Liver biopsy

[dessertpigs]

Hi Everyone,

I'm posting to share my experience. Our nearly 5 year old rescue sow has recently had a liver biopsy.

8 months ago, Misu was admitted with squeeky wees, ultrasound found bladder sludge (which she's on regular cystease and lower calcium diet to manage). Incidentally, her bloods showed anaemia due to chronic disease and elevated liver enzymes. Her ultrasound didn't show any abnormalities of her liver- it looked smooth. We've repeat the bloods twice 6 months ago and this month, with the most recent bloods much worse. Since then she has been happy in herself- but has had a steady weight loss of around 70grams in the 8 months, and sleeps a lot (it's hard to say if she sleeps more than this time last year).

With the recent worsened bloods, our exotic vet advised for a endoscopic liver biopsy under general anaesthetic (cost with rounding to £550). There was no guarantee that the liver biopsy would provide any new information- as the liver may look normal, and any samples taken may not be representative of the underlying problem- but it may show something that could slow progress of the disease, or reverse it. As Misu is relatively well in herself, has a good quality of life and has previously recovered well from anaesthetics, we thought the risks were worth the benefits in her case.

During the endoscopy, there was something to see on Misu's liver- a section was grey and gnarly. Overall the rest of the liver was a normal colour, a little larger than usual and in some places bumpy. The grey part of the liver was immediately behind her stomach. As stomach's are full of air, so don't conduct the sonic waves, this is unlikely to have been seen on a repeat ultrasound.
There were gnarly liver samples have been sent for histology and cultures, which we are waiting on the results for- which I'll share on this post.

Misu was stable throughout her op. She ate after the anaesthetic, but was a bit drowsy that evening. She had very clicky breathing, which resolved over the next 24 hours. She is on a good dose of metacam until her results are back. We gave her some supplemental feeding for the first 2 days, but she quickly communicated it wasn't needed. Her daily weights are stable, and she's back to her usual sassy self, zooming about at veg time. If anything, her neutered boar-friend acted more distressed by the journey than her- he really hates being in a car.

We don't know what her results will show- but we are glad that we are arranged these tests before she is more unwell in herself as she has had a quick recovery following the anaethetic. We're fortunate to have an experienced exotics team guiding her care.
I know in humans grey livers are usually cirhottic- so not reservable liver damage- but there were sections of her liver a more normal colour. Regardless of whether we have a curative or palliative treatment or no treatment, we'll hopefully have better information to guide our piggies care. We'll wait, see and later update.

I'd like to thank the forum admins- we wouldn't be with our current vets, or have weighed Misu this regularly without the work you put into your guides. Thank you!

 

[Wiebke]

Hi Everyone,

I'm posting to share my experience. Our nearly 5 year old rescue sow has recently had a liver biopsy.

8 months ago, Misu was admitted with squeeky wees, ultrasound found bladder sludge (which she's on regular cystease and lower calcium diet to manage). Incidentally, her bloods showed anaemia due to chronic disease and elevated liver enzymes. Her ultrasound didn't show any abnormalities of her liver- it looked smooth. We've repeat the bloods twice 6 months ago and this month, with the most recent bloods much worse. Since then she has been happy in herself- but has had a steady weight loss of around 70grams in the 8 months, and sleeps a lot (it's hard to say if she sleeps more than this time last year).

With the recent worsened bloods, our exotic vet advised for a endoscopic liver biopsy under general anaesthetic (cost with rounding to £550). There was no guarantee that the liver biopsy would provide any new information- as the liver may look normal, and any samples taken may not be representative of the underlying problem- but it may show something that could slow progress of the disease, or reverse it. As Misu is relatively well in herself, has a good quality of life and has previously recovered well from anaesthetics, we thought the risks were worth the benefits in her case.

During the endoscopy, there was something to see on Misu's liver- a section was grey and gnarly. Overall the rest of the liver was a normal colour, a little larger than usual and in some places bumpy. The grey part of the liver was immediately behind her stomach. As stomach's are full of air, so don't conduct the sonic waves, this is unlikely to have been seen on a repeat ultrasound.
There were gnarly liver samples have been sent for histology and cultures, which we are waiting on the results for- which I'll share on this post.

Misu was stable throughout her op. She ate after the anaesthetic, but was a bit drowsy that evening. She had very clicky breathing, which resolved over the next 24 hours. She is on a good dose of metacam until her results are back. We gave her some supplemental feeding for the first 2 days, but she quickly communicated it wasn't needed. Her daily weights are stable, and she's back to her usual sassy self, zooming about at veg time. If anything, her neutered boar-friend acted more distressed by the journey than her- he really hates being in a car.

We don't know what her results will show- but we are glad that we are arranged these tests before she is more unwell in herself as she has had a quick recovery following the anaethetic. We're fortunate to have an experienced exotics team guiding her care.
I know in humans grey livers are usually cirhottic- so not reservable liver damage- but there were sections of her liver a more normal colour. Regardless of whether we have a curative or palliative treatment or no treatment, we'll hopefully have better information to guide our piggies care. We'll wait, see and later update.

I'd like to thank the forum admins- we wouldn't be with our current vets, or have weighed Misu this regularly without the work you put into your guides. Thank you!

Thank you for sharing your experience. It is great to hear your feedback since guinea pig livers (like kidneys) are very much an area that is still just beyond the horizon in terms of veterinary operative and effective medications capabilities. We are getting there with diagnostics now.

My fingers are firmly crossed for Misu. We are here for any ongoing moral and practical home care support if wished.

 

[dessertpigs]

Thank you for sharing your experience. It is great to hear your feedback since guinea pig livers (like kidneys) are very much an area that is still hovering just beyond the horizon in terms of veterinary operative and effective medications capabilities.

My fingers are firmly crossed for Misu. We are here for any ongoing moral and practical home care support if wished.

Thank you!

 

[Wheekallweek]

Good luck Misu! Hope the results don't show anything sinister

 

[weepweeps]

Good luck Misu. I hope it’s something treatable.

 

[piggieminder]

Good luck to you and Misu. I hope you get some easily treated results.
Thank you so much for sharing your story.

 

[dessertpigs]

Misu's results came back this week.
Cultures were negative.
Histology showed widespread shrinkened liver cells and inflammed bile ducts. Along with the appearance the affected liver has likely had a severe insult at some point in the past, causing irreversible damage and liver fibrosis.

The results ruled out infection and cancer. Diagnosis is Idiopathic cholangiofibrosis, which is a new and poorly understood illness. Usually seen in adults piggies, tends to run in certain colonies. (Her original cage mate died about a 8 months ago following seizures, thought to be a central brain lesion- so died around 3 1/2 years old).

No curative treatment options- supportive things to try. We can try milk thistle plants or supplements. If we get to it, we can also try medications that are used to support the liver in cats and dogs, but our vet is not convinced that there work well in piggies- but some piggie guardians say this works.

We were considering adding in another sow or two to our group (Sometimes her cage mate seems he wants more interaction than she is willing to give)- as we don't fully understand the cause, it's hard to know if this is something that is still a risk to her current cage mate, so we've decided to stick to our pair for now.

Misu herself is currently doing well. She has put on some weight since her operation, and is a happy girlie pop-corning and zooming. We have a plan for follow-up with the vet, and will take her back if concerned. We'll be weighing her twice a week from now on.
For now she's doing well- and we'll get some milk thistle on stand by to try. We don't know how long she will live with this- we originally identified the abnormal liver results incidentally, as she went in for blood tests as part of a work up for urinary sludge/squeeky wees in October.

Overall we're glad that we've done the tests- but as there is little research into exotics, it's hard to have so many new questions without answers. For now, she's a happy girlie- and we'll keep spoiling her with plenty of fresh hay.

 

[Wiebke]

Misu's results came back this week.
Cultures were negative.
Histology showed widespread shrinkened liver cells and inflammed bile ducts. Along with the appearance the affected liver has likely had a severe insult at some point in the past, causing irreversible damage and liver fibrosis.

The results ruled out infection and cancer. Diagnosis is Idiopathic cholangiofibrosis, which is a new and poorly understood illness. Usually seen in adults piggies, tends to run in certain colonies. (Her original cage mate died about a 8 months ago following seizures, thought to be a central brain lesion- so died around 3 1/2 years old).

No curative treatment options- supportive things to try. We can try milk thistle plants or supplements. If we get to it, we can also try medications that are used to support the liver in cats and dogs, but our vet is not convinced that there work well in piggies- but some piggie guardians say this works.

We were considering adding in another sow or two to our group (Sometimes her cage mate seems he wants more interaction than she is willing to give)- as we don't fully understand the cause, it's hard to know if this is something that is still a risk to her current cage mate, so we've decided to stick to our pair for now.

Misu herself is currently doing well. She has put on some weight since her operation, and is a happy girlie pop-corning and zooming. We have a plan for follow-up with the vet, and will take her back if concerned. We'll be weighing her twice a week from now on.
For now she's doing well- and we'll get some milk thistle on stand by to try. We don't know how long she will live with this- we originally identified the abnormal liver results incidentally, as she went in for blood tests as part of a work up for urinary sludge/squeeky wees in October.

Overall we're glad that we've done the tests- but as there is little research into exotics, it's hard to have so many new questions without answers. For now, she's a happy girlie- and we'll keep spoiling her with plenty of fresh hay.

HUGS
Thank you for the feedback; that is indeed way out of our normal scope. I hope that Misu will still have a good while with you since the problem was spotted early before it was causing major symptoms. Liver symptoms are generally rather vague and are not easy to pick up anyway. And there seems to be no medication for liver issues in ginea pigs.

Concentrate on her quality of life and enrichment (which is a lot more than just toys, treats and cuddles) to make the very best of the remaining time and create lots of precious memories of you sharing it with Misu.
Enrichment Ideas for Guinea Pigs

If you feel that it helps you, start a memory folder with a daily picture of what you have been up to together on the day. Love transcends time; it is never about the length but about the quality of a life and what you have made of it. You can pack a lifetime of love into a surprisingly short time.
Take a leaf from your piggies and live in the now with Misu. See every morning she is there to greet you as a special blessing. I always turn the life clock back to zero when a piggy of mine gets the bad news and see every day more as a precious gift; whether that is just a few days, weeks, months or even a year or several after a very narrow escape. This means that I won't be left with feelings of guilt or failure whenever they leave because I know that I have done my best for and with them.

 

[piggieminder]

Thank you so much for the interesting update.
It sounds like you have found a really good vet. Which vet are you using? I have been thinking of going to a different one with my piggies as I am having growing concerns over the place we have been using. Sadly most of Bristol's vets seem to have been taken over by the same company.
I wish you and Misu well and hope she does well in the future.

 

[dessertpigs]

Thank you, Wiebke for your kind words and advice. We'll try some of the other enrichment ideas. Today we celebrated her possible 5th birthday, and her 1 1/2 years of sharing our home. She's had some free roam time with lots of tunnels and a veg search in a room she doesn't visit often.

piggieminder- we go to Highcroft vets in Whitchurch, Wells Road- which is on the recommended vets page. They are a training practice, so sometimes we see exotic interns. For any of the complex procedures or discussion of results it's been with the permanent exotic team. They have updated their website recently- so perhaps it's also been taken over by a main company. Also an advantage that they have the hospital at that branch- disadvantage they seem pricey (but we're able and happy to pay that).

 

[piggieminder]

Thank you @dessertpigs . I have been going there for 10+ years, they have been very good but with the interns the experience is not as good as it was. The intern thing has only been happening for a few years, some of them have been brilliant but some obviously don't like guinea pigs. I prefer to see a vet I know and trust and can build a relationship with. I have 6 piggies, 2 of them elderly so I am there a lot and have started to dread going because I don't know who we are going to see.

 

[Wiebke]

Thank you, Wiebke for your kind words and advice. We'll try some of the other enrichment ideas. Today we celebrated her possible 5th birthday, and her 1 1/2 years of sharing our home. She's had some free roam time with lots of tunnels and a veg search in a room she doesn't visit often.

piggieminder- we go to Highcroft vets in Whitchurch, Wells Road- which is on the recommended vets page. They are a training practice, so sometimes we see exotic interns. For any of the complex procedures or discussion of results it's been with the permanent exotic team. They have updated their website recently- so perhaps it's also been taken over by a main company. Also an advantage that they have the hospital at that branch- disadvantage they seem pricey (but we're able and happy to pay that).

Wheeky wheekday to you, Misu!

Take pride in having given her a good normal life span and filled it with happiness. The rest you cannot choose or control. Just enjoy every day she has got with you as a bonus from now on.

 

[dessertpigs]

I'm adding an update to this post.

Misu has mostly been doing well. She is a very gorgeous girlie and loves food and free roam times.

3 weeks ago we woke up to a puffed up piggie, who recovered and was the easiest happiest going girl for her appointment in the afternoon. The exotic team did give us 2 weeks worth of metacam, with the plan of giving a dose if puffed up next time- then take to the vet if no improvement. If she needs metacam regularly, and this is not enough, we can consider amitriptyline.

This weekend, she has needed 3 doses, 1 last evening, and 1 this morning. She is eating and drinking, and interacting- but puffed up (not completely round, no squinty eyes or hunching) when lying down or resting. I've called our vets and we have an appointment Tuesday, and will call back for urgent appointment if her pain worsens or is more consistent.

I think we're heading into palliative care territory, either regular analgesia or making hard decisions in her best interest. We're not there yet, but our time left together feels shorter.

Photo of our gorgeous girl as a croissant, sleeping with eyes nearly closed.

 

[Wiebke]

I'm adding an update to this post.

Misu has mostly been doing well. She is a very gorgeous girlie and loves food and free roam times.

3 weeks ago we woke up to a puffed up piggie, who recovered and was the easiest happiest going girl for her appointment in the afternoon. The exotic team did give us 2 weeks worth of metacam, with the plan of giving a dose if puffed up next time- then take to the vet if no improvement. If she needs metacam regularly, and this is not enough, we can consider amitriptyline.

This weekend, she has needed 3 doses, 1 last evening, and 1 this morning. She is eating and drinking, and interacting- but puffed up (not completely round, no squinty eyes or hunching) when lying down or resting. I've called our vets and we have an appointment Tuesday, and will call back for urgent appointment if her pain worsens or is more consistent.

I think we're heading into palliative care territory, either regular analgesia or making hard decisions in her best interest. We're not there yet, but our time left together feels shorter.

Photo of our gorgeous girl as a croissant, sleeping with eyes nearly closed.

BIG HUGS

I am very sorry. Bank holidays are always worse for emergencies.

You may find these links here helpful. They are as complete, practical and how-to precise as we have been able to make them. I sincerely hope that you won't need them but they are there for your support, included during our own downtime.

This is our one-stop emergency and crisis care collection:

Thread 'Emergency and Crisis Care as well as Bridging Care until a Vet Appointment'

Mar 14, 2019

1 Statement
2 Emergency assessment and accessing vets
- How urgent is my guinea pig's problem?
- Finding an emergency vet
- Seeing a vet not familiar with guinea pigs (including lists of safe and dangerous medications)
3 First Aid care and easily available products
- General 'always have at home' stuff and comfort measures for very ill guinea pigs
- Improvising support feed; recovery formulas...

• Wiebke
• Replies: 4
• Forum: Emergency Information and Care

• 

This the guide I am never happy to link in but it will talk you through it all step by step if the worst comes to pass. I have tried to make it as practical as I could, knowing that the devil is always in the gritty details that tend to get skimmed or glossed over:

Thread 'A Practical and Sensitive Guide to Dying, Terminal Illness and Euthanasia in Guinea Pigs'

Feb 20, 2020

1 Your mental health, sensitivities and work commitments
- Mental health and support resources
- Sensitivity aspects
- When work and other commitments clash
2 Life or death emergency – Can my piggy be saved?
- Contacting a vet clinic at all times and link to life and death emergencies list
- What to do if I cannot access vet care instantly?
- The need to save up for emergency vet access
3 Is my...

• Wiebke
• Replies: 6
• Forum: End of Life and Bereavement Support Corner

• 

My thoughts are with you and Misu (who is clearly getting plenty of moral support from her bestie as well!

 

[dessertpigs]

Thank you. I've been reading through the guides- but don't think she needs taking to the vet at this stage.
She will go from lying down, perhaps looking uncomfortable to coming up to me begging for my lunch/cucumber, to exploring happily, then back to sleeping comfortably, then later looking uncomfortable.

My husband is away this weekend, and I'm feeling run down with cold. Our fridge/freezer broke down this week- I got a mini fridge for veggies, but struggling without tea 1st thing in the morning.
It's hard to know if she's worse, or if I'm noticing more than my husband who WFH most of the week. For now, she seems OK- but will go to the vet if she needs more pain relief, assessment or considering saying goodbye.

 

[Wiebke]

Thank you. I've been reading through the guides- but don't think she needs taking to the vet at this stage.
She will go from lying down, perhaps looking uncomfortable to coming up to me begging for my lunch/cucumber, to exploring happily, then back to sleeping comfortably, then later looking uncomfortable.

My husband is away this weekend, and I'm feeling run down with cold. Our fridge/freezer broke down this week- I got a mini fridge for veggies, but struggling without tea 1st thing in the morning.
It's hard to know if she's worse, or if I'm noticing more than my husband who WFH most of the week. For now, she seems OK- but will go to the vet if she needs more pain relief, assessment or considering saying goodbye.

HUGS
I am very sorry that it is one of these times when it all happens at once and you are feeling very low and stressed out.

I sincerely hope that Misu has some more days with a decent quality of life with you. It gets more difficult the closer you come, and all the little ups and downs get bigger.

Knowing what to do (where to access it easily) can help to mitigate the stress and the helplessness. The end, whenever it comes will always be shock - no matter how much you brace for it - and it will always come too soon.

In view of it being a long bank holiday weekend I wanted to make sure that you are covered.

Please look after yourself as much as your piggies.

 

[dessertpigs]

I forgot to say thank you, Wiebke for your last post. Your kind supportive words are always appreciated.

Misu has been happily munching on grass with her bestie. Then doing spins and paws at veg time- but husband saw her looking uncomfortable at rest, so understood why she needed the metacam.

 

[weepweeps]

Sending Misu and you hugs.

I had a terminal piggy recently and I knew I wouldn’t syringe feed him. I gave him pain meds to keep him comfortable. As long as he was coming out for veggies and seemed happy then that was good enough quality of life.

I think you will find she will go from being ok to suddenly not being ok. I didn’t even have time to get him to the vets. He chose to pass peacefully and home with me by his side.

 

[dessertpigs]

It's been a few months since I've updated about our sassy lady. She is doing well.

She had a vet appointment end of November, and was an utter flirt with the vets, very engaging. We haven't needed to give any pain relief since those blips in August, but she has lost some weight since her last appointment. She's not needed any repeat bloods, as she is otherwise doing well, apart from one slightly reddened back paw (which didn't need any intervention or pain relief).

It seems this is a steady illness for weight loss, but in terms of symptoms/pain comes in unpredicable waves- and currently we are in a good spot.

Ultimately, we did decide to add another sow to our group, who has provided both of our piggies with much needed interaction. Our original conversation with the vet wasn't an absolute no to adding to our pair, but reporting that some of the cases have found the illnesses present in colonies. Her original cage mate died of a separate illness and had normal liver function. There really isn't much literature on the illness, with some theories that it is caused by a toxin exposure. As Misu and her original cage mate came to us from a rescue at 3.5 years we do not know her previous background.

It was a hard call to make, and only time will tell if we made the right call to add to our pair when we did. In the meantime all three of our piggies are happy together. We were very worried about what Parkin's reaction would be at the loss of Misu, and it is a great comfort to know that when she does go, he will have his new friend by his side. Misu has benefitted from a new eating buddy, and is more engaged at dinner time. New piggie is chief wheeker, and Misu loves to add to the chorus, as she did with her original cage mate, Gato.

Misu has recently celebrated her 2 year gotcha day. We are very lucky to have her in our life and will continue to celebrate her curious looks and sassy teeth chatters for as long as she is with us.

 

[piggieminder]

Thank you for the update. I am so pleased to hear Misu is doing so well.

 

[fluffysal]

Thank you so much for the update.

 

[dessertpigs]

Another Misu, update.

She is doing well, but now on regular long term meloxicam, rather than as required.

She was due some annual bloods and check up in May, but she went at the end of April, as we had started to give regular metacam, and even then at times she looked a bit puffed up and more lethargic.

She met a lovely new member of the exotics team, who said her abdomen was tender, but this could be due to numerous things (her liver condition, ovarian cysts or bladder irritation- she previously had sludge). Her bloods were repeated and came back with relatively stable liver, but high White Blood Cells. She also had sludge in her wee, so we have restarted her cystease.

We were given options to 1) trial antibiotic course and repeat bloods 2) CT scan to look for any structural change 3) Repeat liver biopsy.
The vets had brought down the price of the CT scans, but we thought it would be in her best interest to trial the antibiotics.

After a couple of weeks, she no longer is puffed up in pain. Her repeat bloods showed a mild improvement in her liver function, and an improvement in her WBC (but not back to normal). We were offered to give her more time, repeat antibiotics, or the other investigation options.

For now, we are seeing how she does without antibiotics, as she has been much happier, no pain and no longer dropping weight. If we are concerned, we'll get back in touch with vets for potential more antibiotics or a CT scan.

She also now has 3 friends. She seems much happier munching and blooping about in her herd, and her feet don't look as red and inflamed compared with 6 months ago.

Loving life despite a craggy liver:

 

[weepweeps]

I’m glad Misu is doing better. You are giving her a wonderful life.

 

[Wiebke]

Thank you for your update. So great that she is doing better. What a lovely girl and how lucky she is to have found such a caring and determined owner.