The decision not to get a liver biopsy for Emma the basset hound

May 16th, 2012 - 6:06 pm KY Time

Howllo Fellow Basset Hound and Liver Lovers.  The title of this blog is a bit odd but I wanted others with similar questions to maybe find this posting on the internet.

Emma is doing good today and is on a course of steroids and liver antibiotics.  We know this is not a cure but we will see if it helps her eat and stay happy.

This post is long but I want to make sure I keep all of this together so I can remember what we did for Emma.

I made a decision a long time ago that I was not going to go the route that I went with Chloe and Lily at the ends of their lives with any other future hounds.  I made long shot bad decisions at a time of panic and not much thought.  I didn’t ask enough questions.  I didn’t do enough research.  I rushed along with the surgeons placing my babies in their hands.  From my experience the procedure or surgery is always pushed over the sometimes more obvious choice.

For both of my hounds (Chloe and Lily) it was surgery to biopsy this or remove that.  My decision was made in a panic situation and the vets were more than willing to rush into complicated and what I eventually found out, unnecessary procedures.  Both Chloe and Lily died on the surgical table.  The what ifs still swirl in my head but the lessons learned were invaluable. Do not be pressured into surgery.  Take a deep breath and figure out what is right for your hound and your family.  In most cases there is time to think things over.

So, when we took Emma in for her non invasive liver ultrasound we knew that we were not going to have any invasive procedures.  I just wanted to see what the condition of her liver looked like and see what the alternatives were to us.  I knew the first and fastest option suggested by the vet would be surgery or a biopsy.  Bingo! Enter the stern surgeon with the grave look on her face as she pontificates, all while looking down, and never at Emma…..

“she will need a liver biopsy before we can suggest any treatment. Her liver is lumpy and large.”

My Mom and I sat looking on, the doctor still looking down never touching Emma.

I asked,

“May I see the ultrasound images?” (knowing full well I was not going to get a liver biopsy).

The stern surgeon looked at me with disgust as if to imply with her manner, what the hell do you know about ultrasound images and what the hell are you questioning me for as she shuffled through the black and white grainy images that cost more than a life time supply of Milk Thistle.

I looked at the images and had no clue what they were. I paid for them and I wanted to see them.   The images of our Emma’s large lumpy liver were right there, in front of me.  I touched them and knew in that instant this woman would never touch my girl again. The nerve of this woman.  Who does she think she is?

She turned her steely eyes to mine….

“I can get her in for the biopsy tomorrow morning”, she rattled off, I could almost hear the adding machine tally in her head.

Did I dare ask another question?  I girded my loins and went for it!

“Hum, doctor?  What are the potential out comes of a liver biopsy?”

Dr. Biopsy turned on her heel and said, “Cancer for one!, the dog will need radiation therapy”. I heard more adding machine clicks but not a total, not yet.

*cough*, and in my head, I am thinking, I wonder why she thinks I would even do that. She has asked me ZERO questions about Emma, not a one.  She seemed miffed we were even in the room.  Talk about your absent bedside manner.

The whole thing was surreal and I knew right then that this woman was a hack.  A total money grubber. A real jerk.  But I wanted to be sure.

I tried to ask one more question which was at this point directed at her back as she was walking out the door. I felt like grabbing the back of her shirt and yanking her back in the room.

“Dr., is there any medicinal therapy we could try first?”  My voice echoing down the long hall towards the surgery suites…..

All I could feel was the rush of the air as the door was slamming in my face as Dr. Biopsy clicked and clacked down the hall saying, without looking at me, “No!”. I looked at my Mom and I said,

“Did that really just happen?”

Well, even thought I had made up my mind from previous experiences this confirmed every thing for me.  No way was Emma ever going to get a biopsy.  Again, Grandma and I both knew that going in but we were hopeful that something could be suggested other than major surgery.  Yes, a liver biopsy is major surgery.  The complications are real and many.  Do you think that was ever discussed with me? Never.  Dr. Biopsy did not even ask about Emma or why she was blind. She has clearly had surgeries before.  Nothing was even asked about howl she did as a surgical patient.

Emma is severely allergic to surgical scrub!  Who cares, “what’s your credit card number?”  was the much more important question as the assistants came filing in. “No food or water after midnight” one gal methodically announced.  “How will you be paying?” the next question came with ease. “You can drop her off at 8:00am”.  Keep in mind, I never said I was getting Emma a liver biopsy.

Come on!  Is it getting this bad? I called my vet in dis-belief.  I told him I was not getting the liver biopsy.  He said, “So, when are you getting it?”

So, fast forward until last Friday.  I take Emma in for her blood tests to see if the disease has progressed and howl much. I am worried because she is not eating. I want some suggestions. Surprise, surprise,  I am still being pressured to get the biopsy.  I emphatically state that I am not getting the biopsy and what else can be done?  The answer is “I won’t judge you for not getting the biopsy, let’s wait and see what the blood test reveals.”  Huh? He won’t judge me?

The blood test is about the same and I again ask for something that might help her eat and decrease the inflammation in the liver.  I know it is not a magic bullet but is there anything?


He said he will call the other internist and I insist that he does not call Dr. Biopsy. Can’t stand that woman.

I wait 2 days, nothing.  I finally go off the deep end.  Emma’s vet calls back and he starts off, and I kid you not, “Well, without the biopsy we really can’t do much diagnosing…. are you sure you don’t want to get the biopsy?”

At this point steam is coming out of my ears….

He goes on….

“I talked to the other internist and he said, that he would suggest the biopsy for Emma and he can’t really advise otherwise without it….”

Are you even kidding me?

He goes on….

“The internist is not suggesting this but now that I know you are not going to get the biopsy”….

(translation, now that the internist knows I am not going to cough up a grand in addition to the 500 for the ultrasound…)

“Let’s try a course of steroids and Metronidazole.”

Turns out, this is the same treatment that would have been suggested after a liver biopsy for someone that does not want the hail Mary alternatives such as radiation, transfusions or whatever else they have to offer that will send a chill so deep up your credit card it will crack.

Nothing and I repeat NOTHING was going to change after the liver biopsy for Emma and I firmly believe they all knew that.

Emma is now on her second dose and even just ate a little bit of dog food.  She is no longer shivering and actually had a wonderful walk to the park. She had a good potty and her tinkle was not reddish.

photo 5

We know that this is not a cure but it might buy us some time and her some comfort. She is even starting back on her Milk Thistle.  I have found a few canine liver sources on the internet that I will share if they work out.

I remember being one of those crying folks, rushed into a health care decision and then making the wrong one.  I know this is the right decision for our family.  Everyone has to figure out what is right for them.  Ask all the questions you want and don’t let anyone slam the door in your face.  I had already made up my mind before we went in that I was not doing anything surgical so to have Dr. Biopsy slam the door and walk away from us was just her showing her butt.  I wonder if she has ever heard of word of mouth? Situations like this used to be suffered in silence but not anymore.

I would put a third mortgage on my home if I thought it would buy Emma more years, it has never been about money to me.  It is about the time we have left with her and the quality of that time.

I think the best vets are great diagnosticians coupled with compassion. The very best add some holistic measures into their practice.

I am going to do right by my hounds and feel good about it.  I must thank Chloe and Lily for teaching me that lesson.  Amazing teachers they were.


More girding the loins later….Cat, Chaps and Emma

PS – thank you to the residents for standing with us and offering so many suggestions and support!  WOW!  Just amazing….


  1. lois lema
    May 16th, 2012 | 8:21 pm

    it saddens me to think that vets just don’t listen to owners…personally i agree with your stance on the biopsy. i doubt it would alter the outcome or treatment so why subject her to the pain of it?

    i believe so many times vet’s are used to just offering what they believe people will go for..the surgery, course of treatment etc & then nothing else. they don’t really listen.

    i left a well known vet practice in my town because of that..they made an ‘assumption” about me because of my address…they assumed i was going to stiff them on a payment (which they had already cashed my “bad” check, & that i was using a bad treatment for heartworm on a + dog..a method developed by cornell vet school…but they deemed it dangerous & told me i was killing my dog & all others he came into contact with. EVEN after i brought in documents & vet studies proving otherwise.

    vets can be pompous asses ..they need to be faced with educated consumers…to keep them honest…

    we want only the best for our family..costliest doesn’t equate with the best.

  2. Cindy, Jethro, Rugs, Oz and Harriet
    May 16th, 2012 | 8:29 pm

    Oh wow. This is a lesson learned for whoever reads. Thank you so much for sharing.

    Emma looks happy. Your doing the best for her. What a great Mom.

  3. Sandy
    May 16th, 2012 | 8:33 pm

    You are sooooo right on this decision. As a doctor myself and a doggy mom, I can say you are doing the right thing 100%. How do these people sleep at night? I have been guilty of rushing into treatments and just making things worse for the kids. I am glad to hear that you are keeping a clear head and making good decisions. Keep up the good mommy skills! Love you guys.

  4. May 16th, 2012 | 8:57 pm

    When our Maxine started declining, we had a wonderful vet. She told me that they could do surgery and treatment that would cost more than $1000 but it was unlikely to change the outcome and just make Max miserable. I really appreciated that she cared for Max and for me … she was so gentle and attentive to Max and her suffering and my sadness. She was a rare vet indeed … wish we still lived near her.

    Our thoughts and prayers continue with you and Emma. Thanks for sharing the little bright spots.

  5. Mary
    May 16th, 2012 | 10:35 pm

    Prayers and drool for sweet Emma, and to you and Grandma. You are absolutely spot on, and the bestest mom. I have learned a LOT from this post and thank you for your insight, and your courage. xoxo

    Mary, Harley, Biggs and Leo

  6. Audra, Colby Chaps & Abby
    May 16th, 2012 | 10:42 pm

    Very well written Cat! This is wonderful advice…..for those of us that have been through this we KNOW extensive testing & surgical procedures is Not Always the best way. No one knows your baby better than YOU….these vets need to listen more!

  7. Gabrielle
    May 17th, 2012 | 9:50 am


    Thank you for ALL advice, experience etc. and I have learned a lot!!! You are absolutely the BEST and what a wonderful Mom you are to your kids! And yes, it must have been heart wrenching to learn ALL of this from Chloe and Lilly and what they had to endure at the hands of Vet’s that have a cash register for a brain! And as for little Emma you are doing the RIGHT thing.

  8. MaureenandSlinky
    May 17th, 2012 | 9:51 am

    Since you are so confident, I am sure you are doing the best thing for Emma. Sometimes the cure can be worse than the problem.

    Please let me know if Slinky or I can do anything for Our Emma, the Mayor or you.

  9. June 30th, 2012 | 12:14 am

    Cat, I’m so sorry about Emma 🙁 I didn’t know she was ill so I’ve gone back to see what was up.

    I don’t blame you for not getting the biopsy, honestly, the treatment is pretty much the same no matter the clinical diagnosis!

    Tucker has liver disease, we’ve been battling it for nearly 7 years. My vet at the time of diagnosis(and my current one) mentioned biopsy as a possibility down the road but explained the hazards of doing one and told me it wouldn’t change the treatment! So, he’s never had one. Just meds and supplements.

    Rest in Peace sweet Emma 🙁

  10. Cat
    June 30th, 2012 | 9:58 am

    Thank you Cindy – Yes, I totally agree with you and wish I had asked you a few more questions now. I did not realize that about Tucker but now that I think back on it, I think I remember from this from reading stuff on Roxies. The Hospice folks totally agreed with me as well. They said that the biopsy is a very ruff procedure on a dog and the benefit is next to nothing. So, again – thanks for your comments and give that beautiful boy Tucker a big kiss from us. I always loved him.

  11. allison
    May 29th, 2013 | 3:51 pm

    I am facing that same decision tonight, with aprocedure scheduled for tomorrow…how is Emma doing?

  12. alex
    July 17th, 2013 | 7:27 pm

    So glad I found this. We have a lovely vet who isn’t even the internist who would preform the biopsy, but she keeps suggesting it get done. I know it’s not about money because we would have to go to a different clinic, but this is the second time in a year she has suggested a biopsy and claims there is no way to suggest appropriate treatment otherwise… My guy is a 9 yr old chi mix and is acting normal, healthy, and hungry, 800 enzyme count be damned… His ultrasound shows an enlarged gallbladder but that’s all.
    We have gone on meds, the count went down, off the meds – up again. My doctor can’t seem to tell me if being on this medication long term is a possibility or not. I was starting to crunch down numbers for a biopsy and then started to look into risks… and then found your post. I am so torn but also inclined not to have anything invasive… He’s acting like a healthy dog, why would I put him through surgery? It makes little sense to me…
    I want to say thank you for posting this. It has given me faith and more reason to push on my doctor to give a variety of medications a try.

  13. Cat
    July 17th, 2013 | 8:35 pm

    alex – I totally think you are making the right decision. I am glad I could help. Keep pushing on because you are the best advocate for your dog. No one knows as much as you do. Glad to hear that your dog is acting healthy and happy.

  14. Madeline
    October 30th, 2013 | 11:40 am

    I took my blue heeler into my vet about a month ago because she has been losing weight and had gotten lethargic the night before. My vet did an ultrasound on her and found out she has a huge mass on her liver that could be cancerous. But unlike your vet, mine did not recommend getting a biopsy, said that it would just cost a lot of money and surgery could be dangerous. He said to just make her comfortable at home. He put her on fluids and pain fluids for that who day and then sent some pain pills home with me when I picked her up. She seems to be so much better with the pain pills is acting like her old self. I am really glad my vet was so honest with me and not in it for the money.

  15. Jennifer Burnette
    April 2nd, 2014 | 9:19 am

    “I have found a few canine liver sources on the internet that I will share if they work out.”

    Did these work out for you? I just found this blog. I have a 4 year old bloodhound and she has had mildly elevated ALT enzymes for a year. 215 was the highest they ever were and they have since gone down to 140 (about a month ago). I had an ultrasound done and there was nothing remarkable, so they want to do the biopsy. I’m hesitant for obvious reasons. I’m trying supplements, which I think are what is causing the levels to go down. Have you found anything to be helpful for your girl?

  16. carey
    December 27th, 2014 | 3:11 am

    I just read this after doing research and I don’t see your follow-up to your statement about posting your liver canine sources. Please advise. I’m desperate! My baby girl is so yellow…all over and I can’t lose another one. Get sister passed away a month and a 1/2 ago. They are both 13. :'(

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