This morning, after feeding Rosie her two meals, I drove to the clinic (by myself, without Rosie) to get yesterday’s blood test results. I had to wait almost two hours because the results were not in yet.
When I finally got the piece of paper, I was already prepared for the worst, but I still had a shock of my life.
The readings are….I don’t know, off the charts?
Her alkaline phosphatase, total bilirubin, GGT, AST and ALT have all increased tremendously, and it points to the fact that Rosie’s liver disease has progressively worsened.
It’s a chronic disease and it is gradually worsening.
The AST is now 506 (previously gone down to 134) and the ALT is 801 now (when we first started treatment it was 640, then 409 and later, 261, but now it’s 801). However, the vet had warned me that steroids can cause the ALT to shoot up so we don’t know if this increase is due to the steroids, or the degree of liver damage is just increasing with more blockages. From the swelling of the liver, it looks like there are more blockages and more liver damage now.
The marker that tells a more accurate story would be the total bilirubin. It has been increasing progressively from 205 to 217 and now, to 320. And this is despite the fact that Rosie has just started to turn a wee bit pinkish (she is not as yellow-orange as during the height of her down period). We thought the bilirubin level will drop, but no, the numbers show otherwise. My only one consolation is that one of the vets did tell me that sometimes, the bilirubin level takes a week to show the drop (if at all there is any drop).
So, what the numbers tell is that Rosie’s liver disease is progressively worsening. What we can do now is to provide palliative and supportive treatment and care, which is what we are already doing. The senior vet said that maybe it is with all these supportive treatment (supplements, etc) that Rosie is feeling better now. And maybe if we hadn’t done all this, the readings would be even worse.
Indeed, clinically, Rosie appears to be much better – she is more willing to eat, she walks around, grooms herself, doesn’t hide under the bed all day. She even comes down from upstairs to greet us when we come home.
I asked the vet if we should stop the steroids since the steroids is making the ALT reading sky-high. The vet explained the steroids has this “feel good” effect and usually, even humans with cancer, take steroids.
So, we will continue with the steroids. All other supplements are to be continued, but we can consider stopping the antibiotics one by one. Doxy can be stopped first. We are keeping the Baytril because if Rosie’s cholestasis is due to a bacterial infection, then Baytril is the antibiotic for it.
The vet mentioned that we do not know exactly what caused Rosie’s liver to be damaged. He did not rule out cancer even though cancer was not detected in the ultrasound. Ultrasound has its limitations and only certain cancers can be seen. It is too dangerous to do a biopsy to investigate further. Poking in a needle may puncture the bile ducts and cause more damage. Rosie may not be able to take anaesthesia too.
One consolation, though, Rosie’s kidney readings are all okay.
So, as for her liver condition and the general decline, we are left with only one option – continue the supplements and TCM.
And live in the present moment. Accept what is, and do the best we can.
Rosie is brighter and more alert than she was previously.
She likes being massaged.
After getting the blood test results, I drove back and took Rosie to the vet’s for an EPO injection. Her PCV (or HCT) is low, which indicates anaemia. Her RBC is also low. Rosie’s HCT reading is 20.2 (normal range is 27 to 47). Let’s hope the EPO works. EPO has to be given 3 times, on alternate days (every two days). So, we will be going to the vet’s on Saturday and Monday to complete the treatment.
Erythropoietin (also known as EPO) is a growth factor that stimulates the production of red blood cells. Most of the cells in the blood are red blood cells, whose main function is to carry oxygen throughout the body. Erythropoietin is used to treat anemia resulting from kidney failure or cancer treatment.
We also did today’s subcut at the clinic.
Back from the vet’s and happily grooming herself.
Animals live in the present moment and that is a good thing.
As long as Rosie feels good enough (whether it’s the steroids, all the supplements or the fluids), it’s good enough. The numbers tell a different story, but what is more important is that Rosie feels good enough.