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Dr. Gary
Dr. Gary, Veterinarian
Category: Veterinary
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Experience:  DVM, Emergency Veterinarian, BS (Physiology)
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My 13 year old Silkie Terrier developed an abscess in his throat

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My 13 year old Silkie Terrier developed an abscess in his throat in Sept 2012, 6 weeks after a teeth cleaning. His breath was never right after the abscess and we tried several rounds of antibiotics. In March 2013 he was in liver failure and had a kiwi gallbladder. We started with a course of Denamarin, amoxicilin, and ursodiol. He has hypothryoidism and takes Soloxine daily. His appetite was terrible because of the antibiotics and overall sickness. To increase the appetite first tried cyproheptadine, then prednisolone. With the decrease appetite for nearly we stopped the amoxicilin for a week. This weeks lab results were terrible. This week was our 5th round of blood tests. Results are poorest this week. ALT from 897 up to 1514, GLT 76 up to 19, ALK Phosphase 718 up to 2341, Bilirubin .6 up to 1.4. White blood cell count down to 2100. We started him immediately back on the amoxicilin and we are going to try Winstrol for the appetite. Any advise? It's a difficult case at best. We love our vet, he is working so hard for our family.
Submitted: 1 year ago.
Category: Veterinary
Expert:  Dr. Gary replied 1 year ago.
Hello, I'm Dr Gary. I've been practicing veterinary medicine since 2007. I look forward to helping with your questions/ concerns.

This is tough indeed. I think the increase in values are directly related to the steroids that were started. That is expected when we start steroids.

I would want to recheck an ultrasound on him. If this is all due to a gall bladder mucocele or bile obstruction, then it could be treated surgically by removing the gall bladder.

If this is a progressive liver disease, then there is not much more you can do therapeutically. The only other appetite stimulant I would try would be Mirtazapine. I have had better luck with that over Cyproheptadine.

If the ultrasound shows the kiwi gall bladder again, I would go in surgically and remove it. I would get a liver biopsy done at the same time just to make sure the liver looks ok microscopically.

Here is a good link on gall bladder mucoceles in dogs:
http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=3402
Customer: replied 1 year ago.

Hello Dr. Gary,


The steriod therapy being the prednisolone appetite stimulant? If so, in your opinion, what is the % higher? Even at 50% higher the values are still incredibly high.


We have yet to start the Winstrol.


Our vet does not recommend the removal of the gallbaldder at this stage because of the age and high % of death due to surgery.


How do I know if the liver disease is a progressive one? Or if it is a reversable disease? Is there such a thing?


What are your thoughts or suggestions to antibiotic choices?


thank you,


Charlene Langlois

Expert:  Dr. Gary replied 1 year ago.
Prednisolone is a steroid. It has side effects of increased thirst/ urination/ appetite/ panting. It is not really an appetite stimulant though, it's a steroid that has a side effect of increased appetite.

Winstrol is another type of steroid. I would not use Winstrol. These are not used much in veterinary medicine and without a true diagnosis yet, it's not indicated.

The only way you will know the extent of the liver disease and chance of treatment success is with a liver biopsy. This can be done while in surgery or with ultrasound guidance with sedation.

I understand the worry about surgery, but Mucoceles are considered a surgical disease. Without surgery, they will progress and eventually rupture and kill the dog. As long as they do ok through the post-op period, surgery is curative. It's not an easy surgery, but the majority of dogs survive and do well.

The antibiotics I typically use in these dogs are: Clavamox, Baytril and Metronidazole. I will do a culture of the bile fluid to further direct my choice. Without a culture, I usually go with the three combined.
Customer: replied 1 year ago.

The gallbladder results 3 weeks ago were .6, showing that it was working close to properly. But with the continued poor appetite we opted to change to prednisolone.


What I cannot understand is how the results now are reversing so quickly even with all of the medications.


Al did not experience any of the side effects you list while on the prednisolone. Except for the increased values. Could it be a direct correlation?

Expert:  Dr. Gary replied 1 year ago.
The bilirubin is actually more of a test of liver function. I have removed gall bladders from mucocele dogs that had normal Bilirubin numbers. It's the ultrasound and the kiwi look that we use to diagnose a mucocele. Once found, surgery is really the only option.

The increased liver values are definitely in part due to the Pred. It may also be that there is a liver disease that is worsening. We just don't know that unless we do a liver biopsy. It does appear that something is worsening in there and it's not responsive to medication. My guess is that it's a mucocele that is starting to rupture or there is some type of liver cancer present.
Dr. Gary, Veterinarian
Category: Veterinary
Satisfied Customers: 17008
Experience: DVM, Emergency Veterinarian, BS (Physiology)
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Customer: replied 1 year ago.

I do appreciate your help today.


 


My vet may have mentioned mococele on the gallbladdar as apart of his explanation of the kiwi, but I do not recall it. I will pursue that topic and I thank you.

Expert:  Dr. Gary replied 1 year ago.
You're welcome, happy to help.

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