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Dog with high liver values.....I need advice please!

This forum is for dog lovers seeking everyday advice and suggestions on health-related issues. Remember, however, that advice on a public forum simply can't be a substitute for proper medical attention. Only your vet can say assuredly what is best for your dog.

  
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Salsa

Heather's Chips- and Salsa
 
 
Barked: Mon Sep 2, '13 8:06am PST 
Hey everyone!

My 6 year old chihuahua Chica has had consistently elevated ALT liver values for over a year. Right now they are hovering around 382 (normal 10-100). She is a little bit on the chunky side but absolutely has NO symptoms. She eats, drinks, runs, plays and is happy as a clam. The vet has had her on a veterinary prescription liver diet for the past 6 months and on Denamarin for over a year.

She is due to go back and get her levels checked in 2 weeks. The vet said 6 months ago that if there hasnt been much of a change she would like for Chica to see an internal medicine vet.

I do have some concerns:

1) Chica has already had an ultrasound with our vet which showed NOTHING. other than a "bright" liver. They even did needle aspirates which showed a small amount of inflammation but nothing very conclusive. She has been given antibiotics for any type of hepatitis, but these did nothing.

2) She has had hip surgery in the past as a puppy, and now blood testing every 3 months for her liver. She is also allergic to vaccines and been to the vet before for massive reactions. Within the past year, she has become so frightened of the vet that she has seizures as soon as you get to the building!! The vet has me giving her valium now before she comes but that is starting to not work. Last time they drew her blood in my car in the parking lot to ease her stress.


Now with the vet mentioning this new doctor, when do I say ENOUGH is ENOUGH? She has no symptoms, is a happy dog, and loves life. I do not want to put her through so many tests and trauma for this and then make her consistently have seizures.

She is such a sweet baby and I hate to see her go through so much. Any advice? What would you do? I am afraid when/if I go to this doctor they are going to want to do more scans, bloodwork and not only does she get SO worked up but it is so expensive and we never really get answers.

Any advice would be greatly appreciated!!!
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Scooter,- PAWS

Power of the Paw- for those who- need it
 
 
Barked: Tue Sep 3, '13 4:56am PST 
Awwww....poor chica...she sures seems to be going through quite a bit. It sounds like she has had enough of these visits. I can understand why your vet ordered an ultrasound...to check for enlarged or inflamed liver.

One thing to understand is this...dogs and cats do a great job of hiding symptoms. I have a cat in renal failure. To me, no symptoms, but she has been in renal failure for over a year. Her numbers aren't terrible but they are moderate to slightly high. I get her tested every 3 months to monitor the levels. She hates going to the vet too. I try to make it as less stressful as possible, but it sure as heck isn't easy.

There is a reason for the consistent elevator liver values. You may not see anything now, but there has to be something underlying. If they can get to the root of it, treat it and keep it stable, she can reduce the number of times she gets tested. Having her so stressed on visits isn't good for her liver either. That's what I hate about our cats visits. Stress isn't good on the kidneys.

An internist may be able to get to the root of why her liver values are consistently high. Regardless of symptoms, I would want to find out why it's happening.

I just wish there was a way to reduce her stress. I totally get it. I'm not sure that helps or not. If the valium helps to keep her calm, and doesn't drug her out too much maybe that is the way to go. I try to restrict visits to first appointments in the morning. It's less stressful on my cat too. Less People, less animals.

Good luck to you! hughughughughughughughug

P.S. on a side note, I'm thinking that getting her to a healthy weight might reduce stress on the liver as well?

Edited by author Tue Sep 3, '13 4:58am PST

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Salsa

Heather's Chips- and Salsa
 
 
Barked: Tue Sep 3, '13 5:58am PST 
Scooter,

I definitely plan to persist on with finding the reason behind the high values. When we return to the vet for her re-check lab work, we will go to the internist if it is recommended. We also do the early morning appointments....larger dogs being in there at the same time freaks Chica out. A couple of times she has even had a seizure with the valium in her system, almost as if the valium didnt even phase her shrug

Like your cat, she goes every 3-6 months depending on the vets recommendation for repeat lab work. We do stay on top of it. I am just afraid that when I go to the internist they will want to biopsy/CT scan which I may have to turn down due to expenses. I am currently unemployed and with the job hunt included, all of this is so stressful! The vet did tell me though that her values are not TERRIBLE, we would just like to know what is elevating them.

She has been on a diet but doesnt seem to lose any weight, and she is on a strict diet....no treats. It is strange....sending prayers for your kitty. Animals are great at hiding symptoms. The vet even told me that Chica has no visual signs/symptoms of anything...no jaundice, lethargy, lack of appetite. She is a ball of hungry energy laugh out loud

Hoping to get this all sorted out soon, before Chica and I both go crazy haha!
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Scooter,- PAWS

Power of the Paw- for those who- need it
 
 
Barked: Tue Sep 3, '13 6:47am PST 
Yea...I definitely get that. Hopefully things can happen one step at a time. If they feel they need to do further testing, as long as she isn't symptomatic maybe it can happen over time. I can also imagine how stressful this is for you with no job at this time. I'm glad the values aren't terribly high.

Maybe the internist can work with you a bit. Priortize the testing. I do hope they find a cause.

As for our kitty, thank you....she's 18 now...we are incredibly blessed to have her for this long. She would never know she's sick...oh and she has a grade 2 heart murmur. We are keeping her as comfortable as possible too. Thanks again

Good luck! hughughughughug
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Vance CGC

You kids g'off- my lawn!
 
 
Barked: Tue Sep 3, '13 7:27am PST 
I would go straight to the internist.

This has been going on for a long time. Your current vet is at a dead end. If nothing has improved yet with what you've been doing, it's not going to be better at this recheck either. Go to the internist, let them pull this round of bloodwork - because that's where they're going to start, and every vet wants the bloodwork to go through their own lab. If you go for a recheck with your current vet, they're going to end up sending you to the internist who is going to want to repeat the same bloodwork you just had done.

Then just hear the internist's plan. You don't have to do anything they recommend.

Ultrasounds may be a good idea. I don't recommend doing a biopsy without a target area, though. I did one, it came back inconclusive. The vets seemed totally unphased by this and recommended we just keep doing biopsies until we got a result. I was literally told, "Well, the biopsy only looks at 1/1,000,000th of the liver, so it's easy to miss without a target area. We should do a second biopsy from a different area." Because I guess 2/1,000,000th of his liver would have made a difference?

Different or more extensive bloodwork may be a good idea as well. It's possible the seizures are caused by whatever is going on the liver, and brought out by stress. I'd look farther into that as well.

As far as saving money, Denamarin is Sam-E and milk thistle, sold exclusively to vets with a brand name. You can buy those on your own for much less. Still expensive, but not as much.
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Salsa

Heather's Chips- and Salsa
 
 
Barked: Tue Sep 3, '13 7:40am PST 
Thank you for your advice smile She has had an ultrasound of her kidneys and liver....which just showed mild inflammation: no masses or any other signs of serious disease. I am taking my older dog to the vet for a physical today and will ask about going right on to the internist.

it is very stressful. Financially I am strapped and I only want what is best for my fur kids. She had needle aspirate biopsies which showed inflammation. Like you said....they can be a hit or miss.

And Scooter, wow your kitty is amazing! smile Glad he is doing well!
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Vance CGC

You kids g'off- my lawn!
 
 
Barked: Tue Sep 3, '13 8:10am PST 
Tumors don't always show up on an ultrasound, so depending on how long ago they were done, they may be worth repeating. If the tumor is very small or behind an organ, it won't show up. This is what happened with Vance (not to scare you, because his exact situation was pretty rare). The tumor was on his duodenum, pressing against his liver, and eventually grew over it. It took about 2 years to show up on ultrasound, but his ALT was high the entire time.

MOST benign tumors like his are operable. His was hit-or-miss, because when it finally did show up, they could not see the source on ultrasound. His also grew faster the longer it was there, so by the time it did show up it was massive. Had it been only on his liver and/or spleen, as most tumors are, it would have been easier.

Edited by author Tue Sep 3, '13 8:11am PST

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Salsa

Heather's Chips- and Salsa
 
 
Barked: Tue Sep 3, '13 10:18am PST 
I asked the vet about Chica this afternoon and she wants to continue to check her values at the clinic. She doesn't think they are high enough to warrant sending her to an internist. When they are checked in a week, if they are remaining around the same or lower, we will just watch her. The levels HAVE gone down before and they barely go up when they do increase.

If they rise more than anticipated, we will repeat the ultrasound as an outpatient internist consult. That way I will only pay about $200 instead of $600 to have the internist do it. So it seems she will be on a maintenance plan, unless things change dramatically: jaundice, vomiting/diarrhea, lethargy, higher than usual levels.

She told me some dogs keep high ALT levels with no explanation, just anomaly. Seems it will be a wait & see. I am grateful and praying for lower or stable levels next week. hug
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Dr. Watson

Not a wiener- dawg!
 
 
Barked: Tue Sep 3, '13 11:53am PST 
I suggest that any biopsy should be guided by fluorsocopy to the target area(s). I also suggest that her ammonia levels and bile acids be checked. Find out the price of the internal med vet. Perhaps your vet could just consult with her for no fee over what labs should be run?
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Dr. Watson

Not a wiener- dawg!
 
 
Barked: Tue Sep 3, '13 12:02pm PST 
Here's some useful reading from one of my favorite sites, which includes both conventional and somewhat alternative treatments: DogAware: Liver Disease in Dogs
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