A little bit of good news and some rather worrying bad news. Pereg has not gained any more weight but has managed to lose 400g - still way up on what she was in February but at least it is 400g in the right direction. The worrying news is that her liver function levels are up and over the top of the parameter. Not excessively but enough to be concerned about. Ram wants to do another blood test in 2-3 weeks as it might just be a one-off. If the level is still high then he will have to do an ultrasound of her liver to see if there is anything specific causing it. If not it means that her medication is now causing problems, as it is processed through the liver. The new surgery is brilliant - much bigger and everything new, unlike the old place which was very cramped and in an old scruffy building - having what used to be a shop [one of two] and all the store rooms at the back which had been turned into the operating theatre, Xray, ultrasound, mini lab etc. Ram's new [well new to me] young vet Michal was also working so she and Da Booga got to meet each other and Pereg let her clip her nails, do her anal glands etc. And we let Pereg wander about while waiting for the results and then while Ram and I discussed her results. I am praying it was just a one-off high and not the start of liver problems. Oh - and the limp. Which of course had gone away. Ram watched Pereg wandering about and said he could not see anything - had a feel and checked her joints and reckons she had just strained her shoulder slightly.
Hi Malka we've just got back from training. Glad to hear the good news and sorry to hear the bad. As you say it could be a one off - I know it sometimes happens with Shar-Pei who need to have yearly blood tests. (Georgina has her first coming up in a couple of weeks time). Here's hoping - fingers and paws crossed - it's nothing serious. Hugs from us all.
Thanks Debra - unfortunately the liver problem is rather serious if it has actually been caused by her medication, because she has been on liver support supplements since soon after starting medication, and I do not know whether there is anything else we can do. Thanks Barbara to you too. Pereg has blood tests every six months [three if her blood plasma level comes back high but that result will not come though for maybe 4-5 days], and this is the first time her ALT has been high. It could indicate some liver damage from the medication or it could indicate nothing. She was great though. I was a bit concerned as to how she would react to the new surgery but she was fine, and liked wandering about once she was off the table [Michal sat on the floor behind her to do her anal glands!]. Michal is a lovely young woman who made such a fuss of Pereg - and Pereg was very relaxed with her. There was also a new vet nurse as well as Dalia, who has been there for as long as I have known Ram. She met a tiny black and white fluffy puppy [while I had puppy cuddles! ] - said hello to Ram's big black Labrador - ignored his new kitten - and let the two young men with the tiny puppy scriggle her head as they took their puppy and left! While we were waiting for the test results three women came in with a young dog and she got head scriggles from them as they went into the examination room - I was just so proud of her as she was so relaxed in what was, for both of us, a strange place - and for her meeting strangers. And I got a massive bear-hug from Ram both when I went in and before we left!
Thanks Carole but I cannot help worrying. However, I was fully aware of the possibility of liver damage from when Ram first put her on Pb, hence the supplements Milk Thistle and SAMe. There was no choice though. Either put her on medication for life with the chance that it might damage her liver, or not medicate her in which case she probably would not have survived very long. I am just so lucky that I have such a wonderful Vet, who not only knows so much about canine epilepsy but also always has the time not only to explain things but to discuss the where's and wherefore's, the what ifs and the what-do-we-do-nexts. He also loves Pereg!
Pereg's blood plasma Phenobarbitone level result has just come through... Phenobarbital: 28.8 µg/mL (15-40 µg/mL) As her blood is always drawn at approximately the same time, ie ± 1½ hours before her next dose is due, it means we always have a comparison, and because she has her medication every eight hours and not the usual twelve hours, this test shows that she always has sufficient Pb in her blood as it is getting near the trough level. Any lower than 25 µg/mL would mean she does not have enough, even though the lower end of the parameter is 15. Only once was the result high and that was because we had been increasing her Pb due to seizure activity, but I slowly reduced the dosage to what it had been, and the next results came back as usual, without any detrimental change in her seizure activity. I have just spoken to Ram - he emailed me the results from the outside laboratory as soon as he received them and was expecting my call. Which leaves us exactly where we were with Sunday's liver function test result, ie not really knowing until she has another chem blood test, hopefully in a couple of weeks. But she is not showing any sign of possible hepatic problems and it was only the one result that was high. It is like walking on a tightrope - a millimetre either side...
Tina, Pereg was fine in herself, in fact Ram reckons that she is one of the healthiest dogs on his books! It was one of the blood test results that were off, not her, but until she has another blood test we will not know. If the ALT liver function result comes back still high I might discuss a slight reduction in her Pb dose to see what happens, and then test again after another few weeks. However, the results that came through this morning from the outside laboratory mean that the therapeutic amount of Pb in her blood is fine. It is not too high but high enough, so she is obviously having the correct dosage, but I am still thinking of maybe a slight reduction depending on the next blood test. It is at times like this, with the cost of blood tests and medication, that I wish I had been able to get vet insurance for her, but it is not really important as if she needs more tests she needs them and she will have them.
Its always hard to know what's right or wrong when it comes to our pets Malka, when test result is high then low or slightly high, we just don't know whether to increase or decrease any medication they are taking.
