Crusoe's Health/Surgery Recap - Gallbladder & Liver

Anyone who follows me has probably seen at least a couple of my updates on my health relating to the liver and gallbladder issues.

I thought this post would be a good way to recap the whole story, top-level, for anyone who is curious but doesn't know what happened.

So, here's what happened in three sentences:

My gallbladder was incidentally discovered to be unhealthy, so I had it removed per-emptively before it could worsen and cause problems. I had always been asymptomatic prior to this surgery, with perfect bloodwork, but after having it removed, my liver enzymes went sky high (meaning something very wrong). This went on for almost 8 months while we worked tirelessly with Cornell University trying to determine WHY this might have happened. Finally, in January 2021, I went for a second surgery and biopsy to find the issue - and it was discovered my bile duct (which is where gallbladder used to be attached), was full of "sand", so this was flushed out. A few months after this, miraculously, my liver enzymes dropped back to normal.

It was a long and hard journey, but at this moment, I am so happy and relieved to say I am in good health.

Late 2019/Early 2020 - Discovering the issue

Back in late 2019/early 2020, it was discovered I had mineralized sludge in my gallbladder through an incidental x-ray. This means it had sorta slime and small sand particles in it.

March 2020 - What to do about it?

Knowing that my gallbladder was not in great shape, it was now a question of what to do...

It's important to note, that at this time (and even the WHOLE time to this day), I was never symptomatic in any way, clinically or in labwork.

So we went to visit the place everyone goes for anything liver-related - Cornell University, to consult with Dr. Sharon Center, who is probably the most reputed liver specialist in canine medicine in the world.

As we wanted multiple opinions, we also consulted with our local internist, as well as another reputed canine liver and gallbladder specialist, Dr. Gookin from NC State.

Anyway, here was the conclusion:

My gallbladder was pretty sludgy. It was still working, and wasn't causing my any issues or symptoms - but there's a very good chance it would one day. And there's also no evidence that this can ever be reversed. It would only progress, but how quickly we don't know.

So, everyone's recommendation was to have it removed, and to have it removed while I was still healthy and asymptomatic, BECAUSE if a dog gets sick from their gallbladder (bilirubin levels go high, etc), this means the liver is struggling. Your liver is what processes anesthesia. So going for surgery once a dog is sick with liver issues is MUCH more dangerous and higher chance of fatality. So chances of success in surgery are much higher while the dog is healthy.

Thus, as hard as it was to make that decision, we decided on surgery.

June 2020 - I had my gallbladder removed at Guelph University

So, my surgery was conducted by Dr. Singh, who I would trust any day. He is an incredible, skilled surgeon.

Everything went well and smooth with the surgery, I was released the next day.

 

July 2020 - Not so fast..

Well, we decided to do a blood test a week after Crusoe's surgery, just to make sure everything was still all good.

But it wasn't.

My liver enzymes (my ALT and ALP) had jumped up to 4x normal. This was not normal.

ALT is an enzyme that gets released during cellular death of the liver. There is a normal range for this value. ALP is an enzyme that gets released when bile flow from the liver is not flowing smoothly. So these were both concerning to see.

As you can see in the chart, generally under a value of 200 for ALT/ALP is normal. Mine climbed immediately to moderately elevated, bounced around a lot (which emotionally was tough for my humans because they would think it MIGHT be improving, but then BANG, back up it goes), and finally jumping to severe levels.

Again, all this time, I was perfectly normal and asymptomatic. Which was a good but challenging part of all this - for if I was sick or suffering, it would have made it easier for Mum and Dad to pursue something more actionable...

You'll also notice my CPLi level (which is a pancreas measure) also started increasing. By the numbers, it could be said I had pancreatitis as well now.

Ugh.

July to December 2020 - What's happening!?

As you can imagine, this was all very disheartening and very hard on my parents... All they wanted in the world was for me to get better.

And not that Mum was any less troubled over all this, it was ESPECIALLY hard for Dad. His day-in-day-job revolves around me - taking photos of me, editing videos, etc. So, everything he did in every minute of the day was just reminding him about me and what I was going on...

 

So, we once again enlisted the guidance of Cornell for their experience in liver issues. Their primary suspicions included:

• An infection that had ascended from my gallbladder contents up to my liver and was causing a liver infection. (Sometimes during the surgery, as the gallbladder is handled, it can push infected material back up the bile duct into the liver. And we did know for a fact my gallbladder had bacteria in it from a biopsy taken from it after it was removed).
• Copper accumulation in the liver was another possibility, but is quite rare in dachshunds, so wasn't too high up there. But sometimes when the liver gets damaged (like during surgery), it released copper (a metal that we all need, but some dogs have a condition where the liver accumulates too much copper which harms nearby cells, which then release more copper, causing a negative feedback loop).
• Other possibility was that I had sediment still left in my bile duct (as the Guelph surgeon had not flushed out the duct at time of surgery as there was no indication at the time that there was any obstruction).

Trying treatments:

So, although Mum and Dad are minimalists (but still believers) when it comes to medications and such, with infection being the primary suspicion, I started a pretty hardcore regiment of antibiotics as early as July.

I stayed on those heavy antibiotics for 8. whole. months.

And it didn't change anything. But Cornell suggested I keep the course, as it was possible the bacteria was resistant, or putting up quite a fight.

As you can imagine, all this was very confusing and difficult to grasp as we all felt so helpless...

January 2021 - Back to Cornell

If you look at the chart back above, you'll see my enzymes jumped dramatically even higher at end of December. So, during peak COVID, we made the complicated trip over the border into New York to visit Cornell University once again.

It was not the type of happy trip we like to take...

 

I went in to have some more evaluations by Dr. Center and the specialists there. They ultimately suggested I go back into surgery to take biopsies of my liver (to identify the type of bacteria if this was an infection), and to flush out my bile duct, as they suspected there might be some sort of partial obstruction going on.

So, Mum and Dad, in the matter of 4 hours, had to decide whether to put me in this surgery or not. It would be a riskier surgery than the first one, for my bile duct is only a few millimeters wide, and they would have to open it up and flush saline through it. They would also have to open a hole into my intestines to reverse-flush as well. Then you have to hope all these holes heal well and don't cause further issue.

So, not a pleasant decision to have to make. In fact, Mum and Dad were sooo close to opting to just wait and see a bit more.

 

But, with my liver enzymes so high, they knew it would only be a matter of time before they caught up with me and started affecting me (symptom/sickness wise).

January 15, 2021 - Second Surgery

So I had a second surgery, which was the most painful day of Mum and Dad's life.

I was in surgery for over 4 hours. But finally it was over and I was out, and I was ok.

 

 

Biopsy & surgery results:

• Almost not surprisingly, the biopsy revealed no bacteria in my liver. So it was never an infection, and I took all those antibiotics for nothing.
• My bile duct was in fact, full of sandy material. Which was now all flushed out and clean.
• I did have some mild pancreatitis
• This one was a surprise, I did have a degree of IBD (inflammatory bowel disease).

To be honest, I wouldn't be surprised if the IBD developed BECAUSE of all my antibiotics I took, which could have killed off and thrown off the balance of my microbiome.

But, this is all the "trifecta" that occurs when there is something wrong with the flow of bile. Since the bile duct is the tube that connects the liver, pancreas, and intestines, when something affects the flow, all three of those organs can get upset, inflamed, and develop issues.

However, it's always easy to look back and say "we should or shouldn't have done that". Cornell is the best of the best on liver issues, and they had strong suspicion it was an infection, so of course I don't blame them for all the antibiotics they recommended.

I also don't blame the original surgeon who didn't flush my bile duct. It was his best judgement at the time, as my bile duct appeared perfect and he didn't want to risk pushing something into it by flushing/messing with it.

So, I spent another week in New York recovering and making sure I was all good before heading back home. I even had a little post-surgery pajama outfit to cover my healing wound/scar.

February 2021 and onward - Final results

We waited about a month to do my next blood test after the surgery, and were VERY eager to see if there would be a positive change.. no change.. or even worse change. We didn't know.

And well, it was better. Much better. In fact, better than we EVER could have hoped. And subsequent tests over the next few months saw my liver enzymes drop down further and further, and finally, miraculously - they were back to normal!!!!

 This was beyond incredible, because all the doctors had told us clearly that we should expect my liver enzymes may NEVER go back to normal.. And that obviously we hoped to lower them, but that we should be prepared that they may always be elevated.

So this was the absolute best result we ever could have hoped for.

I know my parents still to do this, are the most grateful they've ever been in their life for anything with these results. It's truly a dream come true.

I now continue to be a happy, playful pup, with healthy blood work!

Giving back

We could never thank Cornell enough for essentially saving my life. There is no doubt they've added years onto my life by resetting this whole terrible series of events..

So, after seeing these results, we launched The Crusoe Fund at Cornell University, and asked fans like you to donate on my behalf.

Incredibly, we raised a whopping $100,000.

 

This is now maybe the proudest element of my career. This will make an absolutely huge impact, as the funds go towards more clinical research and trials, equipment, and resources, to better help animals like your in the future (even if it's not at Cornell specifically, as their research is the leading developer of medicine and treatments for the entire veterinary industry on liver issues).

So, thank you to my fans, for your support and prayers throughout my journey, and now for the Crusoe Fund.

It's still mind-boggling how such a terrible, scary, long situation turned into such a positive outcome.

We couldn't be happier, and now Mum and Dad - not that they didn't before - but now especially, remind themselves every single day of how special I am and how much they love me.

As I have said from the beginning of my blog,

Keep ballin',