Prednizone for liver disease?

[ladyjane]

Originally Posted by Ellie May

This case has always confused me too. If the blood hemolyzed, the BAT could be redone. The longer you wait to fix a shunt, the riskier it can get. All suspected liver shunt should be looked into by an internal medicine specialist.

In the case of very high bile acids, my girl's vet insisted on a specialist. Most general vets are good at what they do, but they aren't trained to handle this. They aren't trained to assess whether or not surgery is the best option. After an IMS sees a pup and says no surgery needed or whatever, then a general vet is usually able to manage the problem knowing what they are dealing with. The bile acids are really too high for just a general vet to be involved imo.

That is my concern. And, I agree that all "suspected" shunts should be referred out.

[kjc]

Originally Posted by ladyjane

Wow, it must really be messed up. I asked my vet about this and she looked at me like I had lost my mind....so I really need to have the information! I have looked and looked on the web and cannot find it.

No PC yet... but ask your vet then why, if having blood drawn that day, that it is always drawn before vaccines are administered?

LS normally causes a 3 fold increase in the ALT, most times followed by the AST rising. Anything over that, which is around 300-350, is more than likely caused by a toxin, which is anything foreign put into the body, either drugs, any vaccines, and anything by ingestion. Tink's ALT went to 600+ after she ate rancid grease. TLC's pup's ALT went to over 2000 (unknown reason), Madraga's Kiwi's ALT went to over 800+ after having all her vaccines and a Proheart vac all in one day. Just trends I'm seeing on YT.

Originally Posted by Ellie May

If this is about the lepto/liver thing, I really would like to see it too. I have been wondering about this for the last couple years now after seeing something on YT about it. It seems the lepto vaccine has become much safer recently, so I wonder if this was supposed to apply to just the old one or the new one too??

Mainly the old one, but can skyrocket if too many vacs are given together, which happens alot with the Lepto vac.

Originally Posted by ladyjane

KJC had said that the lepto vaccine causes liver enzymes to be higher than a liver shunt does. I honestly have never heard of that and just wondered where she read that.
My vet feels that the vaccine is ok to give, but only IF there is a possibility of exposure.
Just wanting more information.

I think the new lepto vac is okay (not absolutely sure and JMHO) as long as it is given separately and at least 4 weeks apart from any other vaccines. It will still need to be given every 6-8 months to be effective, and is not 100% preventative of getting Lepto, but can lessen the severity of the disease if exposed.

[Ellie May]

Toxins definitely can make the liver enzymes go up. Since there are adjuvants in vaccines (particularly killed vaccines like rabies), I would not be at all surprised if vaccines fell into this category. For bile acids, nobody knows the list of things that can make them go up fully (per E's IMS). But that wouldn't be just lepto. I don't see why lepto would be any worse? And I just haven't seen where in general vaccines make enzymes go up. Millions of dogs are vaccined in the US with enzymes WNL. I haven't seen any actual research to say this happens. Or anything to indicate that the lepto vaccine is more toxic to the liver??

Vaccines can and do cause harm. They are processed in chemicals. But there seems to be no evidence that they cause liver damage often.

Drawing blood before vaccinating isn't something I've paid attention to. I am pretty sure not all vets do that though.

[ladyjane]

Originally Posted by kjc

No PC yet... but ask your vet then why, if having blood drawn that day, that it is always drawn before vaccines are administered?

LS normally causes a 3 fold increase in the ALT, most times followed by the AST rising. Anything over that, which is around 300-350, is more than likely caused by a toxin, which is anything foreign put into the body, either drugs, any vaccines, and anything by ingestion. Tink's ALT went to 600+ after she ate rancid grease. TLC's pup's ALT went to over 2000 (unknown reason), Madraga's Kiwi's ALT went to over 800+ after having all her vaccines and a Proheart vac all in one day. Just trends I'm seeing on YT.



Mainly the old one, but can skyrocket if too many vacs are given together, which happens alot with the Lepto vac.



I think the new lepto vac is okay (not absolutely sure and JMHO) as long as it is given separately and at least 4 weeks apart from any other vaccines. It will still need to be given every 6-8 months to be effective, and is not 100% preventative of getting Lepto, but can lessen the severity of the disease if exposed.

You made the statement. I simply asked where you got the information. No reason for me to ask my vet such a question.

Trends on YT? You consider that research data?

Again you are claiming skyrocketing liver values after vaccines...where are you getting this from?

And, lastly, you have made broad sweeping claims about the lepto vaccine yet now you say you don't know.

Bottom line is that I believe now that you are making things up and that frightens me for people who read your posts. While you may feel things are not right about certain vaccines and treatments, I think you should stick with telling people that it is your feelings and not real data. You are intelligent and you write well...that will tend to give people the idea that what you are saying is fact. Surely you would not want someone to follow your lead and not vaccinate and then lose their pup to a disease?? I believe you mean well..I just think you need to think about that. Just my humble opinion.

[kjc]

Hi... Kathy here. You have a problem. I have the same problem.

I also have a 4 YO female that I have been treating (per my vet) with L/D, antibiotics, Lactulose, and Denamarin, going on 2 years come this May. She's doing great, just an occasional UTI... or so I thought.

When I brought Tinkerbell home, I found out she had already been tested for liver enzymes. Her results showed a need for further testing, so a BAT was scheduled. Her numbers came in slightly (40/126) elevated, but were indicative of Liver Shunt (anything over 100 post = shunt per U of Tenn). My vet said to try her on the low protein food (not prescription) and meds (Lactulose and Denamarin). After 6 months, she had H.E. and was brought out of it with the Lactulose, then was put on a prescription diet, L/D. All else was kept the same.

So now another year has come and gone, and Tink is acting great. Hyper, playful, you-would-never-know-she-has-a-shunt, normal. No more H.E. Nothing except 1 or 2 UTIs. So I try to help others on here and I meet LittleLilly. And I see she has LS and Kidney Stones. They do not show up on xray, but do show up on Ultrasound. I thought it was best to wait and do the U/S at the same time I was going to schedule her surgery, but that was wrong. I needed to find out what shape her kidneys were in. So we did, and she has Kidney stones. Now I know.

This is what happens to dogs with Liver Shunt:

They eat food. Their liver cannot process the amonia and other waste products left over from the digestion process, so it gets passed on to the kidneys. The amonia changes the environment in the dog's kidneys making it able to produce kidney stones (amonium urates in LS dogs). Lactulose helps to bind the amonia in the intestines so they poop it out without going through the kidneys, but some still gets through, so it only slows down the process. They will still produce kidney stones eventually.

Once the Liver Shunt is repaired, the process of excess amonia stops, and the kidneys stop producing stones. Whatever damage was done to the liver goes away because the liver can regenerate itself once the bloodflow is restored. I don't know if kidneys regenerate or repair themselves. So the trick is, the shunt has to be fixed before the kidneys become permanently damaged.

Originally Posted by Becca1

Received Lexie's BAT results and they were kind of shocking, especially since she is showing no symptoms. - Pre: 159 and Post: 380. My vet and I discussed this at length and basically our plan is to do nothing at this time. Does that seem crazy??? I talked to him about her being on Prednisolone prior to drawing her blood (but I didn't have her on this therapy but for about a week before at 1/2 tab every other day); he didn't think that amount would make these numbers high. I had read that it could.

Yes, you need to get an ultrasound to see if she has stones, to find the shunt, and get her on Lactulose immediately, if she's not on it now.

Originally Posted by Becca1

Thanks for your ideas; however, she's eating well, has put on great weight, plays, sleeps and is comfortable, I think I can get on it if things change. We will recheck her numbers; my vet and I discussed getting her to a specialist if something changes. Has anyone else out there gone further just because numbers were high - or has there been extinuating circumstances such as how the dog is feeling and acting?

Yes...ME!

Tink had another BAT in Aug/Sept 2010. 267.5 pre/ 297.9 post. The BAT tests the actual Liver function. No change at all in her bahavior. Still bouncing off the walls. Dogs' livers can still function even if only 25% or less of the entire liver is actually working. And it will regenerate itself.

Tink recently had another UTI, and after reading LittleLilly's story I began to worry about kidney stones, so I immediately scheduled an Ultrasound to see how she was really doing. As I said, she does have stones, and as these can cause problems, I need to get her LS taken care of STAT, before her kidneys go....

So... you need to move on this... get her on the Lactulose, get the Ultrasound, and schedule the surgery. Lactulose first, though.

Here's my thread: http://www.yorkietalk.com/forums/sic...g-results.html

I hope this helps and wish you the best....Kathy

[kjc]

Originally Posted by ladyjane

You made the statement. I simply asked where you got the information. No reason for me to ask my vet such a question.

Trends on YT? You consider that research data?

Again you are claiming skyrocketing liver values after vaccines...where are you getting this from?

And, lastly, you have made broad sweeping claims about the lepto vaccine yet now you say you don't know.

Bottom line is that I believe now that you are making things up and that frightens me for people who read your posts. While you may feel things are not right about certain vaccines and treatments, I think you should stick with telling people that it is your feelings and not real data. You are intelligent and you write well...that will tend to give people the idea that what you are saying is fact. Surely you would not want someone to follow your lead and not vaccinate and then lose their pup to a disease?? I believe you mean well..I just think you need to think about that. Just my humble opinion.

Got it, thanks.

I did say the 'old' lepto vac was causing problems, and the new one I thought was better, but I am not sure about the 'new' one because the 'new' one hasn't been around long enough....

I think this is the article:

The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine

[ladyjane]

Originally Posted by kjc

Got it, thanks.

I did say the 'old' lepto vac was causing problems, and the new one I thought was better, but I am not sure about the 'new' one because the 'new' one hasn't been around long enough....

I think this is the article:

The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine

I see nothing in that article that says that the lepto vaccine causes higher elevations in liver enzymes than liver shunt. That was the statement that you had made. I simply asked for the source.

I am quite finished with this. Bottom line it is not true unless proven in my book and you have not proven it. My main concern is that people will read something like that and fear the lepto vaccine. Period. This is scary to me. Someone might listen and their pup end up with lepto because they were frightened that the pup would have liver failure if it was given the vaccine. I am not trying to be a nudge....merely trying to help people in their decision making processes. There are many people on yt who believe anything they read.....for some reason people have a tendency to read the things on the internet as gospel no matter what. Just like the study done recently with the kids and the tree octopus...there is no such thing but because the website looked real, they all believed it. I just think we all need to be careful about what we write. JMHO

[Becca1]

Originally Posted by 107barney

Hi Becca,

Hemolysis can affect BATs, but not to the degree where your #s would be as high as they are.

I do think a consult with a Board Certified Internist would be worth your while. I think you more specific information and a second opinion from someone with advanced training. MVD #s are usually not that high. Feeling good or not, the liver is not functioning well and your dog should be in the care of a specialist. Yes, I take my dogs to specialists even when they are feeling good if the blood work isn't right.....I just posted about my Barney in another thread and I took him to an internist just because he had two mild abnormalities on his blood work.

Good luck.

Thank you and glad to know you take yours to a specialist if only the bloodwork is off. We are going to re-run the BATs and if the numbers are still high, I will go to Univ of MO Vet school for specialist which is fairly close to where we live.

[Becca1]

Originally Posted by kjc

Hi... Kathy here. You have a problem. I have the same problem.

I also have a 4 YO female that I have been treating (per my vet) with L/D, antibiotics, Lactulose, and Denamarin, going on 2 years come this May. She's doing great, just an occasional UTI... or so I thought.

When I brought Tinkerbell home, I found out she had already been tested for liver enzymes. Her results showed a need for further testing, so a BAT was scheduled. Her numbers came in slightly (40/126) elevated, but were indicative of Liver Shunt (anything over 100 post = shunt per U of Tenn). My vet said to try her on the low protein food (not prescription) and meds (Lactulose and Denamarin). After 6 months, she had H.E. and was brought out of it with the Lactulose, then was put on a prescription diet, L/D. All else was kept the same.

So now another year has come and gone, and Tink is acting great. Hyper, playful, you-would-never-know-she-has-a-shunt, normal. No more H.E. Nothing except 1 or 2 UTIs. So I try to help others on here and I meet LittleLilly. And I see she has LS and Kidney Stones. They do not show up on xray, but do show up on Ultrasound. I thought it was best to wait and do the U/S at the same time I was going to schedule her surgery, but that was wrong. I needed to find out what shape her kidneys were in. So we did, and she has Kidney stones. Now I know.

This is what happens to dogs with Liver Shunt:

They eat food. Their liver cannot process the amonia and other waste products left over from the digestion process, so it gets passed on to the kidneys. The amonia changes the environment in the dog's kidneys making it able to produce kidney stones (amonium urates in LS dogs). Lactulose helps to bind the amonia in the intestines so they poop it out without going through the kidneys, but some still gets through, so it only slows down the process. They will still produce kidney stones eventually.

Once the Liver Shunt is repaired, the process of excess amonia stops, and the kidneys stop producing stones. Whatever damage was done to the liver goes away because the liver can regenerate itself once the bloodflow is restored. I don't know if kidneys regenerate or repair themselves. So the trick is, the shunt has to be fixed before the kidneys become permanently damaged.





Yes, you need to get an ultrasound to see if she has stones, to find the shunt, and get her on Lactulose immediately, if she's not on it now.



Yes...ME!

Tink had another BAT in Aug/Sept 2010. 267.5 pre/ 297.9 post. The BAT tests the actual Liver function. No change at all in her bahavior. Still bouncing off the walls. Dogs' livers can still function even if only 25% or less of the entire liver is actually working. And it will regenerate itself.

Tink recently had another UTI, and after reading LittleLilly's story I began to worry about kidney stones, so I immediately scheduled an Ultrasound to see how she was really doing. As I said, she does have stones, and as these can cause problems, I need to get her LS taken care of STAT, before her kidneys go....

So... you need to move on this... get her on the Lactulose, get the Ultrasound, and schedule the surgery. Lactulose first, though.

Here's my thread: http://www.yorkietalk.com/forums/sic...g-results.html

I hope this helps and wish you the best....Kathy

Thanks - as I stated to Cathy - we are going to re-run BATs and then move on to a specialist. You guys have convinced me and I appreciate everyone sharing their knowledge. Becca

[107barney]

Originally Posted by kjc

I don't know if kidneys regenerate or repair themselves.

Ok I really had to dust off my memory for this one but I think I remember it. Ellie May probably knows it off the top of her head in more detail but here goes...

The kidney in fish can completely regenerate but in mammals it is limited. The reason the liver can regenerate is due to it having unique cells called hepatocytes. Hepatocytes are unipotent cells, meaning they have a characteristic where they can regenerate themselves. Part of the skin is also an example of a unipotent cell.

I believe there are some kidney components that can regenerate but the regnereation biology is not like that of the liver.

[kjc]

Originally Posted by kjc

Concerning the elevated AST and ALT: These values can also increase due to toxins (general term) and by that I mean anything from the dog ingesting mushrooms to getting too many vaccines at one time... and everything inbetween.

http://veterinarymedicine.dvm360.com/vetmed/article/articleDetail.jsp?id=325515&pageID=1&sk=&date=
Increases in serum liver enzyme activities are sensitive indicators of hepatobiliary disease, but these activities can be elevated secondary to various endocrinopathies, gastrointestinal disease, pancreatic disease, systemic disease, and enzyme induction. In asymptomatic patients, a systematic approach is required to obtain a definitive diagnosis. A careful review of the patient's history is essential to uncover vague clinical signs that the owner may have missed and to identify any potential exposure to hepatotoxic agents.

Originally Posted by kjc

I am not a vet.

Originally Posted by kjc

The 'L' Part of the DHL vaccine is Lepto, and is not recommended for use in small dogs... and can cause liver and/or kidney damage. Vaccine reactions (acute and chronic) are treated with prednisone.

Leptospirosis in Dogs How They Catch It, How We Cure It, How We Prevent It

Vaccination:
Your other option is to have your pet vaccinated. The American Animal Hospital Association (AAHA) considers leptospirosis vaccine a “non-core” vaccine for dogs. That is, they do not recommend pets receive it unless there is a good chance they will be exposed to leptospirosis. The main reason for this is that veterinarians see more vaccination reactions following the administration of vaccines containing leptospirosis than any other vaccines. These reactions range from the minor inconveniences of pain at injection site, facial swelling and hives to a fatal anaphylactic reaction. Which pet will experience them cannot be predicted.
... Hopefully, this is a safer product than the old lepto vaccines. No vaccination is without risk.
So you and your veterinarian must decide if your pet’s risk of catching leptospirosis justifies yearly vaccination. In making that decision you must ask if your pet frequents areas that may harbor leptospirosis. You must also know if leptospirosis is occurring frequently in your community.
You must also consider if your pet, or its siblings, have had previous vaccination reactions. Reactions also seem to occur more frequently in smaller breeds than larger ones.

Canine vaccine update (Proceedings) - Veterinary Healthcare=

Canine vaccine update (Proceedings)

Which ones? How often?
http://veterinarycalendar.dvm360.com.../clear_dot.gifApr 1, 2008
By: Craig Datz, DVM
CVC IN BALTIMORE PROCEEDINGS

http://veterinarycalendar.dvm360.com...ource_2363.jpg

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Practitioners often ask if leptospirosis is a problem in their practice area and whether routine vaccination is worthwhile. The risk:benefit ratio is a little different for lepto vaccines than for other products, as acute anaphylaxis in puppies, toy breeds and small dogs is more common. ... Otherwise, lepto may be safely omitted from routine protocols. No vaccine is 100% protective and there is a potential for infection by other serovars not covered in the vaccines (such as bratislava and autumnalis).

Originally Posted by kjc

The main issues I have addressed in this thread are:

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.

The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities - Veterinary Medicine=

Although elevated serum hepatobiliary enzyme activities are frequently identified, they do not necessarily indicate clinically important hepatic disease. There are several reasons for this discordance. First, increased serum hepatobiliary enzyme activity can originate from nonhepatic tissues. Second, the liver's dual blood supply and large blood flow make it uniquely sensitive to injury due to systemic disorders and diseases in organ systems drained by the portal circulation, particularly the gastrointestinal tract and the pancreas. Finally, drugs can induce excess hepatobiliary enzyme production in the absence of liver damage

Increases in serum ALT activity are considered liver-specific in dogs. ALT activity can increase with severe muscle necrosis,... ...Serum ALT activity may also increase because of induction of enzyme synthesis by corticosteroid use...

Pertinent historical information includes the administration of any potentially hepatotoxic drugs, supplements, or nutraceuticals; exposure to any environmental toxins or infectious agents; recent anesthetic events; and details on housing, supervision outdoors, travel, and vaccination status. Carefully question owners about any possible vague signs of underlying disease such as intermittent gastrointestinal signs (e.g. vomiting, diarrhea, weight loss), behavioral changes, polyuria or polydipsia, or exercise intolerance. In the case of primary hepatobiliary disease, clinical signs may not be apparent until the disease process is advanced because of the liver's large regenerative capacity and functional reserve.


In patients with portosystemic shunts, twofold to threefold increases in serum ALP, ALT, and AST activities have been recorded ...

[Therefore, increases over twofold to threefold are more likely to be caused by toxins, drugs, vaccines, or other foreign vectors not found naturally occuring in the body. Note: there may be exceptions to this statement. -KJC]

[107barney]

The article cited by KJC was" The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities"

I disagree with KJC's inferences and conclusions overall.

I also wanted to point out that the article above DOES NOT mention the word "leptospirosis" one time.

KJC research is good, but it is not going to fix your or others' dogs. Yes the liver regenerates itself, but not in the face of structure abnormalities like a liver shunt. It's like putting a piece of plastic over your house when your roof blew off. You have to fix the roof, and there is no way around it.

[ladyjane]

Originally Posted by 107barney

The article cited by KJC was" The diagnostic approach to asymptomatic dogs with elevated liver enzyme activities"

I disagree with KJC's inferences and conclusions overall.

I also wanted to point out that the article above DOES NOT mention the word "leptospirosis" one time.

KJC research is good, but it is not going to fix your or others' dogs. Yes the liver regenerates itself, but not in the face of structure abnormalities like a liver shunt. It's like putting a piece of plastic over your house when your roof blew off. You have to fix the roof, and there is no way around it.

Pretty much my thoughts on all of this.

[Ellie May]

I agree with you KJC in that all drugs can potentially cause enzyme number changes and/or damage to the liver and/or kidneys because drugs are metabolized to the greatest extent by these organs.

But I've seen nothing that would indicate that vaccines do this to a greater extent. It would also have to be rare because otherwise every vaccinated dog would be walking around with high liver enzymes. There is also nothing indicating that lepto is the worst on the liver or that it increases liver enzymes more than the rest. I guess that goes along with remembering that all drugs have the potential to do strange things to the body and a veterinarian should assess whether or not there is enough benefit before using them. In hte case of most vaccines and for most dogs, it is worth it.

The two to three fold thing is interesting. I'm not so sure that toxins almost always make liver enzymes skyrocket though. This is something I will have a talk with E's vet about when I get a chance because I'm sure she has treated things like this many times.

[107barney]

Originally Posted by Ellie May

I agree with you KJC in that all drugs can potentially cause enzyme number changes and/or damage to the liver and/or kidneys because drugs are metabolized to the greatest extent by these organs.

But I've seen nothing that would indicate that vaccines do this to a greater extent. It would also have to be rare because otherwise every vaccinated dog would be walking around with high liver enzymes. There is also nothing indicating that lepto is the worst on the liver or that it increases liver enzymes more than the rest. I guess that goes along with remembering that all drugs have the potential to do strange things to the body and a veterinarian should assess whether or not there is enough benefit before using them. In hte case of most vaccines and for most dogs, it is worth it.

The two to three fold thing is interesting. I'm not so sure that toxins almost always make liver enzymes skyrocket though. This is something I will have a talk with E's vet about when I get a chance because I'm sure she has treated things like this many times.

That was KJC's conclusion of the article and not what the article stated.

The article stated that in cases of asymptomatic elevated liver enzymes, a diagnostic approach includes assessing breed disposition to liver shunt, since dogs with liver shunts are noted to have a twofold to threefold elevation. The article did not suggest in any way shape or form that vaccination was the cause of these elevations. In fact the only reference to vaccination AT ALL in that article was that the clinician should note the vaccination status of the animal, something that is done routinely by all vets. So I did not read that article as being about vaccination, but about guiding a practitioner to diagnosis when the clinical picture is showing elevations.

The part of the article referencing the two to three fold elevation in liver enzymes in dogs with single PSS referred to the following article as support for that proposition -

Allen L, Stobie D, Mauldin GN, et al. Clinicopathologic features of dogs with hepatic microvascular dysplasia with and without portosystemic shunts: 42 cases (1991-1996). J Am Vet Med Assoc 1999;214:218-220. Available abstract at http://www.ncbi.nlm.nih.gov/pubmed/9926012

The conclusion was that dogs with shunts have higher elevations than dogs with MVD alone and had nothing to do with vaccines! It further never mentions Leptospirosis from what I can see without a pubmed subscription.