Liver Disease?

[Xenia]

Hi my little boy just turned 5 in january and is 5.8 pounds. Recently when he got his teeth cleaned, they also did his yearly checkup. They found a trace of PSS Protein in his urine. We had a Bile Acid test done afterwards.

Pre - 100
Post - 101

These numbers are so high, but the fact that they don't change much have me confused. I have seen others have numbers, but usually there is a much bigger difference. The vet has suggested and ultrasound and biopsy. I'm scared about doing the later.

Anyone have any advice? Thank you!

[Scoobstersmom]

Do you have other liver values, such as ALT or ALP? An ultrasound is a good next step as it is a non-invasive test. As far as the biopsy, I would ask your vet what they are looking for and what they expect to find, and how the results would change the treatment protocol. Liver disease (unless a shunt is suspected) is often treated the same way with meds, supplements and diet change. My yorkie had liver disease diagnosed at 2, and lived till 16. He did not have a biopsy. We treated with supplements, occasional antibiotics and diet change.

Diana

[MauiGirl]

Here is one of the best articles written about liver disease, and will help you understand what they might be looking for: http://www.vet.utk.edu/clinical/sacs...NAL-201304.pdf

I know how stressful it must be for you, but try to stay calm as you proceed with whatever tests are necessary to diagnose the problem and establish a treatment plan.

I went through this when Tiki was 7 months old, and had an ultrasound, which did not show a shunt (however, they don't always show up). I declined a biopsy, because the only purpose of that would be to confirm if she had MVD, which would be treated with medical management, diet and supplements. We chose to treat her "as if" MVD was present, and she is now almost 7 years old and doing just fine as long as we don't feed her to much protein or fat.

[Xenia]

Thank you Scoobstermom and MauiGirl! I was nearly in tears when the vet forwarded me his results.

So I should get more tests done. Should I just request a full liver panel for him? I heard some give theirs Sam-e and Milk Thistle as a supplement.

[Scoobstersmom]

Xenia, if pre-anesthesia blood work was done prior to the dental, then basic liver values would have been included. If they were elevated, I'd be surprised if your vet went forward with the dental without first investigating the cause of the liver issues.


A good next step would be a "sit down" with your vet to ask what he suspects as the cause of the elevated BATS. Elevated bile acids can be caused by a shunt or MVD (many little shunts within the liver) but there are other causes such as hepatitis, gall bladder disease or sludge, or problems with the pancreas. An ultrasound (with high resolution equipment and read by a board certified radiologist rather than your regular vet) is a good non invasive diagnostic tool and can provide information about the liver, kidneys, pancreas and gall bladder. Ultrasound guided needle biopsies of the liver are not terribly invasive but often come back with inconclusive results, but an open liver biopsy is major surgery, so I would be asking tough questions before agreeing and would want that type of surgery done in a specialty hospital and by a specialist.


If your dog appears well and is eating and otherwise acting normally, you might consider talking with your vet about changing your dog over to a low protein liver friendly diet and treating with supplements for 30 days or so and then repeating the bile acid test. Many types of liver disease are managed well with diet changes, supplements and medications, and many dogs live for years with well managed liver disease.


Both milk thistle and samE are good supplements for the liver. I used Denamarin for my dog. Denamarin is one pill that is a combination of milk thistle and samE. I ordered it from Amazon (no prescription required) at a good price and the convenience was worth it for me.


A helpful tip is to always ask for copies of all lab work and test results, and then to keep them in a file. My vet just emailed the copies directly to me. If your pup needs to see a vet on a weekend or at night when your vet is not available, it is useful to have those copies handy to take with you.


At this point, your vet is your best source of information. These are just some suggestions to bring up when you talk with him. I always found that the more informed I was when I talked to my vet, the better the conversations went.


Good luck with your pup, and please keep us posted.


Diana

[MauiGirl]

Originally Posted by Xenia

Thank you Scoobstermom and MauiGirl! I was nearly in tears when the vet forwarded me his results.

So I should get more tests done. Should I just request a full liver panel for him? I heard some give theirs Sam-e and Milk Thistle as a supplement.

I am sorry for the stress that this has brought on you. I can remember how devastated I was when I too was surprised with news that my pup could have a problem. I got so much support from YorkieTalk members at that time, and one of the most powerful things one member told me is "this is not a death sentence, this is something that can be managed". It took me a long time to relax and have confidence, and now Tiki is almost 7 and doing very well.

Scoobstersmom Diana has such good advice for you. Your vet will be your guide, but we are here to support you.

I am curious, was the pre-op blood work done on the day of dental cleaning in house, or was it a more extensive blood test that was sent out a week earlier? When was the bile acid test done, and was it done fasting? There certainly are a few things that can affect results.

[Scoobstersmom]

Good point, Maui Girl! I was wondering, if the BATS were done soon after the anesthesia, could that have also affected the results?


I'm surprised - if pre-anesthesia blood work was done - that a vet would go ahead with a dental before investigating the cause of the liver issues.


Diana

[MauiGirl]

Originally Posted by Scoobstersmom

Good point, Maui Girl! I was wondering, if the BATS were done soon after the anesthesia, could that have also affected the results?


I'm surprised - if pre-anesthesia blood work was done - that a vet would go ahead with a dental before investigating the cause of the liver issues.


Diana

That is unusual. The whole point of pre-op blood work is to make sure the pup is healthy before undergoing anesthesia. With Tiki I had a full panel drawn and sent out to a lab a week before her schedule spay, and when ALT and ALP were a bit elevated, they canceled surgery and then went ahead with bile acid testing and ultrasound. She was eventually cleared for spay after a year.

Those were frightening days, trying to diagnose. She seems so happy and healthy now I almost forget she is "liver challenged", until somebody comes along and shares some bacon or cheeseburger with her and she gets sick for a week or so. She did not do well with Denamarin; I tried to crush it and hide in her food, and if she detected the scent at all, she reused to eat. She was so thin, I gave it up, and she has been more normal since then.

[Scoobstersmom]

Maui Girl, if you were hiding the Denamarin in food, it probably wasn't doing what it needed to do anyway. It has to be given on an empty stomach, at least one hour before or two hours after meals. My little guy would never eat the chewables, so I got the little blue pill. I used to set it on my nightstand before I went to bed, and then when I woke up to use the john, I would pop it in his mouth. We were both half asleep at that point and he never fought it.

My little guy was diagnosed with liver disease when he was two. He had a chronic fungal infection in his lungs and was on oral Fluconazole off and on his whole life, and that medication is horrible on the liver. We finally let him go in October, at the age of 16. It was not related to his liver disease. With proper management, we were able to maintain his liver numbers fairly well. But that nasty fungus was in his bones as well and for so long that they were weak and ripe for arthritis to set in. When he got so uncomfortable getting around, I would not let him suffer. I sure miss that little guy!

Diana

[MauiGirl]

Scoobstersmom, sorry to hear your lil one had so much to deal with, but you sure did a good job of caring for him to reach 16 yrs. That is amazing, and something even healthier Yorkies are lucky to achieve. Was his liver disease MVD or something else?

[Scoobstersmom]

Thanks for the kind words, Maui Girl. No, he did not have MVD. He had chronic hepatitis caused by damage from medication. Later in his life he had some issues with his gall bladder and we added ursodial, which managed the gall bladder/bile flow issues. He had liver disease for 14 years. Maybe some kind of record. LOL


Diana

[Xenia]

Thank you for all the support and wonderful information. Scooter's pre blood work was completely normal. We mentioned he had been drinking a lot of water and vomiting a bit, so they did the urine test during the dental. A week after that they did the bile test.

101 - fasting
100 - two hours after eating fatty and high protein food.

He is scheduled to get an ultrasound with a radiologist later this week.

[Xenia]

Scooter got his ultrasound today and....

They still have no idea. I attached the report. They said the only off thing is that his liver looked "mottled". They gave us some Science Diet K/D and wants to retest him in 3 weeks. I'm at a bit of a loss since we do not have an answer.

Is there some sort of treat I can give him? I make treats from brown rice flour, flaxseed, egg, peanut butter pumpkin and oats. The girls can have them still, but the Vet said to stop everything. I feel so bad to give them treats and he won't be able to have any. Is there a K/D treat?

The radiologist suggested opening him up and taking out a part of his liver. No way am I going to put my baby through so much pain for a wild goose chase.

[MauiGirl]

Sorry you didn't get answers. I can understand not wanting to open him up for a liver biopsy. Even if they did find MVD, there is no surgery or cure for it, you would treat it with "medical management" low protein diet and perhaps supplements. He is a little guy, and surgery itself comes with risks. It will be interesting to see if things change just by diet.

As far as treats, my girls mainly only get green beans (cooked or frozen) for treats, and they love them. They also love a bit of sweet potato and surprisingly bites of Romain lettuce. I think veggies and maybe some fruits would be your best treat option.

[Scoobstersmom]

Xenia, I'm also sorry you didn't get the answers you were looking for. At the same time, the ultrasound report did not show any awful abnormalities either, so that is a good thing.


I'm a little confused as to why the K/D was prescribed rather than a hepatic diet. (Royal Canin makes a decent hepatic diet.) Were Scooter's kidney numbers (BUN - Creatinine) elevated? I know he had proteinuria. Was a UTI ruled out, which can often cause proteinuria? The diet thing confused me because liver diets are generally low in fat, and kidney diets are high in fat. If it's actually canned K/D you are feeding, you can slice it right out of the can into thin slices, bake it in the oven at 350 until it's crispy (20-30 minutes), cool, then break into treat sized pieces and use as treats. The pieces should be stored in the refrigerator in an airtight container. Many veggies and fruits are both liver and kidney friendly (green beans, sweet potato, leafy veggies like kale or spinach, small slices of peeled apple (no seeds), watermelon, etc), but if your vet said nothing but K/D, I'd be inclined to stick with that until you had the retest in a few weeks, which is a great idea.


Did your vet suggest Milk Thistle or Denamarin as a supplement for the liver?


In the ultrasound, it mentioned cholangiohepatitis. Hepatitis just means inflammation of the liver, and the cholangio is referring to inflammation of the bile ducts in the liver. Hepatitis is often managed with diet change, supplements like milk thistle or denamarin, and antibiotics. If there is inflammation in the bile ducts, Ursodial (generic for Actigall) is a good supplement but requires a prescription from your vet.


If your dog is eating and feeling well within himself, it seems like your vet is following a good course of treatment in changing the diet and repeating the labs in a few weeks. Funny thing about the liver numbers. One thing I noticed after dealing with liver disease in my dog for 14 years is that the numbers can climb rapidly, but also drop rapidly. You may see a huge change in just a few weeks.


Hope this helps. Sending good thoughts for your little guy!


Diana