Well.. the plot thickens.
Welcome to the world of veterinary medicine when as soon as you think things are going right, something decides to prove you wrong.
On this weeks episode, it’s the case of Ethel.
I really did think that we had Ethels case somewhat figured out. She was eating and drinking again, she was no longer vomiting or jaundice, her liver values were trending in the right direction, her ear infection seemed to be getting better, and her head tilt and facial nerve paralysis was less pronounced.
She came in today for an ear exam and re-check bloodwork.
The good news was… her ear infection is significantly better but there is still an infection present.
The bad news was… her liver values has taken a turn for the worse. She has a moderately increase ALT and ALP (ALP>> ALT) and mild hyperbilirubinemia. This was incredibly disappointing. We did a liver ultrasound and it showed that the liver had some abnormalities (mixed echogenicity, rounded liver edges, irregular appearance). For some reason, her liver is showing signs of disease. Unfortunately, without more diagnostics, we can’t accurately diagnose why.
SO WHATS NEXT?? We are going to take a liver biopsy next week to send away to a histopathologist. He/she will look at the cells in the liver and hopefully be able to give us more information about prognosis and management/treatment options.
FOR THE TIME BEING we are treating with a few different medications.
WHAT ARE WE DOING FOR THE EAR?
After a long conversation with @molly (my vet friend with a dermatology background), we decided to start treating the ear infection with a ear medication called Baytril Otic. We are going to continue on systemic oral antibiotics too but increase the dose. We also have her on a really low dose of a steroid to help address some of the inflammation in the ear. Hopefully, next week the inflammation has gone down more and we can get a scope in the ear to see if the ear drum (tympanic membrane) is damaged.
WHAT ABOUT THE LIVER?
We started Ethel on two liver drugs:
1.Ursodiol: is a bile acid that to reduce liver inflammation and fibrosis. It also increases bile flow in the liver.
2.Zentonil (S-Adenosyl-Methionine (SAMe) & Silybin): used for treatment of liver disease
Now, it’s a waiting game to see how she does until we can perform a liver biopsy next week.
If you have any input or suggestions, please don’t hesitate to comment below!