Erlina continues to do well. We have tapered the medications she was on. She has some labwork pending the end of this week and if that is good we will start slowly switching her from her special diet to a regular diet.
She is troubled by leg pain that seems to move from leg to leg - sometimes disappearing for days at a time.
Bill continues to do well, making an uneventful recovery from shoulder replacement surgery. He still has months of rehab and physical therapy ahead.
If you want to comment, please send an email to:william {at} HoundsOfHeaven.com,or go to our website: www.HoundsOfHeaven.com
Tuesday, August 17, 2010
Sunday, August 8, 2010
Erlina - much later
For those of you who wrote asking if something was wrong... yes it was.
Starting about the time of the last post, Erlina was not doing well. She was confused, lost her bite restraint, and became lethargic. A comprehensive workup revealed that a fetal vein that bypasses the liver had not closed shortly after birth as it should. This is called Portal-Systemic Shunt ("PSS"). The usual treatment for this condition is to surgically open the abdomen and chest, open the liver (because the bypass vein is inside the liver) and put a ring on it that slowly closes the vein over a 1 - 2 week period. The surgical mortality is about 50-70%.
Luckily, there is an interventional radiologist (IR)at Michigan State University who does a new procedure, Percutaneous Transjugular Coil Embolization (PTCE). We say "luckily" because there are only 3 places in the US that do this procedure.
Under annesthesia the IR places a catheter into the vena cava (the very large vein that travels from the pelvis to the heart) and guides it (with CT guidance) to the location where the fetal vein joins the vena cava and then places a large stent.
Take a look. The thing that looks like a tubular strainer, is the stent.
After the stent is placed, the IR places small dacron covered coils through the stent into the fetal vein. The IR then places enough coils to partially block the fetal vein. You do not want to place too many coils, because the liver is immature and could not handle the full blood flow immediately.
Here you can see one coil in place and watch the IR place a 2nd coil. The coils are just above the stent. .
Over the succeeding week the coils form blood clots around them when progressively block the fetal vein, allowing enough time for the liver to develop. About 40% of the time this works. Another 40% of the time a second procedure is needed to place more coils. The remaining 20% of the time the dog, while much improved, still has significant liver bypass.
We are now 4 weeks after the procedure. We still don't know yet if it was adequately effective, but she sure is doing well.
Here she is with Rhianon:
Notice how much larger she is than she was in late April.
She is still not as active as she was before everything fell apart, but she is doing much better.
Now it is Bill's turn for surgery, so the Blog will officially be on vacation for awhile because his left arm will be in a sling for 6 weeks and that makes typing difficult.
If you want to comment, please send an email to:william {at} HoundsOfHeaven.com,or go to our website: www.HoundsOfHeaven.com
but don't expect a reply in less than 6 weeks.
Starting about the time of the last post, Erlina was not doing well. She was confused, lost her bite restraint, and became lethargic. A comprehensive workup revealed that a fetal vein that bypasses the liver had not closed shortly after birth as it should. This is called Portal-Systemic Shunt ("PSS"). The usual treatment for this condition is to surgically open the abdomen and chest, open the liver (because the bypass vein is inside the liver) and put a ring on it that slowly closes the vein over a 1 - 2 week period. The surgical mortality is about 50-70%.
Luckily, there is an interventional radiologist (IR)at Michigan State University who does a new procedure, Percutaneous Transjugular Coil Embolization (PTCE). We say "luckily" because there are only 3 places in the US that do this procedure.
Under annesthesia the IR places a catheter into the vena cava (the very large vein that travels from the pelvis to the heart) and guides it (with CT guidance) to the location where the fetal vein joins the vena cava and then places a large stent.
Take a look. The thing that looks like a tubular strainer, is the stent.
After the stent is placed, the IR places small dacron covered coils through the stent into the fetal vein. The IR then places enough coils to partially block the fetal vein. You do not want to place too many coils, because the liver is immature and could not handle the full blood flow immediately.
Here you can see one coil in place and watch the IR place a 2nd coil. The coils are just above the stent. .
Over the succeeding week the coils form blood clots around them when progressively block the fetal vein, allowing enough time for the liver to develop. About 40% of the time this works. Another 40% of the time a second procedure is needed to place more coils. The remaining 20% of the time the dog, while much improved, still has significant liver bypass.
We are now 4 weeks after the procedure. We still don't know yet if it was adequately effective, but she sure is doing well.
Here she is with Rhianon:
Notice how much larger she is than she was in late April.
She is still not as active as she was before everything fell apart, but she is doing much better.
Now it is Bill's turn for surgery, so the Blog will officially be on vacation for awhile because his left arm will be in a sling for 6 weeks and that makes typing difficult.
If you want to comment, please send an email to:william {at} HoundsOfHeaven.com,or go to our website: www.HoundsOfHeaven.com
but don't expect a reply in less than 6 weeks.
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