Liver disease

[MauiGirl]

I can't thank you all enough for all your support and advice as I navigate thru the diagnosis process. It really means a lot to me to hear from people who have gone thru this and understand the process, as I am continually asked to make decisions about tests I know nothing about.

One of the frustrating things about living in Maui is the limited medical resourses here (for pets AND humans). I don't even know if scintography is done here, but I'll be asking as soon as the vet clinic opens this morning. I was surprised to find that the person who does ultrasound is on another island and only flies over here when she has 6 or more waiting; and we are only #3 on the list. She usually comes once every 4-6 weeks. If it was important, I'd fly Tiki over to Big Island to get it sooner. My vet would normally be sending us to a Vet internist, but there isn't one in Hawaii, so we are doing the best we can.

The more I learn, the harder it is. Hearing that elevated ALT indicates liver cell death, and smallish liver on xray, has my tears flowing all over again. I need to focus on "don't panic, liver disease isn't a death sentance". We are going to figure this out and fix it, whatever it is.

As I'm sitting here struggling, Tiki and Meika have the zoomies, chasing each other in and out of every room and up and down stairs. I need to learn from them..... live for the moment!

Today's challenge, search for pet food. Tiki (liver challenged at 7 months old, 7#) needs low protien, Meika (5 months but stocky 6# Morkie) can switch to adult food now, and Niko (13 yr. old, 20# Schnauzer) probably needs a senior food cause he's gained a bit from getting into puppies food.

Sorry this got so long, it's an emotional day for me. Thanks for listening and continuing to give me input.

Warmest Aloha,
Sandy

[Ellie May]

No veterinary internist in Hawaii?
Do you have a veterinary school anywhere there?
If not, you probably can't do scintography.
I would be more hesitant to do ultrasound under these circumstances though because they are only 60-80% reliable and a lot of it depends on the expertise of the interpreter. If she isn't an internist, I wonder if she has enough experience to read one showing LS. I guess with no scintography available though, you will probably need to do ultrasound.

I don't know how much shipping would be to Hawaii, but I have been very happy with getting Ellie's Denosyl from entirelypets.com. It is one of the cheapest places to get it.

[TLC]

Ahhh....I am so sorry, I know the stress of this all.

Roxy's first BAT was pre 43 and post 100.9 and I was scared of LS. She shows only slight signs of liver issues and now that I know what they are I can see it, but to the normal folk she would appear fine.

I had TJ BAT too and his post was 43

I put them both on a special diet. I did further blood work, urinalysis, coagulation and a U/S on Roxy. All was normal. The U/S showed a normal size and shape liver.

I have since BAT them both another 5x last year. TJ's post came down to below normal all the time, as a matter of fact, his last post was 1.3
Roxy's pre came down, but her post is in the 60 to 85 range.

We are treating her as if she has MVD ~ b/c that's most likely what she has. She gets a special home made diet and supplements and she is thriving once again. Seeing her 'play' is an incredible sight

We are here for your support and the Yahoo Group(s) are Great too!

[MauiGirl]

Originally Posted by TLC

Ahhh....I am so sorry, I know the stress of this all.

Roxy's first BAT was pre 43 and post 100.9 and I was scared of LS. She shows only slight signs of liver issues and now that I know what they are I can see it, but to the normal folk she would appear fine.

I had TJ BAT too and his post was 43

I put them both on a special diet. I did further blood work, urinalysis, coagulation and a U/S on Roxy. All was normal. The U/S showed a normal size and shape liver.

I have since BAT them both another 5x last year. TJ's post came down to below normal all the time, as a matter of fact, his last post was 1.3
Roxy's pre came down, but her post is in the 60 to 85 range.

We are treating her as if she has MVD ~ b/c that's most likely what she has. She gets a special home made diet and supplements and she is thriving once again. Seeing her 'play' is an incredible sight

We are here for your support and the Yahoo Group(s) are Great too!

Did either of your furkids have elevated ALT? I'd love to hear more about your special home made diet; did you design it yourself, or with a vet or nutritionist? I am totally open to home cooking, and have been doing partial home cooking for months in addition to puppy kibble.

I'm off to the other side of the island to vet and shopping, and will check back in here this evening.

Thanks, as always

[MauiGirl]

Originally Posted by Ellie May

No veterinary internist in Hawaii?
Do you have a veterinary school anywhere there?
If not, you probably can't do scintography.
I would be more hesitant to do ultrasound under these circumstances though because they are only 60-80% reliable and a lot of it depends on the expertise of the interpreter. If she isn't an internist, I wonder if she has enough experience to read one showing LS. I guess with no scintography available though, you will probably need to do ultrasound.

I don't know how much shipping would be to Hawaii, but I have been very happy with getting Ellie's Denosyl from entirelypets.com. It is one of the cheapest places to get it.

Our vet told me Saturday that if we lived on the mainland, she'd be sending us to an internist, but there wasn't one in Hawaii. I assume no vet schools either, but will re-check that. They send all tests to the mainland. I share your concerns regarding ultrasound, and no matter what tests are forthcoming, I want to send everything to a specialist on the mainland.

I would gladly even fly Tiki to the mainland for diagnosis and treatment EXCEPT THAT due to Hawaii's strict quarantine laws, I wouldn't be able to bring her back into the state for 6-10 months. She'd need a rabies shot, if not 2, and 6 months of follow up on the mainland before being cleared back into Hawaii. With her condition, a rabies shot could kill her. As long as she lives here, she won't need one. Another complication of living in paradise.

I'm also wondering if we may go thru all these tests and still not know for sure what it is. Still in the back of my mind I wonder if she ate something toxic outside. No symptoms, except in August she started diarrhea once, and I happened to find out that day that Meika had coccidia, so the vet treated both even though she didn't test Tiki. Both were clear after 10 days of meds. I always watch her and pull leaves and plants and palm seeds out of her mouth. We don't use pesticides inside or out. Or I wonder about pancreatitis, cause my Schnauzer had that once about 10 years ago from eating a hunk of prime rib fat.

I mentioned Denosyl to the vet, and she said it would be ok to try even at this stage, so I'm picking up some there today. She said their version has milk thisle in it too. That will get us started, and I'll look for other sources for future if it is costly. As soon as I see what foods are available, I may have to order that online too.

My brain is so tired of thinking about it all.

Thanks again. I'll check back in when I return this evening.

[JaLaYorkieGirl]

I am so sorry that you are going through all of this, it has to be so stressful. After reading Dr. Sharon Center's lecture notes from her lecture at the YTCA specialty this year in New York I would not recommend anything until you do a Protein C Test. This is the cheapest and the least invasive next step with very accurate results. If her Protein C comes back normal you know she has MVD and if it comes back abnormal then it would indicate a shunt.

If you want her lecture notes I would be happy to e-mail them to you, just pm me your e-mail address. You could then forward them to your vet.

An ultrasound if negative will still keep you wondering but with the Protein C test there is no wondering, you get an answer right away.

[MauiGirl]

When I first mentioned Protein C to the vet, she seem not to know a lot about it, so I took her printed material (from LadyMom on p. 1 of this thread), including how careful to be with test, and how to send to Cornell. Vet still pushed for ultrasound, and said IF LS is found, then we wouldn't have to go further. She seemed to indicate that Protein C wouldn't detect LS, unless I am confused.

I'll feel much better when the more experienced vet/surgeon is back in their office next week and can talk to me.

Stressful and frustrating.... YES. But, just for today I'll do what I can and get supplements, and work on her diet, and mostly just hug her to pieces. She is such a sweet angel, and senses my concern, she acts like she wants to comfort me.

[Ellie May]

TLC, Yorkieluv and I all homecook for our liver compromised dogs. TLC and I have nutritionists, Yorkieluv somehow has the whole thing figured out and could probably be a nutritionist herself. And I think Ladymom does too now. I'm probably missing some.

With quarantine requirements like that, I wouldn't be flying her out of there either but if she needs surgery, that would be a difficult decision.

[Ellie May]

Originally Posted by MauiGirl

When I first mentioned Protein C to the vet, she seem not to know a lot about it, so I took her printed material (from LadyMom on p. 1 of this thread), including how careful to be with test, and how to send to Cornell. Vet still pushed for ultrasound, and said IF LS is found, then we wouldn't have to go further. She seemed to indicate that Protein C wouldn't detect LS, unless I am confused.

I'll feel much better when the more experienced vet/surgeon is back in their office next week and can talk to me.

Stressful and frustrating.... YES. But, just for today I'll do what I can and get supplements, and work on her diet, and mostly just hug her to pieces. She is such a sweet angel, and senses my concern, she acts like she wants to comfort me.

BAT and ALT can be up for more reasons than just LS or MVD. So a Protein C test would be good but just because it is normal, I don't think that automatically means it is MVD (unless it is strongly suspected because of her breed).

[MauiGirl]

So the vet clinic had Tiki's Rx ready at the front office; it is Marin, 1/4 tab per day. There was a note on my invoice that they were out of the other product (I think a Denosyl sam-e type), but said this would be good.

I found Natural Balance Vegetarian (other suggested foods were not stocked here), and so far all 3 dogs are not interested in the new food, and pick every crumb of their old kibble out of the bowl. It will take time I'm sure.

Now I just wait, and continue to research, until the other more experienced vet gets back next week. It was good to get out of here and do some shopping and get my mind off everything.

[LuvMySissy]

Originally Posted by MauiGirl

So the vet clinic had Tiki's Rx ready at the front office; it is Marin, 1/4 tab per day. There was a note on my invoice that they were out of the other product (I think a Denosyl sam-e type), but said this would be good.

I found Natural Balance Vegetarian (other suggested foods were not stocked here), and so far all 3 dogs are not interested in the new food, and pick every crumb of their old kibble out of the bowl. It will take time I'm sure.

Now I just wait, and continue to research, until the other more experienced vet gets back next week. It was good to get out of here and do some shopping and get my mind off everything.

I would highly recommend a consultation with Susan Davis regarding diet as well as supplements that can help. We just talked with her yesterday for Sissy - who is not sick at all, yet her repeated blood panel showed an even higher level of Lipase (pancreatitis) than when first diagnosed last year. Here is her website. You can get a consult scheduled pretty quickly and it will be well worth the $78.00. There are a few YTers who have used her with great results. You may even want to schedule the joint consultation with her and Dr. Gordon - might give you even more insight and information...
Pet Health Pet Nutritionist Holistic Pet

[Ladymom]

Originally Posted by MauiGirl

When I first mentioned Protein C to the vet, she seem not to know a lot about it, so I took her printed material (from LadyMom on p. 1 of this thread), including how careful to be with test, and how to send to Cornell. Vet still pushed for ultrasound, and said IF LS is found, then we wouldn't have to go further. She seemed to indicate that Protein C wouldn't detect LS, unless I am confused.

I'll feel much better when the more experienced vet/surgeon is back in their office next week and can talk to me.

Stressful and frustrating.... YES. But, just for today I'll do what I can and get supplements, and work on her diet, and mostly just hug her to pieces. She is such a sweet angel, and senses my concern, she acts like she wants to comfort me.

Actually, a Protein C test will tell you whether you are dealing with a shunt or MVD. It really is the next step, not an ultrasound. Even if you get an ultrasound done, you may still not know what you are dealing with since they can be as low as 60% reliable in diagnosing shunts.

Why don't you ask your vet to consult Dr. Center? Her email address is underneath her picture.

Faculty of the College of Veterinary Medicine - Sharon A. Center

Here are a couple of good links to diets for liver compromised dogs. The second lnk you have to scroll down to the bottom and look in what almost looks like the footnotes:

Liver | B-Naturals.Com Newsletter

Nutritional Support for Dogs and Cats with Hepatobiliary Disease -- Center 128 (12): 2733S -- Journal of Nutrition

Marin is great. You don't need a prescription, though. I get it here:

Marin for Small to Medium Dogs (30 Tablets)

[Ellie May]

Originally Posted by MauiGirl

So the vet clinic had Tiki's Rx ready at the front office; it is Marin, 1/4 tab per day. There was a note on my invoice that they were out of the other product (I think a Denosyl sam-e type), but said this would be good.

I found Natural Balance Vegetarian (other suggested foods were not stocked here), and so far all 3 dogs are not interested in the new food, and pick every crumb of their old kibble out of the bowl. It will take time I'm sure.

Now I just wait, and continue to research, until the other more experienced vet gets back next week. It was good to get out of here and do some shopping and get my mind off everything.

Marin is okay but does contain a small amount of liver which isn't healthy for her liver. I think Hepato Support is probably better for some dogs. I personally would give Denosyl also. We just do Denosyl here but are thinking about adding Hepato Support.

[Yorkieluv]

Plain milk thistle OR hepatosupport is recommended for liver compromised dogs AND denosyl or vetri-dmg.

We give our liver compromised yorkie milk thistle and vitamin E and alternate between denosyl and vetri-dmg. Ellie may is absolutely correct about the marin containing yeast and liver which are high in purines (not recommended).

[MauiGirl]

Ok, so I paid $28 for Marin at the vet's and I now see online it is only $15; and now I hear I shouldn't use it at all. Hummm.

I'll order Denosyl and maybe vetri-dmg, and hepato support.

Yorkieluv, do you give yours milk thistle and Vit. E in a dog formula, or is human grade ok to use, and how do you know how much? Same question pertaining to sam-e, would human grade be ok, and how much.

Is Denosyl the same as sam-e? Sorry for so many questions, just trying to get educated quickly.