Abnormal Labwork AGAIN! :(

[bellasmomok]

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 , so I won't be holding my breath.)

[bchgirl]

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.

[bellasmomok]

Originally Posted by bchgirl

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.

[Ellie May]

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.

[bellasmomok]

Originally Posted by Ellie May

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!

[bchgirl]

Originally Posted by bellasmomok

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?

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.

[Ellie May]

Originally Posted by bellasmomok

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!

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 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.

[bellasmomok]

^^^ 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....

[Patti]

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.

[bellasmomok]

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....

[Ellie May]

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?

[bellasmomok]

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! ) 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?? ) 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...

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?

[Ellie May]

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?

[bellasmomok]

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?)

[bellasmomok]

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.)