IncasSupportTeam
02-28-2021, 03:23 PM
Hi everyone! My girl, Inca, is a 10 year old spayed Miniature Schnauzer. Most of her life has been uneventful in terms of veterinary procedures (other than calcium oxylate bladder stones in 2019 and her spaying at the age of 4 years). We live on the west coast of Canada.
This is going to be a long story (sorry) -
In mid-December 2020, Inca was not herself. Not excited for meals (although there was no problem with her appetite) and standing with a hunched back and her nub of a tail tucked in. I took her to the vet, who ran bloodwork, checked her over physically and thought she might be experiencing some arthritis. The bloodwork was concerning – high total protein, globulin, ALT and ALP. Luckily, the mobile ultrasound vet was coming in for another client that day so we booked an ultrasound for Inca which showed that she had what appeared to be a biliary mucocele forming. We did more bloodwork the next day which showed that her platelets were low. The vet who saw her said we could wait and do another ultrasound in a month (and not knowing how quickly they can grow, I agreed) – no medication prescribed other than Gabapentin for the “arthritis” pain and instructions to go to the Emergency Vet/Surgical Specialists if she got sicker. (This is the one vet at the clinic who I can not relate to and I have asked not to have my dogs seen by her unless it is an emergency and she is the only person available).
The Gabapentin caused Inca to be really confused. We saw her staring at walls like she wanted a door to open. I stopped it after 3 doses as I did not like the effect on her. After Christmas, we noticed she was walking into the other dogs and objects which were in the way when moving around the house and she seemed to be extremely hungry. In the beginning of January, I made an appointment with a different vet at my clinic and she determined that Inca has lost most of her vision. This was sudden and, after eliminating most causes, we thought it fit the signs of Sudden Acquired Retinal Degeneration (but we have to travel to another area of the province to have the diagnosis confirmed and that’s not possible at the moment). Her blood pressure was checked and was good as was the eye pressure. A week later, we retested the eye pressure and it was still good. Her eyes were goopy so a tear production test was done and a diagnosis of keratoconjunctivitis sicca (dry eye) that I am treating with a prescription of Cyclosporin Oil 2% and Optix Eye Health ointment.
The following week, Inca had the follow up ultrasound; the mucocele had grown a lot and they referred me to the Veterinary Surgeon at the Emergency Clinic. Gallbladder Resection surgery was booked for a week later. The surgery went well, the blood work not so well. Still really low platelets and Plateletcrit, high ALT, ALP, low Total Red Blood Cells, Haematocrit and Hemoglobin. She was in the hospital for 2 nights and then sent home with antibiotics and pain control. A liver biopsy was done during the surgery and the microbiology report was good with the culture showing no growth but the pathology report showed “an unexpected lesion which was diffuse severe hepatocellular vacuolation in a pattern strongly suggestive of increased glycogen deposition and therefore suggestive of steroid hepatopathy” and suggesting that the vet might want to follow up with further investigation for Cushings Disease.
Inca had follow up blood work a week after discharge (done at my local vet). She wasn’t her normal self at the appointment – quite lethargic and disinterested (she usually loves the vet and the girls at reception). Her temperature was low. The blood work came back with low Eosinophils and Platelets and High Neutrophils and Basophils. I was advised that she could be very ill and that they had called the Emergency Clinic with the information and I was urged to take her there immediately. She was admitted overnight for observation after a 4 hour investigation. They redid the blood work at the Emergency Clinic and noted that her liver enzymes (ALT, ALP and GGT) were still elevated and that her platelets were almost non-existent but the ones that were there were large so a slide was sent out for a pathologist to review. While there, she had an abdominal ultrasound which showed no free fluid or peritonitis and she was examined by the Internal Medicine Vet. She was sent home at noon with 2 antibiotics (Amoxicillin/Clavulinic Acid and Enrofloxacin) as well as Ursodiol and Cerenia (for nausea). She was also to start on Prednisone (3.75 mg) 2 weeks post surgery so she had 7 of those before we did the next blood work and started tapering her off (due to the suspicion of Cushings) after the results of the Feb 16 test
Chest x-ray was done on February 8 and read by radiologist – all normal. Follow up bloodwork and urinalysis done on February 16. Platelets have improved to just below the low end of the range, Red Blood Cell Count, Eosinophils still low, TT4 low. ALT, ALP, GGT, Cholesterol and Lipase all High, SDMA slightly elevated. The urinalysis showed that the urine is not concentrating well and there was a small amount of protein.
Inca has had loose stool for 4 days this week – had an appointment for Friday afternoon about it and started to clear up. I was giving her Aventi GI and we switched her food to Royal Canin Gastrointestinal Low Fat kibble (she usually eats the same thing in loaf form).
Inca is much more hesitant on our walks and she does not like being in large open spaces (tried walking across a ball field and she froze). I think some of it is her blindness but wind and noises seem to confuse her as well (didn’t before). She gets around well in the house (at least most of the time) and has started managing the 4 steps up/down to the backyard.
She has not gained weight (may have lost weight), she acts like she is starving at meal times (we are feeding her at breakfast and dinner times with snacks at noon and mid-evening), she is drinking a lot but no accidents in the house.
At present, she is getting Ursodiol (250 mg once a day) and Aventi Liver Complete (3/4 tablet a day). I will be trying not to change her food as it is difficult because Inca needs something that will not cause bladder stones and something that does not contain egg (I am anaphylactic and can’t tolerate anything that contains egg even on my skin so I would have to stay away from my dog if she ate them).
We have a Low Dose Dexamethasone Suppression test and Free T4 test scheduled for Thursday, March 4 (a week after the last prednisone).
Hope that wasn’t too much information – I have copies of most of the testing.
This is going to be a long story (sorry) -
In mid-December 2020, Inca was not herself. Not excited for meals (although there was no problem with her appetite) and standing with a hunched back and her nub of a tail tucked in. I took her to the vet, who ran bloodwork, checked her over physically and thought she might be experiencing some arthritis. The bloodwork was concerning – high total protein, globulin, ALT and ALP. Luckily, the mobile ultrasound vet was coming in for another client that day so we booked an ultrasound for Inca which showed that she had what appeared to be a biliary mucocele forming. We did more bloodwork the next day which showed that her platelets were low. The vet who saw her said we could wait and do another ultrasound in a month (and not knowing how quickly they can grow, I agreed) – no medication prescribed other than Gabapentin for the “arthritis” pain and instructions to go to the Emergency Vet/Surgical Specialists if she got sicker. (This is the one vet at the clinic who I can not relate to and I have asked not to have my dogs seen by her unless it is an emergency and she is the only person available).
The Gabapentin caused Inca to be really confused. We saw her staring at walls like she wanted a door to open. I stopped it after 3 doses as I did not like the effect on her. After Christmas, we noticed she was walking into the other dogs and objects which were in the way when moving around the house and she seemed to be extremely hungry. In the beginning of January, I made an appointment with a different vet at my clinic and she determined that Inca has lost most of her vision. This was sudden and, after eliminating most causes, we thought it fit the signs of Sudden Acquired Retinal Degeneration (but we have to travel to another area of the province to have the diagnosis confirmed and that’s not possible at the moment). Her blood pressure was checked and was good as was the eye pressure. A week later, we retested the eye pressure and it was still good. Her eyes were goopy so a tear production test was done and a diagnosis of keratoconjunctivitis sicca (dry eye) that I am treating with a prescription of Cyclosporin Oil 2% and Optix Eye Health ointment.
The following week, Inca had the follow up ultrasound; the mucocele had grown a lot and they referred me to the Veterinary Surgeon at the Emergency Clinic. Gallbladder Resection surgery was booked for a week later. The surgery went well, the blood work not so well. Still really low platelets and Plateletcrit, high ALT, ALP, low Total Red Blood Cells, Haematocrit and Hemoglobin. She was in the hospital for 2 nights and then sent home with antibiotics and pain control. A liver biopsy was done during the surgery and the microbiology report was good with the culture showing no growth but the pathology report showed “an unexpected lesion which was diffuse severe hepatocellular vacuolation in a pattern strongly suggestive of increased glycogen deposition and therefore suggestive of steroid hepatopathy” and suggesting that the vet might want to follow up with further investigation for Cushings Disease.
Inca had follow up blood work a week after discharge (done at my local vet). She wasn’t her normal self at the appointment – quite lethargic and disinterested (she usually loves the vet and the girls at reception). Her temperature was low. The blood work came back with low Eosinophils and Platelets and High Neutrophils and Basophils. I was advised that she could be very ill and that they had called the Emergency Clinic with the information and I was urged to take her there immediately. She was admitted overnight for observation after a 4 hour investigation. They redid the blood work at the Emergency Clinic and noted that her liver enzymes (ALT, ALP and GGT) were still elevated and that her platelets were almost non-existent but the ones that were there were large so a slide was sent out for a pathologist to review. While there, she had an abdominal ultrasound which showed no free fluid or peritonitis and she was examined by the Internal Medicine Vet. She was sent home at noon with 2 antibiotics (Amoxicillin/Clavulinic Acid and Enrofloxacin) as well as Ursodiol and Cerenia (for nausea). She was also to start on Prednisone (3.75 mg) 2 weeks post surgery so she had 7 of those before we did the next blood work and started tapering her off (due to the suspicion of Cushings) after the results of the Feb 16 test
Chest x-ray was done on February 8 and read by radiologist – all normal. Follow up bloodwork and urinalysis done on February 16. Platelets have improved to just below the low end of the range, Red Blood Cell Count, Eosinophils still low, TT4 low. ALT, ALP, GGT, Cholesterol and Lipase all High, SDMA slightly elevated. The urinalysis showed that the urine is not concentrating well and there was a small amount of protein.
Inca has had loose stool for 4 days this week – had an appointment for Friday afternoon about it and started to clear up. I was giving her Aventi GI and we switched her food to Royal Canin Gastrointestinal Low Fat kibble (she usually eats the same thing in loaf form).
Inca is much more hesitant on our walks and she does not like being in large open spaces (tried walking across a ball field and she froze). I think some of it is her blindness but wind and noises seem to confuse her as well (didn’t before). She gets around well in the house (at least most of the time) and has started managing the 4 steps up/down to the backyard.
She has not gained weight (may have lost weight), she acts like she is starving at meal times (we are feeding her at breakfast and dinner times with snacks at noon and mid-evening), she is drinking a lot but no accidents in the house.
At present, she is getting Ursodiol (250 mg once a day) and Aventi Liver Complete (3/4 tablet a day). I will be trying not to change her food as it is difficult because Inca needs something that will not cause bladder stones and something that does not contain egg (I am anaphylactic and can’t tolerate anything that contains egg even on my skin so I would have to stay away from my dog if she ate them).
We have a Low Dose Dexamethasone Suppression test and Free T4 test scheduled for Thursday, March 4 (a week after the last prednisone).
Hope that wasn’t too much information – I have copies of most of the testing.