MY VISIT TO THE INTERNIST, by Nicky

Does this nose make me look handsome?

Yesterday, Mom took me to see a special doctor called an internist.  Her name is Dr. Grigsby, and Mom met her once before on the horrible occasion last January when Gabe had a ruptured bowel.  Dr. Grigsby was the one who figured out what was wrong with Gabe and then put him to sleep after Mom agreed that was the best thing to do.

So I was a little nervous, going to see this internist person, because I thought maybe she would decide to put me to sleep, too.  But I was relieved to find out that Dr. Grigsby just wanted to figure out why I feel yucky and grumpy and have diarrhea so much of the time, and make me feel better.


Mom has already spent a lot of money on me to get blood tests done and also an ultrasound.  And what we learned from all this expensive stuff was that I have high liver values in my blood.  Also I have high folate levels, which might have something to do with vitamin B.  It's all very confusing to a dog who was only bred to run races and not to understand chemistry.  The ultrasound, which cost $315, didn't show anything unusual that was happening inside me.  But the high folate levels meant that I have a "diffuse intestinal disease."  This disease might be inflammatory bowel disease (IBD), like Gabe had, or it might be lymphoma, which is a type of cancer, or it might be an overgrowth of bacteria.

A dog getting the inside of his guts
revealed through endoscopy

My regular vet, Dr. Griswold, said I needed endoscopy to figure out what was going on in my intestines, and that's why Mom took me to see Dr. Grigsby.  Endoscopy is where they stick a long tube thing way down into your throat or up your butt, and it has a light and a camera on it, so they can see what's inside your guts.  Also they can get little snippets of your intestines, and then they can look at these under a microscope and see what is going on in there.

But Dr. Grigsby looked at all the information from the tests I've had, and she told Mom that maybe a couple of things were wrong with me, and one had to do with my liver, and the other was happening in my intestines.  She thought we should start with the liver, and she said she could stick a needle right straight into my liver and suck out a few cells and look at them.


So Mom left me there most of the day, and I had another ultrasound to make sure Dr. Grigsby knew where my liver was so that she would stick the needle in the right place.

These are some liver cells,
and those big yellow
blobs are bile.

After the doctor looked at the liver cells, she called Mom and said that I do not have cancer in my liver, which is very good news.  But what I do have is a whole lot of bile pigment that is not supposed to be there.  This means that the bile is not draining out of my liver in the proper way.  Dr. Grigsby sent my liver cells to the lab so that they could look at them, too, because they might see something that she didn't see.  When she hears from them, she will call Mom.

I did a little bit of research on bile, and I learned that it is made by the liver and stored in the gallbladder.  And what it's used for is to help you digest the fats that are in your food.  Bile also has this stuff in it called bilirubin, which is a really funny word to say.  Anyway, my blood tests showed that I had way too much bilirubin.  The interesting thing about bilirubin is that it is what makes your pee yellow, your poop brown, your bruises turn yellow, and lots of things yellow if you are jaundiced.  I wonder if having too much bilirubin could turn me into a yellow lab.  I hope not, because I don't think I'd want to be a lab.  I really prefer being a greyhound.

Dr. Grigsby prescribed some medicine to help me not have diarrhea so much, and I also some medicine to make my liver better -- except Mom hasn't picked up those pills from the drugstore yet.  And now we just have to wait until we hear from Dr. Grigsby again.  Meanwhile, I plan to take lots of naps because that is something I excel at doing.