Abnormal Labwork AGAIN! :(
 

I think there may be a few of you following this, but I just had Bella's labwork re-checked this morning. Instead of just the smaller panel they do for pre-op blood work, I had them do a full Chem panel and a CBC (they also did pre and post BAT, but I won't get those results until the end of the week since they send them off).

She had a Low Granulosites count (which apparently is a kind of WBC). It was 2.90 and normal is 3.30-12.00. I asked the physician I work with here about it, and he said that it was only a touch low and that he would really only be worried about it UNLESS it was high. (Her WBC count was normal....6.30 in a range of 6.00-16.90....so I guess really low normal, but still normal.)

She also had a Low Amylase (460 with a normal range of 500-1500). The same physician said this is a Pancreas marker, and that again, he would only worry about it if it were high. I wonder why this (and the Granulosites too) were low, though?? Especially since both have a pretty big range of normal, and she is just below the low end of normal for both.....?? Weird.

And AGAIN, her ALT is high! :( A little over 2 wks ago, her pre-op blood work had her ALT at 302 (with a normal range of 10-100). This morning, her ALT was 347 (same normal range)!!! She hasn't had any form of medication at all since 2 wks ago....all she has had is her food, and some people food too (cottage cheese, chicken, veggies....but only in very small amounts). The physician that works with me asked what the vet said about it (I haven't talked to him yet, though) and then said that since all her other Liver Enzymes are normal and her BUN and Creatinine are normal, he probably wouldn't really worry about it......

I guess I'll just have to wait and see what the BAT says. *sigh I was so hoping that ALT would have at the very least gone down considerably if not be normal. I wonder why one Liver Enzyme would be so crazy-high will all the others being normal.....that's just odd to me.

Any thoughts??? Anyone know if a low Amylase should have me concerned at all??

(If her BAT comes back abnormal, I will have them do a Protein C test....I've already discussed that with them. THEN, if that is indicative of either MVD or PSVA, I'll find a specialist and we'll deal. Maybe I'll get REALLY lucky and the BAT will be normal......but, if I didn't have bad luck I'd have no luck at all :rolleyes:, so I won't be holding my breath.)

Well....ALT measures the level of liver enzymes found in the blood...which means her liver is leaking the enzymes. I know you're done the BAT...and personally I would've had that completed too...cause I would really want to eliminate a shunt and would proceed from there to determine if her liver is functioning properly....

Best wishes for Bella.

Thank you for your best wishes. :) What is so confusing to me is why her ALT (Alanin Aminotransferase) is sooo abnormal when her other liver enzymes (especially Alkaline Phospate [ALKP]) are perfectly normal!?

Also, I looked up "Amylase" online and found this on Yahoo Health: "Babies have little or no amylase at birth. By the end of the first year, a baby's amylase level is the same as an adult's level." Of course, they are talking about humans, but maybe it's the same in dogs.....she's only 7 mo. old, so maybe that's why her value is a little low??? I know all the normal ranges on both sets of blood work have been for adult dogs, so my guess is that this is actually normal for her.

Did she end up getting spayed anyway or did you hold off?

I would personally be very concerned with an ALT 3 times the highest it should be in a Yorkie. I think the bile acids test will tell you a lot but even if it's not that, I would look for answers in other testing. Something just doesn't seem right.:(

Ellie's amylase was about that too and it went back up.
Her vet wasn't concerned either.

She did get spayed.....I wasn't told about the sky hight ALT until I went to pick her up and the vet gave me a copy of her labs as I had requested. I saw the value and had to ask about it, since when he called me BEFORE HER SURGERY, he ONLY mentioned that she was slightly dehydrated, probably because she had been NPO for 14 or so hours, and that her BUN was slightly high, probably from the dehydration!! He did NOT say anything about her ALT at all, and when I asked him about it, he said that it wasn't anything to worry about since the other liver enzymes were normal. I couldn't believe he didn't tell me before her surgery or that he didn't suggest any further testing, especially since she is a Yorkie! (Remember, this is the vet that messed up removing her dewclaws....one partially grew back and had to be re-done. He isn't her regular vet.)

So, if her BAT comes back normal, would you go ahead with the Protein C?? Or would you want to consult with a specialist anyway to figure out why it is sooooo high?

Oh, and thanks for sharing about Ellie's amylase levels being low too, and then going back up to normal. That's very reassuring!

If her bat comes back normal....I wouldn't do the protein C test, but I would see a specialist because obviously something is damaging her liver. The fact hers is steadily increasing would concern me.

I thought that was the case...just so many cases of liver issues on here that they get mixed up sometimes. I would be very :mad: with the vet because with an ALT that high, he should have waited in case she needs LS surgery. The spay could've been done at the same time. A liver biopsy would be optional with high bile acids...not really necessary though...and that could've been done also.

If the BAT is normal, there is really no reason to do a Protein C test but she does need further testing. If your vet is not comfortable trying to figure this out, I would go to a specialist.

^^^ I am very mad!! Especially since she could have been saved going under anesthesia again (if she needs to)....that was the whole point of having it all done at once!

Part of it is my fault, really, because I should have found out about all this sooner and had her BAT's done long ago, that way she could have been spayed before her 1st heat AND had anything else that needed doing done too (including shunt surgery)..... *sigh, I guess better late than never, though. I AM still mad at him, though, because it's his JOB to know these things!!! I really shouldn't HAVE to find everything out on my own, but alas....

I am sorry her results are off again. The vet should have told you about the alt being high before surgery. When Cali's BAT came back high we retested and then did an ulrtrasound and then the liver biopsy was done when she was spayed. I did have her under the care of a specialist as she had other problems. If Her BAT's come back high I personally take her to an internal medicine specialist. Keep us posted and I will keep her in my prayers.

Just got my baby's BAT back
 

Resting SBA = 243.0 (Reference Range: <13)
Post-Prandial SBA = 72.6 (R.R.: < 25)

I'm a little puzzled why the Resting is so high....she hadn't had anything to eat since the night before and they drew the labs at 7am???

Again, her 1st set of labs on 10/31 came back with ALT = 302...essentially, everything else (BUN, Creatinine, ALKPH, etc...) was normal.
Her 2nd set of labs on 11/17 came back with ALT = 347....again with essentially everything else normal.

So, what do the experts think?? What should be my next step? Protein C? I haven't done a urinalysis since it hasn't been recommended to me AND since her BUN and Creatinine have been normal. Maybe I should??

Should I get her started on a low protein diet? I'm leaning toward yes....

Well, I'm no expert but I would probably do a Protein C test next.
Ninety-five percent of dogs with liver shunt have high preprandial bile acids.
High readings can sometimes from the gallbladder contracting but that is way too high.

If it were my dog she would go on a low protein diet and supplements immediately.

I'm sorry. :)
Are you okay?

I'm hanging in there...
 

I've had a lot of "waiting" time to sift some of this out, so I haven't fallen apart. But, I'm really worried about my baby too. I was so hoping we'd be able to manage this with diet and supplements....surgery is just so expensive!

The vet is out today and tomorrow, so I probably won't be able to talk with him until Monday at the earliest. I had thought about changing vets before this, simply because he seems to minimize things and he's of the old school vets' line of thought. I found a vet here in town that is holistic (also has a traditional vet in the same practice), and instead of the Hills food that is in my current vet's office (and almost every vet! :rolleyes:) they sell brands like Innova and Sojo (can't remember the others??) I probably ought to have him refer me to an internal med specialist at the very least.

Speaking of Hills, I just remembered that when I got to the clinic Monday morning for her BAT I let her down to run around the lobby and explore since it was so early and no one was there but us. She had been fasting since the night before, BUT she did run over by (and I'm sure sniffed) the dog food he sells. (And who knows, a McGriddle may very well have been on someone's desk when they took her back?? :rolleyes:) But, as you said, that's awefully high. Unless it was high because the gallbladder had just contracted a mere minutes before that....but then again, there has to be some time betweet the gallbladder contracting and the colon reabsorbing, so maybe that didn't make a difference anyway...:confused:

I can go buy the NB Vegetarian tonight but as we talked about before, she isn't going to eat that more than once a day, if that. So can we talk about foods that are ok for liver-compromised dogs, and those that should be avoided?? (I really think it would be great to have a list like this since there are so many liver compromised babies in this breed!)

Here's what I've learned so far:
Good proteins:
cottage cheese
egg
chicken (not as good as the other 2, but maybe ok for asymptomatic?)
fish (what are good ones and what should be avoided?....i just read that they contain a moderate amount of purines, though so maybe they aren't ok??)
soy?? (I've seen this in diets...)

Bad proteins
red meats
exotics
turkey??

Here's another question....what is it about purines that's bad? I found that these also contain a moderate amount of purines: asparagus, cauliflower, spinach, mushrooms, green peas, lentils, dried peas, beans, oatmeal, wheat bran and wheat germ (Purine - Wikipedia, the free encyclopedia). I need to make sure I know what to avoid and why to avoid it. Another purine link: WHFoods: What are purines and in which foods are they found?

In my last post I meant :(, not :).
Just had to clear that up.

Not sure on the purines.
I think it has to do with the liver having a hard time processing them and they become a biigger if there are bladder/kidney issues.

Some people don't like fish because of the purines but it isn't as high in them as chicken and if you don't want to go with soy, egg or tofu, fish may need to be used. You are right about the chicken. Turkey is really questionable. The best answer is probably don't use it (I think it is the excessive amount of tryptophan that makes it hard on the liver) but I do use it. No red meat, pork or exotics.

Peeled and cored apple, watermelon and green beans are all okay for treats.
You can also do peeled and boiled potato and sweet potato.
Can you mash up a small amount of potato and mix it with the NB to get her to eat?

That might work. A few weeks ago I put some cottage cheese over her kibble and she ate more of it since it was coated. But, that just adds protein....I bet she would eat it if I mashed a potato. I'll try that! Is any potato ok? (meaning red or white and obviously sweet?)

Should I go ahead and start supplements too or wait for the vet? From the "Liver Disease" thread, I gather she probably needs to be on Milk thistle, vitamin E, and Vetri-dmg. Looking at the ingredients in the NB Vegetarian, vitamin E isn't in it.

Brown Rice, Oatmeal, Cracked Pearled Barley, Peas, Potato Protein, Canola Oil, Potatoes, Tomato Pomace, Vegetable Flavoring, Flaxseed, Potassium Chloride, Choline Chloride, Taurine, Natural Mixed Tocopherols, Spinach, Parsley Flakes, Cranberries, L-Lysine, L-Carnitine, Yucca Schidigera Extract, Dried Kelp, Vitamin E Supplement, Iron Proteinate, Zinc Proteinate, Copper Proteinate, Ferrous Sulfate, Zinc Sulfate, Copper Sulfate, Potassium Iodide, Thiamine Mononitrate (Vitamin B-1), Manganese Proteinate, Manganous Oxide, Ascorbic Acid, Vitamin A Supplement, Biotin, d-Calcium Pantothenate, Manganese Sulfate, Sodium Selenite, Pyridoxine Hydrochloride (Vitamin B-6), Vitamin B-12 Supplement, Riboflavin (Vitamin B-2), Vitamin D-2 Supplement, Folic Acid.


Also, I'm guessing that since she is absolutely 100% ASSYMPTOMATIC, chicken, rice, and possibly even turkey would be okay for her too? (Brown rice is in the NB.)

Roxy's BATs are in the range of 60 to 100 and she has no symptoms (well she does but they are subtle and you have to know it to see it).

Homemade is so tricky when you don't have the correct supplements. I had a nutritionist look at what I was feeding her and he balanced and gave me the portions.

I have learned so much from the folks at the Yahoo group as far as supplements go. DogLiverDisease : Dog Liver Disease

Roxy gets her main meal which consists of friendship low sodium cottage cheese, egg noodles and a veggie puree (organic carrots, celery, green bell pepper and zucchini). I add the supplements and vitamins, fish oil and canola oil. She eats this 2x a day.

In the morning she gets 1/2 of a Hapto Support capsules, .5ml of Vetri DMG, 1 Vit E oil (100 iu), 1/2 Cosiquin capsule.

Before I leave for work she gets a few pieces of apple.

Dinner she gets the mixture and I add 1/4 teaspoon of Aloe Vera Gel, 1/2 Hepato Support, 1/4 BioPecterin tablet.

Later she gets Romaine Lettuce as a snack.

Occasionally she will get a grain free cookie.

For good poop potty (reformed poop eater) she will get 1 All natural peanut butter chip.

....PM me your private email addy ;)

Since her pre is soooo high, you may want to stay away from chicken and turkey until you know more. It is really your (and your vets) call.

When Ellie's post was 47, her vet consulted an internist who said low protein, Denosyl and 400 IU of vitamin E daily.

Now Ellie gets low-moderate protein and Denosyl.
If I were to be strict with her, she would get low protein food, Denosyl or Vetri DMG, milk thistle, vitamin E and fish oil. Not just any fish oil will work though. Ellie's nutritionist says, "Omega 3 fatty acids: specifically EPA and DHA (not just any "fish oil") may promote a less inflammatory response. The therapeutic dose is not known but the minimum is probably in the range of 50 mg/kg BW per day for at least 3 wks when attempting to alter tissue levels. Your dog should receive a minimm of 130 mg per day. Because your current fish oil product contains 300 mg of EPA + DHA per 1000 mg capsule of fish oil, you need only feed one capsule every other day." She goes on to say it is important to be careful about what fish oil you choose because some aren't monitored for contaminants and potency. She likes USP approved products (you can Google it) and I think some vet products are good also. This was from Dr. Remillard.

Not sure if there is much difference between white and red potatoes nutritionally...

hmmmm....I give Roxy fish oil capsules that I get from Costco...now I have to look if they are USP approved :(

So you don't give her milk thistle, vitamin E, or fish oil then? No Lactulose either...I've read about giving that too?

I think I'll go with NB Veg and mashed potatoes until I have consulted and have a specific plan. Maybe I should wait on the supplements until I know more??

I do not but she really should have them and we may go back to it.
Her ALT has been great and her internist wasn't too concerned (just baffled).
Milk thistle, Denosyl (or Vetri DMG), vitamin e and omegas aren't going to hurt. Ellie doesn't really have neurologic issues, so we don't do lactulose but I'm sure that wouldn't hurt either.

I think she wrote that because it is so easy to just go buy any product and some of those aren't tested or watched closely. If you want to go with a human supplement, I'd get one that is USP approved (the system is VERY confusing to me). I think there are veterinary products that are just fine also.

And that 130 mg thing was for Ellie's weight, so would have to be refigured for other dogs...

May I also ask what treats Ellie gets? Are there any commercial dog biscuits, etc... that are ok? I give Bella a treat when she is left at home alone as a "pacifier". (She can get sassy....for instance, if I were to come home then leave again within the hour, or if I were to run in at luch to grab something and right back out, never seeing her or letting her out, she will PEE on the floor! This isn't because she has to pee, she uses her pads just fine any other time...more of an excitable angry response I think.)
It will be difficult to use human food (green beans/apple/watermelon) as this type of treat as I will end up with a mess!

Also, it may be important to know that if she poops and I don't catch it right away, she shreds it!! I know know if she actually eats any (though I do know she has eaten all of it in the not so distant past...I've only had her for 5 mo.) or if she's playing with it or what?? It is very frustrating and plain old gross that she does this!!

Speaking of eating poop, I'm working on the teeth issue. She does have a little yellow plaque on a couple of what I think are pre-molars. If I'm honest, I would say that I "brush" her teeth with cotton pads saturated in a solution (they came that way) sporadically at best. What do you think of Maxiguard oral cleansing gel?? MAXIGUARD Oral Cleansing Gel - Trusted Pet Pharmacy Along with CET mini toothbrush and CET vanilla mint enzymatic toothpaste?

I've never used MaxiGuard.
We use CET toothpaste and a toddler toothbrush.
Liver issues can affect their teeth.

Ellie gets whatever for treats as long as she isn't allergic, her pancreas isn't going to be set off by it and it isn't going to be a big problem for her liver. That is usually lettuce, banana, apple, bell peppers... I bake her treats also. d Peeing on the floor when she knows you are going to leave is separation anxiety.

Thank you for letting me know how you decide on treats.

Yes, it probably is a form of it. When I first got her, she had the most terrible separation anxiety EVER!!! The first thing I was told was to let her cry it out :( and I'm certain that she spent ALL of those hours crying as she was still crying when I got back home. You cannot imagine the sleeplessness, sadness, frustration I had in the beginning.

Now, she is just fine when I leave in the morning for work; she is fine if I come home for an hour or more before I leave to go to Walmart; etc..

The only time I have the separation anxiety (or something akin) problem is if I'm gone, come home for not long enough for her, and then leave again. Usually she pees next to the door, but once she peed on my bed! (I keep her in my bedroom when I'm gone.) This includes coming home and then having to run back out to the car for something....pee on the floor next to the screen door. I have to take her with me any of these times for fear of having to clean up pee. I know this is a completely separate issue, but I really don't know how to make it better! It makes me sad....I know she's sad whenever she can't be with me. She's ok after I'm gone for awhile, but right away she's sad.

does the cet vanilla mint have xylitol in it ? make sure that does not as i use poultry cet and maxguard was recommended to me by dentist but also chlorhexedine is another thing that is good but if you are seeing alot of tartar get a dental as my demi had alot of tartar and loose teeth and had to have 27 teeth removed due to gum diseaes :( It is good to brush but if you start to see alot of tartar get the dental done

No it has sorbitol in it...I had the company read me the ingredients :D

She is only 7 mo. old right now, so I don't think we ought to do a dental just yet. Every evening I have been holding her and scraping at it softly with my finger nail and it comes right off. It's a hard-ish texture, but it comes off pretty easily. There's a little that's in a ridge and I can't get to it, but I think it will come off with a little brushing. I looks like to me that only that tooth on both the left and right sides of her mouth have any yellow tartar. All the others are sparkly white!

It does not contain xylitol.
CET water additive does and I would absolutely not recommend it.
I like the vanilla-mint because for one it smell like root beer floats ;) and the poultry contains poultry digest and I imagine the other flavors have meat ingredients in them too.

more questions....
 

Yesterday I joined the DogLiverDisease Yahoo group and filled out my new member questionnaire, complete with all lab values, diet, etc... I have been telling you that her BUN was normal because it was 25 with a normal range of 7-27, but apparently Olga (the moderator) felt that was actually too high. She said that she "would not recommend [*adding mashed potato to her NB Vegetarian to make it more appealing to her*] because of her BUN number. Try soaking the NB vegetarian in water so that it soaks up the water (distilled is preferred)-some dogs like it this way." I have a question in to find out why potato is not okay but haven't heard anything back yet.

Anyone know why it's not okay?? I tried soaking it in water this morning and she ate it right up, but I tried that again around 1:00 and she wouldn't touch it. Around 4:00 she walked over to where her dry food is sprinkled on the floor (she won't eat dry food from a bowl and seems to eat it much better if none of the pieces are touching each other :rolleyes:), picked up a piece, walked over to where my boyfriend was sitting on the floor, and set it down. Then she looked at me and wanted to play. I tried to get her to eat it, but she wasn't interested. *sigh! How am I supposed to get her to eat 3-4 times per day if she doesn't want to eat it???!! :( Sooooo, I've thought about buying a few grocery items (celery, carrots, etc...--suggestions WELCOME!) and boiling it all to make a broth, which I would then be able to poor over her food to let it soak and make it more appealing, hopefully. Would that be okay?? Could I put chicken in there....i.e. is chicken broth ok even though chicken is not? Also, is her BUN considered high? I'm going to have a urinalysis done ASAP (Thanksgiving is next week, so I don't know if I'll be able to do it then) to make sure there aren't any crystals.

Any suggestions?.......I'm open to anything! I don't want to feed my baby something that's dumping toxins into her system, but at the same time I want her to enjoy her food and get to be as normal as it is possible for her to be. Help!

Also....
 

I'm looking for biscuit type treats that would be okay for her. When I leave her home alone she stays in my carpeted bedroom which isn't conducive to using apple bits, watermelon, etc... Since she does still have some separation anxiety, a treat seems to help when I leave. I have been looking at ingredients in a commercial dog treats (Sojos brand) and will list them here. Please give me an opinion on whether the ingredients are okay or if I just need to stay away. Also, I am more than willing to bake treats for her, so if anyone has a recipe that would be okay for an assymptomatic liver compromised dog, I would be super ultra grateful!!! Here are those ingredients:

Garlic Veggie
Ingredients: rye flour, oat bran, spinach, carrots, broccoli, celery, garlic powder, canola oil, eggs, baking powder.
Guaranteed Analysis: crude protein 11.0% min., crude fat 1.0% min., crude fiber 3.7% max., moisture 9.8% max.

Peanut Butter Honey
Ingredients: rye flour, oat bran, chopped peanuts, peanut butter, canola oil, eggs, honey, baking powder.
Guaranteed Analysis: crude protein 12.0% min., crude fat 11.7% min., crude fiber 2.4% max., moisture 9.8% max

Chicken Pot Pie
Ingredients: oat flour, rolled oats, chicken broth, potato flour, carrots, celery, oil, eggs, baking powder
Guaranteed Analysis: crude protein 10.7% min., crude fat 8.5% min., crude fiber 3.1% max., moisture 9.9% max.

Peanut Butter & Jelly
Ingredients: oat flour, rolled oats, peanut butter, strawberries, oil, eggs, baking powder
Guaranteed Analysis: crude protein 14.0% min., crude fat 15.0% min., crude fiber 2.7% max., moisture 8.0% max.

Apple Dumpling
Ingredients: oat flour, rolled oats, apples, oil, cinnamon, vanilla, eggs, honey, baking powder
Guaranteed Analysis: crude protein 11.1% min., crude fat 11.4% min., crude fiber 4.1% max., moisture 8.0% max.

Blueberry Cobbler
Ingredients: oat flour, rolled oats, blueberries, oil, vanilla, eggs, honey, baking powder
Guaranteed Analysis: crude protein 11.5% min., crude fat 16.4% min., crude fiber 5.1% max., moisture 7.5% max.

Monzies
Ingredients: Organic Rye Flour, Organic Oat Bran, Organic Molasses, Organic Canola Oil, Organic Sesame Seeds, Vegetable Broth, Garlic, Kelp, Baking Powder.
Guaranteed Analysis: Crude Protein 10.0% min., Crude Fat 9.5% min., Crude Fiber 2.5% max., Moisture 10.0% max.

What do you think?

Hi Tara :) I actually responded to your thread on the yahoo group at about 5am this morning, so might go back in there to check...It's a LOT of info, so I would rather not retype it. LOL :) I hope it helps answer some of your questions...