Is there a more affordable option than an exploratory biopsy since the ultrasound for my son’s sick dog didn’t lead to any conclusions?
Original Question: My son’s 6-year-old German Shepherd has been sick since January. He’s not eating, very lethargic, has dark stools, and his blood work shows high liver enzymes (around 5000). Our vet prescribed liquid vitamin D and Metronidazole 250 mg to be taken every 12 hours. He had an ultrasound that showed small normal liver segmental duodenal thickening, small non-specific splenic nodule, and no bile duct obstruction. The benign prostatic hyperplasia could be inflammatory, infected cirrhosis or lymphoma. A surgical exploratory biopsy is suggested. My son has already spent around $1000 and he can't afford surgery. Do you have any ideas for a diagnosis or how to proceed? The dog seemed to be a bit better after the pills were given. - Rose
Thanks for your question.
These are the type of questions that are difficult to answer. It’s a complicated case and it’s very important that I do not give you specific advice because I’m not able to examine your pet but I can give you some guidance.
Every veterinarian has been in the situation where a client has come to a point where they feel they can’t proceed with diagnostics. For whatever reason, whether it’s the expense or not wanting to put their pet through it, I find this is a common situation. Veterinarians will respond in different ways at this point. Personally, I always try to provide options but it’s important that I don’t give an option that can cause harm to your pet.
If your veterinarian is comfortable with this idea, they would have to make an assumptive diagnosis based on all the information they have. They could then come up with general therapies for the liver that are supportive for almost any of these conditions. For example, you can support the liver with supplements, antibiotics, vitamins, specific medication to help biliary flow and all of these medications are generally harmless but may not be of great value given the possibility of ongoing conditions. If the assumption is that cancer exists, it would be extremely dangerous to start administering chemotherapeutic drugs without knowing the real diagnosis because these drugs have very undesirable side effects.
Some veterinarians may treat him and others may not. You need to respect their decisions because it puts the veterinarian at great risk if you are requesting a treatment that they can’t confirm is the right one. Evaluating the success of treatments can be difficult as well. You can repeat some of the diagnostics that you’ve already done after implementing a treatment and see if the results are improving. This still may not tell you whether you have the right treatment but it could lend credibility to the assumptive diagnosis.
I hope this helps. I’m definitely limited in my ability to help you in a complicated case like this. Good luck.
Dr. Clayton Greenway
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