Prednizone for liver disease?

[Ellie May]

Interesting thread.

If I had a dog with LS, I wouldn't feed K/D because I think there are better foods for this issue, but I can't say not to either. I would let an IMS or veterinary nutritionist decide on that. About the pred, I have no answer. The problem saying that it shouldn't be used is we have no idea what is going on here, and even if we did, maybe we're missing something. I mean, it's realllllly easy to miss something that a vet said, and then trying to recap and tell a forum full of people what they said can be difficult. There is always a chance that something got mixed up in the interpretation. So what if there is more than one issue here or? So OP, if a general DVM told you to give pred and you don't want to, then ask an IMS that is experienced with LS.

Vaccines will always be a source of debate. I have something but respect for Dr. Schultz - and Dr. Schultz does not tell owners to follow what he is seeing in the lab. He is researching and isn't going to tell people to stop vaccinating. That's what he does with his own dogs. While I can understand why people would want to follow or do follow his protocol right now, I don't really recommend it. His findings this far are probably exactly right, but we don't really know that. I wouldn't want to tell an owner that stopping vaccines after a one year booster is okay only for their dog to get a serious vaccine-preventable disease because of my advice. When asked, I do explain this is one way to do it, but I try to add that it is still being researched. AAHA is more middle of the road and it's what I say to do for a healthy dog because a lot of vets agree on this method. I am somewhere between the minimalist and AAHA approach personally. BTW, some of the vets who recommend very minimal vaccines (again, don't disagree - just wouldn't say that one should do this unless their dog can't handle vaccines) also do nosodes for heartworms. It's very easy to go too far with the no-drug thing.

Lepto is a serious problem in Michigan. If my dog could handle the vaccine and went outside to play, she would get it. She is small and I would not consider that a reason not to get it. I would, however, consider her to be at higher risk from getting it and would give benadryl first. I'm not concerned about the zoonotic potential as much as I am for her health. Her liver or kidneys would likely crap out if she were to get the disease and I'm not interested in it. This is from somebody whose dog had a very serious reaction to this vaccine. I'd do it again with precautions taken (for a dog with no previous lepto reaction). My view has definitely changed because right after it happened, I didn't think I'd ever allow a small dog to get it again. Hey, a couple weeks ago a dog came back after vomiting several times from a bordatella vaccine which isn't common at all. So - they can react from any of them and I do think now the lepto is safer.

[kjc]

The main issues I have addressed in this thread are:

Is prednisone prescribed for dogs with liver disease?
Yes, but I have never seen it prescribed for dogs with a Liver Shunt for treatment a Liver Shunt.

Does the OP's dog have Liver Shunt?
The OP stated that Her dog had a liver biopsy and the result was Liver Shunt.

I have never heard of this, biopsies are done to rule out MVD and other disorders, not LS. Futher testing is needed to make a diagnosis.

Was a Bile Acid Test done?
The OP is unsure, but will ask her vet.

The dog's AST and ALT are/were very high.
These two values will become elevated when toxins are involved. (By toxins, I mean anything ingested to vaccines received.) In dogs that have Liver Shunt, these values are most often only mildly elevated. Vaccines, such as Lepto, can cause higher elevations of these liver enzymes, and the OP's dog has been repeatedly vaccinated against Lepto. Or maybe the dog has contracted Lepto.

Why is prednisone being prescribed?
To bring the AST and ALT levels down, per the OP. The problem with prednisone is that it suppresses the immune system. If this dog is fighting an infection, this could be an unwise decision.

Did I PM or telephone the OP?
No, I have not, but I am willing to talk with her over the phone or via PM, if she wants to. Just send me a PM.

I have to leave for a while, but let me know if I missed anything....

[gaijingirl]

I have also never heard of prednizone for Liver Shunt. Before Snickers was diagnosed with MVD, he would often get these really bad fevers, which we could only guess were pain induced. Sometimes he'd get really bad and the only thing that could bring him out of it was a dose of prednizone. I never used it more than 3 days and if the fever came on suddenly in the middle of the night, I'd call my vet for instructions...sometimes he only needed it once to break the fever. When we did get the diagnoses for MVD, (and a clostridium overgrowth) one of the questions I asked was whether or not I should give him any prednizone if he were to have another high fever episode again. His specialist at UT did not give me the impression that it would be the best thing for him. But, this is just my personal experience with my own dog...If my general vet had suggested this drug for long term use, I would really want to get a second opinion from another vet, preferably a specialist, to feel comfortable giving this sort of drug. There are some side effects to prednizone that would concern me...

[ladyjane]

Originally Posted by kjc

The dog's AST and ALT are/were very high.
These two values will become elevated when toxins are involved. (By toxins, I mean anything ingested to vaccines received.) In dogs that have Liver Shunt, these values are most often only mildly elevated. Vaccines, such as Lepto, can cause higher elevations of these liver enzymes, and the OP's dog has been repeatedly vaccinated against Lepto. Or maybe the dog has contracted Lepto.

You are saying that the Lepto vaccine causes higher elevations of liver enzymes than LS?

Where is this information?

I have never heard of such a thing, but would be interested in seeing the data to back this up so that I can discuss it with my vet. We have not had a problem with lepto in this area, but I want to be informed in case it ever happens and I need to make a decision about this vaccine for my pups.

[Ellie May]

I'm very confused about all of this at best. How can a shunt be dx with just a biopsy? That is one reason why I don't know what to say about the pred. It doesn't even sound like there is a solid dx yet. If my dog had LS, I would give pred if (and only if) a specialist overseeing the liver told me that I should. If pred had to be given here and the liver function was a concern, prednisolone would be chosen first as far as I know.

[ladyjane]

Originally Posted by Ellie May

I'm very confused about all of this at best. How can a shunt be dx with just a biopsy? That is one reason why I don't know what to say about the pred. It doesn't even sound like there is a solid dx yet. If my dog had LS, I would give pred if (and only if) a specialist overseeing the liver told me that I should. If pred had to be given here and the liver function was a concern, prednisolone would be chosen first as far as I know.

Oh, I would definitely be going to an internal med specialist.

[107barney]

Originally Posted by Ellie May

I'm very confused about all of this at best. How can a shunt be dx with just a biopsy? That is one reason why I don't know what to say about the pred. It doesn't even sound like there is a solid dx yet. If my dog had LS, I would give pred if (and only if) a specialist overseeing the liver told me that I should. If pred had to be given here and the liver function was a concern, prednisolone would be chosen first as far as I know.

At post #30 the OP stated that the vet was treating with prednisolone.

[Becca1]

[QUOTE=Ellie May;3422517]Interesting thread.

If I had a dog with LS, I wouldn't feed K/D because I think there are better foods for this issue, but I can't say not to either. I would let an IMS or veterinary nutritionist decide on that. About the pred, I have no answer. The problem saying that it shouldn't be used is we have no idea what is going on here, and even if we did, maybe we're missing something. I mean, it's realllllly easy to miss something that a vet said, and then trying to recap and tell a forum full of people what they said can be difficult. There is always a chance that something got mixed up in the interpretation. So what if there is more than one issue here or? So OP, if a general DVM told you to give pred and you don't want to, then ask an IMS that is experienced with LS.

I appreciate your thoughts. She had been on L/D and responded so much better to K/D (and ate it better). I did see on the TN website that K/D is used in some LS dogs. One of my vets (both in the same office) has a dog with his own liver issues, so has does a lot of research and made the suggestion to try the K/D and so far so good. However, I do see so much praise about Royal Canin LS and wondered about trying that, but do not see if it comes in a canned version??? She absolutely won't eat dry.

As I said, I am going to go with his suggestion of 1/2 tab of Prednisolone every other day and then check her levels. Right now, she is eating well, no HE symptoms, no vomiting, etc., and I will monitor her closely.

[Becca1]

Originally Posted by 107barney

At post #30 the OP stated that the vet was treating with prednisolone.

Yes, I'm sorry - I did, at first say Prednisone - but the drug is Prednisolone and I've read that it is highly suggested over Prednisone.

[ArmaniMan]

Originally Posted by Ellie May

I'm very confused about all of this at best. How can a shunt be dx with just a biopsy? That is one reason why I don't know what to say about the pred. It doesn't even sound like there is a solid dx yet. If my dog had LS, I would give pred if (and only if) a specialist overseeing the liver told me that I should. If pred had to be given here and the liver function was a concern, prednisolone would be chosen first as far as I know.

I agree- I think this pup should see a specialist to get a definite diagnosis. If there is a shunt and surgery is possible you don't want to delay it and if surgery is not possible you want to have a specialist overseeing the long term care. Or- it could be something all together different. Once you have a good specialist overseeing this pups care, then i recommend you follow their advice.

[Ellie May]

That is better then. Still couldn't say why it was prescrbied to bring down liver values.

Have you seen a specialist yet? What are they saying? Do they think this steroid is a good idea? What supplements did they say to give?

When Ellie's high bile acids were first noticed, I was pretty much forced to go to an IMS after they got over a certain number. Now that we have settled on a protocol and such, her regular vet deals with it. That was only after the IMS said that she believed Ellie was in no danger.

[Ellie May]

The lepto vaccine - I had read something about research being done bec ause it seemed to be causing liver damage (the old vaccine). But when asking for clarification or what's going on in that research, I seem to get no answers. So I am very skeptical that that ever took place. Would love a link from pubmed about it b/c that's where it would be if it is peer reviewed and accepted. Very interesting. I just haven't found anything to back it up.

[Becca1]

Originally Posted by kjc

The main issues I have addressed in this thread are:

Is prednisone prescribed for dogs with liver disease?
Yes, but I have never seen it prescribed for dogs with a Liver Shunt for treatment a Liver Shunt.

Does the OP's dog have Liver Shunt?
The OP stated that Her dog had a liver biopsy and the result was Liver Shunt.

I have never heard of this, biopsies are done to rule out MVD and other disorders, not LS. Futher testing is needed to make a diagnosis.

Was a Bile Acid Test done?
The OP is unsure, but will ask her vet.

The dog's AST and ALT are/were very high.
These two values will become elevated when toxins are involved. (By toxins, I mean anything ingested to vaccines received.) In dogs that have Liver Shunt, these values are most often only mildly elevated. Vaccines, such as Lepto, can cause higher elevations of these liver enzymes, and the OP's dog has been repeatedly vaccinated against Lepto. Or maybe the dog has contracted Lepto.

Why is prednisone being prescribed?
To bring the AST and ALT levels down, per the OP. The problem with prednisone is that it suppresses the immune system. If this dog is fighting an infection, this could be an unwise decision.

Did I PM or telephone the OP?
No, I have not, but I am willing to talk with her over the phone or via PM, if she wants to. Just send me a PM.

I have to leave for a while, but let me know if I missed anything....

I am going to quote from the biopsy (done at Univ of MO at Columbia Vet Med School): Microscopic finding: Two liver biopsy samples were rec'd and each bisected; all of the pieces were put into cassette and processed for histological exam. The liver tissue had several histological abnormalities. There were numerous iron granulomas scattered randonly in the parenchma. Iron granulomas are focal collections of iron-filled macrophages. The portal tracts were much closer together throughout this liver than in the normal liver (hepatic atrophy) the portal tracts did not contain any profile of the hepatic vein. Each portal tract contained one or more branches of the bile duct, one or more branches of the hepatic artery and one or more collapsed endotheilal lined channels but no obvious branch of the portal vein. Final diagnosis: the histologocal changes in this liver are diagnostic of congenital portosystemic shunt.

Now, when my vet went in to get the liver tissue he noticed that her gallbladder was quite full of "sludge" and he cleaned that out. Prior to surgery she had been on Bactrim (???) I believe as an antibiotic, but she didn't tolerate that well, so following surgery he placed her on Metro and for about a week did quite well, but after another week of being on Metro, she started showing slight HE symptoms. Took her off Metro, placed her on a marin supplement and that's where we've been for 6 mo's -doing quite well. No further HE symptoms.

Just 2 weeks ago took her back for blood check and that's when we noticed her liver enzymes had elevated slightly and he decided to put her on the Prednisolone.

Her vaccines consisted of DHL/Rabies her first year; second year boosters were given; - 3 years old, began showing signs of liver disease, so has not had vaccines since 2009. Liver issues started roughly 6 mo's after last set of vaccines. There have not been BAT's done, but I will discuss this with our vet.

From what I have read, I am thinking this is an intrahepatic shunt and not an extrahepatic, so she's not a good candidate for surgery. This is my story and I feel blessed that she is doing as well as she is doing since I have read so many sad stories and so many are living with daily issues.

[Becca1]

This is what I picked up off the on-line Yahoo yorkie forums - it is interesting.

Corticosteroids

Corticosteroid therapy is indicated in treatment of chronic active hepatitis, cholangiohepatitis, and immune-mediated hepatopathies. Corticosteroids have several therapeutic benefits in liver disease. They reduce the inflammatory component of liver disease and arrest destruction of hepatocytes in chronic active hepatitis and immune-mediated hepatopathies by reducing tissue lymphocyte and plasma cell numbers. They may also be of value in reducing mild degrees of fibrosis. Corticosteroid use may lead to an increase in serum albumin levels and bile flow and may decrease serum transaminase levels.
The preferred corticosteroids are prednisone or prednisolone. Because corticosteroids are normally metabolized by the liver before renal excretion, the dosage must be carefully calculated to avoid signs of corticosteroid excess. In general, the starting dosage of prednisone for inflammatory liver disease in dogs is 0.5 mg/lb divided BID for 2-4 weeks, followed by a decrease in dosage by one-half at each of several ensuing 2-6 week intervals, until an alternate day remission dosage of 0.1 - 0.2 mg/lb is reached.
Long-term therapy is usually necessary for chronic active hepatitis. Reinstitution of therapy after a relapse is not often as successful in controlling the disease as the initial therapy. The course of therapy for cholangiohepatitis is variable (3-4 months to several years). Affected animals should be monitored by periodic recheck of blood chemistry profiles and bile acid assays and repeat liver biopsies where possible.

[TLC]

Wishing you the best.

After all that has been done though, I too am really shocked that your Vet opened her up for a liver biopsy and didn't even do a BAT first (very odd since you say he has liver disease experience). And during this, did you Vet look to see if he could see a shunt?

Although I have no idea, I doubt she has an intrahepatic shunt, as they are really more common in larger breed dogs. She could very well have MVD though.

I would insist on the BAT and I would get a referral for a Specialist at this point.