Wednesday, December 31, 2008

Love Her Or Liver

Ah, yes, liver. Some people love it, some people hate it. Some have never tried it. Myself, I love the liver. I don't especially like it cooked for dinner, but a nice liverwurst (on dark rye with a thick slice of crisp Bermuda onion and some mustard) can be a real treat. Moreover, this is my ace in the hole for medicating tough-to-pill dogs. It doesn't work for EVERY dog, but I'd say a good 98% would go for it. Liverwurst has a strong aroma (which helps disguise the smell of medication) and the flavor is enticing enough that most dogs don't care WHAT you put in there, they'll eat it. You could butter a scorpion with liverwurst and most dogs would eat it. Handily, liverwurst is easily shaped into a little meatball around a pill, too, so dosing is typically quite easy. I advise using the less-expensive kind, however; the gourmet version is stickier, and the meatball can be hard to get off your finger. It's like trying to throw peanut butter.

One important note: You should use only the amount of liverwurst necessary to get the pill into the dog.

I hit on the liverwurst idea several years ago, when I had a dog who needed long-term pain management. She took only a week to go through most of my pilling tricks: bread, cheese, canned dog food, hot dogs - all of those she learned to peel off the pill, eating the treat and spitting the pill cheerfully at my feet. She was difficult to pill otherwise - an American bulldog, she had a tongue that was capable of swelling at an instant's notice to a size that would fill a small cooler, let alone the back of her throat. Let me tell you, trying to get a pill past the muscular hump of her tongue whilst wrestling the rest of her muscular body was not a job for wimps. I'd have done it though, three times a day, except for the fact that it was an exercise in futility. Being an American bulldog, she was never offended by the pill wrestling; she appeared to consider it a good game. A good game which, at its conclusion, would wind up with me all hot and sweaty and covered in dog spit, her panting happily with a big goofy grin on her face, and the pill in a wad of unusable mush somewhere in the room (perhaps smeared across my thigh, perhaps mashed into the carpet, perhaps festooned along the wall in artistic loops and swirls.)

One day in desperation I tried liverwurst. For the next six months, three times a day, she never spit a pill. Not one. I believe in the power of liverwurst.

Mind you, pilling is not the ONLY power of liverwurst. One day while I took the pills to the bulldog, one of the Border collies counter-surfed the remaining package of liverwurst from the worktop. I returned to the kitchen in time to see him eating the yellow paper wrapper that had, only moments before, contained perhaps a quarter pound of liverwurst.

Oh, well. I resigned myself to a night of interrupted sleep, since I was sure I would have diarrhea (and lots of it) to deal with that night. As it turns out I was half right: no diarrhea, but Finn developed a horrific, cornea-melting gas that lasted for three days. It was powerful enough to wake me from a sound sleep (GAH! What is that SMELL?!?) It was powerful enough to imbue itself into any surface Finn laid or sat upon. It was powerful enough to sear the lining off your mucous membranes. I didn't dare wear my contact lenses. I think it was a close cousin to some of the lethal gasses released on WWI battlefields. I've never seen the recipes for any of those, but I wouldn't be surprised if they started with "First, find a dog. Next, feed it a pound of liverwurst..."

Poor Finn. He was sure I didn't love him any more, because I would not let him sleep on the bed, and any time he came near me - and at random intervals during the night - I would suddenly seize him and spray his behind liberally with grooming spray. (Hint: DO NOT use a food-scented spray such as pina colada. This will make you gag and put you off of pina coladas forever. Stick with baby powder scent or something similar.)

Apart from its culinary properties, the liver is an amazing piece of work. It processes our food, it stores fuel, it metabolizes medications, it manages our blood sugar (in concert with the pancreas); it makes bile and clotting factors and proteins, filters out bacteria from the blood, detoxifies poisons, conjugates and excretes all manner of things. Without it we would die miserably. Fortunately for us and our alcohol-swilling ways (amongst other behaviors), the liver has an enormous reserve capacity. You could go in there today with a tiny little hammer and whack 70% of your liver cells on the head and kill them - and so long as you left the support structures of the liver intact, it would repair itself. Alternatively, you could have a surgeon divide your liver in half and give half to a worthy liverless recipient, and (given a little support) each half of the liver would grow back, so that in the end you'd have two functioning livers, one in each person.

An amazing organ, the liver. Little wonder that when things aren't going well for the liver, things aren't going well for any other part of an animal.

Mind you, when things go badly for the liver, sometimes it's not the liver's fault, really. Sometimes it's that pesky gall bladder that's responsible.

The gall bladder's job - and here I know you'll be surprised - is to store gall (otherwise known as bile). It doesn't just store it, though; it is supposed to contract when we eat so that bile flows into the duodenum, where it will start to emulsify and break down our food (which, if the stomach has done its job, will by then be an indistinguishable mush of everything we ingested a while earlier). Once the food items are sufficiently tiny, they can pass through the lining of the gut and into the bloodstream, where they will be taken by the portal circulation to the liver, at which time the liver will perform its complex magic.

However, if your liver and your gall bladder do not get along, there will be trouble. If bile is backing up, for instance, because the gall bladder isn't sending it into the gut, the liver will end up being bathed in bile - which, after all, is intended to break down things like food, things like, oh, I don't know - the liver. If the gall bladder is infected, or has a stone or a tumor, your liver will be sad.... and so will you. Sometimes we can, by means of a combination of meds, fix this problem. Sometimes we end up at surgery. Sometimes, most unhappily, we lose. Even the mighty liver can become so damaged that it cannot rally in time, or develop cirrhosis, or have a tumor. But mostly, bless it, it gives us a fighting chance to win.

It's been a week for liver problems at the clinic. One of my nurses has just had her gall bladder out. Not three days later one of my liver patients - who had responded well to meds - came back for a routine recheck, only to have high liver enzymes again. Drat. Out comes the ultrasound, and - well, lookie here: a gigantic gallstone. Maybe you'd like to see the surgeons for that?

You know I'm going to have a third one, don't you?




In this case it's Pepper, my nearly-thirteen-year-old step-dog. She doesn't LOOK sick, does she? Pepper has had a prior bout with hepatitis, about a year ago. She really wasn't showing a lot of signs; she didn't vomit or act ill, but she ate only half her meal one night and refused it the next morning. This is a dog that never refuses food. In her, skipping one and a half meals is cause for concern. So, I emailed my boyfriend in Asia (where he was flying at the time) and asked for permission to do some workup. He green-lighted me, naturally, so I started hunting around and came up with some iffy liver enzymes and a few other things. Nothing very far off normal, but I put her on meds. A month later she was perky and lively and bossing around all the other dogs, just like usual.

All her follow-ups have been normal, and she's been well. But last night she refused dinner, and this morning she refused breakfast. And guess who's in Asia again? Sigh. Well, that's one of the perks of dating a vet; we notice these things and go after them. So, in we went (on my day off) and did some bloods. Hm. Liver numbers are off again, less so than last time, but off. While we're at it, let's just have a peek at that gall bladder. Which means laying Pepper on her back in a padded trough and shaving her abdomen for a little ultrasound action. None of these ideas is really okay by Pepper, but with the assistance of J and E and some soft talk, we prevail.

Hmm. Gall bladder doesn't look too bad, but those bile canals aren't looking quite right. Plus there are patchy areas where the liver looks swollen. Time for meds, prescription food, nursing care. Especially nursing care, which means cossetting and snuggling and keeping her toasty warm, dosing her food with active-culture yogurts for the probiotics (and the taste, no doubt), and of course letting HER sleep with my down comforter.


And of course, the meds. Guess I'd better go get some liverwurst.

15 comments:

Karl Katzke said...

AKDD, I absolutely love your writing. I don't know how you manage to tell so many great stories in a week.

FWIW, buttering my Ridgie's pills with peanut butter always makes them go down smoothly. I did notice that for people who don't like messing with liverwurst or other gooey things, Greenies has recently come out with "pill pockets" ... I've seen them sold at some vets.

AKDD said...

Cute photo, Karl! Ever go lure coursing with your Ridgie? It's fun.

Glad you're enjoying the blog. I think I have all those great stories (and thanks for saying that!) for two reasons: One, vet med is FULL of stories. Tons of them, and I've been in this field for nearly 20 years, if you include school. That's a lot of stories. And two, I've been around animals all my life, and I'm not brand new myself! :D

I did forget to mention peanut butter - and cream cheese (especially the salmon flavor). The pill pockets work well for some dogs (and even cats); other animals won't go for it. I guess that's part of what keeps my job interesting - they're all individuals!

Holly said...

Awww, that is an adorable photo of Pepper, what a sweetheart and what a lucky girl she is. Give her a scritch for me.

The liverwurst overdose was hysterical......especially since it was not me!

MaskedMan said...

Mmmmm... Liver...

Liverwurst is great, just the way you describe it. I know my wife loves me, because she sometimes even kisses me after such a feast.
;-)

Why is it, that I fear the papaya-scented grooming spray bit was the voice of painful experience..?

Suka, fortunately, is easy to pill. Any attempt to disguise the pill, even a poor one, is sufficient for her to take the pill. I think she's mostly interested in the formalities being observed. She's big on formalities (won't eat until told, has a specific routine for going out on walks, and so on); I fancy it as some kind of mental checklist: "Hmmm. Pill - Check. Pill covered in some disguise - Check. Yup - We're 'go' for pill swallowing."

Pepper looks completely at home snuggled up in your comforter. Plus, nothing like a warm furry body to keep the bed at a nice comfortable temperature fo you.

Dragon43 said...

You should get snowed in more. It seems to cause you to write more. So I get more great stuff to read.
:: It is all about me !!! ::; ;)

I do loves me goose liver. I can't spell that other 'L' word. Anywho, we will try it on Squeaker, the kitty that makes your bulldog look like an easy job. Ever see a cat turn completely around inside her skin, feet, claws and all and squirm out of a hole the size of a quarter? Squeaker can do it if she even thinks you have a pill.

Great stories this time again. Also looking forward to Masked Man's race coverage this year. I am on the race mailing list and get their emails all year. they do not do half as interesting job as Masked Man does. I think there is a genetic writing thing going on in your family....

I also love to eat goose liver and about 2-3 times a year I conveniently forget that is gives me a nasty case of gout. Just getting over one at this time. :: sigh ::: Yea!!! for cranberries and dark cherries. Epsom salts & lettuce.

Have a great new year and be well and warm....
Gus aka 3½¢ aka Dragon43

Jean said...

I really enjoy your blog, with its combination of humor and informative narration. I've been lurking for a while, and find myself checking it almost daily now.
My pill-taking senior dogs do like the liverwurst solution best, but I also find chicken or beef baby food is a very close second. It's a bit more difficult to "wrap" around the pill, but it slides down even easier than liverwurst. My "I'm not gonna swallow THAT!" senior sheltie can still manipulate the pill out of the liverwurst, but has yet to figure out how to spit out the pill without spitting out the high-value babyfood too! So down the hatch it goes.

AKDD said...

MM - why, YES, the fruit-scented grooming spray caveat DID come from personal experience, whyever do you ask? [gags in memory of the combo scent] :D

Dragon - thanks, and I'm glad my shivering is of service to you! :D (Hey, at least some good is coming of it!) Let me know if the liverwurst thing works on your kitty.... they are notoriously difficult to pill. Sigh.

Jean, glad you're enjoying the blog! The babyfood thing is another oldie but goody, although Pepper will spit the pill out of that so fast it'll ricochet. She's a sucker for canned food and cottage cheese, though!

Karl Katzke said...

AKDD, believe it or not, I moved to TAMU (hence the 12th Puppy cap!) to date a vet student. (That's long past, but I got interested in vet med while helping her study, and have maintained it as a hobby in various ways ... like reading your blog!)

We've tried lure coursing, but she's unfortunately "too smart" ... or too lazy. Sometimes they're the same. After she got the principle, she just intercepts the lure at some point and takes the treat. Same deal with the laser pointer. My male hound mutt thinks the pointer is fun, my primadonna Ridgie looked at the red dot, looked at the red thing in my hand, saw them move at the same time, and walked away with her nose in the air. She could have so much fun if she was just a little bit dumber...

It's not just that you've been in the field a long time, but that you also feel a deep connection with your career and the world around you because of it. This comes out so strongly in your writing that when a new post shows up in my feed reader, I usually save it for bedtime -- the stories are invariably comforting and so imbued with the cycle of life that they bring a profound peace to anyone who reads them. That -- that's an impressive level of art.

Unfortunately, my hobbyist-level vet med knowledge ... and my pocketbook ... has gotten quite a workout since I rescued my two. The Ridgie, Eo, has bilateral hip dysplasia (and just had her two FHO operations this year -- at 2 y.o.) and Henry has extreme anxiety. I tell stories and blog over at http://dogs.katzke.net if you're interested in two "interesting" cases.

AKDD said...

Karl - thank you, most sincerely, for your kind remarks about my writing. I'm quite touched. I think you just made my day... frigid as it is here today, I feel all warm and peaceful now.

Sometimes having smart dogs sucks, doesn't it? :D I have an acquaintance who once pointed out, very astutely, that most people DON'T want a smart dog - they just THINK they want a smart dog, until they actually have one and learn The Error Of Their Ways. But for some people, smart is the only way to go. They may aggravate the crap out of you, but at least you're never bored!

On my way over to have a look at your site... your way of speaking of your dogs is quite engaging.

Laurie said...

Dragon43: I feel your pain with pilling your cat. Our vet recently said "wow, your cat REALLY doesn't like pills, does he?"

Errrm, no.

We recently stumbled on the pill pockets at a local pet store. They work like a charm on our cat. They goooosh up nicely around the pill and they must taste good for the feline set.

Barb said...

Here's to Pepper's recovery! I hope she's much better by now.

The liverwurst gas story was hysterical! Of course, these things are only funny either 1. in retrospect, or 2. when they happen to someone ELSE'S dog.

BTW, chicken hearts make WONDERFUL natural pill pockets. Either raw or cooked, if the dog likes them the little chamber is a perfect fit for a capsule.

AKDD said...

Oooh! Good tips on the pill pockets for kitties and the chicken heart thing. I can't think why I never thought of that... I used to pill a binturong that way at the zoo, except that it was a whole (thawed) duckling and we'd put the pills in the duckling's mouth and then toss it in there. The binturong looooved his duckling in the morning. Good thing, too, beucase have you ever seen one up close? I would NOT want to try to medicate it another way!

It is true that the Great Liverwurst Capers of 2003 are MUCH funnier now that I've finally gotten the smell out of my carpet. (Just kidding. It only too a week or so. It only SEEMED like forever!) :D

starting over said...

I have been lurking for a while, throughly enjoying your writting.

I laughed at the gas attack. My French Bulldog chose that exact moment to walk beneath the table and let out a silent but deadly. So I got smell-o vision. And to make it worse, where I am it is about -40, so no windows to open!

AKDD said...

Ahhh, bulldog gas. A significat weapon in the arsenal-o-stench. However, I do love the Frenchies. Charming little creatures, and anything that looks like a bat is okay by me.

Where are you that you're 40 below zero? I had a mere 25 below last night, so I guess I'm going to have to stop whining....!

Tammy said...

I am reading through your archives, so am late to comment, but wanted to add my version of pilling. :-)

My almost 13 year aussie cross is now on Tramadol for spinal stenosis (as well as Metacam) and is very aware of my trying to slip things past her. So, I have to give her an uncontaminated yummy bite that she chews thoroughly. No longer suspicious, she will gulp the second bite. FTW. Another thing that works well for me is Velveeta...and is perhaps a bit less messy than liverwurst.

And, I agree, nothing beats liverwurst with onion and mustard, though I prefer a soft, fresh sheepherder's bread. :-)