Okay. It's been another tough day.
I took Simone in this morning to the OSU veterinary hospital. I gave her case history to a fourth year medical student, and then proceeded to wait an hour and a half in the exam room for the doctor to come in. Simone was pretty mellow, and took a nap on the floor while we waited.
The doctor finally came in around noon and examined Simone. He made a good first impression (he has a sexy Australian accent) and discussed the tests that he wanted to perform. He said he wanted to start out with a CBC and chemistry panel to check her liver enzymes (since her eyes looked a little yellow), and then do a liver aspirate (since her liver is so enlarged) and an abdominal ultrasound. Depending on the results of the abdominal ultrasound, he said they may want to do a bone marrow biopsy to check for bone marrow cancer. I left Simone with them and then went home to wait by the phone.
The vet student called around 4pm and told us that Simone would be ready to pick up at 5pm. She said they wanted to take her off the new immunosuppressent drug, and lower her steroid drug to two pills twice a day. We got there at 5pm, waited until 5:45pm, and then the doctor came in. He was very good at explaining what he thinks is going on. He said that the initial diagnosis of immune-mediated thrombocytopenia seemed to be accurate, and that her platelet rebound once she was put on steroids was good evidence of that. He said that her anemia doesn't appear to be immune-mediated though, since one of the tests they did (Coombs test) came back negative. Aside from a 1 cm mass, her spleen appeared normal. He thinks her enlarged liver is due to the new immunosuppressent drug, as it can apparently rather toxic to the liver. He wants to take her off that immediately, and give her liver a chance to recover. He said he also thinks that she has been on such a high dose of steroids for such a long period of time that may be what is causing her to have problems with her red blood cells. He thinks that lowering the steroids, and getting down to the lowest dose possible, will help her red blood cells to rebound. So, he thinks her overall prognosis has the potential to be positive, so long as there isn't another underlying cause (which, on this horrible roller coaster ride, there still could be). Only time will tell. We're going to take a baby step and discontinue the one drug and lower the dose of the other and hope for the best.
Simone's X-ray from 9/5/07
So, around 6:00pm, Simone was finally brought back in to see us. She didn't seem herself. She was drooling, and only did an obligatory tail wag. She swaggered down the hallway and out into the parking lot with us. When we got outside, she urinated, but couldn't use her back legs very well and seemed to be having trouble. I got to the car and took her dinner out, but she wasn't interested in it at all. When she made it to the car, she collapsed. Her gums were paper white and her heart was racing. She seemed distant and not aware of her surroundings. Gary ran back to the building (which was now closed and locked), and pushed the intercom. After being asked where he got the inside phone number (apparently someone was new and didn't realize they had an intercom phone in the parking lot!), a crew of six vets rushed out with a stretcher and loaded Simone up. They took her inside and told us they would call us later.
In shock, Gary and I headed home to again wait by the phone. At 7:30pm, the vet called and talked to Gary. He said it appeared that she was bleeding internally. He said it seemed likely that a clot had been dislodged when they did the liver aspirate, and she began bleeding. He said they had started a plasma transfusion and that she seemed to be responding. He said he would call back in a couple of hours and give us an update.
At 8:45pm, he called again, and said that Simone seems to be perking back up. He said they had taken her outside to pee and that she was wagging her tail and her eyes had reanimated. He said that her blood pressure was back up to a normal range and that the blood in her abdominal cavity had a lower packed cell volume (16) than her arterial blood (27). While neither value is good (normal is 42), the lower value in the abdominal cavity indicated that there wasn't a direct arterial bleed. So, they have a pressure bandage on her abdomen, should be finishing up her plasma transfusion, and will be keeping an eye on her tonight. We were told to expect a call from the vet student in the morning to let us know what's going on and when we might expect to be able to pick Simone up.
We're exhausted, but encouraged. At the top of the roller coaster again, but it's so much better to be up here than at the bottom. It seems like we've been spending too much time there.
Thanks for all of your kind words and thoughts. We'll keep you posted.
Love, Carley and Gary
