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.