Prednizone for liver disease?

[kjc]

Originally Posted by ladyjane

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.

Sorry I'm so late in getting back... I couldn't find the link, I'm using a temp PC now, when I get my PC back, I think I saved it on there.

[kjc]

Okay.... After trying to find the info for LJ, I came across something I find a bit odd... the protocol your vet seems to be following is the same as for Copper Storage Disease, which can affect all dogs, but is rare in Yorkies, is normally associated with Bedlington Terriers. It is treated with prednisolone, every other day and treatment can continue for 6 months to a year. Additional biopsies are required to monitor the copper levels. L/D is low in copper and is food of choice, as these dogs also have problems associated with amonia (also in LS dogs) taking Lactulose will benefit them also. BATs are recommended.
This would explain the elevated AST and ALT values. Also read that corticosteriods will cause elevations in these liver enzymes (and can influence the BAT results). Usually with Liver Shunt, 3 or more of the Liver enzymes are elevated.

Not saying that your pup doesn't have a shunt, but there is definitely something else going on also. And one thing my vet did say, is that basically all liver disease is treated very similarly.

I agree with TLC though... why did't your vet look for a shunt while he was in there... but as more biopsies will be done, he'll have an opportunity to look again next time.... and intrahepatic shunts are found in large breed dogs (not that there isn't a first time).... probably not worth doing the BAT with her being on prednisolone as results will be higher than they really are), Gall Bladder sludge can cause problems too with test results and ammonia processing.

Also with the Metronidazole, some dogs don't tolerate it at all.

Definitely interesting case... Hope your baby is doing well and pulls through with flying colors! Keep posting updates... I'll be watching....

[kjc]

Found this article of interest:

Veterinary Healthcare - Emerging liver diseases (Proceedings)

[Becca1]

Originally Posted by 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.

Yes, our vet did x-rays and ultrasound for shunt and did not see evidence of one from viewing. I do not know why he has chose not to do the BAT's, but I will ask (he has been out of town this week). Thanks for your thoughts.

[Becca1]

Originally Posted by kjc

Found this article of interest:

Veterinary Healthcare - Emerging liver diseases (Proceedings)

Excellent article. I am going to forward this to my vet - there may definitely be something associated with our Yorkie and this article - it's worth a look. - Thanks!!

[107barney]

Did your vet do only a biopsy or did he do exploratory surgery? If doing a minimally invasive biopsy, it does not surprise me that he did not find a shunt because it was probably done either by ultrasound-guided needle biopsy or minimally invasive surgery (laparoscopy). Larger samples and such and more digging around would be done with full open exploratory surgery - a much more invasive procedure. It's been many years since I talked about these issues with Daisy's doctors but from what I recall, they were different surgical procedures depending on the goal.

I don't necessarily agree that there is a problem that your vet did not do BATs. Blood work and clinical findings are read as a whole in determination of the next steps. When Barney had a persistent elevation of a certain liver enzyme, the next step was a biopsy if the mild elevation of this certain liver enzyme continued. No one talked about BATs. This was a course of action recommended by my general vet. I got a second opinion from Daisy's internist and he said Barney's biopsy was not warranted just yet. They determined this based on Barney's blood work as a whole, his veterinary history, his clinical presentation upon physical examination, his current state of being, and other factors.

I see no reason why you could not ask your vet about some of the things other posters have suggested. Personally, I'd be making sure I consulted with a bd. cert. vet internist as you will cut to the chase faster and get the answers to all of it really quickly. I like to think of my general vet as Grand Central Station. Sometimes I get off the train there, and sometimes I need to change trains and go somewhere else. The thing is, my general vet has all the directions I need to choose the right train and to help me to get to my destination. Sometimes I know what to do based on my experience, but most of the time I don't. Corny analogy but true, I probably should not share that thought with my vet though.

[kjc]

Originally Posted by Becca1

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.

Sounds like an exploratory was done, not ultrasound-guided needle biopsy or minimally invasive surgery (laparoscopy).

[Becca1]

Originally Posted by 107barney

Did your vet do only a biopsy or did he do exploratory surgery? If doing a minimally invasive biopsy, it does not surprise me that he did not find a shunt because it was probably done either by ultrasound-guided needle biopsy or minimally invasive surgery (laparoscopy). Larger samples and such and more digging around would be done with full open exploratory surgery - a much more invasive procedure. It's been many years since I talked about these issues with Daisy's doctors but from what I recall, they were different surgical procedures depending on the goal.

I don't necessarily agree that there is a problem that your vet did not do BATs. Blood work and clinical findings are read as a whole in determination of the next steps. When Barney had a persistent elevation of a certain liver enzyme, the next step was a biopsy if the mild elevation of this certain liver enzyme continued. No one talked about BATs. This was a course of action recommended by my general vet. I got a second opinion from Daisy's internist and he said Barney's biopsy was not warranted just yet. They determined this based on Barney's blood work as a whole, his veterinary history, his clinical presentation upon physical examination, his current state of being, and other factors.

I see no reason why you could not ask your vet about some of the things other posters have suggested. Personally, I'd be making sure I consulted with a bd. cert. vet internist as you will cut to the chase faster and get the answers to all of it really quickly. I like to think of my general vet as Grand Central Station. Sometimes I get off the train there, and sometimes I need to change trains and go somewhere else. The thing is, my general vet has all the directions I need to choose the right train and to help me to get to my destination. Sometimes I know what to do based on my experience, but most of the time I don't. Corny analogy but true, I probably should not share that thought with my vet though.

Oh, its a great analogy - just like we now use general practitioner doctors that guide us to the specialists. I remember my vet saying he didn't feel he could get enough of the liver tissue samples with a needle biopsy and did something a bit more invasive - her scar was at least as long as when she had her hysterectomy. He said once he did open her up he noticed her gallbladder being full - I don't believe he saw a shunt - at least he didn't say so. I do also remember that we did bloodwork quite often and he would check her levels and since they were not coming down where he thought they should be, is when he decided on the biopsy. He was glad to know what the biopsy showed, (and at least it was not a cancer problem) but it really didn't change his course of treatment since he did like using the metro, but once that drug didn't work, we took her off that and just used the marin supplement and K/D.

I have my notes ready to speak with him next week. Thanks for your thoughts.

[ladyjane]

Originally Posted by Becca1

Oh, its a great analogy - just like we now use general practitioner doctors that guide us to the specialists. I remember my vet saying he didn't feel he could get enough of the liver tissue samples with a needle biopsy and did something a bit more invasive - her scar was at least as long as when she had her hysterectomy. He said once he did open her up he noticed her gallbladder being full - I don't believe he saw a shunt - at least he didn't say so. I do also remember that we did bloodwork quite often and he would check her levels and since they were not coming down where he thought they should be, is when he decided on the biopsy. He was glad to know what the biopsy showed, (and at least it was not a cancer problem) but it really didn't change his course of treatment since he did like using the metro, but once that drug didn't work, we took her off that and just used the marin supplement and K/D.

I have my notes ready to speak with him next week. Thanks for your thoughts.

Now I am really confused. Who diagnosed the shunt?

[kjc]

Originally Posted by 107barney

The new Lepto vaccine has been around since 2004. This OP's dog is only 4 years old. Unless the vet is cheap and outmoded, I'd assume they woudl use the most up-to-date vaccines and protocols (another reason I stick with AAHA vets by the way who at least have some objective standards they follow). I do suppose that a vet could deem one product to be better based on the serovars showing up in diseased animals in that particular geographic area so maybe that is part of the individualized assessment of risk and benefit that a professional does.

I think I remember reading that the human vaccine was developed in 2004, the canine vaccine didn't come out till 2009. (I Googled 'Leptosporosis')

Originally Posted by 107barney

But I have to say, I've never heard of a vaccine creating a liver shunt. I'd like to ask my vets about this one, but would want to point to at least some credible or reliable veterinary source (such as a peer reviewed journal article) as a springboard for the discussion. If one such reliable source exists, I'd like to read it to learn more about this.

I've never heard of this either. Where did you find that statement?

Originally Posted by Becca1

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.

The fact that one of your vets is treating his own dog that has liver issues is reassuring. Instead of changing vets, as I previously suggested, you could always ask to have a BC liver Specialist brought in to access and review your pup's case with your current vets.

[kjc]

Originally Posted by ladyjane

Now I am really confused. Who diagnosed the shunt?

The lab... from the biopsy... (post #43)


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.

[107barney]

[QUOTE=kjc;3425177]I think I remember reading that the human vaccine was developed in 2004, the canine vaccine didn't come out till 2009. (I Googled 'Leptosporosis')


Here are some links including one announced at a vet continuing education informing vets of the new product.

Leptospira Vaccine - DVM

This guy who is a vet also talks about it
Leptospirosis in Dogs How They Catch It, How We Cure It, How We Prevent It

In 2008, Fort Dodge came out with this pet owner information site on lepto as well.
Canine Lepto Disease

[Becca1]

Originally Posted by ladyjane

Now I am really confused. Who diagnosed the shunt?

The diagnosis of congenital portosystemic shunt was stated on the Univ. of MO results of the biopsy

[Becca1]

Originally Posted by kjc

The lab... from the biopsy... (post #43)


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.

Thanks. You re-stated better than I.

[ladyjane]

Originally Posted by Becca1

The diagnosis of congenital portosystemic shunt was stated on the Univ. of MO results of the biopsy

OK...so exploratory was done when the biopsy was done and there was no shunt; so they are treating it as MVD??? I believe that the histiological changes in the liver could be either and since there was no external shunt seen the diagnosis of MVD??.