The Story of Brownie

Brownie Daley is an 8 yr MC Standard Poodle who presented to VESCONE in February of 2004. Brownie had been ill for 5 days. He was vomiting and had a poor appetite.

Physical examination revealed a quiet, thin patient, he was only 54 lbs. Brownie also had a fever, and was jaundiced (yellow gums and whites of his eyes). Brownie was admitted to the hospital and placed on intravenous fluids. Blood work, urinalysis, radiographs, and an abdominal ultrasound were performed.

Brownie’s liver enzymes and bilirubin were very high – this meant his liver was not working properly. His blood clotting tests were abnormal, which is not uncommon in patients with liver disease. The liver produces clotting factors that help clot blood. His liver was small and was abnormal in appearance on ultrasound.

Vitamin K was started to try to correct the clotting problems. After 2 days and little improvement in both the clotting values and Brownie’s overall condition, a plasma transfusion, from VESCONE’s in-house blood bank, was given to enable us to safely obtain an ultrasound guided liver biopsy. Plasma is an important component of blood that helps replace those clotting factors that are not being produced by a sick liver.

The liver biopsy was performed under light sedation. Our Radiologist worked closely with Dr.Spielman to diagnose the underlying disease process. Dr. Schwarz, VESCONE’s Radiologist, used the guidance of ultrasound, to introduce a needle through the abdominal wall into the liver. A small piece of liver was obtained and submitted to a team of pathologists to examine microscopically to aid in the diagnosis.

Supportive care was continued at VESCONE, 24 hours a day, while Brownie was in the Intensive Care Unit at VESCONE. Although he was no longer vomiting, his appetite was still poor. Brownie’s owner elected to take him home on supportive treatment pending the biopsy results.
Brownie’s owner was instructed to give him Pepcid AC and metoclopramide, medications that help combat nausea, and ursodeoxycholic acid (Actigal), which helps bile flow more smoothly through the liver. His owner was taught by the Internal Medicine nursing staff, to give him daily subcutaneous (under the skin) fluids to keep him hydrated.

The biopsy results were available late the following day. Brownie had severe chronic active hepatitis (CAH) with fibrosis. CAH is a severe, life threatening inflammatory disorder of the liver. Fibrosis is a secondary scarring of the liver that results from the inflammation. There is no specific cause, although a process involving the immune system is most likely. Certain drugs and other disease processes have been implicated as well. CAH is a life threatening illness. The prognosis is very guarded. Often, despite proper therapy, the patient succumbs to the disease. It was also established that Brownie had a urinary tract infection.

Both Brownie and Brownies mom were fighters. We talked at length about the illness, and the possible consequences. Brownies mom wanted to do everything, pulling out all the stops.
With the aid of Dr. Spielman’s careful guidance and support, Brownie continued to receive daily subcutaneous fluid therapy. In addition, several of the oral medications would now be administered through an injectable route, similar to the fluid therapy. It was felt by delivering injectable medication, we could get Brownie’s blood levels up more quickly, alleviating the need to ingest pills on an empty stomach.

Prednisone, a potent anti inflammatory agent, and Baytril, a potent antibiotic were added to the mix. We continued the Actigal as well. Daily phone calls kept Dr. Spielman and her team of nurses working together to create the best plan and treatment regime for Brownie every step of the way. Over the next several weeks, serial blood tests were obtained, and we watched the liver enzymes and bilirubin continue to fall closer and closer to the normal range. Brownie was starting to eat and feel “like his old self” into March. All medication was slowly switched to oral administration, and Brownie’s blood work was essentially normal by April. He has even gained 12 lbs at this point, and we were considering putting him on a diet!

The medication was slowly tapered over the summer. By fall, Brownie was on just a low dose of prednisone, Actigal, and Pepcid AC.

Bile acids, a liver function test, were performed in September. They were normal, supportive of complete resolution of the inflammation.

We discussed obtaining a follow up biopsy at that time, however due to the invasiveness of the test in a patient who was feeling so well, Brownie’s mom elected not to proceed with additional testing.

Brownie was seen for a routine follow up in November. It was felt he was drinking and urinating more over the previous few weeks.

Repeat blood tests looked great; however Brownie had a urinary tract infection once again. Brownie was started on antibiotics, and a urine culture was repeated mid way though the course, only to find that the bacteria was no longer sensitive to this antibiotic. The only option was to once again, send him home on injections, as the necessary antibiotic was not available in an oral formulation. Brownie had to be checked every couple of days, assessing blood work and urinalyses, making sure there were no adverse affects to this antibiotic, as it has been implicated in causing damage to the kidneys. Both Brownie and his mom sailed through these 10 days and did beautifully.

A follow up culture 1 week after the antibiotics were finished revealed the same resistant infection. An abdominal ultrasound was performed to look for a possible underlying cause of these infections. No stones, tumors, or other abnormalities were noted. A longer course (2 weeks) of the same antibiotic was then recommended.

Once again, Brownie responded very well to the treatment. He was no longer drinking and urinating excessively, and a follow up culture was negative.

Brownie’s most recent follow up was on the one year anniversary of his admission to VESCONE. Clinically, he’s perfect. He is maintained on just Pepcid and Actigal once daily. His blood work and urine culture were normal.

He will be scheduled for periodic follow ups every several months.

Brownie’s most recent weight is 66lbs, and he is a beautiful, robust fellow.
He has mixed emotions when he visits, but the tail wag always wins out.

We love Brownie, and are so glad to have been a part of his life for the last year, and look forward to many more to come!