Simone Update 9/17

We just got back from an hour-long visit with Simone. She seems to be doing okay today, but isn't as perky as she was yesterday. Rotations took place today, so we have a new vet in charge of her case, Dr. Brownlee, and a new fourth year student named Deborah. Simone had bloodwork done around noon, and the results showed that while her ALT value is lower than it was, her other liver enzyme and bilirubin levels have continued to climb. She's pretty yellow. They are becoming more concerned about the high liver enzyme values. Dr. Brownlee says a couple of things could be going on. One is that she may have a ruptured gallbladder or leak in a vessel connecting the gallbladder to the liver that is letting bile get out. She wants to do another ultrasound tomorrow to look at her gallbladder specifically and see if there is any evidence of a leak. Another possibility is that her liver is failing, which worries us and the doctor. If there is a gallbladder leak/tear, surgery will probably be required. If it's liver failure, then there are medications they can give her to try and help that.

Simone was panting pretty hard when she was brought into the exam room for our visit, but it settled down once she laid down on the floor and we started petting her. They have had her in the oxygen cage off and on all day and have been monitoring her breathing. Her blood gas is still pretty low. Dr. Brownlee said they might do a scan tomorrow where they would inject her with a dye and then take an X-ray to see how the vessels in the lungs are looking. She thinks it's likely that there are blood clots in her lungs. She said if that is the case, then the goal is to prevent her from making any more, and then give her body time to form new vessels to allow for a better exchange of oxygen.

Simone's red blood cell count dropped a little, down to 30. The doctor said that she wasn't too concerned about it though, as it was likely that is was due to her body breaking down some of the blood cells from the transfusion. While not normal, she said many dogs can go on to live well with low red blood cell counts in this range.

Dr. Brownlee said she did have a patient many years ago who was treated for the immune-mediated thrombocytopenia and responded poorly to prednosone. She thinks that while it is rare, Simone may be having the same problem, and that the prednosone could possibly the root of all of her problems. She said they would continue to decrease her dose, and try and get it as low as possible so that she will have high enough platelet levels, and minimal side effects to her liver/blood cells. Time will tell.

As it stands right now, we're looking at another 2-3 days in the ICU, maybe longer. We will just continue to take one day at a time and hope that her bilirubin and liver enzyme levels begin to fall back down to normal levels. The one encouraging thing was that she did eat a cup of her dry food, and a little bit of her canned duck and tater. Deborah said she thought it was funny that Simone would only eat the canned food if it was spoon fed to her.

What can we say, that's our girl :)