Sick dog/endoscopy

[JMM]

Hugs given to the boy.

His bile acids are already elevated (and they can vary widely), so they go by his previous ultrasound studies to compare and were not concerned about the sludge in his gall bladder. Of course, when we biopsy his liver again, we'll have even more information.

[JMM]

Mikey is doing great since coming home. He is eating pretty well (one meal a day), drinking a ton, no vomiting. He has diarrhea, but just when he would normally go. Tonight it was even a little better and he didn't need a total hose off. He got to spend most of the day hanging around and napping outside today...he loved it!

[JMM]

Biopsy results are in:

Mild IBD

Gee, that helped. Next step is a liver biopsy. His internist said we should go to Cornell as well. I didn't think about it on the phone, but I would rather do his biopsy here so he can recover at home. I don't want him stressed and having surgery and traveling all at once. That seems like too much for him. I'll call on Monday to see if she is ok with the biopsy here and giving him a week or two to recover and then going to Cornell.

[Traci]

Did she suggest Cornell doing the surgery? Perhaps she was referring to their experience. If you could get everything done at once, at Cornell, perhaps that would be better. I understand about the stress and travelling, but if your vet is questioning her own experience, it would be in Mikey's best interest to be at Cornell.

Sorry if I misunderstood.

[JMM]

The surgeon who does laproscopy here is very experienced and she is quite comfortable with them doing it. I think it is that she doesn't feel that there are many more treatment options so is hoping the vet school might have something more experimental to offer. I was kind of dazed on the phone so I will call and talk to her Monday about doing the biopsy here versus at Cornell. Clearly, we'll do whatever is best for Mikey.

[Traci]

Oh, I know you will.

I'm not surprised the results indicated IBD, but I still think there may be something with his diet or medications (too much of or too little of or combination of). Why doesn't your vet consult with Cornell rather than suggest you see them?

I realize yur vet is telling you bile acids testing may be moot concerning the MVD, but if they weren't specifically looking for anything, she could be missing something, such as secondary (or even primary, who knows) cholangiohepatitis, etc. Also, you mention changes in the liver noted from the ultrasound....what changes exactly? Size, shape, cysts/masses/abcesses or jagged edges, or ?

[JMM]

His liver is mottled looking and slightly enlarged on ultrasound. It is basically the same as it was almost a year ago on ultrasound (we do that annually). I think a new liver biopsy at this point, with his ALT up again, is definately in order. We'll send it to Dr. Center at Cornell again even if we do it down here. Reading over the internist's last report (I have to admit I get frazzled on the phone sometimes so reading the report is often more helpful), it looks like the concern is some progressive hepatitis or fibrosis changes.

Traci, I really appreciate your replies. You always help me get together a solid list of questions. I was under the impression we were being sent to Cornell hoping something somewhat experimental would be available to Mikey. I should ask specifically what we're hoping for with the trip.

We're going to stop some of his medications now. We won't stop the metronidazole, prilosec, or zofran since I see a noticable difference with those. We're stopping Cisapride and Carafate first (no ulcers right now).

Do you have any experience with Leukeran? It has been briefly mentioned but it didn't sound really promising. I've only ever seen it used in cats with low grade intestinal lymphoma.

[Traci]

I don't know if it would be appropriate for Mikey's condition, since you're still (more or less) lacking a true diagnosis. It is a ctytoxic drug primarily used in chemotherapy or in combination with other drugs in chemo therapy.

Imuran (azathioprine) was what you attempted last time, wasn't it? Mikey had a bad reaction to that at least once, yes? Or, at least his bloodwork showed significant changes while on it? I'm not sure an immunosuppression drug would be the best choice for Mikey at this point, (the pred would carry less risk I think), but I would be concerned it may cause more harm than good.

Edit: I have davetism, sorry, cytotoxic but you probably already knew that.

[JMM]

He's still getting the azathioprine. There is definately decreased vomiting with it. I think overall he tolerates it quite well. He's getting a weenie dose of pred right now, too.

It doesn't really sound like Leukeran is that appropriate for him...I think we'll do the liver biopsy this week or next if we can and just get it over with and get some results.

[JMM]

Heard back from the internist's office. They are so good.

It is fine to do the biopsy here. We'll send the sample to Dr. Center at Cornell and, unless it gives us a fabulous answer, go up to see if there is anything not normally being used that could help Mikey.

We have a consult with the surgeon Wednesday after Mikey's bloodwork appointment.