out from the other boosters even in a health dog. Many dogs experience side effects from vaccinations and it's also possible that they didn't want the shots to affect the blood work. So while it may be significant that they did not give him the shots, it does not necessarily foretell doom.

Best of luck to Jake, and try to remember that if you get stressed out, he will notice and he won't understand why, which will probably stress him out too.
posted by hindmost at 9:11 PM on February 4, 2007 [1 favorite has favorites]

I'm no vet, but blood work will take a few days to get back. For all I know CEA levels might now be used in canine blood work as a diagnostic marker, as well as to determine hepatic function. The ultrasound likely detected a mass of some kind. Don't worry about the vaccines as hindmost said.
This probably doesn't set you at ease, but if the news were worse I believe you might have been given more news that day. Reach out to the vet directly. A vet tech might unintentionally muddy things.
I have the best dog on the Eastern Seaboard and wouldn't know what foot to put in front of the other if she went before her time.
Stay loose if you can, your dog will feel it (echoing hindmost again).
posted by nj_subgenius at 9:24 PM on February 4, 2007

tell me the results of the ultrasound i paid for before i give you another nickel! in case you've forgotten, you're working for me and jake, we aren't working for you! i am both jake's master and your master, but the difference is, jake has a good relationship with me right now. if you don't modify your behavior to improve your relationship with me right now, i'm gonna have to discipline you!
posted by bruce at 11:35 PM on February 4, 2007

Agree completely with both hindmost and nj_subgenius, just wanted to add my good wishes to you and Jake.
posted by ceri richard at 3:03 AM on February 5, 2007

Not only do you want to know what the results of the ultrasound were, you need to know how the results of the proposed tests are going to affect management of Jake.

Worst case: say the vet explains that Jake either has liver cancer or hepatitis that will soon become liver cancer. In both cases you watch him and when he becomes obviously distressed you put him down. Or perhaps if he has hepatitis you put him on hideously expensive drugs that both make him sick and that prolong his life for six months. (I'm inventing these scenarios out of whole cloth: I don't know anything about liver conditions in dogs or their treatments, I just know I love my dog to pieces and this is a horrible situation to be in.) You may decide you don't want further testing because if it's just a choice between two bad outcomes you may prefer that Jake not have to undergo further interventions.

Think hard about what you want the biopsy information to do for you. A biopsy is a big deal.

Further, intervention that might be appropriate for a human who can understand what the purpose is and who can have hope may not be appropriate for an animal who doesn't understand anything beyond present sufferings and pleasures. You need a vet who can talk you through your decisions. You might want a second opinion from an older vet who was trained before invasive testing was generally available and who has an established practice without lots of expensive equipment to pay off. Not to say that you might not decide to stick with your current vet, just that you could probably use an alternative informed perspective to think about. That way you will be more comfortable with whatever decision you ultimately make and will not be constantly second-guessing yourself.

Alison
(Who has two small eleven year old dogs, one of whom is the best dog in the world, and who will be in your situation in just a few years and who is dreading that time.) (That is, small dogs tending to have longer lifespans than large dogs, it should statistically be in a few years and not this afternoon.)
posted by kika at 5:23 AM on February 5, 2007 [1 favorite has favorites]

yes, ask the vet for a rundown on jake's condition. help the vet get over his paternalism - not good for business.

jake obviously has liver damage, the question is "how extensive?". he would have scarred (dysfunctional) liver tissue from 5 years of on again/off again liver problems (visible on ultrasound) and the effectiveness of recent antibiotic therapy would indicate hepatitis (inflammation of liver). livers can and do deteriorate in the absence of malignant tumours. don't think the worst. not yet.

IANAV but jake has a compromised liver, not necessarily malignant, and may therefore require lifestyle changes to improve his final years.

blood tests (including liver function tests) would indicate how much clout jake's liver currently has to process drugs and dietary protein. it makes good sense to withhold (unnecessary) drugs until the extent of jake's liver failure is known.

jake's plan may end up being a low protein diet, some vitamins, minimum medications, gentle exercise and maybe fluid management for the rest of his days. bonus: with the new diet you may also find jake's fretful disposition improves too. the blood dyscrasias of unmanaged liver disease typically dull affect/awareness.

good luck with jake's management plan.
posted by de at 7:51 AM on February 5, 2007

De’s answer even addresses the question! I like it.

While I was giving worst-case scenarios, it was as an exercise in deciding whether further testing was likely to turn up anything interesting. Not because I think Jake’s a goner. For instance, if the Plan that de proposed would be appropriate for uncomplicated liver damage but the vet wants to rule out malignancy — why? Is the malignancy going to be treated any differently than the uncomplicated liver damage? Would you be going for surgery or chemo in the case of malignancy, or would you just try to maintain him on an uncomplicated-liver-damage type Plan until he started to develop pain? Unless you can answer these questions you don’t know whether you want the tests done in the first place.

I have too much experience with vets who want to know exactly what an animal is dying of. Sometimes all you ultimately need to know is “Poupoune is a respectable age for her breed, she’s pretty sick, and while I don’t know exactly what it is I can’t think of anything she might have that has a treatment you’d want for her. We can try Plan X to see how she does on it because she’s not in actual pain right now, but if she gets worse we can discuss some end-of-life plans when you’re ready.”
posted by kika at 9:44 AM on February 5, 2007

Thank you ALL for your words of support and answers. I meet with the vet tomorrow to get the skinny on "what's up with Jake" and discuss plans. They will not give me information over the phone even though I explained that this uncertainty is awful. We're hopeful that it will all be good and that we just have some lifestyle changes...

(PopeChunk's wife)
posted by lostinsupermarket at 9:11 AM on February 6, 2007

Yes, please keep us updated. I’m watching this post!
posted by kika at 3:32 PM on February 6, 2007

me too. if it's not too much trouble let us know.
posted by nj_subgenius at 5:35 PM on February 7, 2007