By the time we arrived to the office, Honey was already starting to feel better.We drew a blood sample for a complete chemistry panel and blood count and took a full set of radiographs.
The radiographs did not show any significant changes. The blood test results did not indicate any immediate life threatening problems were occurring with the kidneys; her hydration, glucose, protein and cell counts were normal ruling out sepsis. I elected to send the remainder of the blood samples to our outside lab for a complete analysis, including pancreatic testing.
In the meantime, Honey received fluid therapy along with additional gastrointestinal medications since I had a suspicion that she may be experiencing an episode of pancreatitis, despite not having eaten anything unusual. Some patients will show non-specific symptoms as Honey was; although most have a history of eating fatty foods or getting into the garbage.
The following day I received the blood test results. Despite some seriously elevated pancreatic and liver tests, Honey was acting nearly normal. I would need to test her further to determine the cause of these elevated levels.
The fact that Honey was from a puppy mill, put her at an increased risk for congenital liver and other internal organ diseases.
She had already been started on a low fat intestinal diet and by the time her tests arrived, she had already eaten her morning meal, so I would delay her liver specific bile acid tests and an abdominal ultrasound until tomorrow – after an overnight food fast.
The ultrasound was unremarkable and the base-line bile acid result came back normal, however the post-prandial test (two hours after eating food) was elevated indicating that her liver was affected by the pancreatic inflammation,most likely caused by the medications that I was trying to wean her off. I would need to get her off the medications sooner than I would have preferred,however this discovery made it necessary.
I would also need to continue the low-fat GI diet and start some liver supplements.Since her base-line test was still normal, I felt that I would likely be able to completely reverse this problem.
On the other hand, I would need to be vigilant for any signs of pain as well as arecurrence of her nightmares that up until now had been fairly well controlled.
Over the next two weeks, Honey tolerated the new diet and medications well. She wasnow completely off her old pain medications and as feared started to have an occasional nightmare, but not anything like she once had. I would wake upseveral times during the night to comfort her out of her dream by gently petting and telling her that she was now safe. She would open her eyes and lickmy hand and then fall back to sleep.
Watch for Part XIII in a couple of weeks…
William T. Carlisle, DVM