Risks of liver biopsy?

Good morning Dr. Marie!

Remember me? From last month with Oreo's bile acid test results and I had sent you his lab work from the Univeristy of Wisconin-Madison. If you need me to, I can resend that. So a month ago, I was to follow up with my local vet with a repeat bile acid test and retest of liver enzymes.

His biles are still abnormal. His pre meal test was up from less than 1 to a 34.6 and his post meal was down just slightly from a 61 to a 53.5 His ALT was normal this month at 81 and his ALKP was up to 452 from 374.

So the internist had prescribed an antibiotic in case there was some kind of infection going on but she has decided that was not the case. She recommended carrying on with the Denamarin and repeat liver enzymes in a month.

I talked to her about a laparoscopic liver biopsy and she said that was an option but she asked me if I really want to put Oreo through that. Well, yes and no really.

Peace seems to still elude me regarding all of this. I am better but still am not etirely comfortable assuming it is MVD. I can accept it if it turns out that he does have MVD but I keep thinking maybe, it might not be and maybe it would be something else or maybe nothing at all? I know alot of people say to jusr assume he has MVD and treat him as if he does. But in case he wouldnt have it, I would like to know. Alot of foods must be avoided and treats too if he does have it. If he doesn't have it, it would be nice to know as I would proceed differently.

I have not switched internists really but the way it works at UW-Madison is they do differnt rotations and the orginal internistis now off on a different rotation for 3 more weeks. So one of her partners and I spoke and she told me I would deffinatley have a diagnosis if I had the liver biopsy done. However, these internists are hard to get ahold of when I am off work. So I come to you.

I have read that this is minimally invasive and that the liver regenerates itself after anything is taken from it. His clotting panel was normal back in December so we assume he should have no problem there.

I want to do this so I know but yet as I am sure you understand, it makes me nervous too. Some people have suggested to me I am doing a huge injustice to Oreo by "putting him through such a procedure." Just how far back will this set him, do you know? I know he will have several small incisions, but other than that, am I being an awful dog mom to him? I know each dog is different but for most part, dont dogs bounce back fine from this? Do you know what the recovery time is on this?

I asked the internist what she would do if Oreo were hers and she told me that knowing what she knows, she would go ahead and assume he has MVD but if she were me and she really needed to know, she would go ahead and do it.

I know anytime anyone goes under anesthesia, there is a slight risk. But he did fine back in October with removal of 2 lipomas. They used propofol on him then and was up and alert within 10 minutes.

At UW-Madison, they dont have surgeons doing this, it is internists who have been trained to do it. Not all have but I am told even the ones who havent done it, will scrub up and assist when told. I am told there will be plenty of help on hand.

So you kind of know me by now, I want a definitive answer but yet this makes me nervous. When it is all done, I know I will be glad I did it. I will know for sure what the deal is.

Am I being a bad mom to Oreo by doing this? Is it wrong to not want to just assume he has MVD? I guess I just need assurance that these procedures do go fine and dogs bounce back!

Thank you Dr. Marie!

Suzie

Hi Dr. Marie

Thanks for your reply back to me. I do think having this done will help me to come to terms with this. I dont worry at all about the anesthesia, maybe I am an oddball because alot of things I research, people are really worried about that.

I was told that depending how well he does afterwards, he might get to come home with me that night. However, there might be a chance he would need to stay overnight. I guess every animal is different in recovery?

I am debating whether I should just take that week and use it for vacation so I can be home with him for several days after the surgery. In your experience with these, do dogs need alot of monitoring for many days after?

I have been watching some youtube videos of the procedure done and it is interesting. I did see some bleeding though and wondering if after a section is removed, is some bleeding to be expected?

It's great to know most dogs bounce back fairly quickly. Should activity level be curtailed for a while though? Oreo loves to play with his toys.

How many incisions can I expect and do stitches dissolve or have to be removed? Will he feel pain inside his abdomen? I ask this because when I have my gallbladder removed, for about a month, I felt like I had done 500 abdominal crunches. Hoping he doesn't have to experience that!

Thank you Dr. Marie! :-)

Suzie

Hi again!

Yes, it will be laparoscopic as I think their reasoning is this is the very best route to go to get best diagnosis?

Dogs indeed are amazing and in Oreo's favor of course is he feels so chipper as it is, overall blood work looks like he is a healthy little pooch. :-)

I will take the day off of work of course and the next day too then as if he would need to stay overnight, I would have to pick him up then.

If you dont mind, I will keep you posted on when it is done and how he does?

Sure wish you would come to UW-Madison vet school for a job!! lol

Blessings!!

Suzie
p.s. you are very welcome for the bonus!

Dr. Marie

I spoke to the internist last night about Oreo's upcoming liver biopsy and like you said, she would expect Oreo to be back to his old self in about 24-36 hours. She also said she didnt expect him to need a pet sitter when I go to work 2 days later. I kennel him anyways, so he wouldnt be bopping around the house.

He will most likely have two incisions and stitches will be dissolvable, number of incisions can vary she said.

Major question I asked her was how many of these have been done? She told me that she hasn't done one herself, although her main interest is hepatic disease. She will be scrubbing in she said though but another internist who was trained will take the lead. They do about 9 a year and she told me she has never seen a complication. I'm thinking only 9 a year? I guess I would be more comfortable knowing they did dozens and dozens a year.

UW-Madison vet school has a very excellant reputation though but should the fact that they only do about 9 a year be a red flag for me? I dont have the time to be able to travel to a facility where these are done more often.

Sorry for asking another question! lol

Suzie