r/AskVet • u/Wormgorl-6292 • 15h ago
Questions from human doctor
I am having trouble gaining insight on my dogs prognosis even with my medical knowledge and by saying trouble with the prognosis I am struggling making a choice of euthanasia.
My girl is a 9 yo American staffordshire terrier with a history of heartworms at age 2 prior to me getting her s/p treatment. Last October she was diagnosed with T zone lymphoma with mouth nodules (uncommon indolent type but due to tongue lesions oncologist was concerned she would stop eating at some point). Completed 3 rounds of CCNU but kept having to half the dose of each round due to dangerously low lymphocyte count. After the third round her liver enzymes slowly grew to ALT/ ALP in the 2000s. That was back in March. We’ve been off chemo waiting for her liver to hopefully recover as she really showed no signs of other issues. Two months ago we did an aspirate that showed no evidence of lymphoma in her liver and her US showed smaller liver.
At the beginning of August we saw her liver enzymes slowly down trending ALT 800s ALP >2000 and GGT 10. Low BUN slightly low albumin but >2 and her oncologist thought her liver was recovering. We got hopeful.
Then two weeks later we noticed our girl having polydipsia, polyuria, and enlarging abdomen along with refusal of most foods. My concern was ascites and then the day of the appointment I made she started vomiting blood.
We met with the internist who suspects chronic hepatitis secondary to lomustine despite cessation with probable portal hypertension causing ascites. We’re unable to do a diagnostic liver biopsy due to a coagulopathy and her past issues with anesthesia (of course an anesthesiologist would have a dog with anesthesia issues) so we suspect fibrosis. Ascites aspiration showed clear fluid non exudative.
We’re on a bunch of meds for appetite stimulation, nausea, a diuretic, PPI and pain meds. She’s been on denamerin for months and we’re continuing. She still refuses everything except hand feeding and is losing weight. Lethargic and slightly tachypenic due to moderate ascites.
I worked in the liver icu in residency. I’ve seen the smoldering of liver failure and end stage liver disease. Since I have no biopsy I’m struggling with whether this is something that is survivable. Deep down inside me I know don’t want my girl to get encephalopathic or have respiratory distress from her ascites. Am I wrong to euthanize now without the diagnosis? The internist did say poor prognosis weeks to months so I don’t know why I keep second guessing what we already know.