So it's been an interesting few weeks... Let's catch up on the good stuff, first.
Phoebe has pretty much entirely recovered from her "attack" of Idiopathic Vestibular Disease. Her balance is back. She runs, jumps up and down off the sofa, chases Charlie and does everything normally. There is just the very slightest residual head-tilt, but it's so slight, it doesn't bother her and we knew to expect that. She's made a great recovery.
We've been concerned over the past few weeks about Phoebe's appetite and her eating in general. Normally, Phoebe is ravenous. She eats almost anything you give her. She can be a bit finicky about her food from time to time-- wanting wet food, then wanting dry food, wanting baby food, etc...-- but she eats. Over the past few weeks, though, she's lost weight and her appetite has diminished. We were concerned that this might be related to her taking Trilostane for Cushing's Disease so last week she went back to Dr. Mlekoday for an ACTH stim test. The results came back that she was running a bit low on steroid-- meaning, over the past 5 years on Trilostane, even though we keep adjusting the dose down and down, it's been "over-correcting" her a bit. Dr. Mlekoday wanted us to take her off the meds, and we did.
The unexpected part of the visit were the findings that her BUN was elevated and there were Casts in her Urine. This is, typically, a tip off to some sort of kidney inflammation, infection or renal disease. To approach the infectious angle, we started her on Baytril. We were going to wait to re-check her urine for casts next Friday but we've been concerned about her demeanor. This is hard to explain; There's nothing specifically off or obviously wrong with Phoebe but she's not herself this past week. Initially I took it to be possibly irritation from the new (powerful) antibiotic and/or the withdrawing from Trilostane. Even our Dog-walker, Jill, said that Phoebe doesn't seem her normal self. Dr. Mlekoday didn't want to wait on this, so we brought her in this morning for another stim test, and a repeat urinalysis.
We're waiting on the results of the stim test and we'll have those tomorrow. If it's high, we put her back on the Trilostane. If it's low, we can take a bit of a drug holiday. However, her BUN level was abnormally elevated today, again. Though Phoebe is only a bit over half way through the course of Bayril, this means that the cause is less likely to be infection. They did an abdominal ultrasound. Her kidneys and the adrenal glands (which sit on top of the kidneys and are important factors in some kinds of Cushing's Disease) were normal. However, they found an abnormal signal which looks like an early, forming mucocele in her gallbladder. Additionally, there is a region of small intestine which looks to be thickened and inflamed. Historically, mucoceles were considered to be surgical emergencies as they often will cause rupture of the gallbladder with peritonitis. However, given advances in abdominal ultrasonography, they now are finding these "pre-mucoceles" so much faster than ever before that they often treat them effectively with antibiotics.
However, there are lots of "what is that?" questions on her ultrasound. Nothing that looks like a frank tumor, but things that jump out as looking different than on other ultrasounds she's had. Given this, her weight loss and our consensus that she's "not herself", we've been referred for a Gastroenterology consult at NYC Veterinary Specialists-- the folks who took great care fo Chandler (Phoebe's brother) before he passed away. We called and got the first available appointment- this coming Monday, at 12 noon.
So, for now, we wait the weekend, celebrate Michael's birthday and the fact that our Phoebe girl is around to share another one of our lives' milestones. We are confident that, no matter what ultimately comes out of all of this as the final diagnosis, Phoebe will be well. She beats all of the odds, statistics, changes, predictions, etc... her entire life. Why should this be any different? It won't be...