Mikey is home from the vet

[JMM]

Monday he looked really bad and I took him in. His ALT was almost 500. He spent Monday night in CritiCare and has been on IV fluids since Monday morning. The verdict was it is doubtful due to his response that it was the azathioprine. They think his ALT went up due to progression of his disease. It was down in the mid 300's yesterday, but today was back up to 440. He got to come home today for good after a shot of depo just to see if it helps at all. If he can bounce back, we can try azathioprine again. If not, we'll let him go.

[Marty]

Mikey, Mikey....rally boy......my prayers are for you!

[Tambrey]

Prayers that Mikey gets through this rough time in his life...

[Traci]

Was your vet able to contact a specialist through the gastroenterology society org I gave you info on? I'd think that would be worth a shot for a consult.

I'm so sorry Mikey is so ill, he's in my prayers, and hoping your vet can come up with something. Please, JMM, consider getting a consult, I know you've seen two already, but if someone out there somewhere has more experience, it would be worth it to find out.

[ShelbysMom]

Oh no, sorry to hear that Mikey is not doing well. I'll say a little prayer for him. Keep us posted on his condition.

[JMM]

Traci, Mikey's internist spoke to a vet at Iowa State who suggested what she was planning - azathioprine. Jergins??? or something like that...I will talk to her again next week. Their only other suggestion was to rebiopsy him and work him up again. If his vets think there is a real possibility it turned into cancer, I might consider it...otherwise I hope we can get him back on the azathioprine.

[Beth Va]

Many prayers sent for Mikey.

[k9Karen]

I'm so sorry to hear this JMM. Sending good wishes your way and hoping everything turns out OK. Keep us posted.

[Traci]

JMM....momentary confusion here....in October you had Mikey on cyclosporine....currently, he was recently taken off Imuran. Was prednisone used concurrently as well? Is he now on a low dose of prednisone? Did your vets mention the possibility of toxic doses?

Since Imuran can cause bone marrow suppression, I would be looking closer into that, and since it is an immunosuppression drug just as prednisone, it's possible that the Imuran is not for Mikey, it can carry the same or more severe side effects and liver toxicity, so be prepared you may not be able to put him back on it.

If you have the option, and of course, if he recovers enough to be a good anesthesia candidate, I would opt for another biopsy, at least to rule out hepatic toxicity vs chronic hepatitis or encephalopathy, any of which may require a complete re-evaluation in treatment protocol.

Poor baby, he remains in my prayers....what else did the vet at ISU suggest other than the Imuran? Did he suggest a further diagnostic plan?

[JMM]

The first steroid we tried for his IBD was dexamethasone recommended by Dr. Center at Cornell (she's on the gastro society listserv) to treat both that and his liver. Even on daily dosing, his GI symptoms did not significantly improve. Next he was put on prednisolone, which he had no response to. He was then placed on budesonide which did not work. Finally he was put on cyclosporine. It took a while to get him to a therapeutic level which also had no effect. When we started azathioprine, I was told that normally it is used with prednisone, but that in Mikey's case, adding prednisone would not increase the quickness of response because he would not respond to the pred. We tried pred two separate times.

When he got very sick Monday and had a high ALT, they stopped his Imuran considering the possibility of toxicity. Other differentials included progression of his IBD or becoming more symptomatic with his MVD. His liver was biopsied a year ago and he has MVD with eosinophilic hepatic venule inflammation. It was not severe and his IBD should be causing most of his symptoms.

His CBC has been closely monitored since the start of the Imuran and is normal. Would we need something more?

Because of the sudden increase in his ALT (it was just normal), and the fact that it did not go down stopping the Imuran and treating as if it were liver assault, his regular vets and internist suspect it has to do with his out of control IBD progressing.

Cyclosporine and azathioprine were the suggestions from Iowa. They agreed the cyclosporine trial was unsuccessful.

He has been biopsied twice and they would require full thickness, not endoscopic biopsies if we did it again. His first was endoscopic, his second during an exploratory with liver biopsy. He had a very rough recovery last time so I am hesitant to try again without a good possibility of treatable cancer. It was a year ago that it was done. What do you think?

We also tried treating him as if liver disease was his primary problem with 2 different protocols, neither of which helped. We also tried stopping all medication which was a disaster. He's had 3 years of various diets and approaches and has gotten much worse in the last year.

Is there somebody else specifically in that society I should contact? The guy's name is Jergens and it looks like he has published quite a bit on IBD. Dr. Center at Cornell has also consulted on the case and looked at the pathologies. Then we've had 2 imed people locally.

We're suppose to restart his Imuran today at 5 mg every other day. He has a recheck ALT tomorrow and again next week and another CBC in about 10 days.