Daisy's Diagnosis- Any Advice?
 

We took Daisy to have blood work done because of her changing behavior and heavy panting and fear at night. We wanted to be sure the dog food wasn't causing problems. Blood work showed elevated liver enzymes. The new vet we took her to thought she might also have a kidney or urinary infection so we had an ultrasound and needle draw from her liver and for her urine. From these tests the ONLY thing that showed up was a mild irritation of the liver due to the aging process. Daisy just turned 11 and she is a 17 pound dynamo who has never been sick.

Well, it cost me a pretty penny to find this out but I was terrified that there was something seriously wrong with Daisy because of maybe getting some bad food or treats or something. I got that bad bag of blue buff food with all the extra life source bits and I was sure that she was very ill and probably dying because of a poor choice made by me. Also the vet was throwing around words like cancer and scaring me to death.

We changed her food to Wellness Core Small Breed Formula.

I don't mind spending the money to find out that she checks out ok. I am thanking God that she did and now I have peace of mind about a lot of things. We thought she would get some meds to clear it up and monitor her levels periodically.

But here is my dilemma now. For treatment of a mild liver inflammation he is suggesting the following treatment: (it seems so aggressive to us....can anyone give us advice? We don't want to put her on Hills prescription unless absolutely necessary and don't want her on long term meds unless absolutely necessary...this seems like a lot of meds to us)
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Given her symptoms are so vague and seemingly inconsistent at present, I would elect to treat what we have the best evidence for and that is a mild liver inflammation.

We will get her started on a supplement called denamarin.* It is an antioxidant that accumulates in the liver to reduce inflammation.* We will also start her on ursodiol which helps thin the bile as well as decrease liver inflamation.* The other medical component is an antibiotic called metronidazole.* We briefly discussed that there could be dietary factors at play here as well.* While I have absolutely no proof that the blue buffalo food is a contributor here, I think it would be prudent to change off of it.* The ideal diet for dogs with liver disease is called Hill's Science Diet L/d.* I'll have our office manager order her some.* It should be here next week.* This food needs to be fed exclusively once the transition period (two weeks) is over.* That includes not adding chicken, treats, or other diets to the food.* It comes in canned and dry.* I have people use one for regular feeding and the other for treats and such.

The denamarin and metronidazole are available today at the clinic.
The ursodiol is a mail order medication.* It will likely be early next week before we get it in.
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The long term plan is to take about 2 weeks to transition her onto the new food.* We start the medications as soon as we get them.* About 30 days down the road we will recheck just a urine sample (to be sure there is nothing more popping up with that) and her liver values.* If they have resolved, we begin drawing down the supplements over several months.* If they have not, we will discuss things further.

How elevated were the enzymes?
I would change her food but not to l/d
I wouldn't bother with the meds.

ALP 690
ALT 348

This is a new vet. I put my faith in him to test her and give me good advice. I just don't want to get carried away with a bunch of lifetime changes unless she needs it to save her life.

Thanks for looking at my post and advising!

Yes I would do denamarin with that ALT. Not sure I would do the ursadiol though. Did she have an ultrasound?
You could consider a lower fat option with moderately restricted protein. Purina HA is a good one, or you could home cook and have a recipe made (you'll need a customized consult).
Not sure what the logic is for metronidazole. Unless the dog had diarrhea I would not be wanting to use it.

BTW, my dog has had liver disease since being diagnosed at age 6....she's turning 14.... She cannot eat l/d and it's high in fat. They don't even rec that anymore unless the dog has neurological signs.

I'm not a vet so I can't say what you should do, but I disagree with my vets all the time and I've always taken the position that I know my dog best. I also think I know the breed very well. The propensity is high for pancreatitis and age adds to that risk. I just had my dog set off by a diet lower in fat than l/d and it was a shocker. The vet community in my humble view sometimes is too lax with our breed and pancreatitis. There are many foods that are appropriate for a liver impaired dog that are lower in fat.

Wait, I am seeing he wants a short course of metro. I guess that would be ok. My internists have always selected amoxicillin for suspicious liver infections.

I wish I had advice, but I don't. Just wanted to support you and Daisy, and I hope she is feeling better very soon!

sorry no advise here either, but will keep lil Daisy in my thoughts and prayers.

If this were my dog, I would follow the vet's advice to get her on a food that has easily-digested proteins and is low in protein for her inflamed liver and once it has healed itself and is improved, you can wean her back off of it should the vet think that is okay. The thing is to get the inflammation down asap as that is never good in any age dog, but particularly an older one.

I sure hope Daisy feels better soon.

How is daisy doing?

My Olivia had much higher numbers and she was on Amoxicillin, Denamarin and Ursodiol. She was on Purina NF already due to the fact that she has PLN. Personally, I would probably do the meds because they are what will fix the liver issues. I might, as Cathy suggested, change the food but it would not be to Hill's LD. My Teddy Bear had liver shunt surgery last year and does have some mild elevation of his BATs. The surgeon told me that all LS pups do have some degree of MVD. She does not put them on liver diets...and the vet nutritionist does not either. She opts for moderate protein. Hope this helps.

Olivia was on the Denamarin for a long time and is still on the Ursodiol. Neither of those meds are harmful in any way and can help while not hurting anything.

Ursadiol can set off pancreatitis. Of course like everything else that must be weighed for the individual dog etc etc. Since the vet here said that this is a mild liver inflammation due to the aging process, I'm not sure I would do all of what is being suggested.