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Megans gall bladder and liver problems - any advice appreciated

Lynne

Well-known member
Hello everyone.

I have been reading Cavalier Talk since before Christmas, as we have been going through hell and back regarding my baby Megans problems, but I didn't want to post anything until I had a good idea of what to post. Megan is an 8 year old black and tan. She may be 9, but we are not sure as she was a 4 year old rescue pup, when we got her. She is very small, and was massively overweight when we got her, but we put her on a strict Burns Diet, and within six months she turned into a gorgeous svelt and healthy girl. Luxating Patella in the first year apart, she has been very very well over the last three years but before Christmas we started to see symptoms that things were not right. Excessive drinking, runny poo, and little puddles in the house (she will have been mortified to do this as she is very well house trained). The final straw was being off her food (unknown as megan is a very greedy dog), and a very bloated tummy one evening and wheezing when we picked her up. So straight to the vets.

A very very long story short - her tests were all over the place - excessively high in some areas, very low in others, and their scans showed 'funny' things. We went from the possibility of liver disease, to a possible tumour, to everything appears healthy but her gall bladder is in the wrong place and has 'grains' in it etc., and in the end we were referred to a specialist vet in Solihull called Willows.

This Friday they discovered that she had lots of gall stones, and they strongly suggested that we had her gall bladder removed, and at the same time they would take a biopsy of her liver. Gall bladder op went well, and megan is responding very well, and we think she can come home tomorrow. They feel her quality of life will be massively improved now that the gall bladder has gone.

BUT - (there is always a but) her liver is another thing. The surgeon said he had never seen a liver like it, and he thinks it is congenital. She has been surviving on only two liver lobes. One is very very small, the other is very very large. neither of them look healthy. They have taken a biopsy of both, and the results should be back within five days.

The surgeon is a liver specialist and says he is intrigued by what he saw, and needs the results to give us an idea what happens from now on and how we manage it. As he is a liver specialist I am taking hope from the fact that he would have recognised cancer/tumour instantly probably, so the biopsy must be for something else.

So, my question is - No.1 highly unlikely but has anyone else every come across this before? and No.2 we were adapting her diet before the operation to help her liver, by giving her chicken, white rice, fish, pasta and low fat cottage cheese, (which she wolfs down) and also adding milk thistle and SamE to her meds - can anyone else suggest an easy on the liver diet? and also what sort of quantity is she supposed to be eating. She is currently 6kg weight.

Sorry, this was supposed to be a long story short, but it has turned into quite a long one, and I have missed so much out in between.

Thank you for reading and I hope someone can look at this and give me hope/help/advice.

Lynne x
 
Wow, that's quite a story for you and medical history for Megan. So sorry she has to go through this. I actually have no advice to give, but I know there are some on the board who have had to handle liver issues and hopefully they will see this and give some suggestions.

Good luck and please come back and let us know how Megan is and the results of the biopsy.
 
Tommy who died in November had kidney disease and pancreatitis so finding a diet that was suitable for him was very difficult.
I was referred to Marge Chandler, a veterinary nutritionist at the Royal ( Dick ) School of Veterinary Studies Nutrition Service in Edinburgh. The results of Tommy's tests were sent by email and she devised a home cooked diet for my lovely old boy.

Unfortunately there were many other setbacks for Tom and I eventually had to make the final decision to let him go but at least I knew I had given him every chance I could.

My understanding is there are only two qualified Veterinary Nuritionists in the UK. It may be worth asking your Surgeon if he will refer your little girl.
 
Hello there, thank you for your replies.
This morning at 6am Megan had a seizure at home. As she has never had one before, we called the emergency vet immediately and took her to surgery straight away. (She was flailing around, limbs stiff, and she wee'd as she was doing this - it probably lasted about two minutes in its intensity). Her limbs were still quite stiff by the time we got to the vets, but she had calmed down a bit. By the time we left her there, she had started to soften up a little, and was moving her front paws by herself, but she still had a bit of a head tilt. Her eyes, gums and belly all looked very pale, almost pale yellow. We have just had a call from the vet (7:30am) to tell us that she is now starting to snooze, that her head tilt has gone, that the blood tests showed that her ALB and Bilirubin still looked high post op, and that they are now waiting for Jane (the head medical at Willows in Solihul) to get into the surgery at 8am, when they can give her a call.
We are just waiting for another call so we can go back.Not sure what we can do now.
Thanks,
Lynne
 
10:45am Tuesday 15th. Just called the vets as they hadn't been in touch, and they have told me that megan has had another seizure since we left her first thing this morning, exactly the same as the first, from our description. Thankfully she was in the right place, as she has come out of it well, and is again snoozing. They have given her Diazapan, so they say she won't have another seizure. Although they are still waiting for the specialist vet to get in touch, they are sure that the problem is liver related, and seeing as her liver is so unusual, it may not be as straight forward. I have just given the specialist vet a call myself to try and give them a nudge but she is in appointments, so I have logged my message as urgent. Everything I have read on seizures so far this morning tells me that they are mostly managed with the right meds and diet, but I am worried and scared that my little megan can't take all this so soon after her gall bladder op, and as the liver biopsys are not due back until Friday, there is nothing to help the vets as yet. If anyone has experience of seizures could they please take a little time to give me a little pep talk please?
Many thanks
Lynne
 
No experience of seizures, but do hang in there and try not to worry too much -- save your energy for her :flwr:. Chances are things WILL be manageable. :)

I learned this when dealing with my dogs with SM, after I spent months very upset over one dog prior to an MRI. It turned out he was totally clear for SM and clear again 4 years later on a second MRI -- and it was his then-asymptomatic half brother who had a syrinx on that first MRI visit. I felt like I'd expended so much in worry, needlessly, and over the wrong dog! It's so much better to try as best as possible to aim towards getting all the info you can but not making any assumptions til you have further tests results. I know how hard it can be as your mind races to think of all the possibilities. I think it is most productive to be as informed as possible by doing background reading, so you feel ready and able to ask questions, and so you have in mind some possible scenarios for the future -- without getting overly concerned about and attached to any of them until you have more information from doctors. And even with a worrying diagnosis you'd be surprised how well an individual dog can do sometimes. I had a severe MVD rescue girl live very cheerfully for three years when she should have had more like 6 months. They can really amaze us. :)
 
Hi Karlin,
Thank you so much for that message - it means a lot that someone can talk to me, and give me a different perspective to my vet (s) and my husband. I have just read out your words to him, and he feels better having heard them. The specialist vet has been in touch and is going to keep an eye on proceedings at my local vet and ring me later in the afternoon once she has spoken to them again. Also, local vet has been in touch again - no more seizures since the 8:30am one, and they are hoping to be able to get some results from the liver biopsy today as they have both escalated it as an emergency, so we may get feedback and a way forward sooner than later. They may keep her in overnight, and although Im upset I can't be with my little girl, I know she is better off being with people who know what to do, if she does go downhill again. Yes Geeky husband has spent all morning on the internet learning what he can about seizures post op, general, and anything similar so that we can be ready for whatever comes next. I am very much in two places at once - I want to know, but I dread the knowing, and I just want her home again. I'll update once I have a little more information, and thank you once again.
Lynne x
 
This is a serious situation - read up on dog hepatic encephalopathy as this is most likely the cause of the seizures from what you have described (jaundice, high bilirubin, and I presume that you meant to say low albumin, not high). You can search here on the forum as Sins had a Cavalier with this, and I recall that there is much information on those threads. I have info on my home computer that I saved after I compiled some info for her, but I won't be home until tonight. Don't take the time to read up on seizures in general because this won't be applicable for hepatic encephalopathy.

http://www.petmd.com/dog/conditions/endocrine/c_dg_hepatic_encephalopathy#.UPVNjOg-Ke0

Did you discuss the possibility of PSS - portosystemic liver shunt - with the specialist? This is a congenital (present at birth) defect that can be corrected by surgery, but the surgery is usually done when the dog is very young. The biopsy would be definitive for cancer or other problems - just looking doesn't really rule these things in or out.

It is excellent that they removed her gall bladder. Gall bladder rupture is not uncommon, and the results can be fatal, so I'm very glad to hear that this possibility is now gone.

I can give you a lot of information about diet, supplement, lactulose, etc., but it sounds as if your specialist is doing all of the right things. Let's wait until you know more. Dr. Jean Dodds (in the US) has a lot of good info on the web, and Dr. Donald Strombeck also has a great site about home cooking for particular diseases. This is something you can easily do at home.

Best wishes, and you and Megan are in my thoughts and prayers,

Pat

P.S. Just read the link I gave and learned that PSS can also be acquired - I did not know that before now.
 
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Thanks Pat, much appreciated. The specialist vet is ringing us later this afternoon (hopefully with the news that the results from the liver biopsy have come through) so I shall flag that up with her. We have just had a look at hepatic encephalopathy on the link you gave, she has only had the increased thrist, urination and now the seizures from the list of possible symptoms. Would they have been able to see if we were dealing with a pss on the (many) scans possibly? Or is it not easy to see that way? I picked up one of your earlier posts regarding Dr. Dodds, and so thats where i learned about white food i.e. pasta, chicken, fish, white rice, cottage cheese etc., Im just not sure about quantity for her, but that is something I can hopefully worry about another time. I'll definately have a look at Dr. Strombecks home cooking site too - Im sure that is the way to go.
We have just had a call from the local vet who say she is looking brighter and happer than this morning (not difficult), and was tail wagging. She has had lactulose to absorb any amonia, and is also on a drip to flush out anything else.
So, really we are now waiting for the specialist vets phone call, the results, and hopefully a plan of action.
All the best
Lynne.
 
Thanks Pat, much appreciated. The specialist vet is ringing us later this afternoon (hopefully with the news that the results from the liver biopsy have come through) so I shall flag that up with her. We have just had a look at hepatic encephalopathy on the link you gave, she has only had the increased thrist, urination and now the seizures from the list of possible symptoms. Would they have been able to see if we were dealing with a pss on the (many) scans possibly? Or is it not easy to see that way? I picked up one of your earlier posts regarding Dr. Dodds, and so thats where i learned about white food i.e. pasta, chicken, fish, white rice, cottage cheese etc., Im just not sure about quantity for her, but that is something I can hopefully worry about another time. I'll definately have a look at Dr. Strombecks home cooking site too - Im sure that is the way to go.
We have just had a call from the local vet who say she is looking brighter and happer than this morning (not difficult), and was tail wagging. She has had lactulose to absorb any amonia, and is also on a drip to flush out anything else.
So, really we are now waiting for the specialist vets phone call, the results, and hopefully a plan of action.
All the best
Lynne.

Seizure in the presence of liver disease is the classic sign of hepatic encephalopathy, so you don't need to see the entire list of symptoms. And yes, you would expect to see PSS on ultrasound, but from what you've reported, this sounds like a complicated case. If I could see the reports I may understand more, but then again I have a hard time translating UK blood chemistry values since they are different from US values (which are burned into my brain!). Very low albumin is serious - that can result in ascites (the abdominal bloating from fluid leaking), and the high bilirubin indicates primary liver disease (whereas elevated liver enzymes can be the result of lots of different things). Jaundice is also a significant symptom of primary liver disease. She may also be anemic because of red blood cell problems caused by the malfunctioning liver. There are lots of different liver diseases -

http://canineliverdiseasefoundation.org/?p=25

but let's get more information before you read about anything and everything. Make note of the gallbladder mucocele in the above link. I wish you had learned about diet from your vet instead of a post on CT, but glad to hear about the lactulose, milk thistle and SAM-e. Dr. David Twedt is the US veterinary "liver guru," and I've got lots of source material from him. But again, let's wait and see what you learn rather than wasting your time reading material that is not relevant. I know you want her home, but hospitalization is a good place for her right now.

Pat
 
Well, we sent to see Megan last night, and she was very doped up, and not really aware we were there. We have feared the worse all night, and the local vets had a nurse sleep with her all night, so that someone was with her all the way. We have just been in to see her this afternoon, and whilst a lot more perky than last night, there are other things now to take into consideration. Her new tests show her Bilriubin up to an horrendous 5521, it just seems to be going up and up. Her jaundice has gone, but she has a slight anemia now, and her breathing is quite heavy. She was very happy to see us, and was very frustrated that she couldnt have cuddles initially, so we eventually took her out of the cage and sat with her laid on our knees and she calmed down a lot, but was making quite a few squeeking sounds, which isn't megan at all. It was time for her pain killers, so they gave her an injection through the drip, and she immediately zoned out. We made a note of the pain killer they are using which is called comfortan, because we were so surprised at how fast it worked. Having come home we looked it up and it clearly says that it must not be used on dogs with liver problems. We have put a call into the specialist vet to ask her if she was aware they were using this, and also if there is an alternative, and we also have just spoken to the local vet who say they are aware of its suggested uses, but they wanted to ensure that she was pain free, and under the circumstances they felt it was the one to use. So this has of course worried us.
Her liver biopsy did not come back yesterday, but we have had a message from the specialist vet to say that they will definately be with us by the end of the evening. I know the decision for Megans future really lies with the results. I just feel she is on a knife edge right now - no matter what is done, her bilirubin results keeping going up, and I feel the local vet is trying to get us ready for what they feel is inevitable. We will only do whatever is right for Megan, but I do want to give her a good chance because we believe that she is fighting. Am I wrong to question the use of the Comfortan? could it be doing more harm than good?
Thank you to anyone reading.
Lynne x
 
Sorry, my apologies its not her bilirubin at 5521, my husband says it was the ALP. Whatever it is, it was flipping high. Sorry, my head really is all over the place at the moment. I'll double check these and put the right totals up once the specialst vet has rung.
Lynne
 
It would be inappropriate for me to write what I am thinking on a public forum.

https://www.abbeyvet-export.co.uk/pdfs/Comfortan A4.pdf

Yes, Lynne, you are correct to question the use of this drug. Yes, it could be very harmful. Do you have copies of her blood chemistry reports - not just a verbal report? As the owner, I'd want to see the series of reports. Why is she on a pain-killer? Has she been or is she currently in pain? What kind of pain and what do they think is the source of the pain? This is difficult to say, but I wonder if the local vet has given up. This is where a specialist is important.

Your decision would be based on not just the diagnosis (or differential diagnoses if that is what you get - and this means a list of all of the possible things that might be wrong) but also on the treatment options, her quality of life, and the response to treatment options assuming that there are things that you can try to help her get well. Also, be aware that biopsy results can often be inconclusive so these results may not give you a clear direction on what to do.

Sky high alk phos (a liver enzyme) is not as alarming to me as her bilirubin, albumin and hematocrit. Those values will give more information about how serious this is.

Pat
 
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Following this and can only say you are doing great work on staying on top of this and Pat is as so often, very helpfully right in there with very informed advice. I can only hope you get Megan home before long.
 
Hi Pat,
Thank you for replying so quickly. We are going back in about 20 minutes, so I am going to ask for a copy of her last tests so that I can let you see exactly what they are. they talk them through with us, and each time I try to remember, but there is so much else to take in, all I hear is very high, and getting higher in some cases. We are still waiting for the specialist vet to call us, but in the mean time the local vet has called and said their head guy is going to ring them to chase those results and is also going to ask them about the Comfortan. Apart from obviously having the seizure when we rushed her in yesterday morning, megan gave no signs of being in pain, so we shall ask about that tonight too. She was very vocal this afternoon, and her breathing was laboured and deep - both of which seem to be side effects of the comfortant. Still no signs of the report yet either.
We will report back as soon as we get back home.
 
Thank you Karlin, I very much appreciate your thoughts, and I more than welcome Pats replies - so often you can be railroaded down an alley without knowing there was another route, and for that we are especially grateful. We are now talking to the specialist vet on the phone as I type (husband is talking, I am typing). He isn't saying very much, and the specialist is doing all the talking, so I shall have to add another post very shortly.
 
So sorry to hear your girl is so ill.
Just over a year ago,our oldest cavalier had hepatic encephalopathy.Pat was a wonderful support to us,all through Christmas,as we fought to save her.She knew immediately what it was...
Once she comes through her biopsy,hopefully she will improve on a liver support diet,you can either prepare your own diet for her,or Royal canin do a prescription hepatic support food.In our girl's case,she had liver cancer which had spread to her lymph nodes,the surgeons clearly saw this as they decided to do the biopsy via a small incision and get a good look inside.You really do need to push to get the biopsy results,and I hope you have some encouraging news.
If she is fitting because of the encephalopathy,they really need to stop dosing her with drugs,in order to prevent further liver damage.
Sins
 
Ok, so, not good news. I am writing this all down, and then we are heading off to the vets. We will not be making any decisions until tomorrow. The biopsy result was worrying to poor. the small sections of her liver lobes are non functional, and have probably never been functional from birth. the large lobe has severe colongitus (excuse spelling) and a lot of fybrosis which specialist vet says indicates late stage liver disease. She believes that the antibiotics that she is on are the best ones to try and help manage the situation, and the lactulose. She suggests that we see how she manages over the next 24 - 48 hours, her recommendation is to reduce the use of the comfortan, in terms of dose and frequency, but both her and her team think the mix of meds is the right one for megan as she is, but really she was just going around in circles about how she is so sorry, etc., and that she agrees with the local vets use of meds under the circumstances. She said that we should consider Megans wellbeing when making our decision, which of course we would.
I just don't know anything now really. We are going up to the vets for the last appointment at 7:15 to see the head vet there, and then to spend some time with megan. I doesnt seem that there is a way forward other than the inevitable.
Lynne.
 
Hi Pat,
We are going back in about 20 minutes, so I am going to ask for a copy of her last tests so that I can let you see exactly what they are. they talk them through with us, and each time I try to remember, but there is so much else to take in, all I hear is very high, and getting higher in some cases. Apart from obviously having the seizure when we rushed her in yesterday morning, megan gave no signs of being in pain, so we shall ask about that tonight too. She was very vocal this afternoon, and her breathing was laboured and deep - both of which seem to be side effects of the comfortant. Still no signs of the report yet either.
We will report back as soon as we get back home.

I always get copies of all reports, and take notes about what my vets are telling me. I often type up questions or observations and give a written copy, and vets have told me that is helpful. It's also great to have an "at home chart" so that in an emergency you don't have to rely on your memory and can just give the file to the ER vet.

I truly don't understand why they have given the strong analgesic/pre-anesthetic - that to me is a signal that they have given up, which causes great concern. I'd want to see the blood chem reports before and after she had this drug - and all of the reports since the beginning of these problems so that I could track the values in response to what was going on at the time.

Pat
 
What terrible circumstances, I'm so sorry to hear that Megan is struggling so much.

If I could offer a suggestion, take pictures of the blood chemistry reports (if you have an iPhone I recommend the Scanner Mini app, instead of the regular camera). If you can post those here you won't have to try to keep clear which are which, and there are a few people who will be able to help you sort out which numbers are the most important.
 
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