|Barked: Mon May 13, '13 6:56am PST |
|I personally would not do a liver biopsy on a 14-year-old, asymptomatic Yorkie. From your description, it also sounds like they have no target area with the biopsy, which is extremely significant.
Aside from anesthesia risk, bleeding out is a huge concern. Livers are full of blood to begin with, and our ability to clot properly depends upon healthy liver function. If you do decide to biopsy, demand a clotting test first. You'll need a hospital staffed 24/7 because he will need to be admitted and watched for bleeding all night.
Which enzymes are elevated are significant as well. If it's just the ALT... Well, you can elevate that with a night of heavy drinking and Tylenol for the hangover. It's not good, but it's not as bad as if all the liver enzymes are elevated.
Anyway... I have been through this. Vance's ALT spiked when he was 8. Ultrasound showed an "abnormally bright, inflamed liver." Since it was only ALT, I decided to try changing his diet and adding liver-supporting supplements first. His ALT did lower, although it never returned to a normal range. His symptoms (bile vomiting mostly) subsided.
About 6 months later he had an episode of Hemorrhagic Gastroenteritis and ended up hospitalized for 3 days. His ALT was up again (as would anyone's who had just been through that) and since he was admitted anyway and I was afraid things were getting worse, I agreed to an ultrasound with biopsy. The ultrasound was exactly the same as the previous one, and the biopsy came back inconclusive. When I questioned this, the vet casually said, "Well, you know, we had no target area so we're just looking at a random 1/1,000,000th of his liver. We recommend trying a second biopsy." Since I didn't see what good looking at a random 2/1,000,000th of his liver would do, I refused and took him home.
I did give him a course of GI and a course of liver-specific antibiotics after this. It was possible he had an infection in his liver. Antibiotics aren't that risky, so I was comfortable trying them just in case that was the problem. Turned out it wasn't, but at least we knew. A few vets wanted me to try steroids without diagnosis, but I refused since it was about a 50/50 shot of whether they would help some now with complications down the road, or straight out kill him.
The best thing I did for him was changing his diet and supplements. Milk thistle is the go-to for ailing livers. Make sure you're buying a quality supplement, as processing does matter! You can also try adding SAM-E (cheapest at WalMart) which is exactly what the Denosyl vets prescribe is - SAM-E and milk thistle. He was also on probiotics and amino acids to help digestion, because the easier it is to digest the less the liver has to work.
In terms of diet, we went all home cooked. Everything was ground or pureed (easy digestion) and the meat was as low fat as possible. If lean meat was too expensive, I would buy 80/20 and drain it well, then blot it with paper towels. I fed as much fish as I could afford (even canned mackerel is ok). I fed 40 - 60% fiber, which is too much for a healthy dog, but in Vance's case it coated his stomach against the bile he was overproducing and helped absorb some of it. Later on he needed antacids too.
If homecooking isn't an option for you, look for canned foods that fit the low fat with fiber criteria. Kibble is the worst thing you can give to a dog with GI, liver, spleen, pancreas or gallbladder issues.
The trick with what you're going through is to just keep weighing the options against the risk and reward they come with. Get second opinions, from special-ists if possible. Monitor his condition - given our dead-end, I just did bloodwork every 6 months and ultrasounds if any values had spiked... Of course if he had any sort of episode I did both then. That should give you enough information to keep making the best choices for him.
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