My last mini-pupdate was posted March 17th.

“Let me explain.  No, there is too much.  Let me sum up.”  ~Inigo Montoya, from The Princess Bride

So when last I mentioned her health, Nuala had contracted a urinary tract infection (UTI).  That was addressed with antibiotics, and we would have to go back in 2 weeks’ time to have her urine tested again.  Also at this time, the vet wanted to take another blood sample to see how her liver was recovering after the Metacam.  Her annual exam and shots would be due then as well, so we decided to make a day of it.

While the UTI had cleared up, there was still significant protein in her pee, or proteinuria.  This is an indicator of kidney damage.  Nu’s blood was also analyzed for kidney enzymes, and they were all in perfect balance.  So on one hand, there was evidence of kidney damage, and on the other, there was none.

In the meantime, Nu had somehow ruptured one of the blood vessels in her right ear and had developed an aural haematoma.  We had to get some drops for her ears to treat the ongoing inflammation that likely caused her to rupture the vessel with scratching in the first place, but neither draining nor surgery was recommended (too painful).  Her body will take care of the situation on its own in a few weeks, though her wee ear will never be the same.

Other than having a ridiculously fat ear, she’s doing fine.

The vet wanted her in to test her blood pressure (hypertension in dogs can cause proteinuria) and take some abdominal x-rays to see if a growth of some sort, or kidney stones could be detected.

Nothing abnormal turned up on the x-rays.  No stones, no growths.  On her kidnies, anyway.  What the x-rays did reveal was an enlarged liver and spleen (sweet Jesus).

Nu’s blood pressure was elevated and so a course of ACE inhibitors was started.  She’ll likely be on those for the rest of her life, but we’re going back in a month to have everything checked again.  We are also transitioning her to a new food (a specialized kidney diet) and hoping that her food allergies don’t result in the mange-like fur-loss she’s experienced in the past.

More diagnostics were recommended to establish the reason for the liver and spleen enlargement, involving a trip to Newmarket, the closest town equipped to do veterinary ultrasounds.  Alternatively, our vet could perform a laparoscopic procedure and possible biopsy (if required).

Phil and I discussed it, and even though the option of sedation was offered, the travel would be more torture to Nuala than any resolution the ultrasound might reveal.  She HATES the car.  Even laparoscopic procedures are invasive, though minimally so.  We had to decide where we would draw the line.

If there is some infection or tumour causing the enlargement of her organs, there’s little that can be done in either case.  Liver and spleen are pretty important and highly vascular organs and several diseases that affect either usually result in internal bleeding, or disseminated intravascular coagulation (DIC).

We’d already gone through the heartbreak of hemangiosarcoma with our last dog, and though we authorized surgery, it did little for her other than to confirm that her condition was terminal.  Ultimately internal bleeding was the cause of her demise.

Organ failure is another possibility, but there are no transplant programs for pets.

There’s also a chance that whatever condition she has that’s causing the enlargement of her liver and spleen won’t become an issue in her lifetime.  She’s just passed her eighth birthday and most dogs don’t make it very far into their teens.

You might see this as naive optimism, or unnecessarily harsh, but Phil is Mr. Science and he used to work as a laboratory technician for humans.  He’s well-aware of the potential issues and has shared his insights.

Aside from which, Nu is behaving normally.  Other than a little limp, exacerbated by the leg-tugging required to get a good abdominal x-ray, she’s fine.  In this morning’s snow, she was doing her usual pup-angels and seal impression.  She was also scavenging for dirty tissues and all manner of tasty (to her) garbage.  By all accounts, she’s a happy dog.

It would be different if she was experiencing further pain, or other abnormal behaviour.

We’re going to take things a step at a time.  Use the ACE inhibitors and k/d (Hill’s Kidney Diet) for the month and see if they improve her blood pressure and proteinuria.

For us, it’s a matter of quality of life for Nuala.  The ACL injury we had to do something about.  It caused her a great deal of pain and could have caused other injuries and difficulties in the future.  When she sheared a tooth off, oral surgery was a must.  When she lost patches of fur due to a food allergy, hypoallergenic food was the fix.

Now the kidney diet and ACE inhibitors are necessary.  We’re just about at our limit with what we can reasonably do to ensure Nu’s continued, happy existence, though.

Will let you know how all of this pans out.

How are your animal muses doing these days?  I sincerely hope all is well.