Elevated Liver Enzymes

March 12, 2009 by Lisa  
Filed under Blog

A year ago at Jake’s annual checkup a senior panel was done and his Alk Phos level was elevated at 360. We had follow up 3 and 4 month follow up testing and it was unchanged. No other values were elevated at that time. We had our annual checkup last week and the results of his liver enzyme panel were not good. This time not only was the alk phos elevated to 662 but his ast and alt levels were also elevated, 289 and 687 respectfully. Obviously this was very disheartening as he is clinically asymptomatic. He shows no signs of any problems associated with these results. I immediately got on the internet and started reading to understand more about the potential for liver disease and found your foundation website. I wanted to tap into your experience and knowledge and hopefully get some feedback from you. We have an appointment Monday for xrays. My concern is this is the first time other enzyme levels have been elevated and could this be a fluke or testing error!! I found a round table discussion on this and it suggested repeating the test in 2 to 3 weeks to substantiate the results. I need to have this discussion with my vet and will do so Monday. Another concern is what I am feeding Jake. About six months ago I put him on a raw food diet (Primal). I tried to find info to see if this could be potentiating a liver problem. The only supplements he is on are kelp and a probiotic. I did have him on milk thistle when the initial alk phos level was elevated but only did this for two months. He has been on other nutritional supplements for skin and coat but I stopped those. I forgot he is also on organic coconut oil. There is a local health food store that specializes in dog nutrition and I have been following some of their recommendations for maximizing Jake’s health. Other than this Jake has had occasional ear , skin, and pad issues but for the most part had remained in good health. I might also add we exercise regularly, walking twice a day weather permitting. Needless to say I am quite concerned and any help you can provide would be greatly appreciated. I am considering requesting a consult to see an internal vet specialist. I have some other questions about further testing such as serum bile acid. I might also add that I am in medicine myself and knowing what I know about the human element heightens questions and poses trust issues in the care and treatment of Jake!!! I have had some unpleasant vet experiences and just changed vets so at this point my confidence level is being tested and it scares me… Thanks for listening and I look forward to hearing from you.

Thanks

Barb and Jake

Can Someone Help Me?

February 13, 2009 by Lisa  
Filed under Blog

I am attempting to look for an underlying cause of liver disease in our 10 year old Scottish Terrior. Two years ago, she became very sick at her stomach after having her teeth cleaned. Coincidentally, this was also the time perimeter of the dog food scare. (The food she was eating was not on any of the lists publicized.) I have been assured by more than one source that if she had experienced an episode from the dental cleaning, the liver would not have continued to deteriorate over this course of time. The blood work found that her liver enzymes were grossly abnormal. Radiography was performed and we were advised to have an ultrasound. The ultrasound found that her gall bladder was enlarged and we were referred to UT Vet Hospital in Knoxville for possible emergency surgery and further diagnosis. UT did not see the urgency with the gall bladder and she was hospitalized and monitered for a couple of days. She was released feeling well.

A couple of months later, her liver enzymes continued to be abnormal. We returned to UT for additional testing . They performed a needle biopsy and found a few abnormal cells in her liver, but nothing (they felt) to go further.

She was placed on Ursidial, Benazapril, Denamarin, and Fish Oil. Her bloodwork continued to be monitored at least once each 3 months and the results varied. The liver enzymes continued to be elevated, but increasingly additional protein was found in her urine. Her diet was changed to a high quality low protein diet. She continues to feel well. However, she had increased water consumption. Currently, her urine is very diluted. Sometimes, large proteins show in the urine and other times smaller proteins show up causing us to believe there is some globular nephritis happening.

This has continued over the last 2 years. Every test that we know of has been run including multiple Cushings tests with no results and continued blood and urine tests. A few weeks ago, she did test positive for atypical Cushings. The vet school at UT is not convinced that the atypical test conclusion is accurate.

Our vet referred us back to UT requesting an ultrasound be performed. It was non-conclusive. They recommended a laparascopic biopsy with additional bile, copper, etc tests. We received the results today and they have no idea what the underlying problem could be. Her liver is fragile and the biopsies broke apart with very little bleeding when extracted. Cancer biopsies have shown to be negative. The copper test was not back but the slides showed no crystals. There is some evidence of regeneration. They feel she may be a first and I feel that there has to be another “baby” out there that has had an evasive diagnosis.

I would very much like any suggestions, ideas, etc that anyone may have had that has experienced a difficult diagnosis. Any suggestions to continuing to preserve the liver and promoting regeneration will be grateful.

I would gratefully appreciate you forwarding this email to anyone has any sources that may be familiar with this type of case or know of anyone with professional interest in liver disease. I feel certain that there are internists that specialize in liver care and disease but I have no way of knowing who they are.

Thanks and love,
Malie